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Introduction Coital incontinence (CI) during orgasm is a form of urinary incontinence possibly because of detrusor overactivity (DO), as the underlying pathophysiological condition. Women with this symptom usually show a pharmacological lower cure rate than those with DO alone. The ultrasound measurement of the bladder wall thickness (BWT) allows an indirect evaluation of detrusor muscle thickness, giving a potential index of detrusor activity. Aim We wanted to understand if CI at orgasm could be a marker of severity of DO by comparing BWT in women with both DO and CI at orgasm vs. women with DO alone. In addition we aimed to confirm if CI during orgasm is related to antimuscarinics treatment failure. Methods This is a prospective cohort study performed in two tertiary urogynecological referral departments, recruiting consecutive patients seeking treatment for symptomatic DO. Main Outcome Measures All patients were thoroughly assessed including physical examination, urodynamic evaluation, and BWT measurement according to the International Continence Society/International Urogynecological Association and ICI recommendations. Solifenacine 5 mg once daily was then prescribed and follow-up was scheduled to evaluate treatment. Multiple logistic regression (MLR) was performed to identify risk factors for treatment failure. Results Between September 2007 and March 2010, 31 (22.6%) and 106 (77.4%) women with DO with and without CI at orgasm were enrolled. Women complaining of CI at orgasm had significantly higher BWT than the control group (5.8 ± 0.6 mm vs. 5.2 ± 1.2 mm [ P = 0.007]). In patients with CI at orgasm, the nonresponder rate to antimuscarinics was significantly higher than controls ( P = 0.01). After MLR, CI at orgasm was the only independent predictor decreasing antimuscarinics efficacy (odds ratio [OR] 3.16 [95% CI 1.22–8.18], P = 0.02). Conclusions Women with DO and CI at orgasm showed a significantly higher BWT values and worse cure rates than women with DO alone. CI at orgasm could be a marker of a more severe form of DO. Serati M, Salvatore S, Cattoni E, Siesto G, Soligo M, Braga A, Sorice P, Cromi A, Ghezzi F, Cardozo L, and Bolis P. Female urinary incontinence at orgasm: A possible marker of a more severe form of detrusor overactivity. Can ultrasound measurement of bladder wall thickness explain it?.

To determine the incidence of vaginal cuff dehiscence after minimally invasive hysterectomy, we reported our series of total laparoscopic hysterectomies with transvaginal colporraphy.We then conducted a systematic search of PubMed to retrieve published series of laparoscopic and robotic hysterectomies, in which different techniques for vaginal cuff closure were used.In our study group, vaginal cuff dehiscence occurred in 2 of 665 (0.3%) patients. Our literature search identified 57 articles, for a total of 13,030 endoscopic hysterectomies. Ninety-one postoperative vaginal separations were reported (0.66%). The pooled incidence of vaginal dehiscence was lower for transvaginal cuff closure (0.18%) than for both laparoscopic (0.64%; odds ratio [OR], 0.28; 95% confidence interval [CI], 0.12-0.65) and robotic (1.64%; OR, 0.11; 95% CI, 0.04-0.26) colporraphy. Laparoscopic cuff closure was associated with a lower risk of dehiscence than robotic closure (OR, 0.38; 95% CI, 0.28-0.6).Current evidence indicates that transvaginal colporraphy after total laparoscopic hysterectomy is associated with a 3- and 9-fold reduction in risk of vaginal cuff dehiscence compared with laparoscopic and robotic suture, respectively.

Objective Older patients are usually regarded as suboptimal candidates for surgical operations, particularly in cases of reparative, non-life-saving procedures. The aim of this study was to analyze the feasibility and safety of surgical treatment for pelvic floor dysfunction in advanced-age women. Methods A single-center descriptive study was performed through a retrospective medical records review. Women 75 years or older who underwent a surgical operation for urogynecological dysfunction (pelvic organ prolapse, urinary incontinence, or both) between January 2000 and December 2009 were considered. Results Overall, 138 women were included. Median age was 77 years (range, 75-95 y). Women underwent different types of surgical correction. The following procedures (alone or in combination) were performed: 102 (73.9%) vaginal hysterectomies, 106 (76.8%) anterior repairs, 36 (26%) posterior repairs, 9 (6.5%) colpocleisis, 4 vaginal vault ileococcygeus suspensions (2.9%), and 22 (15.9%) tension-free vaginal tape procedures. One (0.7%) intraoperative and five (3.6%) postoperative complications occurred. Urinary retention rate after surgical operation was 5.8%. Only one (0.7%) woman was discharged with a Foley catheter because of voiding difficulty. Clinical follow-up showed 87.6% anatomical success in women with genital prolapse and a subjective success rate of 86.4% in women undergoing anti-incontinence procedures. Conclusions Our study shows that reconstructive surgical operation is a viable treatment option for pelvic floor dysfunction in older patients.

Introduction and hypothesis Aims of this study were to compare the ultrasound measurement of bladder wall thickness (BWT) in women with different urodynamic diagnosis and to correlate BWT to the different urodynamic findings of detrusor overactivity (DO). Methods Two hundred forty seven women with urinary symptoms have been prospectively enrolled. Urodynamics and transvaginal ultrasound BWT were performed Patients were divided into four urodynamic subgroups. BWT of women with DO was compared with the BWT of any other subgroup Results Women with DO had a BWT value significantly higher (p

OBJECTIVE The aim of this study was to analyze temporal trends in adoption of laparoscopy in a cohort of older women (> or =70 y) undergoing gynecologic abdominal procedures and to assess operative outcomes compared with those of open procedures. METHODS A prospective entered database was queried for all women aged 70 years or older undergoing surgery at our department during a 9-year period. Surgical outcomes were compared according to the type of surgical approach (laparoscopy vs open) and assessed over time. RESULTS Two-hundred thirty-one women were identified. Of these, 116 underwent laparoscopic procedures, and 115 had open abdominal surgery. The study groups were similar with regard to demographics and preoperative variables. Conversion to laparotomy due to intervening complications occurred in one case (0.9%). Among women with early-stage gynecologic malignancies, overall and postoperative complications were lower in the laparoscopy group than in the open surgery group. Estimated blood loss and hospital stay were lower in the laparoscopy group than in the open surgery group, for both benign and malignant conditions. The annual proportion of laparoscopic cases has increased significantly during the study period from 12% in 2001 to 79.3% in 2007 (P for trend < 0.0001). No difference was found in operative time, number of lymph nodes harvested, and complication rates, when data of subsequent time periods were compared. CONCLUSIONS Older women who undergo laparoscopy have a significantly shorter hospitalization and fewer complications compared with older women who undergo open surgery. Laparoscopy should be considered in all women in whom a gynecologic abdominal procedure is planned regardless of age.

