Aim: The purpose of this study is to determine the (1) importance of liberal use of intraoperative cystoscopy in routine gynecological surgeries for detection of urinary tract injuries, (2) time taken for intraoperative cystoscopy, and (3) complications associated with cystoscopy.
Materials and methods: The study was started in March 2015 that enrolled 170 patients up to June 2016 with a follow-up period of 12 months.
Settings and design: Prospective study in a tertiary care center. Patients undergoing all gynecological and urogynecological surgeries were included in the study. Malignancy was excluded. Cystourethroscopy was performed following gynecological surgery using a 20 F 30° telescope. A study pro forma was prepared to record case information.
Results: Three bladder injuries were diagnosed by intraoperative cystoscopy during antiincontinence surgery [tension-free vaginal tape (TVT)] and hysterectomy. Following total laparoscopic hysterectomy (TLH) with normal cystoscopy, one patient returned 1 month postoperatively with right ureteric injury. Three patients had immediate postoperative urinary tract infection. One patient complained of flank pain with fever 48 hours following surgery. Further investigation with computed tomography intravenous pyelogram (CT IVP) was negative for urinary tract injury. She was treated conservatively.
Conclusion: Obstetricians/gynecologists (OB-GYNs) should have a low threshold to perform intraoperative cystoscopy during gynecological surgeries for early detection of urinary tract injuries.
Clinical significance: Early recognition and repair of urinary tract injuries lead to decreased morbidity for the patient, with successful outcome of repair at the time of detection. This is possible by performing an intraoperative cystoscopy during gynecological surgeries.
DOI: 10.5005/jp-journals-10058-0016 |
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Ajmani SN. Importance of Colposcopy for screening of Premalignant Lesions of Cervix: An Experience of Tertiary Public Health Hospital in India. Int J Gynecol Endsc 2017; 1 (2):65-68.
Aim: The aim of this article is to correlate the clinical, cytological, and colposcopic findings for detection of premalignant lesions of cervix.
Materials and methods: A total of 100 nonpregnant females attending the gynecology outpatient department (OPD) in Kasturba Hospital, New Delhi, India, were enrolled in the study. Papanicolaou (Pap) smear was done in first OPD visit. Colposcopy was done in these patients and patients with satisfactory colposcopy were subjected to biopsy if any abnormal finding was detected; in those with unsatisfactory colposcopy, endocervical curettage and conization were done. Samples were sent for histopathology examination and findings were correlated.
Results: The Pap smear was evaluated according to Bethesda system, which showed 70 patients had inflammatory smear, 6 had inflammatory with definitive organism, and 14 were abnormal. Out of 14 abnormal smears, 5 cases of atypical squamous cells of uncertain significance (ASCUS), 8 cases of low-grade squamous intraepithelial lesion (LSIL), and 1 case of squamous cell carcinoma (SCC) were noted. Sensitivity of Pap smear for detecting all grades of cervical intraepithelial neoplasia (CIN) was found to be 50%.
On colposcopy, 30% had normal appearance and 38% had miscellaneous findings; 28 patients with abnormal colposcopy finding were graded according to Reid's colposcopy index, and findings showed 26 abnormal and 2 suspected of invasive cancer. Biopsy was done in 32 patients, including abnormal and unsatisfactory colposcopy.
Sensitivity of colposcopy for detecting all grades of CIN and SCC was found to be 92.85%. After combining both Pap smear and colposcopy, detection rate was 100%.
Conclusion: Colposcopy and Pap smear should be done together for early detection of premalignant cervical intraepithelial lesions to reduce the burden of cervical cancer and its associated morbidity and mortality.
At hysterectomies in patients beyond the age of 45 years, we have to decide on concomitant adnexectomies, tubectomies, or oophorectomies as ovarian or tubal cancer prevention. Ovarian conservation should be considered in many women having pelvic surgery as oophorectomy runs with decreased long-term health outcomes. Oophorectomy is indicated for women with an adnexal mass, i.e., suspicious for malignancy or for a mass that increases in size or complexity when monitored with serial sonography. Adnexal torsion can usually be treated with detorsion rather than adnexectomy. Oophorectomy decreases the likelihood of repeat surgery in women with severe, symptomatic endometriosis, but ovarian conservation should be considered in those women who are younger than age 40, since conservation avoids early surgical menopause. Tubectomy or salpingectomy with hysterectomies, however, is considered today as good standard care at hysterectomies for adnexal cancer prevention.
