Female sexual function and quality of life after pelvic floor surgery: a prospective observational study.

INTRODUCTION AND HYPOTHESIS: Knowledge about the impact of pelvic floor surgery on sexual function is limited and inconsistent. A prospective study assessed the impact of surgery for prolapse (POP) or stress urinary incontinence (SUI) on sexual function and determined the biopsychosocial predictors for changes in sexual function after surgery. MATERIALS AND METHODS: Sexually active women scheduled for correction of POP and/or SUI were recruited over a 6-month period. Consenting participants were asked to complete the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to evaluate sexual function. The King's Health Questionnaire and Prolapse Quality-of-Life Questionnaire were used to assess UI and POP symptoms and their impact on quality of life (QoL), respectively. Women were reviewed over a period of 1 year post-surgery. RESULTS: Ninety-one patients were followed up over 1 year. After stratification into only or both SUI and POP surgery, global sexual function improved significantly in each group (p < 0.001). The improvement in the overall QoL score after pelvic surgery showed a significant correlation with the improvement in global sexual function (SUI group: r = - 0.38, p < 0.01; POP group: r = - 0.44, p < 0.05). For women undergoing SUI surgery, only educational level and prior hysterectomy had a significant association with improved sexual function. For women undergoing POP surgery with or without SUI surgical repair, no sociodemographic characteristics were preditive of improvement of sexual function. CONCLUSIONS: Significantly improved sexual function was observed 1 year after pelvic floor surgery, and the improvement was predicted by other social and physical factors in addition to normal functional anatomy.

Successful management of a rudimentary uterine horn ectopic pregnancy by combining methotrexate and surgery: A case report.

Pregnancy in a non-communicating rudimentary uterine horn is rare but presents a significantly increased risk of maternal and foetal morbidity due to uterine rupture. We describe a case of rudimentary horn pregnancy diagnosed in the first trimester in an asymptomatic and haemodynamically stable woman. Medical termination of the pregnancy was performed with systemic and intrasacular methotrexate. Laparoscopic uterine horn excision was performed three months after termination. This case shows that early diagnosis of a rudimentary horn pregnancy is key to the successful management of this condition. Preoperative medical termination in an asymptomatic woman proved to be an effective and safe option that minimized surgical risks.

Higroma quístico - Diagnóstico pré-natal, prognóstico obstétrico e pediátrico / Cystic hygroma - Prenatal diagnosis, obstetric and pediatric outcome

Introdução: O higroma quístico (HQ) é uma malformação congénita diagnosticada durante a gravidez pela demonstração ecográfica de uma estrutura quística na região occipitocervical. Pode surgir isolado ou em associação a anomalias cromossómicas, malformações fetais ou síndromes genéticas, com prognóstico global reservado. O objetivo deste trabalho foi avaliar a conduta obstétrica e os resultados pediátricos dos sobreviventes com higroma quístico (HQ). Material e métodos: Estudo retrospetivo descritivo de 224 grávidas com HQ fetal, diagnosticadas ou referenciadas ao Centro de Diagnóstico Pré-Natal da nossa instituição, entre janeiro de 1991 e julho de 2011. Resultados: A idade gestacional média ao diagnóstico foi de 13 semanas, 77,7% dos casos diagnosticados no primeiro trimestre. Ecograficamente, 66 casos estavam associados a hidrópsia. O cariótipo fetal foi determinado em 206 casos, com deteção de 107 anomalias cromossómicas. O cariótipo foi normal em 99 casos, tendo sido detetados 12 casos de doenças genéticas e 18 de malformações estruturais fetais. A interrupção médica de gravidez foi a opção de 111 pacientes, registaram-se 39 casos de morte in utero e 61 nados-vivos. O tempo médio de seguimento dos sobreviventes foi de 75 meses, tendo-se verificado um desenvolvimento psicomotor adequado em 30 casos. Conclusão: Perante o diagnóstico de HQ, é essencial esclarecer a etiologia, de modo a definir o prognóstico e orientar corretamente a gravidez. Existe uma forte correlação entre o diagnóstico de HQ com aneuploidia fetal, conferindo-lhe pior prognóstico em comparação com os casos de HQ sem evidência de alterações cromossómicas ou malformações estruturais fetais, geralmente com bons resultados neonatais e pediátricos (AU)

