Is Hysteroscopy Better than Ultrasonography for Uterine Cavity Evaluation? An Evidence-Based and Patient-Oriented Approach

Evaluation of the uterine cavity is an important part of the gynecological check, especially in symptomatic women and, over the last few decades, a number of technical and technological advancements has allowed a superb investigation of this organ. Traditionally, transvaginal ultrasound (TVUS) has been the first-line diagnostic tool for evaluating uterine diseases, also considering that gynecologists are familiar with the technique since it is included in the basic training in obstetrics and gynecology. Nevertheless, to date “office hysteroscopy” received growing attention since the development of smaller-diameter hysteroscopes which has made it possible to easily perform the hysteroscopy …

Fractional CO2 Laser: the new frontier for the treatment of vulvo-vaginal atrophy symptoms

The vulvo-vaginal atrophy (VVA) is a chronic condition characterized by gradual involution of the mucous membranes and vulvo-vaginal tissues, which is manifested in the climacteric phase. Numerous therapeutic options, hormonal and non-hormonal, have been proposed to alleviate the symptoms related to VVA, but to date none of them is able to guarantee long-term effects. The use of Fractional CO2 Laser technology applied to the vulvo-vaginal area represents an innovative procedure to make a real "regeneration treatment" of the vaginal tissues. In fact, it is possible to spread the laser energy in the various layers of the vaginal wall, reactivating the synthesis of extracellular matrix and col…

Cellular schwannoma of the retroperitoneum with cystic degeneration, mimicking an ovarian cyst, with CKAE1/AE3 and desmin expression.

Schwannoma is an encapsulated benign tumour usually presenting as a solitary mass on the flexor surfaces of the extremities, neck, mediastinum, posterior spinal roots and cerebellopontine angle, an...

Spontaneous bilateral tubal pregnancy in a nulliparous woman. Laparoscopic diagnosis and treatment

A 34 year-old nulliparous woman was referred to our Department, complaining of vaginal bleeding and intermittent lower abdominal cramping. serum level of β-hCG was 4954 IU/L. Transvaginal ultrasound examination revealed no gestational sac in the uterine cavity and a right adnexal mass, suggestive of ectopic pregnancy; left adnexal area appeared regular. At laparoscopy, the presence of an ectopic pregnancy was confirmed in the right tube; on the left side, surprisingly, there was an intact infundibular ectopic pregnancy. Right tuba was removed; considering the condition of nulliparous of the patient, we decided to perform a linear salpingostomy. Histologic exam confirmed the diagnosis of spo…

Parasitic myomas after laparoscopic surgery: an emerging complication in the use of morcellator? Description of four cases

Objective To report the development of parasitic myomas after the use of a morcellator. Design Retrospective study. Setting Tertiary care referral center for the treatment of benign gynecologic pathologies. Patient(s) Women undergoing surgery for uterine fibroids. Intervention(s) Chart review. Main Outcome Measure(s) Presence of parasitic leiomyomas. Result(s) We identified four cases of parasitic myomas over the 3-year study period. Two out of the four were symptomatic. The prevalence of this complication, considering all women with whom the electric morcellator was used (n = 423) was 0.9% (95% CI, 0.3–2.2%). Considering exclusively the women who underwent myomectomy (n = 321), it was 1.2%…

Excision of ectopic adrenocortical tissue during laparoscopy for isolated tubal torsion

Ectopic adrenal tissue is an occasional finding during surgery procedures. These remnants are usually found near the primary gland or along the course of gonadal vessels consistently with embryologic development. The appearance is of a small but distinct, soft, round, yellow nodule and only cortical adrenal tissue is normally observed. We report a case of an emergency laparoscopic salpingostomy for isolated tubal torsion with excision of EAT, incidentally found in left ovarian pedicle, followed by postoperative resumption of regular menses and regression of hirsutism. Although intraoperative research of ectopic adrenal tissue is not necessary its removal is indicated in case of incidental f…

Early onset Mirror Syndrome associated with foetal sacrococcigeal teratoma: a rare entity

