Journal of Gynecologic Surgery

This study aimed to evaluate the occurrence, the risk factors, and the management of patients undergoing mesh erosion following an anterior prosthetic reinforcement by the vaginal route. We retrospectively reviewed the medical records of 247 consecutive patients who underwent a vaginal prosthetic reinforcement for cystocele and/or a suburethral sling urethropexy for stress urinary incontinence (SUI). With a minimal follow-up of 24 months, 18 cases of vaginal erosions occurred (7.3%). Four groups of risk factors were identified: (1) a prior history of vaginal surgery; (2) the absence of symptomatic SUI, uterine prolapse, and rectocele grade III; (3) the type of colpotomy, colpectomy, rectovaginal, and vesicovaginal dissection, vaginal wound, and vaginal hematoma; and (4) the absence of antibiotic prophylaxis and the absence of an indwelling urethral catheter. All patients required a surgical management, and 55% (n = 10) of them needed two surgeries and 22% (n = 4) had persistent disorders. Procedures should reduce the risk of mesh exposure. Management of mesh exposure should systemically combine radical surgery (i.e., maximal excision of the prosthetic material) and antibiotics cover.

Objective: The differential diagnosis of symptomatic hemorrhagic corpus luteum includes various causes of acute abdomen that are usually associated with either leukocytosis and/or fever. The aim of this study was to evaluate whether hemorrhagic corpus luteum could also be associated with the clinical and/or laboratory presentation of acute abdomen. Methods: This work was a retrospective case series study, including 84 hospitalizations (81 women) owing to symptomatic hemorrhagic corpus luteum from January 2005 to February 2006. Results: The most prevalent complaint, common to all women, was abdominal pain. Other symptoms and signs included fever (10.7%), nausea or vomiting (13%), urinary complaints (9%), and shoulder pain (1.1%). The mean hemoglobin concentration was 12.8 g/L on admission and 11.9 g/L on discharge. White blood cell (WBC) counts exceeding 11,000 cells/mL were present on admission in 33% of patients. The WBC count repeated before discharge decreased significantly (from 14,051 cells/mL to 8131 cells/mL; p < 0.01). Further, the presence of leukocytosis on admission was correlated with other clinical, laboratory, and ultrasonographic findings. We found a significant correlation between leukocytosis, a marked decrease in hemoglobin concentration, and a longer hospital stay. Conclusion: Leukocytosis may be a feature of hemorrhagic corpus luteum. The presence of fever, nausea, vomiting, and, particularly, leukocytosis should not rule out the diagnosis of hemorrhagic corpus luteum when evaluating women with acute abdominal pain.

Laparoscopic colposuspension for stress urinary incontinence appears to have short-term benefits, including a lower perioperative complication rate, shorter hospital stay, and a quicker recovery but seems to be more costly, takes longer to perform, and has a steep learning curve, when compared to open colposuspension. The suture technique appears to be superior to mesh/fibrin sealant. Current evidence suggests that it is as effective as open colposuspension up to 3–5 years postsurgery. Compared to newer, self-fixing suburethral sling procedures, there appears to be no significant difference in subjective cure rates within 18 months to 2 years of follow-up, although significantly higher objective cure rates at 18 months were found with the latter. However, the long-term cure results remain uncertain.

Purpose: The aim of this study was to present a sonographic sign and strengthen the clinical sign for the diagnosis of specific, dense, intraperitoneal adhesions, following an earlier cesarean section. Results: Abdominopelvic sonography showed altered sonographic findings when described adhesions were present, and this sonographic sign (altered findings) endorsed the diagnosis of specific adhesions from a clinical sign. Conclusions: This paper describes, for the first time, the sonographic findings that can corroborate a clinical diagnosis of dense, intraperitoneal adhesions following a cesarean section.

This paper is a case report illustrating a patient who had the insertion of the Essure Implant (Conaptus (CPTS), Mountainview, CA) with a perforation into the peritoneal cavity and entrapment into the omentum, causing chronic pain. It illustrates how this small implant can cause morbidity, and the use of fluoroscopy can aid in locating the tiny microinsert if it is dislodged into the abdominal cavity.

Two (2) cases of three consecutive repeated ectopic pregnancies are presented in this paper. The etiology, symptoms, and management of the cases are discussed and the literature is reviewed.

In this paper, we report the case of a successful pregnancy in a woman with a previous history of spontaneous uterine rupture following laparoscopic myomectomy. There are only a few cases of laparoscopic myomectomy complicated with spontaneous uterine rupture in subsequent pregnancy, as reported in the literature. The interesting parts of this case are the additional assisted reproductive techniques employed, along with the substrate of thrombophilia. This case highlights, once more, the risks associated with laparoscopic myomectomy, particularly in nulliparous women, along with the need for increased awareness for signs of uterine rupture in a future pregnancy.