Introduction: Airway management is difficult in pregnant patients due to various factors; we in this study undertake changes in airway related to endotracheal intubation during active labour through Mallampati Score
Materials and methods: Study was conducted in 100 pregnant females by noting Mallampati Score before start of labour, at second stage of labour and after 15 minutes of delivery.
Conclusion: Airway difficulty increases with duration of labour and is reflected through Mallampati scores.
Cervicovaginal agenesis is one of the rarest müllerian anomalies, whose true incidence is still unknown. It is characterized by the absence of cervix and vagina, along with functioning endometrium and normal tubes and ovaries. It clinically presents as a case of primary amenorrhea along with cyclical lower abdominal pain. It can be associated with other anomalies like skeletal and renal anomalies. Earlier, hysterectomy was considered as a definitive surgery for this condition; however, it has been replaced with more conservative approach, like uterovaginal anastomosis with creation of neovagina. In the literature, successful pregnancy has been reported in those patients who underwent conservative surgery.
Transverse vaginal septum is a developmental defect in vaginal embryogenesis that leads to incomplete fusion between müllerian duct component and urogenital sinus component of vagina. Septum may be complete but usually has laterally placed tiny hole giving an impression of vaginal vault without cervix. We describe a case of untreated transverse vaginal septum with small tiny aperture diagnosed during labor and confirmed during lower segment cesarean section.
Choriocarcinoma is a highly malignant epithelial tumor arising from the trophoblastic tissue. It commonly occurs in women of reproductive age. Persistent gestational trophoblastic disease (GTD) following molar pregnancy is a potentially fatal complication that must be recognized early and treated aggressively for both immediate and long-term recovery. While complete molar pregnancies are rare, they are associated with a host of potential complications that include invasive gestational trophoblastic neoplasia. In this study, we report the case of a 21-year-old young woman who presented 1.5 months after evacuation of a molar pregnancy. She had invasive and metastatic gestational neoplasia (GTN) complicated by uterine rupture and hemoperitoneum. This was successfully managed by exploratory laparotomy and hysterectomy.
Scar endometriosis is an infrequent type of extrapelvic endometriosis. Scar endometriosis is an infrequent type of extra pelvic endometriosis. Diagnosis can be difficult due to its presentation as abdominal lump. Histopathology yields confirmative diagnosis. In this case report we will discuss abdominal wall endometriosis following caesarean section. We shall evaluate the incidence, pathophysiology, course, diagnosis, treatment and prevention of this condition
Purpose: The purpose of the article is to know how to progress ovum pick up (OPU) in cases where the ovaries are superiorly placed and are difficult to approach vaginally.
Material and methods: We performed OPU in cases where the ovaries are superiorly placed and are difficult to approach vaginally. This is a case study of eight patients where the ovaries were not approachable: four cases of Mayer–Rokitansky–Küster– Hauser (MRKH) syndrome, three cases of endometriosis, and one case of pelvic inflammatory disease (PID) over a period of 2 years from December 2014 till December 2016. There were four cases of MRKH syndrome out of which in two the vagina was only about 2 to 3 cm in depth. It was very difficult to even insert the vaginal probe. In two cases of MRKH syndrome the ovaries were superiorly placed and were not approachable by the routine OPU needle through the guide of transvaginal probe; in two cases of endometriosis, endometrioma was 4 to 5 cm in size. There was one case of endometriosis and one case of PID.
Discussion: A laparoscopic approach for OPU may be the answer in cases of superiorly placed ovaries in cases of MRKH syndrome going in for surrogacy and also in some cases of severe endometriosis and PID where it may be difficult to approach the ovaries. In all these cases, OPU could be completed with the transvaginal ultrasound probe kept suprapubically and the OPU needle was guided through the guide and all the follicles could be aspirated without the need for laparoscopy
Limitations, reasons for caution: The procedure should be carefully done in very obese women. The anatomical location of the inferior epigastric vessels should also be known to avoid any bleeding from these vessels at the time of the procedure.
Wider implications of the findings: Can be done by a routine in vitro fertilization specialist. It removes the need of calling a laparoscopic surgeon in such difficult cases.
Results: It is noninvasive with just a needle puncture on the lower abdomen and all the follicles can be retrieved.
Conclusion: This novel method of using the transvaginal probe abdominally for OPU in cases of superiorly placed ovaries can avoid