Outcome assessment with blinded versus unblinded POP-Q exams.

OBJECTIVE: To determine whether blinded and unblinded Pelvic Organ Prolapse Quantification (POP-Q) examinations differ in a randomized trial. STUDY DESIGN: Blinded POP-Q examinations performed at 3 months and 1 year were compared with unblinded examinations performed by the surgeon in a randomized trial of vaginal mesh for pelvic organ prolapse. RESULTS: Sixty-five patients were included in the study. Correlations between the blinded and unblinded POP-Q points and stages varied from low to moderate (rho = 0.29-0.78). At 3 months, the blinded overall prolapse recurrence rate was 45.3% compared with 39.1% based on unblinded staging (P = .34). At 1 year, the blinded overall recurrence rate was significantly higher than the unblinded recurrence rate: 68.3% vs 53.3% (P = .004). The 1-year blinded anterior wall recurrence rate was also higher than the recurrence based on unblinded staging: 56.7% vs 43.3% (P = .021). CONCLUSION: Use of unblinded POP-Q staging resulted in underestimation of 1-year overall recurrence after prolapse repair.

Lipomatous angiomyofibroblastoma: a case report of a unique vulvar mass.

BACKGROUND: Vulvar masses are commonly biopsied in the outpatient setting. They may present as clinically benign masses, but the pathological evaluation and diagnosis is important in establishing the correct management. CASE: A 41-year-old El Salvadoran woman presented with a nontender vulvar mass of over 12 years' duration that had enlarged rapidly over the past 8 months. After surgical excision, the pathologic diagnosis was a rare lipomatous variant of angiomyofibroblastoma. CONCLUSION: The lipomatous form of angiomyofibroblastoma is a very rare vulvar tumor, and to our knowledge 8 have been identified and we present the ninth. Although it is benign, there is an aggressive variant of angiomyofibroblastoma that is locally invasive and requires wide local excision to prevent recurrence.

Nuclear factor-kappa B localization and function within intrauterine tissues from term and preterm labor and cultured fetal membranes.

BACKGROUND: The objective of this study was to quantify the nuclear localization and DNA binding activity of p65, the major transactivating nuclear factor-kappa B (NF-kappaB) subunit, in full-thickness fetal membranes (FM) and myometrium in the absence or presence of term or preterm labor. METHODS: Paired full-thickness FM and myometrial samples were collected from women in the following cohorts: preterm no labor (PNL, N = 22), spontaneous preterm labor (PTL, N = 21), term no labor (TNL, N = 23), and spontaneous term labor (STL, N = 21). NF-kappaB p65 localization was assessed by immunohistochemistry, and DNA binding activity was evaluated using an enzyme-linked immunosorbent assay (ELISA)-based method. RESULTS: Nuclear p65 labeling was rare in amnion and chorion, irrespective of clinical context. In decidua, nuclear p65 labeling was greater in the STL group relative to the TNL cohort, but there were no differences among the TNL, PTL, and PNL cohorts. In myometrium, diffuse p65 nuclear labeling was significantly associated with both term and preterm labor. There were no significant differences in ELISA-based p65 binding activity in amnion, choriodecidual, and myometrial specimens in the absence or presence of term labor. However, parallel experiments using cultured term fetal membranes demonstrated high levels of p65-like binding even the absence of cytokine stimulation, suggesting that this assay may be of limited value when applied to tissue specimens. CONCLUSIONS: These results suggest that the decidua is an important site of NF-kappaB regulation in fetal membranes, and that mechanisms other than cytoplasmic sequestration may limit NF-kappaB activation prior to term.

Intraoperative and postoperative gastrointestinal complications associated with laparoscopic sacrocolpopexy.

OBJECTIVE: This study aimed to quantify the risks of intraoperative and postoperative gastrointestinal (GI) complications associated with laparoscopic sacrocolpopexy and identify possible risk factors. METHODS: A total of 390 medical records were retrospectively reviewed for GI complications. Complications were classified as functional complications [ileus, small bowel obstruction (SBO), and prolonged nausea/emesis] or bowel injury. Nausea/emesis was considered prolonged if these symptoms resulted in a hospital stay of greater than 48 hours, or in readmission. RESULTS: Functional GI complications included 1 ileus, 3 SBOs, and 3 cases of prolonged nausea/emesis. The combined rate for ileus and SBO was 1.0% and the rate of prolonged nausea/emesis was 0.8%. Functional GI complications were associated with prior abdominal surgery (P = 0.048), but there were no differences in age, body mass index, estimated blood loss, or operative time.There were 3 small bowel and 2 rectal injuries for a bowel injury rate of 1.3%. Bowel injury was not associated with prior abdominal surgery (P = 0.071), age, body mass index, estimated blood loss, or operative time. The total reoperation rate for SBO or bowel injury was 0.8%. CONCLUSIONS: The rates of GI complications in laparoscopic sacrocolpopexy are low. Prior abdominal surgery was associated with an increased risk of functional GI complications, but not bowel injury. This information should assist surgeons with preoperative patient counseling.

Effect of operative technique on mesh exposure in laparoscopic sacrocolpopexy.

OBJECTIVES: To determine if opening the vaginal cuff during laparoscopic sacrocolpopexy influences the rate of mesh exposure. METHODS: A total of 390 medical records were retrospectively reviewed for demographic information, operative technique, and relevant outcomes. RESULTS: Eleven mesh exposures (2.8%) and 14 suture extrusions (3.6%) were found, none involving visceral organs. Mesh exposure was more common when the vaginal cuff was opened, either during hysterectomy or when allowing transvaginal attachment of mesh in patients with a prior hysterectomy (4.9% vs 0.5%; relative risk [RR], 9.0, P = 0.012). In cases where concomitant hysterectomy was performed, a higher mesh exposure rate was seen in open-cuff hysterectomy (total vaginal hysterectomy/laparoscopically assisted vaginal hysterectomy) compared to supracervical hysterectomy (4.9% [9/185] vs 0% [0/92]; P = 0.032). Mesh exposure was more common when the mesh was sutured laparoscopically compared with transvaginally in patients undergoing open-cuff hysterectomy (14.3% [5/35] vs 2.7% [4/150]; RR, 5.4; P = 0.013). Permanent suture extrusion was significantly associated with laparoscopic versus transvaginal suturing of mesh (5.6% vs 0.6%; RR, 8.8; P = 0.010). Five patients underwent reoperation for mesh exposure, whereas most suture extrusions were asymptomatic; and all were managed nonsurgically. CONCLUSIONS: We found that preserving the integrity of the vaginal cuff led to a lower incidence of mesh exposure in patients undergoing laparoscopic sacrocolpopexy. When hysterectomy is indicated, a supracervical technique should be strongly considered as the mesh exposure rate was significantly lower. If removal of the cervix is indicated, the risk for mesh exposure remains low and should not preclude total hysterectomy, though transvaginal mesh attachment may be preferable.