In the mirror syndrome, maternal symptoms mime foetal and placental oedema. The pathogenesis is unknown. The most common etiologic associations are rhesus isoimmunization, twin-twin transfusion syndrome and viral infections. Few reports are associated to foetal tumors and particularly to sacroccoccigeal teratoma (SCT). Based on several published series, foetal SCT with placentomegaly and hydrops is almost universally fatal; foetal surgery is not typically offered for hydropic foetuses beyond 26 weeks of gestational age. Delivery of the foetus is the choise treatment when mirror syndrome is present with supporting the pregnancy until delivery is necessary for maternal indications or the foet…

The methylenetetrahydrofolate reductase C677T polymorphism and the risk of congenital heart diseases: a literature review

Congenital Heart Diseases (CHDs) are the most commonand serious developmental anomaly and the leading non-infectious cause of mortality in the first year of life. Despite the advances in diagnosis and treatment, understanding of the developmental causes and aetiologies of CHDs has been limited. The hyperhomocysteinemia is one of the proved risk factors related to the occurrence of CHDs. The connection between cardiac defects, folate and hyperhomocysteinemia could be explained by a mutation in the methylenetetrahydrofolate reductase (MTHFR) gene. Indeed, the C677T MTHFR mutation produces a thermolabile variant of MTHFR with reduced enzymatic action resulting in higher plasma levels of homocy…

The Patient and Observer Scar Assessment Scale to Evaluate the Cosmetic Outcomes of the Robotic Single-Site Hysterectomy in Endometrial Cancer

ObjectiveThe objective of this study was to evaluate the cosmetic outcome of robotic single-site hysterectomy (RSSH) in early-stage endometrial cancer.MethodsWe prospectively collected patient demographics, operative times, complications, pathologic results, and length of stay on all patients who underwent RSSH for early-stage endometrial cancer. The Patient and Observer Scar Assessment Scale (POSAS) was used for the evaluation of the cosmetic outcome.ResultsForty-five patients were included in our study from January 2012 to October 2015. The median age of patients was 63 years (range, 35–84 years), and the median body mass index was 26.5 kg/m2 (range, 18–39 kg/m2). No laparoscopic/laparoto…

Unexpected finding of urachal remnant cyst. Tips for laparoscopic approach

Highlights • Urachal cyst is a common anomaly related to the incomplete obliteration of the urachal lumen. • This condition, per se asymptomatic, is not without risk. • In symptomatic cases, the main approach is the laparoscopic excision.

Hysteroscopic Isthmoplasty: Step-by-Step Technique

Study Objective To demonstrate our technique for surgical hysteroscopy performed with a standard-size resectoscope or miniresectoscope in 3 cases of isthmocele. Design Step-by-step demonstration of the technique using slides, pictures, and video (educative video) (Canadian Task Force classification III). Setting Isthmocele is a characteristic semidiverticular anomaly of the anterior isthmic wall of the uterus, located at the site of a previous cesarean delivery scar. The etiopathogenesis of isthmocele remains poorly understood, although several hypotheses have been proposed. Factors that may possibly play a role in niche development include a very low incision through cervical tissue, inade…

Feasibility and Acceptability of Office-Based Polypectomy With a 16F Mini-Resectoscope: A Multicenter Clinical Study

Abstract Study Objective To investigate the feasibility and acceptability of office hysteroscopic polypectomy using a novel continuous-flow operative 16F mini-resectoscope. Design Multicenter prospective case series (Canadian Task Force classification III). Setting “SS Antonio e Biagio” Hospital, Alessandria, and University “Federico II” of Naples. Patients One hundred eighty-two patients with endometrial polyps. Interventions Hysteroscopic polypectomy performed with 16F mini-resectoscope in an office setting, without analgesia and/or anesthesia. Measurements and Main Results Polypectomy was successfully performed in 175 patients in a single surgical step (96.15%), with only 1 patient (.54%…

Is intravesical instillation of hyaluronic acid and chondroitin sulfate useful in preventing recurrent bacterial cystitis? A multicenter case control analysis.

