Laparoscopic Single-site “In-bag” Ovarian Dermoid Cystectomy in a 16-week- pregnant Patient

Study ObjectiveTo demonstrate a novel “in-bag” ovarian cystectomy technique for a large adnexal mass in pregnancy.DesignStepwise demonstration with narrated video.SettingAn academic tertiary care hospital. The patient was a 26-year-old woman, gravida 1, para 0, at gestational age of 7 weeks and 3 days who presented to the emergency department with persistent left pelvic pain and was diagnosed with a 16 cm × 10 cm × 12 cm dermoid cyst. She re-presented at gestational age of 16 weeks and 3 days with worsening pelvic pain, and the decision was made to proceed with surgical intervention.InterventionsLaparoscopic transumbilical single-site surgery for the surgical management of adnexal masses in pregnancy has been demonstrated to be feasible and safe 1, 2, 3. However, single-site laparoscopic ovarian cystectomy can be very challenging in pregnancy, especially when the need for suturing arises. Exteriorizing the ovary and cyst after intraperitoneal drainage may allow for extracorporeal suturing that is faster and easier; however, it may increase the probability of spillage of cystic contents if it is not performed in a bag, which can then cause peritonitis in cases of dermoid cysts. A combination of in-bag and extracorporeal ovarian cystectomy is a novel alternative minimally invasive approach that is cosmetic, safe, and effective.Several helpful techniques in this novel combination technique include the following: • Creating an umbilical incision of at least 2 cm or one that is large enough for better manipulation of both the surgical bag and adnexal mass. • Tightening the bag appropriately around the infundibulopelvic ligament so that it is not too tight leading to compromised blood supply and tissue necrosis, yet not too loose resulting in leakage of cystic contents. • Ensuring that the infundibulopelvic ligament is stabilized within the surgical bag. • Inserting small-sized wound retractor into the bag for better exposure during cystectomy. • Having a double-suction irrigation setup for large adnexal masses, as demonstrated in this patient, to reduce the spillage of cystic contents.The procedure was successfully performed in approximately 110 minutes, and the fetal heart rate postprocedure was 128 bpm through bedside transabdominal ultrasound. Estimated blood loss was 5 mL, and the patient was discharged the same day with an uneventful 4-week postoperative follow-up.ConclusionLaparoscopic single-site “in-bag” ovarian dermoid cystectomy is feasible, effective, and safe in pregnant patients with a large adnexal mass. This technique results in better stabilization of the ovarian cyst and reduction of cystic content spillage.     

Long-term follow-up of patients surgically treated for ruptured ovarian endometriotic cysts

ObjectiveApproximately 4% of women are admitted to hospitals because of ovarian cyst rupture, hemorrhage, or torsion. Endometriotic cyst rupture is a rare surgical emergency associated with severe peritonitis and pelvic adhesion, and we aimed to determine its prognosis and long-term outcome.Materials and MethodsWe reviewed and analyzed the medical records of 11 patients (mean age, 31.8 ± 7.2 years) with ruptured endometrioma and a history of dysmenorrhea (4.9 ± 2.3 of maximum 10) who were surgically treated, and then regularly followed-up for more than 3 years (range, 35–261 months).ResultsPrevious ultrasound examinations revealed pelvic cysts in seven patients. Three patients had a history of endometrioma surgery. In the emergency room, eight patients complained of uterine motion tenderness. Sonography revealed residual ovarian tumors (size range, 4.2–10.4 cm), with or without fluid accumulation in the cul-de-sac. Surgical enucleation by laparoscopy or laparotomy revealed high revised American Fertility Society endometriosis scores (78 ± 20.1) as well as high adhesion scores (48.7 ± 11.3). In the postoperative period, four patients had recurrent ovarian tumors that were related to elevated serum cancer antigen 125 levels and high postoperative pain scores. In contrast, three patients who became pregnant during the postoperative period had low serum cancer antigen 125 levels and pain scores.ConclusionEndometrioma rupture should be considered in females presenting with sudden lower abdominal pain, associated with a history of dysmenorrhea and preexisting pelvic cysts. Emergency surgical intervention may lead to a better prognosis, particularly in patients without a history of previous endometrioma surgery.     

