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BACKGROUND Bladder instillation of hyaluronic acid (HA) is an acceptable treatment for bladder pain syndrome/interstitial cystitis (BPS/IC). The treatment is limited by a high proportion of non-responders (~30%-40%). Here, we aimed to evaluate predisposing factors associated with treatment outcomes. METHODS This is a prospective multicenter study. We enrolled a total of 137 (out of 140) women with refractory IC. They all underwent a standard protocol of 6-month intravesical HA therapy (initial 4 weeks, once weekly, followed by once monthly). To assess the outcomes, we used the pain Visual Analog Scale (Pain-VAS), Interstitial Cystitis Symptom and Problem Index (ICSI & ICPI), and a scaled Global Response Assessment (GRA). RESULTS The age of patients was 47.6 ± 27.5 (range 24-77) years. We found statistically significant improvement (p < 0.001) in the Pain-VAS and the ICSI & ICPI scores both after the initial 4-weekly instillations and at the end of 6-month treatment. Those who reported moderate/marked improvement on GRA at the 2 follow-up visits were considered responders: 39.4% (n = 54) at the first follow-up, and 59.9% (n = 82) at the second follow-up. No remarkable side effect was noted. After statistical analyses, treatment outcomes on GRA were positively associated with baseline functional bladder capacity and with Pain-VAS scores. The initial treatment responses optimally (p < 0.001) predicted final treatment outcomes (McNemar). CONCLUSION Intravesical HA therapy is safe and effective for most (~60%) of our patients with refractory IC. Functional bladder capacity and Pain-VAS scores before treatment, and the early treatment responses are helpful predictors of treatment outcomes.

Background Systemic lupus erythematosus (SLE) can directly affect various part of the ocular system, but there was no comprehensive analysis of ophthalmic disorders of patients with SLE using population-based data. The aim of this study was to investigate the frequency and prevalence of ophthalmic disorders for ophthalmologist visits in adult patients with SLE and to evaluate the risk of dry eye syndrome, cataracts, glaucoma, episcleritis and scleritis, and retinal vascular occlusion in these patients. Methods The Taiwan’s National Health Insurance Research Database was used to assemble a SLE cohort consisting of newly diagnosed SLE between 2000 and 2012. A comparison cohort was also sampled from the same database and it consisted of 10 patients without SLE for each patient with SLE, based on frequency matching for sex, five-year age interval, and index year. Both cohorts were followed until either the study outcomes have occurred or the end of the follow-up period. Results Patients with SLE (n = 521) exhibited a significantly higher prevalence (68.1% vs. 60.5%, P = 0.001) and frequency (median 5.51 vs. 1.71 per 10 years, P P P P = 0.002) were significantly higher in patients with SLE. In addition, the risk of several SLE related ophthalmic disorders, including episcleritis and scleritis (adjusted IRR 6.11, P P = 0.023) were significantly higher in patients with SLE. Conclusions The increased risk of dry eye syndrome, cataracts, glaucoma, episcleritis and scleritis, and retinal vascular occlusion in patients with SLE deserves vigilance.

Seprafilm becomes brittle and sticky after contact with water, rendering it difficult to use in laparoscopic surgery. Hence, Seprafilm is not used frequently in laparoscopic surgery. This prospective randomized controlled trial aimed to compare the feasibility of two methods of application of Seprafilm: wet and non-wet. Two groups comprised 30 patients, each with 180 pieces of Seprafilm. Symptomatic patients who underwent laparoscopic surgeries, including hysterectomy and adnexal surgeries, were recruited. Successful application of Seprafilm was defined as a smooth attachment to the site of application. Sticky and fractured Seprafilm sheets were defined as failed applications. Between March 2016 and December 2017, 60 patients underwent laparoscopic Seprafilm placement. The preparation time was 32.67 ± 16.63 and 79.50 ± 22.01 s in the non-wet and wet groups, respectively (p &lt, 0.00). The success rate of application was 95.4% in the non-wet group and 98.3% in the wet group (p = 0.09). Placement time was 599.50 ± 90.18 s and 592.53 ± 105.82 s in the non-wet and wet groups, respectively (p = 0.25). In conclusion, the wet and non-wet application methods of Seprafilm were feasible in laparoscopic surgeries. The preparation time was different between the two groups. However, the rate of successful application and placement time was not different between the two groups.