Abstract Objective Urinary tract infections (UTIs) are common in the female population and, over a lifetime, about half of women have at least one episode of UTI requiring antibiotic therapy. The aim of the current study was to compare two different strategies for preventing recurrent bacterial cystitis: intravesical instillation of hyaluronic acid (HA) plus chondroitin sulfate (CS), and antibiotic prophylaxis with sulfamethoxazole plus trimethoprim. Materials and methods This was a retrospective review of two different cohorts of women affected by recurrent bacterial cystitis. Cases (experimental group) were women who received intravesical instillations of a sterile solution of high concen…

Preterm birth: seven-year retrospective study in a single centre population

Preterm birth is a health and social problem, considered the leading cause of neonatal mortality worldwide. It is associated with higher rates of neurodevelopmental morbidity, sensorineural impairments and other complications. The aim of the study was to describe the incidence and the major risk factors associated with preterm birth. METHODS: We performed a single center, observational and retrospective Cohort study in the Division of Obstetrics and Gynaecology, University Hospital "G. Martino", Messina. Clinical records of all pregnant women who delivered from 1st January 2010 to 31 of December 2016 were collected. RESULTS: In the 7 years considered, a total of 7954 pregnant women were inc…

Laparoscopic management of quadruplet heterotopic pregnancy after ovarian stimulation cycle

Introduction. We report a rare case of a heterotopic abdominal pregnancy with three intrauterine pregnancy, one with a viable fetus, treated successfully by laparoscopy. Methods. A 40-year-old patient with primary sterility, who un- derwent pharmacological ovulation induction, presented abdominal pain in the right iliac region. A trans-vaginal ultrasound showed an image suggestive of ectopic gestation near the right ovary, associated with three intrauterine gestational sacs with only one viable fetus. Basing on this observation, we performed an operative laparoscopy that confirmed the presence of a right ectopic abdominal pregnancy. Since the right ampullar tubal was ruptured and bleeding, …

Early Endometrial Cancer. Case-control study to evaluate the efficacy and safety of the new Robotic Single-site System

Objective: To compare surgical and cosmetic outcomes of robotic single-site (RSS) versus robotic multiport (RMP) approaches in early stage endometrial cancer. Methods: This is a perspective case-control study, comparing perioperative and early post-operative outcomes in RSS (cases) and RMP (controls) patients with early stage endometrial cancer. Clinical data including patient's demographics and peri-operative measures were recorded. Complications, hospital stay and post-operative pain were also considered. Cosmetic result was evaluated with Patient and Observer Scar Assessment Scale (POSAS). Results: A total of 15 women who underwent RSS were matched with 13 controls treated by RMP. No sig…

Vulvo-vaginal atrophy: A new treatment modality using thermo-ablative fractional CO2 laser.

a b s t r a c t Objective: To evaluate the efficacy and feasibility of thermo-ablative fractional CO2 laser for the treatment of symptoms related to vulvo-vaginal atrophy (VVA) in post-menopausal women. Methods: From April 2013 to December 2013, post-menopausal patients who complained of one or more VVA-related symptoms and who underwent vaginal treatment with fractional CO2 laser were enrolled in the study. At baseline (T0) and 30 days post-treatment (T1), vaginal status of the women was evaluated using the Vaginal Health Index (VHI), and subjective intensity of VVA symptoms was evaluated using a visual analog scale (VAS). At T1, treatment satisfaction was evaluated using a 5-point Likert …

PARASITIC DERMOID CYST COEXISTING WITH ABSENCE OF AN ADNEXA

Vaginohysteroscopy for the diagnosis and treatment of vaginal lesions.

