Postoperative Voiding Dysfunction: The Preferred Method for Catheterization.

OBJECTIVES: Bladder drainage can be achieved by clean intermittent self-catheterization (CISC), transurethral indwelling catheterization (TIC), or with a suprapubic tube (SPT). The primary objective of this study was to determine patient preference for catheter type in the management of potential voiding dysfunction after pelvic organ prolapse (POP) surgery. METHODS: Between 2012 and 2016, patients scheduled for POP surgery were recruited into the study. Before surgery, patients were informed of the potential for postoperative voiding dysfunction and the catheter choices were discussed. Each patient's choice was recorded along with baseline information, surgery performed, and perioperative details. After surgery, voiding dysfunction, length of catheter use, scores on a catheter satisfaction questionnaire, as well as uroflowmetry and urine culture testing were assessed. RESULTS: Of those recruited to the study (N = 150), 6.7% chose CISC, 7.3% chose TIC, and 86% chose SPT. Catheter satisfaction score 1 week after surgery was significantly better for SPT compared with CISC and TIC (P = 0.005). In addition, at week 1, 33% of CISC, 25% of TIC, and 13% of SPT had a PVR of more than 30% (P = 0.002) on uroflowmetry, and 33% of CISC, 50% of TIC, and 24% of SPT had a positive urine culture (P = 0.05). CONCLUSIONS: This study has shown that patients prefer SPT over CISC and TIC for management of voiding dysfunction after POP surgery. Use of SPT showed better satisfaction rates, better uroflowmetry results, and lower infection rates 1 week after surgery. Patient preference is an important factor in this decision and can help facilitate a clinical approach.

Fibroid infected with Escherichia coli requiring surgical removal following uterine artery embolization.

BACKGROUND: Uterine fibroid necrosis and infection is a rare but potentially serious event following uterine artery embolization (UAE). We describe a case of surgical removal of an infected necrotic uterine fibroid. CASE: A 31-year-old Jehovah's Witness with severe anemia presented with sepsis following UAE. The uterus was preserved by performing transvaginal surgical removal. Final pathology demonstrated Escherichia Coli infection of the necrotic fibroid. The patient improved postoperatively. CONCLUSION: Surgical removal of an infected necrotic fibroid may be a preferred option for women wishing to avoid hysterectomy following UAE. Appropriate case selection and optimization of hemoglobin concentration before UAE is important to minimize complications.

Contexte : La nécrose et l'infection d'un fibromyome utérin constituent un événement rare, mais potentiellement grave, à la suite de l'embolisation de l'artère utérine (EAU). Nous décrivons un cas de retrait chirurgical d'un fibromyome utérin nécrosé et infecté. Cas : Une témoin de Jéhovah de 31 ans connaissant une anémie grave a présenté une sepsie à la suite d'une EAU. L'utérus a été préservé au moyen de l'exécution d'un retrait chirurgical transvaginal. L'examen pathologique final a démontré la présence d'une infection à Escherichia Coli dans le fibromyome nécrosé. L'état de la patiente s'est amélioré à la suite de l'opération. Conclusion : Le retrait chirurgical d'un fibromyome utérin nécrosé et infecté pourrait constituer l'option à privilégier pour les femmes qui souhaitent éviter l'hystérectomie à la suite d'une EAU. Avant la tenue d'une EAU, il s'avère important de bien sélectionner les patientes qui pourraient en tirer avantage et d'optimiser la concentration en hémoglobine, et ce, afin de minimiser les complications.

Plasma interleukin-18 (IL-18) levels are correlated with antioxidant vitamin coenzyme Q(10) in preeclampsia.

OBJECTIVE: Alteration of cytokines level and oxidative stress are both associated with preeclampsia (PE). We have investigated if IL-6 and IL-18 levels were related to coenzyme Q(10) (CoQ(10)), an antioxidant and a marker of oxidative stress in the plasma from normotensive and preeclamptic pregnancies. DESIGN: IL-6 and IL-18 levels were determined by enzyme-linked immunosorbent assays in plasmas from preeclamptic (n = 29) and normotensive pregnancies (n = 30). The concentrations of CoQ(10) in the different redox forms were measured in plasma using liquid chromatography coupled to electrochemical detection. Data were analyzed using the Wilcoxon Rank-Sum test and correlations were obtained by the Spearman's Rho test. MAIN OUTCOME MEASURES: IL-6 concentrations were 2.8-fold higher in preeclamptic plasmas than in controls (p = 0.0006), and IL-18 concentrations were found significantly lower in preeclamptic samples than in controls (p = 0.007). No correlation was found between IL-18 or IL-6 and antioxidant vitamin CoQ(10) in plasmas from normotensive pregnant women. However, in PE, IL-18 level was positively correlated with the reduced form of CoQ(10) (r = 0.3680, p = 0.0495). CONCLUSION: This is the first demonstration that IL-18 is potentially linked to oxidative stress in PE, since its level correlates with the concentration of the powerful antioxidant CoQ(10). These results also associate the immune system with the oxidant/antioxidant imbalance observed in PE.

Specific systemic antioxidant response to preeclampsia in late pregnancy: the study of intracellular glutathione peroxidases in maternal and fetal blood.

OBJECTIVE: The physiopathology of preeclampsia is still unclear, but an imbalance between reactive oxygen species (ROS) and antioxidants, also called oxidative stress, appears to be an important contributing factor. The ROS promote lipid oxidation and are known to induce stress proteins, such as hemeoxygenase 1 (HO-1) and heat-shock protein 70 (Hsp-70). We hypothesized that glutathione peroxidases (GPx), a major class of antioxidant enzymes that regulate cell homeostasis by neutralizing lipid peroxides, are altered in the blood of preeclamptic women and neonates (venous cord blood). METHODS: Thirty-one preeclamptic and 30 normotensive pregnancies were recruited. The blood was fractionated using a discontinuous gradient to separate the different cell types. The messenger ribonucleic acid (mRNA) expression of GPx-1 and -4, HO-1, and Hsp-70 were analyzed by quantitative reverse transcriptase-polymerase chain reaction. GPx-1 and -4 protein level in blood cells was also detected by Western blot. The experiments were analyzed using the Student t test. RESULTS: The HO-1 and Hsp-70 mRNA expression in whole blood was significantly higher in both fetal and maternal circulations (P < .05). We also discovered that GPx-4 mRNA was 1.6-fold higher in blood of women with preeclampsia than in control pregnancies (P = .04). The latter was associated with an increase of both GPx-1 and GPx-4 protein and mRNA levels in the lymphocyte/monocyte fraction of the blood. Significantly higher GPx-4 mRNA levels in the fetal circulation of the preeclamptic group than the control group were also detected (P < .001). CONCLUSION: These data indicate that preeclampsia is associated with a specific antioxidant response in both maternal and fetal circulations, likely in response to the deleterious oxidative stress observed in this syndrome.