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Objective: To report on chronic urinary retention after surgery for deep endometriosis and the possible risk factors for this complication., Design: Descriptive study., Setting: University hospital., Patient(s): Four patients with deep endometriosis who developed this complication., Intervention(s): Laparoscopic surgery, intermittent self-catheterization (ISC)., Main Outcome Measure(s): To identify site(s) of lesion associated with this complication., Result(s): Four patients developed this complication from damage to the inferior hypogastric plexus involving the sympathetic and/or parasympathetic afferents from the bladder. One patient regained complete bladder function 8 months after surgery, and the others required ISC at the time of writing (13, 24, and 3 months after surgery). Patients with lesions located laterally and deep in the uterosacral ligaments especially near the ischial spines were at high risk. All patients were, however, satisfied with the results of surgery., Conclusion(s): Most such injuries are unpredictable, but in our experience, two of three patients with lesions near the ischial spine developed this complication. Chronic urinary retention after radical endometriosis surgery is rare and often under reported. Although most lesions are unilateral and have a potential for improvement, it is not known how long these effects will last. More data from other centers may help in providing additional information., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

We report a case of unilateral adnexal absence with a peritoneal loose body. Laparoscopic findings and medical history suggested that she had adnexal torsion in her childhood followed by its calcification and autoamputation., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To present two cases of endometriosis in patients with Glanzmann's thrombasthenia (GT) and discuss the underlying pathophysiology of endometriosis., Design: Case report., Setting: Gynecology practice in a university teaching hospital., Patient(s): Two sisters, aged 24 and 28 years, previously diagnosed as having GT., Intervention(s): Surgical exploration., Main Outcome Measure(s): Pathologic examination of surgical specimens was performed., Result(s): A diagnosis of endometriosis was confirmed pathologically for two sisters previously diagnosed as having GT., Conclusion(s): Women with GT seem to represent an important human model of endometriosis from which important data on the pathophysiology of endometriosis can be acquired.

Objective: To find the risk factors of torsion and malignancy for adnexal tumors during pregnancy., Design: Retrospective, historical cohort study., Setting: University hospital., Patient(s): Patients from 1990 to 2004 with adnexal tumors >or=4 cm during pregnancy., Intervention(s): Surgery undertaken antepartum, concurrently with cesarean delivery, or postpartum., Main Outcome Measure(s): Tumor size, progression, pathology, incidence of malignancy, and torsion., Result(s): Almost all 213 managements analyzed had good surgical and obstetric outcomes. In 174 patients who were followed through pregnancy with known tumor existence, 14.84% +/- 3.05% encountered tumor torsion. Adnexal masses with sizes between 6 and 8 cm had a significantly higher risk of torsion compared with other sizes (22.41% vs. 9.48%; odds ratio 2.8, 95% confidence interval [CI], [1.1, 6.6]). Sixty percent of the torsion happened between the 10th and 17th weeks of gestation, and only 5.9% happened after 20 weeks. The incidence of malignancy was 3.4%, while that of ovarian cancer was 2.3%. Tumor diameters >or=10 cm at initial diagnosis had a higher risk of malignancy versus smaller sizes (8.77% vs. 0.85%; odds ratio 11.2, 95% CI, [1.3, 97.9]), and tumor growth rates >or=3.5 cm/week also had a significantly higher risk of malignancy versus lower rates (8.33% vs. 0.88%; odds ratio 10.2, 95% CI, [1.0, 101.2])., Conclusion(s): Adnexal tumors bearing higher risks for torsion and malignancy should be strongly considered for an aggressive strategy of management during pregnancy.

Objective: To present four rare cases of congenital unilateral tubal and ovarian abnormalities with their laparoscopic images., Design: Case report., Setting: Baskent University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey., Patient(s): Three patients with infertility showing abnormality on hysterosalpingography and a fourth patient with acute pelvic pain who were admitted to our clinic., Intervention(s): All four patients underwent laparoscopic surgery., Main Outcome Measure(s): Case 1 showed an absence of a distal tubal segment with ipsilateral ovarian agenesis. Case 2 showed a unilateral partial distal tubal absence with normal adjacent ovary. Case 3 showed a twisted and adherent tube with ipsilateral ovarian absence. Case 4 showed a unilateral ovarian agenesis and contralateral acute adnexal torsion., Result(s): We detected four cases of unilateral ovarian and partial tubal absence in these operations., Conclusion(s): We present four unusual cases of unilateral ovarian and partial tubal absence. The absence of one ovary and tube may be explained by two possible etiopathogenic causes: asymptomatic adnexial torsion or congenital malformation.

Objective: To describe a novel technique for application of a Seprafilm (modified hyaluronate-carboxymethylcellulose) barrier laparoscopically, and to assess the adequacy of coverage of desired sites., Design: Retrospective cohort study., Setting: University tertiary hospital., Patient(s): One hundred twenty-seven patients who underwent fertility-sparing laparoscopic surgery., Intervention(s): The Seprafilm was rolled up in a plastic package, then delivered through the main trocar. It was unrolled and positioned to cover the traumatized surface of the uterus, ovaries, and tubes. During application, the pelvis was photographed, videotaped, and the pictures were reviewed by two surgeons., Main Outcome Measure(s): The adequacy of the application was divided into three levels as to whether the Seprafilm could cover all the traumatized surfaces., Results: Of the first 15 patients, 4 of 15 (26%) had successful coverage of the traumatized surface with the first sheet of Seprafilm. Of the following 112 patients, 97 of 112 (86.5%) had successful coverage with the first sheet. The success rate climbed to 96% after the second or third sheet. The average time for the application of six pieces (one sheet cut into six pieces) was 21 +/- 4 minutes. The posterior cul-de-sac is difficult to apply well., Conclusion(s): It is feasible to apply the antiadhesion barrier Seprafilm laparoscopically. Further studies will be needed to assess the efficacy of reducing adhesion following such use.