Outcome and efficacy of a transobturator polypropylene mesh kit in the treatment of anterior pelvic organ prolapse

ObjectiveTo report the efficacy and complications of anterior pelvic organ prolapse (POP) repair with mesh placed through the transobturator route (Perigee system; AMS, Minnetonka, MN, USA).MethodsIn total, 198 women with anterior POP grade II or higher according to the POP Quantification (POP-Q) system were treated with the Perigee procedure. The primary outcome was defined as anterior POP grade I or lower at 12 months’ follow-up. The secondary outcomes included the incidences of perioperative, mesh-related, short-term, and long-term postoperative complications.ResultsThe cure rate was 92.9% overall and 90.6% among women who had previously undergone a hysterectomy or a traditional anterior colporrhaphy. The mean POP-Q Aa and Ba values were significantly improved after the procedure (Aa 2.2 cm [0.0 to 3.0 cm] versus ? 2.1 cm [? 3.0 to ? 1.2 cm]; Ba ? 2.5 cm [? 1.0 to 4.2 cm] versus ? 2.2 cm [? 5.5 to ? 1.0 cm]; P < 0.001). Vaginal or bladder erosions were observed in 3 patients. Other short- and long-term complications were infrequent and not statistically significant.ConclusionThe Perigee procedure is effective in the treatment of anterior POP and does not have serious complications even among women with previous hysterectomy or traditional anterior colporrhaphy.     

Rapidly growing ovarian endometrioid adenocarcinoma involving the vagina: a case report

ObjectiveWe present a rare case of a very rapidly growing stage IV ovarian endometrioid adenocarcinoma involving the uterine cervix and vagina without lymph node involvement.Case ReportA 43-year-old woman visited the hospital with complaints of lower abdominal discomfort and vaginal bleeding over the previous 3 months. Serum levels of tumor marker CA 125 and SCC antigen (TA-4) were normal. On magnetic resonance imaging, a 7.9 × 9.7 cm heterogeneous mass with intermediate signal intensity was observed in the posterior low body of the uterus. Two months ago, a computed tomography scan revealed an approximate 4.5 × 3.0 cm heterogeneously enhanced subserosal mass with internal ill-defined hypodensities. A laparotomy, including a total abdominal hysterectomy with resection of the upper vagina, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, appendectomy, total omentectomy, and biopsy of rectal serosa was performed. A histological examination revealed poorly differentiated endometrioid ovarian adenocarcinoma with vaginal involvement. The patient had an uncomplicated post-operative course. After discharge, she completed six cycles of adjuvant chemotherapy with paclitaxel (175 mg/m²) and carboplatin (300 mg/m²) and has remained clinically disease-free until June 2010.ConclusionEpithelial ovarian cancer may grow very rapidly. The frequent measurement of tumor size by ultrasonography may provide important information on detection in a subset of ovarian carcinomas that develop from preexisting, detectable lesions.     

The effect of maximal surgical cytoreduction on sensitivity to platinum-taxane chemotherapy and subsequent survival in patients with advanced ovarian cancer

