Perioperative complications in abdominal sacrocolpopexy, sacrospinous ligament fixation and prolift procedures.

BACKGROUND: Pelvic organ prolapse is an important problem for women. To overcome this issue, different operational technics are in use, such as abdominal sacrocolpopexy, sacrospinous fixation, and the total Prolift procedure. AIMS: This study assessed perioperative complications in abdominal sacrocolpopexy, sacrospinous fixation, and the total Prolift procedure. STUDY DESIGN: Retrospective comparative study. METHODS: Perioperative complications were defined as any complication occurring during surgery or the first 6 weeks postoperatively. Forty-five patients underwent abdominal procedures, 60 patients underwent sacrospinous fixation, and 43 patients underwent the total Prolift procedure. RESULTS: In the abdominal group, one bladder injury, four hemorrhages, and three wound dehiscences occurred. In the sacrospinous group, one rectal injury and one postoperative vault infection occurred. In the Prolift group, one bladder injury and one hemorrhage occurred. Minor complications were more frequent in the abdominal group than the others. The operating time and hospital stay of the abdominal group were significantly longer than the others. The Pro-lift procedure had less operating time and hospital stay than other procedures. CONCLUSION: The total Prolift may be a novel alternative for apical prolapse with low perioperative morbidities and complications.

Perioperative complications in vaginal mesh procedures using trocar in pelvic organ prolapse repair.

INTRODUCTION AND HYPOTHESIS: This study aimed to document intraoperative and early postoperative complications associated with the use of vaginal mesh with trocar in pelvic organ prolapse (POP) repair. METHODS: This is a retrospective review of 120 cases of vaginal repair of POP using vaginal mesh. Of the 120 patients, 31 underwent anterior mesh repair (Light mesh 10, Avaulta 1, Perigee 1, and Prolift 19); 35 underwent posterior mesh repair (Light mesh 2, Posterior IVS 17, and Prolift 16); and 54 underwent anterior and posterior mesh (total) repair (Light mesh 8, Prolift 32, and Prolift M 14). RESULTS: Three bladder injuries (2.5%) and one distal rectal injury (0.8%) occurred during dissection. Three of four organ injuries (75%) had previous prolapse repair. Overall four patients (3%) required transfusion. Urinary retention exceeding 5 days occurred in four patients. Three of them (60%) also underwent TVT-O. Groin pain occurred in two patients one of whom underwent TVT-O. Gluteal pain occurred in one patient. Early mesh exposure occurred in the vaginal cuff of a patient who underwent hysterectomy. CONCLUSIONS: The vaginal mesh procedures may be done with relatively few perioperative complications. However, there is a need for more randomized controlled trials with long-term follow-up to clarify its postoperative long-term complications and morbidities.

The effect of different preparations of hormone therapy on tumor necrosis factor-alpha levels in women with surgical menopause.

The aim of the present prospective controlled study was to examine the influence of 17beta-estradiol and tibolone on tumor necrosis factor-alpha (TNF-alpha) levels in healthy women with surgical menopause. Forty-five surgically menopausal women were included in the study. Thirty women were randomized to receive tibolone 2.5 mg or 17beta-estradiol 2 mg daily for 16 weeks. Fifteen surgically menopausal women who refused hormone therapy served as controls. Serum was collected from the subjects at baseline and at the end of the study for TNF-alpha assay. Neither tibolone nor 17beta-estradiol showed a significant influence on TNF-alpha level at the end of 16 weeks in comparison with baseline. Although tibolone induced a trend toward decreased level of TNF-alpha (3.30 +/- 0.42 vs. 2.56 +/- 1.94 microg/dl), this was non-significant. The slight increase observed in TNF-alpha level in the control group was also insignificant (3.60 +/- 1.20 vs. 4.10 +/- 0.70 microg/dl). Overall, these results demonstrate no significant effects of either tibolone or 17beta-estradiol on circulating TNF-alpha level in surgically menopausal women. However, the significant difference achieved between the tibolone and control group after treatment is promising and needs to be investigated in trials with longer treatment periods.