Objective: To investigate the effects of genistein on reperfusion injury in a rat ovarian torsion-detorsion model., Design: Controlled experimental study., Setting: University animal research laboratory., Subject(s): Thirty-two Wistar-Albino rats., Intervention(s): The rats were divided into four groups. Sham operation was performed in group I. In group II, 5 mg/kg genistein was given intraperitoneally (IP) during laparotomy, and right ovaries were removed 4 hours later. In group III, right ovaries were subjected to 4 hours of adnexal ischemia by use of vascular clips, and after ischemic insult, 4 hours of reperfusion was maintained by removing the clips. In group IV, after the ischemic period, 5 mg/kg genistein was given IP, and 4 hours of reperfusion was maintained. Right ovaries were surgically removed at the end of the procedure in each group., Main Outcome Measure(s): Ovarian histopathologic findings were scored and compared among study groups. Serum and ovarian tissue malondialdehyde (MDA), glutathione peroxidase, and superoxide dismutase, levels were measured., Result(s): Ovarian tissue damage scores were significantly different among groups and were seen to correlate with ovarian tissue MDA levels. Genistein significantly decreased the tissue damage scores, ovarian tissue MDA levels, and serum MDA levels., Conclusion(s): Genistein attenuates ischemia-reperfusion injury in rat adnexal torsion-detorsion model.

The present case documents normalization of ovarian perfusion after conservative laparoscopic treatment of adnexal torsion. At our institution, Doppler flow assessment in cases of suspected torsion represents an important element of diagnosis and, in this case, allowed for early diagnosis with conservative laparoscopic treatment with documented normalization of ovarian flow postoperatively.

Studying the incidence of bilateral adnexal disease and dense adhesions, two groups of patients with severe endometriosis were distinguished, suggesting that a stage V needs to be considered in the AFS classification.

We present a case where, for the first time, unwinding of ischemic hemorrhagic adnexum was performed successfully through the laparoscope without the need to operate. Aspiration of ovarian fluid before detorsion facilitates the procedure; follow-up showed spontaneous follicular growth. We conclude that laparoscopic detorsion of ischemic adnexum is feasible. Apparently, oocytes are not damaged by the torsion and the ovary resumes normal function. This procedure should be considered in women during the reproductive age and in every case where malignancy can be ruled out.

A series of 201 cycles of ovarian hyperstimulation syndrome (OHSS) in 154 women were reviewed. Pregnancy occurred in 75 of 201 cycles. Twelve pregnant women (16%) presented with torsion of hyperstimulated ovary, but only 3 out of 126 patients (2.3%) who did not conceive had torsion. Because diagnosis of adnexal torsion is usually uncertain and surgical intervention is likely to be delayed, these infertile women risk losing their ovaries. The clinical picture of torsion of adnexa in patients with OHSS is presented here. The combination of ovarian enlargement, abdominal pain, nausea, progressive leukocytosis, and anemias might indicate torsion of adnexa. Although during operation the adnexa appears dark, hemorrhagic and ischemic, we suggest that it can be saved by simply unwinding it. In 11 such cases intraoperative unwinding of the adnexa was performed, and in 8 patients it was the only operative procedure. No postoperative complications were noted and in all the cases the ovaries were proven functional by ultrasonography. We concluded that torsion of hyperstimulated adnexa in patients who conceived after gonadotropin therapy, is a special entity that requires more attention to achieve early diagnosis. Nevertheless even with delayed diagnosis, the ovary can still be saved.

Five cases of hydrosalpinx simplex were studied by light microscopy and scanning electron microscopy (SEM). Comparison was made with normal fallopian tube epithelia. By light microscopy numerous ciliated cells as well as nonciliated cells were found in both hydrosalpinx and normal tubal material. In hydrosalpinx material the epithelium was found to be compressed to one-sixth its usual height. The SEM survey of large areas of hydrosalpinx did not reveal any deciliation. In fact, the mucosa of the hydrosalpinx did not differ conspiciously from that of a healthy fallopian tube. However, some nonciliated cells with collapsed areas were revealed by SEM. The significance of the compressed areas is unknown.

An intraperitoneal inflammatory process has been associated with infertility in women without anatomic distortion of the pelvic viscera, particularly with endometriosis. This phenomenon was investigated by measuring peritoneal fluid (PF) and serum levels of a major secretory product of the macrophage, lysozyme, in fertile and infertile women undergoing laparoscopy. Serum lysozyme levels were in the normal range and did not correlate with total PF lysozyme. Regression analysis revealed a negative correlation between adnexal adhesions and PF volume (P less than 0.05), PF leukocyte number (P less than 0.05), and total PF lysozyme (P less than 0.05). Significant correlations were found between total PF lysozyme and PF volume (r = 0.72, P less than 0.0001) and leukocyte number (r = 0.67, P less than 0.0001). These results suggest that a localized intraperitoneal inflammatory reaction is associated with infertility in the absence of anatomic distortion of the pelvic viscera.