Urogynaecologia 2020-05-09T03:19:10+00:00 Francesca Savio Open Journal Systems <p>The journal publishes original articles dealing with the latest advances in the field of Urogynecology, as infections of the genito-urinary system, endometriosis, genito-urinary alterations in menopause, diagnostic protocols and medical-surgical treatment of urinary incontinence, pelvic static disorders, perineology, uro-gynecologic rehabilitation therapy, etc. Urogynaecologia wide spreading allows a valid knowledge sharing mean among scientists and scholars all over the world. <strong>Urogynaecologia is the official journal of A.I.U.G., <em>Associazione Italiana di Urologia Ginecologica e del Pavimento Pelvico</em>.</strong></p> Diagnostic tools for female urethral diverticulum: Current perspectives 2020-05-09T03:16:55+00:00 Gloria Calagna Marco Vella Maria Elena Mugavero Giorgio Gugliotta Salvatore Polito Antonino Perino Gaspare Cucinella <p>Although once considered quite a rare condition in the past, female urethral diverticulum (UD) would now appear to have a higher frequency, perhaps due to greater attention from physicians. To date, there is no agreement on which is the best method for diagnosis of female UD. Traditionally, the approach was based on quite invasive techniques, such as voiding cystourethrography, and double-balloon urethrography, with satisfactory results but relevant limitations. More recent high-resolution imaging techniques, such as 2D-3D ultrasonography (US) and magnetic resonance imaging (MRI) have also been applied in the study of the abnormalities of the female urethra. US had the advantage of the outpatient setting, non-invasiveness and absence of contrast medium use; MRI, is characterized by high sensitivity thanks to multiplanar capability, with an optimal characterization of periurethral diseases or its abnormalities, and lack of ionizing radiation. A real innovation is represented by computer tomography-voiding cystourethrography, a rapid technique that allows for high quality simultaneous 2D and 3D images of the urethra, well correlated to MRI and consequently with surgical results. Here, we report and comment the available tools in the diagnosis of female UD, focusing particularly on pros and contra of different methods.</p> 2019-05-03T12:25:02+00:00 Copyright (c) 2019 Gloria Calagna, Marco Vella, Maria Elena Mugavero, Giorgio Gugliotta, Salvatore Polito, Antonino Perino, Gaspare Cucinella Predictive factor for successful retrograde ureteral stent insertion in obstructive uropathy due to advanced cervical cancer 2020-05-09T03:19:10+00:00 Bambang Sasongko Noegroho Akhmad Mustafa <p>Cervical cancer is the 3<sup>rd</sup> most common cancer in women. Some of the patients came with kidney failure due to malignant ureteral obstruction. Retrograde ureteral stent insertion as palliative urinary diversion often performed on these patients, but it has high failure rate and often has to be converted to nephrostomy, giving the patient unnecessary burden due to failed procedure. In this study, we evaluate factors that may predict successful ureteral stenting in cervical cancer patients to avoid unnecessary burden to the patient. Data were collected from 2014-2017. We evaluate the clinical, ultrasound and laboratory findings before stent insertion of the patient with successful compared to failed insertion. Comparative study was done using independent T-test and Mann-Whitney U test for nonparametric data. Odds ratio (OR) were calculated using contingency table and P value calculated using Fisher exact test. There were 41 patients diagnosed with cervical cancer performed retrograde ureteral stenting. From 41 patients, 20 (48.7%) were successful and 21 (51.3%) failed. Low hydronephrosis grade (OR=85.8; P&lt;0.0001), low stage (OR=6.0; P=0.0098), radiotherapy (OR=3.7; P=0.04) were strong predictor for successful stent insertion. In bilateral hydronephrosis, more daily urine output (OR=29.2; P=0.002) and normal creatinine level (OR=6.3; P=0.03) were strong predictors for successful retrograde stenting, while bladder infiltration was strong predictor for stent failure (OR=0.0684; P=0.0021). Low hydronephrosis grade, no bladder infiltration, normal creatinine level, more daily urine output, low clinical staging and radiotherapy are predictive factors to predict a successful ureteral stenting in cervical cancer patients.