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Objective: Voiding Dysfunction (VD) is one of the most common disorders among women, which is characterized by a disorder in urination. Pelvic organ prolapse is one of the factors that can affect VD. In this study, the relationship between prolapse in the anterior, posterior, and apical areas and VD has been evaluated. Materials and methods: This is a cohort retrospective study. The participants in this study were women with VD, who referred to the pelvic floor disorders clinic of Imam Khomeini Hospital in Tehran in 2018-2020. Clinical information was obtained retrospectively from the hospital's electronic data system, also symptoms (intermittent stream, incomplete voiding, poor flow, post void dribble, straining to void, stage anterior, posterior and apical) and urodynamic parameters (including EMG, PVR100, Qmax12, and pdet20) were evaluated, which included detailed questionnaires (Urinary Distress Inventory 6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7)), pelvic examination, and complete urodynamic evaluation. Results: There was a direct relationship between the age of the patients and the stage of prolapse (p 100 had a significant relationship with the stage of prolapse in the apical area (p=0.001). Conclusion: Intermittent stream and straining to void were related to the stages of prolapse in the apical and anterior regions. It was also concluded that the greater the prolapse, the higher the value of PVR > 100.

Background & aim: A vaginal septum is a condition in which the wall of the tissue dividing vagina does not resolve completely. This complication can be transverse and longitudinal. Although the occurrence of a transverse vaginal septum is 2 per 100,000 births, the exact etiology of this anomaly remains still unidentified. In this study, a case of high transverse vaginal septum with vaginal and cervical agenesis is reported.Case report: A 13-year-old single and virgin girl presented with cyclic abdominal pain. On examination and magnetic resonance imaging, vaginal and cervical agenesis was diagnosed. Surgical therapy included an incision in the lower part of the uterus at the site of the bulging and the use of a hysterometer passing down the uterus. The cervix was not touched, cervical agenesis was diagnosed, and the patient underwent abdominal hysterectomy and bilateral tubal salpingectomy. The pathological results confirmed the cervical agenesis.Conclusion: It is recommended that in patients with high transverse vaginal septum, hysterectomy be performed for the treatment of cervical and vaginal agenesis. However, it may not be a suitable treatment choice for some cases, and it is better to decide based on the patient's condition.

Objective: Pericervical ring reconstruction through restoration of pubocervical and rectovaginal fascia is performed concomitantly with sacrospinous hysteropexy as a transvaginal native tissue procedure for vaginal apical prolapse.The main goal of this study was to assess subjective and objective outcomes of sacrospinous hysteropexy and additional pericervical ring reconstruction. Materials and methods: We conducted a prospective and observational study. All participants underwent sacrospinous hysteropexy and pericervical ring reconstruction and perineorrhaphy. Surgical complications, anatomical and functional efficacy were assessed. Results: 108 cases were included in this study. The mean follow-up timeframe was 18.62 ± 1.22 months (minimum 12 and maximum 26 months). All parameters of subjective outcomes were improved significantly. The overall anatomic success rate was 92.59%. Mean operation time was 50.64 ± 20.8 min. No major intraoperative or postoperative complications were found. There was no statistically significant difference in demographic characteristics including age, BMI, gravidity, medical comorbidities, menopausal status, sexual activity, pretreatment prolapse severity scores between subjects with failure, and good anatomical outcome. Recurrence was mostly observed in patients with higher prolapse stages of anterior and apical compartments. Baseline POP-Q parameters Ba, C, D were significantly higher in cases with failure. Conclusion: Our study disclosed sustainable anatomic and subjective outcomes of modified sacrospinous hysteropexy by means of additional pericervical ring reconstruction.

Introduction: To compare the modified McIndoe versus Davydov vaginoplasty techniques in terms of anatomical results, sexual performance, and satisfaction. Methods: From September 2019 to June 2021, a comparative study was conducted on 20 patients with MRKH syndrome who underwent either McIndoe vaginoplasty (McIndoe group, 10 cases) or Davydov vaginoplasty (Davydov group, 10 cases) in a university-based tertiary care hospital (Imam Khomeini Hospital) in terms of anatomical results, sexual performance, and satisfaction. Functional results were assessed using the Female Sexual Function Index (FSFI). Results: All surgical procedures (n = 20) were performed successfully. Patients in the modified McIndoe group were similar to those in the Davydov group in terms of hospital stay and intraoperative complications. However, postoperative complications were higher in the McIndoe group. There were no significant differences in the neovaginal length and width of the two groups at the 6-month follow-up (P > 0.05). Other parameters (duration of mold use and blood transfusion) were similar for all patients in the two groups. At 12 months after surgery, all patients had regular sexual activity. No significant differences were found in either group. Conclusions: In terms of anatomical results, sexual performance, and satisfaction, the two techniques were similar.

