Secondary School Girls’ Experiences of Menstruation and Awareness of Endometriosis: A Cross-Sectional Study

Study ObjectiveTo characterize typical menstrual characteristics in a large sample of secondary school girls, as well as knowledge of typical (ie, normal) menstruation, endometriosis awareness, and educational needs. To establish whether self-reported atypical period symptoms indicate menstrual characteristics suggesting the need for further clinical review for a specialist opinion.DesignCross-sectional survey.SettingSecondary schools in West Midlands, England.ParticipantsA total of 442 girls, aged 15-19 years.Interventions and Main Outcome MeasuresThe questionnaire determined demographic characteristics, age at menarche, menstrual cycle patterns and experiences, awareness of endometriosis, and preferences for learning about it.ResultsPeriod pain was common (94%), with pain reported as moderate/severe (86%). Girls reported missing school due to their menstrual periods (23%), mainly because of pain. Most believed their period was typical (63%); however, 27% were unsure, and 30% did not know whether it was regular. Self-report of atypical periods was associated with symptoms suggesting need for clinical review and with consulting a doctor [χ²(2) = 36.272, P < .001)]. Only 8% could describe endometriosis, although 86% wanted to learn more about it.ConclusionMost secondary school girls report dysmenorrhea. Although most girls reporting atypical periods had seen a doctor, more than one-fourth did not know whether their period was typical or regular. The majority do not have knowledge of endometriosis, contrasting with adolescents’ familiarity with other common chronic conditions such as diabetes and epilepsy. We suggest menstrual health education (MHE) to improve knowledge of typical menstruation and pain treatment, aiding earlier identification of problematic period symptoms that might indicate underlying pathology.     

Graduating Obstetrics and Gynaecology Residents’ Readiness for Practice: A Cross-Sectional Survey Study

ObjectiveThis study sought to evaluate the self-reported and program director–reported comfort of graduating Canadian obstetrics and gynaecology residents in independently performing various surgical skills.MethodsA Web-based survey was distributed to four cohorts of graduating obstetrics and gynaecology residents across Canada (2014-2017). Residents were asked to indicate their comfort level with independently performing 34 core surgical procedures by using a five-point Likert-type scale. A similar survey was sent to program directors. Comfort scores for residents and program directors were compared using quantitative and qualitative methods as appropriate (Canadian Task Force Classification II-3).ResultsResident and program director survey response rates were 168 of 320 (52.5%) and 20 of 48 (41.7%), respectively. Residents were “comfortable” or “very comfortable” performing 7 of 13 (54%) gynaecology and 4 of 6 (67%) obstetrics List A procedures independently. Program directors reported that residents were “comfortable” or “very comfortable” performing 10 of 13 (77%) gynaecology and 4 of 6 (67%) obstetrics List A procedures. Compared with program directors, residents reported lower comfort with certain minimally invasive and obstetrics List A procedures (P < 0.05). Differences in comfort when performing several List A procedures were related to training program size and plans to pursue fellowship. Qualitative analysis revealed several major and minor themes supporting the dichotomy between residents’ lack of comfort and program directors’ expectation of comfort.ConclusionGraduating residents were not comfortable performing many core surgical procedures independently. Additionally, program directors believed that trainees were more comfortable than they reported, and comfort varied according to program size and future fellowship plans. The new competency-based curriculum is an opportunity to address this gap.     

Risk of Damage to the Somatic Innervation of the Penis during the AdVance™ Procedure: An Anatomical Study