</p> 2019-03-29T14:49:53+00:00 Copyright (c) 2019 Bambang Sasongko Noegroho, Akhmad Mustafa A 9-year audit of the efficacy of diathermy for cystitis cystica 2020-05-09T03:18:43+00:00 Zhuoran Chen Lucy Bates Nevine Te West Kate H. Moore <p>The aim of this study was to assess whether cystoscopy with diathermy for cystitis cystica in patients with recurrent urinary tract infection (UTI) is associated with decreased incidence of UTI. A retrospective 9-year audit was performed in a single urogynaecology centre. Patients with proven recurrent UTI and failed conservative therapy underwent cystoscopy with diathermy to cystitis cystica. The number of UTI’s 12- months pre and post cystoscopy was evaluated using women as their own controls with multivariant analysis of cofounding factors. Of 82 patients with recurrent UTI, 47 patients underwent cystoscopy with diathermy to cystitis cystica (median follow up 2 months [interquartile range, IQR6-31, one patient lost to follow up]). Pre-cystoscopy median UTI per annum was 3 per patient (IQR1-4). Post cystoscopy, median UTI for each woman was significantly reduced (median reduction -2[IQR-5-1], mean -2.14[95%CI -2.94, -1.34], P=&lt;0.001). In the subgroup of patients who had previous vaginal mesh repair for prolapse (n=8) there was no significant benefit from diathermy (median reduction - 1.5[95%CI -0.988, 3.988], P=0.197). In conclusion, cystoscopy and diathermy of cystitis cystica was generally associated with significant reductions in UTI’s in the 12 months following diathermy.</p> 2019-03-29T16:24:14+00:00 Copyright (c) 2019 Zhuoran Chen, Lucy Bates, Nevine Te West, Kate H. Moore Outcomes of colpectomy for uterovaginal and posthysterectomy vault prolapse: A comparative study between normal and overweight women 2020-05-09T03:17:49+00:00 Pattaya Hengrasmee Parit Wachasiddhisilpa Chutimon Asumpinwong Pichai Leerasiri <p>The objective of the study is to compare success and perioperative outcomes of colpectomy for severe prolapse between normal and overweight patients. This is a retrospective cohort study of 95 non-sexually active women undergoing colpectomy for severe prolapse between July 2010 and December 2015. Vaginal hysterectomy was performed for those with uterovaginal prolapse. Prolapse stage and location were identified according to Pelvic Organ Prolapse Quantification (POP-Q) measurements. Demographic data and perioperative outcomes were recorded. Patients were categorized into normal-weight and overweight groups according to World Health Organization body mass index classification for adults. During postoperative visit, prolapse symptoms and POP-Q measurements were re-evaluated. Objective cure was defined as prolapse at or above hymen, while subjective cure determined as resolution of prolapse sensation. One-third was determined as overweight. Objective cure was 81.1%, whereas subjective cure was 95.8%. Overweight patients significantly demonstrated poorer perioperative outcomes including increased blood loss, more advanced stage prolapse, and lower success rates. In conclusion, colpectomy is an effective repair procedure for non-sexually active women with severe prolapse due to low perioperative morbidities and favorable surgical outcomes. However, special precaution is required when performing this procedure in overweight women.</p> 2019-04-02T14:31:39+00:00 Copyright (c) 2019 Pattaya Hengrasmee, Parit Wachasiddhisilpa, Chutimon Asumpinwong, Pichai Leerasiri Vesico-vaginal fistula: A clinical study 2020-05-09T03:16:02+00:00 S.V. Krishna Reddy Ahammad Basha Shaik <p>In a retrospective study, the records of 34 women with a mean ± SD age of the patients was 36.62 ± 9.02 years were assessed; 32.35% of the vesico-vaginal Fistula (VVF) occurred after abdominal hysterectomy, 11.77% after Caesarean section, 32.35% after difficult vaginal delivery and 23.53% after instrumental delivery. Six women (17.64%) had a previous failed repair. The duration (mean ± SD) of the VVF was 5.68 ± 1.59 months. Of the 34 VVF patients, 20 (58.82%) were Mid-Vaginal VVF, 8 (23.53%) were Circumferential VVF, 3 (8.82%) were Juxta cervical VVF and 3 (8.82%) were Juxta Urethral VVF. An abdominal approach was used in 21 cases (61.76%), vaginal repair was contemplated in 8 (23.53%) cases and Laparoscopic in 5 (14.71%). At a mean duration of follow-up was 33.06 ± 1.72 months and the VVF was cured in 28 (82.4%) patients. Only previous intervention and timing of surgery (P=0.004) and surgical approach (P=0.02) maintained significance in our study. An abdominal/ Laparoscopic approach seems to give superior results. Previous failed repair had a significant negative effect on success. A late repair (≥6 months) is associated with higher success rates.