Urodynamic evaluation: can it prevent the need for surgical intervention in women with apparent pure stress urinary incontinence?

Objectives: To identify how many patients with symptoms of pure stress urinary incontinence (SUI) do not require any surgical treatment on the basis of urodynamics (UDS) and how many patients still do not require surgery 1 year after UDS. To assess the outcomes of these patients at 12-month follow-up.

Patients And Methods: Women with pure SUI received UDS and were prospectively divided into four groups, comprising women with: urodynamic stress incontinence (USI); detrusor overactivity (DO); USI + DO; and inconclusive UDS.

Nerve-sparing minilaparoscopic versus conventional laparoscopic radical hysterectomy plus systematic pelvic lymphadenectomy in cervical cancer patients.

Aim: To present our preliminary experience with nerve-sparing minilaparoscopic radical hysterectomy plus pelvic lymphadenectomy for the surgical treatment of cervical cancer and to compare outcomes with those of the conventional laparoscopic approach.

Methods: Data of 87 consecutive women who underwent minimally invasive surgery for early and locally advanced stage cervical cancer were prospectively collected. Ten women who underwent laparoscopic surgery using a nerve-sparing technique performed through 3-mm ancillary ports were compared with the 77 patients who had standard laparoscopic surgery previously with 3 sovrapubic 5-mm trocars.

Perioperative allogenic blood transfusions and the risk of endometrial cancer recurrence.

Purpose: To evaluate the effect of perioperative blood transfusions on the risk of recurrence of endometrial cancer.

Methods: This study is a retrospective analysis of 358 consecutive patients, without a history of other tumors, who underwent surgery for endometrial cancer between January 2000 and April 2010.

Results: Women who did not need any transfusion (N = 331) and patients who received allogenic blood donations (N = 27) were compared in terms of risk of cancer recurrence.

A randomized trial of preinduction cervical ripening: dinoprostone vaginal insert versus double-balloon catheter.

Objective: We sought to compare the efficacy of a double-balloon transcervical catheter to that of a prostaglandin (PG) vaginal insert among women undergoing labor induction.

Study Design: In all, 210 women with a Bishop score ≤6 were assigned randomly to cervical ripening with either a double-balloon device or a PGE2 sustained-release vaginal insert. Primary outcome was vaginal delivery within 24 hours.

Transumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial.

Objective: We sought to compare transumbilical (TU) and transvaginal (TV) route for retrieval of surgical specimens at laparoscopy.

Study Design: Women scheduled for a laparoscopic resection of an adnexal mass were randomized to have their surgical specimen removed either through a posterior colpotomy (n = 34) or the umbilical port site (n = 32). Group allocation was concealed from patients and bedside clinicians.

Use of an antispasmodic (rociverine) to shorten the length of labor: a randomized, placebo-controlled trial.

Objective: To determine the effectiveness of rociverine, an antispasmodic drug, for reducing the duration of labor among nulliparous women managed according to a standard intrapartum protocol.

Design: Randomized controlled trial.

Setting: An academic tertiary care hospital.

Lymphoceles, lymphorrhea, and lymphedema after laparoscopic and open endometrial cancer staging.

Purpose: To evaluate the incidence of lymphoceles, lymphorrhea, and lymphedema after systematic pelvic lymphadenectomy in patients who underwent laparoscopic or open abdominal staging for endometrial cancer.

Methods: A total of 138 consecutive women who underwent systematic laparoscopic pelvic lymphadenectomy for endometrial cancer staging were compared to 123 historical control subjects staged via an open approach. Postoperative screening for lymphadenectomy-related complications by ultrasound was consistently performed.

Minilaparoscopic versus conventional laparoscopic hysterectomy: results of a randomized trial.

Study Objective: To compare operative outcomes and postoperative pain of laparoscopic hysterectomy (LH) versus minilaparoscopic hysterectomy (MLH).

Design: Randomized controlled trial (Canadian Task Force Classification I).

Setting: Tertiary care center.

Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature.

Objective: To determine the incidence of vaginal cuff dehiscence after minimally invasive hysterectomy, we reported our series of total laparoscopic hysterectomies with transvaginal colporraphy.

Study Design: We then conducted a systematic search of PubMed to retrieve published series of laparoscopic and robotic hysterectomies, in which different techniques for vaginal cuff closure were used.

Results: In our study group, vaginal cuff dehiscence occurred in 2 of 665 (0.

Urinary symptoms and urodynamic findings in women with pelvic organ prolapse: is there a correlation? Results of an artificial neural network analysis.

Background: International official guidelines recommend urodynamic (UDS) evaluation in patients with pelvic organ prolapse (POP). However, the real benefit of this examination is still the subject of heated and controversial debate. Therefore, we aimed to assess the correlation between urinary symptoms and UDS findings in women with POP through the implementation of a sophisticated computer-based technology in the outpatient workup.

Is transcervical Foley catheter actually slower than prostaglandins in ripening the cervix? A randomized study.

Objective: The purpose of this study was to determine whether the maximum time for cervical ripening (from 24-12 hours) would influence the efficacy of a transcervical Foley catheter and to compare efficacy to that of a prostaglandin E(2) vaginal insert.

Study Design: Three hundred ninety-seven women were assigned randomly to (1) Foley catheter left in place for a maximum of 24 hours, (2) Foley catheter left in place for a maximum of 12 hours, or (3) prostaglandin E(2) controlled-release vaginal insert. Primary outcome was vaginal delivery within 24 hours.

Surgical treatment for pelvic floor disorders in women 75 years or older: a single-center experience.

Objective: Older patients are usually regarded as suboptimal candidates for surgical operations, particularly in cases of reparative, non-life-saving procedures. The aim of this study was to analyze the feasibility and safety of surgical treatment for pelvic floor dysfunction in advanced-age women.