Abstract Background The vaginoscopic approach for hysteroscopy allows detailed endoscopic evaluation of the vaginal walls, fornices, and exocervix. Objectives To review the feasibility and efficacy of vaginohysteroscopy in the diagnosis and treatment of vaginal lesions. Search strategy A systematic review was performed of PubMed/Medline, Embase, Google Scholar, and the Cochrane Database to identify papers published in English. The search terms were “hysteroscopy,” “vaginoscopy,” “vagino-hysteroscopy,” and “vaginal lesion.” The last review was performed on January 31, 2015. Selection criteria Studies in which the diagnosis and treatment of vaginal lesions used the vaginoscopic approach and h…

Hysteroscopic and ultrasonographic evaluation of ulipristal acetate treatment for symptomatic myomas in premenopausal women: a prospective study

Objective: This study aimed to analyze the effects of a six-month therapy with ulipristal acetate (UPA) on myoma size and endometrial thickness in premenopausal women. Material and methods: Seventy-four women undergoing conservative therapy with UPA were enrolled for this study. All women underwent transvaginal ultrasound evaluation to assess the endometrial thickness, and the number and size of myomas at the beginning and after six months. Hysteroscopy and biopsy were performed after six months, if necessary. Results: After six months of treatment, sonographic examination showed a statistically significant (p <.05) reduction of the size of the largest myoma (56.3 ± 5.1 vs. 31.7 ± 10.1 m…

Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference?

""The primary aim of the study was to analyze the endometrioma recurrence rate in patients who underwent laparoscopic excision followed by postoperative long-term regimen of oral contraceptives (OCs).. . MATERIALS AND METHODS: 168 patients who underwent a conservative laparoscopic surgery for endometrioma, during the period between September 2009 and August 2010 in three university hospitals were studied. A long-term OCs therapy was offered to all women following surgery. Patients were randomly divided into three groups according to different progestins used (desogestrel, gestodene, dienogest). Women who refused a postoperative hormonal therapy served as control. Follow-up visits and transv…

Use of trans-labial ultrasound in the diagnosis of female urethral diverticula: A diagnostic option to be strongly considered.

AIM: To demonstrate effectiveness of trans-labial ultrasound (TL-US) in the evaluation of female urethral diverticula (UD). METHODS: In the study period, 20 UD were diagnosed and treated. All data on demographic characteristics, presenting symptoms, physical examination findings, diagnostic and operative procedures, were considered. Patients were referred to TL-US for diverticular evaluation, using a 2D 7.5-MHz endfire probe. For each UD, size, complexity, echogenicity content, and presence of diverticular neck were considered. Follow-up controls were carried out at 1, 6 and 12 months after surgery, to evaluate outcome and need for further intervention. RESULTS: Mean patient age was 46 year…

valutazione isteroscopica della cicatrice isterotomica post-cesareo:classificazione,patologie ad essa correlate e trattamento

Chronic Endometritis

Chronic endometritis is a persistent inflammation of the inner lining of the uterine cavity. Several studies have demonstrated that it is a condition frequently associated with repeated unexplained implantation failure at in vitro fertilization, recurrent miscarriage, as well as poor obstetric outcomes such as preterm labor. The aim of this paper is to provide information about diagnosis and treatment of this condition to improve reproductive outcome. In fact, significantly higher rate of successful pregnancies was achieved in those patients in whom antibiotic treatment was able to normalize both hysteroscopic and histologic endometrial pattern compared with women who were not treated or wi…

Resectoscope versus small diameter hysteroscopy for endometrial polypectomy in patients with "unfavorable" cervix

BACKGROUND: The aim of this study was to compare resectoscopic and small-diameter hysteroscopic techniques for endometrial polypectomy in patients with "unfavorable" cervix.METHODS: Eighty women with a single 2-4 cm sized endometrial polyp, with unfavorable cervical anatomical conditions were enrolled in the study. Forty patients were treated with a 26F resectoscope requiring cervical dilatation (group A), forty patients were treated with a 5-mm hysteroscope requiring vaginoscopic approach (group B). Operative time, fluid absorption, complications, instrument failure, postoperative pain, overnight stay were analyzed. Operative visualization, operative difficulty and overall surgeon's satisf…

Potential impact of a nonavalent anti HPV vaccine in Italian men with and without clinical manifestations

AbstractHuman papilloma virus infection (HPV) is the most common sexually transmitted disease. Little is known about male infection. Nonavalent vaccine against types 6/11/16/18/31/33/45/52/58 was approved and neutral gender immunization programs have been proposed. This study evaluates the potential impact of nonavalent vaccine compared to quadrivalent in male living in Sicily (Italy). 58.7% of samples were HPV positive and forty-four types of HPV were identified. A significant higher estimated coverage of nonavalent vaccine than quadrivalent was observed (64.3% vs. 45.8%), with absolute and relative additional impact of 20.1% and 47.2%, respectively. Low impact of the vaccine were calculat…

