Antibiotics Prophylaxis for Operative Hysteroscopy.

OBJECTIVE: To evaluate the incidence of infectious complications and effect of prophylactic antibiotic administration during operative hysteroscopic procedures. METHODS: A multicentric randomized controlled trial was conducted between January 2012 and December 2013. Women (n = 180) affected by endometrial hyperplasia, myomas, or endometrial polyps undergoing operative hysteroscopy were randomized to receive cefazolin 2 g intravenously 30 minutes prior to the procedure (n = 91) and no treatment (n = 89). RESULTS: No statistical difference in terms of postoperative fever (2.4% vs 2.3%, P = .99), endometritis (0% vs 0%), pain (6.0% vs 10.4%, P = .40), cervicitis-vaginitis (0% vs 0%), pelvic abscess (0% vs 0%), pelvic inflammatory disease (0% vs 0%), and bleeding (0% vs 0%) was noticed. No statistical difference in terms of side effects attributable to antibiotic prophylaxis such as allergy (0% vs 4.8%, P = .12), nausea (10.7% vs 17.4%, P = .27), vomiting (3.6% vs 4.6%, P = .99), diarrhea (4.8% vs 5.4%, P = .99), cephalea (9.5% vs 3.5%, P = .13), dizziness (4.8% vs 2.3%, P = .44), and meteorism (5.4% vs 3.4%, P = .99) was noticed. CONCLUSION: The results of the current study support the recommendation not to prescribe routine antibiotic prophylaxis prior to operative hysteroscopy.

GnRH analogue treatment before hysteroscopic resection of submucous myomas: a prospective, randomized, multicenter study.

OBJECTIVE: To evaluate the efficacy of GnRH analogue treatment before hysteroscopic resection of submucous myomas in patients with abnormal uterine bleeding. DESIGN: Multicenter, prospective, randomized, clinical study. SETTING: Tertiary-care university hospitals. PATIENT(S): Thirty-nine consecutive patients with submucous myomas graded as G0 or G1 according to the European Society for Gynecological Endoscopy classification (myoma size 10-35 mm). INTERVENTION(S): Patients were randomized to either direct surgery or 2 months of GnRH analogues before undergoing hysteroscopic resection of the submucous myoma. MAIN OUTCOME MEASURE(S): Operating times, fluid absorption, difficulty of the operation, surgeon satisfaction with the procedure, intra- and postoperative complications, postoperative pain, and patient satisfaction were recorded. RESULT(S): Patients treated with GnRH analogue had significantly shorter operative times (15.9+/-3.1 minutes vs. 21.3+/-4.0 minutes) and significantly reduced fluid absorption (378+/-137 mL vs. 566+/-199 mL) compared with no preoperative medical treatment. Operative difficulty and overall surgeon satisfaction were significantly better in the GnRH analogue group. Patient satisfaction was similar in the two groups. CONCLUSION(S): GnRH analogue treatment before hysteroscopic resection of G0-G1 10-35 mm submucous myomas was effective in reducing operative times, fluid absorption, and difficulty of the procedure.

An ultra-miniinvasive treatment for stress urinary incontinence in complicated older patients.

OBJECTIVE: To evaluate use of bulking agents (polydimethylsiloxane) as an alternative treatment of female stress urinary incontinence (SUI) in older patients. STUDY DESIGN: Prospective cohort study. MAIN OUTCOME MEASURES: Women with age >75 years old, affected by stress urinary incontinence, presenting to our institution between January 2005 and January 2008 were considered for eligibility in this prospective study. All patients were submitted to transurethral implantation using Macroplastique Implantation System (MIS) (Uroplasty, Minneapolis, Minnesota). Cure of SUI was defined as the resolution of SUI symptoms. Objective cure rate was assessed by urogynecological physical examination and urodynamic assessment performed at 6 and 12 months after surgery respectively. Subjective cure rate was assessed during the interview of the 12th month with a visual analogue scale (VAS) for quantification of SUI severity and a standardized question about the repeatability of the procedure. RESULTS: A total of 27 consecutive patients were enrolled in this study. After 12 months of surgery the objective cure rate was 44% (12 of 27 patients), the improvement rate was 33% (9 of 27) and the failure rate was 22% (6 of 27). The overall success rate was 77% (12 patients cured and 9 improved). 23 (85%) patients would like to repeat this surgical procedure if necessary. CONCLUSION: Transurethral implantation of bulking agents should be considered as alternative treatment of SUI in complicated older patients.