Background: Transverse vaginal septum is a rare mullerian anomaly. Patients with a complete transverse vaginal septum generally complain of primary amenorrhea. Here, we presented a rare case of high transverse vaginal septum with abdominal mass during infancy in addition to chronic pelvic pain and cyclic hematuria during adulthood.Case presentation: The patient was a 26-year-old female with complain of severe abdominal and pelvic pain with significant weight loss. She had a history of surgery for correction of hydrometrocolpos (fluid accumulation in the uterus and vagina) because of transverse vaginal septum at infancy period. She had no gynecologic follow-up until the age of 26 years. At the last surgical evaluation, diffuse pelvic endometriosis with advanced metastatic colon cancer was noted.Conclusion: After diagnosis of transverse vaginal septum during infancy period, detailed counseling should be performed about the other treatment and follow-up which is needed to prevent severe complications that could affect the quality of life.

Objective: Suicide is one of the most important health problems in the world. Financial, academic, social, and environmental difficulties along with genetic, physical, and mental disorders affect suicide attempts. This study aimed to find risk factors for completed suicide in Ilam province according to the suicide registry in Ilam province. Method: This was a prospective study and was performed based on suicide case registration data, pre-determined checklist data, and death registration data in Ilam province from March 2019 to September 2020. Logistic regression models and the Chi-square test were used to determine the relationship between completed suicide and its risk factors. Results: Among 1,410 attempted suicides, 66 (4.7 %) were executed. Rate of completed suicides was higher in men (6.5%) compared to women (4.5%), (p = 0.005), age groups over 65 years (P < 0.001), retirees and farmers (P = 0.009), illiterate people (P < 0.001), villagers (P = 0.02), people motivated due to physical problems (P = 0.016), suicide by physical methods (P < 0.001) and self-immolation (P < 0.001). Logistic regression showed that incidence of completed suicide was significantly higher in the age group over 65 years, illiterate people, people using physical methods, villagers, and men. Multivariate logistic regression also showed that men and individuals using physical methods of suicide were significantly more successful in suicide. Conclusion: Men, the elderly, illiterates, villagers, and people who used physical suicide methods were in high-risk groups. Despite lower prevalence of suicide, a higher rate of completed suicide was demonstrated. To decrease completed suicide rates, we must pay attention to these groups.

Predicting survival time has many Effective implications in life quality management for the remainder of the patient's life. Also, survival data are highly variable and make accurate predictions difficult or impossible. Random Survival Forest by repeated tree construction on Bootstrap samples and averaging on the results of these trees reduce the prediction error and cause further generalization of these results. In this retrospective study, the records of 141 patients with epithelial ovarian cancer who were referred to the oncology and radiotherapy ward of Imam Hossein Hospital in Tehran from 2007 to 2018 were used. Random Survival Forest was fitted to the data to investigate the key factors affecting the first recurrence of epithelial ovarian cancer. The mean age of the patients in our study was 52 (23-82) years and the median time to the first recurrence in these was 17 (0.5-127) months, respectively. According to RSF results, using variable importance criterion (VIMP) metastatic tumor with relative importance 2.665 and also using minimal (MD) by depth 2.349, tumor stage with relative importance 1.993 and depth 2.678, and maximum platelet count with relative importance 2.132 and depth 2.683 were the most important variables affecting in the first recurrence of Epithelial Ovarian Cancer. One of the disadvantages of classical methods is the inappropriate fitting of many variables and the need for specific assumptions. More advanced methods such as RSF without the need for any specific assumptions with less prediction error can well explain event variations when exposed to high-dimensional data.

Introduction: Pelvic organ prolapse (POP) is the descend of pelvic organs including uterus, bladder, and rectum to the vaginal wall. Patients with POP may present with symptoms such as vaginal bulging with other symptoms like urinary, defecatory or sexual dysfunction. This study was conducted to evaluate the changes of POP symptoms one year after pessary fitting. Methods: Patients with symptomatic pelvic organ prolapse who presented to the pelvic floor clinic of an academic hospital between August 2016 and April 2019 were considered. Pelvic organ prolapse symptoms including urinary, defecatory, sexual and bulging symptoms were recorded before and one year after pessary fitting. pelvic floor distress inventory (PFDI)-20 and pelvic floor impact questionnaire-7 (PFIQ-7) were evaluated before and after treatment for all subjects. Results: We analyzed the characteristics of 110 patients who used the pessary for 12 months. At the baseline, the most common prolapse symptoms were vaginal bulging and pelvic pressure. All urinary, defecatory and sexual symptoms significantly improved one year after regular pessary use(P