ObjectivesLimited information exist about the frequency of micrometastases, their topographic distribution and prognostic impact in patients with cervical carcinoma (CX).MethodsLymph nodes of patients with surgically treated CX, FIGO IB to IIB, with pelvic lymph node involvement, were re-examined regarding the size of metastatic deposits, their topographic distribution within the pelvis. Lymph node status (pN0 vs. pN1mic = metastasis < 0.2 cm vs. pN1 = metastasis > 0.2 cm) was correlated to recurrence free (RFS) and overall survival (OS).Results31.4% of all patients (281/894) represented pelvic lymph node involvement. 22.2.% of the node positive ones showed micrometastases (pN1mic). Most commonly, obturator and internal nodes were affected by pN1mic, without any side differences. Patients with macrometastases (pN1) and micrometastases (pN1mic) represented significant reduced RFS-rate at 5-years (62% [95% CI: 54.2 to 69.8] for pN1 and 68.9% [95% CI: 55.5 to 82.4] for pN1mic) when compared to patients without metastatic disease (91.4% [95% CI: 89.0 to 93.8]; p < 0.001) The 5-years OS-rate was decreased in patients with metastatic disease (pN0: 86.6% [95% CI: 83.7 to 89.5], pN1mic: 63.8% [95% CI: 50.9 to 76.7], pN1: 48.2% [95% CI: 40.4 to 56.0]; p < 0.0001). These differences persisted in detailed analysis within these subgroups. In multivariate analysis, tumor stage, pelvic lymph node involvement and micrometastases were independent prognostic factors.ConclusionsA remarkable number of patients with CX show micrometastases within pelvic nodes. Micrometastatic disease represents an independent prognostic factor. So, all patients with pelvic lymph node involvement, including micrometastatic deposits, might be candidates for adjuvant treatment.     

Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie's disease--a placebo-controlled pilot study

IntroductionTransdermal and intralesional verapamil has been reported to be useful in the treatment of Peyronie’s Disease. This study evaluates a topically applied calcium channel blocker (verapamil hydrochloride 15% gel), a topically applied calmodulin blocker (trifluoperazine), and a topically applied weak calcium channel blocker (magnesium sulfate), each incorporated in a transdermal vehicle.AimThis pilot study was conducted to assess the efficacy of a 15% verapamil gel applied topically to the penile shaft twice daily for the treatment of Peyronie’s Disease.Main Outcome MeasureTo assess improvement in curvature, plaque size, resolution of painful erections, and improvement in erection quality.MethodsTwo simultaneous, three armed, double blinded, placebo-controlled studies were conducted. After randomization into one of four groups, patients were treated for 3 months. At the end of 3 months’ treatment using blinded drug, each patient was treated with open label topical verapamil for 6 months. The studies were completed after each patient had been treated and evaluated for 9 months after randomization.ResultsFifty-seven patients were randomized. In total, 94.4% of patients treated for 9 months with topical verapamil experienced improvement in curvature with an average percent curvature change of 61.1% compared with 43.6% curvature improvement at 3 months. At 9 months the average percent plaque change was 84.7% compared with 55% at 3 months. Pain resolution at 9 months was 100% compared with 87.5% at 3 months. Patient perception of erection quality also increased at 9 months to 81.8% compared with 72.7% at 3 months.ConclusionsTopical verapamil gel proved effective in eliminating pain on erection, decreasing the size of plaque, decreasing curvature, and improving erection quality in patients with Peyronie’s Disease. Treatment results improved significantly after 9 months’ treatment as compared with 3 months’ treatment. Fitch WP III, Easterling WJ, Talbert RL, Bordovsky MJ, and Mosier M. Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie’s Disease—A placebo-controlled pilot study.     

Pelvic node removal and disease-free survival in cervical cancer patients treated with radical hysterectomy and pelvic lymphadenectomy

ObjectiveTo examine the relationship between the number of pelvic nodes removed and 5-year disease-free survival in early-stage cervical cancer patients who underwent radical hysterectomy and pelvic lymphadenectomy (RHPL).MethodsThe medical records of 826 cervical cancer patients who underwent RHPL and who had at least 11 pelvic nodes removed at Chiang Mai University Hospital between January 2002 and December 2008 were reviewed. The patients were divided into 4 groups according to the number of nodes removed: 11–20 nodes (n = 243); 21–30 nodes (n = 344); 31–40 nodes (n = 171); and ≥ 41 nodes (n = 68). The 5-year disease-free survival of patients in each group was compared. The clinicopathological factors were analyzed using Cox regression to identify independent prognostic factors.ResultFive-year disease-free survival was not significantly different among the 4 groups. When patients with and without nodal involvement were considered separately, the 5-year disease-free survival in all groups was not significantly different. At multivariate analysis, the number of pelvic nodes removed was not an independent prognostic factor.ConclusionThe number of pelvic nodes removed was not associated with 5-year disease-free survival or number of positive pelvic nodes.     