The aim of this study was to compare the clinical outcomes of transvaginal mesh (TVM) surgery with and without midline fascial plication for anterior prolapse repair. This is a prospective randomized trial in a teaching hospital. This study compared patients with anterior vaginal wall prolapse (POP-Q Ba &gt, −1) who were randomly assigned to either transvaginal mesh (TVM, Avaulta SoloTM, CR Bard. Inc., Covington, GA, USA polypropylene mesh delivery system) (group A, n = 32) or TVM with concomitant midline fascial plication (group B, n = 32). The outcomes of anatomy correction and life quality were evaluated using a pelvic organ prolapse quantification system and questionnaires. Sixty-four patients were included from January 2011 through April 2014 in this study. Group A had a mean age of 63.7 years and a body mass index (BMI) of 25.4 kg/m2. Group B had a mean age of 62.9 years and a BMI of 25.4. The mean follow-up duration was 18.6 months (range 12–50). At the 12-month follow-up, anatomic recurrence was higher in Group A (5/31, 16.1%) than in Group B (1/30, 3.3%) but without statistical significance (p = 0.19). Improvements in symptoms and quality of life were not significantly different between the two groups. Mesh extrusion was detected in three of 61 patients (4.9%): two from group A (6.7%) and one from Group B (3.2%). TVM with concomitant midline fascia repair for anterior vaginal prolapse had a comparable anterior support and mesh exposure rate compared with TVM alone. Trial Registration: IRB-B09904021

BACKGROUND Minimally invasive surgery (MIS) has rapidly advanced, but its use in transplant patients has lagged. We share our experience of MIS for patients after kidney and liver transplantation and compare our results with similar studies in the literature. MATERIAL AND METHODS This study included 14 MIS (12 laparoscopic, 2 transvaginal) procedures for 13 transplant cases (6 liver and 7 kidney) done from May 2006 to May 2018. Gastrointestinal surgery was performed in 6 cases: appendectomy performed 8 months after liver transplant and 16 months after kidney transplant in 2 cases, radical right hemi-colectomy performed 6 weeks after liver transplant in 1 case; exploration for chylous ascites 6 months after liver transplant in 1 case, sleeve gastrectomy performed 3 years after kidney transplant in 1 case, and partial hepatectomy performed 12 years after kidney transplant in 1 case. For urological problems, 2 patients received ipsilateral right-side nephroureterectomy performed 10 and 12 years after kidney transplant, and 1 patient received contralateral left-side nephroureterectomy performed 12 years after kidney transplant. The 2 liver transplant patients with huge incisional hernias received repair approximately 3 and 2 years after liver transplant. Three patients underwent gynecological surgery: 2 transvaginal for pelvic floor reconstruction in 1 patient with liver transplant and 1 hysterectomy in a kidney transplant patient, and 1 laparoscopic-assisted hysterectomy in a kidney transplant patient. We retrospectively analyzed the clinical presentation, operative findings, operation time, postoperative complications, and length of stay. RESULTS The postoperative course was uneventful, with early resumption of oral intake, including immunosuppressants administered the same as in the non-transplant patients. All surgical procedures in these transplant patients were achieved without conversion, showed stable kidney and liver function, had better surgical outcomes in comparison with traditional surgery, and most of them were discharged within 1 week. CONCLUSIONS Laparoscopic and non-laparoscopic MIS surgery are feasible and safe for abdominal organ transplant patients and are helpful for timely intervention in cases with acute abdomen. No adjustment of immunosuppressant is usually needed, as oral intake can be resumed very soon after surgery.