The effect of ethinyl estradiol-cyproterone acetate treatment on homocysteine levels in women with polycystic ovary syndrome.

OBJECTIVE: Women with polycystic ovary syndrome (PCOS) have multiple risk factors for cardiovascular disease. The cardiovascular risk marker homocysteine (Hcy) is elevated in women with PCOS. This prospective study investigated the effect of oral contraceptives containing ethinyl estradiol-cyproterone acetate (EE-CA) on serum Hcy levels in women with PCOS. STUDY DESIGN: A total of 30 women with PCOS were enrolled in this prospective study. The diagnosis of PCOS was made according to the criteria of the Rotterdam PCOS consensus workshop group. All women took oral contraceptives containing EE/CA (35 microg/2 mg) for 3 months. Serum samples for Hcy, lipid profile and hormones were obtained during the early follicular phase (days 3-5) of the spontaneous or progestin-induced bleeding at baseline, and after the third treatment cycle. RESULTS: Three months of EE-CA therapy significantly decreased the Hcy levels from 55.97 +/- 16.04 to 54.03 +/- 16.15 (P = 0.01). A significant correlation was observed between the Hcy and total and free testosterone levels (r = 0.44, P = 0.015 and r = 0.46, P = 0.001 respectively). CONCLUSIONS: Although the decrease in Hcy levels with EE-CA therapy was statistically significant, further studies are necessary to determine the clinical benefit of this treatment.

Does postoperative misoprostol use induce intestinal motility? A prospective randomised double-blind trial.

BACKGROUND: Misoprostol has been shown to increase colonic activity and decrease colonic transit time in chronic constipation patients. AIMS: The aim of this prospective, randomised, double-blind study was to examine the effectiveness of rectally administered misoprostol on inducing intestinal motility after gynaecological surgery. METHODS: Eighty women who underwent hysterectomy were divided randomly into three groups. Group A received misoprostol 200 microg rectally while group B received 400 microg rectal misoprostol after surgery before leaving the operating room. Patients in group C received no drugs. Bowel sounds in four quadrants were checked every hour and possible side-effects of misoprostol like nausea, vomiting, and distension were evaluated. The time interval between surgery and flatus pass and the need of analgesics were noted. Statistical analyses were done with Mann-Whitney U-test and chi2 tests where available. RESULTS: The time between surgery and presence of bowel sounds in four quadrants were similar in all groups (2.7 +/- 1.6, 2.9 +/- 1.2, 2.8 +/- 1.3 h, for groups A, B, and C, respectively). No difference was observed in flatus pass time. The incidence of nausea was significantly increased in group B compared to controls (P < 0.01). Additional analgesic need was significantly higher in groups A and B when compared to controls (P < 0.05 and P < 0.01, for groups A and B, respectively). CONCLUSION: Rectally administered misoprostol does not improve intestinal motility in the early postoperative period and thus, it is not effective in providing early oral food intake. On the contrary, it causes distention that requires additional analgesics and vomiting that naturally limits oral diet intake.

Vaginal removal of prolapsed pedunculated submucosal myoma during pregnancy.

Pedunculated submucosal myomas are generally associated with infertility and are most often encountered during the preconception period. This report describes a 38-y-old pregnant woman in whom a pedunculated submucosal myoma resulted in preterm labor and was successfully removed vaginally at 26 wk gestation. The procedure described here is simple and quick and can be performed during pregnancy, if necessary.

Perioperative complications in abdominal sacrocolpopexy and vaginal sacrospinous ligament fixation procedures.

This study assessed perioperative complications in abdominal sacrocolpopexy and vaginal sacrospinous ligament fixation procedures. Perioperative complications were defined as any complication occurring during surgery or the first 6 weeks postoperatively. Forty-five patients underwent abdominal procedures (20 sacrohysteropexy and 25 sacrocolpopexy) and 60 patients underwent vaginal sacrospinous fixation. Of the 105 patients, 13 had vaginal vault prolapse. In the abdominal group, one bladder injury, four hemorrhages, and three wound dehiscences occurred. In the vaginal group, one rectal injury and one postoperative vaginal vault infection occurred. Major and minor complications were more frequent in the abdominal group than in the vaginal group. Blood loss was not significantly different. The operating time and hospital stay in the abdominal group were significantly longer than in the vaginal group. In conclusion, abdominal sacrocolpopexy had a higher rate of perioperative complications and longer hospital stay and operating time.

