Tension-free vaginal tape and laparoscopic mesh colposuspension in the treatment of stress urinary incontinence: immediate outcome and complications--a randomized clinical trial

BACKGROUND: The purpose of the study was to evaluate the immediate outcome and complications of the tension-free vaginal tape (TVT) and laparoscopic mesh colposuspension (LC) procedures in the treatment of female stress urinary incontinence (SUI). METHODS: One hundred and twenty-eight patients suffering from urodynamically confirmed SUI were recruited to this multicenter, randomized clinical trial. After randomization there were seven drop-outs--121 patients were operated upon: 70 patients in the TVT group and 51 in the LC group. The patients were evaluated according to the study protocol before operation and 6 weeks after it. The independent sample t-test and the Mann-Whitney U-test were used to calculate statistical differences between the study groups. RESULTS: Immediate cure rates, defined as negative stress test with 300 mL saline in the bladder, were similar (92.9% in the TVT group and 88.2% in the LC group; p = ns). Return to normal voiding was faster in the TVT group (9.2 h in the TVT group vs. 24.4 h in the LC group; p = 0.004). Fewer analgesics were used in the TVT group and hospital stay was shorter in this group. Complication rates associated with the procedures were similar and the number of complications was small. CONCLUSIONS: The immediate outcome of both procedures is the same. The rates of complications were similar. However, the TVT procedure seems to be less invasive and requires fewer hospital resources than LC.     

Simple sling resection and a second, intermediate polypropylene mesh for treatment of vaginal tape protrusion concurrent with recurrent urinary stress incontinence after TVT procedure

The tension-free vaginal tape (TVT) procedure is a simple, effective and minimally invasive method for the surgical treatment of urodynamic stress incontinence (USI). Yet, complications such as mesh protrusion and recurrent urinary leakages after TVT have been reported. A case of recurrent USI complicated with vaginal mesh protrusion following a TVT procedure was referred. Video-urodynamics and introital ultrasonography confirmed that the recurrence of USI was secondary to mal-position of the protruded TVT. A simple salvaging procedure was carried out. The mal-positioned distal protruded TVT was resected and a second intermediate piece of polypropylene (Prolene) mesh was replaced at mid-urethra. The operation time was short and blood loss was minimal. The patient was objectively continent at 6 months follow-up with no defect of healing. Considering the cost-effectiveness and invasiveness of the surgeries, the method of inserting an intermediate mesh is clinically useful.     

Hematocolpos associated with a remote history of chronic vaginitis and a diagnostic vaginal biopsy: a case report

Bacterial vaginitis is commonly seen in the pediatric population. Severe or recurrent cases may be associated with ulcerative lesions. We report a case of vaginal biopsies of ulcerative lesions in a 9-year-old which led to severe vaginal adhesions, stenosis, and hematocolpos. A vaginoscopy and resection from below were not successful and an exploratory laparotomy with uterine perforation and sounding into the upper vagina were required to reopen the lower vaginal canal. We recommend the limited use of vaginal biopsies in the face of a typical vaginitis presentation, and aggressive treatment to promote mucosa healing when biopsies are required.     

Methemoglobinemia induced by topical vaginal sulfanilamide cream in a patient with cervical cancer: a case report

BACKGROUND: Methemoglobinemia is a rare disorder most commonly associated with the ingestion or topical application of an offending exogenous agent. The clinical consequences of acute methemoglobinemia can be devastating and include lethargy, headache, and dyspnea and, as methemoglobin concentrations rise, respiratory depression, confusion, seizures, and even death. CASE: Here we present a case of acute methemoglobinemia induced by exposure to topical vaginal sulfanilamide cream in a 36-year-old woman with a FIGO stage IIIB squamous cell cervical carcinoma. CONCLUSION: Although methemoglobinemia associated with topical anesthetics has been well documented, to our knowledge this is the first reported case of methemoglobinemia induced by exposure to topical sulfanilamide cream. Although patients undergoing intracavitary radiation treatment for cervical cancer are at risk for cyanosis due to the development of deep vein thromboses and pulmonary embolism, methemoglobinemia should be suspected in the setting of acute cyanosis with a normal arterial oxygen pressure.     