Introduction: Fetal cystic hygroma (CH) is a congenital malformation prenatally diagnosed by the demonstration of a cystic structure in the occipitocervical region on ultrasound. It may appear isolated or in association with chromosomal abnormalities, fetal malformations or genetic syndromes, with a poor overall prognosis. The main purpose of this work was the evaluation of the obstetric management and paediatric outcome for the survivors of CH. Material and method: Retrospective analysis of 224 pregnant women with fetal CH, diagnosed or referred to our prenatal diagnosis centre, from January 1991 to July 2011. Results: The mean gestational age at diagnosis was 13 weeks and 77.7% of cases were diagnosed in the first trimester. On ultrasound, 66 cases were associated with hydrops. Fetal karyotype was obtained in 206 cases, and chromosomal abnormalities were found in 107. Fetal karyotype was normal in 99 cases, detected 12 cases of genetic diseases and 18 cases of fetal malformations. Elective pregnancy termination was undertaken by 111 patients. There were 39 cases of spontaneous fetal demise and 61 live births. The mean follow-up of survivors was 75 months, and normal paediatric outcome was confirmed in 30 cases. Conclusion: It is essential to clarify the underlying aetiology of CH in order to establish a prognosis and counselling. There is a strong association with fetal aneuploidy and significantly worse outcome in contrast in cases without evidence of chromosomal or structural abnormalities, most of them carrying good prognosis (AU)

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[Minimally invasive surgery in women with recurrent stress urinary incontinence]. / Cirurgia minimamente invasiva na mulher com incontinência urinária de esforço.

OBJECTIVES: Evaluate the efficacy and safety of minimally invasive surgical techniques as second procedure in recurrent stress urinary incontinence (SUI). STUDY DESIGN: We retrospectively analyzed data on patients submitted to this type of surgery after previous surgery failure, since September 2002 to December 2006. Several parameters were evaluated: women's age, symptoms, previous surgery, urodynamics results, procedure technique, complications at short (two months) and medium term (one year) results. RESULTS: Of the 73 analyzed cases, 57 patients had been submitted previously to classic surgery and 16 to minimally invasive surgery. In surgery for recurrent SUI using minimally invasive techniques eight complications were registered (five vaginal perforations, two bladder lacerations and one femoral vein laceration); post-op complications occurred in 13 cases (three urinary retentions, two urinary tract infections, one anaemia and seven vaginal sling erosions). Short-term cure, improvement and failure rates were 69.9%, 28.8% and 1.4%, respectively. At medium term, these rates were of 54.8%, 41.1% and 4.1%, respectively. CONCLUSIONS: Minimally invasive surgery for recurrent SUI is a valid option after previous surgery failure, given the low morbidity and reduced failure rate at short and medium term.

Laparoscopia na decisão da estratégia terapêutica para o casal infértil / Laparoscopy in the decision of treatment strategy for the infertile couple

OBJETIVO: avaliar a contribuição da laparoscopia diagnóstica na abordagem do casal infértil. MÉTODOS: estudo retrospectivo com análise dos 86 casos consecutivos de pacientes acompanhadas em consulta de esterilidade que foram submetidas à laparoscopia entre Janeiro de 2004 e Dezembro de 2006. Oitenta e duas pacientes tinham realizado histerossalpingografia (HSG) previamente à laparoscopia. Avaliaram-se os achados laparoscópicos bem como os procedimentos acessórios efetuados, e correlacionaram-se os achados histerossalpingográficos com os da laparoscopia. A análise estatística foi efetuada com o Statistical Package for the Social Sciences 15. A sensibilidade e a especificidade da HSG foram determinadas e os intervalos de confiança calculados assumindo-se um erro alfa de 0,05 (IC95 por cento). RESULTADOS: na laparoscopia foram identificadas alterações compatíveis com endometriose em 21 casos (24,4 por cento), salpinge uni/bilateral em 14 casos (16,3 por cento) e doença inflamatória pélvica em 16 casos (18,6 por cento). Procedeu-se à adesiólise e à fulguração dos focos de endometriose em oito pacientes. Foram feitas duas salpingostomias, duas quistectomias do paraovário, duas quistectomias do ovário e três drillings do ovário. A prova de permeabilidade tubar foi normal em 44 casos (53 por cento), revelou obstrução unilateral em 21 (25,3 por cento) e obstrução bilateral em 17 (20,5 por cento). Os resultados da histerossalpingografia foram concordantes com os da laparoscopia em 44 dos 82 casos (53,7 por cento). Quando definimos doença como qualquer forma de obstrução tubar presente na laparoscopia, a sensibilidade da HSG foi 0,79 (IC95 por cento=0,62-0,9) e a especificidade 0,58 (IC95 por cento=0,42-0,73). Quando limitamos a definição de doença à presença de obstrução tubar bilateral na laparoscopia, a sensibilidade e a especificidade da HSG foram 0,47 (IC95 por cento=0,24-0,71) e 0,77 (IC95 por cento=0,64-0,86), respectivamente. Em nove casos (15,3 por cento) em que a HSG havia sido normal ou revelado apenas obstrução unilateral, a laparoscopia revelou obstrução bilateral. Em 15 casos (65,2 por cento) em que a HSG havia demonstrado obstrução bilateral, a laparoscopia foi normal ou revelou apenas obstrução unilateral. CONCLUSÕES: a laparoscopia demonstrou sua relevância diagnóstica e terapêutica revelando-se fundamental na clarificação do status tubo-peritoneal. Permitiu a realização concomitante de atos terapêuticos, possibilitando a definição da melhor estratégia terapêutica no casal infértil.