Assessment of ovarian volume reduction with three-dimensional ultrasonography after cystectomy for endometrioma

ObjectiveThe aim of our study was to assess ovarian tissue loss related to endometrioma cystectomy by 3D-ultrasonography.Patients and methodsWe have retrospectively included 15 women with no previous ovarian surgery who benefited from cystectomy of an unilateral endometrioma the diameter of which was superior to 30 mm. Cystectomy has been performed using an ovarian tissue-sparing procedure with no incision of the ovarian cortex. Patients underwent ultrasonography at least 9 months after the surgery. Several ovarian parameters, such as the area on longitudinal cross-section, the volume and the antral follicles count (AFC), were measured on both operated and contra lateral ovary, and then were compared using Mann and Whitney test. The relationship between the reduction of operated ovary volume and preoperative endometrioma diameter was evaluated by multiple regression.ResultsOperated ovary presented a significant reduction in area (mean reduction 229.8 mm² ± 47.6; P < 0.0001), volume (mean reduction 5.8 cm³ ± 1.16; P < 0.0001) and AFC (mean reduction 5.1 ± 3.8, P = 0.002). No statistically significant correlation was found between operated ovary volume reduction and preoperative endometrioma diameter.Discussion and conclusionEndometrioma cystectomy leads to significant reduction in ovarian parenchyma volume and AFC, when compared to contra lateral ovary. This event must be taken into account in the choice of treatment strategy, especially in the case of enlarged, bilateral and recurrent endometriomas, recurrence, as well as in women presenting with other risk factor for ovarian failure.     

Predicting delay in presentation in men with Peyronie's disease

IntroductionMany men with Peyronie's disease (PD) delay presentation to a urologist. The reasons for this are unclear.AimTo define the differences in men who present early compared to those presenting in a delayed fashion and to determine predictors of delayed presentation.MethodsA retrospective analysis of all patients presenting for the first medical evaluation of PD. All patients underwent a standard history and physical examination and had a standardized deformity assessment. Demographic and PD parameters were recorded.Main Outcome MeasuresStatistical comparison was used to define factors that were different between early and delayed presenters and multivariable analysis was used to define predictors of presentation >12 months.Results482 patients were analyzed, 61% presenting ≤12 months, 39% >12 months. Mean patient age was 52 ± 13 years and mean duration of PD was 17 ± 30 months. Mean measured curvature was 42° ± 19°. Multivariable analysis revealed that delayed presentation patients were significantly more likely to be older (odds ratio [OR] = 4.0), to be in long-term relationships (OR = 3.6), to have dorsal curvature (OR = 2.5), to have curvature <45° (OR = 3.3), to be heterosexual (OR = 2.0), and to have simple deformity (OR = 1.5).ConclusionsOne-third of men with PD presented in a delayed fashion and they tended to be older, to be in long-term relationships, to have dorsal curvature, or to have simple deformity. Mulhall JP, Alex B, and Choi JM. Predicting delay in presentation in men with Peyronie's disease.     

Laparoscopic hysterectomy versus abdominal hysterectomy for severe pelvic endometriosis

