Distinct types of uterine adenomyosis based on laparoscopic and histopathologic criteria.

PURPOSE: To analyze laparoscopically treated cases of adenomyosis based on intraoperative and histopathology findings and to correlate different types with patients' presenting symptoms and characteristics, as well as with the surgical approach. MATERIALS AND METHODS: Sixty-eight women who underwent laparoscopic treatment of adenomyosis at a referral center for gynecological laparoscopy. RESULTS: Four distinct types of adenomyosis could be identified: diffuse, sclerotic, nodular, and cystic (54.5%, 13%, 28%, and 4.5% of cases, respectively). Menorrhagia as the main presenting symptom was significantly more frequent in patients with the diffuse type (84%) compared to those with sclerotic (44%) and nodular (37%) types (p = 0.025 andp = 0.001, respectively). All cases of cystic and nodular adenomyosis were treated by laparoscopic excision of the lesion. Eighty-nine percent of patients with sclerotic adenomyosis were treated with wide laparoscopic excision of the abnormal tissue. Eighty-one percent of patients with diffuse adenomyosis were treated with laparoscopic hysterectomy. CONCLUSIONS: Adenomyosis can be classified in four distinct types with differences in the presenting symptoms, as well as in the ideal surgical approach.

Secondary repair of the perineum following childbirth.

The aim of the study was to evaluate secondary repair of the perineum following perineal trauma at childbirth. Patients who underwent secondary repair reported with symptoms of superficial dyspareunia, vulvo-vaginal pain, vaginal stenosis and broken or gaping wound. The study included 103 women over a 16-year period that underwent refashioning of the perineum at Northwick Park Hospital by the same surgeon. Among the cases, 81.6% were nulliparous and 18.4% were multiparous. Labour was induced in 30.1%, and 38% of the women required instrumental delivery. The length of the second stage of labour was 89 +/- 60 min for nulliparae and 50 +/- 48 min for multiparae. In 53.4% of the women, an episiotomy was performed. Catgut sutures were used in 69% of primary repairs. Predisposing factors for the need for secondary repair included nulliparity, forceps delivery, episiotomy, prolonged second stage of labour, surgeons' inexperience and the choice of suture material. Secondary repair is associated with a good result. A majority of women who required refashioning of the perineum for superficial dyspareunia presented late after the onset of the problem. In carefully selected women, such cases of superficial dyspareunia are easily treatable and surgery needs to be considered as an option.