Partial bicorporeal uterus with unexpected cervical findings and a longitudinal obstructing vaginal septum - a case report.

Mullerian duct anomalies are prevalent in 4-7% of the female population and come in many different shapes and forms. A lot of effort has already gone into trying to classify these anomalies, and some are still found that do not match any of the subcategories. We report a 49-year-old patient, presenting with abdominal pressure and recent onset of abnormal vaginal bleeding. A laparoscopic hysterectomy was performed, which revealed a U3a-C(?)-V2 mullerian anomaly with three cervical ostia. The origin of the third ostium remains unclear. Early and correct diagnosis of Mullerian anomalies is of the utmost importance to provide individually tailored care and to avoid unnecessary surgeries.

The rationale of opportunistic bilateral salpingectomies (OBS) during benign gynaecological and obstetric surgery: a consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG).

Ovarian cancer (OC), is a disease difficult to diagnose in an early stage implicating a poor prognosis. The 5-year overall survival in Belgium has not changed in the last 18 years and remains 44 %. There is no effective screening method (secondary prevention) to detect ovarian cancer at an early stage. Primary prevention of ovarian cancer came in the picture through the paradigm shift that the fallopian tube is often the origin of ovarian cancer and not the ovary itself. Opportunistic bilateral salpingectomy (OBS) during benign gynaecological and obstetric surgery might have the potential to reduce the risk of ovarian cancer by as much as 65 %. Bilateral risk-reducing salpingectomy during a benign procedure is feasible, safe, appears to have no impact on the ovarian function and seems to be cost effective. The key question is whether we should wait for a RCT or implement OBS directly in our daily practice. Guidelines regarding OBS within our societies are therefore urgently needed. Our recommendation is to inform all women without a child wish, undergoing a benign gynaecological or obstetrical surgical procedure about the pro's and the con's of OBS and advise a bilateral salpingectomy. Furthermore, there is an urgent need for a prospective registry of OBS. The present article is the consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG) regarding OBS.

Evolution of the mechanical properties of a medical device regarding implantation time.

BACKGROUND: Our study aimed at understanding the influence of healing time on the mechanical properties of meshes used in pelvic organ prolapse, once implanted in an animal model using the rat. METHODS: A standard polypropylene mesh was implanted in 42 rats in order to evaluate the mechanical properties of the implanted mesh. Explantation occurred at 1, 2, 3, 4 and 5 months and mechanical tests were performed. Each sample was mechanically evaluated by a uniaxial tensile test with a machine (BIOTENS). Biological tissues presented a nonlinear relation between stress and strain so it could be modeled by the 2 parameters C0 and C1 of a second-order Mooney-Rivlin law. RESULTS: The rigidity in small deformation might not be affected by healing time or the presence of the synthetic implant. On the contrary, changes seemed to occur on the stiffness in large deformation (C1). The stiffness with the mesh composite changed with healing time. The "two-month implantation" rat group was significantly more rigid than the two control groups (pcontrol/2months = 0,04 and pplacebo/2months = 0,04). The 2- and 3-month healing groups were significantly more rigid than the 1-month healing group (p1/2months = 0,01 and p1/3months = 0,003). After 2 months, the mechanical properties seemed to stabilize (p2/3months = 0,44, p2/5months = 0,16 et p3/5months = 0,3). CONCLUSION: In order to evaluate the mechanical properties of an implanted mesh, the optimal time for explantation seems to be 2 months. Once this period is over, a more physiological mesh will be developed in order to be similar to native vaginal tissue once implanted and colonized by scar tissue.

Experimental study of the mechanical behavior of an explanted mesh: The influence of healing.

To better understand the in vivo mechanical behavior of synthetic mesh implants, we designed a specific experimental protocol for the mechanical characterization of explanted mesh under uniaxial tension. The implantation of a mesh leads to the development of scar tissue and the formation of a new composite made of native tissue, a mesh implant and scar tissues. This study focused on three points: determining the minimum representative size of mesh implants required for mechanical test samples, highlighting the influence of healing, and defining the healing time required to ensure stabilized mechanical properties. First, we determined the minimum representative size of mesh implants for the mechanical characterization with a study on a synthetic composite made of mesh and an elastomeric matrix mimicking the biological tissues. The size of the samples tested was gradually decreased. The downsizing process was stopped, when the mechanical properties of the composite were not preserved under uniaxial tension. It led to a sample representative size 3cm long and 2cm wide between the grips. Then an animal study was conducted on Wistar rats divided into eight groups. One group was set as control, consisting of the healthy abdominal wall. The other seven groups underwent surgery as follows: one placebo (i.e., without mesh placement), and six with a mesh installation on the abdominal wall and healing time. The rats were sacrificed after different healing times ranging from 1 to 5 months. We observed the influence of healing and healing time on the mechanical response under uniaxial tension of the new composite formed by scar, native tissue, and textile. It seems that 2 months are required to ensure the stabilization of the mechanical properties of the implanted mesh. We were not able to tell the control group (native abdominal wall) from the placebo group (native and scar tissue). This protocol was tested on two different prostheses after 3 months of healing. With this protocol, we were able to differentiate one mesh from another after host integration.