IntroductionOne of the methods to treat post radical prostatectomy stress urinary incontinence is the AdVance™ (American Medical Systems®, Minnetonka, MN, USA) male sling procedure. During this procedure, the somatic innervation of the penis may be at risk for injury. Six AdVance™ procedures were performed in six donated bodies at the Anatomy and Embryology Department of the Leiden University Medical Centre. The pelves were dissected and the shortest distance between the sling and the dorsal nerve of the penis (DNP) was documented.AimThe aim of this study was to describe the anatomical relation between the AdVance™ male sling and penile nerves based on the dissection of six adult male pelves.MethodsThe AdVance™ male sling procedure was conducted in six donated male bodies. After placement, the pelves were dissected and the shortest distance between sling and the DNP was documented.Main Outcome MeasureThe main outcome measure was the distance between the AdVance™ male sling and the DNP.ResultsThe mean distance of the sling to the DNP was 4.1 mm and was found situated directly next to the nerve (distance 0 mm) in 4 out of 12 (33%) hemipelves. The distance of the sling to the obturator neurovascular bundle was 30 mm or more in all six bodies.ConclusionsDamage to the DNP caused by the AdVance™ male sling procedure appears to be an extremely rare complication, which has not been described in current literature. The proximity of the AdVance™ to the DNP could, however, pose a risk that should be taken into consideration by physicians and patients when opting for surgery. Hogewoning CRC, Elzevier HW, Pelger RCM, Bekker MD, and DeRuiter MC. The risk of damage to the somatic innervation of the penis during the AdVance™ procedure; An anatomical study. J Sex Med 2015;12:1705–1710.     

Does a Uterine Manipulator Increase the Distance of the Ureter to the Cervix and/or Vagina? An Anatomical Cadaver Study

Study ObjectiveTo determine whether advancing a manipulator increased the distance of the ureter to the cervix and/or vagina.DesignProspective.SettingAcademic institution.PatientsA total of 22 intact fresh-frozen female pelvises.InterventionsA total of 6 ureteral distances were measured per pelvis. Included were the following measurements on each side: (1) from the lateral cervical wall to the ureter at the intersection with the uterine artery; (2) from the lateral cervical wall to the parametrial ureter; and (3) from the vagina to the ureter at the intersection with the uterine artery. All measurements were obtained with and without advancement of a uterine manipulator.Measurements and Main ResultsThe average distance from the ureter to the cervix and vagina without advancing the manipulator was 2.8 and 3.1 cm, respectively, and the distance from the parametrial ureter to the cervix was 3.3 cm. When the manipulator was advanced, all ureteral distances increased by 0.8, 0.6, and 0.6 cm, respectively, in 12 of the 22 pelvises (55%). Advancing the manipulator did not increase at least 1 of the distances in 10 of the 22 pelvises (45%). The advancement of the manipulator lengthened the 2 shortest ureteral distances of 1 cm noted in 1 pelvis (4.5%) by 0.9 and 0.4 cm.ConclusionThe uterine manipulator increased the distance of the ureter to the cervix and vagina for all measurements in 55.5% of the pelvises. The greatest increase was 0.9 cm. The manipulator did not increase at least 1 of the distances in 10 of the 22 pelvises (45.4%).     

Clitoral Vascularization and Sexual Behavior in Young Patients Treated with Drospirenone–Ethinyl Estradiol or Contraceptive Vaginal Ring: A Prospective,Randomized, Pilot Study

IntroductionOral contraceptives (OC) are effective for birth control and have good cycle control and tolerability. However, the hormonal components could modify mood and libido.AimThe aim of this study is to evaluate the genital vascular effects and sexual behavior of an OC containing 30 μg ethinyl estradiol and 3 mg drospirenone in comparison with a flexible combined contraceptive vaginal ring.MethodsForty women underwent a sonographic assessment of the clitoral anatomy and vascularization and were administered the McCoy Female Sexuality Questionnaire (MFSQ) and the Beck's Depression Inventory questionnaire (BDI). Estradiol, androstenedione, testosterone, and SHBG were assayed. Free Androgen Index (FAI) and Free Estrogen Index (FEI) were calculated. The patients were randomly submitted to OC (group I; n = 21) or vaginal ring (group II; n = 19).Main Outcome MeasuresUltrasonographic clitoral volume, pulsatility index (PI) of dorsal clitoral arteries, MFSQ, BDI, and hormonal and biochemical assays were analyzed.ResultsAfter therapy, the testosterone levels were reduced in both groups, whereas estradiol decreased only in group I women. The SHBG increased in all the subjects, and both FAI and FEI decreased. The clitoral volume decreased in all the women. The PI of the dorsal clitoral artery increased only in patients on OC. The hormonal contraception was associated, in both studied groups, with a significant decrease of the two‐factor Italian MFSQ score, which was more marked in OC users. In group I subjects, there was a reduction of the number of intercourse/week and a reduction of orgasm frequency during intercourse. The pain during intercourse worsened after OC use. The vaginal ring users reported a vaginal wetness.ConclusionsSix‐month treatment with hormonal contraception is associated with a diminished MFSQ score. However, the frequency of sexual intercourse and orgasm was reduced only by the use of OC. The OC use was associated with increased pain during intercourse. Battaglia C, Morotti E, Persico N, Battaglia B, Busacchi P, Casadio P, Paradisi R, and Venturoli S. Clitoral vascularization and sexual behavior in young patients treated with drospirenone–ethinyl estradiol or contraceptive vaginal ring: A prospective, randomized, pilot study. J Sex Med 2014;11:471–480.     

