Perfusion magnetic resonance imaging in Asherman syndrome.

Background: Microvascular scarring compromises the functionality of the endometrium, and vascular flow at the junctional zone (JZ) may be the key to understanding poor reproductive outcomes in women with Asherman syndrome (AS).

Aims: To investigate whether vascular perfusion of the uterus, measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is impaired in women with intrauterine adhesions (IUA) and AS.

Materials And Methods: A prospective observational cohort pilot study of 23 women with IUA treated with hysteroscopic synecholysis and a control group of two patients with cervix cancer were subject to DCE-MRI with gadolinium to assess uterine vascularity.

Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus.

Background: Since the development and publication of diagnostic criteria for pudendal nerve entrapment (PNE) syndrome in 2008, no comprehensive work has been published on the clinical knowledge in the management of this condition. The aim of this work was to develop recommendations on the diagnosis and the management of PNE.

Methods: The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method.

Topical treatment of vulvodynia, dyspareunia and pudendal neuralgia: A single clinic audit of amitriptyline and oestriol in organogel.

Background: Vulvodynia and pudendal neuralgia comprise significant contributors to vulvar-related pain and its impact on daily life.

Aim: A retrospective clinical audit was conducted at the Women's Health & Research Institute of Australia, Sydney, to determine the pattern of use and the efficacy of the application of topical amitriptyline 0.5% plus oestriol 0.

Asherman syndrome: Audit of a single-operator cohort of 423 cases.

Background: The diagnosis of Asherman syndrome, or 'intra-uterine adhesions' is often overlooked when the symptoms of amenorrhea and hematometra are missing.

Aims: This audit reviews the clinical data of a large cohort of patients treated by a single operator.

Materials And Methods: From July 1998 till the end of December 2017, 423 patients with intra-uterine adhesions were treated by a single operator.

Fractional CO laser for treatment of stress urinary incontinence.

Objectives: To evaluate the impact of trans-vaginal fractional CO laser treatment on symptoms of stress urinary incontinence (SUI) in women.

Study Design: Women clinically diagnosed with SUI preferring non-surgical treatment were recruited to the study. Fractional CO laser system (MonaLisa T, DEKA) treatments were administered trans-vaginally every 4-6 weeks for a total of three treatments.

Medication Use and Pain Management in Pregnancy: A Critical Review.

Background: Pain during pregnancy is common, and its management is complex. Certain analgesics may increase the risk for adverse fetal and pregnancy outcomes, while poorly managed pain can result in adverse maternal outcomes such as depression and hypertension. Guidelines to assist clinicians in assessing risks and benefits of exposure to analgesics for the mother and unborn infant are lacking, necessitating evidence-based recommendations for managing pain in pregnancy.

Live birth rate and obstetric complications following the hysteroscopic management of intrauterine adhesions including Asherman syndrome.

Study Question: What are the live birth rate and risks of obstetric complications following the surgical management of intrauterine adhesions (IUA) such as Asherman syndrome (AS)?

Summary Answer: The live birth rate is 63.7%, and obstetric complications including placentation issues, prematurity and postpartum hysterectomy require that pregnancies in women after treatment for IUA should be considered moderate to high risk.

What Is Known Already: Studies reviewing short-term surgical, menstrual and fertility outcomes following hysteroscopic management are reassuring, with success correlated to the severity of IUA.

Pain after vaginal prolapse repair surgery with mesh is a post-surgical neuropathy which needs to be treated - and can possibly be prevented in some cases.

Post-surgical neuropathy leading to chronic pain is a recognised complication. It also can occur after surgery for pelvic organ prolapse repair involving mesh. Post-surgical neuropathy needs to be identified and properly treated to minimise the occurrence of chronic pain.

Sacral neuromodulation for pelvic pain and pelvic organ dysfunction: A case series.

Background: The use of neuromodulation is growing and it is an established therapy for conditions such as bladder dysfunction. It is an increasingly used therapy for the management of chronic perineal pain but little research is currently available looking at its efficacy.

Aim: We present a series of 52 patients who underwent placement of a neuromodulator, the majority of whom suffered from perineal pain, with most placements via the sacral hiatus.

A severed IP ligament as a cause for trans-vaginal uterine bleeding post termination of pregnancy: a case report.

Uterine perforation is an uncommon yet serious complication of surgical management of first and second trimester termination of pregnancies. The rate of uterine perforation is under reported, as patients are usually asymptomatic. Although uncommon, uterine perforation can cause life-threatening complications for some patients.

Medium to long-term gastrointestinal outcomes following disc resection of the rectum for treatment of endometriosis using a validated scoring questionnaire.

Objective: To assess the gastrointestinal functional outcomes and symptoms of low anterior resection syndrome after disc resection for deeply infiltrative endometriosis (DIE) using a validated scoring system.

Design: Retrospective study to assess the gastrointestinal functional outcomes after rectal disc resection for DIE using a validated scoring system.

Setting: University tertiary referral centre.

Combined site-specific sacral neuromodulation and pudendal nerve release surgery in a patient with interstitial cystitis and persistent arousal.

