Safety and effectiveness of uterine fibroid embolization in patients with scarred uterus.

AIM: To evaluate the safety and effectiveness of uterine fibroid embolization (UFE) in patients with a scarred uterus caused by a previous myomectomy or cesarean section. METHODS: A total of 140 patients who underwent embolization for symptomatic fibroids were included in this retrospective study. The patients were divided into two groups, those with a history of myomectomy and/or cesarean section (scarred uterus group, n = 56), and those without surgical history involving the uterus (no-scar group, n = 84). Demographics, embolization details, outcomes, and complications were analyzed. RESULTS: The overall clinical success rate was 89.28% in the scarred uterus group and 95.24% in the no-scar group. There was no statistical difference in infarction rate or change in fibroid volume in follow-up magnetic resonance imaging between the groups. There was one major complication in the no-scar group, but there was no statistical difference in complications between the groups. The mean follow-up period was 25.9 months. The mean symptom-free time was 27.2 months in the scarred uterus group and 21.9 months in the no-scar group without a significant difference. There were no statistically significant differences in symptom changes, recurrence, and complication rates between the groups. Recurrence seen on imaging or regrowth was more common in the group with myomectomy history. However, there was no significant difference in symptom recurrence rates. CONCLUSION: No statistically significant difference in technical and clinical outcomes was observed between the two groups. There was no significant increase in complication rates of UFE in scarred uterus group.

Management of non-obstetric traumatic vulvar haematoma: a retrospective review of 33 cases.

The cases of non-obstetric traumatic vulvar haematomas are rare, and there is a lack of consensus statements for the necessity of surgical intervention. We retrospectively analysed the data of 33 cases (mean age: 25.7 years) of non-obstetric traumatic vulvar haematoma (mean haematoma size: 8.4 cm). Women who underwent surgery (surgery group) were compared to those who received conservative management (conservative group). Twenty-four patients underwent surgery; most cases were of haematoma removal and primary closure. Nine patients received conservative management, such as ice bag application, antibiotics, or analgesia. The rate of deviation of the contralateral vulva because of haematoma was higher (54.2% versus 11.1%, p = .047) and the mean haematoma size was larger (9.5 versus 5.2 cm, p = .004) in the surgical than in the conservative group. While conservative management affects cases of minor vulvar haematoma, surgical evacuation of haematoma can be performed in cases of large haematoma (mean size: 9.5 cm), severe pain, distorted vulvar anatomy, and invisible urethral opening for indwelling urinary catheter.IMPACT STATEMENTWhat is already known on this subject? Cases of non-obstetric traumatic vulvar haematomas are rare. There are no consensus statements for the necessity of surgical intervention.What do the results of this study add? The study showed that surgical evacuation of haematoma can be performed in cases of large haematoma (mean size: 9.5 cm), severe pain, distorted vulvar anatomy, and invisible urethral opening for indwelling urinary catheter. Moreover, surgical management could hasten recovery.What are the implications of these findings for clinical practice and/or further research? The results of this study can be used in counselling non-obstetric traumatic vulvar haematomas. Further research is needed to confirm these findings.

The effect of preoperative intravenous lidocaine on postoperative pain following hysteroscopy: A randomized controlled trial.

BACKGROUND: The use of hysteroscopy for the diagnosis and treatment of uterine and endometrial abnormalities is often associated with postoperative pain. This randomized controlled trial aimed to assess the efficacy of preoperative intravenous (IV) lidocaine in reducing pain after hysteroscopy. METHODS: In total, 138 patients undergoing elective hysteroscopy at the CHA Bundang Medical Center, Seongnam, Korea were randomly assigned to a control group (n = 69) or a lidocaine group (n = 69), which received normal saline or IV lidocaine at 1.5 mg/kg, respectively. The primary outcome was the incidence of postoperative pain. RESULTS: The incidence of pain was significantly lower in the IV lidocaine group than in the control group at the post-anesthesia care unit (27.3% vs 68.2%, P < .001). The visual analog scale (0-10) score (median [interquartile range]) was lower in the IV lidocaine group than in the control group (0 [0-2]) vs 2 [0-4]), P < .001). The use of rescue analgesics and postoperative nausea and vomiting were similar between the 2 groups. This study demonstrated that administering 1.5 mg/kg of preoperative IV lidocaine can be a simple method to reduce incidence of pain after hysteroscopy. CONCLUSION: Preoperative bolus administration of 1.5 mg/kg of IV lidocaine may be used to decrease incidence of pain after hysteroscopy under general anesthesia.

Correlation between obesity and pelvic organ prolapse in Korean women.

