Surgical outcomes of sacrospinous ligament fixation at the time of vaginal hysterectomy for vaginal vault prolapse prevention: 10 years review.

AIMS: To study the non-recurrent prolapse rate after vaginal hysterectomy colpoperineorrhaphy and sacrospinous ligament fixation (SSLF) with or without anterior colporrhaphy, with or without posterior colpoperineorrhaphy. MATERIALS AND METHODS: A retrospective cohort study was carried out at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, during January 1, 2012-December 31, 2021. The inclusion criteria were Thai women diagnosed with uterovaginal prolapse and undergone vaginal hysterectomy, with or without anterior colporrhaphy, with or without posterior colpoperineorrhaphy, with SSLF and had the complete pelvic organ prolapse quantification (POP-Q) information at the 12 months follow up. The recurrent case was defined as any compartment prolapse ≥ stage II by POP-Q classification at 1, 3, 6, 12 months follow up. RESULTS: Of 71 cases included, 20 cases had recurrent prolapse at 12 months. The incidences of non-recurrent prolapse rate at 1, 3, 6, and 12 months were 70/71 (98.59%), 65/70 (92.86%), 58/65 (89.23%), and 51/58 (87.93%). The overall PHVP prevalence at 12 months was 2/71 (2.81%). The anterior compartment prolapse were 18/71 (25.35%) at 12 months. The most common postoperative complications were the urinary tract infection (4.23%). There were one case of nerve entrapment and one case of stitches exposure that required stitches removal. CONCLUSION: SSLF at the time of vaginal hysterectomy is safe and effective in post hysterectomy vaginal vault prolapse prevention. But there are high recurrence rate of anterior compartment prolapse at 12 months. Preoperative counseling and long-term follow up after SSLF is advocated.

Knowledge, attitude and acceptability regarding antenatal perineal massage in Thai pregnant women.

INTRODUCTION AND HYPOTHESIS: Antenatal perineal massage for obstetric anal sphincter injury prevention is not routinely performed in Thailand. Due to the cultural conservatism in the country, attitudes and acceptability need to be evaluated before procedure implementation. This research was conducted to evaluate knowledge, attitudes, and acceptability of antenatal perineal massage and identify associated factors for acceptability in antenatal perineal massage among Thai pregnant women. METHODS: A cross-sectional study was conducted in the antenatal clinic at King Chulalongkorn Memorial Hospital, Bangkok, Thailand between July 2021 and June 2022. Thai women with singleton pregnancies at 22 weeks or more of gestation without an indication for cesarean section were enrolled. Knowledge, attitudes, and acceptability of antenatal perineal massage were assessed using a self-administered questionnaire. In-depth interviews with pregnant women who were not interested in antenatal perineal massage were also completed. RESULTS: A total of 144 pregnant women were enrolled with 119 participants (83%) having an accepting attitude about antenatal perineal massage. Results on knowledge included 22 (15%) participants aware of this practice, 46 participants (31.9%) knew it should be practiced after GA 34 weeks, 52 participants (36.1%) knew the massage should be maintained for 5-10 min, and 37 participants (25.7%) knew it should be performed daily. Factors associated with acceptability of antenatal perineal massage were prior interest in perineal massage and trust in the benefit of the perineal massage in facilitating vaginal delivery. Reasons for disagreeing in antenatal perineal massage included never hearing of perineal massage, concern about pregnancy complications, fear of pain, believing it to be a useless procedure, and previous successful vaginal delivery. CONCLUSIONS: We found high acceptability for antenatal perineal massage. This program should be routinely explained and offered to Thai pregnant women to prevent severe perineal trauma and postpartum complications.

Efficacy of Erbium YAG laser treatment in overactive bladder syndrome: a randomized controlled trial.