Objective To date, few studies have examined end-of-life (EOL) care and healthcare costs for patients with ovarian cancer. We evaluated the effects of hospice care on the quality of EOL care and healthcare costs for patients with ovarian cancer in the final month of life. Materials and Methods We conducted a population-based study and analyzed data from Taiwan9s Longitudinal Health Insurance Database, which contains claims information for medical records of patients, healthcare costs, and insurance system exit dates: our proxy for death between 1997 and 2011. Results A total of 176 women who died of ovarian cancer were investigated. Of these patients, 32 (18.2%) had received hospice care. Univariate analysis revealed that the patients with hospice care (H group) had lower proportions of intensive care unit admission (0% vs 15.3%) and cardiopulmonary resuscitation (0% vs 18.1%). The mean health care cost per person during the final month of life for H group was approximately 5.5% significantly higher than patients without hospice care (non-H group) (US $3121 ± $376 vs $2957 ± $347). The effects of hospice care on intensive care unit admission, receipt of cardiopulmonary resuscitation, and more than 1 emergency room visit could not be assessed because no cases of these 3 occurrences were observed among the H group by the multivariate regression model. No significant difference was observed between the H and non-H groups in terms of chemotherapy during the final 2 weeks of life. The H group had higher probabilities for more than 1 hospitalization and death in acute hospitals after adjusting for confounders. Conclusions The aggressiveness of EOL cancer care and healthcare costs could not be offset in the final month of life among women with advanced ovarian cancer who received hospice care. The factors of more hospitalizations and dying in hospital warrant further investigation.

To evaluate the short-term impact of surgical repair with total transvaginal mesh (TVM) on sexual function among women with pelvic organ prolapse (POP).Twenty-seven sexually active women who underwent total TVM procedures for symptomatic POP at Buddhist Dalin Tzu Chi General Hospital between 2007 and 2010 were included in the retrospective study. Preoperative and postoperative assessments included pelvic examination using the POP quantification (POP-Q) system, urodynamic studies, and a personal interview to evaluate urinary and sexual symptoms via the urogenital distress inventory (UDI-6), incontinence impact questionnaire (IIQ-7), and female sexual function index (FSFI).The mean patient age was 51.4 years (range 36-68 years) and the mean parity was 2.7(range 0-4). Regarding POP-Q parameters, there were significant improvements at points Aa, Ba, C, Ap, and Bp after surgery (P0.001). Similarly, the UDI-6 and IIQ-7 scores significantly dropped postoperatively (P0.01). After surgery, the scores for the dyspareunia and the lubrication domains of FSFI worsened significantly (P0.05). There was no significant change in other domains (desire, arousal, orgasm, satisfaction, and total score; P0.05). Two-thirds (66.7%) of women had a lower total FSFI score postoperatively.TVM surgery was found to contribute successfully to the anatomic correction of POP, but individual domains of sexual function sometimes worsened.

Introduction The effect of transvaginal mesh (TVM) surgery on sexual function between premenopausal and postmenopausal women remains controversial. Aim To compare the changes in sexual function of premenopausal and postmenopausal women following TVM repair. Methods One hundred and fifty-two consecutive women with symptomatic pelvic organ prolapse (POP) stages II to IV were referred for TVM procedures at our hospitals. Sixty-eight women were included because they were sexually active and had complete follow-up. All subjects were divided into the premenopausal (N = 36) and postmenopausal (N = 32) groups. Preoperative and postoperative assessments included pelvic examination using the POP quantification (POP-Q) system and a personal interview with the Female Sexual Function Index (FSFI), Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7). Main Outcome Measures The FSFI, UDI-6, and IIQ-7 questionnaires. Results The mean age, rates of hypertension, and previous hysterectomy were significantly higher in the postmenopausal group (P 0.05). Similarly, the UDI-6 and IIQ-7 scores significantly decreased postoperatively (P 0.05). There were no significant changes in other domains and total scores in both groups (P > 0.05). However, higher rates of worsening dyspareunia and total scores were noted in the premenopausal group (P = 0.03 vs. 0.033). Conclusion TVM procedure is effective for the anatomical restoration of POP. However, individual domain of FSFI such as dyspareunia may worsen in the premenopausal women. Additionally, our results revealed that over one third of premenopausal women could have a worsening sexuality domain postoperatively, with significantly higher rate of deteriorated dyspareunia and total FSFI scores than postmenopausal women.