PURPOSE: to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple. METHODS: retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG) prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95 percentCI). RESULTS: the laparoscopy revealed 21 cases of endometriosis (24.4 percent), 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3 percent), and 16 cases of pelvic inflammatory disease (18.6 percent). Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53 percent), revealed unilateral obstruction in 21 cases (25.3 percent) and bilateral obstruction in 17 cases (20.5 percent). The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7 percent). HSG sensitivity was 0.79 (95 percentCI=0.62-0.9) and its specificity was 0.58 (95 percentCI=0.42-0.73) when the disease was defined as any form of tubal occlusion detected with the laparoscopy, wheter this occlusion was one-sided or two-sided. HSG sensitivity and specificity were 0.47 (95 percentCI=0.24-0.71) and 0.77 (95 percentCI=0.64-0.86), respectively, when the definition of the disease was limited to two-sided tubal occlusion. In nine cases (15.3 percent) in which HSG had shown normal findings or only a unilateral occlusion, laparoscopy revealed a two-sided occlusion. And in 15 cases (65.2 percent) in which HSG had shown a two-sided occlusion, laparoscopy revealed normal findings or one-sided occlusion. CONCLUSIONS: the laparoscopy demonstrated its diagnostic and therapeutic relevance, proving to have fundamental importance for the clarification of the tuboperitoneal status. It has permitted the development of concomitant accessory therapeutic procedures, thus defining the best treatment strategy for the infertile couples.

[Laparoscopy in the decision of treatment strategy for the infertile couple]. / Laparoscopia na decisão da estratégia terapêutica para o casal infértil.

PURPOSE: to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple. METHODS: retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG) prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95%CI). RESULTS: the laparoscopy revealed 21 cases of endometriosis (24.4%), 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3%), and 16 cases of pelvic inflammatory disease (18.6%). Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53%), revealed unilateral obstruction in 21 cases (25.3%) and bilateral obstruction in 17 cases (20.5%). The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7%). HSG sensitivity was 0.79 (95%CI=0.62-0.9) and its specificity was 0.58 (95%CI=0.42-0.73) when the disease was defined as any form of tubal occlusion detected with the laparoscopy, whether this occlusion was one-sided or two-sided. HSG sensitivity and specificity were 0.47 (95%CI=0.24-0.71) and 0.77 (95%CI=0.64-0.86), respectively, when the definition of the disease was limited to two-sided tubal occlusion. In nine cases (15.3%) in which HSG had shown normal findings or only a unilateral occlusion, laparoscopy revealed a two-sided occlusion. And in 15 cases (65.2%) in which HSG had shown a two-sided occlusion, laparoscopy revealed normal findings or one-sided occlusion. CONCLUSIONS: the laparoscopy demonstrated its diagnostic and therapeutic relevance, proving to have fundamental importance for the clarification of the tuboperitoneal status. It has permitted the development of concomitant accessory therapeutic procedures, thus defining the best treatment strategy for the infertile couples.