ObjectiveTo compare the surgical outcomes of laparoscopic hysterectomy (LH) versus abdominal hysterectomy (AH) in patients with severe pelvic endometriosis.MethodsA retrospective review of patients undergoing hysterectomy for endometriosis was conducted between January 2002 and December 2007. A total of 503 patients had severe pelvic endometriosis; of these, 115 patients underwent LH and 388 patients underwent AH. Surgical outcomes—including operative time, blood loss, length of hospital stay, and need for blood transfusion—were analyzed and compared between the 2 treatment groups.ResultsOperative time was significantly longer for LH than for AH (185.1 ± 48.7 minutes and 139.9 ± 52.4 minutes, respectively; P < 0.001). However, estimated volume of blood loss, length of hospital stay, and complication rates were significantly less for patients in the LH group than for those in the AH group (302.6 ± 255.1 mL versus 760.9 ± 633.2 mL [P < 0.001]; 3.5 ± 1.1 days versus 6.4 ± 3.0 days [P < 0.001]; and 18.3% versus 49.0% [P < 0.001], respectively).ConclusionCompared with AH, LH was associated with fewer complications. LH should, therefore, be the preferred surgical option for women with severe pelvic endometriosis who require a hysterectomy.     

Surgical outcomes and patient satisfaction after dermal, pericardial, and small intestinal submucosal grafting for Peyronie's disease

IntroductionPeyronie's disease, a localized fibrosis of the tunica albuginea surrounding the penile corpora, results in penile curvature and sexual dysfunction. Surgical management involving grafting to straighten the penis is the treatment of choice in conditions unresponsive to conservative therapy where penile length preservation is important.AimTo determine surgical outcomes and patient satisfaction after dermal, pericardial, and small intestinal submucosal grafting for Peyronie's disease.Main Outcome MeasuresThe International Index of Erectile Function (IIEF), postoperative self-reports, patient satisfaction, and clinical characteristics were used to measure outcomes.MethodsWe retrospectively reviewed charts of 36 patients who underwent surgery for Peyronie's disease requiring grafting from 1999 to 2005. Follow-up to subjectively assess outcomes was conducted.ResultsAverage patient age at surgery was 55 ± 1 years. Body mass indexes were similar among all groups. Erectile dysfunction risk factors were comparable with 36% reporting hypertension and 22% hypercholesterolemia. Overall patient follow-up time was 673 ± 98 days. Self-reported resolution of penile curvature was noted in 60% of dermal, 100% of Tutoplast, and 76.9% of Stratasis graft recipients. Stratasis patients maintained presurgery length (54%) and rigidity (77%) more so than dermal (30%, 60%) and Tutoplast (23%, 39%) patients. Assessment of erectile dysfunction using the IIEF-5 captured significant improvements in patients receiving Stratasis grafts (preoperative: 10.1 ± 1.1 vs. postoperative: 17 ± 1.6). Overall, 89% of patients reported satisfaction following surgical intervention.ConclusionsSurgical management of Peyronie's disease results in correction of penile curvatures and high rates of patient satisfaction. Loss of penile length and decreased rigidity occurred to a lesser degree with Stratasis grafts. While detailed informed consent is essential in this patient population, novel materials such as Tutoplast and Stratasis grafts improve outcomes following surgical correction of Peyronie's disease. Kovac JR, and Brock GB. Surgical outcomes and patient satisfaction after dermal, pericardial, and small intestinal submucosal grafting for Peyronie's disease.     

Predictive factors for failure of pelvic arterial embolization for postpartum hemorrhage

ObjectiveTo assess the efficacy of pelvic embolization in women with postpartum hemorrhage (PPH) and to determine factors associated with embolization failure.MethodsIn a retrospective observational study, data were analyzed from 98 consecutive women who underwent pelvic embolization for intractable PPH between January 2007 and November 2009 at Beaujon Hospital, Clichy, France. Women with persistent PPH despite pelvic embolization were compared with women who had cessation of hemorrhage and attained hemodynamic stability.ResultsAmong the 98 women, 66 (67.3%) had been transferred from another hospital after delivery. Pelvic arterial embolization failed to control PPH in 8 (8.2%) women. On univariate analysis, factors significantly associated with embolization failure were the presence of placenta accreta (P < 0.005), hemoglobin level (P < 0.05), prothrombin time (P < 0.04), fibrinogen level (P < 0.03), red blood transfusion (P < 0.02), number of packed red blood cell units transfused (P < 0.05), and fresh-frozen plasma transfusion (P < 0.02). Hospital-to-hospital transfer with a notable time interval between delivery and embolization was not associated with increased risk of failure.ConclusionPredictive factors significantly associated with failed pelvic arterial embolization were the presence of placenta accreta, biologic factors, and transfusional factors. Delay due to inter-hospital transfer did not affect the outcome of embolization.     