Ultrasonographic cervical length measurement at 10-14 and 20-24 weeks gestation and the risk of preterm delivery.

OBJECTIVE: To compare cervical length measurements at 10-14 and 20-24 weeks gestation in asymptomatic women with singleton pregnancies and to assess the measurements as a predictor of preterm delivery. STUDY DESIGN: In this prospective study, cervical length was measured in 152 asymptomatic women with singleton pregnancies using transvaginal ultrasonography at 10-14 and 20-24 weeks gestation. The primary outcome measure was spontaneous preterm delivery before 35 weeks of gestation. The mean cervical length was calculated at both stages, and lengths were compared between the term and preterm groups. RESULTS: The rate of spontaneous preterm deliveries was 10.5%. The mean cervical length at 10-14 and 20-24 weeks was 40.5 and 37.1mm, respectively. The cervical length at 10-14 weeks was not significantly different between those who delivered at term (40.9 mm) and those who delivered preterm (38.6 mm). By contrast, the cervical length at 20-24 weeks was significantly shorter in the group that had preterm deliveries (28.4 mm) than in those who had term deliveries (37.8 mm) (P < 0.001). The cervical shortening was more apparent in the group that delivered prematurely (from 38.6 to 28.4 mm) than in that which delivered at term (from 40.9 to 37.8 mm). CONCLUSION: Cervical length measurement used to predict preterm delivery was found to be more predictive at 20-24 weeks. Cervical length measurement at 10-14 weeks was not reliable for predicting preterm delivery. The mean cervical length tapered gradually from the first to the second scan, and the more rapid cervical shortening was found to be associated with increased risk for preterm delivery.

Abdominal sacrohysteropexy in young women with uterovaginal prolapse: results of 20 cases.

OBJECTIVE: To report the results of abdominal sacrohysteropexy with polypropylene mesh in young women who wish to retain their uteri following uterovaginal prolapse. STUDY DESIGN: Twenty young women underwent abdominal sacrohysteropexy and concomitant reconstructive surgery. The preoperative and postoperative protocols included a urogynecologic history, physical examination, voiding diary, 1-hour pad test, cough stress test, multichannel urodynamic studies and administration of a validated, prolapse-specific symptom inventory and quality of life instrument. RESULTS: Of the 20 patients with marked uterovaginal prolapse, 13 had urodynamic stress incontinence. Anterior and posterior vaginal wall prolapse and urodynamic stress incontinence recurred in 1 of 20 patients (5%) at a mean follow-up of 25 months. Nineteen patients stated that their sex life had improved, although 3 of them had dyspareunia. One patient was dissatisfied owing to persistent dyspareunia. The postoperative values on the symptom inventory and quality of life scores were significantly lower than the preoperative values. The low scores suggest satisfaction and no symptoms of prolapse. CONCLUSION: Abdominal sacrohysteropexy is effective and safe in the treatment of uterovaginal prolapse in women who wish to retain their uteri. It maintains a durable anatomic restoration, normal vaginal axis and sexual function. The success rate is excellent for correcting prolapse, and the complications are minimal.

Risk factors associated with gallstone and biliary sludge formation during pregnancy.