Objective: Rapid technological advances in the last century and the large amount of information have made it difficult to analyze a large number of independent variables. In such circumstances, the existence of interactions of different degrees in the model is expected, in this case, the Cox model cannot be useful and the nonparametric method of random survival forest can be a useful alternative. This study compares the prediction error of random survival forest with Cox and Weibull models in predicting the time to the first recurrence in patients with epithelial ovarian cancer. Method: In this retrospective study, the records of patients with epithelial ovarian cancer who referred to Imam Hossein Hospital in Tehran from 2007 to 2018 were used. To investigate the factors affecting the first recurrence of these patients, RSF was fitted to the data. Finally, prediction error of Cox, Weibull and RSF were compared using C-Index and Brier score. Results: Brier score was calculated 0.16 for RSF, and 0.24 for Cox, also C-Index was calculated 0.34 for RSF and 0.42 for Cox. Brier score was calculated 0.092 for Cox and 0.089 for Weibull, so the prediction error of RSF was lower than both Cox and Weibull models. Conclusion: Random survival forest with a suitable fit on many variables and without the need for a special default with a prediction error less than the Weibull and Cox methods can predict the response variable when confronted with high-dimensional data.

Background: The Coronavirus 2019-nCOV (COVID-19) epidemic by SARS-CoV-2 is spreading worldwide, and by March 1, 2020, 67 countries, including Iran, have been affected. Many studies are being conducted at home and abroad to predict the outbreak of the disease so that they can make the necessary medical and health decisions in a timely manner. Methods: we used the SIR model to identify parameters to calculate epidemic features and some estimates of the new coronavirus. Data on the transmission of the novel coronavirus were extracted from the GitHub source in the covid19.analytics software package. Results: According to our model estimates, the rate of infection β = 1 and the rate of removal γ = 0.667 and index R0 = 1.497 were obtained. Because the value of R0 is more than one, it is still an epidemic disease. Given that tfinal~132 days was estimated, we can expect the transmission of this epidemic to stop in Iran after July 3, 2020, provided that existing quarantine measures and patient isolation rates continue as usual. In comparison with the global SIR model, we reached the peak of the infection earlierthan the global model, but in improved and susceptible cases, we performed better than the global model. The graph of recovered and susceptible cases in Iran earlier than the global model cut off themselves. Conclusion: Forecasts are set to be a useful guide for deciding whether to transfer COVID-19. According to the predictions and estimates made, more attention should be paid to control measures

Objective: The aim of this study was to evaluate the safety and efficacy of fractional CO2 laser for treatment of vulvovaginal atrophy. Materials and methods: In this clinical trial study, we evaluated the laser effect on vulvovaginal atrophy in 47 women aged 43-80 years. Each woman was treated with fractional CO2 laser, SmartXide2V2LR, DEKA, Monalisa Touch, vaginal 360o probe and cosmetic probe. The severity of vulvovaginal atrophy symptoms was evaluated before first session of laser and every 4 weeks after laser treatment until 12 weeks. Adverse effects including pain and itching were assessed at all visits. The statistical analysis was performed using SPSS version 23. Results: The response to laser therapy for vaginal dryness was significantly (p

Division of Female Pelvic Medicine and Surgery, Department of Obstetrics and Gynecology, Emam Khomeini Hospital, Tehran University of medical sciences proposed a clinically relevant algorithm to guide appropriate decision making based on underlying risk stratification and resource utilization in order to resume elective surgeries, following COVID-19 pandemic crisis. The consequence of standardized decision-making factors and transparency of the principles will provide more assurance, consistency, and reliability on both sides, care providers and the patient. It also will decrease ethical dilemmas and moral criticism for surgeons. Eventually, this approach is applicable in any other disaster preparedness as a logical stratification of surgical indications for the female pelvic floor surgical procedures.

The current evidence regarding the association between vitamin D status and pelvic floor disorder (PFD) are inconclusive. This meta-analysis was aimed to summarize existing data demonstrating the association between Vitamin D status and PFD using published observational studies. All national and international databases including Web of Science, PubMed, Google Scholar, and Scopus were searched up until January 30, 2018, and related published studies retrieved for meta-analysis. The effect sizes of Vitamin D status were presented as standardized mean difference (SMD) with 95% confidence interval (CI), using random-effect models and inverse variance method. The Cochran Q statistic and I2 tests were used to evaluate the heterogeneity across included studies. Seven studies with 3219 women were included our meta-analysis. There was heterogeneity existing among included studies (I2 = 96.4%, P < 0.001), so a random-effect model was used. The findings of this meta-analysis revealed that the mean serum Vitamin D levels in women with PFD were significantly lower than healthy women (SMD −0.60; 95% CI, −1.06, −0.13; P = 0.01). This meta-analysis demonstrates lower levels of serum Vitamin D in women with PFD rather than healthy women. Additional prospective studies regarding the association between Vitamin D status and PFD are required to confirm our findings.

