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Realistic models to understand the developmental appearance of the pelvic nervous system in mammals are scarce. We visualized the development of the inferior hypogastric plexus and its preganglionic connections in human embryos at 4–8 weeks post‐fertilization, using Amira 3D reconstruction and Cinema 4D‐remodelling software. We defined the embryonic lesser pelvis as the pelvic area caudal to both umbilical arteries and containing the hindgut. Neural crest cells (NCCs) appeared dorsolateral to the median sacral artery near vertebra S1 at ~5 weeks and had extended to vertebra S5 1 day later. Once para‐arterial, NCCs either formed sympathetic ganglia or continued to migrate ventrally to the pre‐arterial region, where they formed large bilateral inferior hypogastric ganglionic cell clusters (IHGCs). Unlike more cranial pre‐aortic plexuses, both IHGCs did not merge because the 'pelvic pouch', a temporary caudal extension of the peritoneal cavity, interposed. Although NCCs in the sacral area started to migrate later, they reached their pre‐arterial position simultaneously with the NCCs in the thoracolumbar regions. Accordingly, the superior hypogastric nerve, a caudal extension of the lumbar splanchnic nerves along the superior rectal artery, contacted the IHGCs only 1 day later than the lumbar splanchnic nerves contacted the inferior mesenteric ganglion. The superior hypogastric nerve subsequently splits to become the superior hypogastric plexus. The IHGCs had two additional sources of preganglionic innervation, of which the pelvic splanchnic nerves arrived at ~6.5 weeks and the sacral splanchnic nerves only at ~8 weeks. After all preganglionic connections had formed, separate parts of the inferior hypogastric plexus formed at the bladder neck and distal hindgut., The umbilical arteries separate the lesser pelvis from the abdomen. Development of the inferior hypogastric plexus is divided into migration of neural crest cells (blue dots) to para‐ and pre‐arterial positions, followed by association of the ganglionic cell cluster with the superior hypogastric nerve, then the pelvic splanchnic nerves, and finally the sacral splanchnic nerves. Only thereafter nerves and ganglionic cells extend from this plexus along the bladder wall and the caudal hindgut.

Background The transanal approach to ileal pouch-anal anastomosis [Ta-IPAA] provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis [UC]. The aim of this study was to assess the long-term functional outcomes after Ta-IPAA vs transabdominal IPAA [Abd-IPAA] in UC. Methods A multicentre cohort analysis was performed between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL [Cleveland global quality of life] score at 12 months with a functioning pouch was considered the primary end point. Results A total of 374 patients [100 Ta-IPAA vs 274 Abd-IPAA] were included. Ta-IPAA demonstrated a comparable overall quality of life [CGQL score] to Abd-IPAA [0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p = 0.1]. Quality of life [7.71 ± 1.17 vs 7.30 ± 1.46; p = 0.04] and energy-level items [7.16 ± 1.52 vs 6.66 ± 1.68; p = 0.03] were significantly better after Ta-IPAA, while the quality of health item was comparable [7.68 ± 1.26 vs 7.64 ± 1.44; p = 0.96]. Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies [>10/24 h: 22% vs 21%; p = 1.0] and the rate of a single episode of major incontinence during the following 12-month period [27% vs 26%; p = 0.89] were similar. The differences in 30-day morbidity rates [33% vs 41%; p = 0.2] and anastomotic leak rates were not significant [6% vs 13%; p = 0.09]. Conclusions This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.

A 63-year-old postmenopausal woman was referred for a mass on MRI: a well-defined 13 cm hyperechoic mass with high fat content. Exploratory laparotomy revealed normal ovaries and an enlarged uterus; hysterectomy was performed. Histological examination found uterine lipoleiomyoma, a rare benign type of uterine myoma.