To evaluate the efficacy of vaginal Erbium YAG laser in postmenopausal women presenting with overactive bladder syndrome (OAB) and vaginal atrophy. A single center, randomized sham-controlled study was conducted between July 2019 and August 2022. Thai postmenopausal women diagnosed with OAB and who complained of one or more of vaginal atrophy symptoms (VAS) were included. The participants received either one treatment session of vaginal Erbium YAG laser or the sham procedure. The primary outcome was the Thai version Overactive Bladder Symptom Score. The secondary outcomes included results from the Thai version Overactive Bladder questionnaire (OAB-q), Patient Perception of Bladder Condition Questionnaire, bladder diary, VAS score, and Vaginal Health Index score (VHI). Outcome measurements were assessed between groups at 12 weeks after treatment. Fifty participants were included and randomized. Twenty-five participants were assigned to the vaginal laser group, and 25 to the sham group. At 12-week follow-up, vaginal Erbium YAG laser demonstrated improvement compared with sham group in total Overactive Bladder Symptom Score (6.03 ± 3.36 vs 8.44 ± 3.39, P = 0.015), nocturia (1.71 ± 0.74 vs 2.32 ± 0.70, P = 0.004), and urgency (2 [3] vs 3 [4], P = 0.008). Coping and social subscale of OAB-q, daytime micturition frequency, urgency and maximum urine volume, VAS and VHI scores also significantly improved in the vaginal laser group. This study showed the efficacy of the vaginal Erbium YAG laser in treatment of OAB and vaginal atrophy in postmenopausal women. The improvement of OAB symptoms scores was confirmed by the bladder diary.

Patient-reported goal achievements after pelvic floor muscle training versus pessary in women with pelvic organ prolapse. A randomised controlled trial.

The aim was to assess the achievement by self-determined goals in pelvic organ prolapse (POP) participants receiving pelvic floor muscle training (PFMT) compared to vaginal pessary. Forty participants with POP stage II to III were randomly allocated to pessary or PFMT. Participants were asked to list up 3 goals they expected from treatment. Thai version of Prolapse Quality of Life Questionnaire (P-QOL) and Pelvic Organ Prolapse Incontinence Sexual Questionnaire, IUGA-revised (PISQ-IR) were completed at 0 and 6-week period. At 6-week post-treatment, they were asked if their goals had been achieved. The totally achieved goals in the vaginal pessary group were 70% (14/20) significantly higher than PFMT group at 30% (6/20) (p = 0.01). The mean ± SD of the post-treatment P-QOL score in the vaginal pessary group was significantly lower than the PFMT group (13.90 ± 10.83 vs 22.04 ± 5.93, p = 0.01), but not different in all PISQ-IR subscales. Pessary treatment for POP yielded better total goal achievements and better quality of life than PFMT for POP treatment at a 6-week follow-up.Impact statementWhat is already known on this subject? Pelvic organ prolapse (POP) can severely affect the quality of life, causing physical, social, psychological, occupational, and/or sexual dysfunction. Individual patient goal setting and goal achievement scaling (GAS) offers a new method of patient-reported outcome measurement (PRO) in therapeutic success such as pessary or surgery in patient with POP. But there is no randomised controlled trial comparing pessary vs pelvic floor muscle training (PFMT) using GAS as the outcome measurement.What do the results of this study add? The results showed that women with POP stage II to III who received vaginal pessary had higher totally goal achievements and better quality of life than the women received the PFMT at 6-week follow up.What are the implications of these findings for clinical practice and/or further research? The information about the better goal achievements by using pessary can be used as the tools for counselling for patients with POP for selecting the choices for the treatment in the clinical setting.

POP stage II to III patients treatedwith vaginal pessary had higher totally goal achievements and better quality of life than treated by PFMT.

Thai translation and validation of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) and Pelvic Floor Distress Inventory (PFDI-20).

INTRODUCTION AND HYPOTHESIS: The Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR) and Pelvic Floor Distress Inventory (PFDI-20) are the questionnaires for evaluating sexual function and quality of life in women with Pelvic Flood Dysfunction (PFD). These two tools have been translated into many languages. The aims were to translate PISQ-IR and PFDI-20 into Thai and to assess their validity and test/re-test reliability. METHODS: Two hundred Thai women with PFD were recruited from an outpatient gynecologic clinic at King Chulalongkorn Memorial Hospital during June-December, 2017. All women completed the Thai version of PISQ-IR and PFDI-20 twice at an interval of 2 weeks and completed the Thai version of FSFI and P-QOL questionnaires at first visit for analysis of criterion validity. RESULTS: For PISQ-IR, the internal consistency (Cronbach's alpha) ranged from 0.49 to 0.95 in the non-sexually active (NSA) group and 0.63 to 0.89 in the sexually active (SA) group. The test-retest reliability [intraclass correlation coefficients (ICCr)] of all subscales ranged from 0.79-0.96 in the NSA group and 0.92-0.96 in the SA group. For total PFDI-20 score, Cronbach's alpha was 0.93 and ICCr 0.83. The criterion validity (correlations of PISQ-IR subscales to FSFI) ranged from low to high correlation (r = 0.10-0.64) while the correlations of PISQ-IR subscales to PFDI-20 scores ranged from low to moderate correlation (r = 0.20-0.36). CONCLUSIONS: The Thai versions of the PISQ-IR and PFDI-20 proved to have good internal consistency with strong reliability. They are valid tools for evaluating sexual function and quality of life in Thai women with PFD.

Effect of vaginal estrogen in postmenopausal women using vaginal pessary for pelvic organ prolapse treatment: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: Evidence and recommendations for the use of intravaginal estrogen for prevention of bacterial vaginosis and pessary-related complications are limited and controversial. We hypothesized that adding intravaginal estrogen to pessary use would decrease the incidence of bacterial vaginosis and other pessary-related complications. METHODS: A single-center, open-label, randomized, parallel study was conducted between April 2018 and August 2020. Participants were randomized to either receive intravaginal estriol 0.03 mg plus Lactobacillus acidophilus 100 million viable cell vaginal tablets or have no treatment. The Amsel criteria, normal flora index, visual analog scale, Thai version of the ICIQ-VS (International Consultation on Incontinence Questionnaire-Vaginal symptoms) questionnaire, vaginal abrasions and vaginal bleeding were evaluated at entry and at 2- and 14-week follow-up. RESULTS: Seventy-eight women were included and randomized to two groups (39 women per group). At 2-week follow-up, one participant in the intervention group and two participants in the control group were diagnosed with bacterial vaginosis (2.7% vs. 5.7%, p = 0.609). At 14-week follow-up, two participants in the intervention group and two participants in the control group were diagnosed with bacterial vaginosis (5.7% vs. 6.2%, p = 0.926). Normal flora index was significantly different at 2-week follow-up [8 (6.3) vs. 5 (6.0), p = 0.032]. There was no significant difference in the visual analog scale, Thai version of the ICIQ-VS, vaginal abrasions and vaginal bleeding between the 2- and 14-week follow-ups. CONCLUSIONS: This study shows no benefit of intravaginal estrogen in reducing bacterial vaginosis, vaginal abrasions, vaginal bleeding and pain in postmenopausal women using a vaginal pessary for pelvic organ prolapse treatment.

Knowledge, Attitude, and Practices (KAP) Survey Towards Pelvic Floor Muscle Training (PFMT) Among Pregnant Women.

OBJECTIVE: To assess knowledge, attitude, and practices (KAP) of pelvic floor muscle training (PFMT) among Thai pregnant women. PATIENTS AND METHODS: One hundred and ten Thai pregnant women who attended the antenatal clinic of a tertiary care hospital were recruited. They were classified as "aware" if they could recognize PFMT. Questionnaires regarding the participants' attitudes and practice toward PFMT were subsequently collected from "aware" group. RESULTS: The mean ±SD of age and gestational age were 30.5 ±5.4 years and 20.8 ±10.8 weeks, respectively. Sixty-one participants (55.5%) recognized PFMT, but only seventeen (27.9%) correctly answered all of the questions, which is classified as perceptive. There was no association between their educational level and PFMT knowledge (p = 0.63). Most of them (98.4%) understood that PFMT can be performed during pregnancy and believed that PFMT did not affect the pregnancy outcomes. However, only 10.7% of the aware women performed PFMT irregularly during pregnancy. CONCLUSION: Half of the pregnant women in this study were aware of PFMT. The majority of women felt that PFMT had positive effects on their health, emotions, sex, and quality of life. Education concerning PFMT and motivation to maintain the adherence of practicing the exercises are required.

