Successful treatment of infertility due to retrograde ejaculation by instillation of serum-containing medium into the bladder. A case report.

The treatment of infertility caused by retrograde ejaculation has often been ineffective. The unphysiological composition of the urine is the main reason complicating the recovery of motile sperm. We describe a case of retrograde ejaculation caused by a congenital defect of the internal sphinchter muscle of the urinary bladder. In this case, motile sperm were only recovered if the bladder had been filled previously with artificial culture medium (Ham's F-10) supplemented with the patient's own serum. Two pregnancies followed intrauterine insemination with sperm recovered in this way.

Abdominal hysterectomy versus supravaginal uterine amputation: psychic factors.

In the present study, the psychic complaints after abdominal hysterectomy (n = 105) and supravaginal uterine amputation (n = 107) are investigated. The first author interviewed personally all the subjects preoperatively and 6 weeks, 6 months, 1 year and 3 years postoperatively. The proportion of subjects without psychic symptoms increased from 49.5% to 67.7% in the hysterectomy group (p less than 0.01) and from 53.3% to 76.8% in the amputation group (p less than 0.001). The difference between the groups at 3 years phase was significant (p less than 0.01). From the single symptoms, nervousness or irritability and depression, decreased during the follow-up period significantly in the amputation group but not in the hysterectomy group. The results clearly indicate that the view of an increased risk for depression or other psychic complications after removal of the uterus should be revised. On the other hand, the results support our earlier findings that supravaginal uterine amputation is still an applicable method in benign conditions.

Influence of preoperative intracavitary high (Co60, Cathetron) and low dose-rate (radium) irradiation on surgical difficulties and postsurgical morbidity in patients with uterine carcinoma.

A study was made to determine whether high dose-rate afterloaded Co60 (Cathetron) can be safely used in preoperative radiotherapy for patients with St. I-II cervical or endometrial cancer without an increase in surgical difficulties or postsurgical morbidity when compared with conventional radium therapy. Seventy-five patients with cervical cancer St. Ia-IIb were operated on radically two to three weeks after preoperative intracavitary radiotherapy of which 31 had been treated with the Cathetron and 44 with radium. Furthermore, 144 patients with endometrial cancer St. I-II were also operated on, of which 49 had received Cathetron and 95 radium treatment. No statistical differences were found between the two treatment groups in the duration of the operations, blood loss, or the frequency of early or late postoperative complications.

Sexual behaviour and cervical intraepithelial neoplasia in teenagers.

Four groups of females 19 years of age were studied in order to investigate the sexual factors in the development of cervical intraepithelial neoplasia (CIN) in teenagers. Group A consisted of 101 females treated for CIN, group B of 55 females with inflammatory atypic cytology (Pap cl. II), group C of 73 women with cervical chlamydial infection, and group D of 114 females with normal cervical cytology and negative chlamydial isolation. Subjects in group A had had significantly more deliveries and legal abortions than the subjects in the other groups. They used also more often oral contraception and had been treated more often for vaginal infections than the subjects in the other groups. Coital activities in group A had started at a significantly younger age than in group D; in the latter group 40% had no history of sexual intercourse. Also the numbers of partners and the coital frequency in group A were significantly higher than in group D. Our study provides further evidence for the theory that CIN is, at least partly, a sexually transmitted disease.

Colposcopic, cytological and histological evaluation of the cervical stump 3 years after supravaginal uterine amputation.

Colposcopic, cytological and histological (endocervical curettage) evaluation of the remaining cervical stump was done 3 years after 99 supravaginal uterine amputations performed for benign condition. Peroperative electrocoagulation of the endocervical mucosa had been done in all the patients and postoperative ectocervical electrocoagulation in 39 (39.4%) cases. No active inflammatory, premalignant or malignant changes were detected at the 3-year examination of the cervix. Furthermore, normal adenomatous epithelium had been wholly or partly relaced by squamous epithelium in 89% of the cases.

Supravaginal uterine amputation versus hysterectomy with reference to subjective bladder symptoms and incontinence.

Studies on postoperative symptoms of hysterectomy have devoted scarcely any attention to malfunctioning micturition and pressure sensation in the bladder region. Postoperative occurrence of incontinence is mentioned in some studies. Preoperatively, 33.3% of abdominal hysterectomy patients and 38.3% of patients with supravaginal uterine amputation complained of pressure sensation in the bladder region; one year after operation the corresponding percentages were 9.6 and 10.3. Prior to the operation, a sensation of residual urine after micturition occurred in 28.6% of hysterectomy patients and 35.5% of supravaginal amputation patients; at 1 year postoperatively these figures were 22.1 and 10.3% respectively. The decrease in the supravaginal amputation group is statistically highly significant. Preoperative incontinence occurred in 36.2% of hysterectomy and 47.7% of supravaginal amputation patients. Twelve months postoperatively the values were 28.8 and 22.6% respectively, the decrease in the supravaginal amputation group being again statistically highly significant. Development of log-linear models for both groups gave interactions "earlier urinary tract infections/sensation of residual urine" and "earlier urinary tract infections/incontinence". Thus the greater reduction in the symptoms in the supravaginal amputation group appears to result rather from the type of operation than from the differences in the two patient groups.