As useful and necessary as radiotherapy may be, it is associated with irreversible long-term adverse effects including loss of bladder function. In the majority of cases the small bowel, sigmoid rectum and ureter are also affected. The extent of injury depends on the irradiated area, the applied dose and the quality of application. Three factors are essential when choosing a urinary diversion: the length of functional ureter, the position of the bowel outside of the irradiated area and the type of diversion. A continent diversion is best performed through a ascending-transverse or transverse-descending colon pouch. The efferent segment is diverted through the umbilicus. The simplest technique for an incontinent diversion is a conduit using the ascending colon or the right colon flexure. If the length of the ureter does not suffice for such a conduit, the ideal solution is a transverse conduit, as this conduit can be attached to both renal pelves, while simultaneously allowing free choice of the lateral location of the stoma. In case of an exenteration, a double stoma on one side of the body should be avoided in order to prevent maintenance issues.

Background. This article presents clinical cases of bladder cancer (BC) developed after previous irradiation and diagnosed in flat suspicious area by cross-polarization optical coherence tomography (CP-OCT) based on analysis of characteristics of scattered light, and with histological material confirmed by nonlinear microscopy.Objective: to present clinical cases and features of BC diagnosis in presence of radiation-induced changes.Materials and methods. Intra-vitam examination of the bladder mucosa was performed using the OKT 1300-U system (Institute of Applied Physics of the Russian Academy of Sciences, Nizhniy Novgorod). Areas that appeared malignant per CP-OCT data were biopsied. Apart from traditional examination of histological samples with hematoxylin and eosin staining, tissue samples were analyzed using nonlinear microscopy in the mode of second harmonic generation (collagen state analysis) and emission of two-photon fluorescence excitation (elastin state analysis).Results are presented through 2 cases of BC in patients with side effects of radiation therapy of varying severity. CP-OCT allowed in-life differentiation of areas of post-radiation inflammatory changes and malignant tumors developed as a result. Nonlinear microscopy provided information on the state of connective tissue matrix of the bladder in the context of radiation changes and transition to tumor.Conclusion. Radiation changes of the bladder mucosa, especially severe ones, can conceal development of malignant tumors. Use of optical methods helps in differential diagnosis of cancer and post-radiation changes of the bladder. CP-OCT is an optimal noninvasive method of examination of the bladder mucosa during cystoscopy. Demonstration of clinical material is aimed at practicing urologists to increase their vigilance in relation to possible BC in patients who underwent radiation therapy of the organs of the lesser pelvis.

The sigmoid colon is about 40 cm in length and begins below the pelvic inlet and ends at the rectosigmoid junction. It normally lies in the lesser pelvis. Anatomical variations of the sigmoid colon were described by various authors. The length and form of sigmoid colon are the most variable of all colonic segments. In this case, the sigmoid colon was found covering the left half of the transverse colon, hiding the spleen and in contact with the left lobe of the liver. In addition, it had no visible taeniae coli and sacculations. The sigmoid colon was 66 cm in length, 7 cm in lumen width, and in suprapelvic position. Awareness of the possible variation of colon especially of the sigmoid is necessary for adequate clinical, surgical and radiological management.

IntroductionDifferent surgical techniques are used to cover the defect in the floor of the lesser pelvis after an ‘extralevator’ or ‘extended’ abdominoperineal excision for advanced rectal cancer. However, these operations are potentially mutilating, and the reconstruction method of the pelvic floor has been studied only sparsely. We aim to study whether a porcine-collagen implant is superior or equally beneficial to a gluteus maximus myocutaneous flap as a reconstruction method.Methods and analysisThis is a multicentre non-blinded randomised controlled trial with the experimental arm using a porcine-collagen implant and the control arm using a gluteus maximus muscle and skin rotation flap. Considered for inclusion are patients with rectal cancer, who are operated on with a wide abdominoperineal rectal excision including most of the levator muscles and where the muscle remnants cannot be closed in the midline with sutures. Patients with a primary or recurrent rectal cancer with an estimated survival of more than a year are eligible. The randomisation is computer generated with a concealed sequence and stratified by participating hospital and preoperative radiotherapy regimen. The main outcome is physical performance 6 months after surgery measured with the timed-stands test. Secondary outcomes are perineal wound healing, surgical complications, quality of life, ability to sit and other outcomes measured at 3, 6 and 12 months after surgery. To be able to state experimental arm non-inferiority with a 10% margin of the primary outcome with 90% statistical power and assuming 10% attrition, we aim to enrol 85 patients from May 2011 onwards.Ethics and disseminationThe study has been approved by the Regional Ethical Review board at Umeå University (protocol no: NEAPE-2010-335-31M). The results will be disseminated through patient associations and conventional scientific channels.Trial registration numberNCT01347697; Pre-results.