To evaluate the accuracy of Transrectal Sonography (TRS) and a new technique, Transvaginal Sonography with Water-Contrast in the Rectum (RWC-TVS), in the diagnosis of rectosigmoid endometriosis, and the accuracy of Barium Enema (BE) and RWC-TVS in the detection of intestinal stenosis due to endometriosis. In a prospective study, we compared the findings of TRS and RWC-TVS performed before surgery with the operative and pathologic findings in 61 consecutive patients who underwent laparoscopy or laparotomy for suspected rectosigmoid endometriosis. The accuracy of BE and RWC-TVS in the detection of intestinal stenosis was evaluated comparing the radiologic and ultrasonographic results with the macroscopic findings at surgery and pathology. RWC-TVS diagnosed rectosigmoid endometriosis with the same accuracy of TRS and was equally efficient as BE in the detection of a significant intestinal lumen stenosis. For the diagnosis of rectosigmoid endometriosis the sensitivity, specificity, positive and negative predictive values of TRS and RWC-TVS were 88.2% and 96%, 80%, and 90%, 95.7%, and 98%, and 57.1% and 81.8%, respectively. For the detection of intestinal stenosis the sensitivity, specificity, positive and negative predictive values of BE and RWC-TVS were 93.7% and 87.5%, 94.2% and 91.4%, 88.2% and 82.3%, and 97% and 94.1%, respectively. RWC-TVS is a new, simple technique for a single-step and accurate preoperative assessment of rectosigmoid endometriosis.

To compare postoperative pain after laparoscopic and vaginal hysterectomy for benign disease.A prospective randomized trial was designed to compare laparoscopic hysterectomy and vaginal hysterectomy in patients with uterine volumeor=14 weeks of gestation. Postoperative pain was measured using the visual analog scale (VAS) at 1, 3, 8, and 24 hours postoperatively. Intra- and postoperative outcomes were carefully recorded, including the need for postoperative rescue doses of analgesia.A total of 82 patients were enrolled. Patients who underwent vaginal hysterectomy complained of higher postoperative pain at each VAS evaluation (VAS-1 hour, P.0001; VAS-3 hour, P.0001; VAS-8 hour, P.0001; VAS-24 hour, P = .0003) with a higher need for rescue analgesia (P.0001) and a longer hospitalization (P = .001). The other perioperative characteristics were comparable between the 2 groups.Laparoscopic hysterectomy provides an advantage over vaginal hysterectomy in terms of postoperative pain, need for rescue analgesia and hospital stay, with similar perioperative outcomes.

The paucity of long-term oncologic results published in the literature still prevents the scientific community from cementing the place of laparoscopy as the procedure of choice for managing endometrial cancer. We present the outcomes of consecutive patients with endometrial cancer managed laparoscopically with3-year follow-up.Data from 117 consecutive women undergoing surgery for treatment of a clinical stage I endometrial cancer and who achieved at least 3-year follow-up were prospectively analyzed. These cases were compared with a historical cohort of 122 consecutive patients with endometrial cancer who had undergone surgery through laparotomy.The laparoscopy and laparotomy groups were similar with regard to baseline patient characteristics, surgical stage, proportion of tumors with unfavorable histology and high grade, as well as patterns of adjuvant therapy. The median (range) follow-up of surviving patients was 52 (36-84) months in the laparoscopic cohort and 80 (36-151) months in the laparotomy cohort. Women who underwent laparoscopy and those who underwent laparotomy had similar 3-year recurrence-free survival rates (91.4% vs. 88.5%, P = 0.52), as well as similar 3-year overall survival rates (94.0% vs. 93.4%, P = 1.0). Multivariate analysis showed that advanced surgical stage, unfavorable histology, and patient age65 years significantly affect survival, regardless of the surgical approach used.Cancer control in women with endometrial cancer does not appear to be worsened by laparoscopic surgery. In the absence of level I evidence to establish long-term recurrence and survival equivalence, analysis of series as they mature is crucial to fully evaluate disease control afforded by laparoscopy.

Introduction Very limited knowledge exists concerning the impact of Loop Electrosurgical Excisional Procedure (LEEP) on female sexual function in women with cervical intraepithelial neoplasia Aim To investigate sexual function in women who underwent LEEP for the treatment of cervical intraepithelial lesions, using a validated questionnaire (Female Sexual Function Index [FSFI]). Main Outcome Measures FSFI questionnaire on six domains of female sexuality (desire, arousal, lubrication, orgasm, satisfaction, and pain). Methods Consecutive sexually active women, who underwent LEEP for the treatment of cervical intraepithelial neoplasia were enrolled in this study. All women were asked to complete a copy of FSFI questionnaire, at the time of LEEP and after 6 months. We finally compared the results of the pre-LEEP questionnaire and the post-LEEP questionnaire for each patient. Results A total of 67 sexually active women undergoing LEEP for the treatment of cervical intraepithelial lesions were enrolled. Nine of these patients (13.4%) completed only the questionnaire regarding their sexual function before LEEP; thus we did not include them for final analysis. In our study population, data showed a sexual function overall unchanged after LEEP; only the variable “desire” (sexual interest) became significantly worse ( P = 0.02). Conclusions LEEP for the treatment of cervical intraepithelial lesions doesn't affect women's sexuality, when compared with sexual function before surgery. In our study, all FSFI sexual function domains but desire, did not show significant change after LEEP. Serati M, Salvatore S, Cattoni E, Zanirato M, Mauri S, Siesto G, Cromi A, Ghezzi F, and Bolis P. The impact of the Loop Electrosurgical Excisional Procedure for cervical intraepithelial lesions on female sexual function.

OBJECTIVE: The objective of the study was to compare scar quality associated with different types of wound closure methods after cesarean section (CS). STUDY DESIGN: Patients were randomized to have skin closure following CS with either staples or 3 different types of subcuticular sutures. Scar quality was evaluated 2 and 6 months postoperatively. The Vancouver Scar Scale, the Patient and Observer Scar Assessment Scale (POSAS), and a visual analog scale were used as scar assessment tools. RESULTS: Of the 180 patients who were recruited, 123 successfully completed the study. No difference in both subjective and objective scar rating was detected across groups at either 2 months or 6 months. In the overall study population, objective scores correlated with patient rating, and correlation was strongest between the observer and patient components of the POSAS (r = 0.48). CONCLUSION: In women undergoing CS, stapled wounds and those closed with subcuticular sutures result in equivalent cosmetic appearance of the scar.