Rates of Complications and Reoperation after Myomectomy—the Impact of Surgical Approach: A Statewide Population-based Cohort Study from 2005–2018

Study ObjectiveTo assess rates of and factors associated with complications and reoperation after myomectomy.DesignPopulation-based cohort study.SettingAll non-Veterans Affairs facilities in the state of California from January 1, 2005, to December 31, 2018.ParticipantsWomen undergoing abdominal or laparoscopic myomectomy for myoma disease were identified from the Office of Statewide Health Planning and Development datasets using appropriate International Classification of Diseases, Ninth and Tenth Revision and Current Procedural Terminology codes.InterventionsDemographics, surgery facility type, facility surgical volume, and surgical approach were identified. Primary outcomes included complications occurring within 60 days of surgery and reoperations for myomas. Patients were followed up for over an average of 7.3 years. Univariate and multivariable associations were explored between the above factors and rates of complications and reoperation. All odds ratios (ORs) are adjusted ORs.Measurements and Main ResultsOf the 66 012 patients undergoing myomectomy, 5265 had at least one complication (8.0%). Advanced age, black, Asian race, MediCal and Medicare payor status, academic facility, and medical comorbidities were associated with increased odds of a complication. Minimally invasive myomectomy (MIM) was associated with decreased complications compared with abdominal myomectomy (AM) (OR, 0.29; 95% confidence interval [CI], 0.25–0.33; p <.001). Overall, 17 377 patients (26.3%) underwent reoperation. Medicare and MediCal payor status and medical comorbidities were associated with increased odds of a repeat surgery. Reoperation rates were higher in the MIM group over the entire study period (OR, 2.33; 95% CI, 1.95–2.79; p <.001). However, the odds of reoperation after MIM decreased each year (OR, 0.93; 95% CI 0.92–0.95; p <.001), with the odds of reoperation after AM surpassing MIM in 2015.ConclusionThis study identifies outcome disparities in the surgical management of myomas and describes important differences in the rates of complications and reoperations, which can be used to counsel patients on surgical approach. These findings suggest that MIM can be considered a lasting and safe approach in properly selected patients.     

Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40–70 Years

BackgroundSexual function declines with age and erectile dysfunction (ED) is a common condition worldwide; however, prevalence rates vary markedly between populations and reliable data specific to New Zealand (NZ) are lacking.AimTo assess the prevalence of ED in NZ men using a population-based cross-sectional survey.MethodsPostal questionnaires were sent, according to a modified Dillman method, to a randomly selected age-stratified population-based sample of 2,000 men 40 to 70 years old obtained from the electoral roll. Self-reported erectile function was assessed using the five-item International Index of Erectile Function (IIEF-5) and the single-question self-assessment tool.OutcomesThe prevalence of ED is presented as crude, age-adjusted to the distribution of the NZ population, and standardized to the World Health Organization World Standard Population (WSP). Associations between sexual function and age were analyzed using χ² test.ResultsThe response rate was 30% (599) and 28% (562) were complete for analysis. The crude prevalence of ED was 42% (22% mild, 10% mild to moderate, 6% moderate, and 4% severe), the age-adjusted prevalence was 38%, and the WSP-adjusted prevalence was 37%. Among men reporting ED, 16% were medically diagnosed and 22% were treated. ED affected 24% of men in their 40s, 38% in their 50s, and 60% in their 60s (P < .001). Age was associated with a significant increase in diagnosed ED (P = .001), treated ED (P = .006), dissatisfaction with current sexual function (P < .001), associated anxiety or depression (P = .023), and a decrease in sexual activity (P < .001).Clinical TranslationApproximately one in three NZ men 40 to 70 years old might have ED. Although comparable to overseas populations, this prevalence is high.Strengths and LimitationsThis study provides the most reliable, comprehensive, and current information on ED and its risk factors in NZ men. Strengths include the large sample, the use of random selection from a population-based sampling frame, established effective survey methods, and the validated IIEF-5. Limitations include the inability of cross-sectional data to determine causation, non-sampling errors associated with the population-based sampling frame, the low response rate, the inability to assess non-respondents, the possibility of men with ED who were sexually inactive not responding or not completing the IIEF-5, and the inherent inability to rule out recall bias.ConclusionED is a marker of subclinical cardiovascular disease. The high prevalence and low levels of diagnosis and treatment indicate a lost opportunity for timely intervention to delay or prevent the progression toward clinical disease.Quilter M, Hodges L, von Hurst P, et al. Male Sexual Function in New Zealand: A Population-Based Cross-Sectional Survey of the Prevalence of Erectile Dysfunction in Men Aged 40–70 Years. J Sex Med 2017;14:928–936.     

Perception of Labial Size and Objective Measurements-Is There a Correlation? A Cross-Sectional Study in a Cohort Not Seeking Labiaplasty

IntroductionPoor genital self-image is a common phenomenon leading to an increasing interest in female genital surgery over the last years.AimThe aim was to correlate objective measurements of the labia minora with the individual subjective perception of the labial size.MethodsIn a cross-sectional study with 200 premenopausal women (median age 33.5 years) presenting for gynecological issues other than vulvar diseases, labial width and length were measured, and psychological and physical complaints were assessed. Multivariable logistic regression analyses were performed to identify factors that influenced self-reported complaints and subjective perception of labia size.Main Outcome MeasureThe main outcome measure was labial appearance (width and length in mm, color), subjective perception of the labial size, and complaints.ResultsThe median width of the labia minora was 19.0 mm (interquartile range = 12.6–27.5), and the median length was 35.5 mm (interquartile range = 27.8–48.9). The objective size of the labia was significantly associated with womens' subjective perception of the labial size, but not with self-reported complaints. Nearly one-third of the women (n = 53, 27%) reported complaints of their labia minora which were mainly physical (n = 41, 77%) or a combination of physical and psychological problems (n = 9, 17%), while only a small group reported experiencing only psychological complaints (n = 3, 6%). Predictors of complaints were previous cosmetic surgery and the subjective perception of the labia size. The latter was significantly associated with discomfort during intercourse and when visiting a sauna and by labia minora that protruded over the labia majora.Clinical ImplicationsCutoff values to define labial hypertrophy and to justify labial reduction surgery should be avoided.Strength & LimitationsThis is a large sample of labial measurements in women not seeking labiaplasty. Standardized and validated questions regarding quality of life, sexuality, and body image could have provided more insight into psychological aspects.ConclusionThese data demonstrate the variability of labial anatomy and its perception.Widschwendter A, Riedl D, Freidhager K, et al. Perception of Labial Size and Objective Measurements-Is There a Correlation? A Cross-Sectional Study in a Cohort Not Seeking Labiaplasty. J Sex Med 2020;17:461–469.     

Efficacy of Transabdominal Ultrasound–guided Percutaneous Microwave Ablation in the Treatment of Symptomatic Adenomyosis: A Retrospective Cohort Study

