Reproductive Outcomes of Hysteroscopic Septoplasty Techniques

Percutaneous versus Laparoscopic treatment for simple renal cysts: a meta-analysis

OBJECTIVE

To compare the percutaneous and laparoscopic treatment for renal cyst in order to determine the optimal therapy for patients with renal cyst.

METHODS

A systematic search of PubMed, Cochrane Library, Web of Science, and EMBASE databases was conducted for articles published through Jun 3, 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

RESULTS

We found 493 studies form databases, and 6 were considered for the evidence synthesis. A total of 1631 cases were included. Of these patients, 488 cases undergone laparoscopic treatment, and 1143 cases undergone percutaneous treatment. Symptomatic and radiologic success were higher for laparoscopic treatment (odd ratio, OR, OR=3.59, 95% confidence interval, CI, 1.45-8.88, P=0.006; and OR=7.46, 95% CI 3.99-13.94, P<0.00001, respectively). Minor or severe complications were similar between the two treatments (OR=1.54, 95% CI 0.40-5.98, P=0.53; OR=3.13, 95% CI 0.03-359.76, P=0.64, respectively).

CONCLUSION

Laparoscopic treatment for renal cyst was associated with better symptomatic and radiologic success, and its complication was no more than percutaneous treatment.

Rupture of a myomectomy site in the third trimester of pregnancy after myomectomy, septoplasty and cesarean section: A case report

Uterine rupture during pregnancy is a rare but dangerous complication. A history of cesarean section is known to be a risk factor, but other types of uterine surgery can also increase the risk. We report a case of rupture of a myomectomy site in the third trimester of pregnancy without uterine contractions in a woman who had previously undergone myomectomy, septoplasty and cesarean section. The 39-year-old woman (gravida 2, para 2) presented at 29 weeks' gestation with uterine contractions. She was successfully treated with tocolytics. At 32 weeks of pregnancy, in the absence of contractions, the patient complained of severe abdominal pain and she became hypotensive. Emergency laparotomy and cesarean section were performed, resulting in the delivery of a live infant. The myomectomy site was found to have ruptured but the cesarean and septoplasty scars were intact. This case suggests that myomectomy scars are at greater risk of rupture during pregnancy than those resulting from cesarean section and septoplasty.

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Previous cesarean, septoplasty and myomectomy are risk factors for uterine rupture.

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The characteristics of uterine rupture depend on the types of surgery the woman has previously undergone.

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After myomectomy, uterine rupture can occur during pregnancy without contractions.

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Myomectomy may be a bigger risk factor for uterine rupture than cesarean section.

Assessment of hysteroscopic role in management of women with recurrent pregnancy loss

OBJECTIVES

To assess the hysteroscopic value in the management of intrauterine lesion in women with recurrent pregnancy loss.

METHODS

This study was done in Ain Shams Maternity Hospital after the approval of the research Ethics Committee, during the period between August 2014 and December 2015 where 200 nonpregnant women with a history of three or more consecutive unexplained first and second trimester miscarriages before 20 weeks were recruited from recurrent miscarriage clinic. A written informed consent was obtained from all women before participation.

RESULTS

This current study was conducted in Ain Shams University Maternity Hospital during the period between August 2014 to May 2015 a total of 200 women with history of recurrent miscarriage were included in the study. Regarding the results of this study the mean age was 30.5(5.7), the mean number of previous abortion 3(3-5) the mean number of the first trimesteric abortion was 2 with range (2-2) the mean number of second trimesteric abortion was 2 with range (1-2). In this study, 88% of patients were nullipara. It was also found that hysteroscopic findings were found in 58.5%. Uterine anomalies was present in 21%, including septate uterus and intrauterine adhesion (IUAs) were present in 12.5%. Endometrial polyps were present in 8.5%, bicornute uterus in 4.5%, unicornuate uterus in 4.5% while submucous myomas were present in 7.5%. It was found that 48.5% need hysteroscopic intervention including 21% need septectomy 12.5% need adhesiolysis, 6.5% need myomectomy while 8.5% need polypectomy. The study found that no statistically significant difference between patients with normal hysteroscopic finding and patients with abnormal hysteroscopic finding as regard age, time of previous abortion and number of previous abortion. But there was statistically significant difference as regard number of previous delivery and abnormal HSG.

CONCLUSIONS

It appears that hysteroscopy is a useful tool in the diagnosis and treatment of the causes of recurrent miscarriage that can be performed safely without anesthesia in most cases. The prevalence of uterine anomalies in patients with recurrent miscarriages is 54.5%, septate uterus is the most common anomaly and for this reason uterine anomalies should be systematically assessed in patients with recurrent miscarriage.

Advanced Hysteroscopic Surgery: Quality Assurance in Teaching Hospitals

Advanced hysteroscopic surgery (AHS) is a vitally important technique in the armamentarium for the management of many day-to-day clinical problems, such as menorrhagia, surgical excision of uterine myomata and septa in the management of female infertility, hysteroscopic excision of chronically retained products of conception (placenta accreta), and surgical removal of intramural ectopic pregnancy. In today's climate of accountability, it is necessary that gynecologists take a more active role in assuring the quality of their work. In this article, we discuss the quality assurance system from the point of view of the surgical audit meetings in some of the major teaching hospitals affiliated with the University of Queensland (Brisbane, Queensland, Australia).