Objective To investigate the prognostic significance of preoperative plasma fibrinogen concentration, with particular focus on tumor dissemination and nodal involvement, in a substantial cohort of patients with endometrial cancer. Methods The study population comprised 336 women with endometrial cancer who underwent surgical staging at two tertiary institutions, from 2000 to 2009. Pretreatment plasma samples from the study cohort were assayed for fibrinogen by the Clauss assay. Information on demographics, laboratory testing, histopathology and follow-up was gathered from databases of prospectively collected data. Factors associated with survival were identified in a Cox proportional hazards model. Univariate and multivariate analyses were used to evaluate predictors of extrauterine disease and nodal metastasis. Results One-hundred-thirty-seven (40.8%) patients exhibited preoperative hyperfibrinogenemia. Univariate analysis demonstrated that histological type, tumor grade, depth of myometrial invasion, surgical stage, patient age, and hyperfibrinogenemia affect disease-free (DFS) and overall survival rates significantly. When these variables were entered simultaneously into a Cox regression model, raised preoperative levels of plasma fibrinogen retained significance as poor prognosticator of DFS (HR 2.0, 95%CI 1.1–3.6) and overall survival (HR 2.7, 95%CI 1.3–5.5). Preoperative hyperfibrinogenemia was an independent determinant of extrauterine disease (OR 2.7, 95%CI 1.3–5.6). In the subcohort of women with endometrioid histology, increased fibrinogen concentration at presentation was predictive of pelvic nodal involvement (OR 3.6, 95%CI 1.1–11.7). Conclusion Plasma fibrinogen level may be of value in the prediction of outcome, improve the stratification of endometrial cancer patient, at diagnosis, based on their risk of recurrence, and possibly alter their treatment accordingly.

Objective: The aim of this study was to evaluate the feasibility and safety of laparoscopic surgical management of apparently early-stage endometrial cancer in older women and to compare clinical outcomes between older and younger women. Methods: Our prospective oncological database was retrospectively reviewed to identify all consecutive women who underwent surgery for endometrial cancer from 2002. Data available included information about demography, comorbidities, surgical outcomes, histology, adjuvant therapies, and follow-up. Women were divided in two groups according to age (older, 965 y, and younger, e65 y). Univariate and multivariate analyses were performed to identify factors that negatively impact disease-free and overall survival. Results: A total of 48 (44.4%) older and 60 (55.6%) younger women were included. Groups were comparable in operative time, blood loss, need for blood transfusions, nodal count, and intraoperative and postoperative complications. Cancer in older women was more frequently upstaged than that in younger women (17 [35.4%] vs 8 [13.3%], respectively; P = 0.01). The 2- and 5-year disease-free survival rates were 82% versus 96% (P = 0.003) and 74% versus 93% (P = 0.0005) and the overall 2- and 5-year survival rates were 87% versus 98% (P = 0.006) and 83% versus 95% (P = 0.01) for older and younger women, respectively. Multivariate analysis showed that advanced surgical stage, unfavorable histology, high-grade tumors (grade 3), and deep myometrial invasion (950%) are independent risk factors for recurrence. Conclusions: In the absence of absolute anesthesia contraindications, laparoscopy seems to be feasible and safe in older women with endometrial cancer. Comprehensive surgical staging should be offered, regardless of age, to avoid understaging and to optimize treatment strategies.

We report our experience with laparoscopic staging of apparent early ovarian cancer, and we critically review the current literature on this issue. Potential limits of laparoscopic technique and theoretical concerns of using pneumoperitoneum-based surgery in this setting are addressed.Methods:Surgical, pathological, and oncological outcome data of consecutive patients undergoing comprehensive laparoscopic staging for presumed early ovarian cancer at our institution were prospectively collected.Results:The median operative time was 348 minutes (range, 255-450 minutes). The median estimated blood loss was 250 mL (range, 50-3000 mL). The mean number of pelvic and paraaortic lymph nodes harvested was 24.5 (SD, 6.3) and 9.8 (SD, 7.1), respectively. The disease was upstaged in 6 women (23.1%). No conversion to laparotomy and no intraoperative complication occurred. One patient had a retroperitoneal hematoma recognized in the postoperative period, and this required laparotomy and ligature of the hypogastric arteries to achieve hemostasis. The median follow-up period was 26.7 months (range, 2-83 months). Recurrence-free survival was 96.1%.Conclusions:Our results suggest that laparoscopic comprehensive surgical staging is a valuable treatment option for ovarian cancer patients with apparent early disease. Evidence is beginning to accumulate suggesting that minimally invasive surgery is at least equivalent in surgicopathological outcomes and middle-range oncological results to the conventional treatment approach, and early concerns are proving largely unfounded.

Feasibility and safety of laparoscopic management of gynecologic cancers have been established by numerous clinical trials. However, the degree to which such results are achievable outside the context of formal research programs and the actual extent of laparoscopy uptake since its introduction are unclear. Purpose of this study was to examine the impact upon operative and cancer outcomes of the incorporation of laparoscopy into the surgical practice of our gynecologic oncology service. Data from 383 consecutive women undergoing surgery for the treatment of an apparently early-stage gynecologic cancer between 2000 and 2008 were analyzed. Integration of minimally access surgery for the treatment of invasive malignancies began with borderline ovarian tumors in 2001 and proceeded sequentially to include endometrial, ovarian, and cervical cancer patients. The annual proportion of laparoscopic cases has increased significantly over the study period from 7.7% in 2001 to 90.9% in 2008 (P

The study was aimed to test the hypothesis that preservation of the fallopian tubes at the time of total laparoscopic hysterectomy (TLH) increases the risk for postoperative infection. The study group consisted of 137 consecutive women undergoing TLH with conservation of the ovaries, who had concomitant bilateral total salpingectomy at the time of TLH. The control group included 145 women who had had TLH without salpingo-oophorectomy before the study period. Women undergoing bilateral total salpingectomy at the time of TLH had a lower rate of infectious morbidity compared with those who had TLH alone (3/137 versus 14/145, P = 0.01). Multivariable analysis showed that bilateral total salpingectomy at the time of TLH and blood loss are independent predictors of infectious morbidity.

