Total versus subtotal abdominal hysterectomy influence on the urinary bladder function

To evaluate lower urinaiy tract flinctions in asymptomatic patients after subtotal abdominal hysterectomy and total abdominal hysterectomy. Forty mtdtiparous premenopausal patients, subjected to subtotal and total abdominal hysterectomy for non malignant causes, and with no urinary complains, were divided into two groups: Group A: Twenty patients in whom subtotal abdominal hysterectomy was performed. Group B: Twenty patients in whom total abdominal hysterectomy was undertaken. Urodynamic data [cystometry, uroflowmeny, and abdominal detrusor leak point pressure] were collected preoperatively, at the 4[th] week, and at the 4[th] month postoperative in both groups. The mean age of group A and B were 42.58 +/- 12.09 years and 43.9 +/- 13.21 years respectively. The mean parity of group A and B were 2.01 +/- 1 1.08 deliveries and 2.61 +/- 1 1.36 deliveries respectively. The mean body mass index of group A and B were 31.25 +/- 12.85 kg/m[2] and 30.7 +/- 1 3.01 kg/m[2] respectively. There were no statistically significant differences between both groups as regards the age, parity, and body mass index. Four weeks postoperative, patients of group A and B complain of frequency [in 20% and 40%], urgency [in 5% and 25%], urge incontinence[in 5% and 20%] respectively. After 4 months of the operation, frequency persisted in [10% and 25%]; urgency persisted in [5% and 20%], However, urge incontinence disappeared in the only one case of group A, which suffered from, while diminished in group B to 10% of the cases. Stress incontinence had never occurred in both studied groups postoperatively. No statistical significant differences were found in the bladder capacity and detrusor muscle activity preoperatively compared with follow up at 4 weeks and at 4 months postoperatively in both groups. Also, No statistical sign[ficant difference was found in residual urine volume preoperative compared with follow up at 4 weeks and at 4 months postoperatively of group [A]. However, significant postoperative increase in the residual urine volume is observed in patients of group [B]. Insignificant urinary complainsand functions changes, except, urgency and residual urine volume are significantly complicating total hysterectomy more than subtotal hysterectomy, with improvement occurred 4 months after the operation

Agonist stop - antagonist, a new protocol for super - ovulation in poor responders

To analyze the value of adding Gn-RH antagonist to agonist stop protocol, and to compare agonist stop-antagonist protocol, in normal and low responders. 69 previously poor responders on long agonist protocol [group A], 63 normal responders who did not become pregnant after >/= 2 previous ICSI cycles on long agonist protocol [group B], and 14 women with premature progesterone rise on previous non-agonist cycles [group C]. Group A, and B patients were randomly allocated into either agonist stop protocol, agonist stop-antagonist, or HMG antagonist only protocol, while all group [ patients were stimulated using agonist-antagonist protocol. Duration of stimulation, number of ampoules, number of follicles, late follicular estradiol and progesterone, and cycle outcome. Agonist antagonist protocol was associated with significantly lower late follicular progesterone than the other protocols in groups A, and B, and than the previous attempts in group C. There was a trend toward lower cancellations and higher pregnancy rate using the new protocol. The use of agonist stop-antagonist protocol resulted in lower late follicular progesterone and trend toward a higher pregnancy rate