Surgical and Functional Outcome of Laparoscopic Vaginal Suspension Combined with Suture Rectopexy for Management of Pelvic Organ Prolapse

Abstract Purpose Laparoscopic techniques to treat pelvic organ prolapse are gaining popularity around the globe due to their low recurrence rates and better functional results compared to perineal techniques. However, the optimum surgical procedures are not yet determined. In the current research, we suggest a novel surgical approach, laparoscopic vaginal suspension with suture rectopexy, to treat multiorgan pelvic prolapse. Methods This prospective cohort trial was conducted from March 2018 to March 2022 and comprised 35 females with multiorgan pelvic organ prolapse with obstructed defecation symptoms. A residual rectal prolapse was still present despite the manual reduction of uterine prolapse. Patients' conditions before and after the operation were monitored regarding the obstructed defecation score, sexual function, need for laxatives, anorectal manometry pressures, anorectal sensations, and recurrence. The mean follow-up duration was one year. Results Modified Longo score for obstructed defecation significantly decreased at six and twelve months after surgery. Additionally, a significant reduction was reported in the number of patients who needed laxatives at six and twelve months after surgery. Anorectal manometry pre- and post-surgery showed a significant elevation in the mean squeeze pressure and a decline in all rectal sensations. All parameters of the female sexual function scoring system increased postoperatively. No recurrence was reported during follow-up. Conclusion For multiorgan pelvic prolapse, laparoscopic vaginal suspension combined with suture rectopexy has excellent functional outcomes, minimal morbidity, and low cost.

Analytical study to evaluate the relation between vaginal Birth Order and pelvic organ prolapse quantification stages

Background: Pelvic organ Prolapse (POP) is the downward displacement of central pelvic organs that are normally located at the level of or adjacent to the vaginal vault. These conditions are common and affect a progressively larger percentage of women as age advances especially in the postmenopausal years.Methods: Data were collected as a retrospective study. Thorough history was taken and physical examination was done. Demographic details of each patient were recorded including age, residence type, education and socio- economic status. A detailed history of all the patients was obtained included parity, live birth and nutrition status.Results: Most of the patients belong to birth order 4 or more than that [73 (62.9%)] followed by birth order 3 [26 (22.4%)] and 2 [16 (13.8%)] whereas 38 (32.7%) patients had birth order >4. In patients with birth order ≥4 and 3 had higher distribution of POPQ stage III and IV respectively.Conclusions: From Present study it can be concluded that vaginal childbirth plays a major role in development of POP. POPQ stages were statistically significant with high birth order.

Mid-term efficacy of laparoscopic sacral colpopexy of combined transabdominal-transvaginal approach in the treatment of stageⅣpelvic organ prolapse / 中华妇产科杂志