Objectives To present our initial experience with micro-laparoscopy in the surgical treatment of endometrial cancer and to compare its outcomes with those of conventional laparoscopic approach. Methods Consecutive patients undergoing surgical staging of endometrial cancer using exclusively 3-mm working ports and a 3- or 5-mm laparoscope at the umbilicus (microlaparoscopy group; N = 23) were compared with historical controls selected from consecutive women who have had staging with conventional laparoscopy (N = 80). Results No difference was found in demographics and preoperative variables between the two groups. Conversion from microlaparoscopy to a conventional laparoscopic technique occurred in two cases (9.7%), while there was no conversion to open surgical staging in either group. There were no significant differences between the microlaparoscopy group and the control group with regard to estimated blood loss [100 (10–400) vs. 100 (10–400), P = 0.09], number of pelvic lymph nodes (19.2 ± 7.4 vs. 18. 6 ± 7.2, P = 0.79), and complication rate (intraoperative: 0% vs. 2.5%, P = 1.0; postoperative: 8.7% vs. 13.7%, P = 0.73). Operative time was similar between groups when analysis was restricted to the last 20 conventional procedures performed period prior to beginning of the microlaparoscopy trial [155 (110–300) vs. 160 (115–295), P = 0.17]. The median length of hospital stay was 2 (1–10) days for women undergoing microlaparoscopic procedures compared to 3 (1–15) days for those undergoing conventional laparoscopy (P = 0.001). Conclusions These preliminary results suggest that microlaparoscopy is a safe and adequate surgical option for endometrial cancer staging, with the potential to further decrease invasiveness of the conventional laparoscopic approach.

Introduction Surgical treatment for cervical cancer is associated with a high rate of late postoperative complications, and in particular with sexual dysfunction. Aim To evaluate sexual function in women who underwent radical hysterectomy (RH), in comparison with a control group of healthy women, using a validated questionnaire (Female Sexual Function Index [FSFI]). Then we tried to evaluate the possible differences between laparoscopic RH and abdominal RH in terms of their impact on sexuality. Methods Consecutive sexually active women, who underwent RH for the treatment of early-stage cervical cancer between 2003 and 2007, were enrolled in this study (cases) and divided into two groups, according to the surgical approach. All women were administered the FSFI. The results of this questionnaire were compared between patients who underwent laparoscopic RH (LPS group) vs. women who underwent laparotomic RH (LPT group). The cases of RH were also compared with a control group of healthy women, who were referred to our outpatient clinic for a routine gynecologic evaluation. Main Outcome Measures FSFI questionnaire on six domains of female sexuality (desire, arousal, lubrication, orgasm, satisfaction, pain). Results A total of 38 patients were included. We also enrolled 35 women as healthy controls. FSFI score was significantly higher in the healthy controls vs. the cases of RH. In the LPS group, the total score and all the domains of the FSFI were lower in comparison with the healthy controls, whereas three of the six domains (arousal, lubrication, orgasm) and the total score of FSFI were lower in the LPT group if compared with the controls. There were no significant differences between LPS and LPT group. Conclusions RH worsens sexual function, regardless of the type of surgical approach. In our experience, laparoscopy did not show any benefit on women's sexuality over the abdominal surgery for cervical cancer. Serati M, Salvatore S, Uccella S, Laterza RM, Cromi A, Ghezzi F, and Bolis P. Sexual function after radical hysterectomy for early-stage cervical cancer: Is there a difference between laparoscopy and laparotomy? J Sex Med 2009;6:2516–2522.

Objective To test the hypothesis that intrauterine growth restriction (IUGR) is associated with decreased thymus size in the human fetus. Methods The thymus perimeter was measured in 60 consecutive IUGR fetuses at prenatal ultrasound examination. IUGR was defined as an abdominal circumference (AC)

Background Progression to needlescopic techniques for advanced gynecologic procedures currently performed with conventional laparoscopy still is in its infancy, and published series are currently lacking in the gynecologic literature. This study aimed to report initial experience with incorporating needlescopic instruments in the performance of total laparoscopic hysterectomy (TLH). Methods The study group consisted of 32 consecutive women undergoing needlescopic hysterectomy. The control group included 54 women who underwent conventional TLH over the preceding 12-month period and met the same inclusion criteria as the study group. Conventional TLH was performed using 5-mm working ports and a 10-mm laparoscope. The needlescopic hysterectomy differed from the conventional laparoscopic procedure in that 3-mm working ports were used as well as a 3- or 5-mm laparoscope at the umbilicus. Otherwise, the trocar layout and surgical technique were identical. Parameters of technical feasibility (operating time, estimated blood loss, perioperative complications) were considered major statistical end points. Results In the study group, all but one procedure were performed successfully using the needlescopic approach. One patient in the needlescopic group required conversion to standard TLH because of uncontrollable bleeding from the uterine artery. The operative time and estimated blood loss of needlescopic hysterectomy were comparable with those of standard TLH. No significant complication occurred in either group. Conclusions For properly selected patients, the needlescopic technique can be applied to TLH safely and effectively.

Objective The purpose of this study was to compare 2 methods of expansion of the uterine incision at the time of cesarean delivery. Study Design Women who underwent a low-segment transverse cesarean delivery were assigned randomly to have the blunt expansion of the uterine incision by the physician separating the fingers either in a transversal direction or in a cephalad-caudad direction. The primary outcome measure was the incidence of unintended extensions. Results The transversal (n = 406) and cephalad-caudad (n = 405) expansion groups were similar with regard to patient characteristics, indication to surgery, type of anesthesia, and proportion of emergency procedures. No difference in the need for transfusions (0.7% vs 0.7%; P = 1.0) or estimated blood loss (440 ± 341 vs 398 ± 242 mL; P = .09) was noted. The incidence of unintended extension (7.4% vs 3.7%; P = .03) and blood loss of >1500 mL (2.0% vs 0.2%; P = .04) was significantly higher in the transversal expansion group, compared with the cephalad-caudad group. Transversal expansion was an independent contributor to unintended extension and blood loss of >1500 mL. Conclusion Because it is associated with less risk of unintended extension and excessive blood loss, expansion of the uterine incision with a cephalad-caudad traction should be preferred to transversal expansion when a cesarean delivery is performed.

The purpose of this study was to evaluate the feasibility and surgical outcome of a policy of routine specimen retrieval through the umbilical port, avoiding the enlargement of ancillary port-site incisions. A total of 1116 women underwent laparoscopic surgery for the treatment of a pelvic mass with extraction of the specimen through the umbilical port site (a total of 1453 retrieval procedures). All retrieval procedures were successfully carried out with this technique. Neither intraoperative complication related to the retrieval procedure nor accidental rupture of the endoscopic bag occurred. There was an injury to the epigastric artery. Neither trocar-site hernias (both umbilical trocar insertion sites and extraumbilical sites) nor port-site metastases occurred.

The aim of this study was to assess the efficacy of tolterodine in women with overactive bladder (OAB) and concomitant anterior vaginal prolapse. In this prospective study, 235 consecutive women with OAB symptoms and urodynamic diagnosis of detrusor overactivity who either had no prolapse or had pure anterior vaginal prolapse were included: 184 women (group 1) had no prolapse and 51 women (group 2) had anterior prolapse greater than and equal to stage IIa. Tolterodine 4 mg slow release once a day was prescribed. After 12 weeks, women were reassessed using a 3-point scale (no change, improvement and cured). A total of 158 (85.9%) women in group 1 and 31 (60.8%) women in group 2 reported improvement or cure (P = 0.0002). Women with OAB and significant anterior vaginal prolapse should be informed of a reduced efficacy of antimuscarinics in treating their urinary symptoms.