Early Polycystic Ovary Syndrome as a Possible Etiology of Unexplained Premenarcheal Ovarian Torsion

Study ObjectiveTo study evidence of polycystic ovary syndrome (PCOS) in premenarcheal adolescents with unexplained ovarian torsion.DesignRetrospective observational case series.SettingTertiary university clinical centerParticipantsSix premenarcheal adolescents and six adults with acute ovarian torsionInterventionA chart review.Main Outcome MeasuresContralateral ovarian size, operative findings, ovarian pathology, hormone testingResultsFive of the six premenarcheal cases had no pathologic explanation for their ovarian torsion. In four of the cases, size measurements of the contralateral ovary were noted to be larger than the criterion of their respective age group. Three of the four cases had either an ovarian volume (28.5 cm³) or an area (16.0 cm² and 57.6 cm²) that was above the size criterion for a polycystic ovary (volume >10 cm³ or area > 5.5 cm²). Pathology of a wedge biopsy of one of the contralateral ovaries suggested evidence of polycystic ovary. Finally, hormone testing available in three of the cases revealed elevated testosterone levels in two. Among the adults, half of the cases had a pathologic explanation for ovarian torsion. One out of the five cases had a contralateral ovary that was significantly enlarged and this was noted in a woman with a diagnosis of PCOS. The remaining two cases had extensive necrosis of the torsed ovary and no other diagnosis was made.ConclusionWe propose that premenarcheal girls presenting with ovarian torsion, without obvious ovarian pathology, be screened for ultrasound and biochemical evidence of PCOS. In those with evidence of PCOS, treatment with oral contraceptives should be considered taking into account the age and pubertal development, to decrease ovarian volume.     

Sentinel lymph node biopsy in early-stage cervical cancer: utility of intraoperative versus postoperative assessment

ObjectiveTo determine the diagnostic accuracy of sentinel lymph node (SLN) detection using lymphoscintigraphy, intraoperative blue dye, and radiocolloid in patients with early-stage cervical cancer.MethodsIntra-cervical injection of technetium-99 sulfur colloid and lymphoscintigraphy were performed preoperatively. Isosulfan blue was injected intra-cervically immediately prior to surgery. SLNs were excised and examined intraoperatively (imprint cytology and frozen section) and postoperatively (H and E histology and immunohistochemistry (IHC) for cytokeratin).ResultsThirty eight patients were evaluable. Laparoscopy and laparotomy were performed in 28.9% and 71.1%, respectively. Subjects had squamous cell carcinoma (n = 26), adenocarcinoma (n = 10) or adenosquamous (n = 2) histologies. 55.3% had cervical tumors < 2 cm. The overall SLN detection rate was 92.1%. The external iliac region just distal to the common iliac bifurcation was the most common SLN location. A mean of 2.1 SLNs were detected per patient with bilateral SLNs observed in 47.4%. On final pathology, metastatic nodal disease was identified in 15.7% of patients. Of these, 83.3% were detected in the SLNs. Sensitivity of SLN detection of metastasis was 100% for patients with cervical tumors < 2 cm. However intraoperative evaluation by imprint cytology and frozen section correctly identified lymph node metastasis in only 33.3%.ConclusionsSLN detection is feasible and accurately reflects pelvic nodal basin status when performed in early-stage cervical cancer patients. However, while current intraoperative pathology techniques for assessing nodal metastases reliably detect metastases larger than 2 mm, they lack sufficient sensitivity to detect micrometastasis and isolated tumor cells.     