Objective To evaluate the clinical effect after laparoscopic sacral colpopexy (LSC) of combined transabdominal-transvaginal approach on stage Ⅳpelvic organs prolapse (POP). Methods The clinical data of 65 patients undergoing LSC of combined transabdominal-transvaginal approach from January 1st, 2010 to July 30th, 2017 due to POP stage Ⅳ in First Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. Objective outcome was assessed by comparing preoperative and postoperative pelvic organ prolapse quantification (POP-Q) systems. Subjective effects were assessed by comparing pelvic floor distress inventory-short form 20 (PFDI-20), pelvic floor impact questionnaire short form (PFIQ-7), pelvic organ prolapse/urinary incontinence sexual questionnaire-12 (PISQ-12) and patient global impression of improvement (PGI-I). Results All 65 patients were successfully performed without any intraoperative complications. Fifty-three patients were followed in the clinic department and 12 were followed up by telephone. The follow-up duration was 6.1-80.3 months and the median follow-up duration was 24.5 months. The bleeding loss was 20-250 ml. Postoperative urethral catheter residence day was (2.5± 1.1) days, length of postoperative stay was (6.2±1.7) days. The postoperative POP-Q scores were compared with preoperative scores which had significantly improved except pb (all P<0.01). The objective cure rates of vaginal anterior wall, apical and posterior wall prolapse stageⅣwere 90% (47/52), 100% (23/23) and 95% (20/21).About PGI-I, except for 1 patient who chose"improvement", the other 64 patients (98%, 64/65) all chose"significant improvement". Furthermore, preoperative and postoperative PFDI-20, PFIQ-7, and PISQ-12 scores were all statistically significant (all P<0.01). Subjective efficacy was significant. Three cases (5%, 3/65) of postoperative fever occurred. Two cases (4%, 2/53) had mesh exposure. Six patients (11%, 6/53) had recurrence of postoperative prolapse. Five cases had recurrence of vaginal anterior wall prolapse and no reoperation was performed; 1 case was recurrence of posterior vaginal wall prolapse who diagnosed as vaginal posterior wall prolapse stage Ⅲ; no recurrence of apical prolapse. The rate of reoperation (including exposed-mesh removal and pelvic floor reconstruction surgery) was 5% (3/65). Conclusions The LSC of combined transabdominal-transvaginal approach has a high subjective efficacy rate. The objective cure rate in the case of apical prolapse stage Ⅳ is one hundred percent.The LSC of combined transabdominal-transvaginal approach has low mesh exposure, low postoperative infection and the reoperation rate, which is one of optional pelvic floor reconstruction surgery. However, there is still a risk of recurrence in patients with POP stageⅣwith severe bladder bulging.

Recurrencia en pacientes intervenidas mediante sacrocolpopexia laparoscópica por prolapso de cúpula vaginal poshisterectomía / Vaginal Vault Prolapse Recurrence in Patients Undergoing Laparoscopic Sacrocolpopexy

Introducción: el prolapso de cúpula vaginal es una complicación que afecta entre 0,2 y 2 por ciento de las pacientes con antecedente de histerectomía total. La meta principal del tratamiento quirúrgico consiste no solo en mejorar la sintomatología, sino además evitar la recurrencia. Objetivo: determinar la frecuencia de la regularidad en pacientes intervenidas mediante sacrocolpopexia laparoscópica por prolapso de cúpula vaginal poshisterectomía y su posible relación con algunas variables sociodemográficas y quirúrgicas. Métodos: se realizó un estudio observacional, descriptivo y transversal, en una serie consecutiva de 41 pacientes atendidas quirúrgicamente en el Centro Nacional de Cirugía de Mínimo Acceso de La Habana, Cuba desde el 1º de agosto de 2008 hasta el 30 de abril de 2016. Resultados: la recurrencia se presentó en cinco pacientes de la serie (12,2 por ciento) después de un tiempo medio de seguimiento de 7,3 años. En ellas fue mayor la frecuencia de comorbilidad dado por la presencia de antecedentes patológicos personales (9,8 por ciento frente a 2,4 por ciento), así como de histerectomía previa por vía convencional en relación con la laparoscópica (7,3 por ciento frente a 4,9 por ciento). Las diferencias encontradas no fueron significativas. La tasa de éxito (supervivencia libre de recurrencia) a los cinco años fue de 84,4 por ciento. Conclusiones: se presentó una baja frecuencia de recurrencia en las pacientes intervenidas sin poder establecer su posible asociación con algunas variables seleccionadas(AU)

Introduction: Vaginal vault prolapse is a complication that affects 0.2 to 2 percent of patients with a history of total hysterectomy. The main goal of surgical treatment is not only to improve symptoms, but also to avoid recurrence. Objective: To determine the frequency of regularity in patients undergoing laparoscopic Sacrocolpopexy due to prolapse of the vaginal vault and its possible relation with some sociodemographic and surgical variables. Methods: An observational, descriptive and cross-sectional study was conducted in a consecutive series of 41 patients surgically treated at the National Center for Minimally Access Surgery, Havana, Cuba from August 1, 2008 to April 30, 2016. Results: Recurrence occurred in five patients of the series (12.2 percent) after a mean follow-up time of 7.3 years. Their frequency of comorbidity was higher due to the presence of personal pathological history (9.8 percent vs. 2.4 percent) as well as previous hysterectomy by conventional route in relation to laparoscopy (7.3 percent vs. 4.9 percent). The differences found were not significant. The success rate (recurrence-free survival) at five years was 84.4 percent. Conclusions: A low frequency of recurrence in the patients who underwent surgery. It was not possible to establish their possible association with some selected variables(AU)

