Ultrasound changes in the relationship between the urethra and bladder neck caused by prolapse repair: feasibility and reliability of measurements.

The objective of this study was to assess whether intraoperative transperineal ultrasound can be used to assess changes in the relationship between the urethra and bladder caused by a prolapse repair operation. The reliability of the measurements was also assessed. A total of 25 women having an anterior colporrhaphy operation had pre- and post-repair imaging using a standard bladder volume. There was a statistically significant change (p ≤ 0.04) in the posterior urethrovesical angle (PUA) from 115° (SD 37) before surgery, to 135° (SD 30) after surgery. There was no significant change (p = 0.93) in the anterior urethrovesical angle before 73° (SD 14) after surgery 73° (SD 14). Interclass correlation coefficients showed good reproducibility for all measurements. Ultrasound can be used to measure changes in the relationship of the urethra and bladder produced by anterior colporrhaphy. Clinically, the effect of these changes is to reduce the angulation of the urethra in relation to the bladder.

Heterotopic pregnancy: simultaneous intrauterine and ectopic pregnancy following IVF treatment with the birth of a healthy child.

Although spontaneous simultaneous intrauterine and ectopic pregnancy was an extremely rare event in the past, it is increasingly being diagnosed since the rate of assisted reproduction technique (ART) gestations increased. Due to the serious consequences, delayed diagnosis should be prevented in order to salvage the viable intrauterine fetus and avoid maternal morbidity and mortality. This case report demonstrates that the pitfalls of the diagnosis of heterotopic pregnancy make early diagnosis difficult and the prevention of heterotopic pregnancies by single embryo transfer should be continuously discussed. The role of high resolution ultrasound scans and the importance of close monitoring of early pregnancies following ART are emphasized because early diagnosis of heterotopic pregnancy results in a similar perinatal outcome as singleton pregnancies.

[Feto-amniotic shunting for lower urinary tract obstruction (LUTO)--a case report]. / Feto-amniale Shunteinlage bei distaler fetaler obstruktiver Uropathie - eine Kasuistik.

Posterior urethral valves are the main cause of fetal lower urinary tract obstruction (LUTO) with typical sonographic signs like urinary tract dilatation and reduction of amniotic fluid. LUTO is associated with a high rate of perinatal mortality and is the main cause of kidney failure in early childhood. In such cases vesico-amniotic shunting is a common but risky procedure of fetal surgery to prevent anhydramnion and lethal lung hypoplasia. This case report demonstrates that lung hypoplasia can be prevented by vesico-amniotic shunting of the fetal megacytis in the 23rd week of gestation in a fetus with lower urinary tract obstruction and anhydramnion. The prenatal measured concentration of cystatin C in the fetal urine correlated with the postnatal impaired kidney function. The indication and therapeutic benefit of vesico-amniotic shunting remain controversially discussed in the literature because until today there is no evidence for a reduction in perinatal or long-term morbidity due to early fetal kidney damage. The earlier ultrasound detection of LUTO during the first trimester of pregnancy proposes the possibility of earlier intervention and protection of nephrogenesis. First case studies about first trimester vesico-amniotic shunting have been published; the influence on the postnatal kidney function merits further well-structured investigation.