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Purpose To evaluate the efficacy of two progestins, levonorgestrel intrauterine system (LNG‐IUS) and dienogest (DNG), for adenomyosis. Methods This study enrolled 157 women with adenomyosis, randomized to either LNG‐IUS (n = 76) or DNG (n = 81) groups as a controlled clinical trial for 72 months. Participants were classified by three different localizations of adenomyosis: diffuse, focal, and extrinsic. VAS (Visual analog scale) score, days, and amount of uterine bleeding were assessed. Uterine volume or bone mineral density (BMD) were measured by three‐dimensional ultrasonography or dual‐energy X‐ray absorptiometry. Results LNG‐IUS and DNG comparably reduced pain scores in patients with adenomyosis. With regard to pain control, DNG offered greater efficacy than LNG‐IUS in 3 months of treatment. In all types of adenomyosis, the days of bleeding after 12 months with DNG were significantly decreased compared to those with LNG‐IUS. The decrease of whole uterine body was transient in any subtypes. A comparable decrease in BMD due to age‐related changes in both groups was observed. Conclusions LNG‐IUS and DNG could be useful for long‐term management of adenomyosis. In terms of durations of uterine bleeding, DNG was superior to LNG‐IUS for 6 years., We described the efficacy of two progestins, levonorgestrel intrauterine system (LNG‐IUS) and dienogest (DNG) in the treatment of adenomyosis as a first controlled clinical trial. Patients were classified by three different localizations of adenomyosis: diffuse, focal, and extrinsic. DNG proved superior to LNG‐IUS in terms of the duration of uterine bleeding.

Background We evaluated the necessity of urinary trypsin inhibitor for patients with threatened premature labor. Methods We enrolled 146 women with singleton pregnancies who were treated for threatened premature labor as inpatients. The uterine cervical length of each patient was ≤ 25 mm at 22-35 weeks of gestation on transvaginal ultrasonography. The patients were divided into two groups: the urinary trypsin inhibitor group (91 patients treated with urinary trypsin inhibitor daily) or non-urinary trypsin inhibitor group (55 patients not treated with urinary trypsin inhibitor). The childbirth outcomes were retrospectively assessed. Results The median cervical length measured on the day of admission was almost similar between the urinary trypsin inhibitor and non-urinary trypsin inhibitor groups. Depending on the symptoms of uterine contractions, we determined whether ritodrine hydrochloride and/or magnesium sulfate would be appropriate for treatment. The median gestational week at birth was 38 weeks in the urinary trypsin inhibitor group, and no obvious differences were observed when compared with the non-urinary trypsin inhibitor group. With regard to birth weight, no significant difference was found between the two groups (urinary trypsin inhibitor group, 2776 g; non-urinary trypsin inhibitor group, 2800 g). Conclusion Our data showed no significant beneficial effects of urinary trypsin inhibitor in the maternal course and delivery outcomes.

Background: Hysterectomy is commonly performed for uterine myomas, uterine cancers, and uterine prolapses. In this study, we aimed to evaluate the procedures for improving our surgical skill in total laparoscopic hysterectomy (TLH). Methods: Retrospective video reviews of TLH surgeries for 30 patients at our hospital were performed. The operation period was divided into the four phases (phases 1, 2, 3, and 4). We divided the TLH procedures into nine consecutive steps and evaluated the critical factors to complete this surgery. Results: Median surgical time, blood loss amount, and uterine weight were 107 min, 5 mL, and 241 g, respectively. Total surgical time in phrases 3 and 4 was significantly shorter compared with that in phase 1. Duration of surgical time positively correlated with uterine weight (P=0.0346) and blood loss amount (P=0.0001), whereas there was no significant correlation between the uterine weight and blood loss amount. In phases 3 and 4, there were no correlation between the uterine weight and the surgical time. Conclusions: The most crucial factor for determining surgical time in our TLH procedures would be the identification of ureter and the transection of uterine artery (P