Hysteroscopic versus histopathological agreement in the diagnosis of chronic endometritis: results from a retrospective observational study.

PURPOSE: To evaluate the agreement rate between hysteroscopy and pathological examination in case of chronic endometritis. METHODS: A retrospective observational study carried out at Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, Spain, from January 2021 to June 2022 was performed by obtaining data from 115 medical records of women who underwent office hysteroscopies that was compared with the findings of final histological examination of endometrial biopsy. Cohen's kappa index was used to evaluate this agreement rate. In addition, sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were obtained. RESULTS: The agreement between hysteroscopic findings and histological examination showed a modest result with a Cohen's kappa index of 34%. In addition, we obtained a specificity of 70% and a sensitivity of 64%. The positive and negative predictive value were 60.8% and 73.4%, respectively. An excellent agreement rate (100%) between histological and hysteroscopic results was observed in presence of hyperemia and micropolyps. CONCLUSION: Although the sample size is not as large as that of other studies published so far, the first glance of our experience is that hysteroscopic signs are not yet sufficient to make an accurate diagnosis of chronic endometritis, thus requiring a histopathological confirmation to make it.

Complications of Pessaries Amenable to Surgical Correction: Two Case Reports and a Systematic Review of the Literature.

BACKGROUND: Forty percent of women will experience prolapse in their lifetime. Vaginal pessaries are considered the first line of treatment in selected patients. Major complications of vaginal pessaries rarely occur. METHODS: PubMed and Embase were searched from 1961 to 2022 for major complications of vaginal pessaries using Medical Subject Headings (MeSH) and free-text terms. The keywords were pessary or pessaries and: vaginal discharge, incontinence, entrapment, urinary infections, fistula, complications, and vaginal infection. The exclusion criteria were other languages than English, pregnancy, complications without a prior history of pessary placement, pessaries unregistered for clinical practice (herbal pessaries), or male patients. The extracted data included symptoms, findings upon examination, infection, type of complication, extragenital symptoms, and treatment. RESULTS: We identified 1874 abstracts and full text articles; 54 were assessed for eligibility and 49 met the inclusion criteria. These 49 studies included data from 66 patients with pessary complications amenable to surgical correction. Clavien-Dindo classification was used to grade the complications. Most patients presented with vaginal symptoms such as bleeding, discharge, or ulceration. The most frequent complications were pessary incarceration and fistulas. Surgical treatment included removal of the pessary under local or general anesthesia, fistula repair, hysterectomy and vaginal repair, and the management of bleeding. CONCLUSIONS: Pessaries are a reasonable and durable treatment for pelvic organ prolapse. Complications are rare. Routine follow-ups are necessary. The ideal patient candidate must be able to remove and reintroduce their pessary on a regular basis; if not, this must be performed by a healthcare worker at regular intervals.

Is hysterosalpingo-foam sonography (HyFoSy) more tolerable in terms of pain and anxiety than hysterosalpingography (HSG)? A prospective real-world setting multicentre study.

BACKGROUND: In 60% of sterile couples a female factor is present, with these being tubal factors in 30-50% of cases. A tubal patency test is also required in women without a male partner undergoing fertility treatment. Thus, an accurate, safe and tolerable technique should be available. The aim of this study is to determine and to compare hysterosalpingo-foam sonography (HyFoSy) and hysterosalpingography (HSG) tolerability in terms of pain and anxiety. METHODS: This is a prospective real-world setting multicentre study conducted in two tertiary hospitals in Madrid. 210 infertile women/women without a male partner looking to get pregnant were recruited; 111 for the HyFoSy group and 99 for the HSG group. Tolerability was measured in terms of anxiety by the State Trait Anxiety Inventory (STAI) and pain by the Visual Analogue Scale (VAS). RESULTS: Median VAS score in HyFoSy group was 2 (P25; P75: 1; 3) versus 5 (4; 8) in HSG group, p < 0.001. The median State-STAI score in the HSG group was 18 points (10; 26) versus 10 (7; 16) in the HyFoSy group (p < 0.001); the median Trait-STAI score in the HSG group was 15 (11; 21) versus 13 (9; 17) in the HyFoSy group (p = 0.044). CONCLUSIONS: HyFoSy shows higher tolerability to both: pain and anxiety. It is related to less pain and less post-test anxiety than HSG.