Long-term effects of neovaginal reconstruction with sigmoid loop technique on sexual function and self image in patients with gynecologic malignancies: results of a prospective study

ObjectiveWe evaluated the long-term results of sigmoid vaginoplasty in women with gynecologic malignancies after radical pelvic surgery, with specific focus on safety and effects of the procedure on patients' sexuality and self image.MethodsThis prospective study included women with gynecologic malignancies who underwent partial or complete colpectomy as part of the cancer treatment. In all cases a pedicled sigmoid loop was used for the neovaginal reconstruction. Systematic clinical examination was performed and validated questionnaires about sexuality (Female Sexual Function Index), quality of life (SF-12) and susceptibility to depression (ADSk-15) were answered by all patients at the earliest 6 months after vaginoplasty.ResultsSeven patients with sigmoid vaginoplasty, recruited between 11/2003 and 02/2008, were evaluated in the present analysis. Mean patients age was 48 ± 8.49 years. Mean neovaginal length was 6.4 cm (range: 2–12 cm). The mean Female Sexual Function Index (FSFI)-score of all patients was 16.6 ± 12.6. In the subset of sexually active patients the mean FSFI-score was 22.5 ± 9.4 higher. Regarding early operative morbidity and complications, sigmoid vaginal reconstruction appears to be a safe procedure, though in a long-term assessment 85% of the patients developed a vaginal stenosis with the need for operative bougienage.ConclusionsThe vaginal reconstruction using a sigmoid loop is a safe and well accepted procedure in patients with gynecologic malignancies. However lower sexuality scores seem to be achieved than in non-cancer patients after equivalent vaginoplasty. Cancer-related physical and psychological comorbidity seem to have negative effects on the overall outcome and patient's satisfaction.     

Validation of the female sexual function index in women with chronic pelvic pain

IntroductionChronic pelvic pain (CPP) is a common gynecological problem that is also associated with sexual dysfunction.AimThe purpose of this research was to investigate the validity and reliability of Female Sexual Function Index (FSFI) in women with CPP.MethodOne hundred women with CPP and 100 age-matched subjects without CPP were compared in the study.Main Outcome MeasuresSexual function was assessed by FSFI.ResultsInternal consistency (Cronbach's alpha values = 0.91–0.97) was high for all scales. There were significant differences between women with and without CPP for each of the FSFI domain and total scores with very large effect sizes (1.29–2.56) (P < 0.0001, for all). Interdomain correlations of FSFI in the CPP group corresponded well to each other (P < 0.0001, for all). Moreover, test–retest reliability (r = 0.79–0.90) was also within acceptable ranges for this population.ConclusionWe concluded that the FSFI showed good ability to discriminate between women with and without sexual dysfunctions in the CPP population. Verit FF, and Verit A. Validation of the Female Sexual Function Index in women with chronic pelvic pain.     

The effect of bladder fullness on evaluation of pelvic organ prolapse

ObjectiveTo investigate the effect of bladder fullness on pelvic organ prolapse (POP) staging via the Pelvic Organ Prolapse Quantification System (POP-Q).MethodsSixty women with advanced POP underwent pelvic examination with maximal Valsalva straining via POP-Q with an empty bladder and after transcatheter bladder filling to maximum cystometric capacity, with simultaneous intra-abdominal and intravesical pressure recordings. Main outcome measures included POP-Q values and staging with full versus empty bladder.ResultsAn empty bladder was associated with a significantly higher POP-Q staging (median, 3 vs 2; P < 0.0001); and a lower location of points Ba (4.51 vs 1.37; P < 0.0001), Aa (2.58 vs 0.62; P < 0.0001), Bp (? 0.68 vs ? 1.10; P = 0.01), Ap (0.83 vs ? 1.27; P = 0.002), C (1.57 vs ? 1.07; P < 0.0001), and D (0.14 vs ? 2.77; P < 0.0001) compared with a full bladder. However, genital hiatus, perineal body, and total vaginal length values were not significantly affected by bladder fullness. No differences in intra-abdominal or detrusor pressures were noted between empty and full bladder states.ConclusionPOP-Q assessment with a full bladder is associated with underestimation of POP severity. Therefore, bladder emptying should be a standard requirement for POP-Q staging and reporting.     

Ruptured Hemorrhagic Corpus Luteum Cyst in an Undescended Ovary: A Rare Cause of Acute Abdomen

BackgroundUndescended ovaries are typically detected during infertility evaluations and are frequently associated with uterine malformations. Ruptured hemorrhagic corpus luteum cyst of an undescended ovary is an unusual cause of acute abdomen in an adolescent.CaseA 15-year-old girl presented with right lower quadrant pain, nausea, and vomiting, and transabdominal sonography and magnetic resonance imaging of the pelvis showed a 10 cm × 5 cm sized cystic mass at the level of the pelvic brim, anterior to the psoas muscle suggestive of a retroperitoneal hemorrhagic cyst. At surgery, the uterus and left adnexa appeared normal, but the right ovary was not visible within the pelvic cavity, and the right pelvic retroperitoneum was distended. After opening the retroperitoneum and aspirating blood clots, the undescended ovary with a ruptured cyst was visualized within the retroperitoneum. Right ovarian wedge resection was performed and the right ovary was repositioned in the pelvic cavity.Summary and ConclusionRupture of a corpus luteum cyst in an undescended ovary should be included in the differential diagnosis of acute abdomen in adolescents.     

The Prevalence of Abnormal Liver Enzymes and Metabolic Syndrome in Obese Adolescent Females with Polycystic Ovary Syndrome

ObjectivesWe sought to determine the prevalence of abnormal liver enzymes suggestive of nonalcoholic steatohepatitis and metabolic syndrome in obese adolescent females with polycystic ovary syndrome.DesignA retrospective chart review.ParticipantsPatients included 39 obese (body mass index Z score ≥ 2) adolescent females with a diagnosis of polycystic ovary syndrome. Clinical and biochemical data in these patients were reviewed.Main Outcome MeasuresAspartate and alanine aminotransferase levels, lipid panel, blood pressure, body mass index, and glucose intolerance were the main outcome measures of the study.ResultsThe study showed that 15.4 % (6 of 39) of patients had elevated aminotransferase levels, suggestive of nonalcoholic steatohepatitis, and 43.6 % (17 of 39) of patients qualified as having metabolic syndrome. Finally, 10.2 % (4 of 39) of patients were found to have both liver dysfunction and metabolic syndrome.ConclusionLiver dysfunction consistent with nonalcoholic steatohepatitis and metabolic syndrome are prevalent in obese adolescent females with polycystic ovary syndrome. Therefore, early screening and further work-up for both disease states are warranted in cases of young adolescent females with polycystic ovary syndrome.     

Height, weight, BMI and ovarian cancer survival

ObjectivesOvarian cancer is a highly fatal gynecologic malignancy. Prognosis is primarily based on clinicopathologic features. There is interest in the role of modifiable factors including overweight and obesity, although data to date have been inconclusive. Here we evaluate the relationship between body size and ovarian cancer survival among 1423 women diagnosed with epithelial ovarian cancer in a large population-based study.MethodsInformation on risk factors and characteristics was collected by telephone. Vital status was determined both by computerized record-linkage and by chart review. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for height, weight and body mass index (BMI) in association with ovarian cancer-specific mortality.ResultsHeight, weight and BMI 5 years prior to diagnosis did not significantly predict ovarian cancer survival in this study. The HR for ovarian cancer-specific mortality for women with a weight of > 61 kg compared with > 50–55 kg was 0.91 (95%CI 0.71–1.20). The HR among women with a BMI ≥ 30 kg/m² compared to 18.5– < 25 kg/m² was 1.11 (95%CI 0.87–1.42). These findings did not vary by histologic subtype.ConclusionsOur results do not support a role of height, adult weight or adiposity in ovarian cancer prognosis.