Treatment for vaginal atrophy using microablative fractional CO2 laser: a randomized double-blinded sham-controlled trial.

OBJECTIVE: The aim of this study was to evaluate the efficacy of vaginal CO2 laser for the treatment of vaginal atrophy compared to the sham procedure. METHODS: Between June 2016 and May 2017, postmenopausal women with moderate to severe intensity of any vaginal atrophy symptoms (VAS) were invited to participate in the study. A total of 88 women were randomized to receive treatment with either vaginal CO2 laser or sham procedures every 4 weeks for three sessions. Both the participants and the evaluators were blinded to the treatment. Vaginal Health Index (VHI) score (primary outcome), VAS score, and the item for vaginal dryness from the International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms questionnaire were compared between the two groups by intention-to-treat analysis at 12 weeks after treatment. RESULTS: Eighty-eight women were enrolled into the study and nine women were lost to follow-up. After 12 weeks of laser treatment, the VHI, VAS, and International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms (item for vaginal dryness) scores were significantly improved. For VHI and VAS scores the mean difference between the laser group versus the sham group was 1.37 (95% CI: 0.12-2.63), P < 0.001 and -1.52 (95% CI: -2.21 to -0.82), P = 0.03, respectively. CONCLUSIONS: This study demonstrated that the application of microablative fractional CO2 laser was effective in treating vaginal atrophy. It could be a promising alternative treatment for postmenopausal women with vaginal atrophy. : Video Summary:http://links.lww.com/MENO/A582.

Video Summary:http://links.lww.com/MENO/A582.

Attitudes toward pessary use among Thai women with pelvic organ prolapse.

AIM: This study was conducted to investigate attitudes toward pessary use in Thai women with pelvic organ prolapse (POP). METHODS: Ninety Thai women with symptomatic POP without any history of previous prolapse treatment were recruited. Participants completed a questionnaire about attitudes toward pessary use in Thai language. Patient characteristics and decision-making factors were identified. RESULTS: Forty eight women (53.3%) decided to use a pessary. Most respondents felt that pessary use would improve emotional status (56.2%), pain (52.0%) and quality of life (75%). The opinions of family members and post-application bleeding, discharge, irritation and pain were important factors in decision-making. CONCLUSION: Many Thai women with POP prefer a pessary. Their decision is influenced by opinions of family members and complications of pessary use. Counseling about the advantages and uncommon complications of pessary use should be provided to both patients and family members to improve higher pessary acceptance.

Overactive Bladder Symptom Scores responsiveness before and after anticholinergic treatment in women with overactive bladder: The pilot study.

AIM: The aims of this study were: (i) to evaluate change of Overactive Bladder Symptom Scores (OABSS) from before to after solifenacin treatment; and (ii) to evaluate correlation between change of OABSS and 3-day micturition diary, International Prostate Symptom Score (IPSS), and Patient Perception of Bladder Condition (PPBC). METHODS: Thirty-six women, aged > 18 years, diagnosed as having overactive bladder (OAB) at King Chulalongkorn Memorial Hospital, with the symptoms of urgency, frequency with or without urge incontinence for more than 3 months, and at least three episodes of urgency with or without incontinence during the last 3 days prior to the study, were recruited during January 2010-May 2011. All cases received solifenacin 5-mg treatment once a day and were asked to record a 3-day micturition diary and to complete the Thai version of the OABSS, IPSS, and PPBC questionnaires at weeks 0, 4, and 12 after treatment. RESULTS: The OABSS, IPSS, and PPBC scores and all parameters of the 3-day micturition diary had changed significantly by weeks 4 and 12. The OABSS correlated significantly with IPSS score (r = 0.44), PPBC score (r = 0.39), and urgency episodes (r = 0.48). CONCLUSION: The OABSS had good responsiveness, similar to the other questionnaires (the IPSS and PPBC) and the 3-day micturition diary. The use of OABSS is recommended in OAB women for evaluation after anticholinergic drug treatment.

