Perineal abscess three years after a transobturator sling.

OBJECTIVE: This study aimed to report a unique perineal abscess after placement of a transobturator sling, involving the thighs and obturator regions bilaterally without involving mesh exposure. CASE REPORT: A 66-year-old woman treated for stress urinary incontinence with a transobturator sling developed a late bilateral obturator infection 30 months after surgery. This complication appeared 6 months after chemotherapy for breast cancer. Sling removal through vaginal and bilateral inguinal incisions was performed. The patient evolved well, without recurrence of the infection or incontinence. DISCUSSION: This case presents a unique scenario of muscle and skin infection after sling placement without any mesh exposure or vaginal involvement. The occurrence of the infection only after chemotherapy may indicate that immunosuppression had participation on its development. Care should be taken when exposing this mesh in contaminated perineal areas.

Uterine leiomyoma: understanding the impact of symptoms on womens' lives.

BACKGROUND: Most women report negative experience about the symptoms of uterine leiomyoma (UL) in their lives, such as abnormal uterine bleeding and pelvic pain. Many studies have been conducted about efficacy of UL treatment, but little research has been performed about womens health related quality of life (HRQL). METHODS: This is a semi-structured, descriptive, observational, qualitative study that was performed during eight months. Focus group (FG) interviews were performed with women attending at a tertiary hospital in Brazil, who were consecutively included in the study. Seventy women with symptomatic UL were recruited to this study. FG duration was one hour with mediators with 5-6 women at each group. Collected data from discussions was processed according to thematic analysis and stored at a qualitative software. RESULTS: Women were negatively influenced by the presence of symptomatic UL. The major themes that were noticed during analysis were: beliefs and attitudes towards UL; limitation to social and professional activities; sensation of fear/unfairness/discouragement towards the symptoms and adverse effects during treatment with GnRH analogs. CONCLUSIONS: Symptomatic UL has a negative impact on womens HRQL. Health providers should consider such impact when counseling women on their treatment options, since it may have an important influence in these patients' decision-making process. While current pharmacological treatments may improve disease specific outcomes, such as bleeding intensity and tumor volume, they fail on actually improving quality of life.

Comparison of the efficacy and safety of surgical procedures utilizing autologous fascial and transobturator slings in patients with stress urinary incontinence.

OBJECTIVE: To evaluate whether the conventional autologous fascial (AF) sling is superior or equal to the readjustable transobturator (TOT) sling in efficacy and safety in women with stress urinary incontinence (SUI). STUDY DESIGN: This was a retrospective study comprised of a sample of 463 patients from 2003 to 2009. A total of 203 women received TOT slings for urodynamically confirmed SUI, and 260 patients received AF slings. We analyzed the subjective success rate (cure and/or improvement) after 12 and 24 months of surgery as well as any immediate and late surgical complications. RESULTS: Both groups were statistically similar with regard to age, parity, body mass index, number of previous gynecological surgeries, and antiincontinence therapies. After 12 months patients with the TOT sling had a higher subjective percentage efficacy rate when compared to those with the AF sling (94% vs. 88%, p < 0.05); however, after 24 months this percentage was no longer statistically significant (88.7% vs. 84.6%, p = 0.20). The TOT sling presented fewer postoperative complication rates (14.1% vs. 25.6%, p < 0.05), similar intraoperative complication rates (1.15% vs. 2.3%, p = 0.22) and a shorter mean operative time (23 vs. 112 minutes, p < 0.05) than the AF sling. CONCLUSION: Both techniques had similar subjective efficacy rates, but the TOT sling demonstrated fewer postoperative surgical complications than the AF sling.

O valor da doplervelocimetria na avaliação do leiomioma uterino / The role of Doppler velocimetry in the assessment of uterine leiomyoma

Os autores fizeram uma revisão de literatura acerca da análise doplervelocimétrica como ferramenta ultrassonográfica do comportamento biológico da vasculatura uterina e do leiomioma uterino, e procuraram averiguar, por meio de revisão da literatura, se o Doppler poderia diferenciar o leiomioma do leiomiossarcoma e avaliar a resposta ao tratamento clínico com agonistas do GnRH, moduladores seletivos de receptores de progesterona e procedimentos minimamente invasivos destes tumores. Outros tipos de tratamento não foram avaliados. Apesar do restrito número de estudos e da baixa casuística de cada pesquisa isoladamente, observou-se que há uma mudança no índice de resistência dos parâmetros doplervelocimétricos após o tratamento farmacológico e/ou minimamente invasivo do leiomioma uterino; as demais variáveis se comportam de forma variável. Concluiu-se, portanto, que a doplervelocimetria parece não se constituir ainda um parâmetro confiável para diferenciar o leiomioma do leiomiossarcoma e de avaliação de resposta ao tratamento clínico

The authors performed a literature review about Doppler velocimetry as the ultrasonographic tool of the biological behavior from uterine and leiomioma vascularization. They also tried to ascertain through literature review if Doppler could differ between leiomioma to leiomyossarcoma and assess response to clinical treatment with GnRH agonists, selective modulators of progesterone receptors and minimally invasive procedures of these tumors. Other types of treatment were not evaluated. Despite the restrict number of studies and low sampling of each research, there was a change on resistant index from Doppler velocimetry patterns after pharmacological and/or minimally invasive treatment of uterine leiomioma; other indices behaved diversely. Therefore, we concluded that Doppler velocimetry does not constitute a good pattern to differ uterine leiomioma from leiomyossarcoma and of response assessment to clinical treatment

Giant perineal leiomyoma incidentally manifested at a recent episiotomy site: case report.

Benign leiomyomas are common soft tumors, arising especially in the female genital tract; unlike uterine leiomyomas, they rarely occur in perineal regions. They can develop wherever smooth muscle is present. Herein is reported the case of a large perineal leiomyoma in a 36-year-old woman who noted a palpable mass close to the rectum 1 year after she had delivered vaginally, in the same region of as a mediolateral episiotomy. Complete surgical excision was performed. Histopathologic findings were compatible with benign leiomyoma. At postoperative follow-up, no signs of anal dysfunction were noted. There was no pathologic correlation between formation of the leiomyoma and the episiotomy despite a possible association between the presence of fibrosis and development of leiomyomas, which was found during a literature review. Microarray analysis will be necessary to elucidate this hypothesis.

Leiomioma cervical gigante: relato de caso / Giant cervical leiomyoma: case report

Os autores descrevem uma histerectomia abdominal realizada devido ao grande sangramento causado pelo leiomioma cervical de grande volume, e fazem uma revisão de literatura sobre o tratamento cirúrgico e as variações técnicas. Verificou-se que o tratamento de escolha é a miomectomia, embora não exista padrão definido para o tipo intracervical. Porém, a via laparoscópica, apesar de benéfica para a paciente, apresenta inúmeras dificuldades técnicas, como suturar a base pedicular após enucleação do leiomioma, sangramento no intraoperatório e distorção anatômica causada pelo tamanho tumoral. Diversas técnicas para minimizar tais dificuldades também são descritas.

The authors describe an abdominal hysterectomy performed due to large bleeding caused by a giant cervical leiomyoma, and they carry out a literature review about the surgical treatment and techniques variations. It was verified that the first surgical choice is myomectomy, although there is not a defined pattern for intracervical type. However, the laparoscopic approach presents several technical difficulties, such as suture of leiomyoma pedicle after its enucleation, intraoperative bleeding, and anatomic distortion caused by tumor size, despite it has more benefits for the patient. Other techniques for minimize such difficulties are also described.