AIM: To define the risk factors in gallstone and sludge formation, and to investigate the incidence of gallstone and biliary sludge formation during pregnancy in a group of healthy pregnant women. METHODS: Sixty-nine healthy pregnant women in early gestation and 28 nulliparous healthy controls were enrolled. Gallbladder volumes, gallbladder ejection fraction (GBEF), serum triglyceride and cholesterol levels were determined in both groups. In the pregnant group, repeated measurements were performed immediately after delivery and compared with initial levels. Risk factors, which are associated with gallstone and biliary sludge development during pregnancy, were determined by linear regression analysis. RESULTS: No statistically significant difference was observed in the assessed parameters of pregnant women in early gestation and controls (both P > 0.05). In the pregnant group, gallstone and biliary sludge development during pregnancy were detected in 6.3% and 10.9% of cases, respectively. The detected parameters were significantly higher early after delivery than in early gestation, while GBEF was lower (both P < 0.001). Lower GBEF was the most significant factor (P < 0.001) associated with gallstone and sludge formation during pregnancy, while multiple childbirths was the other (P = 0.04). CONCLUSION: Decrease in GBEF is the most significant risk factor for newly developed gallstone and sludge in pregnant women, while multiple childbirths is the other but less important risk factor.

Effect of clomiphene citrate on ovarian, endometrial, and cervical histologies in a rat model.

OBJECTIVE: To examine the effect of clomiphene citrate (CC) on the ovarian, endometrial, and cervical histologies in a rat model. METHODS: The rats (n = 40) were randomly assigned to 4 treatment groups: CC 50 (repetitive doses of 0.2 mg CC); CC 100 (repetitive doses of 0.4 mg CC); CC 200 (repetitive doses of 0.8 mg CC), and control (repetitive doses of normal saline). Each study group received its CC dose intraperitoneally in 2 ml saline for 5 days and the controls received 2 ml saline only. Each treatment cycle was repeated six times. Six months later the rats were euthanized. Their ovaries, uterine horns, and cervices were removed and examined for histologic changes. RESULTS: We found no significant difference in the number of follicles and corpora lutea of the study groups (p > 0.05). The numbers of granulosa, theca, and luteal cells of the CC 100 and CC 200 groups were significantly higher than those of the CC 50 group and controls (p < 0.05). There was no important finding related to pre-malign and malign changes in ovarian, endometrial and cervical samples of the control and CC 50 groups. Focal atypia and atypical mitoses were noted in 2 cases of granulosa cells in the CC 100 and CC 200 groups. CONCLUSION: We did not find an association between the use of CC and ovarian, endometrial, and cervical neoplasms; nevertheless, we noticed an increase in granulosa, theca and luteal cells with high doses of CC, which may be a risk factor for granulosa, theca, and luteal cell tumors.

Congenital sialoblastoma (embryoma) associated with premature centromere division and high level of alpha-fetoprotein.

Sialoblastoma is a rare, locally aggressive, and potentially malignant perinatal salivary tumor that predominantly affects the parotid glands. To date, 29 cases of sialoblastoma have been reported. We report a further case of sialoblastoma diagnosed at 37 weeks of gestation presenting with novel findings that are the premature centromere division and a high level of alpha-fetoprotein.

Transperineal versus transvaginal ultrasonographic evaluation of the cervix at each trimester in normal pregnant women.

AIMS: To compare transvaginal and transperineal ultrasonography in the assessment of cervical length and cervical changes in normal gravid patients at each trimester. METHODS: Transperineal and transvaginal ultrasonographic cervical length was measured on 104 asymptomatic pregnant women between 10 and 14, 20-24, and 30-34 weeks' gestation and the presence of a funnel was also noted. The study used the McNemar chi2 test to assess the difference between two methods in their ability to obtain a measurement, and the Pearson correlation coefficient to determine the relationship between the paired transperineal and transvaginal cervical lengths. RESULTS: Cervical length measurements were obtained by transvaginal ultrasonography in all 104 patients and by transperineal ultrasonography in 101 patients (97.1%) (P = 0.1). By gestational age, the greatest length discrepancy (2.8 mm) between the two ultrasonographic methods was found at 10-14 weeks (P < 0.001). At 20-24 and 30-34 weeks' gestation, the mean length differences were less than 1 mm (P < 0.01 and P = 0.337, respectively). Cervical funnelling was observed in 16 patients by both methods, whereas in two patients from the 20-24 week gestational age group, funelling was observed by transvaginal ultrasonography and not by transperineal ultrasonography. CONCLUSIONS: Cervical length measurements by transperineal ultrasonography show good correlation with transvaginal ultrasonographic measurements and it is a satisfactory alternative to a transvaginal evaluation of the cervix throughout pregnancy.