Objective: To report the neglected pessary in a patient with pelvic organ prolapse. Pelvic organ prolapse (POP) is one of the most important medical challenges in women especially elderly. One of the conservative treatments of symptomatic POP is pessary placement. Case report: A 84-year-old woman, para 10 was referred to female pelvic floor clinic of an academic hospital for vaginal bleeding and neglected vaginal pessary. Vaginal examination in the pelvic floor clinic revealed an entrapped ring pessary in severely atrophic vaginal mucosa with purulent discharge. Conclusion: Although pessary is the first choice and one of the best conservative treatment for pelvic organ prolapse, it shouldn’t be used for poor cooperative patient who cannot comply with regular follow-up visits which may cause harmful complications.

Background: The differential efficacy between long GnRH agonist with antagonist can partly be due to the preexisting differences in the early antral follicles before ovarian stimulation.Objective: To compare the effect of pretreatment by estradiol with GnRH antagonist on antral follicular size coordination and basal hormone levels in GNRH antagonist protocol.Materials and Methods: On cycle day 3 (control/day 3), women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones then were randomized to receive oral estradiol 4mg/day (n=15) or 3mg cetrorelix acetate (n=15) in luteal phase before subsequent antagonist protocol. Participants were re-evaluated as on control/day 3.Results: There was a significant reduction of mean follicular sizes in each group after medical intervention (7.63±2.11 Vs. 4.30±0.92 in group A and 8.73±1.96 Vs. 4.13±1.11 in group B) (p=0.0001). The magnitude of follicular size reduction was significantly higher in group B (-4.60±2.04 Vs. -3.33±2.28) (0.027). There was a non significant attenuation of follicular size discrepancies in two groups. FSH and inhibin B levels in the day 3 of the next cycle in both groups were significantly decreased but did not have significant difference between two groups.Conclusion: Both luteal E2 and premenstrual GnRH antagonist administration reduces the follicular sizes significantly and GnRH antagonist acts more potently than E2 in this way but attenuation of follicular size discrepancies in both treatment is not significant

Objective: The aim of this study was to compare the effects of the transverse muscle-cutting Maylard incision and the Pfannenstiel incision for hysterectomies, in terms of postoperative complications, pain, and quality of life. Materials and Methods: This randomized, double-blind study compared two laparotomy techniques. All hysterectomies were performed for benign conditions. Eighty cases were randomly assigned to receive either Pfannenstiel or Maylard incisions. Measured intraoperative variables included volume of blood loss and duration of surgery. Postoperative variables included abdominal distension, postoperative pain, and quality of life. Results: Postoperative abdominal distension was significantly lower in the Maylard group (p = 0.004). There were no differences in intraoperative characteristics and duration of hospitalization, hemorrhage volume, or duration of surgery between the two groups. Conclusion: Hysterectomy performed via the Maylard incision was associated with the use of fewer additional analgesics than hysterectomy performed via the Pfannenstiel incision.

Background & Objective: Overactive bladder (OAB) is a syndrome that has serious adverse effects on daily activities and therefore causes many economic burden and psychological consequences. The present study was conducted with aim to determine if there are differences between clinical symptoms and detrusor overactivity (DO) in patients with overactive bladder syndrome (OAB). Materials & Methods: This cross-sectional study was conducted on women with symptoms of overactive bladder referred to the urodynamic unit of pelvic floor clinic of Vali-E-Asr Reproductive Health Research Center between February 2018 and December 2022. Patients were divided into two groups with DO (DO group) and without DO (NDO group) based on urodynamic findings and then compared in terms of demographic characteristics and urodynamic variables in filling and voiding phase. Results: Among the 125 analyzed patients, DO was diagnosed in 36 patients (28%). DO group had older age (P=0.02), a greater number of menopause (P=0.03) and more disturbing urinary condition in the questionnaire (ICIQ-OAB) (P=0.02). Conclusion: As the results of this study showed, nearly one-third of OAB patients had DO. The presence of DO is associated with older age and has a greater effect on the quality of life. Also, they had lower first desire and maximal capacity in urodynamic study. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the quality of life, pelvic discomfort, and sexual function of patients who underwent posterior pericervical repair or level I to III surgical procedures for pelvic organ prolapse (POP) after 5 years of follow-up. This retrospective cohort study enrolled 107 women with POP who were referred to the Imam Khomeini Hospital Complex, an academic center affiliated with the Tehran University of Medical Sciences, Tehran, Iran, from 2014 to 2021. The patients underwent transvaginal surgery using native tissue, in which the rectovaginal fascia was attached to the pericervical ring. The Pelvic Floor Distress Inventory-20 (PFDI-20) and Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) questionnaires were completed by each patient before and 5 years after surgery. Of the 107 patients, only 78 completed the 5-year follow-up. The mean PFDI-20 scores before, 12 months, and 5 years after surgery were 141.87 ± 34.48, 100.87 ± 26.48, and 37.49 ± 56.39, respectively, indicating a significant improvement in the patients' symptoms after surgery (P < 0.001). The total mean score of ICIQ-FLUTSsex was 3.67 ± 3.63 (range, 0-10). In total, 22 (28.2%) women had an ICIQ-FLUTSsex score of 0, indicating no problems. The attachment of the rectovaginal fascia to the pericervical rings can be an effective surgical technique for correcting posterior vaginal wall prolapses, without significant morbidity. The PFDI-20 score improved significantly from before surgery to 12 months and 5 years after surgery. [ABSTRACT FROM AUTHOR]