The aim of this study was to identify the predictors of improved overactive bladder (OAB) symptoms after transvaginal mesh repair.Eighty women with pelvic organ prolapse (POP) stage II to IV reporting OAB symptoms were scheduled for transvaginal mesh procedures. Preoperative and postoperative assessments included a bladder diary, urodynamics, and a personal interview about urinary symptoms.Sixty-three (78.8%) women experienced improvement of OAB symptoms (Improvement group), and 17 (21.2%) women remained unchanged or worsened (Persistence group) postoperatively. A univariate analysis of patients' characteristics showed no difference between two groups regarding parity, diabetes, hypertension, prolapse status, preoperative urodynamic parameters, and urinary symptoms (P0.05). However, the age (P = 0.042) and preoperative detrusor overactivity (DO) (P = 0.03) were two significant predictors of postoperative OAB improvement.Women with POP may experience improvement of their OAB symptoms after transvaginal mesh repair. Both age and DO were two predictors in our univariate analysis, and the latter was the only significant predictor of symptom relief after adjusting age factor.

The purpose of this study was to compare tension-free vaginal tape (TVT) and the TVT-obturator (TVTO) procedures.Multicenter retrospective cohort study (Canadian Task Force classification II-2).Tertiary teaching hospitals.We reviewed 82 women with urodynamically proven stress incontinence undergoing either TVT (n = 53) or TVTO (n = 29) without concomitant surgery.TVT and TVTO procedure.All subjects underwent urinalyses, 1-hour pad testing, perineal ultrasonography, and urodynamic studies, as well as validated questionnaires before and 1 year after surgery. Mean operative time was significantly shorter in the TVTO group (16.8 +/- 10.7 minutes vs 28.6 +/- 6.9min, p.01; unpaired t-test). The subjective and objective cure rates were comparable for the TVT and TVTO groups (p = .085 vs .19, respectively; Fisher's exact test). At rest or during Valsalva, the middle of the TVTO tape localized more distally than that of TVT on ultrasound scanning (p.01; unpaired t-test). A higher rate of urethral kinking during straining was noted in the TVT group compared with the TVTO group after surgery (87% vs 25%, p.01; chi2 test). After TVT, maximum urethral closure pressure increased significantly (83.6 +/- 24.6 cm H2O vs 69.2 +/- 25.9 cm H2O, p.05), but this was not the case in the TVTO group (67.8 +/- 15.0 cm H2O vs 63.2 +/- 12.3 cm H2O, p.05; paired t test).With comparable subjective and objective cure rates, TVTO has the advantages over TVT with shorter operative time. However, the TVTO tape is at a less acute angle and localizes to a more distal part of the urethra, resulting in a lower rate of urethral kinking and less urethral compression.

Transobturator tape procedure using small intestinal submucosa (SIS) is designed for the diminishment of the complications of tension-free vaginal tape procedures, and SIS can lower the erosion rate of mesh. However, we here report a case which developed graft-versus-host disease following the use of SIS for the transobturator procedure.

Intravesical instillation with a hyaluronic acid (HA) solution is an effective treatment for interstitial cystitis/bladder pain syndrome (IC/BPS), but its impact on sexual functioning of patients is not known.The aim of this study was to evaluate the changes in sexual function of women with refractory IC/BPS who underwent a second-line intravesical HA therapy.A total of 103 women diagnosed with refractory IC/BPS were enrolled in this prospective, multicenter study. Sexual function was evaluated using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-9). Bladder-related symptoms and bother were assessed by the Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), and a pain visual analog scale (VAS), respectively. Data were analyzed with univariate methods or multivariate logistic regression analysis accordingly.Changes in PISQ-9, ICSI, ICPI, and pain VAS scores after treatment were assessed.Mean age and duration of symptoms was 43.6 ± 11.8 and 5.1 ± 5.0 years, respectively. ICSI, ICPI, and pain VAS scores were significantly (P 0.001) improved after 1 month and 6 months of treatment. Of the 87 (84.5%) sexually active women evaluated, PISQ-9 total scores improved significantly (P 0.001) from the baseline (mean 18.9 ± 6.4), after 1 month (20.4 ± 5.8), and 6-months (21.5 ± 5.6) of treatment. Significantly improved PISQ-9 items included "dyspareunia" (P 0.001) and "negative reactions" (P = 0.015) during sexual intercourse, and "intensity" (P 0.001) of sexual orgasms. After a logistic regression analysis, we found that a baseline PISQ-9 score was negatively correlated with the duration of IC/BPS symptoms (P = 0.022). Meanwhile, the changes in PISQ-9 scores were positively correlated with the reduction in ICSI scores after treatment (P = 0.045).Intravesical HA is an effective treatment for refractory IC/BPS. A longer duration of IC/BPS symptoms may be a predictor of poor sexual function. However, intravesical HA may improve sexual function along with the reduction of IC/BPS symptoms.

