impact of the tension free vaginal tape-obturator [TVTO] procedure on incontinence intensity and quality of life, experience at King Hussein Medical Center

Objective: to assess the benefits and complications of tension free vaginal tape-obturator surgical application after twelve months follow up

Methods: this prospective investigation included 324 female patients, aged 41-62 years and diagnosed of moderate to severe pure or mixed stress urinary incontinence with mainly stress incontinence who were scheduled for tension free vaginal tape-obturator surgical application method at King Hussein hospital, King Hussein medical center, Amman, Jordan, during the period Jan 2009 - Jan 2014. Pre-operative assessment included intensity of stress urinary incontinence and post- void residual recording, while post- operative assessment included complications, intensity of urinary stress incontinence and quality of life. Incontinence impact scale on quality of life was used. The intensity of urinary incontinence was classified according to the Stamey incontinence score

Results: twenty eight cases [8.6%] experienced anterior vaginal wall prolapse [stage 2 and 3 anterior wall prolapse]. There was a significant difference between pre- and post- operative stress urinary incontinence intensity and quality of life scores. [P < 0.05]. No significant intraoperative complications were recorded but postoperatively 29 patients [8.95%] experienced pain in the inner part of the thigh. The cure rate was 81.5 %[ 264] and the incontinence episodes were improved in 35 cases [10.8%], while the procedure was labeled failed in 25 cases [7.7%]

Conclusion: the tension free vaginal tape-obturator surgical application method is a safe and beneficial management of female stress urinary incontinence with a significant success rate and reduced post- operative complications

Vulvar lipoma: a case report

Lipomas are multilobular benign tumours of fat usually arising in the superficial subcutaneous tissues of the trunk and limbs but may also be found in the peritoneal cavity and within muscles. Lipomas are usually soft, fluctuant, painless, subcutaneous lumps measuring from two to 20 cm in diameter. Most lipomas are excised for cosmetic reasons. Lipomas of the vulva are rare and not so many cases were reported in the literature. We present a case of a large vulvar lipoma in a 30-year old woman

Discontinuation rates among women using either the combined oral contraceptive pills or an intrauterine contraceptive device for contraception: a comparative study

To study the contraceptive practice of women using combined oral contraceptive pills and intrauterine contraceptive devices in 4 Jordanian military hospitals; [Prince Hashem Bin Al Hussein, Prince Ali Bin Al Hussein, Princess Haya Bent Al Hussein, and Queen Alia Hospitals] and to study the reasons for discontinuation of these methods among women less than 44 years of age. A retrospective analysis of the family planning medical files of 5800 clients who were current or past user of the contraceptive pills or intrauterine devices for contraception during the period between January 2007 and December 2009 was done. Fifty-eight percent [33671 5800] were current or past contraceptive pills users and 41% [2433/5800] were current or past intrauterine device users. Women included in the study were those who had discontinued using the pills or the devices for more than 6 months [n = 3200], which in turn were divided into two groups: Group A, oral contraceptive pills users [n=2050] and Group B, intrauterine devices users [n = 1.150]. We then analyzed according to age, parity, obstetric history, medical history, duration of contraception and reasons for discontinuation of these methods; the data were compared between the two groups.The use of contraceptive methods varies across age, but combined oral contraceptive pills was found to be the most commonly used method among the study population. Only 29% of group A discontinued the pills because of their desire to conceive compared to 23.6% of group B. Fifty-two percent of group A stopped the pills because of undesired side effects, compared to 65% among group B. Four-point-four percent of group A stopped the method due to medical indication compared to 3.2% in group B. Fourteen-point-six percent of group A stopped the pills for personal reasons or lack of availability of the drugs and 8.2% of group B had the device removed because it reached the expired date [being in uterus for 10 years]. However, this is not considered a reason for discontinuation. The main side effects of combined oral contraceptives were breast discomfort, mood changes, weight gain, headache, nausea and vomiting, whereas the commonest side effects related to intrauterine contraceptive device were menstrual bleeding disorders, recurrent vaginal infection, and pelvic pain. In spite of the safety and high efficacy of combined oral contraceptive pills and intrauterine devices as contraceptive methods more than half discontinued their use because of undesired side effects. This may be improved by careful patient selection and appropriate counseling

Pandemic influenza A/[H1N1] 2009: chest x-ray findings among pregnant women at Queen Alia Military Hospital

Revision of chest radiograph findings in pregnant women with laboratory confirmed influenza A [H1N1] 2009 virus infection. A total number of 134 patients attended Queen Alia Hospital with suspicion of H1N1 virus infection, 56 cases were confirmed to have Influenza A [H1N1] infection by Real-Time Polymerase Chain Reaction. These 56 women were admitted to our hospital and form our study population. Group 1 was formed by patients admitted to intensive care unit and required mechanical ventilation [no. 4/56]. Group 2 was formed by the patients with admission to the ward [no. 52/56]. All chest X-rays of those patients were evaluated for the pattern [consolidation, ground glass and nodules], distribution and extent of abnormality. Four patients representing group 1 who were admitted to intensive care unit and needed mechanical ventilation consequently died. All of them had abnormal initial chest x -ray. Of those 3/4 [75%] had bilateral lung involvement in the form of consolidation with lower zone predominance. Of the n=52 admitted patients, n=39 [75%] had abnormal initial chest X-ray. Of these, eight patients had bilateral consolidation. Lower zone predominance was noted in n=22 patients [56.5%]. None of those patients died. Chest x-ray was normal in 13/56 of patients initially, but rapid deterioration was noted in significant number of patients. Lower zones were slightly predominant than central zones [25:18] and the predominant pattern of involvement was consolidation

Adenomyosis: frequency of hysterectomy in histopathological specimens at two Jordanian Military Hospitals

This study was conducted to identify the frequency, clinical symptoms and risk-factors of adenomyosis in hysterectomy specimens in a sample of Jordanian women. A total of 138 hysterectomy specimen pathology reports were reviewed at Queen Alia Military Hospital and Prince Hashem Bin Al-Hussein Hospital during the period between January 2007 to December 2008. The patients were divided according to the histological diagnosis and this was related to demographic and clinical data collected from the records of these women. Adenomyosis was identified in 51 women [37% of cases]. Forty-eight of these women [94%] were in their forties [P>0.05], while 49 [96%] were multiparas [P<0.05]. Dysmenorrhoea, chronic pelvic pain and dyspareunia were statistically significant while menorrhagia wasn't. The histological diagnosis of fibroid uterus, in addition to adenomyosis was made in 22 women [P>0.05]. The mean age at hysterectomy was 47.3 years in women with adenomyosis and 51.4 years in women without the condition [P<0.05]. In the adenomyosis group, parity proved to have statistical significance while age, body mass index and smoking status weren't. Adenomyosis is a common finding in hysterectomy specimens. It is more common in multiparous women with dysmenorrhoea, chronic pelvic pain and dyspareunia