Correlations of third-trimester hiatal biometry obtained using four-dimensional translabial ultrasonography with the delivery route in nulliparous pregnant women.

PURPOSE: The goal of this study was to evaluate normal hiatal dimensions in the third trimester in nulliparous Thai pregnant women and to establish which biometric factors were associated with various pregnancy outcomes. METHODS: Fifty-seven consecutive nulliparous pregnant Thai women in their third trimester were recruited on a voluntary basis from April to October 2014. All subjects underwent four-dimensional (4D) translabial ultrasonography. Hiatal biometric parameters were measured at rest, while performing a Valsalva maneuver, and during contraction. Information about the patients' eventual deliveries was obtained from their medical records. RESULTS: The mean values of the patients' age, body mass index, and gestational age at the time of examination were 27.4±5.47 years, 26.7±3.48 kg/m(2), and 36.6±1.49 weeks, respectively. No subjects had vaginal lumps or experienced prolapse greater than stage 1 of the Pelvic Organ Prolapse Quantification system. Ultrasonography showed that the mean values of the hiatal area at rest, while performing a Valsalva maneuver, and during contraction were 13.10±2.92 cm(2), 17.50±4.81 cm(2), and 9.69±2.09 cm(2), respectively. The hiatal area at rest, the axial measurement at rest, and the axial measurement while performing a Valsalva maneuver were significantly associated with the route of delivery (P=0.02, P=0.04, and P=0.03, respectively). CONCLUSION: The route of delivery was associated with hiatal biometric values measured using 4D translabial ultrasonography, based on the results of nulliparous Thai women in the third trimester.

Should we use the shorter Thai-version quality of life and symptoms questionnaires in women with overactive bladder?

AIM: The aim of this study was to test: (i) the validation and reliability of the Thai versions of overactive bladder (OAB) questionnaires (the 8-item and 3-item Overactive Bladder Symptoms Score questionnaires [OAB-v8 and OAB-v3, respectively] and the Overactive Bladder Questionnaire [OAB-q]); and (ii) the correlation of the OAB-v8, OAB-v3, and the single-question Quality of Life Questionnaire (1-QoL) to the OAB-q in Thai women with OAB. MATERIAL AND METHODS: During January to March 2011, 36 Thai women with OAB attending a urogynecology clinic at Chulalongkorn Hospital, Bangkok, Thailand were recruited. All questionnaires were given as a psychometric test twice, 2 weeks apart. RESULTS: Cronbach's alpha of the OAB-v8 was higher (and above 0.7) than OAB-v3 at both week 0 and week 2. The intraclass correlations (ricc ) were 0.64, 0.85, and 0.97 for the OABV8, OAB-v3, and OAB-q, respectively. The correlation coefficient (r) of OAB-v3 and OAB-q at weeks 0 and 2 (0.40 and 0.49) were lower than those for OAB-v8 and OAB-q at weeks 0 and 2 (0.62 and 0.62). All questions on the OAB-v3 had a lower weighted kappa than OAB-v8. There was no statistically significant difference in the OAB-q score in each level of 1-QoL score at week 0 (P = 0.12) and at week 2 (P = 0.29). CONCLUSION: The reliability of the OAB-v3 is poorer than that of the OAB-v8. The OAB-v3 is poorer correlated to the OAB-q than to the OAB-v8. A short questionnaire, such as the OAB-v3 and the 1-QoL, has poor reliability and is poorly correlated to the OAB-q and is not recommended as a replacement for the standard questionnaires, such as the OAB-q and the OAB-v8. The OAB-v3 should only be used in large screening populations where there are time limits.