Introduccion . Las ramas del plexo sacro juegan un rol importante en la inervacion motora y sensitiva del miembro inferior. En operaciones de la medula espinal observamos diversas variedades y nos motivo para iniciar este estudio dirigido a determinar la formacion del plexo sacro desde la emergencia de cada raiz en los agujeros sacros hasta la formacion de sus ramas terminales. Material y metodo . Se examinaron 100 plexos sacros en 50 cadaveres adultos con el proposito de determinar incidencia de las variaciones nerviosas. Tambien consideramos el recorrido de sus ramas, sus anastomosis y grosor. Destacamos las particularidades de la inervacion motora en el diagnostico, ademas de la complejidad y variaciones anatomicas. Resultados . En general observamos 3 raices sacras con la participacion de S4 y el tronco lumbo-sacro de L4 y L5, y 4 nervios sacros. Habitualmente se observo un recorrido ascendente doble de la raiz S1, mientras que para las otras raices la emergencia doble no fue comun. El tronco lumbosacro se engroso en 19 casos. La division muy alta del nervio ciatico (en la pelvis menor) se observo en 2 casos. El nivel de ramificacion de los otros nervios dependio del tipo de plexo. Conclusion . Nuestro estudio revelo variaciones relativamente frecuentes y variaciones anatomicas extraordinarias en la formacion de las raices nerviosas y la ramificacion del plexo sacro. El conocimiento detallado de estas variaciones es util para el propio diagnostico y el tratamiento quirurgico de las lesiones del plexo sacro y el dolor idiopatico. Introduction . Branches of sacral plexus play an important role in the motor and sensory innervation of the lower limb. Various variations observed during the spinal operations have motivated us to start the study aimed on determination of the sacral plexus formation from its exit of particular roots from sacral foramina up to their formation into terminal branches. Material and method. One hundred sacral plexuses have been examined on 50 adult cadavers for a purpose to find out an incidence of its neural variations. We have considered also the course of their branches, the anatomoses and their thickness. We highlighted the motor innervation particularities in the relation to the diagnosis besides its anatomical complexity and variability. Results . Commonly were observed 3 sacral roots with the share of S4 and lumbosacral trunk of L4 and L5 and 4 sacral nerves. Doubled ascending course of S1 root was often observed, by the other sacral roots the doubled exit was not so frequent. Lumbosacral trunk was thickened in 19 cases. Very high division of the sciatic nerve (in the lesser pelvis) was observed in 2 cases. The branching off level of other nerves depended on the plexus type. Conclusion. Our study revealed a relatively frequent variabilities and described some extraordinary anatomical variations in the formation of nerve roots and branches of the sacral plexus. The detailed knowledge of these variabilities is useful for the proper diagnostics and surgical treatment of the sacral plexus injuries and unexplainable paient‘s complaints.

The cake or lump kidney is a rare form of fusion. The pancake kidney is always found in the pelvic cavity, in the greater or lesser pelvis. However, we report a case of pancake kidney which was found inside abdominal cavity while investigating 32-year-old male for lower limb pain. CT scan with IV contrast reveals ‘fused mass situated in the right side of abdominal cavity with course uncrossed ureters opening separately into the urinary bladder found incidentally with patient work up’. Pancake kidney in this case was managed conservatively without any complication. This malformation is usually present in pelvic cavity, so blood supply is almost constant but in rare cases might be different and follows location of this anomaly.

Preclinical studies indicate that an optimal diet during pelvic radiotherapy may be able to prevent radiation-induced survivorship diseases that diminish cancer survivors' intestinal health. We do not yet know what this optimal diet might be because scientific studies needed to determine what dietary advice might best be given to patients during treatment. Oncology clinics in Sweden were contacted to determine the nature of dietary advice given to gynaecological and prostate cancer patients at each clinic before, during and after radiotherapy. Reports from these clinics revealed that dietary advice given to patients differs from one clinic to another. This was as expected, since it was known that the scientific evidence needed to identify the best possible diet is not yet available. Clinical studies of the effects of different diets are urgently needed if we are to prevent survivorship diseases that decrease intestinal health.