Background & Objective: Defecatory dysfunction is a common problem among women who are referred for urogynecological care. Pelvic organs prolapse (POP) which is a downward displacement of pelvic organs is one of the common conditions among patients with defecatory problems. This study was planned to evaluate the correlation of obstructive defecatory symptoms with the site and severity of pelvic organ prolapse and the anorectal manometry results. Materials & Methods: This cross-sectional study was performed between Dec 2018 and Nov 2019. A total of 150 women with symptoms of defecatory problems were enrolled. Patients were classified in two groups according to each compartment prolapse staging and severity: stage =2 and stage >2. The correlation between defecatory symptoms and pelvic organ prolapse examination, anorectal examination and anal manometry were evaluated. Results: A total of 150 women were evaluated. There was a significant correlation between higher stage of anterior compartment prolapse (cystocele stage>2) and constipation (P=0.035). Although all the defecatory symptoms were more frequent in anterior prolapse stage>2, but the difference was not significant (P>0.05). There was no significant correlation between defecatory symptoms and severity of posterior compartment prolapse. There was a significant correlation between stage>2 of apical prolapse and all the defecatory symptoms (P=0.05). The abnormal anal resting and squeeze pressure and abnormal balloon expulsion test were more frequent in stage >2 of all compartments prolapse, but the difference was not significant (P>0.05). Conclusion: Obstructed defecation syndrome was more frequent in patients with higher stages of anterior and apical prolapse. Abnormal manometry results were more frequent in patients with defecatory dysfunction with advanced vaginal prolapse. [ABSTRACT FROM AUTHOR]

Introduction: Genitourinary syndrome of menopause (GSM) is a common complication secondary to estrogen depletion which leads to tissue changes in the female genitourinary tract. Here, we sought to investigate the short- and long-term effects of CO2 laser therapy on symptoms of GSM in postmenopausal women. Methods: In this clinical trial, 47 postmenopausal women with symptoms of GSM were included. Participants underwent vaginal and extra-vaginal CO2 fractional laser treatment in three sessions, with intervals of one month between each session. Symptom severity, including itching, dyspareunia, vaginal discharge, and dryness, was assessed at each session using a modified Vaginal Health Index (VHI), where the intensity was rated on a Visual Analog Scale (VAS) from 1 to 10 (1 indicating minimal symptoms and 10 representing maximum severity). Additionally, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was administered. Patients were followed for one to three years after the final laser treatment session. Results: The scores of all subscales, including itching, dyspareunia, urinary incontinence, vaginal discharge, and dryness, improved significantly following three sessions of CO2 fractional laser (P values < 0.001). However, except for the urinary incontinence domain (P = 0.058), none of the symptoms maintained improved after one to three years from the last intervention. Conclusion: CO2 fractional laser treatment is appropriate for treating symptoms related to GSM. But it seems that it needs to be used continuously for the maintenance effect on itching, dyspareunia, urinary incontinence, vaginal discharge, and dryness. The exact timing of laser sessions should be identified in further studies since the beneficial outcomes of the intervention seem temporary. [ABSTRACT FROM AUTHOR]