24-Hour pad tests in Thai continent women.

BACKGROUND: Twenty-four hours pad test is a simple tool to establish the differential diagnosis between high amount of vaginal secretion and urinary incontinence, evaluate the severity, and assess the result after treatment in women with urinary incontinence problem. The normal value of 24-hour pad test has been studied in non-Thai population. However; this may be different based on race. Therefore, this value in Thai population is important. OBJECTIVE: Identify the normal value of 24-hour pad test in Thai continent women by accurately comparing pad's weight before and after use. The secondary objective was to identify the factor associating the amount of vulvo-vaginal secretion. MATERIAL AND METHOD: Continent women were screened to exclude urinary incontinence by urogenital distress inventory (UDI-6) questionnaire. Participants were requested to use pad test for 24 hours. During study period, participants were advised to do their routine as usual but avoid exercise and sexual intercourse. Participants were able to change the pads as needed and asked to put the used pad in airtight plastic bag, kept them in a sealed envelope, and sent them to the researcher at their earliest convenience. Once received, the pads were kept in airtight plastic bag and were weighed. Weights were recorded. RESULTS: Two hundred twenty continent women were eligible to participate in the present study to determine the normal value of 24-hour pad test as our reference value. The median of 24-hour pad test was found to be 1.8 g of which the 95 percentiles was 4.7 g. The high amount of vaginal secretion were affected by premenopausal status, hormonal contraceptive used, and duration after menopause less than 5 years, which these factors were associated with estrogen. CONCLUSION: The authors developed a normal value of the 24-hour pad test that could be used as reference or initial information for further evaluation and diagnosis of urinary incontinence in Thai women.

Symptom score change and patient versus doctor satisfaction in overactive bladder before and after anti-muscarinic treatment.

AIMS: To evaluate voiding symptoms and questionnaire score change before and after anti-muscarinic treatment and evaluate the correlation of agreement in patient and doctor satisfaction after treatment. METHODS: Forty women newly diagnosed with overactive bladder (OAB), attending the urogynecology clinic at Chulalongkorn Hospital during April-June 2011 were recruited. Tolterodine 4 mg orally once daily was given for 4 weeks. A voiding diary and Thai version of the OAB questionnaires eight-item Overactive Bladder awareness tool (OAB-v8), Overactive Bladder Symptoms Score (OABSS) and Overactive Bladder QOL (OABq) were completed before and at the end of treatment. At the end of the trial, self-report patient satisfaction, and doctor satisfaction (according to symptom improvement in the voiding diary) were assessed. Student's t-test and weighted kappa coefficients were used in statistical analysis. Sample size was calculated from an OAB questionnaire pilot study with 20% addition for loss to follow up. RESULTS: All voiding parameters and questionnaire scores (OAB-v8, OABSS and OABq) were improved after treatment. Weighted kappa was only 0.06, between doctor and patient satisfaction. CONCLUSION: OAB-v8 and OABSS questionnaires can be used as screening and follow-up tools. There is poor agreement between patient and doctor satisfaction. Satisfaction should therefore be measured from the patient's perspective.

Reliability of Thai-Version Overactive Bladder Symptom Scores (OABSS) Questionnaire and the Correlations of OABSS with Voiding Diary, International Prostate Symptom Score (IPSS), and Patient Perception of Bladder Condition (PPBC) Questionnaires.

