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Background: Several studies have addressed the issue of undetected uterine pathology in women undergoing hysterectomy for pelvic organ prolapse (POP). However, these studies differ largely with respect to the incidence of malignancy found, study population, and preoperative evaluation., Objectives: To assess the risk of unexpected pre-malignant and malignant uterine pathological findings after vaginal hysterectomy for POP repair, in a single medical center in Israel., Methods: A retrospective study was performed of all patients who underwent vaginal hysterectomy due to symptomatic POP between January 1990 and April 2015 in a single tertiary medical center. Selected clinical and pathological data were retrieved from the computerized medical records. All specimens were routinely sent for histopathological assessment. All women were managed according to a uniform protocol that required the presence of a preoperative normal Pap smear, and included preoperative transvaginal sonography and endometrial biopsy when indicated. Patients in whom premalignant or malignant lesions were found preoperatively were not included in the study., Results: The study comprised 667 patients. The overall rate of malignant or significant premalignant pathologies (6 cases) was 0.89%, including one (0.14%) case of endometrial carcinoma. All premalignant and malignant pathologies were found only in post-menopausal patients. The rate of significant endometrial pathological lesions found in asymptomatic post-menopausal women was only 0.35%., Conclusions: The rate of preoperatively undetected abnormal histopathological findings in patients who undergo vaginal hysterectomy due to POP is very low, and therefore more extensive preoperative evaluation is not warranted in them.

Introduction: The first fertility unit dedicated to the treatment of couples infected with chronic viral diseases in Israel was established at the Rambam Medical Center in 2010. A multidisciplinary approach is needed in order to provide appropriate treatment to the viral disease, and to minimize the risks of infecting the partner, the embryo and others in the fertility unit., Objective: To review 2 years-experience providing fertility care to couples seropositive for HIV, HBV and HCV., Methods: Retrospective study., Results: Between the years 2010-2012, 92 couples underwent 183 oocyte retrievals and fresh embryo transfers and 77 cycles of frozen-thawed embryo transfer. Forty three percent of the couples were seropositive to HBV, 30% seropositive to HIV, 20% seropositive to HCV and 7% infected with more than one virus. In 52.3% of cases the male partner was infected, in 38% the female partner was infected and in 9.7% both partners were infected. Fifty one percent of the couples received antiviral therapy before admission to the unit or did not need antiviral therapy due to inactive disease. Twenty nine percent of the couples received anti-viral drugs while being treated in the fertility unit and 10% needed anti-viral treatment before beginning fertility treatment due to high viral load. Horizontal or vertical viral disease transmissions were not recorded., Conclusion: Upon admission to the fertility unit the majority of couples had good control of their viral infections and either was under anti-viral treatment or did not need any further treatment. From our experience and a review of the literature, controlling the viral disease is the key to safe fertility treatment, and eliminating the risk of infecting the embryo, newborn, partner, and others within the fertility unit.