A 44-year-old woman had a history of papillary thyroid carcinoma and underwent total thyroidectomy and I ablation therapy. During the follow-up, 2-mCi I cancer workup showed an unusual shape of uptake in the pelvic region. Hybrid SPECT/CT revealed uptake posterior to the uterus, where sonography showed an 85.4-mm right ovarian endometrioma just corresponding to the location. Laparoscopic salpingo-oophorectomy showed right ovarian endometrioma (7 cm) and left ovarian cyst (4 cm). Pathologic findings showed bilateral endometriosis. After that survey, follow-up I cancer workup showed left supraclavicular, pretracheal, and right hilar metastatic lymphadenopathy with pulmonary metastasis, but no pelvic uptake was noted.

To evaluate the clinical and urodynamic outcomes of transvaginal mesh repair (TVM) for the treatment of pelvic organ prolapse (POP).One hundred and twenty-four women with POP stage II to IV were scheduled for a TVM procedure. Preoperative and postoperative assessments included pelvic examination, urodynamic testing, and a personal interview about urinary symptoms using a standard questionnaire.We found a significant improvement at points Aa, Ba, C, Ap, and Bp (P0.001) except for total vaginal length (P=0.08), and the overall success rate was 93.5% (116/124). Various urinary symptoms improved significantly following TVM (P0.01). In addition, residual urine, functional urethral length, and the rate of detrusor overactivity, improved significantly after surgery (P0.05). Apart from vaginal erosion (14/124; 11.3%), the rates of other surgical complications were acceptably low.TVM is an effective procedure for the treatment of POP and urinary symptoms, this being possibly related to postoperative release of urethral obstruction. Vaginal erosion is less likely to occur beyond the learning curve.

This study aims to compare clinical outcome using the Perigee/Apogee® vs. Prolift® devices for the treatment of pelvic organ prolapse (POP).One hundred and eight women with POP stages II to IV were scheduled for either Perigee/Apogee® (Perigee group; n = 60) or Prolift® device (Prolift group; n = 48). Preoperative and postoperative assessments included pelvic examination, urodynamic study, and a personal interview about urinary and sexual symptoms.Despite different follow-up period (20 months for the Perigee group vs. 12 months for Prolift group; P 0.01), the success rates for two groups were comparable (P 0.05). Postoperative points Aa and Ba of Prolift group were significantly higher than the other group (P 0.01). The prevalences of detrusor overactivity and urinary symptoms decreased significantly postoperatively in both groups (P 0.05). Comparisons of all operative complications revealed no significant differences between the two groups (P 0.05).Perigee/Apogee® and Prolift® devices for POP repair have comparable success rates, mesh-related morbidities, and similar impacts on functional outcome.

The aim of this review was to assess the recent evidence on the effectiveness and complications of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures for female stress urinary incontinence between January 2008 and March 2009.A meta-analysis of recent studies revealed that the short-term objective cure rate was borderline worse in the TOT group compared with TVT [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.37-1.00; P = 0.05]. Bladder perforation (OR 12.23; 95% CI 2.86-52.34) was significantly more common, whereas groin/thigh pain was significantly less in the TVT group (OR 0.32; 95% CI 0.11-0.92; P = 0.022). Postoperative urinary retention was slightly more in women undergoing TVT than those undergoing TOT (OR 1.6; 95% CI 0.90-3.12; P = 0.06). The rates of vaginal erosion (OR 0.34; 95% CI 0.09-1.33), de-novo urgency (OR 1.21; 95% CI 0.52-2.79) and urinary tract infection (OR 0.88; 95% CI 0.56-1.38) were comparable in both procedures. In addition, TVT appeared to be more obstructive than TOT, as evidenced by ultrasonographic and urodynamic findings. Changes in sexual function need further investigation because this issue has not been well studied for either sling procedure.TOT has the advantages over TVT with shorter operative time and a relatively lower complication rate. For women with intrinsic sphincter deficiency, however, TVT appears to be a better option because it is more obstructive.