The midurethral polypropylene sling for stress incontinence: 22-month results of 81 patients.

OBJECTIVE: The objective was to review a cost-effective procedure called the midurethral polypropylene sling (MPS) in the treatment of urodynamic stress incontinence (USI). STUDY DESIGN: A self-fashioned sling (7.5 x 1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia by a special needle carrier. The sling is placed around the urethra and its sutures are tied on the fascia. The procedure was performed on 81 patients. Of these patients, 73 had USI. The remaining 8 patients with uterine prolapse, who did not have USI, underwent the MPS prophylactically. Of 81 patients, 35 underwent the MPS alone, 46 underwent the MPS and abdominal or vaginal procedures. RESULTS: Three patients had bleeding in excess of 300 ml necessitating a vaginal tamponade. One had hematoma and the other underwent a laparotomy. Urinary retention for more than 3 days was observed in 6 of the patients who had the MPS alone, in 7 of the patients who had both MPS and abdominal procedures, and in 13 of the patients who had MPS with vaginal procedures. The sling was cut in 3 patients due to persistent urinary retention. Of 73 patients with USI, 70 were completely cured (95.9%) at a mean of 22 months' follow-up. CONCLUSION: The cure rates and complications of the MPS were comparable to those of the tension-free vaginal tap (TVT) procedure for the treatment of USI. The procedure costs about US$ 9. We conclude that the MPS can be considered as an alternative to the TVT procedure.

A case of primary Addison's disease with hyperemesis gravidarum and successful pregnancy.

We followed up a pregnant woman with Addison's disease diagnosed before conception. She presented with hyperemesis gravidarum. Throughout pregnancy, she received prednisone and the basic disease did not deteriorate during pregnancy. She was delivered by caesarean section due to breech presentation. The fetal prognosis was good.

Primary omental pregnancy presenting with hemorrhagic shock. A case report.

Abdominal pregnancy is a very rare and serious type of extrauterine gestation that accounts for approximately 0.003% of all ectopic pregnancies. Omental pregnancy, an extremely rare form of abdominal pregnancy, can be primary or secondary to a tubal pregnancy that aborts out of the fimbria and reimplants in the peritoneal cavity. We present an additional case of primary omental pregnancy at 12 gestational weeks presenting with symptoms of hemoperitoneum and acute abdomen.

A new, simple, safe, effective and cost-effective procedure for genuine stress incontinence: midurethral polypropylene sling.

We developed a cost-effective procedure for genuine stress incontinence (GSI) that has the advantages of the tension-free vaginal tape (TVT). The midurethral polypropylene sling procedure (MPS) is carried out under local anaesthesia. A self-fashioned sling (7.5 x 1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia using a needle and the sling is placed around the urethra. Ten patients underwent the MPS and were followed up for a mean of 6.2 months. All patients were cured. The short-term results of the MPS were comparable to those of the TVT. The procedure costs approximately US dollar 9. We conclude that the MPS can be considered as an alternative to the TVT procedure.

Ten-year results of Marshall Marchetti Krantz and anterior colporraphy procedures.

OBJECTIVE: To evaluate subjective results of Marshall Marchetti Krantz (MMK) and anterior colporraphy (AC) procedures. STUDY DESIGN: Patients who had operations for genuine stress incontinence 10 years ago were surveyed regarding their current incontinence status. Results of both procedures were evaluated and compared. RESULTS: Fourteen of 28 patients in the MMK group and 21 of 67 patients in the AC group were evaluated at 10 years, the cure rates were found to be 64% and 38%, respectively. CONCLUSION: We conclude that the success rate of both procedures declines over time. The anterior colporraphy procedure appears to have a lower success rate than MMK, although this was not found to be statistically significant.