The problem of chronic venous insufficiency in women during pregnancy is of current concern. A total of 115 pregnant women in the first, second and third trimesters of gestation were examined in a stage-wise manner. During the first stage we conducted a comprehensive clinical study with the obligatory consultation by the obstetrician-gynaecologist. At the second stage, all women were subjected to ultrasonographic examination of the venous system of both lower extremities and the small pelvis. Studying the diameters of the deep veins of the right and left lower limbs, as well as the paired veins of the small pelvis demonstrated no statistically significant differences, which made it possible to evaluate these parameters as a whole. In all pregnant women, the lumen of the examined vessels was uniform, with the veins being patent, compliant, stained on colour Doppler mapping. Respiration-synchronized, phasic blood flow was registered. In the course of the study it was revealed that the diameter of the veins of the lower limbs and small pelvis increased as gestation proceeded. The findings of ultrasonographic angioscanning showed that by the third trimester of pregnancy the diameter of the femoral vein was 1.5-fold larger and that of the popliteal vein was 1.4-fold larger. The diameter of the veins of the pampiniform plexus of the ovaries during gestation was noted to have increased 1.13-fold. This was accompanied and followed by deterioration of tonic-and-elastic properties of the venous wall and the development by the third trimester of valvular insufficiency with the emergence of venous congestion. Seventeen (16%) women were found to have varicose syndrome. The above mentioned alterations of venous haemodynamics appeared to lead to impairment of blood flow in the affected veins and to the emergence of thrombogenic zones in the valvular sinuses. Of the 115 women examined, 77 (67%) were found to have degree 1 sludge and 36 (31.3%) had degree 2 sludge, with the D-dimer level in these women having increased to 773.3±37.5 ng/ml. Degree 3 sludge was observed in 2 (1.7%) women previously operated on for acute venous thrombosis. Their D-dimer level amounted to 954.3±43.2 ng/ml. It was demonstrated that studying the valvular sinuses for detection of sludge during examination of pregnant women allowed obstetricians-gynaecologists and physicians of ultrasonographic diagnosis to form risk groups for the development of deep vein thrombosis and to timely take appropriate measures aimed at prevention of the pathology concerned.

Paralysis of the femoral nerve secondary to iliopsoas haematoma is a rare post-traumatic complication. Because of the large differential diagnosis, a high level of suspicion is required for its early recognition. Treatment modalities are controversial due to the rarity of this entity. An 18-year-old student presented with complete paralysis of the knee extensors and a sensory deficit on the anterior side of the thigh 5 weeks after a sport accident. MRI of the lesser pelvis showed an iliopsoas haematoma. Surgical decompression was performed and recovery was complete at 6 months of follow-up.

The article is a literature review presenting modern data on applied anatomy of the pelvic veins, diagnosis and treatment of pelvic varicose veins, pelviperineal reflux and vulvar varicosity, lower limb varicose veins, which were caused by pathological reflux from varicose pelvic veins. Presented is the information on tactical approaches in treatment of combined varicose veins of the pelvis and lower limbs, surgical decision-making for correction of pelviperineal reflux, methods of operative and phlebosclerosing interventions on pelvic and superficial veins of the perineum and lower limbs.В обзоре литературы представлены современные данные о прикладной анатомии тазовых вен, диагностике и лечении варикозной болезни таза, пельвио-перинеального рефлюкса и вульварного варикоза, варикозной болезни нижних конечностей, причиной которых послужил патологический рефлюкс из варикозных вен таза. Представлена информация о тактических подходах в лечении сочетанной варикозной болезни вен таза и нижних конечностей, выборе метода хирургической коррекции пельвио-перинеального рефлюкса, способах оперативных и флебосклерозирующих вмешательств на тазовых и поверхностных венах промежности и нижних конечностей.