Biofeedback in pelvic floor muscle training for women with prolapsed pelvic organs / 中华物理医学与康复杂志

Objective To explore the curative effect of biofeedback-controlled electrical stimulation combined with the pelvic floor muscle training among women with prolapsed pelvic organs.Methods Sixty women with pelvic organ prolapse were divided at random into an observation group and a control group,each of 30.Both groups were given biofeedback-controlled electrical stimulation of the vaginal muscles,but the observation group also received Kegel training and pelvic floor function training using a vaginal dumbbell.The intervention consisted of 2 courses with an interval of 2 weeks.One course met 15 times,3 times a week,lasting 30 minutes each time.Before and after the treatment,both groups were assessed using pelvic floor electromyography and the GRRUG method was used to evaluate their pelvic floor muscle strength.Results Before the treatment,there were no significant differences between the observation and control groups in terms of the average amplitude of the potentials generated by the pelvic floor muscles in resting,in rapid contraction or in endurance contraction.After the treatment the observation group generated significantly higher potentials than the control group on average.The pelvic floor muscle strength of the observation group reached level V in 23 cases,significantly more than the 9 cases observed in the control group.The total effectiveness rate of the observation group was 96.7％,significantly higher than the control group's 73.3％.Conclusion Biofeedback-controlled electrical stimulation combined with pelvic floor muscle training is effective in treating females with pelvic organ prolapse.

Malla para la reparación del prolapso vaginal apical y anterior: resultados subjetivos y complicaciones / Vaginal mesh for repair of apical and anterior vaginal prolapse: subjective outcomes and complications

Resumen Antecedentes: la aplicación de mallas con fijación al ligamento sacroespinoso para corregir el prolapso apical de órganos pélvicos tiene tasas de éxito objetivo de 92%, con 2-12% de eventos adversos. Objetivo: evaluar los resultados clínicos posteriores a la aplicación de la malla UpholdTM en pacientes con prolapso apical, con o sin útero. Materiales y métodos: estudio retrospectivo y descriptivo efectuado en pacientes atendidas en la Clínica de Urología Ginecológica del Instituto Nacionalo de Perinatología Isidro Espinosa de los Reyes entre los meses de noviembre de 2013 a marzo de 2017 con prolapso de órganos pélvicos de la cúpula a quienes se aplicaron mallas que se fijaron al ligamento sacroespinoso. A las pacientes con incontinencia urinaria de esfuerzo se les colocó una cinta mediouretral. Resultados: se estudiaron 22 pacientes de las que 72% (n = 16) tenían histerectomía previa. El estadio del prolapso de órganos pélvicos fue II en 18% (n = 4), III en 41% (n = 9) y IV en 41% (n = 9). El compartimento anterior se encontró afectado en 41% (n = 9) y en 59% (n = 13) el apical. El 54% (n = 12) de las pacientes tenía incontinencia urinaria de esfuerzo. A 9% (n = 2) de las pacientes solo se les colocó la malla UpholdTM, a 45% (n = 10) se les practicó una cirugía concomitante para corrección del prolapso de órganos pélvicos (colpoplastia posterior [n = 5], colpoperineoplastia [ n = 4] y 1 culdoplastia) y para incontinencia urinaria de esfuerzo a 68% (n = 15) se les colocó una cinta mediouretral. El 9% (n = 2) tuvieron lesión vesical, 40% (n = 9) retención urinaria, 4.5% (n = 1) exposición y 4.5% (n = 1) extrusión. El éxito subjetivo y objetivo fue de 100%. Conclusiones: la colocación de la malla Uphold con fines de corrección del prolapso apical tiene buenos resultados, con mínimos efectos adversos. El procedimiento antiincontinencia concomitante incrementa la retención urinaria.

