Surgical Treatments for Women with Stress Urinary Incontinence: A Systematic Review.

Stress urinary incontinence affects a large proportion of women in their lifetime. The objective of this review was to describe and compare the latest surgical trends in urinary incontinence and focus on the literature advantages, disadvantages, complications and efficacy of surgical procedures regarding this pathology. Using network meta-analysis, we have identified the most frequently used procedures (Burch surgery, midurethral sling and pubovaginal sling), and we have described and characterized them in terms of effectiveness and safety. Midurethral procedures remain the gold standard for surgical treatment of stress urinary incontinence, although the potential of serious complications following this procedure should be taken into consideration always. There is a clear need for a much more unified evaluation of possible complications and postoperative evolution. This process will help practitioners to adapt and individualize their strategy for each patient.

Technical Tips and Tricks after 10 Years of HyFoSy for Tubal Patency Testing.

BACKGROUND: Hysterosalpingo-foam sonography (HyFoSy) has gained popularity in the last decades, as it represents a feasible, well-tolerated, and minimally invasive method of evaluation of tubal patency in cases of infertility. The purpose of this study was to communicate the technical tips and tricks based on our experience in performing HyFoSy, with the aim to improve the feasibility, to reduce the pain, and to evaluate pregnancy-obtaining rate after procedure. METHODS: Our observational study includes 672 patients from infertile couples who underwent HyFoSy for tubal patency evaluation. During HyFoSy, tubal pathway and patency as well as the level of pain were evaluated. A telephonic questionnaire was conducted in order to assess the pregnancy obtaining rate in the first 3 months and more than 3 months after the procedure. RESULTS: The median age in our group was 33.5 years. Most of our patients (61.16%) underwent HyFoSy in the 8-10 days of the menstrual cycle. Tubal patency was present bilaterally in 86% cases, unilaterally in 11% of patients, and was absent in 3% of cases; 75% of patients related absent or tolerable pain, 17% described HyFoSy as a painful procedure, and 8% experienced extreme pain. After HyFoSy, pregnancy was naturally obtained in 10.86% of cases within the first 3 months after HyFoSy. CONCLUSIONS: HyFoSy represents a useful, easy to use, and painless tool in female infertility evaluation and should be considered as a complementary method of the transvaginal ultrasonography, completing the genital tract imaging with information about the hidden part of the standard examination: tubal patency. HyFoSy provides information about patency, caliber regularity, pathway, and occlusion location of the fallopian tubes; therefore, it should be introduced along with transvaginal ultrasound as a first-line infertility exploration method.

Fetal sacrococcygeal immature teratoma - report of two cases and review of the literature.

Sacrococcygeal teratomas (SCTs) are rare congenital tumors. With the improvement of diagnostic imaging methods and follow-up protocols in pregnancies, in utero detection of these tumors has increased. Despite these progresses, SCTs may present difficulties in establishing in utero diagnosis and subsequent management. We present two cases of SCT in 18 weeks, respectively 22 weeks pregnancy, diagnosed using ultrasound imaging and pathologically confirmed. Also, the article aims to recapitulate clinicopathological aspects and prognosis of these lesions, following the review of the literature.

Unexpected location of endometrial adenocarcinoma - a case report.

Endometrial adenocarcinoma (ADK) is one of the most common uterine cancer and the fourth neoplasia mortality cause in women according to the literature data. ADK is encountered in the sixth decade of life, the mean age being 63 years. Only 2-5% of cases are found in women less than 40 years old. We present the case of a 63-year-old woman admitted in our Clinic for hypogastric pain and reduced vaginal sanguinolent discharge. The genital examination and transvaginal ultrasound (US) scan were strongly suggestive for a type 0 myoma tending to be expelled through the cervical canal. Laparotomy and total hysterectomy with bilateral adnexectomy were performed. Histological examination identified a grade G1 well-differentiated endometrioid ADK without uterine wall invasion. The immunohistochemistry study for estrogen receptors expression revealed moderate and strong nuclear immunostaining in more than 70% of the tumoral cells, as well as a mosaic p16 immunoexpression, a cytokeratin 7 (CK7) immunophenotype, no p53 overexpression and low Ki67 index (estimated at 10-15%). Considering the incidental finding, the early stage and limited localization of the ADK at the myoma surface level surgery was considered sufficient as treatment but follow-up was conducted by magnetic resonance imaging (MRI) and general examination every six months. The most interesting aspect of the case was the atypical presence of an active myoma in menopause and the totally unsuspicious US appearance of the endometrium. The endometrial ADK was accidentally discovered in an unusual specimen without any other symptom.

Clinical and morphological correlations in early diagnosis of endometrial cancer.

The prevalence of endometrial cancer among asymptomatic women is rather reduced also due to the absence of a cost-efficient test, as there are no ideal screening examinations for endometrial cancer. Several methods were proposed in medical practice to discover endometrial neoplasia at an early stage, among which: endometrial biopsy, endovaginal ultrasound, targeted biopsy hysteroscopy. This study was made on a group of 38 patients monitored for metrorrhagia in the interval between July 1, 2014-July 1, 2016. All patients were monitored clinically and by ultrasound, endometrium samples were taken by biopsied uterine curettage, and a histopathological examination was performed, completed by immunomarking, whenever necessary. The clinical and paraclinical methods allowed for the creation of a protocol by which patients were monitored. This protocol allowed for the modulation and effectiveness of the treatment, establishing the best therapeutic conduct and the remote supervision.