Aim . Examinatio n of efficacy of the double-lumen “pipe in pipe” drainage set mounted in the cavity of the lesser pelvis by the method developed by the authors for conservative treatment of colorectal anastomotic leak. Materia l and methods. Dat a have been analyzed for 124 patients operated in two surgeries of the base No.2 of the Republican Clinical Onco- logic Dispensary of the Ministry of Health of the Republic of Tatarstan, whose surgery was completed with formation of colorectal anastomo- sis; aspirating drainage of the cavity of the lesser pelvis was performed with double-lumen drainage of the authors’ design, mounted in the retroperitoneal part of the cavity of the lesser pelvis through a puncture in the anterior abdominal wall. No patient was applied a preventive intestinal stoma. Results . 4 (3.2 %) out of 124 patients died after surgeries. 21 (16.9 %) patients experienced colorectal anastomotic leak, which was resolved in a conservative manner in all patients. Conclusion . Ou r data allow us to speak about the efficacy of this technique of drainage of the cavity of the lesser pelvis in colorectal anastomotic leak.

A 17-year-old young man presented at our clinic with asymptomatic microhematuria. Ultrasonography and computer tomography found an intraperitoneal lesion of unknown dignity located on top of the bladder. Surgical exploration and histological examination confirmed the diagnosis of a secondary pelvic spleen, a lien bipartitus.

Adhesions in abdominal surgery, especially in operations in the lesser pelvis are an omnipresent problem, both in consideration of the access to the actual operation field as well as regarding to the scheduled surgical procedure itself. In hysterectomies they frequently represent a considerable obstacle which has to be mastered by the various operation techniques.

A 17-year-old young man presented at our clinic with asymptomatic microhematuria. Ultrasonography and computer tomography found an intraperitoneal lesion of unknown dignity located on top of the bladder. Surgical exploration and histological examination confirmed the diagnosis of a secondary pelvic spleen, a lien bipartitus.

Background Surgery in the lesser pelvis is associated with a high complication rate as surgeons are spatially limited by solid anatomic structures and soft tissue borders. So far, only two-dimensional (2D) parameters have been used for risk stratification. Purpose To precisely measure the inner pelvic volume a computed tomography (CT)-based three-dimensional (3D) approach was established and compared to approximations by 2D parameter combinations. Material and Methods Thin-layered multi-slice CT datasets were used retrospectively for slice by slice depiction of the inner pelvic surface. The inner pelvic volume was then automatically compounded. Combinations of two to four 2D dimensions determined in 3D volume rendered reconstructions were correlated with the inner pelvic volume. Pearson’s correlation coefficient and Chi square test were used for statistical calculations. Significance level was set at P Results In total 142 patients (91 men, 51 women) aged 64.8 ± 10.6 years at surgery were included in the study. Mean calculated pelvic volume was 1031.13 ± 180.06 cm3 (men, 996.57 ± 172.43 cm3; women, 1093.34 ± 178.39 cm3). Best approximations were obtained by combination of the 2D measurements transverse inlet and pelvic height for men (r = 0.799, P Conclusion We describe a precise and reproducible CT-based method for pelvic volumetry. A less time consuming but still reliable approximation can be achieved by combination of two to four 2D dimensions.

Background Ultralow anterior resection for mid and distal rectal cancers has been reported routinely performed using either a laparoscopic ultralow anterior resection (LAR) or laparoscopic pull-through with coloanal anastomosis (LPT). This study evaluated the postoperative and functional outcomes. Methods Between January 2007 and December 2008, 40 consecutive patients had laparoscopic surgery for rectal cancers. The data were prospectively collected. Results There were 21 patients (21 men; mean age 61.2 ± 3.2 years standard error of the mean [SEM]) in the LAR group and 19 (16 men; mean age 61.4 ± 2.4 years SEM) in the LPT group. Tumor characteristics, adjuvant therapy given, mean follow-up (overall 33.5 ± 1.4 months SEM), intraoperative time, blood loss, mesorectum quality, conversion rate (LAR n = 2, LPT n = 1), pain score, time for ileostomy to function, subsequent incontinence scores, and complication rates (LAR n = 7, LPT n = 9) were not different between groups, but benign anastomotic strictures were higher after LPT (n = 4, LAR n = 0, P = .042). The latter was associated with chemoradiotherapy ( P = .015). There were 2 systemic cancer recurrences both in the LPT group but no local recurrences to date. Conclusions The LAR technique may have less risk of anastomotic strictures, particularly with adjuvant therapy. LPT may be considered selectively for a bulky distal rectal tumor in a small pelvis with comparable functional results.