BACKGROUND: Overactive bladder (OAB) is defined by subjective symptoms such as urgency, frequency, and urge incontinence, rather than objective measures. Using questionnaires like OABSS can help in diagnosis and evaluation of patients'symptoms for further assessment. OBJECTIVE: To evaluate test-retest reliability of OABSS in 2-week interval and to evaluate the correlation of OABSS with voiding diary, IPSS, and PPBC. MATERIAL AND METHOD: Between August 2009 and January 2011, 56 Thai women aged more than 18 years, attending urogynecology clinic at King Chulalongkorn Memorial Hospital were recruited in the study. They were diagnosed as having the overactive bladder with these criteria, symptoms of urinary frequency, urgency with or without urge incontinence, for more than three months, and at least one episode of urgency with or without incontinence in last three days. After giving the written informed consents, the patients were instructed to complete the voiding diary before starting the study and at the second visit (two weeks apart). The Thai version of self-answered questionnaires (OABSS, IPSS, and PBC) were also given at 0- and 2-week visit. The questionnaires were translated by one linguist from the Language Institute, Chulalongkorn University, Thailand, and translated back by another linguist to English. The content and language validity were checked by one urogynecologist at our department. The study was conducted after the protocol was approval by the Institutional Review Board (IRB). RESULTS: The test-retest reliabilities (intraclass correlation) of the OABSS, PPBC, and IPSS total score were 0.88, 0.44, and 0.85. The overall Cronbach's alpha of OABSS was 0.31 and 0.41 at 0- and 2-week respectively. CONCLUSION: Thai version of OABSS was reliable, valid, and related to the abnormal voiding symptoms. Further use of Thai version OABSS questionnaire was advocated for both clinical study and clinical practice in Thai women with OAB.

Laparoscopic surgery for presumed benign ovarian tumor during pregnancy.

BACKGROUND: The surgical management of ovarian tumors in pregnancy is similar to that of non-pregnant women. The procedures include resection of the tumor (enucleation), removal of an ovary or ovaries (oophorectomy), or surgical excision of the fallopian tube and ovary (salpingo-oophorectomy). The procedure can be done by open surgery (laparotomy) or keyhole surgery (laparoscopy) technique. The benefits of laparoscopic surgery include shorter hospital stay, earlier return to normal activity, and reduced postoperative pain. However, conventional laparoscopic surgery techniques required the infusion of gas carbon dioxide in the peritoneum to distend the abdomen and displace the bowel upward to create the room for surgical manipulation. Serious complications such as abnormally high levels of carbon dioxide in the circulating blood (hypercarbia) and perforation of internal organs have also been reported. These serious complication may be harmful to the fetus. OBJECTIVES: To compare the effects of using laparoscopic surgery for benign ovarian tumor during pregnancy on maternal and fetal health and the use of healthcare resources. SEARCH METHODS: We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 11 November 2012. SELECTION CRITERIA: Randomized controlled trials with reported data that compared outcomes of laparoscopic surgery for benign ovarian tumor in pregnancy to conventional laparotomy technique. DATA COLLECTION AND ANALYSIS: Two review authors planned to independently assess trial quality and extract data. MAIN RESULTS: The updated search did not identify any randomized controlled trials. AUTHORS' CONCLUSIONS: The practice of laparoscopic surgery for benign ovarian tumour during pregnancy is associated with benefits and harms. However, the evidence for the magnitude of these benefits and harms is drawn from case series studies, associated with potential bias. The results and conclusions of these studies must therefore be interpreted with caution.The available case series studies of laparoscopic surgery for benign ovarian tumour during pregnancy provide limited insight into the potential benefits and harms associated with this new surgical technique in pregnancy. Randomized controlled trials are required to provide the most reliable evidence regarding the benefits and harms of laparoscopic surgery for benign ovarian tumour during pregnancy.

Preemptive analgesic efficacy of parecoxib vs placebo in infertile women undergoing diagnostic laparoscopy: randomized controlled trial.