Abstract Introduction: The use of mesh with fixation to sacoespinous ligament (SEL) for correction of pelvic organ prolapse has a success rate of 92% and adverse events are reported in 2-12%. The aim of this study was to evaluate the clinical results after the application of Uphold mesh in women with apical prolapse with or without uterus. Methods: A retrospective and descriptive study, 22 patients with E ≥ II voult pelvic organ prolapse who underwent vault fixation or hysteropexy to SEL and mediourethral tape (CMU) in those with stress urinary incontinence (SUI) from November-2013 to March-2017. Results: 72.7% (n = 16) had previous hysterectomy. The pelvic organ prolapse stage was grade II in 18% (n = 4), III in 41% (n = 9) and IV in 41% (n = 9), the anterior compartment was affected in 40.9% and 59% (n = 13) for apical. 54.5% (n = 12) had SUI. In 9% (n = 2) were placed exclusively Uphold, concomitant surgery was performed for correction of posterior compartment pelvic organ prolapse in 45% (n=10) and at 68% (n = 15) CMU was placed. 9% (n = 2) had bladder injury, 40% (n = 9) urinary retention of patients with CMU application, 4.5% (n = 1) exposure and 4.5% (n = 1) extrusion. Subjective and objective success was 100%. Conclusions: The placement of Uphold has successful results in the correction of apical prolapse. The concomitant anti-incontinence procedure increases the presence of urinary retention.

Biofeedback in pelvic floor muscle training for women with prolapsed pelvic organs / 中华物理医学与康复杂志

Objective To explore the curative effect of biofeedback-controlled electrical stimulation combined with the pelvic floor muscle training among women with prolapsed pelvic organs.Methods Sixty women with pelvic organ prolapse were divided at random into an observation group and a control group,each of 30.Both groups were given biofeedback-controlled electrical stimulation of the vaginal muscles,but the observation group also received Kegel training and pelvic floor function training using a vaginal dumbbell.The intervention consisted of 2 courses with an interval of 2 weeks.One course met 15 times,3 times a week,lasting 30 minutes each time.Before and after the treatment,both groups were assessed using pelvic floor electromyography and the GRRUG method was used to evaluate their pelvic floor muscle strength.Results Before the treatment,there were no significant differences between the observation and control groups in terms of the average amplitude of the potentials generated by the pelvic floor muscles in resting,in rapid contraction or in endurance contraction.After the treatment the observation group generated significantly higher potentials than the control group on average.The pelvic floor muscle strength of the observation group reached level V in 23 cases,significantly more than the 9 cases observed in the control group.The total effectiveness rate of the observation group was 96.7％,significantly higher than the control group's 73.3％.Conclusion Biofeedback-controlled electrical stimulation combined with pelvic floor muscle training is effective in treating females with pelvic organ prolapse.

Artérias mesentéricas cranial e caudal em mocós Kerodon rupestris (Wied, 1820) / Cranial and caudal mesenteric arteries in rock cavy Kerodon rupestris (Wied, 1820)