Objective: To understand the pathophysiological mechanism of incontinence during orgasm and to compare women affected by symptomatic detrusor overactivity (DO) with and without incontinence at orgasm in terms of efficacy of antimuscarinic treatment. Methods: All consecutive sexually active women with incontinence during intercourse were prospectively included and divided into two groups: women with coital incontinence at orgasm or at penetration. The two forms of coital incontinence were correlated to the urodynamic finding of DO. Women complaining of overactive bladder (OAB) symptoms, with urinary incontinence at orgasm and urodynamically proven DO (cases), were prescribed tolterodine 4 mg extended release for at least 12 wk. The cases were compared in terms of efficacy of treatment on OAB symptoms to consecutive patients with symptomatic DO without coital incontinence (control group). Results: Among the 1133 women who underwent urodynamic testings during the study period, 132 patients were eligible for final analysis. A significant difference in DO was observed in women with incontinence at orgasm (34 of 49; 69.4%) compared with women with incontinence during penetration (24 of 83; 28.9%) (p < 0.0001). The 34 women with incontinence at orgasm associated with DO were given antimuscarinics treatment and were compared with 53 controls. Fourteen of 34 (41.2%) and 9 of 53 (17%) women did not respond to antimuscarinics in the cases and in the control group, respectively (p = 0.023). Conclusions: Incontinence at orgasm is associated with DO in the majority of cases. This is the first study showing an inferior efficacy of antimuscarinic treatment in women with Do complaining of incontinence at orgasm. (C) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.

A case of comprehensive laparoscopic surgical staging for ovarian dysgerminoma in a 13-year-old girl is described. A 20-cm pelvic mass, rising from right adnexum, was incidentally diagnosed, and the patient underwent laparoscopic right salpingo-oophorectemy. Pathologic findings were consistent with diagnosis of pure dysgerminoma. We then performed laparoscopic staging including peritoneal washing; resection of right infundibulopelvic ligament; systematic pelvic, common iliac, and infrarenal paraaortic lymphadenectomy; appendectomy; and infracolic omentectomy. Uterus and left adnexum were spared to preserve future fertility. Currently, the patient is alive and free of disease after 21 months of follow-up. To our knowledge, this is the first reported case of comprehensive laparoscopic surgical staging for ovarian neoplasm in a 13-year-old patient.

STUDY OBJECTIVE: We sought to evaluate the incidence of postoperative voiding dysfunction in patients undergoing vaginal hysterectomy (VH) or total laparoscopic hysterectomy (TLH) and to identify risk factors for the development of postoperative urinary retention after uncomplicated total hysterectomy. DESIGN: Prospective cohort study (Canadian Task Force classification II-2). SETTING: Gynecology department of a university hospital. PATIENTS: Two hundred thirty-three consecutive women undergoing TLH or VH for benign gynecologic disease. INTERVENTIONS: A regimen of immediate catheter removal after the operation was instituted. A strict voiding trial protocol was used during the study period. Postoperative voiding dysfunction was defined as failure of first voiding trial after surgery (urinary retention) or postvoid residual volume of greater than 150 mL necessitating recatheterization. MEASUREMENTS AND MAIN RESULTS: A total of 49 women (21%) developed postoperative voiding dysfunction, of which 32 (13.7%) had complete urinary retention and 17 (7.3%) had a postvoid residual volume greater than 150 mL. None of these patients experienced voiding dysfunction beyond 48 hours. There was no statistical correlation between development of postoperative voiding dysfunction and demographic, historic, preoperative, and postoperative variables collected. The only factor with significant impact on postoperative voiding dysfunction was vaginal approach to hysterectomy (OR 2.8; 95% Cl 1.5-5.4). Hospital stay was significantly longer for women experiencing voiding difficulties than for those who voided efficiently (2.2 +/- 0.8 [95% Cl 1.5-1.9] vs 1.7 +/- 1.2 [95% Cl 1.9-2.4] days; p

In this review we critically evaluate what we know and what we still do not know about pathogenesis, diagnosis and treatment of ureteral endometriosis, highlighting areas of controversy.Recent studies have produced new insights into diagnostic and management options for ureteral endometriosis.The diagnosis of ureteral endometriosis entails a high index of suspicion for the disorder. Imaging techniques are of limited value in providing an accurate depiction of extension of ureteral lesions. Preliminary results suggest that magnetic resonance urography is accurate in differentiating between intrinsic and extrinsic forms of ureteral involvement, but further studies are required to define its role in directing better treatment. Current controversies in the treatment of ureteral endometriosis are over whether segmental resection and anastomosis or ureterolysis are indicated, and whether minimal-access procedures are equally effective than their traditional open counterparts. Recent studies suggest that laparoscopic ureterolysis can be an effective treatment option in most patients with ureteral endometriosis but that recurrence rates are not negligible, as suggested in pioneering works. Successful application of laparoscopic surgery, even for procedures that have traditionally necessitated laparotomy, has been reported. Extensive experience with endourological techniques is prerequisite for success.

Objective. To compare the surgicopathologic outcome of total laparoscopic radical hysterectomy (LRH) with that of abdominal radical hysterectomy (ARH) for the treatment of early-stage cervical cancer. Methods. Radical hysterectomy specimens of sequential patients undergoing LRH ( N =50) were compared with those of historical controls selected from consecutive women who have had conventional ARH ( N =48), and who met the same criteria for eligibility as the cases. To evaluate the extent of parametrial resection, parametrial tissues were systematically measured at their widest dimensions before tissue processing. Results. No difference was found in demographics, histologic type, tumor stage and grade between the two groups. The parametrial width was similar between LRH and ARH in both type II (right parametrium: 2.4 cm (1–3) vs. 2.3 (1.8–4.0), p =0.28; left parametrium: 2.3 cm (1.8–4) vs. 2.2 (1.2–3.0), p =0.54) and type III radical hysterectomy (right parametrium: 3.8 cm (2.3–6.5) vs. 3.4 (1.7–7.0), p =0.59; left parametrium: 3.6 cm (2–6) vs. 3.5 (1.5–6.5), p =0.82). There were no significant differences between the two groups with regard to lymph nodes yield and likelihood of identifying positive margins or metastatic disease. Conclusion. Our results suggest that laparoscopically managed patients with cervical cancer undergo a similar extent of surgery as those treated with the traditional ARH, as judged by objective pathologic criteria.