Supravaginal uterine amputation with peroperative electrocoagulation of endocervical mucosa. Description of the method.

Discussion on the advantages of abdominal hysterectomy versus supravaginal uterine amputation has concentrated on the incidence of carcinoma in the remaining stump, mortality, and other serious complications. During the period 1952-78 we have performed 2712 supravaginal amputations with peroperative electrocoagulation of endocervical mucosa. The incidence of stump carcinoma was 0.11% in this material. In our prospective studies we have shown that supravaginal amputation has certain advantages over abdominal hysterectomy as regards long-term morbidity. In this paper we describe the method we are using when performing supravaginal uterine amputation.

Non-specificity of symptoms related to adenomyosis. A prospective comparative survey.

A total of 212 patients coming for removal of the uterus due to a benign condition were interviewed by the first author before operation. Of these patients 28 had adenomyosis, while 157 had neither adenomyosis nor external endometriosis; these two groups were compared with respect to duration of menstrual bleeding, dysmenorrhea, dyspareunia, urinary symptoms and sacral and lower abdominal pain. There were no inter-group differences in the frequencies of these symptoms. It is concluded that although patients with adenomyosis have many symptoms, none specific to adenomyosis can be found.

The effect of infused prostaglandin F2 alpha on plasma antidiuretic hormone and renin activity in early human pregnancy.

The effect of infused prostaglandin F2 alpha plasma antidiuretic hormone and renin activity in early pregnancy was investigated in eight women. After infusion for one and three hours (infusion speed 50 micrograms/min) the PRA had decreased significantly. During the same time the blood pressure also showed a decreasing tendency. No changes were found in plasma vasopressin concentration.

Analysis of intrapartum fetal deaths: their decline with increasing electronic fetal monitoring.

Over a 12-year period, from 1970 to 1981, 30 600 babies were born at the Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland. During that period, the use of electronic fetal monitoring increased remarkably, being involved in 9, 12, 33 and 95% of all vaginal deliveries during four consecutive 3-year periods. The number of intrapartum deaths during the same 12-year period was 52, giving an overall rate of 1.7 per thousand. When 15 lethally malformed infants are excluded, the rate becomes 1.2 per thousand. In the four consecutive 3-year periods, the death rates were 1.7, 1.9, 1.0 and 0.3 per thousand. Electronic fetal monitoring was not undertaken in any of the cases leading to fetal death. The main factor leading to fetal death could be considered to be hypoxia in approximately 90% of the deaths of normally formed babies. The most common reasons for hypoxia were placental abruption and cord entanglement, yet in many cases only the decreased placental perfusion could be suggested to have caused the hypoxia. The mean weight of those babies that died intrapartally decreased significantly, being approximately 1 250 g during the last 3-year period.

Sinusoidal fetal heart rate.

Two cases with sinusoidal fetal heart rates (SHR) with good perinatal outcome are reported. Since nonstress tests, oxytocin challenge tests and serum free estriols were normal, SHR was considered not indicative of fetal compromise. A SHR can occasionally be found in connection with reactive nonstress test. In those cases it may be of minor importance when compared to the situations when the tracing also shows a nonreactive nonstress test and the perinatal outcome is often poor.

Factors affecting the pulmonary toxicity of bleomycin.

Bleomycin induced lung toxicity was retrospectively analyzed in 39 patients with vulval malignancy (group A) and in 23 patients with head and neck carcinoma (group B). Group A consisted of non-smokers, mean age 69.8 years, who received the drug as intravenous injections. Group B contained mainly heavy smokers, mean age 60.6 years, treated with intramuscular injections of bleomycin. In group A, 6 patients (15.4%) and in group B only one patient (4.3%) developed typical pulmonary fibrosis. Advanced age, a high total dose of bleomycin, and intravenous bolus injections of the drug seemed to be major factors responsible for the development of lung fibrosis, whereas smoking had no obvious effect.

Supravaginal uterine amputation vs. hysterectomy. Effects on libido and orgasm.