No estudo sobre a origem e ramificações das artérias mesentéricas cranial (AMCr) e caudal (AMCa) do mocó, foram utilizados 20 animais (18 machos e 2 fêmeas) de diferentes idades, que, após morte natural, foram dissecados rebatendo-se as paredes torácica e abdominal, pelo antímero esquerdo, expondo-se a aorta que foi então canulada em seu trajeto pré-diafragmático, procedendo-se a injeção de neoprene látex corado, no sentido caudal. A seguir, foram fixados em solução aquosa de formol a 10 por cento, durante 48 horas, e posteriormente dissecados. Os resultados mostraram que em 18 animais (90 por cento), a AMCr originou-se da aorta abdominal isoladamente, logo após a artéria celíaca, emitindo as artérias cólica média (CoM), pancreaticoduodenal caudal (PDC), duodenojejunal (DJ), jejunal (J) e ileocecocólica (ICeCo). Em um mocó (5 por cento), as AMCr e AC se originaram da aorta abdominal em um tronco comum. Neste caso, a AMCr originou às artérias CoM, PDC, ICeCo e J. Em uma observação (5 por cento), as artérias AMCr e AMCa surgiram em tronco comum. Neste animal, as artérias PDC, DJ, ICeCo, CoM e J foram originadas da AMCr, enquanto as aterias cólica esquerda (CoE) e retal cranial (ARCr) derivaram da AMCa. Dois animais (10 por cento) apresentaram como colaterais da AMCr as artérias CoM, PDC, DJ, J e o tronco ICeCo, que originou às artérias CoD e ileocecal (ICe). No que diz respeito a AMCa, nos 20 casos (100 por cento) originou as artérias CoE e RCr.

In this study about the origin and ramification of the cranial (CrMA) and caudal (CaMA) mesenteric collateral arteries of the rock cavy, 20 animals (18 males and 2 females) of different ages, originated from the Wild Animals Multiplication Center of the Universidade Federal Rural do Semi-Árido (Cemas/Ufersa), were used. After the natural death, the walls of the abdominal cavity of the animals, in the left antimere, were dissected to cannulate to the aorta in pre-diaphragmatic path. Then they were fixed in 10 percent formaline and conditioned in order to study their anatomy. The results showed that in 18 animals (90 percent) the CrMA arose, separately, of the abdominal aorta, soon after the celiac artery (CA), originating, by this time, the middle colic (MCo), caudal pancreaticduodenal (CPD), duodenojejune (DJ), jejune (J) and ileocecocolic (ICeCo) trunk from which derives the ileocecal (ICe) and the right colic (RCo) arteries. In one rock cavy (5 percent), the CrMA and CA originate from abdominal aorta in a common trunk. In this case the CrMA originated the CPD, MCo, ICeCo, and J. In one observation (5 percent) CrMA and CaMA appear in common trunk. In this animal, CPD, DJ, ICeCo, MCo and J arteries were originated of the CrMA, while the left colic (LCo) and rectal cranial (RCr) arteries were originated of the CaMA. Regarding the CaMA, in 20 cases (100,00 percent) it originates the LCo and the rectal cranial arteries.

Research about function rehabilitation of pelvic organs by pelvic floor muslce training and electrical stimulation / 中国实用护理杂志

Objective In order to know the effect of rehabilitation of pelvic organs by pelvic floor muscle training and electrical stimulation. Methods Divided 330 pregnant women into the integrated group(120 cases),the experimental group(100 cases) and the control group(100 cases) randomly. Rou-tine nursing cares was used in the control group, pelvic floor muscle training and electrical stimulation were used in the integrated group in addition, pelvic floor muscle training was used in the experimental group. Evaluated the rehabilitation condition of pelvic organs in the 42nd day after delivery among the three groups. Results All the indexes which can indicated the rehabilitation condition of pelvic or-gans in the integrated group and the experimental group were significant better than those of in the con-trol group, while there was no significant differences about the above indexes between the integrated group and the experimental group. Conclusions Pelvic floor muscle training combined with electrical stimulation can effective promote the rehabilitation of function of pelvic organs, and then prevent the in-cidence of related diseases.

CT Differentiation of Periappendiceal Inflammation with Appendicitis and Pelvic Inflammatory Disease in Woman with Right Lower Quadrant Pain