Objective. To compare the results of laparoscopic staging of apparent early ovarian cancer (EOC) with those obtained with comprehensive surgical staging via laparotomy. Methods. Consecutive patients undergoing comprehensive laparoscopic staging for presumed EOC (LPS group; N =15) were compared with historical controls selected from consecutive women who have had conventional staging with open surgery (LPT group; N =19). Results. No difference was found in demographics and preoperative variables between the two groups. There were no significant differences between the two groups with regard to median number of lymph nodes and likelihood of identifying metastatic disease. No conversion to laparotomy and no intraoperative complication occurred in the LPS group. Operative time was significantly longer in the LPS group when compared with the LPT group (377±47 vs. 272±81 min, P =0.002). One patient in the LPS group had a retroperitoneal haematoma recognized in the postoperative period, and this required laparotomy and ligature of the hypogastric arteries to achieve haemostasis. Minor postoperative complications occurred in 1 (6.7%) patient in the LPS group and in 8 (42.1%) patients in the LPT group ( P =0.047). Hospital stay was significantly shorter in the LPS group [3 (2–12) vs. 7 (4–14) days, P =0.001]. Median (range) follow-up time was 16 (4–33) and 60 (32–108) months in the LPS and LPT group, respectively. Eleven (73.3%) patients in the LPS group and 13 (68.4%) in the LPT group received adjuvant treatment. There were no recurrences in the LPS group whereas 4 (7.1%) recurrences occurred in the LPT group. Overall survival was 100% in both groups. Conclusion. Our results suggest that laparoscopic comprehensive surgical staging of EOC is as safe and adequate as the standard surgical staging performed via laparotomy.

Objective To determine whether a large cross-sectional area of the umbilical cord is a predictor of fetal macrosomia. Methods Consecutive patients of > 34 weeks' gestation, who presented for sonographic examination and who delivered within 4 weeks of the examination, were included in the study. The sonographic cross-sectional areas of the umbilical cord, the umbilical vessels and the Wharton's jelly were measured in a free loop of the umbilical cord. Logistic regression analysis was used to determine significant predictors of macrosomia (actual birth weight > 4000 g and > 4500 g). Fetal biometric parameters (biparietal diameter, abdominal circumference and femur length), sonographic estimated fetal weight and umbilical cord area > 95th centile for gestational age were used as covariates. Results During the study period, 1026 patients were enrolled. Fifty-three (5.2%) newborns had a birth weight > 4000 g, and 22 (2.1%) weighed > 4500 g. The proportion of cases with a large umbilical cord was significantly higher in the group of macrosomic compared with non-macrosomic infants (54.7% vs. 8.7%, P 4000 g and > 4500 g (odds ratio (95% CI), 20.6 (9.2–45.9) and 4.2 (1.2–17.7), respectively). The sensitivity, specificity and positive and negative predictive values of a sonographic large umbilical cord were 54.7%, 91.3%, 25.4%, and 97.4%, respectively. The combination of abdominal circumference > 95th centile and large cord predicted 100% of macrosomic infants. The proportion of umbilical cords with a Wharton's jelly area > 95th centile for gestation was significantly higher in macrosomic fetuses of diabetic compared with non-diabetic mothers. Conclusions Sonographic assessment of umbilical cord area may improve the prediction of fetal macrosomia. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

The objective of the study was to assess sonographic changes in cervical length and posterior cervical angle in women undergoing cervical ripening with an extraamniotic Foley catheter and to determine whether pre- and postripening ultrasound parameters could help predict successful cervical ripening and the outcome of labor induction.Cervical length and posterior cervical angle were measured by transvaginal sonography in 155 women with a Bishop score of 4 or less before placement of a transcervical Foley catheter for cervical ripening. At the time of Foley removal, women who did not enter active labor underwent a second ultrasound assessment of the cervix. Outcome measures were successful ripening, vaginal delivery, vaginal delivery within 24 hours, and vaginal delivery achieved with the Foley only. Multiple logistic regression models were generated to identify pre- and postripening clinical and ultrasound parameters independently associated with successful induction.Forty patients (25.8%) went into active labor after spontaneous expulsion or removal of the Foley, without any additional intervention. A successful cervical ripening was obtained with the transcervical catheter in 46 women (29.6%). One hundred six women (68.4%) had vaginal delivery. No correlation was found among maternal body mass index, maternal age, clinical cervical dilatation, sonographic posterior cervical angle, and any of the outcomes of interest. Multiple logistic regression showed that preripening sonographic cervical length was an independent predictor of successful ripening (odds ratio [OR] 10.2, 95% confidence interval [CI] 3.6 to 28.5), vaginal delivery (OR 2.6, 95% CI 1.2 to 5.5), vaginal delivery achieved with only Foley (OR 17.2, 95% CI 3.9 to 76.2), and vaginal delivery within 24 hours (OR 3.3, 95% CI 1.5 to 7.3). In the subgroup of women who did not enter labor with the transcervical Foley, at the time of catheter removal, a significant change was found in sonographic cervical length (33.1 mm [12.2 to 54.1] vs 24.0 mm [7.6 to 42], P.0001] and sonographic posterior cervical angle (110 degrees C [70-160] vs 137 degrees C [88-170], P.0001), compared with preripening findings. Transvaginal ultrasound cervical length was the only postripening characteristic that independently predicted vaginal delivery (OR 3.5, 95% CI 1.3 to 9.1).Transvaginal sonography seems a useful diagnostic tool to assess objectively the efficacy of the Foley catheter as ripening method and helps predict the likelihood of a successful induction of labor in individual women who require preinduction cervical ripening.

Objective: To evaluate maternal and neonatal outcomes in a large series of patients undergoing cervical ripening with a Foley catheter. Methods: The database of the Labor and Delivery Unit of the University of a teaching hospital in Italy was used to identify consecutive patients with a Bishop score (BS) of 4 or less who underwent pre-induction cervical ripening with a Foley catheter. The main outcome measures were clinical chorioamnionitis, endometritis, and suspected and culture-proven neonatal sepsis. Results: Of 602 women undergoing cervical ripening with a Foley catheter, 160 (26.6%) went into active labor without additional interventions. Oxytocin was administered immediately after removal of the Foley catheter in 188 (31.2%) of the women, and 254 (42.2%) required an application of prostaglandin E2 vaginal gel. The cesarean delivery rate was 25.6%. The median time to delivery was 1469 min (range, 94–3350 min). Of the women who gave birth vaginally, 225 (50.2%) were delivered within 24 h. Clinical chorioamnionitis and postpartum endometritis occurred in 3 (0.5%) and 6 (1.0%) of the women, respectively. Neonatal sepsis was suspected in 4 (0.7%) of the newborns but blood culture results were negative in all cases. Conclusion: Transcervical use of the Foley catheter is safe for pre-induction cervical ripening, and the associated risk of maternal or perinatal infections is negligible.

