Office hysteroscopic metroplasty with diode laser for septate uterus: a multicenter cohort study.

OBJECTIVE: To investigate the effectiveness and safety of office hysteroscopic metroplasty by diode laser for the treatment of septate uteri. STUDY DESIGN: We performed a prospective cohort study including 41 nulliparous women diagnosed with septate uterus and a history of primary infertility or recurrent miscarriage. All patients underwent hysteroscopic metroplasty for the treatment of the uterine septum, which was performed in-office setting using a 4.3 mm continuous-flow hysteroscope and a 15-watt diode laser at 1470 nm. Surgical and reproductive outcomes after 2 years of follow-up are reported. RESULTS: The procedure was well tolerated by 93% of patients. No surgical complications were reported. Thirty women out of 38 (78.9%) became pregnant: 17 (56.7%) pregnancies were spontaneously conceived, and 13 (43.3%) were obtained with assisted reproductive techniques. Twenty-four (80%) of the 30 pregnant women had a live birth, with a cumulative live birth of 63.2% among the 38 women (95% CI: 45.9-78.2%). There were no cases of post-partum hemorrhage or uterine rupture among 14 (58.3%) women who had vaginal deliveries. CONCLUSION: Office hysteroscopic metroplasty for septate uterus using diode laser appears to be a feasible and safe alternative to other available techniques and has sufficient efficacy in terms of reproductive outcomes to be considered for further investigations.

Emergent genital infection by Leptotrichia trevisanii.

We report the first case of an association between Leptotrichia trevisanii and an episode of pelvic inflammatory disease (PID) and the second case of the isolation of this infection in the cervical canal. A 45-yr-old woman was admitted to our emergency department with clinical and radiological signs and symptoms compatible with an episode of PID. She was hospitalized for intravenous antibiotic control and treatment and the subsequent surgical drainage of abscesses. Cultures were taken throughout the process, but only cultures from cervical canal exudate were positive, with the growth of L. trevisanii species. It appears important to carry out a complete microbiological screening, not limited to conventional agents, on adequate clinical samples to detect possible infectious agents that may be missed in these cases.

Hysterectomy in women with obesity: complications related to surgical site.

BACKGROUND: The aim of this study was to describe the trends in surgical routes in obese women who underwent hysterectomy for benign disease at our center and compare complications in different groups. METHODS: Retrospective study done between 2011 and 2015 in women with a Body Mass Index≥30 who underwent hysterectomy for benign disease at Virgen de las Nieves Universitary Hospital in Granada, Spain. We studied three groups based on the surgical route chosen for hysterectomy: vaginal, abdominal or laparoscopic. The rates of intraoperative and postoperative complications, major complications, reintervention and days of hospital stay were compared. RESULTS: Abdominal hysterectomy was associated with the highest risk of postoperative complications and the longest hospital stay. Laparoscopic hysterectomy had a higher risk than vaginal hysterectomy of major complications. There were no significant differences between groups for any of the other variables. CONCLUSIONS: In obese women vaginal hysterectomy was associated with the lowest morbidity, and should be the approach of choice whenever feasible.

Resultados de la Ablación-Resección Endometrial con Energía Monopolar. Análisis de Factores Pronósticos / Outcomes of Endometrial Ablation-Resection with Monopolar Electrosurgery. Prognostic Factors Analysis

INTRODUCCIÓN: La hemorragia uterina anormal (HUA) se considera una patología con importantes repercusiones sanitarias y sociales, ya que afecta a un porcentaje elevado de pacientes en edad reproductiva, deteriorando su calidad de vida y suponiendo la principal causa de anemia e histerectomía en mujeres de países desarrollados. El tratamiento dependerá de múltiples factores, siendo la ablación-resección endometrial (ARE) una alternativa apropiada para pacientes que no desean conservar la fertilidad. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo que analiza los resultados de ARE histeroscópica en el Hospital Universitario Virgen de las Nieves de Granada y los factores asociados al éxito o fracaso de la misma. RESULTADOS: Se seleccionaron 260 pacientes premenopáusicas sometidas a ARE histeroscópica acompañada de miomectomía y/o polipectomía en el 60,4 % de los casos, con un tiempo de seguimiento entre 1 y 79 meses. De estas, solo 40 continuaron con menorragia, considerándose por tanto que la técnica resultó exitosa desde el punto de vista clínico en el 84,6 % de los casos, con tasas de amenorrea del 38,5 %, siendo necesario rentervenir al 12,3 % de las pacientes. Al analizar el éxito con el tiempo, a los 5 años de seguimiento, nuestra tasa de éxito clínico ha sido del 70,8 % y nuestra tasa de reintervención del 19,9 %