PURPOSE: We wanted to determine the usefulness of the computed tomography (CT) findings for making the diagnosis between periappendiceal inflammation (PAI) with appendicitis and pelvic inflammatory disease (PID) for the women presenting with right lower quadrant pain. MATERIALS AND METHODS: We retrospectively analyzed the CT findings of 83 women with right lower quadrant pain: PAI in 36 and PID in 47 patients. We reviewed the CT images, including the appendiceal diameter and the enhancing wall thickening, the cecal thickening, the location of the appendix, thickening of the right anterior renal fascia, abscess, mesenteric fatty infiltration, ascites, heterogeneous uterine enhancement and paralytic ileus. Statistical analysis was performed by using the t-test for the diameter of appendix, and the x2 test or Fisher's exact test for the CT findings. RESULTS: The mean diameter of the appendix was 11.0+/-3.4 mm for the PAI subjects and it was 6.7+/-2.0 mm for the PID subjects (p<0.0001). Wall thickening of the appendix was more commonly detected in PAI (25 subjects, 69%) than in PID (15 subjects, 32%) (p=0.0007). Thickening of the right anterior renal fascia was more commonly detected in PAI (18 subjects, 50%) than in PID (7 subjects, 15%). Cecal thickening, ascitis, heterogeneous uterine enhancement and paralytic ileus were not significantly different between PAI and PID. Abscess and mesenteric fatty infiltration were more frequently detected in the RLQ, and in the abdomen or pelvic cavity in PAI and PID, respectively (p<0.05). There was no significant difference in the distribution of ascites between the diseases. CONCLUSION: The CT findings of the appendiceal diameter, enhancing wall thickening and thickening of the right anterior renal fascia are useful for making the diagnosis of PAI. The abdominal and pelvic distributions of abscess and mesenteric fatty infiltration are highly suggestive findings of PID.

Transcatheter Ovarian Vein Embolization for Pelvic Congestion Syndrome: Short-Term Outcome

PURPOSE: To evaluate the short-term therapeutic effectiveness of ovarian vein embolization using coils for pelvic congestion syndrome (PCS), a common cause of chronic pelvic pain, and to determine patient satisfaction. MATERIALS AND METHODS: Forty-four multiparous women aged 26-73 (mean, 39.9) years in whom chronic pelvic pain due to unknown causes had lasted for more than six months, and whose gynecologic findings and laboratory data suggested PCS, underwent transabdominal or transvaginal ultrasonography and selective ovarian venography. PSC was finally diagnosed in 21 of th 44, who underwent 22 ovarian vein embolizations (in one case, bilaterally). The simple pain rating system was used at admission, with a 'minimal' or 'moderate' grade representing discomfort in daily life, and 'severe' indicating the need for medication. Indications for coil embolization included dilatation of the ovarian vein to a diameter of more than 6 mm, reflux involving an incompetent valve, congestion of the pelvic venous plexus (involving the stasis of contrast media), and/or opacification of the ipsilateral internal iliac vein (or contralateral filling). Embolizations were undertaken using coils of optimal size and number, and the mean follow-up period was 217 (31-267) days. By means of a telephone questionnaire, the outcome was classified as a cure, pain reduction, or 'no change, or aggravation', and on the basis of whether or not they would opt for the same treatment, or recommend embolization to others, patient satisfaction was graded as 'substantial', 'moderate', or 'absent. RESULTS: Venous occlusion was confimed at postembolization venography in all 22 cases. Clinical treatment led to symptomatic relief in 76.2% of patients a cure in 33.3% (7/21), pain reduction in 42.9% (9/21) and no imchange, or aggravation, in 23.8% (5/21). Eighteen patients (85.8%) were very (9/21, 42.9%) or moderately (9/21, 42.9%) satisfied with coil embolization. In two, the coil migrated, and was successfully retrieved using a snare loop. CONCLUSION: In this study, ovarian vein embolization using coils for PCS appeared to be both safe and effective in controlling pain. If other causes of pelvic pain are absent, it is thought to be a valuable alternative to surgical procedures.