Nuevas vías de tratamiento en la úlcera de Lipschütz / New treatment options in Lipschütz ulcer

Presentamos el caso de una paciente de 24 años, sin antecedentes médicos de interés, que acude a urgencias por aparición súbita de lesiones vulvares muy dolorosas. Ante la sospecha de úlceras de Lipschütz se pauta tratamiento con antiinflamatorios vía oral sin obtener a las 48 horas buenos resultados. Se decide entonces junto a la unidad de úlceras de nuestro centro realizar tratamiento local en 3 pasos, con excelentes resultados en 72 horas

We report a 24 year old girl case without medical relevant history who attended emergency room with the sudden appearance of very painful vulvar ulcers, suspecting Lipschütz ulcer we treat her with oral anti-inflammatory without any results in 48h. We decided together with ulcers unit to try a 3 step treatment with excellent results in 72 hours

3D Hysterosalpingo-contrast sonography: description of the technique and results / Histerosonosalpingografía con contraste 3D: descripción de la técnica y resultados

Objective: To describe the 3-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) technique and analyze our results with 2 contrast agents: SonoVue® and ExEm Foam®. Material and methods: Cross-sectional study of 160 infertility patients with unknown tubal patency. Results: Bilateral tubal patency was diagnosed in 102/153 (66.7%) patients. A similar proportion of bilateral occlusion was observed with both SonoVue® 5/87 (5.7%) and ExEm foam® 4/66 (6.1%) (p = 0.52). Intrauterine disease was suspected in 33/155 (21.3%) patients: 20% (18/90) with SonoVue® and 23.1% (15/65) with ExEm Foam® (p = 0.644). The visual analog scale (VAS) revealed mild pain (VAS ≤ 4: 86.4% [70/81] with SonoVue® vs. 86.8% [59/68]) with ExEm Foam® (p = 0.951). A pediatric nasogastric probe was easily used to cannulate the cervical os in 128/159 (80.5%) cases. The volume of ExEm foam® used was lower than that of SonoVue® (median: 3 cc vs.20 cc, p < 0.001). Conclusion: 3D-HyCoSy is a reliable, well-tolerated, and effortless tool for the sonographic assessment of sterility. The results were similar with both contrast agents (AU)

Objetivo: describir la técnica y analizar nuestros resultados con histerosonosalpingografía con contraste 3D (HyCoSy-3D) utilizando SonoVue® y Exem Foam®. Material y métodos: estudio retrospectivo de corte transversal en 160 pacientes estériles con permeabilidad tubárica desconocida. Resultados: l 66,7% (102/153) de las pacientes tuvo permeabilidad tubárica bilateral. El diagnóstico de obstrucción tubárica bilateral fue similar utilizando SonoVue® 5/87 (5,7%) y Exem Foam® 4/66 (6,1%), p = 0,52. Diagnosticamos patología intrauterina en 33/155 (21,3%) de las pacientes, 20% (18/90) con SonoVue® vs. 23,1% (15/65) p = 0,644. El dolor percibido resultó leve en la mayoría de los casos (escala visual analógica ≤ 4; 86,4% (70/81) SonoVue® vs. 86,8% (59/68), p = 0,951). La canalización cervical fue sencilla con sonda nasogástrica pediátrica en 128/159 (80,5%). Exem Foam® precisó un menor volumen instilado (mediana: 3 cc vs. 20 cc, p < 0,001). Conclusiones: la HyCoSy-3D es una prueba tolerable, sencilla y rentable para el estudio ecográfico en esterilidad. Ambos contrastes mostraron similares resultados (AU)

Prospective Study of Concordance Between Hysterosalpingo-Contrast Sonography and Hysteroscopy for Evaluation of the Uterine Cavity in Patients Undergoing Infertility Studies.

