The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study.

OBJECTIVE: To investigate the effect of two different laparoscopic methods on ovarian reserve in patients with ovarian endometriomas. DESIGN: Prospective, randomized clinical trial. SETTING: Endoscopy unit of a university hospital. PATIENT(S): Twenty women with endometriomas. INTERVENTION(S): Patients were randomly selected to undergo either laparoscopic cystectomy for endometrioma (group 1) or the "three-step procedure" (group 2). Before and 6 months after laparoscopy all patients were evaluated, and 12 months postoperatively they underwent ultrasound scan examination. MAIN OUTCOME MEASURE(S): The primary end point was ovarian reserve damage based on the alterations of anti-Müllerian hormone (AMH). Secondary end points were the changes of antral follicle count and serum concentration of FSH, LH, E(2), and inhibin B. RESULT(S): Mean serum AMH was reduced significantly from 3.9-2.9 ng/mL in group 1 compared with the reduction from 4.5-3.99 ng/mL in group 2. CONCLUSION(S): Ovarian reserve determined by AMH is less diminished after the three-step procedure compared with cystectomy of endometriomas.

Comparison between 20G and 22G needle for second trimester amniocentesis in terms of technical aspects and short-term complications.

OBJECTIVE: To compare short-term complications of amniocentesis using 20G versus 22G needle. METHODS: A total of 200 women referred for mid-trimester amniocentesis were randomized to a 20G (Group I, n = 100) or 22G amniocentesis needle (Group II, n = 100). The primary outcome was intrauterine bleeding at needle insertion. The operator reported technical aspects and patient's reactions immediately after the procedure. Women's perception of discomfort 30 min after the procedure and complications after 2 weeks were recorded. RESULTS: Intrauterine bleeding at needle insertion was similar between groups (4/100 vs 8/100). When only transplacental taps were analyzed, bleeding was significantly lower in Group I (4/20 vs 8/14, p = 0.035). Fluid retrieval was faster in Group I (9.6 vs 26.8 sec, p < 0.001). In all, 65% of women in Group I versus 30% in Group II reported discomfort during the procedure, although discomfort 30 min after the procedure and complications within 2 weeks after the procedure were similar in the two groups. CONCLUSION: Amniocentesis with 20G needle is associated with lower risk of intrauterine bleeding in case of transplacental needle insertion and allows for faster fluid retrieval, as compared with 22G needle. Nevertheless, 20G needle is associated with more immediate discomfort during the procedure.

Uterine prolapse after pelvic trauma: case report and literature review.

Up to date, the connection of pelvic trauma with genital prolapse is not widely recognized. These cases could be classified in a group where disruption of normal anatomy of the pelvis is apparent (i.e., pelvic fracture), and in a second group, where pelvis remains unaffected by the pelvic trauma (i.e., seat belt-related injuries). The aim of the report is to describe the management of a 39-year-old nulliparous patient presenting with stage III uterine prolapse after pelvic trauma; the patient had a history of Mitrofanoff's procedure for neurogenic bladder followed by closure of the bladder neck and permanent suprapubic urinary catheter for intractable incontinence. The prolapse was managed with a mesh anterior colporraphy combined with sacrospinous hysteropexy. At 3 months follow-up, she is well with no prolapse recurrence.

Gluteo-vaginal sinus formation complicating posterior intravaginal slingplasty followed by successful IVS removal. A case report and review of the literature.

Posterior intravaginal slingplasty (IVS) is a technique used for the treatment of apical prolapse. Type III meshes have been mostly used with this technique. In this article, a case of bilateral gluteo-vaginal sinus tract formation that complicated a posterior vaginal slingplasty with a type III mesh is presented. At 3 months follow-up, the patient complained for bulking through the vagina, continuous offensive vaginal discharge, and constant pain at the buttocks. She had prolapse recurrence, and there was defective healing at the gluteal entry points of the posterior IVS. Ten months after the initial surgery, she underwent a laparotomic subtotal hysterectomy and sacrocervicopexy with prolene type I mesh. At the same time, the posterior mesh was removed allowing the surgeon to discover communication of the canal of the mesh extending from gluteal incisions to the vagina epithelium. The sinus tract was managed surgically with excision of the surrounding tissues. There was no recurrence or other complications at 2 months follow-up.

Evacuation of the cervix after methotrexate administration in the treatment of cervical pregnancy: five cases.

Case studies of five consecutive patients with cervical pregnancy treated with a standard protocol are presented. The aim was to evaluate the place of evacuation with curettage followed or not by cervical tamponade as an additional modality in patients with cervical pregnancies treated initially with methotrexate (MTX). The five patients with cervical pregnancies were treated with local injection and systemic administration of MTX, while in four of them additional cervical evacuation was performed. In two patients, with a gestational age of more than 9 weeks, cervical tamponade was additionally applied. No complications occurred during evacuation with curettage after MTX, and two women managed to become pregnant spontaneously and progressed to full term.

Case report: laparoscopic treatment of a ruptured interstitial pregnancy.

Interstitial pregnancy is a rare but life-threatening condition. A case of a 28-year-old woman with a partially ruptured interstitial pregnancy treated with operative laparoscopy is presented. A laparoscopic cornual resection and a left salpingectomy were performed uneventfully. Serum beta-human chorionic gonadotrophin concentrations were measured serially at weekly intervals until resolved on day 20 postoperatively. It seems, therefore, that laparoscopic treatment is still an effective option for management even in ruptured interstitial pregnancy, preserving the anatomical integrity of the uterus and future fertility, and that rupture of interstitial ectopic pregnancy is not a contra-indication for laparoscopy.

Successful end-to-end cervico-cervical anastomosis in a patient with congenital cervical fragmentation: case report.

Cervical agenesis or dysgenesis (fragmentation, fibrous cord and obstruction) is an extremely rare congenital anomaly. Conservative surgical approach to these patients involves uterovaginal anastomosis, cervical canalization, and cervical reconstruction. In failed conservative surgery, total hysterectomy is the treatment of choice. We report what we believe to be the first successful end-to-end cervico-cervical anastomosis of an unusual case of congenital cervical fragmentation. A 15 year old Caucasian female presented complaining of primary amenorrhoea and cyclic, monthly abdominal pain. At laparotomy, a symmetrical transverse disruption of the cervix in a central and distal part was found and an end-to-end cervico-cervical anastomosis of the two cervical fragments was performed with the use of a 16F Foley catheter as a stent into the endocervical canal. One month after surgery the patient had normal menses. We conclude that a thorough investigation of the patient with suspected cervical anomaly is necessary and conservative surgical treatment should be applied as a first-line treatment option. In the presence of functional and intact cervical segments, the reconstruction of the cervical canal with an end-to-end cervico-cervical anastomosis is feasible and effective.