MR Imaging of Pelvic Floor in Stress Urinary Incontinence

PURPOSE: To demonstrate the anatomy of the female pelvic floor and to determine the anatomic differences between normal controls and women with stress urinary incontinence, using MRI. MATERIALS AND METHODS: Five healthy, young, nulliparous women and 12 with stress urinary incontinence un-derwent MR imaging. We obtained FSE T2-weighted axial images, 3mm thick, of the region extending from the urethrovesical junction to the perineal membrane. The following parameters were determined : angle, asymmetry and signal intensity of the levator ani muscles, the distance between the urethra and symphysis, and the presence, shape and angulation of urethropelvic ligament. RESULTS: In contrast to normal controls, frequent findings in women with stress incontinence were as follows : increased angle(43%), asymmetry(43 %) and higher signal intensity(67%) of the levator ani muscles; increased distance between the urethra and symphysis; loss(43 %), discontinuity (60 %) and dorsal angulation(43%) of the urethropelvic ligament. CONCLUSION: In women with stress urinary incontinence, MRI clearly demonstrates the anatomy of the female pelvic floor, changes in the levator ani muscles, the distance between the urethra and symphysis, and the ure-thropelvic ligament. The modality can therefore be used to evaluate the anatomical changes occurring in cases of stress urinary incontinence.

CT and MR Imaging Findings of Cystic Adenomyosis of the Uterus: Report of Three Cases

Adenomyosis of the uterus is a relatively common gynecologic disease characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Small cystic spaces (not larger than several mil-limeters) are invariably present, and these are filled with blood. Extensive hemorrhagic cystic adenomyosis,however, is rare, and there have been very few radiologic reports of this condition. We describe the CT and MRI features of three cases of histologically confirmed huge cystic adenomyosis.

Imaging Findings of Perineal Disease

The perineum is defined as the region of body below the pelvic diaphragm that lies within the boundaries of the pelvic outlet. It is the region which is home to pathologic conditions which include primary tumors, neoplasms of adjacent organs with secondary invo l vement, congenital or acquired cystic lesions and inflammatory lesions. In this article, we describe CT and MR imaging anatomy and various pathologic processes that affect this anatomic region, with a brief discussion. Emphasis is give n to imaging features that help to characterize specific lesions.

CT Findings in Differential Diagnosis of Pelvic Inflammatory Bowel Mass and Tuboovarian Abscess

PURPOSE: To evaluate the CT findings which may help differentiate pelvic inflammatory bowel mass(IBM) fromtubo-ovarian abscess(TOA). MATERIALS AND METHODS: Twenty-five patients with histologically confirmed TOA(n=14),periappendiceal abscess(n=9), an abscess caused by diverticulitis(n=1), and by ulcerative colitis(n=1) wereevaluated. For TOA, age distribution ranged only from the 3rd to the 5th decade, but for IBM, the range was the 2nd to 8th decade with highest frequency during the 3rd-4th decade. CT findings were retrospectively analysed forbilaterality, internal septa, anterior displacement of the mesosalpinx, and perirectal and mesenteric fat. RESULTS: Mesenteric fat infiltration was detected in all 11 cases of pelvic IBM, but in only two of 14 TOA cases(p<0.05).Anterior displacement of the mesosalpinx was observed in two of 11 pelvic IBM cases and in nine of 14 TOAcases(P<0.05). There were no significant difference in bilaterality, internal septa, or perirectal fatinfiltration. CONCLUSION: Mesenteric fat infiltration was the most reliable finding in differentiating pelvic IBMform TOA. Anterior displacement of the mesosalpinx, and age distribution were also helpful in differentiating thetwo disease groups.

