Comparison of the Effect of Laparoscopic and Abdominal Hysterectomy on Lower Urinary Tract Function, Vaginal Length, and Dyspareunia: A Randomized Clinical Trial.

OBJECTIVES: The effect of hysterectomy on vesicourethral and sexual functions remains controversial. The primary objective of this study was to compare the effects of a laparoscopic hysterectomy and a total abdominal hysterectomy on lower urinary tract function. The secondary aims were to compare the two surgeries in terms of postoperative vaginal length and dyspareunia. MATERIALS AND METHODS: This was a prospective randomized clinical study in which 292 women were assigned to either the laparoscopic hysterectomy (n = 146) or total abdominal hysterectomy (n = 146) groups. The vaginal length and urodynamic measurements were taken, and the patients were asked to grade the presence and severity of dyspareunia using a visual analog scale 3 weeks before and 12 weeks after the surgery. The relationship between the postoperative vaginal length and the incidence of dyspareunia was evaluated. The urodynamic procedures used included uroflowmetry and voiding cystometry to record the maximum flow rate (Q-max) and to assess the bladder capacity. RESULTS: The preoperative vaginal length was similar between the groups, whereas the postoperative vaginal length was significantly longer in the laparoscopic hysterectomy group. When the 15 patients who developed postoperative dyspareunia were evaluated, no differences in the postoperative vaginal length were seen, but a significant difference in the change in the length of the vagina was found when compared with the other patients. No significant difference was found with regard to pre- and postoperative Q-max, bladder capacity, and change in bladder capacity between the study groups. CONCLUSIONS: The change in the length of the vagina was much more remarkable after total abdominal hysterectomy, compared with laparoscopic hysterectomy. It seems that the Q-max and the bladder capacity increase after hysterectomies, regardless of the surgical type. Further prospective randomized comparative studies are warranted to ascertain whether laparoscopic hysterectomies cause less damage to the pelvic floor, compared with abdominal hysterectomies.

Acute abdomen due to rupture of Sertoli cell tumor.

PURPOSE: To present a rare case of Sertoli cell tumor that presents with acute abdomen. CASE: A 28-year-old patient with symptoms of acute abdomen has presented to our emergency department. Her examinations revealed a 12 x 10 cm heterogeneous mass in the right ovarian fossa. Laparotomy was carried out immediately. Frozen pathological study revealed a low-grade sex-cord stromal cell tumor. Right salpingo-oopherectomy was performed. During 2 years of follow-up, there was no evidence of disease. CONCLUSION: Although rupture of a malignant ovarian tumor is an infrequent cause of acute abdomen, it should be considered in the differential diagnosis of acute abdomen.

Treatment of a viable caesarean scar pregnancy with transvaginal methotrexate and potassium chloride injection.

PURPOSE: To present a case of an ectopic pregnancy in a previous caesarean scar in a woman who wishes to preserve her fertility, and its treatment with the local administration of potassium chloride (KCl) and methotrexate (MTX) via a transvaginal needle. CASE: A 35-year-old woman with a viable caesarean scar pregnancy was referred to our hospital. After an unsuccessful treatment attempt by administering 60 mg systemic methotrexate, the patient was treated with local administration of KCl and MTX using a transvaginal needle. The persistent ectopic mass was removed with dilatation and curettage (D&C) 1 week later. The patient had no complications and the treatment was successful in the follow-up examinations. CONCLUSION: Local MTX and KCl treatment using a transvaginal needle together with D&C can avoid unnecessary laparotomy, and helps to preserve the fertility of most women with a caesarean scar pregnancy.