Anterior colporrhaphy plus inside-out tension-free vaginal tape for associated stress urinary incontinence and cystocele.

STUDY OBJECTIVE: To reveal the efficacy and feasibility of concomitant anterior colporrhaphy and tension-free vaginal tape-obturator to treat stress urinary incontinence (SUI) and concomitant cystocele. DESIGN: Controlled trial without randomization (Canadian Task Force classification II-1). SETTING: University hospitals in Rome, Italy. PATIENTS: Fifty consecutive patients with SUI associated with symptomatic cystocele were enrolled into the study. Exclusion criteria were: uterine prolapse greater than or equal to 1, rectocele greater than or equal to 1, overactive bladder, overactive bladder symptoms, intrinsic urethral sphincter deficiency, urinary retention, previous anti-incontinence and/or prolapse surgery, neurologic bladder, psychiatric disease, body mass index greater than 30, and elevated intraabdominal pressure. The preoperative evaluation consisted of: complete history, physical examination, 3-day voiding diary, and urodynamic testing. The International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) was used to subjectively quantify the patient perception of SUI symptom severity. INTERVENTIONS: All patients underwent an ultralateral anterior colporrhaphy plus tension-free vaginal tape-obturator. MEASUREMENTS AND MAIN RESULTS: In all, 43 (91%) and 46 (92%) patients were objectively cured for cystocele and SUI, respectively. The median operating time, blood loss, and hospitalization were 43 minutes (range 35-56), 64 mL (range 40-148), and 1 day (range 1-2), respectively. Overall early postoperative complication rate was 16%, although all were minor. Only 1 patient, at 12-month follow-up, developed tape erosion that required surgical removal. The ICIQ-UI SF questionnaire scores were 13.4 +/- 6.8 and 3.5 +/- 3.2 (p <.01) between preoperative and 12-month follow-up, respectively. CONCLUSION: Concomitant tension-free vaginal tape-obturator plus ultralateral anterior colporrhaphy are feasible and safe procedures for the treatment of SUI and with associated cystocele with a high success rate and low intraoperative and postoperative complications rate.

Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study.

OBJECTIVE: To compare transperitoneal, extraperitoneal and laparoscopic pelvic lymphadenectomy in terms of feasibility and morbidity in patients affected by cervical cancer undergoing radical hysterectomy. METHODS: Consecutive patients affected by stage IB-IIB cervical carcinoma scheduled for radical surgery entered the study. Patients were randomly assigned to transperitoneal (TPL), extraperitoneal (EPL) or laparoscopic pelvic lymphadenectomy (LPL). All patients underwent classical radical hysterectomy. Perioperative data were recorded. Follow up examinations were performed at the 15th, 30th and 60th day after surgery. RESULTS: 168 patients entered the study. The mean operative times were: 63+/-7.6, 54+/-6.7 and 75+/-8.4 min (TPL vs EPL P<0.001; EPL vs LPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. The feasibility of the procedures, analyzed on an intention-to-treat basis, was 96%, 93% and 95% for TPL, EPL and LPL group respectively (P=ns). The average hospitalizations were: 5.6+/-0.9, 3.2+/-0.4 and 3.1+/-0.3 days (TPL vs EPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. CONCLUSIONS: EPL and LPL are as feasible and effective as TPL and can be adequately performed with a reasonable complication rate. LPL showed a statistically significant longer operative time. However, both EPL and LPL can minimize some postoperative complications reducing length of stay.