Pregnancy in a patient with aneurysms of the right coronary artery and an arterioventricular fistula. A case report

A woman with aneurysms of the right coronary artery and right coronary sinus of Valsalva and a right coronary arterioventricular fistula developed angina during pregnancy. Lumbar epidural anesthesia was utilized during induction of labor and cesarean delivery. The patient had no intrapartum evidence of ischemia or congestive heart failure, and she recovered without an immediate recurrence of angina.     

Spontaneous vaginal expulsion of an infected necrotic cervical fibroid through a cervical fistula after uterine artery embolization: a case report

BACKGROUND: Uterine artery embolization (UAE) is promising, minimally invasive therapy being offered to women for treatment of fibroids. Although it seems to be safe and effective, major complications and adverse outcomes have been reported. CASE: A patient treated with UAE for a huge cervical fibroid presented with an infected, necrotic cervical mass lesion 4 weeks after the procedure. Spontaneous vaginal expulsion of the infected cervical fibroid from the left lateral cervical fistula tract occurred 3 weeks later while the patient was receiving antibiotic therapy. After 6 months of intervention, an approximately 99% regression rate in the fibroid volume was achieved. The patient gave birth to a healthy, female infant following a spontaneous, uneventful pregnancy and vaginal delivery. CONCLUSION: UAE appears to be associated with a significant reduction in fibroid volume. Expulsion of the infected, necrotic parts of the fibroid after UAE may be accepted as a natural process. Warning the patient about this potential risk, early recognition of infective complications and lose follow up seem to be crucial to avoiding potentially fatal septic shock.     

Uterine lipoleiomyoma in an elderly patient: a case report

Background Uterine lipoleiomyoma is a rare, fat-containing, benign tumor. The clinical features and optimal treatment of this tumor remain unclear. Case An 80-year-old woman with an extensive cardiac history was referred for assessment of a huge pelvic mass. Magnetic resonance imaging demonstrated a uterine tumor with inhomogeneously high signal intensity. A fat suppression technique showed heterogeneous suppression of the signal intensity, with areas of increased enhancement after Gd-DTPA administration. Hysteroscopy revealed no abnormal findings in the endometrium. She underwent a simple total abdominal hysterectomy, with a preoperative diagnosis of uterine liposarcoma. Histological examination revealed a uterine lipoleiomyoma. Ten days after surgery, she died due to acute non-occlusive mesenteric ischemia. Conclusion In cases where the radiological appearance of a uterine tumor in an elderly patient is suspicious for liposarcoma, the possibility of a benign lipoleiomyoma should be considered. Careful consideration of the patient’s preoperative condition and familiarity with uterine fat-containing tumors are essential for determining an optimal therapeutic approach.     

HELLP syndrome in a pregnant patient with a past history of splenectomy for idiopathic thrombocytopenic purpura. Case report

Case: We present a case of HELLP syndrome occuring in a patient who at the age of 8 years had undergone a splenectomy for idiopathic thrombocytopenic purpura. She was diagnosed as having HELLP syndrome 37 weeks of gestation and had a cesarean section. Received: 4 June 1996 / Accepted: 7 October 1996     

Combined bladder, urethral and uterine rupture after a normal, spontaneous vaginal delivery at home: a case report

BACKGROUND: Uterine rupture and associated injury to the maternal bladder and urethra have been rarely reported. All those cases were associated with a scarred uterus or augmentation of labor. We report a case of simultaneous bladder, urethral and uterine rupture in an unscarred uterus following delivery at home. CASE: A 22-year-old woman was referred from a peripheral hospital to the emergency unit of the Medical Faculty, Yüzüncü Yil University, after delivering at home. On vaginal examination, the bladder neck and proximal one third of the urethra were ruptured. Intraoperatively it appeared that the posterior wall of the bladder and bladder base had ruptured and separated from the level of the interureteric ridge. An extensive rupture of the lower uterine segment to the left sidewall of the uterus was seen. CONCLUSION: To prevent these complications, uneducated, traditional birth attendants should be replaced by at least midwives, and the rate of unsupervised home delivery should be reduced.     