Efficacy of MR Imaging to Evaluate Mullerian Duct Anomalies

PURPOSE: To evaluate the MR imaging of Mullerian duct anomalies (MDA) and analyze its diagnostic accuracy associated gynecologic diseases and effect on treatment plan. MATERIALS AND METHODS: Twelve patients with suspected MDA and three with incidentally-found MDA were included. Axial, sagittal and coronal images of T1-, FSET2- or T2-, proton density- and Gadolinium-enhanced T1-weighted images were obtained with 1.5T (n=13) and 0.5T (n=2) MR machines. On the basis of Buttram and Gibbons' classification, MR images were analyzed and classified as laparotomy (n=7), hysteroscopy (n=7), laparoscopy (n=3) or hystersalpingography (n=2). These were analyzed in terms of external contour of the uterus, intercornual distance, signal intensity of the uterus and septum, associated genitourinary diseases, and the influence of MR imaging on treatment plan. RESULTS: A total of 15 cases of MDA were accurately classified by MR imaging, as follows: didelphyses (n=6: 40%); ageneses (n=3: 20%); septate uteri (n=3: 20%); bicornuate uteri(n=2: 13%) and unicornuate uterus(n=1: 7%). In 14 cases (93%) findings corresponded with those of other examinations. The external contour of the uterus was banana-shaped in the didelphyc and unicornuate uterus, a fundal cleft in the bicornuate, and normal in the septate; intercornual distance was greater in didelphyc and bicornuate uteri. Except in three cases of agenesis, the signal intensity of the uterus was normal; in the septum, on T2WI, this was isosignal in the bicornuate uterus and low in the septate, as compared with that of the myometrium. In four of five cases, associated gynecologic diseases were found on MR imaging; in five cases (33%), there were associated urologic anomalies, and in six (40%), MR imaging influenced the treatment plan. CONCLUSION: MR imaging was valuable for the diagnosis of MDA and the determination of associated gynecologic diseases, and also influenced the treatment plan.

Lymphocele Developed After Pelvic Lymphadenectomy: Treatment by Percutaneous Catheter Drainage

PURPOSE: To evaluate the efficacy of percutaneous catheter drainage for the treatment of postoperative lymphoceles following pelvic lymphadenectomy. MATERIALS AND METHODS: Between January 1995 and May 1996, 23 symptomatic lymphoceles in 20 patients who had undergone pelvic lymphadenectomy for uterine cancer were subjected to percutaneous catheter drainage under sonographic guidance. All the lymphoceles were confirmed by biochemical and cytological examination. When the amount of drainage decreased to less than 5-10ml/day and when the lymphocele was seen on US or sinography to have collapsed, the catheter was removed. US and sinography were performed to evaluate the efficacy of treatment at 1 week after catheter drainage, and all patients were followed up with US at 1, 3, and 6 months after catheter removal. RESULTS: On follow-up sonography, 20 of 23 lymphoceles (87.0%) were seen to have collapsed completely and three had recurred. Of these latter, two were treated by secondary percutaneous catheter drainage, and the other, which was asymptomatic and small, had collapsed spontaneously during the fifth months after catheter removal. Successful treatment of lymphocele was eventually achieved in all patients. The duration of catheter drainage ranged from 3 to 49 (mean, 22) days, and the size of lymphocele on initial sinogram varied from 5x4x3cm to 25x10x10cm; the total volume of drainage ranged from 300 to 17,240 (mean2,012)ml. Complications during the procedure and drainage arose in three cases. In one, there was secondary infection of the lymphocele, and in two, infection at the site of catheter insertion was seen; treatment involved changing the catheter and antibiotics. CONCLUSION: Percutaneous catheter drainage is thought to be a safe and effective alternative to surgery for the treatment of symptomatic lymphoceles following pelvic lymphadenectomy for uterine cancer.

Pelvic Actinomycosis

PURPOSE: To demonstrate the radiologic characteristics of the pelvic actinomycosis. MATERIALS AND METHODS: We retrospectively reviewed the radiologic findings of seven patients with pathologically proven pelvic actinomycosis and analyzed the anatomical location, characteristics of the lesion and alteration of surrounding structures. RESULTS: The location of the lesions were the ovary and adnexa(n=4), rectum(n=1), cecum and terminalileum(n=1), and bladder(n=1). Three of the seven patients had a past history of intrauterine devices.Post-contrast enhanced CT showed an ill-defined mass with inhomogeneous enhancement and a tendency to invade th esurrounding normal tissue plane. CONCLUSION: Pelvic actinomycosis should be included in differential diagnosis when an unusually aggressive infiltrative mass is located in the pelvic cavity, especially in a patient with long-term use of intrauterine contraceptive devices.