STUDY OBJECTIVE: To compare the preemptive analgesic efficacy between parecoxib and placebo in infertile women undergoing outpatient diagnostic laparoscopy. DESIGN: Double-blind, randomized, placebo-controlled study (Canadian Task Force classification I). SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. PATIENTS: Sixty infertile women undergoing diagnostic laparoscopy from November 2009 to January 2011. INTERVENTION: Patients were randomized to receive either 40 mg parecoxib (treatment group) or normal saline solution as placebo (control group) intravenously at 15 minutes before surgery. Postoperative shoulder and wound pain was self-assessed using a visual analog scale at 2, 6, 12, and 24 hours after surgery. Administration of rescue analgesic agents, and adverse effects were recorded. MEASUREMENTS AND MAIN RESULTS: There were 30 patients in each group. Shoulder pain scores at each time measured, as well as wound pain score, was significantly lower in the parecoxib group compared with the placebo group (p < .001). The percentage of patients who required postoperative rescue analgesic therapy was lower in the treatment group compared with the control group (26.7% and 40.0%, respectively; p = .04). The treatment group required less rescue analgesic therapy than did the control group (mean [SD], 314.8 [53.9] and 842.6 [122.7] mg acetaminophen; p = .04). There was no significant difference in adverse effects between the 2 groups. CONCLUSION: Preoperative administration of 40 mg parecoxib, compared with placebo, provided significantly superior postoperative pain relief after diagnostic laparoscopy.

Impact on quality of life after ring pessary use for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to evaluate symptoms associated with pelvic organ prolapse (POP) and quality of life (QOL) improvement in patients who continue ring pessary use at 1 year. METHODS: Seventy-seven symptomatic POP patients had successful fitting, and 64 patients (83.1%) continued use at 1 year. The Thai version of Prolapse Quality of Life (P-QOL) questionnaire was used to evaluate symptoms associated with POP and impact on QOL. A higher score represents a greater impairment on the QOL, whereas a lower score represents a better QOL. RESULTS: Mean age was 66.7 ± 8.6 years, median parity was 4 (range 0-10), 59 patients (92.2%) were menopausal, and none had received hormone treatment. Only nine patients (14.1%) were sexually active. Most patients were in the advanced stage of POP - 32.8% stage 3 and 29.7% stage 4. Improvement of prolapse symptoms and voiding difficulty were reported in 100% and 85.7% of the patients, respectively. Among patients who had lower urinary tract symptoms at pre-treatment, about half of patients improvement in frequency, urgency, and urgency urinary incontinence. Only 9.1% of the patients had improvement in stress urinary incontinence (SUI), and 23.8% of the patients reported new onset of SUI (de novo SUI). The median score from all P-QOL domains except personal relationships were significantly decreased after 1 year of ring pessary use. The median total scores at baseline and at 1 year were 40 and 8, respectively (P < 0.001). CONCLUSIONS: Ring pessary is an effective non-surgical treatment to alleviate symptoms associated with POP. It can improve QOL in symptomatic POP patients.

Successful treatment of a heterotopic tubal pregnancy by gasless laparoscopic surgery.

Heterotopic pregnancy is a rare event and management is by either laparotomy or laparoscopic surgery to remove the extrauterine pregnancy. As there has been no report detailing the use of gasless laparoscopy for management of heterotopic pregnancy, the authors herein report a case of heterotopic pregnancy that was successfully managed by gasless laparoscopic surgery. The subsequent antenatal course was unremarkable. The intrauterine pregnancy carried to term with uneventful maternal and fetal outcomes. Thus, gasless laparoscopy can be used as an alternative method for the management of heterotopic pregnancy.

Validation of the Prolapse Quality of Life (P-QOL) questionnaire in Thai version.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to validate the Thai version of the Prolapse Quality of Life (P-QOL) questionnaire. METHODS: The P-QOL questionnaire was translated into Thai. Test-retest reliability and internal consistency were tested. All patients who visit the gynecologic outpatient clinic of King Chulalongkorn Memorial Hospital between March 2008 and September 2009 completed the P-QOL questionnaires. RESULTS: One hundred fifteen patients with symptomatic pelvic organ prolapse and 60 asymptomatic patients were included. There was a significant correlation between P-QOL domain scores and vaginal examination findings (POP-Q stage). A higher POP-Q stage and a higher impact on quality of life were detected in symptomatic patients. The total scores from all domains were significantly higher in symptomatic patients. CONCLUSION: The Thai version of the P-QOL questionnaire is a valid, reliable, and simple instrument to assess the symptoms' severity and the quality of life in Thai-speaking patients with pelvic organ prolapse.