Introduction: Cervical erosion and squamouse intraepithelial lesion of low grade are most common gynecological problems of women. These changes on cervix are cause of painful coitus and enhanced vaginal secretion. Cryotherapy is widely accepted method in treating these changes and sympthoms. Aim: The aim of this study is to examine the efficiency of cryotherapy in eliminating erosion of cervics and LSIL, as well as conditions following these states. Patients and methods: Cryotherapy was performed in 124 women with cervical erosion (N-74) and LSIL (N-50). Sympthoms that were followed are: vaginal secretion, abnormal vaginal bleeding and pain. Assessment of epithelisation of cervix and evaluation of sympthoms were done 4 and 6 weeks after cryotherapy and PAP test after 4 months in women with LSIL. Statistical method used in result processing was X2 test. Results: The average age of examined women is 37,75±8,2. Enhanced vaginal secretion had 87,09% (N-120), painful coitus 61,29% (N-76), pain in lesser pelvis 52,41% (N-65) and abnormal vaginal bleeding 28,22% (N-35). Erosion of cervix had 14% (N-7) of women with LSIL. After cryotherapy, enhanced vaginal secretion remained in 21,77% (N-27) of women, painful coitus remained in 8,06% (N-10), pain in lesser pelvis remained in 5,6% (N-7) and abnormal vaginal bleeding in 6,4% (N-8). Four weeks after cryotherapy, complete epithelisation of cervix was in 87,90% (N-109) and after six weeks in 93,54% (N-116) of examined women. LSIL was eliminated in 92% (N-46) of women after cryotherapy and in 8% (N-4) results remained the same. Conclusion: Cryotherapy is successful method of elimination of cervical erosion, LSIL and pains with enhanced vaginal secretion.

The authors studied peculiarities of pelvic organs lesions in patients presenting with secondary small pelvic varicose veins (SPVV) induced by endured thrombosis of iliac veins. The study included a total of 70 patients after endured thrombosis of iliac veins verified by radiodiagnostic methods. The average duration of thrombosis amounted to 3.8 years. The patients were subdivided into two groups. The Study Group comprised 48 patients presenting with small pelvic varicose veins revealed by duplex scanning; the Control Group was composed of 22 patients with no varicose pelvic veins. It was determined that characteristic features of patients with secondary SPVV having developed after iliac veins thrombosis included chronic pelvic pain, dilatation of cavernous veins of the rectum, inguinal vein varicosity and varicose veins of the groin and anterior abdominal wall. Formation of secondary SPVV after endured iliac vein thrombosis leads to disorders of pelvic organs, similar to those in primary varicosity, but more often being functional. Endured iliac veins thrombosis in formation of secondary SPVV leads to urination impairments with prevalence of moderately pronounced symptomatology. Small pelvic organs dysfunction in women with secondary SPVV due to endured iliac veins thrombosis manifests itself in dyspareunia, leukorrhea, and dysmenorrhea.

The authors analyzed the experience at the period from September 2000 to January 2014. The total exenterations of the small pelvis were performed on 23 patients (12 men and 11 women) at the age from 37 to 71 years old. Supralevator total exenterations with full visceral reconstruction were carried out in 13 cases out of 23. Total infralevator pelvic exenterations were used in 10 cases. There wasn't the intraoperative lethality. Patients (3 cases) died in postoperative period. Postoperative complications developed in 10 patients, though serious complications, which required an application of surgical strategy were noted only in 3 cases. The mean life span consisted of 29 months. The performance of total exenteration of the small pelvis considerably increased the life span of the patients and in case of application of reconstructive methods allowed restoration of quality of life to high level and obtaining moral, psychological and social rehabilitation.

Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach—among others, laser application—are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO2 laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22–42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in all patients, followed by either laser ablation or electroablation of the endometriotic foci. The results of the laparoscopic treatment were monitored after 3 and 6 months postoperatively. p value of 0.05 was considered to be statistically significant. Patients from both groups reported less intensive pain before/during menstruation (dysmenorrhea) 6 months postoperatively, with more distinct tendency in the electroablation group (p = 0.004) as compared to the laser ablation group (p = 0.025). Despite the initial improvement reported at the 3-month checkup (p = 0.008), 6 months postoperatively, a statistically significant increase in pain intensity was noted in both groups (p = 0.016 and p = 0.032 for CO2 laser ablation and electroablation, respectively). Both surgical methods seem to be effective only in the treatment of endometriosis-related dysmenorrhea, whereas the intensity of other pain complaints (dyspareunia, dysuria, dyschezia, pelvic pain syndrome (PPS)) has remained on the same level.

The pelvis and the spine form a system balancing human skeleton. Within this system, the pelvis adapts to age-related changes in the spine. Previous studies were predominantly focused on changes of pelvic parameters in the sagittal plane. The aim of this study was to reveal age-related changes of lesser pelvic dimensions at different levels of the pelvic cavity in the sagittal and coronal planes and to explore sexual dimorphism in age-related tendencies. The computed tomography pelvimetry was performed on the three-dimensional workstation. The research sample included 211 females aged 18 to 84 years and 181 males aged 18 to 82 years, who underwent an examination at the Riga East University Hospital, Clinical Center “Gailezers,” Latvia. Three pelvic angles and transverse and sagittal diameters of the lesser pelvis were measured at four levels: the inlet, two axial planes in the mid-cavity, and the outlet. The results demonstrated that more pronounced age-related changes occurred in the inlet and the outlet of the lesser pelvis. The mid-cavity was less changing. The transverse diameter between acetabular centers and the sagittal diameter at the level of ischial spines were independent of age. In general, the common age-related trends were observed for pelvic parameters in females and males. A single exception was the proportion of diameters at the level of ischial spines, which decreased in males only. For parameters associated with pelvic floor diseases, age-related changes occurred in the direction of pathology.

To perfect and estimate the possibilities of using a mini-invasive diagnostic procedure under magnetic resonance (MR) guidance in the complex anatomic situations in cases of pathological small pelvic changes of unknown origin.Ten small pelvic interventions were made under MR guidance. The indications for bone biopsy under MR guidance were poor visualization of bone changes or their absence during radiography, including computed tomography. Small pelvic organ and soft tissue biopsies were carried out in the situations of complex location of pathological changes adjacent to critical organs, large vascular and neural structures. All interventions were done using a high-field MR scanner. Freehand biopsy was performed in a stepwise fashion under axial and sagittal T2-weighted image control.Informative histological material was obtained in 100% of cases. No complications were observed.It became possible to verify the diagnosis based on morphological findings and to timely determine management tactics only by target biopsy under MR guidance in these 10 patients with small pelvic changes of unknown origin.

Retropubic tumours without contact to bones or surrounding tissues are extremely rare with only 22 cases being reported in the literature. The majority of tumours described within these reports are osteochondromas in 17 cases, 2 cases of leiomyoma and one case of each fibroma, fibrosarcoma and nodular fasciitis. We now report the case of a 52-year-old-man with a retropubic ganglion cyst, which was resected "in toto" by laparoscopy.

The study was devoted to the problem of postoperative eventrations in gynaecological practice. Coaptation removable sutures were applied in order to prevent similar complications. Operations were performed in the cases of desolate condition of purulent disease of the uterus and uterine appendages with diffuse suppurative peritonitis. An advanced operative technique of suturing through all layers of abdominal wall demonstrated its high efficacy. No one patient (from 39) had the eventration or wound abscess.

Determine levels of sIgA, IgG, IgA in vaginal secretion and saliva of women of reproductive age with chronic inflammatory diseases of small pelvis organs (IDSPO) at exacerbation stage and remission period.Clinical-laboratory and gynecological examination of 105 women was carried out. Based on the results obtained 3 groups were formed: patients with IDSPO at exacerbation stage; patients at remission stage; clinically healthy women. sIgA, IgG, IgA parameters were studied in vaginal secretion and saliva in women with IDSPO at exacerbation stage and remission period by radial immune diffusion in gel by Manchini method.An increase of immunoglobulin level in vaginal secretion of women with IDSPO at remission period and a sharper increase of these parameters during exacerbation of the disease compared with women of the control group were detected. During analysis of sIgA, IgG, IgA levels in saliva in the same groups of women the results were obtained that give evidence that the presence of IDSPO and local immune reaction do not lead to the changes of these parameters.The obtained parameters on the dependence of an increase of immunoglobulin levels in vaginal secretions and the degree of intensity of the inflammatory process give basis to use them with the aim of additional diagnostics.