Tips and tricks in office hysteroscopy

Abstract Office hysteroscopy is a minimally invasive procedure that has been shown to be highly accurate in diagnosing abnormalities of the endometrial cavity and the endocervical canal. It allows the direct visualizing of uterine pathology without the need for general anesthesia and the use of an operating room, generating cost savings and greater compliance among patients. The advent of small-diameter hysteroscopes, the use of saline solution as a distension media, as well as the vaginoscopic technique have widely contributed to the diffusion of this technique worldwide, and currently it can be considered the gold standard for the examination of the uterine cavity. The improved technology…

Hysteroscopy and treatment of uterine polyps.

This article summarizes and analyzes the salient topics on the diagnosis and management of endometrial polyps, focusing on the role of the hysteroscopy. Noninvasive investigations such as transvaginal ultrasonography, with or without the use of three-dimensional ultrasonography (3D US) and contrast techniques, remain the mainstay of first-line investigation. Hysteroscopic resection represents the gold standard minimally invasive treatment for endometrial polyps. It is the most effective management and allows histologic assessment, whereas blind biopsy or curettage have low diagnostic accuracy and should not be performed.

Endometrial cancer: Robotic versus Laparoscopic treatment. Preliminary report

Laparoscopic approach is today the standard treatment for benign and malignant gynecological pathologies. To traditional laparoscopic surgery in the last 10 years we can add the possibility to use a robotic platform. The adoption of this system allows undoubted advantages as the three-dimensional vision, the absence of the physiological tremor with enhanced ergonomics and possibility of using articulable tools. In this study we analyzed the results of 18 patients with endometrial cancer (Stage I) treated with robotic approach. The results were compared with a selected sample of 26 patients, with the same characteristics, treated with traditional laparoscopic approach in the same period by t…

Robotic versus laparoscopic sacrocolpopexy for apical prolapse: a case-control study

The apical prolapse has always been considered the most complex of the defects of the pelvic floor, for both the difficulty of the surgical corrective technique and for the high post-surgical recurrence rate. Today, the laparoscopic sacrocolpopexy can be considered the standard treatment for apical prolapse. In the last years, several author performed robotic sacrocolpopexy, obtaining positive results. So, we developed a case-control study in order to compare the surgical outcome of robotic group with a control group of laparoscopic approach in patients with symptomatic apical pro-lapsed between January 2015 and December 2015 at University Hospital Policlinico “P. Giaccone” and Ospedali Riu…

Cystic adenomyosis spreading into subserosal-peduncolated myoma: How to explain it?

Abstract Introduction Cystic adenomyosis is a rare variant of adenomyosis characterized by well- circumscribed cavitated endometrial gland and stroma located within the myometrium. The cysts usually measure ≥ 1 cm in diameter, contain a “chocolate-colored” fluid and do not open into the overlaying endometrium. Case presentation We present a case of a peduncolated-subserosal cystic adenomyoma, namely cystic adenomyosis, correlated with pelvic MR imaging, laparoscopic surgery technique and histopathology findings. Conclusions In this case, the peculiar growth pattern of cystic adenomyosis in a myoma represents a singular condition rarely reported in the medical literature. We therefore suppor…

Efficacy and acceptance of the sacral neuromodulation in the treatment of female lower urinary tract dysfunctions.

Surgical management of cystic adenomyosis. Why the laparoscopic approach is preferable?

