The beneficial effects of fractional CO2 laser treatment on perineal changes during puerperium and breastfeeding period: a multicentric study

Lasers in Medical Science - Childbirth is a great change in woman life because of hormonal, physical and psychological alterations that are associated with this process. Dyspareunia and perineal...     

Gestational trophoblastic disease in a fifty-one year old woman

Molar pregnancy has always been of interest to physicians because of the diagnostic and management challenges it presents. Its occurrence in patients older than 50 years of age is rare and misdiagnosis is common. A 51 year old black female presented to the gynecology emergency room with vaginal bleeding for twenty days. She was diagnosed with a molar pregnancy by a pelvic ultra-sound. Prior to presenting to the emergency room she had a negative work-up for hyperthyroidism, including a biopsy of a benign thyroid nodule and was also started on Inderal for new onset hypertension. She underwent a primary hysterectomy and subsequently required five courses of actinomycin D for plateauing of the BhCG. The different forms of presentation of gestational trophoblastic disease should be kept in mind so that the diagnosis can be made promptly and appropriate treatment started early, especially in patients with advanced age.     

Success rates, quality of life, and feasibility of sacral nerve stimulation in elderly patients: 1-year follow-up

Introduction and hypothesis

Urgency urinary incontinence (UUI) frequently occurs in elderly. International guidelines recommend pharmacological therapy as first-line treatment, but elderly do not respond in many cases. The purpose of this study was to report cure rates, quality of life, and feasibility of sacral neurostimulation (SNS) as an alternative option in the elderly.

Materials and methods

From October 2008 to April 2010, women >65 years with UUI who were refractory to pharmacological treatments were enrolled in this study and underwent SNS. At 12 months after surgery, patients were asked to compile a 3-day voiding diary and a urogynecologic standardized questionnaire: the Overactive Bladder Questionnaire (OAB-q).

Results

Eighteen patients met our inclusion criteria. Fifteen (83.3 %) underwent implantation of the neuromodulator. Twelve months after surgery, an overall success rate of 83.3 % was registered. A statistically significant difference (P?<?0.0001) between baseline and postsurgery OAB-q scores was recorded.

Conclusions

SNS can be considered an alternative treatment for UUI in older women.     

Urinary incontinence after radical vulvectomy treated with Macroplastique implantation

Postradical vulvectomy urinary incontinence is a common surgery-related complication, especially after subtotal urethrectomy. However, only 1 trial has been reported in the previous literature that described a case of total urinary incontinence treated with an Aldridge sling operation. We present 2 cases of patients affected by postradical vulvectomy, with partial urethral resection and total incontinence successfully treated by transurethral Macroplastique injection. This procedure could be considered as a valid, minimally invasive surgical option to improve the well-being of patients with vulvar cancer affected by postradical vulvectomy urinary incontinence, especially in elderly patients at high operative risk.     

CO2 laser therapy of the Bartholin's gland cyst: surgical data and functional short- and long-term results

The Bartholin's gland cyst is a condition that occurs in approximately 2% of women, most of whom are of reproductive age. Although benign, it is associated with significant patient discomfort. Definitive treatment involves the surgical removal of the entire cyst. The objective of this study was to describe an alternative conservative surgical technique with CO(2) laser adopted in our institution and to evaluate the feasibility, complication rate, and results obtained with this technique in an office setting. Our study showed that CO(2) laser treatment of the Bartholin's gland cyst can be carried out safely in an outpatient setting, with minimum patient discomfort and high long-term cure rates.