Study ObjectiveTo evaluate and compare the clinical efficacy of transabdominal ultrasound–guided percutaneous microwave ablation (PMWA) in the treatment of symptomatic focal and nonfocal adenomyosis.DesignRetrospective cohort study.SettingLongyan First Affiliated Hospital of Fujian Medical University.PatientsFrom May 2019 to October 2021, 107 patients with symptomatic adenomyosis who refused hysterectomy received PMWA.InterventionsPatients were divided into a focal group (n = 47, including 40 focal adenomyosis and 7 adenomyoma cases) and a nonfocal group (n = 60, including 36 diffuse and 24 mixed adenomyosis cases) according to the extent of lesion involvement.Measurements and Main ResultsWe collected and analyzed preoperative baseline data on patient characteristics; postoperative efficacy measures at 3, 6, and 12 months; and intraoperative and postoperative complications. There was a significant post-treatment reduction in the uterine corpus volume and cancer antigen 125 levels, an increase in hemoglobin levels, and an improvement in the Uterine Fibroid Symptom and Health-related Quality of Life scores (consisting of the Symptom Severity Scale and the Health-related Quality of Life scale), dysmenorrhea visual analog scale, and menstrual volume score (MVS) (all p <.05). One patient had recurrence. Most adverse events (72.0%) were mild. Although the nonfocal group had significantly greater anemia severity, higher Symptom Severity Scale and MVS, lower Health-related Quality of Life scale, greater extent and severity of myometrial involvement, and larger uterine corpus volume, after treatment, the uterine corpus volume, uterine corpus reduction rate, cancer antigen 125 levels, hemoglobin levels, Uterine Fibroid Symptom and Health-related Quality of Life score, dysmenorrhea visual analog scale, MVS score, and clinical response rate were similar between the groups (p >.05).ConclusionPMWA had good, similar, short-term efficacy for symptomatic focal and nonfocal adenomyosis.     

Advancing the Science of Environmental Exposures During Pregnancy and the Gene–Environment through the National Children's Study

In this article we provide nurses with information on the importance of studying environmental exposures during fetal, infant, and childhood development in the National Children's Study. Nurses should be aware of this study to aid in mitigating the complex health problems that arise from environment–health interactions. Nurses may help to educate the public, patients, and caregivers and are in an ideal position to be strong advocates for policy change and regulatory monitoring and enforcement.     

Is the Relationship Between Cigarette Smoking and Male Erectile Dysfunction Independent of Cardiovascular Disease? Findings from a Population-Based Cross-Sectional Study

IntroductionCigarette smoking has been implicated in the pathophysiology of cardiovascular disease (CVD) and as a risk factor for erectile dysfunction (ED). However, various aspects of the associations between cigarette smoking, ED, and CVD need further elucidation.AimWe explored the relationship between cigarette smoking, ED, and CVD using data from a population-based cross-sectional study of 1,580 participants.MethodsPostal questionnaires were sent to randomly selected age-stratified male population samples obtained from the Western Australia Electoral Roll.Main Outcome MeasuresIn addition to items covering sociodemographic and self-reported clinical information and smoking habits, the 5-item International Index of Erectile Function was used to assess erectile function.ResultsCompared with never smokers, the odds of ED, adjusted for age, square of age, and CVD, were significantly higher among current smokers (odds ratio [OR] = 1.40; 95% confidence interval [CI] 1.02, 1.92) and ever smokers (OR = 1.57; 95% CI 1.02, 2.42). Similarly, the adjusted odds of severe ED were significantly higher among former smokers. Albeit not statistically significant, the age-adjusted odds of ED among current smokers increased with the number of cigarettes smoked. Among former smokers, the age-adjusted odds of ED were significantly higher 6–10 years following cessation of smoking than ≤5 or >10 years. Compared with never smokers without CVD, the age-adjusted odds of ED among former smokers and ever smokers without CVD were about 1.6. Regardless of smoking, these odds were significantly higher among participants with CVD.ConclusionsCompared with never smokers, former smokers and ever smokers have significantly higher odds of ED. The relationship between smoking and ED is independent of that between smoking and CVD, and not because of confounding by CVD. Patterns of ED in former smokers suggest that there may be a latent interval between active smoking and symptomatic ED, involving a process initially triggered by smoking. Chew K-K, Bremner A, Stuckey B, Earle C, and Jamrozik K. Is the relationship between cigarette smoking and male erectile dysfunction independent of cardiovascular disease? Findings from a population-based cross-sectional study.     