Vulvar involvement in pediatric Crohn’s disease: a systematic review

Purpose: The aim of the study is to report a systematic review (from 2000 to 2017) of all pediatric cases of vulvar Crohn’s disease (VCD) and to highlight the key-points for a correct diagnosis and management of this rare condition. Methods: An electronic search using the Pubmed/Medline, Scopus, EMBASE, Cochrane database and Google Scholar database was performed according to PRISMA guidelines. Results: Twenty pediatric studies and 22 cases of VCD were included for analysis. All the articles reported a single case, except two articles where two cases, respectively, are described. Clinical vulvar examination showed the following main manifestations: vulvar erythema (9/22 cases, 40.9%), vulv…

The Role of Hysteroscopy in the Diagnosis and Treatment of Adenomyosis

Uterine adenomyosis is a common gynecologic disorder in women of reproductive age, characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Dysmenorrhea, abnormal uterine bleeding, chronic pelvic pain, and deep dyspareunia are common symptoms of this pathological condition. However, adenomyosis is often an incidental finding in specimens obtained from hysterectomy or uterine biopsies. The recent evolution of diagnostic imaging techniques, such as transvaginal sonography, hysterosalpingography, and magnetic resonance imaging, has contributed to improving accuracy in the identification of this pathology. Hysteroscopy offers the advantage of direct visualiz…

Laparoscopic treatment of diaphragmatic endometriosis causing chronic shoulder and arm pain

Follow-Up and Relook Hysteroscopy

Intra-uterine adhesions (IUAs) after initial treatment in patients with Asherman’s Syndrome are one of the main challenging issues in the gynecological practice, since its incidence has been increasing over the last few decades, with a reported recurrence rate up to 30%. Asherman syndrome is characterized by variable scarring inside the uterine cavity that can lead to partial or complete dysfunction of the endometrium with impairment of fertility and menstrual pattern (amenorrhea and hypomenorrhea).

'Secondary prevention' against female HPV infection: literature review of the role of carrageenan.

Introduction: Human papillomaviruses (HPVs) are common sexually transmitted pathogens, causally associated with cervical cancer and other anogenital cancers, as well as approximately 20% of head and neck cancers. The HPV vaccine is an exceptional primary prevention tool, but the question of adequate secondary-prevention strategies remains open. The aim of this review is to better clarify the role of carrageenan in HPV prevention-strategies. Areas covered: A comprehensive literature search was performed (PubMed/MEDLINE, Embase, Google Scholar, Cochrane Databases) to identify articles on the use of carrageenan against HPV infection. The studies were identified using combinations of the search…

Primary umbilical endometrioma: Analyzing the pathogenesis of endometriosis from an unusual localization

Abstract Objective This report presents a rare case of symptomatic primary umbilical endometriosis and reviews the literature on the topic with the aim to clarify some questions on the origin of endometriosis. Case report A 33-year-old woman with cyclic umbilical bleeding was found to have umbilical endometriosis. She had no history of pelvic or abdominal surgery. There was no past history of endometriosis or endometriosis-associated symptoms. An omphalectomy was performed after explorative laparoscopy to carefully inspect the abdominopelvic cavity and assess any coexisting pelvic endometriotic lesions. Histological examination confirmed the diagnosis of umbilical endometriosis. Conclusion …

Diagnostic tools for female urethral diverticulum: Current perspectives

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 outp…

Impact of monopolar and bipolar endometrial resection on abnormal uterine bleeding

Study Objective. To compare two procedures for endometrial resection: resectoscopy with monopolar knife versus resectoscopy with bipolar knife. Patients and methods. 76 perimenopausal patients affected by DUB (Dysfunctional Uterine Bleeding), no longer wishing to remain pregnant and having failed to respond to pharmacological treatment, underwent endometrial ablation with monopolar loop (group A: 38 women) or bipolar loop (group B: 38 women). Operative parameters, complication rate, menstrual outcome were considered. Results. Operative time was no different between groups. The amount of distention fluid adsorbed was significantly higher in group A than in group B, and late cumulative compli…

Interstitial Pregnancy: A 'Road Map' of Surgical Treatment Based on a Systematic Review of the Literature.

An electronic search concerning the surgical approach in cases of interstitial pregnancy from January 2000 to May 2013 has been carried out. Fifty three studies have been retrieved and included for statistical analysis. Conservative and radical surgical treatments in 354 cases of interstitial pregnancy are extensively described. Hemostatic techniques have been reported as well as clinical criteria for the medical approach. Surgical outcome in conservative versus radical treatment were similar. When hemostatic techniques were used, lower blood losses and lower operative times were recorded. Conversion to laparotomy involved difficulties in hemostasis and the presence of persistent or multipl…

Endometriosis and strategies of fertility preservation: a systematic review of the literature.

Endometriosis is a common chronic inflammatory disorder, often causing both pain and infertility. It is estimated that 25-50 % of patients undergoing fertility treatments have had endometriosis as it involves an impairment of the ovarian reserve. For these reasons, endometriosis has been highlighted as a condition that may require a fertility preservation procedure, while being benign in nature. The aim of this review is to summarize the current evidence on fertility preservation techniques for patients affected by endometriosis, focusing on the main characteristics of the different approaches. A systematic review of literature was performed by searching in the main electronic databases (ME…

Postpartum pubic symphysis diastasis: A case report and review of literature

Office hysteroscopic treatment of a vanishing external uterine orifice in a postmenopausal woman with an obstetrical history of 44 abortions

Abstract Cervical stenosis, defined as cervical scarring of variable degree, represents a significant anatomical impediment to hysteroscopic procedures. Acquired cervical stenoses are more common than congenital forms and they are mainly associated with aging, estrogen–progesteron drugs, cervical trauma or carcinoma. The overcoming of cervical stenosis at office hysteroscopy is challenging and it often fails requiring the scheduling of the patient for an in-patient treatment under general anesthesia. We report the office hysteroscopy treatment of a vanishing external uterine orifice in a postmenopausal woman with an ultrasonographic report of a heterogeneous and thick endometrium suggestive…

Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review

Abstract Objective The purpose of the present review is to provide a survey of the various measures of preventing adhesions used in hysteroscopic surgery. Study Design A systematic computerized literature search was conducted to provide a survey of the various measures used in hysteroscopic surgery to prevent adhesions. Finally, 29 studies were included in the analysis, showing a wide variety of methods and agents advocated in international literature. They are explained in various sections, based on the IUA prevention approach adopted (surgical technique, early second-look hysteroscopy, barrier method, pharmacological therapy). Results The results of our review show that (i) use of surgica…

Daphne II - Ve.R.S.O project: a new protocol for the management of sexual assault victims

Daphne II - Ve.R.S.O project: a new protocol for the management of sexual assault victims. Sexual assault is a worldwide problem that has not yet been sufficiently acknowledged, as confirmed by analyses and studies carried out at different levels and in different contexts. Internationally, different approaches are taken to the collection of forensic evi- dence and to the clinical and psychological treatment of alleged victims. Italian law n.96, 1996, foreseeing norms regarding rape and abuse, finally gave signifi- cant relevance to sex crimes. In 2004, the European Commission for Justice Internal Affairs and Social Politics promoted the Daphne II pro- gram to support victims of rape and abu…

Placenta Accreta Spectrum Disorder in a Patient with Six Previous Caesarean Deliveries: Step by Step Management

The definition placenta accreta spectrum disorders (PAS) introduced by FIGO (International Federation of Gynaecology and Obstetrics) indicates an abnormal, pathological adherence or invasion of the placenta. The growing worldwide incidence of this pathological entity, and the possible serious correlated surgical risks, has caused a significant increase in attention among the scientific community. Previous caesarean delivery and presence of placenta previa are the main risk factors for the onset of PAS. Here, we present the intriguing case of a 39-year-old woman, at the 33rd week of gestation, with six previous caesarean sections and with a diagnosis of placenta previa accreta. At our referr…

Hysteroscopic Evaluation of Endometrial Changes in Breast Cancer Women with or without Hormone Therapies: Results from a Large Multicenter Cohort Study

ABSTRACT Study Objective The primary aim of our study was to investigate the incidence of endometrial pathologies, especially endometrial cancer, in women with breast cancer treated with tamoxifen (TAM), aromatase inhibitors (AIs), or receiving no treatment (NT). The secondary aim was to identify, in this cohort, ultrasonographic findings that represent robust indications for hysteroscopy and endometrial biopsy, to avoid unnecessary second-level diagnostic procedures. Design Multicenter retrospective cohort study (Clinical Trial ID: NCT03898947). Setting Data were collected from different Italian centers: Regina Elena National Cancer Institute of Rome, Arbor Vitae Centre of Rome, Gaetano Ma…

Data comparison between pharmacological induction of labour and spontaneous delivery. A single centre experience.

