1/9. Intravesical Lippes loop following insertion for the treatment of Asherman's syndrome: a case report.A case report of a 36-year-old Para 6 0 (1 alive) civil servant who developed Asherman's syndrome following repair of ruptured uterus is presented. She had adhesiolysis and insertion of Lippes loop. She defaulted 3 months after presentation and was seen 1 year after with intravesical translocation of the IUCD. This was successfully removed using a forward biting bladder biopsy forceps under direct cystoscopic view. ( info) |
2/9. The prevalence of phimosis of the clitoris in women presenting to the sexual dysfunction clinic: lack of correlation to disorders of desire, arousal and orgasm.physical examination of the genitalia was performed during an evaluation of women with sexual health problems. Cephalad displacement of the right and left labia minora enables full retraction of the clitoral prepuce and complete exposure of the glans clitoris, under normal circumstances. We defined clitoral examination as abnormal when the cephalad force resulted in varying degrees of incomplete foreskin retraction and limited exposure of the glans clitoris. The pathophysiology is likely to be secondary to recurrent vulvar dermal infections of blunt trauma changing prepucial elasticity. Clitoral phimosis, a previously undiagnosed physical finding, was identified in 22% of the women. Other than its link to sexual pain, the clinical significance of this finding, in particular the relation to diminished sensitivity and impaired orgasmic capability, is unclear at this time. ( info) |
3/9. Unusual late complications after two previous cesarean deliveries: a case report.BACKGROUND: women with multiple previous cesarean deliveries (CDs) risk the development of uterine synechiae and ventral fixation of the uterus to the abdominal wall. CASE: A para 2, gravida 2 women who had two prior CDs experienced prolonged menstrual bleeding with persistent cramps, both of which became more severe after insertion of an intrauterine contraceptive device that was subsequently removed. Pelvic ultrasound revealed an enlarged uterus with fibroids. After a failed attempt to perform a dilation and curettage because of uterine synechiae, the patient underwent a total abdominal hysterectomy. During surgery, the gynecologist observed a total dehiscence of the previous uterine incision, with ventral fixation of the uterus to the lower anterior abdominal wall and marked elongation of the portio cervix. CONCLUSION: dysmenorrhea in a patient with multiple previous CDs, mainly of the classical type, should be carefully evaluated and, in addition, when such patient requires a dilation and curettage, the possibility of cervical stenosis and uterine synechiae should be kept in mind. Having had a number of previous CDs may have an adverse impact on the uterine complication rate. ( info) |
4/9. Vaginal calculus secondary to vaginal outlet obstruction.Primary vaginal stones are extremely rare and are often mistaken for bladder calculi on plain radiography. However, intravenous pyelography and sonography can help differentiate between the two. We report a case of a large vaginal stone in a 21-year-old woman referred for apareunia and difficult micturation. The clinical findings of vaginal outlet obstruction and a hard mass anterior to the rectum made us suspect a bladder calculus; however, sonography of the pelvis indicated that the mass was in the vagina. Further examination using a probe to physically define the stone's location confirmed it to be a vaginal calculus. Surgery was performed to repair the outlet obstruction and remove the stone, which permitted the woman to urinate normally and engage in normal sexual relations. ( info) |
5/9. Intrapartum spontaneous uterine rupture following uncomplicated resectoscopic treatment of Asherman's syndrome.Since Asherman first published his series of intrauterine synechiae in 1948, only a few physicians have described the obstetric complications of patients who conceived following surgical treatment of intrauterine synechiae. We present a woman with a history of resectoscopic resection of intrauterine adhesions with a term pregnancy and spontaneous uterine rupture that occurred during the intrapartum period. At emergent cesarean section, hemoperitoneum of approximately 1500 mL was noted and a 10-cm defect was present in the lateral uterine wall; the edges of the defect were bleeding actively. Because of the potential for a disastrous outcome in the rupture of the pregnant uterus, patients treated for Asherman's syndrome should be identified early and appropriate precautions should be taken in their obstetric management. ( info) |
6/9. Intrauterine adhesions after manual vacuum aspiration for early pregnancy failure.OBJECTIVE: To describe the occurrence of intrauterine adhesions after manual vacuum aspiration for early pregnancy failure. DESIGN: Case series. SETTING: Tertiary care center. PATIENT(S): Three women with intrauterine adhesions after manual vacuum aspiration for the treatment of early pregnancy failure. INTERVENTION(S): Chart review. MAIN OUTCOME MEASURE(S): Hysteroscopic diagnosis of intrauterine adhesions after manual vacuum aspiration. RESULT(S): Three cases of symptomatic intrauterine adhesions after manual vacuum aspiration. CONCLUSION(S): Intrauterine adhesion formation may follow manual vacuum aspiration for early pregnancy loss. ( info) |
7/9. Successful use of vaginal sildenafil citrate in two infertility patients with Asherman's syndrome.Vaginal sildenafil citrate (Viagra, Pfizer, Inc., new york, NY) has been shown to be useful in increasing endometrial thickness and achieving pregnancy in women with varied uterine disorders. However, it failed to demonstrate favorable results in the setting of Asherman's syndrome, a condition characterized by the presence of uterine synechiae. We have successfully applied this treatment in two women noted to have inadequate endometrium after surgical resection of uterine synechiae. Both patients had a history of a postpartum uterine curettage with subsequent secondary infertility. Asherman's syndrome was surgically demonstrated and treated in both patients. Postoperatively, both patients were noted to have a thin endometrium and failed to conceive despite fertility treatment. Subsequently, these women achieved pregnancy in the first treatment cycle with vaginal sildenafil citrate. Using transvaginal ultrasound, endometrial thickness was noted to improve when sildenafil citrate was administered. It is suspected that this medication causes selective vasodilatation, resulting in improved endometrial development. ( info) |
8/9. Appendico-vesicostomy in tile management of complex vesico-vaginal fistulae.Complex vesico-vaginal fistulae (VVFs) continue to complicated prolonged obstructed labour in this country. Recently a young lady presented to us with a huge VVF, associated with loss of the urethra and bladder neck, severe gynaetresia and recto-vaginal fistula. Her VVF was successfully managed by an appendico-vesiscostomy. ( info) |
9/9. Successful pregnancy outcome after hysteroscopic adhesiolysis in Asherman's syndrome.Asherman's syndrome is an uncommon finding at hysterosalpingography for infertility. Modern day management entails hysteroscopic confirmation and adhesiolysis. We present one such case of a young woman who had secondary infertility after dilatation and curettage, and who was diagnosed and treated with a successful outcome. ( info) |