Constipation and obstructive bowel disorders are the most common symptoms of prolapse and posterior defects. Prolapse and obstructive defecation disorders are treated using various surgical techniques to repair posterior defects. This study aimed to evaluate the manometry results of patients before and after reconstructive surgery of the posterior compartment. This retrospective cohort study included 40 women with defecation disorders referred to the Imam Khomeini Hospital Complex, an academic center affiliated with Tehran University of Medical Sciences, Tehran, Iran, from 2020 to 2021. Data were collected through medical records and a checklist developed by the researcher before and after surgery. All analyses were performed using SPSS software (version 26), with significance at p<0.05. Forty women with a mean age of 49.47±9.66 years participated in this study. The manometry results showed significant differences in patients before and after surgery in parameters such as maximum resting pressure, push test, constipation, straining during defecation, finger support necessity, sensation of incomplete defecation, dyspareunia, and husband's sexual satisfaction (p<0.001). In addition, all patients had a grade 2 or higher posterior compartment prolapse, which improved in all cases after surgery (p<0.0001). Patients' symptoms significantly improved during the 12-month follow-up after DeLancey level 3 to 1 surgery. This type of surgery proved to be an effective surgical intervention without significant complications in the short-term follow-up. [ABSTRACT FROM AUTHOR]

Objective: Ultrasonography (US) is an acceptable tool to diagnose the placenta accreta spectrum (PAS) among pregnant women. However, the lack of a robust criteria for diagnosis and predicting the severity of the consequences facing pregnant women requires identification of novel biomarkers. Material and Methods: This prospective, cross-sectional study was performed on pregnant women with a probable diagnosis of PAS. Their demographic information, medical and surgical history, blood loss severity (severe ≥2500 mL) following hysterectomy, and the histopathology after the surgery were collected. In addition, the Doppler imaging of both uterine arteries, including the pulsatility index, resistance index, peak systolic velocity (PSV), the PSV of the posterior part of the bladder, cervix, the largest lacuna, and the posterior lacuna of the bladder were calculated by Doppler US. Data were analyzed to investigate the relationship between Doppler markers and the severity of PAS in terms of bleeding, hysterectomy, and histopathology. Results: Fifty-one women were enrolled with a mean age of 35.4±4.11 years and 17 (33.3%) had severe bleeding. There were significant differences between median (range) bladder PSV [57 (34-90) vs. 33 (20-64); p<0.001], cervix PSV [26 (0-63) vs. 18 (0-76); p=0.04] and left uterine artery [89 (81-135) vs. 68 (61-113); p=0.045] for women with and without severe bleeding, respectively. Thirty-four (66.66%) had hysterectomy. Comparison of bladder PSV, cervix PSV, and left uterine PSV for women with and without hysterectomy were 46 (20-90) vs. 39.5 (33-46) (p=0.005), 20 (0-76) vs. 20 (14-26) (p=0.013) and 68 (61-135) vs. 82 (63-101) (p=0.003), respectively. Conclusion: Bladder PSV, cervix PSV, and uterine PSV were significantly higher in pregnant women with PAS, and they may be useful diagnostic and prognostic markers. [ABSTRACT FROM AUTHOR]

Postoperative abscess after colpocleisis is rare. We reported a 67-year-old woman with an abscess after a month of Le Fort colpocleisis. Two abscesses of approximately 5 cm in size were drained. The injection of antibiotics continued up to 7 days after the surgery, and the drain was taken on the 4th day after the operation due to the improvement of the patient's general conditions and no discharge. It is recommended to consider pelvic abscess in patients suffering from fever, pain, pelvic pressure, and diarrhea after pelvic surgeries. Early diagnosis and treatment will reduce mortality and disability in patients. [ABSTRACT FROM AUTHOR]

Background & Objective: Pelvic organ prolapse (POP) is the herniation of the pelvic organs to or beyond the vaginal wall. Patients with POP may present with specific symptoms like vaginal bulge or pressure or associated symptoms including urinary, defecatory or sexual dysfunction, which could negatively affect the quality of life in these patients. This study aimed to assess the surgical outcomes of native-tissue apical suspension by sacrospinous ligament fixation (SSLF) versus uterosacral ligament suspension (ULS). Materials & Methods: This prospective cohort study was conducted to evaluate the outcomes of native-tissue apical suspension for pelvic organ prolapse within one year after the surgery from March 2017 to July 2019 at Imam Khomeini hospital, an academic hospital of Tehran University of Medical Sciences, Tehran, Iran. Inclusion criteria were patients with uterine prolapse at Stage 2 or 3 according to the Pelvic Organ Prolapse Quantification System (POP–Q) who planned for total vaginal hysterectomy and apical suspension using uterosacral ligament suspension (ULS) or sacrospinous ligament fixation (SSLF) with no history of pelvic organ prolapse surgery. The main outcome was surgical consequences within 1 year after surgery. Results: There was no significant difference between the two groups in terms of relapse of anterior, posterior, or apical compartment prolapse. According to the clinical recurrence, although vaginal bulging and pressure were more common in sacrospinous ligament fixation (SSLF) group, the difference was not significant. The number of patients with severe buttock and pelvic pain was significantly higher in the sacrospinous ligament fixation (SSLF) group. Conclusion: sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) are both optimal procedures with the same complications and similar surgical outcomes; however, uterosacral ligament suspension (ULS) had lower post-operative pelvic pain, and also the number of retreatments was lower in this group. [ABSTRACT FROM AUTHOR]