Objectives: To assess the differences in the maternal and fetal outcomes between pharmacological induced and sponta­neous labour in nulliparous women. Material and methods: Observational cohort study carried out over a period of 2 years. Inclusion criteria: nulliparous sin­gleton pregnancies, with cephalic fetal presentation, elective labour induction with intra-vaginal prostaglandin E2 (PGE2) gel (Prepidil® 2 mg) at a gestational age of 41 weeks. Control group: patients who entered labour spontaneously at a gestational age of ≥ 40 weeks. The main demographic maternal characteristics and intra- and postpartum data were extracted from computer records and obstetrics diaries and were used for…

Septate uterus: nosographic overview and endoscopic treatment

To comment on the prevalence, diagnosis, and treatment of the septate uterus, with special reference to hysteroscopic metroplasty and its effect on reproductive outcome, we searched publications in PubMed and Embase. Original articles, meta-analysis, reviews, and opinion articles were selected. The studies suggest that the prevalence of the septate uterus is increased in women with repeated pregnancy loss and infertility. Reliable diagnosis depends on accurate assessment of the uterine fundal contour and uterine cavity by means of magnetic resonance and three-dimensional ultrasound. Pertinent published data comparing pregnancy outcome before and after hysteroscopic metroplasty indicated a m…

Gonadotrophin-releasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis: A multi-center randomized trial

Objectives To evaluate the efficacy of dienogest + estradiol valerate (E2V) and gonadotrophin-releasing hormone analogue (GnRH-a) in reducing recurrence of pain in patients with chronic pelvic pain due to laparoscopically diagnosed and treated endometriosis. Design Multi-center, prospective, randomized study. Setting Three university departments of obstetrics and gynecology in Italy. Population Seventy-eight women who underwent laparoscopic surgery for endometriosis combined with chronic pelvic pain. Methods Post-operative administration of dienogest + E2V for 9 months (group 1) or GnRH-a monthly for 6 months (group 2). Main outcome measures A visual analogue scale was used to test intensit…

Burkitt’s lymphoma in pregnant woman: Difficult management of a rare case

Highlights • Burkitt’s lymphoma, an aggressive non-Hodgkin lymphoma, is extremely rare during pregnancy. • Lymphoma of the small intestine is often overlooked in the early stages of the disease. • We described a multidisciplinary approach, cesarean section with surgical intestinal exploration.

Role of Ovarian Suspension in Preventing Postsurgical Ovarian Adhesions in Patients with Stage III-IV Pelvic Endometriosis: A Systematic Review.

Endometriosis is a benign complex gynecological condition with high morbidity that affects women of reproductive age. Pelvic adhesion formation represents a serious clinical challenge in the management of patients with endometriosis. Several interventions have been proposed over the last few years aiming to reduce post-operative ovarian adhesions formation. The aim of this study is to summarize the evidence of the efficacy of ovarian suspension in the prevention of post-operative ovarian adhesions formation in women undergoing laparoscopic surgery for stage III-IV endometriosis. The research was conducted using electronic databases. A review of the abstracts of all references retrieved from…

Spontaneous rupture of splenic artery aneurysm in pregnancy: is splenectomy always necessary?

Letter to Editor

Efficacy of Low-Dose Paroxetine for the Treatment of Hot Flushes in Surgical and Physiological Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Trials

Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of v…

Uterine preservation in pelvic organ prolapse and urinary stress incontinence using robot-assisted laparoscopic surgery. Case report

Highlights • Pelvic organ prolapse (POP) represents a common and bothersome condition in parous women. • The demand to “save” the uterus has fuelled a renewal of the surgical technique. • Robotic surgery was conceived with the intent to overcome the limitations of laparoscopic surgery. • The characteristics of the robotic system help surgeons to perform conservative management of POP.

Laparoscopic management of diaphragmatic endometriosis: what can we learn