Postpartum Contraceptive Decision-Making of Parous Teens–A Qualitative Study

Study ObjectiveApproximately 25% of teens in the United States will become pregnant before the age of 18, and within 2 years, more than 31% will have a repeat pregnancy. Acknowledging that some adolescents might seek or be ambivalent toward rapid repeat pregnancy, compared with their counterparts, not using a long-acting reversible contraception method increases a teen's risk of another pregnancy in 2 years by more than 35 times. We seek to better understand the influences and factors surrounding adolescent postpartum contraceptive decision-making following the index delivery.DesignWe completed a qualitative study via focused, semistructured interviews during an inpatient postpartum course. The interview guide was modeled after those used in other studies of adolescent contraceptive decision-making, beta tested, and developed iteratively. Interviews were completed, transcribed, coded, and analyzed with the assistance of Dedoose.SettingThe study was conducted at MetroHealth Medical Center in Cleveland, Ohio.ParticipantsParous adolescents aged 13–19ResultsWe performed 12 interviews prior to reaching theoretical saturation. Themes were identified related to the participants’ prior experiences with contraception and prior and current pregnancies. The participants’ contraceptive choices were influenced by personal relationships, varying levels of autonomy, misperceptions, and changing contraceptive needs.ConclusionsWe found that adolescents’ contraceptive decision-making was influenced by their social networks and community, including their parents and friends. Mothers played a key role as adolescents transitioned to gaining more autonomy over their reproductive decisions. Providers should consistently present adolescents with comprehensive contraceptive options as a component of preventive health care.     

Feasibility and Preliminary Effectiveness of a Novel Cognitive–Behavioral Couple Therapy for Provoked Vestibulodynia: A Pilot Study

IntroductionProvoked vestibulodynia (PVD), a recurrent, localized vulvovaginal pain problem, carries a significant psychosexual burden for afflicted women, who report impoverished sexual function and decreased frequency of sexual activity and pleasure. Interpersonal factors such as partner responses to pain, partner distress, and attachment style are associated with pain outcomes for women and with sexuality outcomes for both women and partners. Despite these findings, no treatment for PVD has systematically included the partner.AimsThis study pilot‐tested the feasibility and potential efficacy of a novel cognitive–behavioral couple therapy (CBCT) for couples coping with PVD.MethodsCouples (women and their partners) in which the woman was diagnosed with PVD (N = 9) took part in a 12‐session manualized CBCT intervention and completed outcome measures pre‐ and post‐treatment.Main Outcome MeasuresThe primary outcome measure was women's pain intensity during intercourse as measured on a numerical rating scale. Secondary outcomes included sexual functioning and satisfaction for both partners. Exploratory outcomes included pain‐related cognitions; psychological outcomes; and treatment satisfaction, feasibility, and reliability.ResultsOne couple separated before the end of therapy. Paired t‐test comparisons involving the remaining eight couples demonstrated significant improvements in women's pain and sexuality outcomes for both women and partners. Exploratory analyses indicated improvements in pain‐related cognitions, as well as anxiety and depression symptoms, for both members of the couple. Therapists' reported high treatment reliability and participating couples' high participation rates and reported treatment satisfaction indicate adequate feasibility.ConclusionsTreatment outcomes, along with treatment satisfaction ratings, confirm the preliminary success of CBCT in reducing pain and psychosexual burden for women with PVD and their partners. Further large‐scale randomized controlled trials are necessary to examine the efficacy of CBCT compared with and in conjunction with first‐line biomedical interventions for PVD. Corsini‐Munt S, Bergeron S, Rosen NO, Mayrand M‐H, and Delisle I. Feasibility and preliminary effectiveness of a novel cognitive‐behavioral couple therapy for provoked vestibulodynia: A pilot study. J Sex Med 2014;11:2515–2527.     

