Evaluation of Sacrospinous Hysteropexy vs. Uterosacral Suspension for the Treatment of Uterine Prolapse: A Retrospective Assessment.

OBJECTIVE: This single-center retrospective study aimed to compare the outcomes of vaginal hysterectomy with utero-sacral suspension (VH/USS) versus sacro-spinous hysteropexy (SSHP) in the management of uterine prolapse at a tertiary care center specializing in Urogynecology. METHODS: The medical records of 50 women with stage 2 or more uterine prolapse treated with VH/USS (n = 26) or SSHP (n = 24) were assessed between January 2006 and December 2012. RESULTS: There were no significant differences between the two groups in terms of body mass index (BMI) and parity P = 0.881 and 0.304, respectively. VH/USS procedure was significantly more successful than SSHP procedure with regard to anatomical success (84.62 vs. 41.67%, P = 0.0028). There was a significantly higher anterior prolapse recurrence with SSHP procedure than with VH/USS (33.3 vs. 7.7%; P = 0.034). SSHP was associated with the lower likelihood of anatomical success and a higher risk of recurrent anterior prolapse in multivariate logistic regression analyzes adjusting for potential confounders. CONCLUSION: The findings of this retrospective study indicate that SSHP appears to be associated with less anatomical objective success and an increased risk of recurrent anterior prolapse in comparison to VH/USS. Further validation of our observations by independent investigators is required.

Urogenital fistula in a Saudi Arabian referral center.

PURPOSE: To review all cases of genitourinary fistula, their causes, management and outcome. MATERIALS AND METHODS: A retrospective chart review of all fistula cases referred to the Urogynecology Department, King Fahad Medical City, Riyadh, Saudi Arabia, from January 2005 to December 2011. RESULTS: Sixteen genitourinary fistula cases were identified; nine (56 %) cases of vesicovaginal fistula, four (25 %) cases of vesicouterine fistula, and three (19 %) cases of vesicocervical fistula. Mean age was 41 (29-61) and mean parity was 7.4 (2-15). Out of the 16 cases, 12 (75 %) had obstetrical surgical complications, of which 8 (50 %) had complications of cesarean sections. Twelve of 15 cases (80 %) were cured after primary surgical repair, 2 (13 %) after secondary repair and 1 after tertiary repair. One case was cured after conservative management. CONCLUSION: Most of the genitourinary fistulae were of iatrogenic obstetric causes, mainly cesarean section with none of the cases due to obstructed labor unlike fistulae in developing countries or developed countries fistulae (iatrogenic gynecologic origin).

Robot-assisted laparoscopic repair of rare post-cesarean section vesicocervical and vesicouterine fistula: a case series of a novel technique.

OBJECTIVE: To present experience with robotic repair of complex vesicouterine fistula (VUF) and vesicocervical fistula (VCF) in 3 patients and to describe technique of repair with 18-months follow-up. METHODS: Three patients were diagnosed with VUF or VCF. Two patients had prior history of lower segment cesarean section complicated by bladder injury and the third had difficult labor with vaginal birth after previous cesarean section. Preoperative diagnosis of VUF/VCF was based on classical history, cystoscopy, and imaging studies. All patients underwent pure robotic repair of fistula. The steps of the technique of repair include cystoscopy, bilateral temporary ureteral catheterization, placement of ports, adhesiolysis, separation of bladder and uterus or cervix, closure of bladder and uterus or cervix and omental interposition. RESULTS: Robotic repair was successful in all patients. There were no intraoperative and postoperative complications. All patients were ambulatory on day 1 and were discharged on day 2. Foley catheter was removed after 2 weeks and all patients were followed over 18 months. CONCLUSION: This technique demonstrates robotic repair of rare VCF and VUF performed safely and effectively. The robotic assistance helped in complex dissection and reconstructive steps. This approach is an excellent minimally invasive alternative at centers with robotic technology because these fistulae cannot be repaired vaginally. Experience of the team is important in managing such cases.

Factors associated with cesarean deliveries at Women Specialized Hospital Riyadh, King Fahd Medical City, Kingdom of Saudi Arabia.

BACKGROUND: The risks and safety of cesarean section (CS) differ from place to place in the world. According to the World Health Organization, the best outcomes for mothers and babies appear to occur with CS rates of 5-15%. Increasing maternal age and high parity are among the chief determinants of cesarean deliveries. MATERIALS AND METHODS: A retrospective cohort study was done at the tertiary care facility, King Fahd Medical City, Riyadh from 1 January to 31 December 2008. Observations were recorded from the labor ward registers. Sample size estimated was n=2192. A total of 2907 patients were recruited. All CS at viable gestation were included. Vaginal deliveries were taken as the comparison group. Non probability convenient sampling was done. Factors associated with cesarean deliveries were analyzed using univariate and bivariate analysis methods. Level of significance was set at P≤0.05 and confidence interval (CI)=95% respectively. RESULTS: Independent sample t test and Pearson's chi-square test showed that increasing maternal age, parity (P=0.0001 and 0.002 respectively), and prematurity (P=0.0001) were significant associates for CS. Binary logistic regression also confirmed significant association of increasing parity and prematurity (P=0.02 and 0.0001 respectively). Non-reassuring cardiotocography was the most common indication for CS. CONCLUSION AND RECOMMENDATIONS: Increasing maternal age and parity as well as prematurity were the factors significantly associated with CS. Fetomaternal outcome was comparable between vaginal and abdominal deliveries, despite the high CS rate. Non-reassuring cardiotocography was the most common indication. Secondary tests for evaluation of fetal well being might help to reduce the high CS rate.