Postoperative symptoms of hysterectomy have received relatively little attention. In the present study, the first author has personally interviewed and examined 105 abdominal hysterectomy patients and 107 patients with supravaginal uterine amputation preoperatively and 6 weeks, 6 months and 12 months postoperatively. Participation in the follow-up study was 99.5% (211/212) at one year. This paper deals with the effects of the two operations on libido and the frequency of orgasms. In the statistical analysis, McNemar's test of symmetry and the Fisher exact test were used. Weak or absent libido was reported preoperatively by 28.0% of hysterectomy patients and by 26.4% of amputation patients. One year postoperatively the corresponding figures were 35.4% and 31.4%. No statistical changes were observed between the two groups or within either group. In the frequency of orgasms a highly significant (p less than 0.001) reduction from the situation before operation to one year postoperatively was detected after hysterectomy. In the supravaginal amputation group no statistically significant decrease was detected. Preoperatively the two groups were alike; one year postoperatively the difference was almost significant (p less than 0.05). The reductions in orgasms after hysterectomy as compared with supravaginal amputation appears to result from the greater radicality of the former; at hysterectomy, the autonomous innervation of the proximal vagina and cervix is damaged more than in supravaginal amputation, the anatomy of the vagina is altered and scar tissue forms in the vagina. It is probable that these changes and subconscious psychological reactions due to total removal of the uterus explain why supravaginal uterine amputation gives better results than hysterectomy.

Supravaginal uterine amputation vs. hysterectomy. Effects on coital frequency and dyspareunia.

The author has personally interviewed and examined 105 abdominal hysterectomy patients and 107 supravaginal amputation patients, first preoperatively and then 6 weeks, 6 months and one year postoperatively. At 12 months the follow-up percentage was 99.5 (211/212). This report concentrates on coital frequency and dyspareunia. In the statistical analysis, McNewar's test of symmetry and the Fisher exact test were used. With respect to coital frequency, no statistically significant changes occurred between or within the two groups. Dyspareunia was relieved by either operation, but more so by supravaginal amputation. When dyspareunia was experienced deep within the pelvis, removal of the uterus by either method almost always resulted in disappearance of the symptom.

Peroperative electrocoagulation of endocervical mucosa and later carcinoma of the cervical stump.

The incidence of carcinoma of the cervical stump is, according to literature, 0.3--1.9%. During the years 1952--78, 2712 subtotal hysterectomies for benign conditions were performed in the Department of Obstetrics and Gynecology in Turku. During the operation the endocervical mucosa was electrocoagulated before closing the stump. Of these patients, 3 have since developed carcinoma of the cervical stump; thus the incidence in our material is 0.11%. It has been supposed that subtotal hysterectomy might have certain benefits in some cases. If so, and in view of the cancer risk being so low in our material, we feel that subtotal hysterectomy is still an applicable method.

Conservative treatment of urinary incontinence in women with special reference to the use of oestrogens.

Urinary incontinence was treated conservatively in 100 patients. The follow-up period was 12-24 mth. For post-menopausal women, the oestrogen therapy consisted of oral oestradiol valerate or vaginal oestrone sulphate combined with emepronium bromide. In post-menopausal patients the best results were noted when incontinence had begun at the menopause and when the duration of the complaint was not more than 3 yr. For pre-menopausal patients, the treatment given was generally emepronium bromide. During the follow-up period 15 of the patients, 11 of whom were post-menopausal, became symptomless and 77 improved; that is, the incontinence was only slight and occasional. The treatment was without any effect in 8 of the patients. Oestrogen therapy was successful in most post-menopausal women. In these patients, the best results were obtained when the duration of the incontinence was not more than 3 yr.

Supra-vaginal uterine amputation vs. abdominal hysterectomy: the effects on urinary symptoms with special reference to pollakisuria, nocturia and dysuria.

Post-operative symptoms of hysterectomy have received relatively little attention in the literature. In the present study the first author has personally interviewed and examined 105 abdominal hysterectomy patients and 107 patients with supravaginal uterine amputation pre-operatively and thrice post-operatively. At one year the follow-up percentage was 99.5 (211/212). In the statistical analysis McNemar's test of symmetry and Fisher's exact test were used. Loglinear models were developed where applicable. A number of patients had urinary symptoms pre-operatively: 27.6% of the abdominal hysterectomy and 48.6% of the supra-vaginal amputation patients suffered from pollakisuria; preoperative nocturia and dysuria were present in about 10% of patients in each group. These urinary symptoms disappeared more frequently in patients who underwent supra-vaginal amputation; with regard to pollakisuria the difference is statistically significant. Twelve months post-operatively pollakisuria was present in 10.3% of supra-vaginal amputation and 13.5% of hysterectomy patients. The advantage of supra-vaginal amputation over abdominal hysterectomy with regard to these symptoms may result from the considerably less extensive manipulation of the bladder during supra-vaginal amputation. Possibly the support provided by the remaining stump and the round ligaments fixed to it also help to reduce urinary symptoms in these patients. However, further urodynamic studies are needed.