Rectal tear during normal vaginal delivery with an intact anal sphincter: a case report

BACKGROUND: A rectal tear with an intact anal sphincter is an unusual presentation. Failure to recognize or repair perineal and rectal lesions increases the chance of fistulas and incontinence. CASE: A 37-year-old woman, para 1, was admitted with spontaneous onset of labor at 36 weeks following an uncomplicated pregnancy. During the active second stage of labor, spurting of amniotic fluid through the anus was noted. Labor progressed normally, and the patient delivered a healthy infant of 2.5 kg. Immediate per rectal examination revealed a large rectal tear with an undamaged anal sphincter. The defect was repaired, and the patient recovered completely. CONCLUSION: Systematic examination of the perineum, vagina and rectum should be done to assess the severity of damage after all vaginal deliveries in order to recognize occult as well as visible damage. It should be treated promptly to reduce postpartum morbidity.     

Prenatal diagnosis of inherited epidermolysis bullosa in a patient with no family history: a case report and literature review

OBJECTIVE: The junctional form of epidermolysis bullosa (EB) is a recessively inherited mechanobullous disease in which minimal trauma results in blister formation at the dermal-epidermal junction. A rare form associated with pyloric atresia (JEB-PA) is a severe clinical subtype leading to rapid demise after birth, thus justifying prenatal diagnosis. The case characterized by abnormal ultrasound findings at 35 weeks of gestation (gastric dilatation associated with polyhydramnios) of a patient with no family history is reported. METHOD: Postabortion skin biopsies were analyzed by immunofluorescence that revealed marked reduction of integrin alpha6beta4 in accordance with the diagnosis of JEB-PA. RESULTS: Amniotic fluid contained excess total protein (4 MoM), abnormally high AFP (20.4 MoM) related to skin lesions and abnormally elevated digestive enzyme suggestive of fetal vomiting of bile. The electrophoretic pattern of cholinesterases was unusual (additional slow band). Maternal serum AFP was 3.14 MoM and free beta-hCG 13.1 MoM. Because of these concomitant findings, JEB-PA was suspected. CONCLUSION: The case under study was atypical because of late clinical manifestations of the disease: polyhydramnios, gastric enlargement. As maternal serum AFP at 15 weeks may be normal, it was suggested that discovery of polyhydramnios during the second or the third trimester should prompt biochemical analysis of amniotic fluid, such as AFP and GGTP assay in all cases.     

Office vaginoscopic treatment of an isolated longitudinal vaginal septum: a case report

This case report describes a new treatment of an isolated longitudinal vaginal septum (LVS) by office operative vaginoscopy with a 4-mm rigid hysteroscope in a 27-year-old virgin who reported leukorrhea and recurrent vaginal infections. This technique might represent an effective treatment of an LVS, mostly in patients with an intact hymen. This could allow the inclusion of vaginal lesions among the indications for office endoscopic procedures performed using operative hysteroscopes.     

阴道无张力尿道中段悬吊术治疗压力性尿失禁34例临床分析

目的　评估阴道无张力尿道中段悬吊 (TVT)术治疗女性压力性尿失禁术后近 2年的疗效。方法　对 34例经尿动力学检查证实为压力性尿失禁同时伴有不同程度的阴道前壁膨出患者 ,行TVT术及阴道前壁修补术治疗 ,并对术后 2年内的效果进行随访。结果　 33例患者TVT手术均在局部麻醉加静脉麻醉下完成 ;平均手术时间 2 6 .9min ;术中出血量平均 2 9.8ml;30例 (88% )患者在术后 12h内自行排尿 ,残余尿 <10 0ml;另 4例 (12 % )患者术后需短暂保留尿管。平均住院 2 .9d ,30例 (88% )患者住院 2d以内 ;术后以患者主观感觉评价 ,平均随访 8.3个月 ,32例 (94 % )主观完全治愈 ,2例 (6 % )为明显改善 ,无一例无效 ;手术并发症少。结论　TVT术是治疗女性压力性尿失禁微创、有效和安全的手术方法之一     