INTRODUCTION: Abnormal uterine bleeding (AUB) is considered a disease with important health and social impact, as it affects a large percentage in patients of reproductive age, impairing their quality of life and assuming the leading cause of anemia and hysterectomy in women in developed countries. The treatment will depend on multiple factors, being the endometrial ablation-resection (EAR) an alternative for patients who do not wish to preserve fertility. METHODS: This observational retrospective study analyze the results of hysteroscopic EAR in the Virgen de las Nieves University Hospital, and factors associated with the success or failure of the procedure. RESULTS: We selected 260 premenopausal women who were performed hysteroscopic EAR , preceded by myomectomy and/or polypectomy in 60,4% of patients . Follow up ranged from 1 to 79 months. Only 40 of the 260 selected patientscontinued with menorrhagia, therefore the technique was clinically successful in 84,6% of them, with amenorrhea rates of 38,5%. Moreover, 12,3% of patients needed another additional operative procedure. After 5 years of follow-up our clinic succes rate was 70,8% and 19,9% of reintervention rate. Adenomyosis was a risk factor for clinical failure and reoperation in both bivariant and multivariate analysis. When we consider the follow-up time, adenomyosis triples risk of clinical failure and causes 5,3 fold increase in surgical failure risk. CONCLUSION: Hysteroscopic EAR offers favourable outcomes in patients with abnormal uterine bleeding, but when adenomyosis is suspected we must contraindicate it, or at least the patient must be informed about poor results

Complications of laparoscopic gynecologic surgery.

BACKGROUND AND OBJECTIVES: To analyze the frequency of complications during laparoscopic gynecologic surgery and identify associated risk factors. METHODS: A descriptive observational study was performed between January 2000 and December 2012 and included all gynecologic laparoscopies performed at our center. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, and conversions to laparotomy. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. RESULTS: Of all 2888 laparoscopies included, most were procedures of moderate difficulty (adnexal surgery) (54.2%). The overall frequency of major complications was 1.93%, and that of minor complications was 4.29%. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy. CONCLUSION: Laparoscopic gynecologic surgery is associated with a low frequency of complications but is a procedure that is not without risk. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications.

Tratamiento laparoscópico del quiste dermoide de ovario. Factores asociados a la rotura intraoperatoria, trascendencia clínica y resultados / Laparoscopic treatment of ovarian dermoid cyst. Factors associated with intraoperative spillage, clinical importance, and results

Objetivo. Analizar las peculiaridades quirúrgicas asociadas al tratamiento por vía laparoscópica del quiste dermoide ovárico. Se estudian, igualmente, los factores asociados a la rotura intraoperatoria del quiste y su trascendencia clínica. Material y métodos. Se realizó un estudio retrospectivo de 131 quistes dermoides intervenidos por vía laparoscópica en el Hospital Universitario Virgen de las Nieves desde enero de 2000 hasta diciembre de 2008. Resultados. La edad media de las pacientes fue de 32,4 años. El tamaño medio del quiste fue de 63,8mm. En el 62,6% de los casos se pudo realizar cirugía conservadora (quistectomía). Sólo 2 pacientes precisaron reintervención por problemas hemorrágicos. La estancia media fue de 1,6 días. La rotura intraoperatoria del quiste ocurrió con más frecuencia cuando se practicó quistectomía. No hubo ningún caso de peritonitis. Conclusiones. La laparoscopia es la técnica de elección en el tratamiento quirúrgico del quiste dermoide de ovario. Las complicaciones son mínimas y la recuperación rápida. Si se produce la rotura intraoperatoria del quiste no suele tener trascendencia clínica alguna (AU)

Objective. To analyze the surgical characteristics of laparoscopic treatment of dermoid cyst and the factors associated with intraoperative spillage and its clinical importance. Material and methods. A retrospective research was performed of 131 dermoid cysts treated by laparoscopy at the Virgen de las Nieves University Hospital from January 2000 to December 2008. Results. The mean age of the patients was 32.4 years. The mean size of the cysts was 63.8mm. In 62.6% of the patients, conservative surgery (cystectomy) was feasible. Only two patients needed reintervention due to bleeding complications. The mean length of hospital stay was 1.6 days. Intraoperative spillage was more common when cystectomy was performed. There were no cases of peritonitis. Conclusions. Laparoscopic surgery is the first treatment option in the management of ovarian dermoid cysts. There are few complications and healing is rapid. Spillage is usually clinically unimportant (AU)

Tratamiento conservador del cáncer de endometrio en una pareja estéril / Conservative treatment of endometrial cancer in an infertile couple

El tratamiento conservador del cáncer deendometrio (estadio I) es una opción terapéuticapara aquellas mujeres jóvenes que aún no hancumplido sus deseos genésicos. Aunque los datospublicados sobre los resultados de las técnicas dereproducción asistida (TRA) tras el manejoconservador del cáncer de endometrio son escasos,el pronóstico no parece empeorar con el uso deestas. A continuación, se describe el caso de unapaciente de 29 años, con esterilidad primaria,diagnosticada de cáncer de endometrio en estadioIA, tratada con altas dosis de progesterona oral, ytras el cual quedó embarazada mediante TRA (AU)

