Are there any preventable risk factors for women who had surgery for Pelvic Organ Prolapse and stress Urinary Incontinence?

OBJECTIVE

The present study evaluates the preventable risk factors in symptomatic women with previous surgery for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI).

METHODS

Four hundred and one women previously operated were divided into two groups as; women operated for POP (325 cases) and women operated for SUI (76 cases). The control group consisted of 233 age and body mass index (BMI)-matched subject operated for benign gynecologic reasons and exhibited no evidence of POP or SUI. These groups were compared in terms of age, BMI, gravida, parity, mode of delivery, smoking status, menopause status and chronic diseases.

RESULTS

Grand_multiparity (parity ≥5) increased the risk of POP/SUI surgery and POP surgery 2.71 and 2.94 times, respectively (p=0.0003 and p=0.0001, respectively). Vaginal birth increased the risk of POP/SUI surgery 2.33 times (p=0.03).

CONCLUSION

Grand_multiparity increased the risk of POP/SUI surgery and POP surgery while vaginal birth increased the risk of POP/SUI surgery. Among them, particularly, grand_multiparity seem to be the only preventable risk factors.

Treatment of uterine prolapse with bilateral hydronephrosis in a young nulliparous woman; a new minimally invasive extraperitoneal technique

A 37-year-old nulligravid woman presented with a 2-year history of uterine prolapse along with mixed incontinence. Gynecological examination confirmed third degree cystocele and uterine prolapse. Renal ultrasonography showed enlarged kidneys and marked dilation of the bilateral pelvicalyceal system. She was hospitalized and a ring pessary was inserted after bladder catheterization. Her preoperative evaluation was performed and the patient was operated one month after her first admission. Anterior colporrhaphy along with Kurt Extraperitoneal Ligamentopexy was performed without any complication. A control visit on second postoperative month revealed recovery of incontinence symptoms and no prolapse was observed. To our knowledge this is the first reported treatment of a case with bilateral hydronephrosis due to uterine prolapse that were corrected and overcame with a novel minimally invasive extraperitoneal approach by fixation of bilateral round ligaments to the rectus fascia sheet.

Relation of peritoneal fluid and serum vascular endothelial growth factor levels to endometriosis stage

OBJECTIVE

It is a well known fact that endometriosis is linked with apoptosis, extracellular matrix formation, and angiogenesis. In this study, the authors aim to investigate the relation between the extent of endometriosis and vascular endothelial growth factor (VEGF).

MATERIALS AND METHODS

Twenty-one patients who received laparoscopic intervention due to endometriosis constituted the patient group, whereas 19 patients who were operated due to extra-endometrial benign cyst were included in the control group. Following the laparoscopic pelvic assessment, peripheral blood samples and two cc of free peritoneal fluid from the Douglas pouch were obtained simultaneously. The samples were studied with regards to VEGF level via solid phase sandwich enzyme-linked immunosorbent assay (ELISA) method.

RESULTS

In the patient group, eight cases were diagnosed with Stages I and II endometriosis, while 13 cases were diagnosed with Stages III and IV endometriosis. Among the Stage I and II cases, serum VEGF levels were statistically significantly higher, as compared to the Stage III and IV cases, as well as the control group. Discussion: In conclusion, the authors found a relationship between elevated serum VEGF levels and early stage endometriosis.

A new surgical method of suprapubic and extraperitoneal approach with uterine preservation for pelvic organ prolapse: kurt extraperitoneal ligamentopexy

Objective. To introduce an alternative surgical approach for the optimal treatment of pelvic organ prolapse (POP). Methods. Twenty symptomatic women with grades 2-4 POP diagnosis who opted to choose this alternative surgery were retrospectively analyzed. Results. A total of 22 cases were included. The mean age of the patients was 50.6 ± 13.2 years (29-72 years) with a mean gravid and parity of 5.5 ± 2.66 and 3.4 ± 2.06, respectively. The mean body-mass index of the patients was 24.25 ± 2.43. Nine (45%) patients were premenopausal and 11 (55%) patients were postmenopausal. Uterine descensus was present in all patients, and additionally cystorectocele in 9 patients (45%), cystocele in 6 patients (30%), rectocele in 4 patients (20%), and elangatio colli in 6 patients (30%) were diagnosed. In addition to the alternative surgery, Manchester procedure and anteroposterior vaginal wall repair or Burch procedure was performed where necessary. Mean follow-up time was 48.95 ± 42.8 months (6-171 months). No recurrence of POP occurred. Conclusions. Suprapubic, extraperitoneal, and minimally invasive ligamentopexy of the round ligament to the anterior rectus fascia offers an alternative to conventional POP surgery with favorable outcomes without any recurrence.

Acute pelvic pain: evaluation of 503 cases

AIM

The aim of this study was to investigate the etiology according to the age groups (adolescent, reproductive, and perimenopausal / menopausal periods) of women who were admitted with complaints of acute pelvic pain (APP).

MATERIALS AND METHODS

Data from 503 patients diagnosed with APP were evaluated retrospectively. The patients were divided into three groups according to their ages. The adolescent group consisted of patients who were 19 years of age and under (Group A), the reproductive age group consisted of patients who were between the ages of 20 and 44 years (Group B), and the perimenopausal / menopausal group consisted of patients who were at the age of 45 and above (Group C). The most common causes of APP among the three groups were investigated.

RESULTS

The mean age was 29.9 ± 6.01 years. Gynecologic factors were present in 469 cases, APP was nongynecologic in nature in 24 cases, while the cause was unknown in 10 cases. The patients were evaluated in terms of APP duration, accompanying symptoms, and pain localization. There were 36 cases in the adolescent group, 361 cases in the reproductive age group, and 72 cases in the perimenopausal / menopausal group. Adnexal pathologies were the most commonly observed APP factor in all three groups.

CONCLUSION

APP was most commonly observed in the reproductive period, and adnexal pathologies and infections were etiologically prominent. Early and accurate diagnosis of APP will often enable more effective and conservative treatment methods for life-threatening pathologies.

Unilateral massive ovarian edema in a woman with polycystic ovaries

Massive ovarian edema is a rare cause of ovarian enlargement in young women. We report the case of a 20-year-old woman with unilateral massive ovarian edema with findings on ultrasound of an enlarged policystic ovary and pedicle arterial and venous blood flow observed with color and pulsed wave Doppler examination. Massive ovarian edema can be managed conservatively and blood flow in the pedicle of the ovary is detected by color and pulsed wave Doppler examination.

Unilateral massive ovarian edema and polycystic ovaries. A case report

Massive ovarian edema is a rare cause of ovarian enlargement in young women. We report a case in a 20-year-old woman with unilateral edema associated with the ultrasound appearance of polycystic ovary disease. Arterial and venous blood flow in the pedicle was observed with color and pulsed wave Doppler examination. Conservative management was successful.

Mullerian adenosarcoma of the uterus associated with tamoxifen therapy

Mullerian adenosarcoma of the uterus is a biphasic tumor exhibiting benign epithelial and malignant stromal component. This tumor may occasionally be associated with tamoxifen therapy which is used as an adjuvant drug for breast carcinoma. Reviewing the literature, we found only 12 adenosarcoma cases associated with tamoxifen therapy Thus, the clinical and pathological findings in a 58 years old postmenopausal woman who developed uterine adenosarcoma, following low dose tamoxifen therapy after 8 years, was discussed in this report.