OBJECTIVE: This study aimed to evaluate the correlation between obesity and pelvic organ prolapse (POP), both anatomically and symptomatically, in Korean women. METHODS: We retrospectively reviewed 476 women who visited the urogynecology clinic between January 2013 and December 2016. All the enrolled women were Korean. We sought to evaluate the relationship between obesity and POP, both anatomically and symptomatically, by using a validated tool. Anatomic assessment was performed by a standardized Pelvic Organ Prolapse Quantification (POP-Q) system and symptomatic assessment was performed by a Pelvic Floor Distress Inventory (PFDI)-20 questionnaire. Obesity measurement was performed by measuring body mass index (BMI). RESULTS: We enrolled 476 women in our study. There was no statistically significant correlation between BMI and POP-Q or PFDI-20 scores: Ba (P=0.633), Bp (P=0.363), C (P=0.277), Pelvic Organ Prolapse Distress Inventory-6 (P=0.286), Colorectal Anal Distress Inventory-8 (P=0.960), Urinary Distress Inventory-6 (P=0.355), and PFDI-20 (P=0.355). In addition, there was no statistically significant correlation between BMI and POP-Q or PFDI-20 in patients with severe (greater than stage III) POP. We also separately analyzed the differences in the POP-Q points and PFDI-20 scores between the obese and non-obese groups. There was no statistically significant difference between the groups. CONCLUSION: We evaluated the correlation between obesity and POP using a validated tool. The present study revealed no significant correlation between obesity and POP severity anatomically or symptomatically in Korean women. This contrasts the results of most studies of Western women. Further studies in Asian women are required in order to confirm our results.

Uterine artery embolization versus cesarean hysterectomy in the management of postpartum hemorrhage.

Objective: The purpose of this study was to compare the efficacy and complications between cesarean hysterectomy and uterine artery embolization (UAE) in the management of postpartum bleeding.Material and methods: We analyzed the outcomes of 48 patients who underwent cesarean hysterectomy from October 2007 to January 2017, and 333 patients who underwent UAE for postpartum bleeding which was unresponsive to conservative management. We reviewed all medical records retrospectively, and assessed the length of hospital stay, amount of blood transfused, operative time, and all procedural-related complications.Results: There was a significant difference between the two groups in the mean hospital stay between the cesarean hysterectomy group and the UAE group (12.88 ± 15.37 days vs. 7.37 ± 15.92 days, respectively). The number of transfusions received by those in the cesarean hysterectomy group was larger than that in the UAE group, and this difference was also statistically significant (16.81 ± 11.23 pints vs. 5.59 ± 7.02 pints). The mean operative time of the UAE procedure was significantly shorter than the cesarean hysterectomy procedure (83 min vs. 179 min, respectively). We also closely compared complications during and after the procedures.Conclusion: We concluded that UAE is safer and more effective than cesarean hysterectomy for the management of postpartum hemorrhage unresponsive to conservative management.

The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management.

To investigate the clinical characteristics and risk factors for miscarriage of intrauterine normal pregnancy of patients with a heterotopic pregnancy (HP) after treatment.This was a retrospective study of medical records from CHA Bundang Medical Center. Sixty-four patients who were diagnosed with a HP between February 2006 and July 2017 were included in this study. All analyses were performed using SAS software, version 9.4 (SAS Institute, Inc., Cary, NC). P values < .05 were considered statistically significant.Forty-eight patients had tubal ectopic pregnancies (EP), 10 patients had cornual EPs, 1 patient had a cesarean section scar EP, 4 patients had an ovarian EP, and 1 patient had bilateral tubal EP. Among the 64 patients, 14.1% (9/64) miscarried before 10 weeks of gestation after management. Mean gestational age (GA) at treatment was 5.97 ±â€Š0.50 weeks and 6.80 ±â€Š1.04 weeks for miscarriage and nonmiscarriage group, respectively (P = .008). Significant differences were observed between 2 groups in terms of ultrasonographic features at the time HP was diagnosed (P = .040) Logistic regression models indicated that gestational age at treatment showed significant differences between 2 groups (OR: 0.003, 95% CI: 0.001-0.604).Immediate management after diagnosis could expect favorable prognosis of HP. GA at treatment was the only independent risk factor for miscarriage in patients with HP regardless of treatment methods.

Correlation between the posterior vaginal wall and apex in pelvic organ prolapse.

OBJECTIVE: The aim of our study is to reveal the correlation between the posterior vaginal wall and apex in pelvic organ prolapse. METHODS: We retrospectively reviewed the records of all new patient visits to a urogynecology clinic between January 2013 and December 2015. RESULTS: Four hundred five cases were enrolled in our study. When all POP stages were included, the Bp (pelvic organ prolapse quantification point) had a moderate correlation with the C (Pearson's r=0.419; P<0.001). Cases where Bp was stage 3 and above presented strong positive correlations with C (Spearman's ρ=0.783; P<0.001). Cases where C was stage 3 and above presented also strong positive correlations with Bp (Spearman's ρ=0.718; P<0.001). CONCLUSION: Posterior vaginal wall prolapse and apical prolapse were correlated with each other, and this correlation was more prominent as stage increased. Therefore, when admitting a patient suspected of posterior vaginal wall prolapse or apical prolapse, it is necessary to evaluate both conditions. Especially in cases more severe or equal to stage 3, it is a must to suspect both conditions as the 2 are strongly correlated.

