The enigmatic cervix

A comparison between ultrasound therapy and laser therapy for symptomatic cervical ectopy

The purpose of this study was to compare the clinical efficacy of ultrasound (US) therapy and laser therapy in patients with symptomatic benign ectopy of the uterine cervix. Patients with symptomatic benign ectopy of the cervix (n = 200) were enrolled in this study. Abundant leukorrhea, contact bleeding, recurrent cervicitis and pelvic pain were also evaluated. Patients were allocated alternately to the US and laser groups. In the laser group, Nd: YAG laser was used for tissue vaporization destruction. In the US group, the therapeutic US device Seapostar (Chongqing Haifu [HIFU] Technology, Co. Ltd., Chongqing, China) was applied. Neither anesthesia nor analgesia was used. Results showed that patients in both groups tolerated the procedure well and had excellent treatment outcomes. A symptomatic cure rate of 97.33% was obtained in the US group, and 98.81% was obtained in the laser group (p > 0.05). Ectopy areas were managed with a success rate of 95.95% in the US group, and 96.43% in the laser group (p > 0.05). The rate of side effects (including vaginal reactive discharge and colporrhagia) was found to be lower in the US group than that in the laser group. Mild-to-moderate bleeding occurred in US group (8.42%) and laser group (45.56%). The bleeding rate in the US group is significantly lower than that in the laser group (p < 0.01). We conclude that focused US can treat symptomatic ectopy of the cervix successfully, with excellent clinical results and minimal risk. Focused US therapy appears to be a promising new treatment method for symptomatic ectopy of the uterine cervix.

Female genital tuberculosis and infertility

OBJECTIVES

This study was performed to evaluate the rate of diagnosed female genital tuberculosis and its presentational symptoms and methods of diagnosis.

METHODS

A total of 3088 cases of tuberculosis (TB) who had been registered and treated in the Health Center of Fars Province from 1989 to 1999 were retrospectively studied. From this group, 46 women were diagnosed as having genital TB. The diagnosis in 41 cases was based on the standard pathological criteria of tissue specimens. The other five cases were excluded from this study due to the lack of classical diagnostic criteria. Statistical analysis was performed using the Z-test.

RESULTS

The mean age of the patients at the time of diagnosis was 30.4 years. Seven patients presented with abdominal or pelvic pain (17.07%). In this group three cases underwent laparatomy due to abdominal mass and four patients for tubo-ovarian abscess, which led to the diagnosis. Abnormal uterine bleeding was the cause of diagnostic dilatation and curettage in three other patients (7.31%). However, in 31 cases (75.6%) TB was diagnosed during studies performed to evaluate the cause of their infertility, and the most common diagnostic procedure was endometrial curettage (25 cases). Female genital TB accounted for 1.32% of all tuberculous patients in this study. Of these, 75.6% were infertile by definition (Z=12.13 P<0.0001). TB endometritis was detected in 72.03%, tubal involvement in 34.03%, ovarian TB in 12.9% and cervical TB in 2.4% of the patients.

CONCLUSIONS

This study confirms the presence of a strong relationship between genital TB and infertility; therefore genital TB would be more frequently diagnosed if this possibility was considered in the evaluation of every infertile patient in areas where tuberculosis is endemic.