OBJECTIVES: The purpose of the study was to assess the accuracy of hysterosalpingo-contrast sonography (HyCoSy) for evaluation of the uterine cavity. METHODS: Hysterosalpingo-contrast sonography was compared with hysteroscopy for assessment of the uterine cavity. This work was a descriptive prospective study to assess the concordance between pathologic intrauterine findings using the Cohen κ coefficient. Ninety infertile patients from Puerta de Hierro University Hospital were included in the study. They underwent HyCoSy between June 2016 and April 2017. Fifteen of them had pathologic findings in the uterine cavity during HyCoSy and therefore underwent hysteroscopy. Clinical and sonographic findings were compared in those 15 patients by to evaluate the agreement between both techniques. RESULTS: In this study, intrauterine sonographic findings on HyCoSy and hysteroscopic features of the uterine cavity reached 100% concordance, with a κ coefficient of 1.000 and a 100% agreement rate. CONCLUSIONS: Hysterosalpingo-contrast sonography permits a very accurate evaluation of the uterine cavity, which could be of interest for infertile patients who might be examined for tubal patency.

Manejo conservador de incarceración uterina en 2 gestantes de segundo trimestre / Conservative management of uterine incarceration in the second trimester. Two case report

Presentamos 2 casos de gestantes en el segundo trimestre de embarazo que acudieron a nuestro centro por dolor e incapacidad para orinar, siendo diagnosticadas gracias a la exploración clínica y a la ecografía de incarceración uterina. Ambas fueron manejadas de forma conservadora, una mediante reducción manual con sedación y la otra mediante sondaje vesical y analgesia, lo que facilitó la resolución espontánea del caso. La incarceración uterina es una patología que tiene lugar con mayor frecuencia en el segundo trimestre de la gestación. Ocurre en mujeres gestantes, en la mayoría de las ocasiones, con un útero en retroversión. El aumento del tamaño del útero debido a la gestación produce un atrapamiento uterino entre el promontorio del sacro y la sínfisis del pubis. La clínica habitual es dolor e incapacidad para orinar. El diagnóstico debe estar basado en la exploración clínica y en la ecografía. El tratamiento habitual se basa en la reducción manual en quirófano que suele tener éxito en la mayoría de las ocasiones (AU)

We report the cases of 2 women in the second trimester of pregnancy who attended our center with pain and difficulty voiding. Based on physical and ultrasound examination, both women were diagnosed with uterine incarceration. Management was conservative in both patients, through manual reduction under sedation in one and by bladder catheterization and analgesia in the other, facilitating spontaneous resolution of the uterine incarceration. Uterine incarceration is a rare entity that occurs most frequently in the second trimester. It affects pregnant women, usually with retroverted uterus. The enlarged uterus due to pregnancy induces uterine entrapment in the pelvis between the sacral promontory and pubic symphysis. The most common symptoms are pain and progressive difficulty in voiding. The diagnosis of incarcerated uterus is based on physical and ultrasound examination. The usual treatment is based on manual reduction, which is usually successful (AU)

Evisceración transvaginal espontánea en paciente anciana con prolapso genital / Spontaneous vaginal evisceration in an elderly woman with genital prolapse

Presentamos el caso de una paciente con evisceración vaginal sin antecedentes de cirugía vaginal. La paciente fue intervenida en nuestro centro, realizándose una laparotomía con reposición de asas intestinales, corrección del defecto e histerectomía vaginal. En mujeres posmenopáusicas, la evisceración transvaginal se asocia a un aumento de la presión abdominal, la ulceración vaginal y los esfuerzos al defecar. En un 73% de los casos, existe algún tipo de cirugía vaginal previa. La clínica habitual es dolor, sangrado o sensación de masa en el introito. El íleo terminal es la víscera más frecuentemente implicada y el fórnix posterior de la vagina, el lugar más frecuente de herniación. La prevención está orientada a evitar intervenciones repetidas, alteraciones del suelo pélvico, hipoestrogenismo y aumento de la presión intraabdominal (AU)

We report the case of a patient with vaginal evisceration and no history of vaginal surgery. We performed a laparotomy with bowel replacement, correction of the defect and vaginal hysterectomy. In postmenopausal women, transvaginal evisceration is associated with increased abdominal pressure, vaginal ulceration and straining at stool. In 73% of patients, there is some type of prior vaginal surgery. The most common symptoms are pain, bleeding or sensation of a mass at the introitus. The most commonly involved viscera is the terminal ileum and the most common site of herniation is the posterior fornix of the vagina. Prevention is aimed at avoiding repeat interventions, pelvic floor disorders, hypoestrogenism, and increased abdominal pressure (AU)