Natural history of an untreated presumed hydatidiform mole: a case report

BACKGROUND: Hydatidiform moles (HMs) usually are evacuated by dilation and curettage soon after diagnosis. A small percentage of HMs later progress to choriocarcinomas. CASE: A 20-year-old woman presented with signs and symptoms of an HM. Through poor medical care, noncompliance and misunderstanding, she delayed dilation and curettage for 3 months, until after the condition regressed spontaneously. CONCLUSION: HMs masquerading as miscarriages (or other pregnancy outcomes) may account for some rogue choriocarcinomas that do not appear to follow HMs.     

Transvaginal repair of a vesico-vaginal fistula using a mobilised vaginal flap to form the bladder base: a case report

We describe a case of a vesico-vaginal fistula in a 32-year-old lady presenting with true urinary incontinence. There was a 1.5×1.5 cm deficit in the bladder wall and the left ureteric orifice was very close to the edge of the defect. For a successful transvaginal repair, we used a mobilized vaginal flap to bridge the defect in the bladder wall. This avoided the mobilization of the bladder wall and also prevented the left ureteric orifice from getting entrapped in the suture line. Adjacent wall of vagina was mobilized and stitched over the first layer to achieve water tight repair. Her post operative period was uneventful. The repair healed well and she was discharged in a good condition.     

Embolization of an arteriovenous fistula in the posterior fossa: report of a case]

We report a case of posterior fossa arteriovenous fistula with a possible arterial aneurysm. The patient was a 15-year-old female. She was transferred to us because of a sudden onset of dyspnea, severe headaches, and loss of consciousness. The CT scan found an abnormal vascular lesion in the posterior fossa. Calcification was noted in the wall of the largest abnormal vascular structure. The angiogram showed a focal aneurysmal dilatation of the hemispheric branch of the right posterior inferior cerebellar artery, followed by an arteriovenous fistula, which drained to the right transverse sinus. Embolization was performed by implanting a detachable balloon into the proximal end of the aneurysm. These abnormal vascular structures disappeared completely on the angiogram after the embolization. CT scan one week after embolization showed increased density in these abnormal vascular structures, with no enhancement after contrast, indicating thrombosis or the formation of a blood clot in their lumen. The CT half a year after embolization showed reduction in size and a low density change in the largest vascular structure with calcification in the wall. All other abnormal vascular structures disappeared. An angiogram half a year after the embolization confirmed no recurrence of the aneurysm or arteriovenous fistula.     

Pelvic actinomycosis with colo-ileo-vesical fistula formation: report of a case.

Pelvic actinomycosis with multiple fistular formation is rarely reported in the literature. We herein present a case of pelvic actinomycosis with sigmoid colo-ileovesical fistulae in a 36-year-old intrauterine device (IUD) user. She was admitted to the hospital because of general malaise, weight loss and bilateral palpable adnexal masses. Sonography showed bilateral adnexal masses which contained many echolucent spots. A barium enema examination revealed sigmoid colo-ileo-vesical fistulae. A computed tomographic scan showed bilateral cystic adnexal masses, bilateral hydronephrosis and hydroureter. Preoperatively, pelvic malignancy was suspected. An exploratory laparotomy was performed. Bilateral tubo-ovarian abscesses with extensive adhesions were found. Pathologic examination of the operative specimen revealed pelvic actinomycosis. The patient was treated with penicillin for 14 weeks and had a stable clinical course.