Tension-Free Vaginal Tape-O and -Secur for the Treatment of Stress Urinary Incontinence: A Thirty-Six–Month Follow-Up Single-Blind,Double-Arm,Randomized Study

ObjectiveTo compare the efficacy of the inside-out tension-free vaginal tape–obturator (TVT-O) device versus the single-incision TVT-Secur device 36 months after the procedure.MethodsA single-blind, randomized, parallel-group study on 154 patients with stress urinary incontinence (77 treated with TVT-O and 77 with the TVT-Secur hammock approach). The primary endpoint was the objective cure rate 36 months after the procedure evaluated with the challenge stress test. Secondary endpoints were subjective cure rate (evaluated with bladder diary, quality-of-life questionnaires, and patient-reported outcome tools) and intraoperative and postoperative complications. The primary endpoint was evaluated with a noninferiority study design.ResultsSixty-six patients in the TVT-O group and 64 in the TVT-Secur group concluded the study. Thirty-six months after the procedure, 57/66 patients (86.4%) in the TVT-O and 50/64 (78.1%) in the TVT-Secur groups were objectively cured (noninferiority unilateral u test: p < .05). No differences were observed in the subjective cure and complication rates.ConclusionsTVT-Secur seems not to be inferior to TVT-O in the surgical treatment of stress urinary incontinence and causes less postoperative pain. The possibility of severe blood loss cannot be ruled out when TVT-Secur is used.     

Impact of gestational and parental factors and maternal intake of progesterone on the development of hypospadias: A retrospective case–control study

ObjectiveImpact of environmental, maternal, paternal, and fetal factors on the development of hypospadias have been questioned in association with disrupted hormonal balance. We aimed to examine the association between maternal progesterone use and the associated risk factors and hypospadias.Materials and methodsThere were 429 male children as the cases with hypospadias (n = 280, Group 1) and the controls without hypospadias (n = 149, Group 2). Those working in agriculture and industry, cleaners, and hairdressers were determined as risky occupational groups concerning the exposure of estrogenic endocrine disrupters. The association of progestin usage and the other risk factors with hypospadias were the study outcomes.ResultsThe median gestational age was significantly lower in Group 2 (p = 0.019). Prematurity was more common in Group 1 (p = 0.043). Although the median birth weight in Group 1 was significantly lower (p < 0.001), there was no significant difference between the ratios of low birth weight babies in the groups. The risky occupations were more frequently detected in Group 2 (p = 0.001). The rate and duration of progestin usage in Group 1 were significantly higher than that in Group 2 (p < 0.001).ConclusionLow birth weight and the use and duration of progestins during pregnancy were significantly associated with increased hypospadias risk.     

Mayer–Rokitansky–Küster–Hauser Syndrome and 16p11.2 Recurrent Microdeletion: A Case Report and Review of the Literature

Background

Mayer–Rokitansky–Küster–Hauser syndrome (MRKH; Online Mendelian Inheritance in Man #277000) is a rare disorder of the female reproductive tract. Its etiology is still unknown for most patients, although the genetic background of this condition has been intensively studied. Chromosome 16p11.2 deletion syndrome (Online Mendelian Inheritance in Man #611913) is a well known recurrent deletion syndrome that can present with various clinical phenotypes, including developmental delay, intellectual disability, autism spectrum disorder, obesity, and an increased frequency of congenital defects.

State of the science of maternal–infant bonding: A principle-based concept analysis

Objectiveto provide a principle-based analysis of the concept of maternal–infant bonding.Designprinciple-based method of concept analysis for which the data set included 44 articles published in the last decade from Pubmed, CINAHL, and PyschINFO/PsychARTICLES.Settingliterature inclusion criteria were English language, articles published in the last decade, peer-reviewed journal articles and commentary on published work, and human populations.Measurement and findingsafter a brief review of the history of maternal–infant bonding, a principle-based concept analysis was completed to examine the state of the science with regard to this concept. The concept was critically examined according to the clarity of definition (epistemological principle), applicability of the concept (pragmatic principle), consistency in use and meaning (linguistic principle), and differentiation of the concept from related concepts (logical principle). Analysis of the concept revealed: (1) Maternal–infant bonding describes maternal feelings and emotions towards her infant. Evidence that the concept encompasses behavioural or biological components was limited. (2) The concept is clearly operationalised in the affective domain. (3) Maternal–infant bonding is linguistically confused with attachment, although the boundaries between the concepts are clearly delineated.Key conclusiondespite widespread use of the concept, maternal–infant bonding is at times superficially developed and subject to confusion with related concepts. Concept clarification is warranted. A theoretical definition of the concept of maternal–infant bonding was developed to aid in the clarification, but more research is necessary to further clarify and advance the concept.Implications for practicenurse midwives and other practitioners should use the theoretical definition of maternal–infant bonding as a preliminary guide to identification and understanding of the concept in clinical practice.     

Uterine Artery–sparing Minimally Invasive Radical Trachelectomy: A Case Report and Review of the Literature

Radical trachelectomy is considered in patients with early-stage cervical cancer who desire future fertility. This article is accompanied by a video that provides step-by-step demonstration of a uterine artery–sparing robotic-assisted radical trachelectomy in a patient with stage IB1 squamous cell carcinoma of the cervix, a 2-cm mass, and a desire for future fertility. We also conducted a review of the literature examining the use of uterine artery–sparing techniques among minimally invasive radical trachelectomies. Using PubMed, Google Scholar, and Ovid search tools, 28 total publications were reviewed, of which 16 were eligible for use in our comparison. With the addition of our case report, a total of 154 cases sparing the uterine artery and 40 cases sacrificing the uterine artery were examined, including both conventional laparoscopic and robotic-assisted approaches. Data describing patient demographics as well as surgical, oncologic, and fertility outcomes were collected. The mean age was 30 years for the spared group and 32 years for the sacrificed group. At least 42% of the women in the spared and 53% of the uterine artery–sacrificed group were nulliparous. The majority of cases in both the spared and sacrificed groups represented squamous cell histology (71% for spared and 51% for sacrificed) followed by adenocarcinoma (24% vs 43%). The majority of the patients in both groups had stage IB1 disease (79% for spared vs 65% for sacrificed). The operative times among the 2 groups were similar, with a mean time of 314 minutes (range, 170–420 minutes) in the spared group and 283 minutes (range, 172–345 minutes) in the sacrificed group. The mean estimated blood loss was 173 mL (range, 23–300 mL) in the spared group and 77 mL (range, 50–250 mL) in the sacrificed group. The recurrence rates for the uterine artery–sparing and –sacrificing groups were equal at 2.6% after a mean follow-up of 42 months and 26 months, respectively. The methods of reporting fertility outcomes were varied among the different publications, with 41 patients achieving pregnancy in the spared group and 2 patients achieving pregnancy in the sacrificed group. Among patients who were not trying to conceive or had not conceived, 15 patients in the spared group and 6 patients in the sacrificed group were reported to have normal menses. The successful preservation of uterine arteries supports the maintenance of uterine arterial blood flow and is used by many gynecologic surgeons performing minimally invasive radical trachelectomy, with promising oncologic and obstetric outcomes.     

Transitional cell carcinoma of the ovary: A case–control study

Objectives

The aim of this study is to compare response to chemotherapy and survival between patients with transitional call carcinoma of the ovary (TCCO) and papillary serous ovarian cancer (PSOC).

Methods

We identified women with both pure and mixed TCCO who were treated between 2000 and 2010. Each case was matched to two women with PSOC by age, grade, stage, and year of diagnosis. Correlation between categorical variables was assessed with chi square test. The Kaplan–Meier survival analysis was used to generate overall survival data (OS). Factors predictive of outcome were compared using the log-rank test and Cox proportional hazards model.

Results

Eighty-one women diagnosed with TCCO were selected as cases and compared to 162 controls. Women with TCCO had a lower rate of platinum resistance compared to controls (9% vs. 25%; p = 0.01). When multivariate logistic regression was used to control for other factors independently associated with platinum resistance, patients with TCCO had a significantly lower risk of platinum resistance compared to PSOC. Median progression-free survival was not significantly different (27 months vs. 22 months; p = 0.15) for women with TCCO and PSOC, respectively. Median OS, however, was significantly different at 83 months vs. 52 months for the TCCO and PSOC groups, respectively (p = 0.01). A Cox proportional hazards model identified optimal cytoreduction, transitional cell histology, age, stage, and platinum and paclitaxel chemotherapy as independent predictors of OS.

Conclusions

Patients with TCCO are less likely to demonstrate resistance to platinum chemotherapy and have improved overall survival when compared to patients with PSOC.