Risk factors for massive postpartum bleeding in pregnancies in which incomplete placenta previa are located on the posterior uterine wall.

OBJECTIVE: To identify factors associated with massive postpartum bleeding in pregnancies complicated by incomplete placenta previa located on the posterior uterine wall. METHODS: A retrospective case-control study was performed. We identified 210 healthy singleton pregnancies with incomplete placenta previa located on the posterior uterine wall, who underwent elective or emergency cesarean section after 24 weeks of gestation between January 2006 and April 2016. The cases with intraoperative blood loss (≥2,000 mL) or transfusion of packed red blood cells (≥4) or uterine artery embolization or hysterectomy were defined as massive bleeding. RESULTS: Twenty-three women experienced postpartum profuse bleeding (11.0%). After multivariable analysis, 4 variables were associated with massive postpartum hemorrhage (PPH): experience of 2 or more prior uterine curettage (adjusted odds ratio [aOR], 4.47; 95% confidence interval [CI], 1.29 to 15.48; P=0.018), short cervical length before delivery (<2.0 cm) (aOR, 7.13; 95% CI, 1.01 to 50.25; P=0.049), fetal non-cephalic presentation (aOR, 12.48; 95% CI, 1.29 to 121.24; P=0.030), and uteroplacental hypervascularity (aOR, 6.23; 95% CI, 2.30 to 8.83; P=0.001). CONCLUSION: This is the first study of cases with incomplete placenta previa located on the posterior uterine wall, which were complicated by massive PPH. Our findings might be helpful to guide obstetric management and provide useful information for prediction of massive PPH in pregnancies with incomplete placenta previa located on the posterior uterine wall.

Embolization of Inferior Mesenteric Artery for Intractable Intrapelvic and Vaginal Bleeding After Hysterectomy.

Branches of the internal iliac artery or ovarian artery are the typical sources of pelvic hemorrhage. The inferior mesenteric artery has been rarely reported as the origin of pelvic bleeding. We present 2 cases of intractable intrapelvic and vaginal bleeding after hysterectomy. One patient underwent a hysterectomy because of uncontrolled postpartum hemorrhage and another underwent a vaginal hysterectomy to treat vaginal prolapse. Both patients were subjected to angiography to control continuous vaginal bleeding after hysterectomy. The angiography revealed that the bleeding originated from the inferior mesenteric artery. Selective embolization of the inferior mesenteric artery successfully controlled the intractable intrapelvic and vaginal bleeding without complications. The inferior mesenteric artery is a potential source of intractable intrapelvic and vaginal bleeding for patients with a lower genital tract injury.

The association of pelvic organ prolapse severity and improvement in overactive bladder symptoms after surgery for pelvic organ prolapse.

OBJECTIVE: The purpose of this study was to evaluate the impact of pelvic organ prolapse (POP) repair on overactive bladder (OAB) symptoms in women with POP and the effect of baseline POP severity on improvement in OAB after surgical repair of POP. And we also tried to identify any preoperative factors for persistent postoperative OAB symptoms. METHODS: A total of 87 patients with coexisting POP and OAB who underwent surgical correction of POP were included and retrospectively analyzed and postoperative data was obtained by telephone interview. OAB was defined as an affirmative response to item no. 15 (urinary frequency) and item no. 16 (urge incontinence) of the Pelvic Floor Distress Inventory. POP severity was dichotomized by Pelvic Organ Prolapse Quantification stage 1 to 2 (n=22) versus stage 3 to 4 (n=65). RESULTS: OAB symptoms were significantly improved after surgical treatment (P<0.001). But there was no significant differences in postoperative improvement of frequency and urge incontinence between stage 1 to 2 group versus stage 3 to 4 group. Preoperative demographic factors (age, parity, and POP stage) were not significantly related to persistent postoperative OAB symptoms. CONCLUSION: Women with coexisting POP and OAB who undergo surgical repair experience significant improvement in OAB symptoms after surgery, but severity of POP had no significant difference in improvement of OAB symptoms. Postoperative persistent OAB symptoms were not related to age, parity, body mass index, and POP stage.

Correlates of quality of life after stroke.

The relationship between lesion location and quality of life (QOL) in stroke patients has not yet been clearly revealed. The present study was undertaken to investigate the clinical and anatomical correlates which can predict future QOL in stroke patients. The study subjects consisted of 69 consecutive patients with ischemic stroke who were followed up 2 months after the stroke event at the stroke unit. Quality of life was evaluated during the 2-month follow up period after the stroke. Baseline information or data including clinical and anatomical correlates (Beck Depression Inventory, Beck Anxiety Inventory, Barthel's Index, MRI data) at the time of the stroke event were collected by performing a review of each patient's chart and research data files. Severe subcortical gray matter lesion and depressive symptoms in the acute phase of stroke were of importance in predicting low QOL 2 months after stroke.