Although an abundance of literature exists regarding frequently lifted body areas, there are few reports about body contouring of the mons pubis. Therefore, this paper describes the first clinical results from a new technique, which surgically lifts the mons pubis using superficial fascial system suspension. Fifty patients underwent a lower body lift, including a superficial fascial system suspension of the mons pubis. After a mean follow-up period of 16.9 months (range, 6-31 months), patients were evaluated by standardized preoperative and postoperative photographs using the Pittsburgh Rating Scale. In addition, all patients completed a Likert-type scale questionnaire pertaining to body satisfaction and other bodily changes. Scores from the Pittsburgh Rating Scale improved significantly (P=0.03) from 2.76 (0.43) [range, 1-3] preoperative to 0.5 (0.59) [range, 0-2] postoperative. Fifteen (30%) of the patients assessed the new contour as very good, 26 (52%) patients as good. Eight patients developed a temporary edema in the mons pubis and 1 patient developed an infected fascia suture granuloma, which had to be removed. A mons pubis lift with the aid of the superficial fascial system is a safe surgical technique, which can easily be integrated in body contouring surgeries of the torso.

The purpose of the study was to develop the ultrasound study (USS) and magnetic resonance imaging (MRI) semiotics of small pelvic masses after hysterectomy, to comprehensively use USS and MRI for the diagnosis of these masses, and to define indications for MRI. One hundred and seventy-five female patients with small pelvic masses after hysterectomy were examined. For the specification of the pattern of small pelvic masses and their differential diagnosis, USS and MRI were carried out in 175 and 72 patients, respectively. Four groups of the masses were identified; of them there were tumor-like masses of the uterine appendages in 67 (38.2%) patients, ovarian tumors in 31 (17.7%), other additional masses of the small pelvis in 27 (15.4%), and a mixed variant of its masses in 50 (28.5%). The findings suggest that it is reasonable to concurrently use USS and MRI in the diagnosis of small pelvic masses following hysterectomy for the specification of their pattern and their differential diagnosis. The benefit of MRI is that information images of the basic structures of the small pelvis can be obtained in patients with a marked commissural process after hysterectomy in the absence of limitations in large mass sizes. Practical guidelines were proposed to comprehensively use USS and MRI for the diagnosis of small pelvic pathology.

Variations of the external iliac artery are very rare. We found a rare variation in the left external iliac artery. The artery was long and formed a characteristic loop. The loop was found in the lesser pelvis in close relation to the obturator nerve. This loop may compress obturator nerve and vessels. The knowledge of this loop might be important for gynaecologists, orthopaedic surgeons and urologists since it may be involved in surgeries of hip, ovary and prostate.

Two adult cases of non-rotation were anatomically analysed. The small intestine occupied the right flank and the colon the left. The ileum crossed the midline to enter the cecum from the right. The appendix vermiformis rested on the front of the cecum and extended upwards. The cecum was located in the lesser pelvis. They had no Ladd's bands, but in the first case fibrous bands from the posterior abdominal wall caused kinking. The colon of the first case had an intricate twist under the left kidney. The second case was also complicated with three loops, the third loop posed between the first and the second, accompanied by a rare vascular anomaly, a double inferior mesenteric artery. © 1993 Wiley-Liss, Inc.

We surveyed a total of one hundred and ninety women presenting with small pelvic varicose veins (SPVIV). The chronic pelvic pain syndrome (CPPS) was revealed in nearly a quarter of the examined patients (24.7 %). The women's quality of life was assessed using the SF-36 questionnaire as a more integrative parameter, having demonstrated that women presenting with SPVV had a substantial decrease in all the components of both physical health and mental well-being. The obtained findings have strongly suggested the necessity of carrying out secondary prevention in women suffering from SPVV, even if there are no clinically pronounced manifestations of the disease.