Successful conservative management for early-stagelow-grade endometrial cancer in young womenwishing to preserve fertility has been reported insmall series. Although few data are available on assisted reproductive technology (ART) outcomesafter conservative management of endometrialcarcinoma, ART does not seem to worsenprognosis. We report the case of a 29-year-oldwoman with a history of primary infertility, whowas diagnosed with a well-differentiatedendometrial adenocarcinoma (stage Ia), which wastreated with high doses of oral progesterone. Asuccessful pregnancy was achieved after ART (AU)

Alteración ecográfica del endometrio en mujeres menopáusicas sin metrorragia / Endometrial alterations on ultrasonography in asymptomatic postmenopausal women

Objetivo: Establecer la incidencia de cáncer enmujeres menopáusicas sin hemorragia vaginal ycon endometrio > 5 mm medido por ecografíavaginal.Material y métodos: Estudio retrospectivo queincluyó a 270 mujeres menopáusicas sinhemorragia de origen uterino y con endometrio> 5 mm. Se les realizó una histeroscopia conestudio histológico de cualquier anomalía yvaloramos la incidencia de cáncer de endometrio.Resultados: Detectamos 5 cánceres en 270mujeres, con una incidencia del 1,85%. De las 106pacientes con sospecha ecográfica de pólipoendometrial, diagnosticamos 4 cánceres deendometrio (3,77%), todos en estadio I. Ningunapaciente con cáncer había tenido tratamientohormonal.Conclusiones: La incidencia de cánceres enmujeres menopáusicas sin hemorragia vaginal consospecha ecográfica de pólipo de endometrio(3,77%) obligaría ha realizar una histeroscopia conbiopsia. Creemos que habría que determinar elgrosor endometrial que debemos considerarpatológico en estas mujeres

Objective: To determine the incidence ofendometrial cancer in asymptomaticpostmenopausal women with a sonographicendometrial thickness above 5 mm.Materials and methods: We performed aretrospective study of 270 asymptomaticpostmenopausal women with endometrial thickness> 5 mm on sonography. All women underwenthysteroscopy with histological evaluation ifrequired. The incidence of endometrial cancer wasevaluated.Results: Five cases of endometrial cancer werediagnosed in the 270 women, representing anincidence of 1.85%. Of the 106 patients with asonographic image leading to suspicion of polyp,four were diagnosed with endometrial cancer(3.77%), all of which were stage I tumors. None ofthe 270 women was receiving hormonereplacement therapyConclusions: The incidence of endometrial cancerin asymptomatic postmenopausal women withsonographic suspicion of polyp was 3.77%. Patientswith this sonographic finding should undergothorough hysteroscopy and biopsy to rule outmalignancy. We believe that the cut-off value forendometrial thickness in postmenopausal womenwithout vaginal bleeding should be determined

Embarazo ectópico: de la cirugía de urgencia al tratamiento médico. Evolución de la terapéutica en nuestro centro / Ectopic pregnancy: from emergency surgery to medical treatment. Changing trends in treatment in our center

Objetivo: Analizar la evolución de las distintasmodalidades en el tratamiento del embarazoectópico durante los últimos 9 años.Material y métodos: Se realizó un estudioretrospectivo de 355 casos de embarazo ectópicotratados en el Hospital Universitario Virgen de lasNieves durante el período comprendido entre 1998y 2006. Se analizaron los cambios ocurridos en lasdistintas actitudes terapéuticas durante ese intervalo.Resultados: El tratamiento médico se inició en139 (39,15%) casos, con una tasa de fracasos del10,07%. El tratamiento quirúrgico se realizó en 230(60,85%) mujeres: en 121 casos se practicó cirugíala paroscópica y en 109 una laparotomía.Conclusiones: La cirugía laparoscópica es en laactualidad la primera opción terapéutica en elembarazo ectópico tubárico, a pesar de que enestos últimos años se ha demostrado la seguridad yeficacia del tratamiento médico, posibilitando unaactitud menos agresiva

Objective: To analyze changing trends in themanagement of ectopic pregnancy in the previous9 years.Material and methods: We performed aretrospective study of 355 patients with ectopicpregnancy treated at the Virgen de las NievesUniversity Hospital from 1998 to 2006. Wereviewed and analyzed changes in treatment trendsover this 9-year period.Results: Medical treatment was initiated in 139patients (39.15%), with a failure rate of 10.07%.Surgery was performed in 230 women (60.85%).Of these, laparoscopy was performed in 121 andlaparotomy in 109.Conclusions: Laparoscopic surgery is currently thefirst-line therapeutic option in the management oftubal ectopic pregnancy. However, in the last fewyears, medical treatment has been shown to be safeand effective, allowing a less invasive approach