Eight rats served as control subjects with sham surgeries and eight rats underwent ovariectomy. Two months later, the expression of muscarinic receptors, neuronal nitric oxide synthase (nNOS), and estrogen receptor (R) at the mRNA level were assessed by reverse-transcription polymerase chain reaction. The results showed that performing an ovariectomy in a virgin rat appears to have little effect on the gene expression of detrusor muscarinic receptors and urethral nNOS despite the menopausal events that occurred.

The purpose of this study was to perform an ultrasonographic comparison of tension-free vaginal tape (TVT) and the TVT-obturator (TVT-O) procedure in women with stress urinary incontinence (SUI).We retrospectively reviewed 159 women with SUI undergoing either TVT (n=91) or TVT-O (n=68). All subjects underwent perineal ultrasonographies, pelvic examination, urinalyses, 1-h pad tests, multichannel urodynamic studies and a personal interview using the Bristol Female Lower Urinary Tract Symptoms Questionnaire before and 1 year after surgery.At rest or during Valsalva, the middle of the TVT-O tape localised more distally than the TVT on ultrasound (p0.01). A higher rate of urethral kinking during straining was observed in the TVT group compared with the TVT-O group after surgery (86.9 versus 23.9%, p0.01). Mean operative time was significantly shorter in the TVT-O group (16.2 versus 28.6 min, p0.01). The rate of objective cure was comparable for the TVT and TVT-O groups (94.5 versus 88.2%, p0.05). However, subjective cure rate was significantly lower for the TVT-O than the TVT group (82.4 versus 93.4%, p=0.042). There was no statistical difference between the 2 groups regarding patient characteristics and complication rates.TVT-O tape results in a less acute angle and localises to a more distal part of the urethra, resulting in less urethral compression and a lower rate of urethral dynamic kinking.

Background Approximately 30 sex-chromosome discordant chimera cases have been reported to date, of which only four cases carried trisomy 21. Here, we present an additional case, an aborted fetus with a karyotype of 47,XX, +21/46,XY. Case presentation Autopsy demonstrated that this fetus was normally developed and had male genitalia. Major characteristics of Down syndrome were not observed except an enlarged gap between the first and second toes. Karyotyping of tissues cultured from the fetus revealed the same chimeric chromosomal composition detected in the amniotic fluid but with a different ratio of [47,XX,+21] to [46,XY]. Further short tandem repeat analysis indicated a double paternal contribution and single maternal contribution to the fetus, with the additional chromosome 21 in the [47,XX,+21] cell lineage originating from the paternal side. Conclusion We thus propose that this chimeric fetus was formed via the dispermic fertilization of a parthenogenetic ovum with one (Y) sperm and one (X,+21) sperm.

To the Editor: A 46-year-old woman treated with peritoneal dialysis (PD) for end-stage diabetic nephropathy for 15 months presented with blood-tinged peritoneal effluent. She had undergone abdominal total hysterectomy and right salpingectomy for uterine myoma and adenomyosis 3 years previously. Since the fourth month of PD therapy, she experienced 3 episodes of painless hemoperitoneum, which resolved after rapid peritoneal flushes. At the fourth presentation, blood tests showed a hemoglobin level of 10.1 g/dL (101 g/L), platelet count of 203 10/ L (203 10/L), leukocyte count of 7.85 10/ L (7.85 10/L), CA-125 level of 6.99 (reference range, 0-35) kU/L, and a coagulation profile within the reference range. A non–contrastenhanced computed tomographic scan showed the tip of Tenckhoff catheter puncturing the right ovary, indicating catheterassociated ovarian damage as the cause of bleeding (Fig 1). Laparoscopy further revealed erosion and puncture of a hemorrhagic ovarian cyst by the catheter tip. Because of persistent bleeding, a right-side oophorectomy was performed; pathologic analysis established the diagnosis of ruptured corpus luteal cyst. The patient resumed peritoneal exchanges 3 days after the surgery and remained asymptomatic thereafter. Hemoperitoneum is an infrequent event occurring in 6.1%-8.4% of PD patients, with a mainly benign clinical course. The most common cause in women is retrograde menstruation, but is unknown in men. However, hemoperitoneum arising from ovarian erosion caused by a Tenckhoff catheter is rarely reported. Most hemoperitoneum episodes can be assessed by taking a standard history and may be resolved with rapid peritoneal flushes, whereas specific investigations are warranted for the remaining 20% of patients with persistent symptoms.