Objectives To evaluate the psychopathological profile and the incidence of major depressive disorders in consecutive women attending a Menopause Clinic. Methods Women attending outpatient menopause clinic at Filippo del Ponte Hospital in Varese (Italy), referring to the centre from 1 March to 30 April 2005, were invited to fill up a specific questionnaire while waiting for the visit. The questionnaire included demographics and history (e.g. current or past use of antidepressant drugs); symptoms check list (SCL-90-R); Beck depression inventory (BDI). Results Sixty-four women were enrolled to the study. On the SCL-90-R, “somatic” symptoms cluster was the most frequent. Patients diagnosed as depressed using the Beck depression inventory (BDI) were 18 (28.1%). Thirteen (70%) of currently depressed women presented a positive history of depressive disorders. The analysis of depressed women according to previous depressive disorders revealed higher scores for women with positive history in both scales. Depressed patients have a significantly lower mean age compared to non-depressed patients (53.3 ± 6.2 years versus 57.33 ± 4.9 years, p = 0.023). Conclusions Our preliminary data show a high correlation between a history of depressive disorder and recurrence of depression in the menopausal period. Perimenopause seems to be a higher risk period for the development of a depressive disease compared to menopausal status. The somatization cluster warrants further investigation.

To assess whether pelvic lymph nodes have a left-right asymmetric distribution.The oncologic databases of two gynecologic academic departments were used to identify consecutive patients undergoing pelvic systematic lymphadenectomy as part of the treatment for a variety of gynecologic malignancies. All procedures were carried out in a standardized fashion. Lymph node counts were retrieved from pathological reports.Four hundred and twenty-eight women underwent pelvic lymphadenectomy during the study period. The median lymph node count was higher on the right side than on the left side [10 (0-33) versus 8 (0-29); P0.0001]. A prevalence of right-sided nodes was found in 265 (61.9%) patients, while in 44 (10.3%) cases pelvic nodes were equally distributed on the two sides. The right-sided prevalence was significantly higher than the expected 50% in each type of malignancy and surgical technique subgroup. The right-sided prevalence was statistically significant even when the analysis was performed for different nodal groups [external iliac nodes: 5 (0-23) versus 4 (0-13), P=0.005; hypogastric and obturator nodes: 6 (0-17) versus 5 (0-19), P=0.04]. Moreover, nodal count was higher on the right than on the left in obese [10 (1-33) versus 8 (1-26), P=0.0002] and nonobese women [10 (0-32) versus 9 (0-29), P0.0001].Our findings suggest the existence of a left-right asymmetry in pelvic lymph nodes distribution, with right-sided prevalence.

Study objective To compare laparoscopic-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) for the treatment of endometrial cancer. Design Randomized, controlled trial. Design classification Randomized controlled trial (Canadian Task Force classification I). Setting Two gynecologic oncologic units of university hospitals. Patients Seventy-two women with endometrial cancer randomized to undergo either LAVH or TLH. Interventions Total laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, and systematic pelvic lymphadenectomy. Measurements and main results Parameters of technical feasibility (operating time of hysterectomy phase, estimated blood loss, perioperative complications) were considered as major statistical endpoints. Thirty-seven women were allocated to the LAVH arm, and 35 were allocated to the TLH arm. Mean total operating time was significantly shorter in the TLH than in the LAVH group (184.0 ± 46.0 vs 213.2 ± 39.4 minutes, p = .003). The hysterectomy phase was longer in the LAVH than in the TLH group only in overweight (77.9 ± 9.8 vs 68.1 ± 9.3 min, p = .005) and obese patients (87.7± 13.1 vs. 62.1± 9.9 min, p < .0001). The median estimated blood loss during hysterectomy was similar between groups. Intraoperative complications occurred in three (8.1%) patients in the LAVH group and in one patient (2.8%) in the TLH group (p = .61). No difference was found in the postoperative complication rate between women undergoing LAVH and those who had TLH (24.3% vs 17.1%, p = .56). Within a median follow-up period of 10 months (range 3–17 months), 2 patients in the LAVH group developed recurrent disease. No port site metastasis and no vaginal cuff recurrence were detected in either group. Conclusion Both LAVH and TLH can be performed successfully to manage endometrial cancer, with similar surgical outcomes. Obese patients benefit more from TLH than from LAVH in terms of shorter operating time.

We assessed the outcome of thirteen neonates (five singletons and eight first twins) born after umbilical cord prolapse (UCP) following preterm premature rupture of membranes (PPROM) between 24 and 34 weeks of gestation. The median gestational age at PPROM was 29 weeks + 2 days. The median interval from the diagnosis of UCP to delivery was 60 and 150 minutes in singleton and twin pregnancies, respectively. The median umbilical artery pH was 7.29 [0.06]. Apgar scores ranged between four and 10 at 5 minutes after birth. All infants had a normal neurodevelopmental outcome at two years follow up.

Objective To investigate whether an atypical umbilical coiling pattern at prenatal sonography is associated with adverse pregnancy outcome. Methods A targeted sonographic evaluation of the umbilical cord (UC) was performed in 758 women with singleton gestation, and gestational age above 20 weeks. Atypical coiling was defined as the presence of a spring-shape UC (supercoiling) or an unusual, aperiodic coiling pattern (uncoordinated coiling). Umbilical artery Doppler assessment was conducted in cases with atypical coiling. Pregnancy and neonatal outcomes were investigated. Results Of the study population, 7 and 16 fetuses had an umbilical cord with uncoordinated coiling and supercoiling respectively. Three umbilical cords had a single umbilical artery. Eight patients delivered before 34 weeks of gestation. Eight fetuses were growth restricted. In seven cases, abnormal sonographic findings were detected (three meconium peritonitis, two severe hydronephrosis and two cardiac anomalies). One fetus affected by trisomy 18 presented multiple anomalies. Perinatal death occurred in three cases. Of the surviving newborns, eight were admitted to NICU. Umbilical artery Doppler waveforms presented a systolic notch in seven (30.4%) cases. Conclusions The presence of an atypical umbilical cord vascular coiling is associated with an increased risk of unfavourable pregnancy outcome. The identification of an umbilical artery notch at Doppler investigation is frequently associated with an atypical UC coiling pattern. Copyright © 2005 John Wiley & Sons, Ltd.