Background: Transverse vaginal septum is a rare mullerian anomaly. Patients with a complete transverse vaginal septum generally complain of primary amenorrhea. Here, we presented a rare case of high transverse vaginal septum with abdominal mass during infancy in addition to chronic pelvic pain and cyclic hematuria during adulthood. Case presentation: The patient was a 26-year-old female with complain of severe abdominal and pelvic pain with significant weight loss. She had a history of surgery for correction of hydrometrocolpos (fluid accumulation in the uterus and vagina) because of transverse vaginal septum at infancy period. She had no gynecologic follow-up until the age of 26 years. At the last surgical evaluation, diffuse pelvic endometriosis with advanced metastatic colon cancer was noted. Conclusion: After diagnosis of transverse vaginal septum during infancy period, detailed counseling should be performed about the other treatment and follow-up which is needed to prevent severe complications that could affect the quality of life. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse (POP) is the descend of pelvic organs, including the uterus, bladder, and rectum, to the vaginal wall. Patients with POP may present with symptoms such as vaginal bulging with other symptoms like urinary, defecatory, or sexual dysfunction. This study was conducted to evaluate the changes of POP symptoms one year after pessary fitting. Patients with symptomatic pelvic organ prolapse who presented to the pelvic floor clinic of an academic hospital between August 2016 and April 2019 were considered. Pelvic organ prolapse symptoms, including urinary, defecatory, sexual, and bulging symptoms, were recorded before and one year after pessary fitting. Pelvic floor distress inventory (PFDI)-20 and pelvic floor impact questionnaire-7 (PFIQ-7) were evaluated before and after treatment for all subjects. We analyzed the characteristics of 110 patients who used the pessary for 12 months. At the baseline, the most common prolapse symptoms were vaginal bulging and pelvic pressure. All urinary, defecatory, and sexual symptoms significantly improved one year after regular pessary use (P<0.001). Changes in PFDI-20 and PFIQ-7 before and after pessary use showed a significant improvement in both frequency and satisfaction of sexual function (P<0.001). The study showed significant improvement in bulging, urinary, and defecatory symptoms. Although the majority of patients were not sexually active, a significant proportion of sexually active patients reported an increase in sexual satisfaction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pelvic organ prolapse is a common pelvic disorder among women. A standard staging system is needed to carefully evaluate the extent and severity of the disease, and initiate appropriate treatment. The aim of this study was to compare the two methods of standard and simplified pelvic organ prolapse quantification systems in clinical staging of Iranian women with pelvic organ prolapse. METHODS: This observational cross-sectional study was conducted on all women with complaints of seeing or feeling a vaginal lump or bulge and/or a dragging sensation who were presented to a pelvic floor disorders clinic of Imam Khomeini Hospital in Tehran, Iran, from October 2018 to June 2019. All patients were evaluated in terms of pelvic organ prolapse severity and staging using both instruments. Also, length of time needed to complete the questionnaires were calculated. After data collection, the results of pelvic organ prolapse staging and degree of agreement between two examiners were evaluated. RESULTS: A total of 120 women with mean age of 50.92±13.12 years were evaluated. It was shown that there is an almost perfect agreement (kappa coefficient > 0.8) between standard and simplified pelvic organ prolapse quantification systems in all the 3 compartments. Also, there was almost a twofold increase in the time needed to perform standard pelvic organ prolapse quantification (4.16±1.01 minutes) compared to performing simplified pelvic organ prolapse quantification (2.12±1.14 minutes) (p=0.03). CONCLUSION: According to the results of this study, there is a substantial and almost perfect agreement between standard and simplified pelvic organ prolapse quantification systems in clinical staging of Iranian women with pelvic organ prolapse. It seems that using simplified pelvic organ prolapse quantification system is more applicable in clinical practice for staging of pelvic organ prolapse, with high reliability coefficient. [ABSTRACT FROM AUTHOR]

