[ANCHORLESS VAGINAL IMPLANT FOR THE TREATMENT OF ADVANCED PELVIC ORGAN PROLAPSE].

INTRODUCTION: The use of vaginal mesh in pelvic surgery has previously demonstrated anatomical advantage combined with surgical complications that have called its effectiveness into question. OBJECTIVES: To evaluate the safety and efficacy of an anchorless implant for the repair of pelvic organ prolapse (POP) in women with risk factors for recurrence. METHODS: Retrospective evaluation of the self-retaining support (SRS) implant in women with a ≥2 degree vaginal anterior and apical prolapse with an increased risk of prolapse recurrence. Demographic and clinical data were collected, and women suspected of recurrence, based on a telephone questionnaire, were re-examined. RESULTS: Sixty women were evaluated. Four (6.6%) underwent reoperation due to prolapse recurrence of the posterior and vaginal apex. No intra-operative complications were documented; 4 (6.6%) women had surgical field hematoma treated conservatively. No chronic pelvic pain or dyspareunia were documented. Six (10%) women who reported bulging sensation in the telephone questionnaire were examined and found to have prolapse of the posterior compartment and not of the anterior or apical compartment treated by the SRS. CONCLUSIONS: Use of the SRS demonstrated 93.3% success rate at a mean follow-up of 14 months postoperatively without intra-operative complications and mild post-op complications at follow-up. DISCUSSION: Short term data on the use of the SRS demonstrate that anchorless mesh technique may preserve the benefits of vaginal mesh while eliminating surgical complications. The SRS is a safe and effective surgical alternative for the repair of anterior and apical vaginal prolapse in women with advanced pelvic organ prolapse and risk factors for relapse.

Twin tubal pregnancy: a rising complication?

OBJECTIVE: To present four cases of twin tubal pregnancies and discuss possible etiologies. Twin tubal pregnancies are a rare event, with incidence rates estimated as 1 out of 725-1,580 of tubal pregnancies. DESIGN: Case series. SETTING: Department of obstetrics and gynecology at a tertiary health care facility. PATIENT(S): All women with twin tubal pregnancy diagnosed and treated in the department during the years 2007-2009, according to electronic files and histologic reports. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Artificial reproductive technique preceding twin tubal pregnancies RESULT(S): We diagnosed four twin pregnancies of 163 tubal pregnancies, an incidence of 2.4%. Of the four cases, two conceived after gonadotropin stimulation and intrauterine insemination. The third conceived following in vitro fertilization and intracytoplasmic sperm injection. The fourth was a spontaneous conception diagnosed as monochorial monoamniotic twin tubal pregnancy. CONCLUSION(S): Twin tubal pregnancies may not be as rare as previously thought. Three of the four cases identified during a 2-year period followed artificial reproductive technique. We hope that this report will promote the study of the epidemiology of this event, improve diagnosis, and encourage the development of treatment modalities.

Combined local and systemic methotrexate treatment of viable ectopic pregnancy: outcomes of 31 cases.

PURPOSE: Medical treatment of viable unruptured ectopic pregnancies by systemic methotrexate (MTX) is controversial due to elevated failure rates. This study describes a combined local and systemic MTX administration and compares the outcomes between viable ectopics in different locations. METHODS: This retrospective study evaluated 31 patients treated with combined local (sonographically guided) and systemic MTX for viable, unruptured ectopic pregnancies. Success was defined by pregnancy resolution without surgical intervention. Details on subsequent pregnancies were obtained via telephone questionnaires. RESULTS: The ectopic pregnancies were located in the fallopian tube (n = 23), cesarean section scar (n = 5), and intramural portion of the tube (interstitial pregnancy) (n = 3). beta-Human chorionic gonadotropin levels and gestational weeks were similar. The combined treatment was successful in 73.9%, 100%, and 66.7% of cases, respectively (p > 0.05). Details regarding reproductive outcomes were available for 28 women (90.3%). Eighteen of the 24 women attempting to conceive became pregnant, and 15 of these had at least one live birth. There were three subsequent tubal pregnancies, all in patients with previous tubal pregnancies. CONCLUSION: Combined MTX administration is effective and safe for treating viable cesarean scar pregnancies but is less successful for viable tubal or interstitial pregnancies. Reproductive outcomes following the combined MTX treatment are comparable to other treatment modalities for ectopic pregnancy.

[Adnexal masses: understanding and management].

Asymptomatic adnexal masses have become common findings due to the widespread use of the transvaginal ultrasound. Most asymptomatic adnexal masses are benign, but malignancy should still be excluded. The assessment of women with adnexal masses, intended to detect the ones suspicious for malignancy, includes the medical history, physical examination, ultrasound scan with Doppler flows, and, in some cases, the CA-125 levels. Once the patient has completed the primary assessment, the important decision is whether to follow her conservatively (if a benign condition is probable), or to proceed to surgery (if malignancy is suspected). This review discusses the evaluation, differential diagnosis, and general approach to adnexal masses, and proposes a management flow chart.

Arteriovenous malformation after uterine curettage: a report of 3 cases.

BACKGROUND: Acquired uterine arteriovenous malformation is a rare but potentially life threatening condition and, as such, must be considered in the differential diagnosis of cases of abrupt, profuse vaginal bleeding following uterine curettage. The condition can easily be confused with retained products of conception and gestational trophoblastic disease. CASES: One case was managed surgically, while 2 others were treated with selective embolization. CONCLUSION: A positive medical history, the clinical presentation and features for the the ultrasonic appearance are the main features for the correct differential diagnosis and treatment of traumatic arteriovenous malformation resulting from uterine curettage.