</p> 2019-06-14T08:29:19+00:00 Copyright (c) 2019 S.V. Krishna Reddy, Ahammad Basha Shaik Vaginal length after a laparoscopic sacropexy 2020-05-09T03:17:22+00:00 Kristina Drusany Starič Adolf Lukanović Matija Barbič Mija Blaganje Adriana Cvijić Igor But <p>Vaginal shortening after surgical treatment of pelvic organ prolapse is associated with dyspareunia, which negatively affects women’s sexual life as well as their psychosocial well-being. The aim of the study is to determine the vaginal length in women with high-grade pelvic organ prolapse treated with laparoscopic sacropexy. In the prospective study we included 22 women with high-grade prolapse of the uterus or vagina that were treated. They underwent a gynaecological examination with a measurement of the vaginal length, as well as the evaluation of the degree of prolapse prior to the procedure (laparoscopic sacropexy). The second measurement and evaluation of the vaginal length during the follow-up examination between 6 to 12 weeks after surgery was done. The control group included 23 healthy women, without genital prolapse. There was no statistically significant difference in the mean vaginal length before and after surgery in the group of treated women.</p> 2019-04-08T13:37:45+00:00 Copyright (c) 2019 Kristina Drusany Starič, Adolf Lukanović, Matija Barbič, Mija Blaganje, Adriana Cvijić, Igor But Atherosclerosis in patients with endometriosis 2020-05-09T03:16:28+00:00 Amir Hassan Habibi Elham Alizadeh Neda Hashemi Saeed Razmeh Setareh Siah Mansuri Zahra Ghurchian Amir Hassan Rezaee <p>Endometriosis refers to endometrial tissue implantation including stromal and epithelial tissue outside the uterus. It is an often painful disorder that involves the ovaries and fallopian tubes. The association between endometriosis and atherosclerosis is interesting. The present study was conducted to assess the Doppler findings of the carotid artery in patients with and without endometriosis. In this study that included 30 patients with endometriosis and 30 control subjects, all patients underwent carotid ultrasonography, and the measurement of intima-media thickness (IMT) was done in the distal common carotid artery, proximal to the origin of the carotid bulb, and finally, we compare the IMT in two groups. This study revealed that there are no differences in the IMT between patients with and without Endometriosis.</p> 2019-05-03T12:42:47+00:00 Copyright (c) 2019 Amir Hassan Habibi, Elham Alizadeh, Neda Hashemi, Saeed Razmeh, Setareh Siah Mansuri, Zahra Ghurchian, Amir Hassan Rezaee Transvaginal mesh repair of anterior enterocele following radical cystectomy and ileal conduit diversion 2020-05-09T03:18:16+00:00 Jose Daniel Roman <p>Complex pelvic organ prolapses may develop after radical cystectomy. We report a case of an anterior enterocele, which was repaired vaginally and using mesh placed extraperitoneally. We present the case of a 75-year-old woman who underwent a radical cystectomy and ileal conduit diversion for treatment of invasive bladder cancer. She developed a vaginal vault prolapse 4 months later. She then underwent a vaginal repair and sacrospinous fixation using no mesh. She then presented to our clinic 4 months later with a prolapse recurrence involving an anterior enterocele. She was treated successfully with a transvaginal mesh repair for reconstruction of the anterior vaginal wall, iliococcygeal suspension and colpocliesis. We argue that there is a place for the vaginal use of mesh in the surgical treatment of an anterior enterocele when a substantial loss of endopelvic fascia is encountered. The extraperitoneal technique seems to be a good option while reducing the surgical risks for the patient.</p> 2019-03-29T16:26:57+00:00 Copyright (c) 2019 Jose Daniel Roman