Congenital absence of the vagina with variable uterine development known as Mullerian agenesis or Mayer-Rokitansky-Kuster-Hauser syndrome. Cervicovaginal agenesis in the presence of normal uterus is very rare. Conservative surgery has recently been suggested in patients with congenital cervicovaginal atresia in order to relieve the symptoms and maintain fertility. A 13-year-old female referred to a pelvic floor clinic, because of primary amenorrhea and severe cyclic pelvic pain. Ultrasonography revealed a large amount of blood accumulation in the uterine cavity, and also, the cervicovaginal agenesis was reported. Both ovaries were normal. A neovagina was created by dissection of the space between the bladder and rectum. Under ultrasonography guidance, two Pezzer catheters were inserted between uterine ending and neovagina, so the catheters kept the canal patent, a soft mould was applied to prevent the vaginal stricture. Cervicovaginal agenesis, accompanied by normal functional endometrium, is a rare but challenging Mullerian anomaly in the case of surgical treatment. One of the successful conservative treatment in a fully educated patient is the vaginal reconstruction and uterovaginal anastomosis by stenting and continues the application of vaginal mould. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor dysfunction (PFD) refers to a wide range of issues that occur when muscles of the pelvic floor are weak, tight, or there is an impairment of the sacroiliac joint, lower back, coccyx, or hip joints. PFD and pelvic organ prolapse (POP) affect about 50% of women past middle age. Symptoms include pelvic pain, pressure, dyspareunia, incontinence, incomplete emptying, and gross organ protrusion. Nowadays, there are novel diagnostic tools and therapies proposed for pelvic floor weakness and organ prolapse. Pelvic organ prolapse quantification system (POP-Q) examination and complementary magnetic resonance imaging (MRI) are two methods of diagnosis. Objectives: The goal of our study was to assess the agreement between POP-Q examination and MRI in detecting anterior pelvic prolapses. In addition, we evaluated the additive role of MRI adjunct to POP-Q examination in detecting anterior pelvic organ prolapse. Patients and Methods: An experimental study was carried out on 61 patients having clinical manifestations suggesting pelvic floor weakness. The medical history and physical examination were obtained from all patients. POP-Q examination and dynamic MR imaging was performed. POP-Q results were compared with dynamic MRI findings thereafter. Results: Considering pubococcygeal line (PCL) and H line as reference lines, comparison of MRI and POP-Q findings for detecting bladder neck and urethra prolapses revealed a moderate to good agreement (49% - 80%) rate between MRI and POP-Q examination. This corresponds to a weak to moderate agreement between these two methods. Conclusion: Agreement of MRI and POP-Q is moderate to good for detecting anterior pelvic organs prolapses. MRI could be regarded as a complementary method to POP-Q examination. A combination diagnostic approach, including MRI and POP-Q, for high stage pelvic prolapse is highly recommended. [ABSTRACT FROM AUTHOR]

Congenital absence of the vagina with variable uterine development known as Mullerian agenesis or Mayer-Rokitansky-Kuster-Hauser syndrome. Cervicovaginal agenesis in the presence of normal uterus is very rare. Conservative surgery has recently been suggested in patients with congenital cervicovaginal atresia in order to relieve the symptoms and maintain fertility. A 13-year-old female referred to a pelvic floor clinic, because of primary amenorrhea and severe cyclic pelvic pain. Ultrasonography revealed a large amount of blood accumulation in the uterine cavity, and also, the cervicovaginal agenesis was reported. Both ovaries were normal. A neovagina was created by dissection of the space between the bladder and rectum. Under ultrasonography guidance, two Pezzer catheters were inserted between uterine ending and neovagina, so the catheters kept the canal patent, a soft mould was applied to prevent the vaginal stricture. Cervicovaginal agenesis, accompanied by normal functional endometrium, is a rare but challenging Mullerian anomaly in the case of surgical treatment. One of the successful conservative treatment in a fully educated patient is the vaginal reconstruction and uterovaginal anastomosis by stenting and continues the application of vaginal mould.

Purpose: To compare clinical and urodynamic study (UDS) findings in Iranian women with mixed or stress UI (Urinary Incontinence). Materials and methods: A total of 132 patients with either stress or mixed type of UI were enrolled. After accurate examination, data regarding age, parity, mode of delivery and menopausal state were recorded. Furthermore the presence and severity of UI was evaluated with empty bladder supine stress test (ESST) and cough test in supine and standing positions in all patients. Eligible cases underwent UDS evaluation by an expert urologist using a standardized protocol. Results: Stress and mixed UI were found in 33 (25%) and 99 (75%) patients respectively. By considering clinical evaluation as gold standard, sensitivity, specificity, positive and negative predictive value of urodynamic study were 83.4%, 30.4%, 43.4% and 80% for detecting stress UI and 96.1%, 35.6%, 34.7%, 96.2% for detecting mixed UI respectively. No correlation was noted between ESST or cough test results and Valsalva leak point pressure (VLPP) values in patients with stress UI, however ESST was correlated with VLPP values in patients with mixed UI. Conclusion: Despite a relatively high sensitivity, the specificity was low and urodynamic evaluation seems to be of limited value in the assessment of UI in female patients. [ABSTRACT FROM AUTHOR]