Study objective To assess the impact of preemptive infiltration of port site with local anesthetic on postlaparoscopy pain. Design Randomized, double-blind, controlled trial (Canadian Task Force classification I). Setting Two university hospitals. Patients A total of 170 women scheduled for gynecologic laparoscopic procedures were randomly assigned to pre-incisional infiltration with ropivacaine (n = 86) or with saline solution (n = 84). Interventions Infiltration with either local anesthetic or placebo was accomplished in each port site before skin incision. All patients underwent standard anesthesia induction and maintenance. Measurements and main results Postoperative pain was evaluated with a visual analogue scale and patient interview at 1, 3, and 24 hours after surgery. No difference was found between groups in pain levels, pain location, or in the site of superficial pain at any of the postoperative time periods. The proportion of women requiring analgesia before discharge was similar in the local anesthetic group and in the saline group (22/86 [25.6%] vs 19/84 [22.6%], p=.72). The analgesic consumption in the first 24 hours after surgery and the time to first analgesic request did not differ significantly between the two groups. Conclusion Preemptive infiltration of trocar sites with ropivacaine is not effective in postoperative pain relief.

The mechanisms by which the excess genetic material of chromosome 21 results in the dysmorphologic features of Down syndrome (DS) are largely unknown. It has been found that the extracellular matrix of nuchal skin of DS fetuses exhibits an higher content of hyaluronan (HA) compared to that of euploid fetuses. Since HA plays a central role in many morphogenetic processes during embryogenesis, an alteration in its metabolism could be involved in the pathogenesis of several structural defects of DS. The extracellular matrix of umbilical cord (UC) is the mammalian tissue with one of the highest content of HA. Therefore we sought to explore the quantitative HA modifications during gestation, tissue distribution and HA metabolism in euploid and DS UCs. Euploid UCs (n=28) and UCs from DS fetuses (n=13) were obtained after termination of pregnancy, spontaneous abortion, or at delivery. Quantitative and molecular size analysis were performed using HPLC and FPLC. Tissue distribution was visualized by immunohistochemistry. Gene expression for HA synthases (HAS) and hyaluronidases (HYAL) were quantified by real-time PCR techniques and HYAL activity was detected by zymography. In euploid UC only HA of a molecular weight of 1700 kDA was present while in DS UC an additional lower weight HA molecule of 1100 kDA was found. Immunohistochemistry showed a larger amount of Wharton's jelly HA in DS UCs than in euploid UC. Real-time PCR analysis showed that HAS 2 and HYAL 2 were expressed at significant levels in all specimens. A higher expression of HAS 2 and a lower expression of HYAL 2 was found in the Wharton's jelly of DS fetuses compared to that of euploid fetuses at 14 weeks of gestation. On the contrary, at term HYAL 2 expression was higher in DS specimens than in those from euploid fetuses. Zymographic studies showed a similar behavior with a lower HYAL activity at early gestation and a higher HYAL activity at term gestation in DS UCs compared to euploid specimens. Therefore we can conclude that HA is more represented in DS UCs than in euploid UCs. A complex alteration of the HA metabolism characterized by an increased synthesis of lower weight HA molecules is a peculiarity of DS UCs.

Objective: To evaluate the success rate of tension-free vaginal tape (TVT) performed under spinal and general anesthesia and to assess the efficacy of hydrodissection of the space of Retzius in reducing intraoperative and postoperative complications. Study Design: A total of 149 patients, were enrolled. Of these, 53 patients underwent the TVT placement (alone or in combination with other pelvic surgery) under general anesthesia and 96 under spinal anesthesia. TVT placement was performed as originally described, apart from the hydrodissection of the space of Retzius, that was performed only in 82 cases. In the remaining 67 patients the TVT needles were introduced directly without hydrodissection. Postoperatively, the patients were scheduled for evaluation at 1, 3, 6 and 12 months. Cure was defined as no postoperative stress incontinence. Results: Overall, the incidence of intraoperative and postoperative complications was 3.3% and 14.7%, respectively. No statistical difference was found in the intraoperative (1.9% versus 4.2%, P = 0.65) and postoperative complications (11.3% versus 16.7%) rates between the general and spinal anesthesia groups. No difference was found in the cure rate between groups (96.2% versus 95.8%). Similarly, no difference was found in the rate of intraoperative (3.7% versus 3.0%) and postoperative (15.9% versus 13.4%) complications between patients who had hydrodissection and those who did not. When the analysis was restricted to patients who underwent the TVT placement without concomitant surgery (n = 88), there was no difference in the incidence of intraoperative (2.1% versus 5.0%, P = 0.59) and postoperative complications (14.6% versus 15.0%, P = 1.0) between patients who had hydrodissection and those who did not. Conclusions: Efficacy and safety of the TVT procedure are not affected by the type of anesthesia (general or loco-regional). Hydrodissection of the space of Retzius during TVT placement does not reduce the risks of intraoperative complications.

This study aimed to explore the feasibility and safety of two-port abdominal cavity entry for adnexal surgery.A series of patients undergoing laparoscopy for benign adnexal diseases requiring adnexectomy, ovariectomy, or salpingectomy were enrolled in the study. A 10-mm 0 degree umbilical operative laparoscope and one 3- or 5-mm suprapubic trocar were used. A grasping forceps was inserted through the ancillary trocar to displace medially and cranially the adnexa or the salpinx. The operation then was performed through the operative channel of the operative laparoscope.A total of 53 patients were enrolled. Bilateral salpingo-oophorectomy was performed in 10 cases. The median operative time was 39 min (range, 21-85 min). The median blood loss was 50 ml (range, 0-300 ml). The median size of the adnexal mass was 6 cm (range, 3-12 cm). No intraoperative complication occurred. At the 3-month follow-up visit, no extraumbilical abdominal scar was visible.The use of a two-trocar technique is safe and highly appreciated by the patients it leaves no visible abdominal scars.

Objective. To compare prenatal morphometric changes of umbilical cord components in intrauterine growth-restricted fetuses with and without abnormal umbilical artery Doppler parameters. Methods. Consecutive singleton intrauterine growth-restricted fetuses at a gestational age of older than 20 weeks were compared with matched appropriate-for-gestational-age fetuses. Intrauterine growth restriction was defined in the presence of a sonographic abdominal circumference below the 5th percentile for gestational age at the time of sonography and a birth weight below the 10th percentile. The sonographic examination included pulsed Doppler measurements of the umbilical artery resistance index and measurements of the umbilical cord cross-sectional area and the umbilical cord vessel area. Results. A total of 84 intrauterine growth-restricted fetuses and 168 appropriate-for-gestational-age fetuses were included in the study. All umbilical cord components (umbilical cord cross-sectional area, vein area, artery area, and Wharton jelly area) were smaller in the intrauterine growth-restricted fetuses. The prevalence of lean umbilical cords (cross-sectional area