Intrauterine administered levonorgestrel releasing system [Mirena] for symptomatic endometriosis treatment

To investigate the effectiveness, continuation rates and side effects of levonogestrel releasisng intrauterine system [Mirena], in treating symptomatic stage I or II endometriosis, [according to revised American fertility society classification [rAFS]. Prospective therapeutic, trial analysing changes in pain symptomes in response to the use of the intrauterine levonorgestrel releasing sys tem [IUS] over 12 months of continuous use. Thirty-five symptomatic patients with either stage I or II endometrosis, diagnosed laparoscopically. An intrauterine leronogestrel-releasing system [IUS] [Mirena coil] was inserted and potentially maintained for up to 12 months following endometriosis diagnosis. Severity of dysmemorrhea, normenstrual pelvic pain [chronic pelvic pain] and deep dyspareunias were assessted before insertion of IUS and throughout the study period at 3 months, 6 months, and 12 months follow up visits. Dysamenorrhea, nonmenstrual pelvic pain, and deep dvspareunia markedly improved and their severity were significantly reduced by intrauterine levonorgestrel releasing system, IUS [Mirena]

Endoscopic assisted vaginal oophorectomy: a minimal access surgical techniques at vaginal hysterectomy

Although the advantages of vaginal hysterectomy are well documented, most hysterectomies are still performed abdominally. However, one of the limitations of vaginal hysterectomy is the accessibility of the ovaries particularly in cases with no uterine prolapse. Therefore, it is needed to master techniques of ovarian removal at vaginal hysterectomy. This study reports 100% success rate in removing ovaries in 48 cases at time of vaginal hysterectomy using three different methods of endoscopic assisted vaginal oophorectomy. A 30 degree 10 mm panoramic view diagnostic telescope was used. in absence of pelvic adhesions [n = 40], two different methods of vaginal oophorectomy were used. The Seitsinger tripolar cutting foreceps [Cabot Merdical, Langhorne, USA], and the endoloop using number one polyglactin polymer [vicryl, ethicon, Edinburgh, UK]. In presence of pelvic adhesions, however, [n = 8] adhesiolysis was done under combined minilaparoscopic and culdoscopic assistance using bipolar coagulator and scissors, followed by ovarian extraction through the vaginal canula. The mean operation time for oophorectoiny was 28 minutes [range 18-45], including adhesiolysis, when needed [n = 8], with no injury to ureter, bladder or bowel, and without increased blood loss. In conclusion, the result, of this study confirm that vaginal hysterectomy with vaginal endoscopic assisted oophorectomy is safe and easy to learn and may be an alternative to laparoscopic assisted vaginal hysterectomy even in the presence of pelvic adhesion or to laporoscopic total hysterectomy even in absence of uterine prolapse

Diagnostic significance of trans-vaginal ultrasonography for pre-operative evaluation of stress urinary incontinence in females

The Aim of this work is to demonstrate the dynamic relationships, of the urinary bladder, urethra, urethrovesical junction, and symphysis pubis during stress and to assess the reproducibility of trans-vaginal ultrasonography [TVUS] for preoperative evaluation of stress urinary incontinence in females, together with evaluation of its diagnostic value compared to urodynamic findings. This study was conducted on 97 female patients including 71 patients with clinically diagnosed stress urinary incontinence [SUI] as group [A] for comparison with 26 patients with no urological complaints as control group [B]. All patients underwent complete history and physical examination, laboratory investigations, urodynamic evaluation especially valsalva leak point pressure [VLPP], and trans-vaginal ultrasonography [TVUS]. Patients of group [A] were further subdivided into two sub groups [GI and GII] according to the results of VLPP. GI and GII included 47 and 24 patients with VLPP above and below 60 cm H[2O] respectively. Statistical analysis of seven transvaginal ultrasonic anatomical parameters that include measurement of bladder symphysis distance [BS], rotational angle [RA], bladder neck mobility [BNM], bladder neck vertical descend [BNVD], BN funneling [BNF], BN position [BNP], and posterior urethrovesical angle [PUVA], was done in both study groups at rest and during strain together with correlation of these 7 parameters and urodynamic VLPP findings. A highly statistically significant difference was found in all the seven parameters measured by TVUS in group [A] when compared to control group B and in each patient of the two groups during both phases at rest and during strain [p <0.001]. There is a significant high positive correlation between TVUS parameters and VLPP findings. The sensitivity and specificity of TVUS in detecting SUI were 92.9% and 92.31% respectively when compared to 83.09% and 84.61% of urodynamics. Positive and negative predictive values of TVUS are 97.1%, and 82.7%, respectively. The over all accuracy of TVUS was 92.8% compared to 83.50% of urodynamics. TVUS is a simple minimally invasive endosonographic technique that provides opportunity to combine anatomic and functional views of the urinal bladder and urethra compared to other radiological method. The patients avoiding catheterization hazards, exposures to radiation, and the sophistication of multi-channel urodynamic evaluation, readily accept it. TVUS not only can be considered as a significant reliable tool for diagnosing and classifying [SUI] but also of prognostic value in predicting better successful surgical outcomes with proper choice of the surgery type according to each type of SUI. We strongly believe that TVUS is a technique that deserves to be supported for further applications

Feasibility of colour doppler ultrasound in diagnosing vesicovaginal fistulas

The purpose was to evaluate the feasibility of diagnosing vesicovaginal fistulas by colour Doppler ultrasound with contrast media. Eighteen consecutive patients were examined by vaginal speculum, methylene blue test, cystogram and cystoscopy For ultrasound examination, the bladder was filled with saline, then diluted contrast media [Levovist] was instilled. Colour Doppler ultrasound revealed a jet phenomenon through the bladder wall toward the vagina, confirming the existence of the fistula. 17 patients had vesicovaginal fistulae, and one patient had a vesicoureterovaginal fistula. Colour doppler ultrasound had correct results in 17 of 18 patients [94%]. In follow-up examinations of four patients during a prolonged drainage of the bladder, we could correctly demonstrate the closure of one fistula. Colour Doppler ultrasound with contrast media is a new useful diagnostic tool in the evaluation and follow-up of vesicovaginal fistulas. It is less invasive than cystoscopy and needs no radiation exposure. The examination is well tolerated by the patients