Methods: A single-center descriptive study was performed through a retrospective medical records review.

Female sexual function during pregnancy and after childbirth.

Introduction: Healthy sexual function during pregnancy and after childbirth is one of the cornerstones for couples to evolve from partners to parents.

Aim: The aim of our review is to evaluate the available evidence and define present knowledge about female sexual function during pregnancy and after childbirth.

Methods: PubMed was searched for articles on sexual function during pregnancy and after childbirth, published from 1960 up to date.

Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial.

Objective: To compare postoperative pain after laparoscopic and vaginal hysterectomy for benign disease.

Study Design: A prospective randomized trial was designed to compare laparoscopic hysterectomy and vaginal hysterectomy in patients with uterine volume View Article and Find Full Text PDF

Laparoscopy staging of early ovarian cancer: our experience and review of the literature.

Unlabelled: We report our experience with laparoscopic staging of apparent early ovarian cancer, and we critically review the current literature on this issue. Potential limits of laparoscopic technique and theoretical concerns of using pneumoperitoneum-based surgery in this setting are addressed.

Methods: Surgical, pathological, and oncological outcome data of consecutive patients undergoing comprehensive laparoscopic staging for presumed early ovarian cancer at our institution were prospectively collected.

Surgical and survival outcomes in older women with endometrial cancer treated by laparoscopy.

Objective: The aim of this study was to evaluate the feasibility and safety of laparoscopic surgical management of apparently early-stage endometrial cancer in older women and to compare clinical outcomes between older and younger women.

Methods: Our prospective oncological database was retrospectively reviewed to identify all consecutive women who underwent surgery for endometrial cancer from 2002. Data available included information about demography, comorbidities, surgical outcomes, histology, adjuvant therapies, and follow-up.

First-trimester maternal serum screening and the risk for fetal distress during labor.

Objective: The purpose of this study was to assess whether low pregnancy-associated plasma protein-A (PAPP-A) levels in the first trimester are related to the risk of emergency cesarean section delivery (CS) for fetal distress during labor and fetal intrapartum acidemia.

Study Design: We prospectively studied patients who requested first-trimester biochemical screening for Down syndrome.

Results: Among the 1037 women who were enrolled, 152 women (14.

Use of laparoscopy in older women undergoing gynecologic procedures: is it time to overcome initial concerns?

Objective: The aim of this study was to analyze temporal trends in adoption of laparoscopy in a cohort of older women (> or =70 y) undergoing gynecologic abdominal procedures and to assess operative outcomes compared with those of open procedures.

Methods: A prospective entered database was queried for all women aged 70 years or older undergoing surgery at our department during a 9-year period. Surgical outcomes were compared according to the type of surgical approach (laparoscopy vs open) and assessed over time.

Sexual function after radical hysterectomy for early-stage cervical cancer: is there a difference between laparoscopy and laparotomy?

Introduction: Surgical treatment for cervical cancer is associated with a high rate of late postoperative complications, and in particular with sexual dysfunction.

Aim: To evaluate sexual function in women who underwent radical hysterectomy (RH), in comparison with a control group of healthy women, using a validated questionnaire (Female Sexual Function Index [FSFI]). Then we tried to evaluate the possible differences between laparoscopic RH and abdominal RH in terms of their impact on sexuality.

Incorporating laparoscopy in the practice of a gynecologic oncology service: actual impact beyond clinical trials data.

Background: Feasibility and safety of laparoscopic management of gynecologic cancers have been established by numerous clinical trials. However, the degree to which such results are achievable outside the context of formal research programs and the actual extent of laparoscopy uptake since its introduction are unclear. Purpose of this study was to examine the impact upon operative and cancer outcomes of the incorporation of laparoscopy into the surgical practice of our gynecologic oncology service.

The impact of the mid-urethral slings for the treatment of stress urinary incontinence on female sexuality.

Introduction: No available review has been specifically designed to analyze the relationship between mid-urethral slings for stress urinary incontinence (SUI) and female sexual function.

Aim: The aim of our review has been to go through the available evidence and define the present state of the art about the effects of this specific type of surgery for SUI on female sexuality.

Methods: PubMed was searched for reports about the impact of mid-urethral slings on female sexual function that were published from 1995 to 2008, and the most relevant papers were reviewed.

Surgical treatment for female stress urinary incontinence: what is the gold-standard procedure?

In the last few years, the Burch colposuspension and the fascial slings were often defined from the pages of the most relevant journals of general medicine, as gold-standard procedures for the surgical treatment of stress urinary incontinence (SUI), whereas mid-urethral slings (tension-free vaginal tape (TVT) and tension-free vaginal tape obturator) were attributed a marginal and almost experimental role in this field. This poorly reflect the current scenario of the surgical management of SUI: Recently, a number of meta-analysis have demonstrated that TVT is significantly more effective if compared to colposuspension and that it is followed by significantly lower perioperative morbidity if compared to pubovaginal slings. It is not realistic to suggest to general practitioners that the surgical gold standard for SUI includes the performance of a wide laparotomy, long hospital stays and a high risk of long-lasting intermittent self-catheterisation.

Microlaparoscopy: a further development of minimally invasive surgery for endometrial cancer staging -- initial experience.

Objectives: To present our initial experience with micro-laparoscopy in the surgical treatment of endometrial cancer and to compare its outcomes with those of conventional laparoscopic approach.

Methods: Consecutive patients undergoing surgical staging of endometrial cancer using exclusively 3-mm working ports and a 3- or 5-mm laparoscope at the umbilicus (microlaparoscopy group; N=23) were compared with historical controls selected from consecutive women who have had staging with conventional laparoscopy (N=80).

Results: No difference was found in demographics and preoperative variables between the two groups.