A variety of neuromodulation approaches have been described for the management of pelvic neuropathies, including interstitial cystitis, pudendal neuralgia and persistent genital arousal disorder. The benefits of a combined sacral and pudendal nerve neuromodulator has yet to be explored for these patients. In this report, we describe the case of a 35-year-old woman with a complex pelvic neuropathy resulting in urinary, sexual and gastro-intestinal dysfunction.

Improvement in pelvic pain with botulinum toxin type A - Single vs. repeat injections.

The aim of this prospective study was to report the outcomes of pain and vaginal pressures of successive botulinum toxin type A injections for women with objective pelvic floor muscle overactivity and a two-year history of pelvic pain. Between 2005 and 2008, 37 women underwent injection of 100 IU of botulinum toxin type A into the puborectalis and pubococcygeous muscles with dysmenorrhoea, dyspareunia, dyschesia, and non-menstrual pelvic pain assessed using a visual analogue scale (VAS), and vaginal pressure measured by vaginal manometry, at 0, 4, 12 and 26 weeks from each injection. 26 women (70%) had one injection of botulinum toxin type A and 11 (30%) had 2 or more injections.

Lignocaine plasma levels following topical gel application in laparoscopic and hysteroscopic procedures.

The study aim was to determine plasma lignocaine concentrations resulting from topical application of a newly formulated, sterile two-pack lignocaine gel in laparoscopic and hysteroscopic procedures. This was an open label single-centre study in which six female patients underwent laparoscopy and six underwent hysteroscopy. One venous blood sample was extracted pre-gel application, followed by 10 samples over a 24 hour period following application.

Response to pudendal nerve block in women with pudendal neuralgia.

Objective: To examine the evolution of pain and the duration of numbness after neural blockade of the pudendal nerve in women with pudendal neuralgia and correlate with clinical and historical data.

Design: Prospective, single arm, open label study.

Setting: University hospital and outpatient clinic.

Mechanism of action of the Adiana(®) device: a histologic perspective.

Background: The study was conducted to confirm the mechanism of action of the Adiana permanent contraception device by means of histologic analysis of long-term specimens.

Study Design: Fifteen specimens were obtained from eight subjects undergoing hysterectomy 2 to 4 years after the Adiana procedure. Serial sections were stained with hematoxylin and eosin, as well as epithelial membrane antigen immunostain.

The Adiana System for permanent contraception: safety and efficacy at 3 years.

Study Objective: To evaluate the efficacy of the Adiana System for preventing pregnancy in women desiring permanent sterilization.

Design: This study is a prospective, single-arm, multicenter, international trial. The primary endpoint was pregnancy prevention rate at 12 months.

Lignocaine gel in minimally invasive surgery - A pilot cohort study.

Background: The administration of local anaesthetic at the conclusion of minimally invasive procedures has been shown to reduce postoperative pain. However, it is often not feasible to reach target surgical sites using a needle, making it difficult to administer injectable local anaesthetic. Formulations currently available for topical use are also not sterile, adhere poorly, and are not adjusted to neutral pH at the time of use.

The management of intrauterine synechiae.

Purpose Of Review: Intrauterine adhesions are a rare but significant cause of menstrual disturbance and infertility. Most cases are caused by uterine instrumentation. It is important for clinicians to understand the cause, diagnostic tools and rationale behind treatment.

A comparative, single-blind, randomized trial of pain associated with suction or non-suction drains after gynecologic laparoscopy.

Study Objective: To estimate the difference in pain associated with the wearing or removal of suction or non-suction drains after gynecologic laparoscopic surgery.

Design: A randomized controlled trial from August 2006 through October 2007 (Canadian Task Force Classification I).

Setting: Royal Hospital for Women, Department of Endo-Gynaecology and School of Women's and Children's Health University of New South Wales.

A prospective, randomized, double-blind, placebo-controlled trial of multimodal intraoperative analgesia for laparoscopic excision of endometriosis.

Objective: To assess the efficacy of multimodal intraoperative analgesia in reducing postoperative pain and/or opioid requirements in women undergoing laparoscopic excision of endometriosis.

Design: Prospective, randomized, double-blind, placebo-controlled trial.

Setting: Endogynecologic department of a university teaching hospital.

A 12-month prospective evaluation of transcervical sterilization using implantable polymer matrices.

Objective: To evaluate placement efficacy and reliability of a an intratubal occlusion device for permanent contraception and to assess tolerability and overall satisfaction.

Methods: Seven hundred seventy women with known parity were recruited to participate in a prospective, multicenter study. Bipolar, low-level radiofrequency energy delivery and porous silicon inserts were used.

Fluoroscopically guided synechiolysis for patients with Asherman's syndrome: menstrual and fertility outcomes.

Objective: To describe a 5-year experience of fluoroscopically guided hysteroscopic synechiolysis for Asherman's syndrome.

Design: Retrospective, uncontrolled cohort study.

Setting: Department of Endo-Gynaecology, University of New South Wales, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia.