ABSTRACT Introduction Vesicovaginal fistula (VVF) is the most common urogenital fistula due to iatrogenic cause, primarily associated with gynecologic surgery (1). Although both conservative and surgical management may be considered, the optimal treatment is still uncertain and several studies were published using different techniques (open, laparoscopic or robotic) and approaches (extravesical, transvesical or transvaginal) (2–5). In this context, we aim to report our initial experience repairing VVF with Single-Port (SP) Transvesical (TV) access. Materials and Methods Four patients with a diagnosis of VVF underwent SP-TV VVF repair between May 2022 and December 2023. Diagnosis was confirmed by cystoscopy, cystogram and in two cases by CT Urogram. Under general anesthesia, before robotic time, patients were placed in lithotomy position and a preliminary cystoscopy was performed. Fistula was noted and a 5fr stent was placed through the fistulous tract. Two ureteral stents were placed. Then, with patient supine, a transverse suprapubic 3cm incision and 2cm cystotomy were made for SP access. First step was to mark and remove fistula tract to the vagina. The edges of the vagina and bladder were dissected in order to have a closure free of tension and to create three different layers to close: vagina, muscularis layer of the bladder and mucosal layer of the bladder. A bladder catheter was placed, and the two ureteral stents were removed at the end of procedure. Results Mean age was 53 years old and three out of 4 patients developed VVF after gynecologic surgery. Two patients underwent VVF repair 6 and 8 months after total hysterectomy. One patient developed VVF after total hysterectomy and oophorectomy followed by radiation therapy. Last patient developed VVF after previous urological procedure. Fistula diameter was between 11 and 15mm. Operative time was 211 min, including preliminary cystoscopy, stents placement and SP-access. All patients were discharged on the same day with a bladder catheter, successfully removed between post-operative day 14-18 after negative cystogram. Only in one case a ureteral stent was left because the fistula was closed to the ureteral orifice and we reported one case of UTI twelve days after surgery, treated with outpatient antibiotics. Mean follow-up was 8 months, patients were scheduled for regular follow-up visits and no recurrence was reported. All patients have at least 3 months of post-operative follow-up. Conclusions Our experience suggests that SP Transvesical VVF repair may be considered as a safe and feasible minimally invasive treatment for small/medium fistulae (10-15mm). (VVF cause 1. 1 . (1) open, open (open extravesical, extravesical (extravesical transvaginal 2–5. 25 2–5 2 5 (2–5) context SinglePort Single Port (SP TV (TV access SPTV 202 2023 Urogram anesthesia performed fr Then supine cm close procedure therapy 15mm mm 21 min SPaccess. SPaccess SP-access postoperative post operative 1418 14 18 14-1 antibiotics followup follow up followup. up. smallmedium small medium 1015mm. 1015mm 10 (10-15mm) (1 2– (2–5 20 141 14- (10-15mm ( (2– (2

Abstract Uterine prolapse is a common pathology in the female population as longevity increases. If we take into account the concomitant rectal prolapse that these patients may have, we see a not very high frequency, although both are part of the disorders of the pelvic floor, combined surgical treatment may be a valid option to improve the quality of life of these patients. We present the results of 3 patients who underwent transvaginal hysterectomy and Delorme operation in a single procedure with satisfactory results.

Resumen El prolapso uterino es una patología frecuente en la población femenina a medida que aumenta la longevidad, si tomamos en cuenta el prolapso rectal concomitante que pueden tener estas pacientes, vemos una frecuencia no muy alta, si bien ambos forman parte de los trastornos del piso pélvico, el tratamiento quirúrgico combinado puede ser una opción válida para mejorar la calidad de vida de estas pacientes. Presentamos los resultados de 3 pacientes sometidas a histerectomía transvaginal y operación de Delorme en un solo tiempo con resultado satisfactorio.

Abstract Objective: To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country. Methods: Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices. Results: The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix. Conclusion: In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings. Objective middleincome middle income country Methods Crosssectional Cross sectional 26 obstetriciangynecologists obstetrician gynecologists facilities administered Results 445 44 5 44. years 785 78 78.5 female 977 97 7 97.7 program i.e., ie i e (i.e. length 113 11 3 11.3 43 abnormal 746 74 6 74.6 Conversely 607 60 60.7 p 0.001. 0001 0.001 . 0 001 0.001) 90.6% 906 90 (90.6% cervix Conclusion common prevalent settings 2 4 78. 9 97. i.e. (i.e 1 11. 74. 60. 000 0.00 00 90.6 (90.6 i.e 0.0 90. (90. 0. (90 (9 (

SUMMARY OBJECTIVE: The aim of this study was to compare endometrial thickness with the use of transdermal estrogen (gel) versus oral estrogen (pills) for endometrial preparation in the frozen embryo transfer cycle and serum estrogen concentrations during the preparation cycle, side effects, and chemical and clinical pregnancy rates. METHODS: This was a prospective, randomized controlled trial of women undergoing endometrial preparation for cryopreserved blastocyst transfer. A total of 88 women were randomized, of which 82 completed the study protocol. Of this group, 44 received 6 mg/day of estradiol valerate orally (pills group) and 38 received 4.5 mg/day of estradiol hemihydrate transdermally (gel group). Endometrial thickness was measured using transvaginal ultrasound between the 7 and 10th day of the cycle. Serum estradiol concentrations were measured on the day of initiating the cycle, on control transvaginal ultrasounds, and on the day of embryo transfer. Side effects were documented at each study visit. p<0.05 were adopted as statistically significant. The groups were compared using Student's t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. RESULTS: There were no significant group differences (p>0.05) in endometrial thickness, biochemical and clinical pregnancy rates, miscarriage rate, blood estradiol concentrations, duration of estradiol administration, or cycle cancellation rates. CONCLUSION: Endometrial preparation with transdermal estrogen yielded similar reproductive outcomes to oral estrogen with fewer side effects. OBJECTIVE gel pills rates METHODS prospective 8 protocol 4 mgday mg 3 45 5 4. group. . th ultrasounds visit p005 p 0 05 p<0.0 Students Student s ttest t chisquare chi square Fishers Fisher RESULTS p>0.05 (p>0.05 rate administration CONCLUSION p00 p<0. p>0.0 (p>0.0 p0 p<0 p>0. (p>0. p< p>0 (p>0 p> (p> (p

Resumen La neoplasia ginecológica más frecuente son los leiomiomas uterinos, tumores benignos hormonodependientes que se generan del músculo liso del miometrio. Presentan una alta incidencia en mujeres en edad reproductiva entre la cuarta y quinta década de la vida y suelen disminuir con la menopausia. Generalmente son asintomáticos, pero a menudo se pueden acompañar de dismenorrea, metrorragia o infertilidad. El estudio inicial para su caracterización es la ecografía transvaginal; sin embargo, la resonancia magnética tiene un alto valor diagnóstico, ya que permite una evaluación más específica sobre el tipo, ubicación y número de leiomiomas, así como también permite identificar el tipo de degeneración y diferenciar entre leiomiomas y sus lesiones imitadoras. El objetivo principal de este manuscrito es abordar las principales características en resonancia magnética entre los distintos tipos de degeneración leiomiomatosa, siendo esta una causa de posible dolor abdominal y pélvico agudo.

Abstract The most common gynecological neoplasm is uterine leiomyomas, these are benign hormone-dependent tumors that are generated from the smooth muscle of the myometrium. They have a high incidence in women of reproductive age between the fourth and fifth decades of life and usually decrease with menopause. They are generally asymptomatic, but can often be accompanied by dysmenorrhea, metrorrhagia, or infertility. The initial study for its characterization is transvaginal ultrasound, however, magnetic resonance imaging has a high diagnostic value since it allows a more specific evaluation of the type, location and number of leiomyomas, as well as allowing the identification of the type of degeneration and differentiation. between leiomyomas and their mimic lesions. The main objective of this manuscript is to address the main characteristics in magnetic resonance between the different types of leiomyomatous degeneration, this being a cause of possible acute abdominal and pelvic pain.

Abstract Objective This study aims to create a new screening for preterm birth < 34 weeks after gestation with a cervical length (CL) ≤ 30 mm, based on clinical, demographic, and sonographic characteristics. Methods This is a post hoc analysis of a randomized clinical trial (RCT), which included pregnancies, in middle-gestation, screened with transvaginal ultrasound. After observing inclusion criteria, the patient was invited to compare pessary plus progesterone (PP) versus progesterone only (P) (1:1). The objective was to determine which variables were associated with severe preterm birth using logistic regression (LR). The area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both groups after applying LR, with a false positive rate (FPR) set at 10%. Results The RCT included 936 patients, 475 in PP and 461 in P. The LR selected: ethnics white, absence of previous curettage, previous preterm birth, singleton gestation, precocious identification of short cervix, CL < 14.7 mm, CL in curve > 21.0 mm. The AUC (CI95%), sensitivity, specificity, PPV, and PNV, with 10% of FPR, were respectively 0.978 (0.961-0.995), 83.4%, 98.1%, 83.4% and 98.1% for PP < 34 weeks; and 0.765 (0.665-0.864), 38.7%, 92.1%, 26.1% and 95.4%, for P < 28 weeks. Conclusion Logistic regression can be effective to screen preterm birth < 34 weeks in patients in the PP Group and all pregnancies with CL ≤ 30 mm. 3 (CL mm demographic characteristics RCT, , (RCT) middlegestation, middlegestation middle middle-gestation ultrasound criteria (PP (P 11. 11 1 . (1:1) LR. (LR) AUC, (AUC) sensitivity specificity PPV (PPV NPV (NPV FPR (FPR 10 93 47 46 selected white curettage cervix 147 14 7 14. 210 21 0 21. CI95%, CI95 CI CI95% (CI95%) PNV 0978 978 0.97 0.9610.995, 09610995 0.961 0.995 961 995 (0.961-0.995) 834 83 4 981 98 83.4 98.1 0765 765 0.76 0.6650.864, 06650864 0.665 0.864 665 864 (0.665-0.864) 387 38 38.7% 921 92 92.1% 261 26 26.1 954 95 95.4% 2 (RCT (1:1 (LR (AUC 9 CI9 (CI95% 097 97 0.9 9610 0.9610.995 0961099 0961 0.96 0995 0.99 96 99 (0.961-0.995 8 83. 98. 076 76 0.7 6650 0.6650.864 0665086 0665 0.66 0864 0.86 66 86 (0.665-0.864 38.7 92.1 26. 95.4 (1: (CI95 09 0. 0.9610.99 096109 096 099 (0.961-0.99 07 0.6650.86 066508 066 0.6 086 0.8 6 (0.665-0.86 38. 92. 95. (1 (CI9 0.9610.9 09610 (0.961-0.9 0.6650.8 06650 06 08 (0.665-0.8 ( (CI 0.9610. (0.961-0. 0.6650. (0.665-0. 0.9610 (0.961-0 0.6650 (0.665-0 (0.961- (0.665- (0.961 (0.665 (0.96 (0.66 (0.9 (0.6 (0. (0

Resumo Contexto A síndrome de congestão pélvica (SCP) é uma importante causa de dor pélvica em mulheres adultas, levando à redução da qualidade de vida, abstenção no trabalho, ansiedade, depressão e distúrbios sexuais. Objetivos Avaliar a resposta ao tratamento endovascular por escleroterapia com espuma para varizes pélvicas e traçar o perfil das pacientes com esse diagnóstico acompanhadas no Hospital das Clínicas Cassiano Antônio Moraes, da Universidade Federal do Espírito Santo. Métodos Com base na revisão de prontuários, este estudo descritivo retrospectivo analisa o perfil e a resposta das pacientes submetidas ao tratamento endovascular de varizes pélvicas por escleroterapia com espuma. As variáveis analisadas incluem idade, peso, altura, índice de massa corporal (IMC), paridade, queixa de dor pélvica e critérios ultrassonográficos, comparando o diâmetro dos vasos pélvicos pré e pós-procedimento, e a presença de refluxo venoso ao Doppler transvaginal. Resultados As pacientes analisadas tinham em média 43,3 anos, 2,95 gestações e IMC de 25,37kg/m2. A avaliação ultrassonográfica após intervenção indicou uma redução estatisticamente significativa (valor de p < 0,005) do calibre dos vasos parauterinos, com diâmetro médio de 6,34 mm à direita e 7,26 mm à esquerda antes do procedimento e, respectivamente, 4,37 mm e 4,56 mm após o procedimento. Conclusões A escleroterapia com espuma reduziu o calibre das varizes pélvicas na amostra estudada, com resultados semelhantes aos de outras modalidades de tratamento endovascular dessa comorbidade. A realização de mais estudos prospectivos para avaliação da resposta a essa intervenção se faz necessária para firmá-la como uma opção eficaz para o tratamento da SCP. SCP (SCP adultas vida trabalho ansiedade sexuais Moraes Santo prontuários idade peso altura IMC, , (IMC) paridade ultrassonográficos pósprocedimento, pósprocedimento pós procedimento, pós-procedimento transvaginal 433 43 3 43, anos 295 2 95 2,9 2537kgm2 kgm 25 37kg m2 kg m 25,37kg/m2 valor 0,005 0005 0 005 parauterinos 634 6 34 6,3 726 7 26 7,2 respectivamente 437 4 37 4,3 456 56 4,5 estudada comorbidade firmála firmá la (IMC 29 9 2, 2537kgm 25,37kg/m 0,00 000 00 63 6, 72 7, 4, 45 5 0,0 0,

Abstract Background Pelvic Congestion Syndrome is an important cause of pelvic pain in adult women, leading to reduced quality of life, absenteeism from work, anxiety, depression, and sexual disorders. Objectives To evaluate the response to endovascular treatment for pelvic varicose veins using foam sclerotherapy and outline the profile of patients with this diagnosis followed up at the Hospital das Clínicas Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Brazil. Methods Based on review of medical records, this retrospective descriptive study analyzes the profile and response of patients undergoing endovascular treatment for pelvic varicose veins by foam sclerotherapy. The variables analyzed include age, weight, height, body mass index, parity, pelvic pain complaints, ultrasound criteria comparing the diameter of pelvic vessels before and after the procedure, and presence of venous reflux on transvaginal Doppler ultrasound. Results The sample of patients analyzed had an average age of 43.3 years old, a mean of 2.95 gestations, and a mean BMI of 25.37kg/m2. Ultrasound assessment after the intervention indicated a statistically significant reduction (p-value < 0.005) in the caliber of the parauterine vessels, with mean diameters of 6.34 mm on the right and 7.26 mm on the left before the procedure and 4.37 mm and 4.56 mm respectively afterwards. Conclusions Foam sclerotherapy reduced the caliber of pelvic varicose veins in the study sample. The results were similar to those of other endovascular treatment methods for this comorbidity. Further prospective studies to assess the response to this intervention are necessary to establish it as an effective option for treatment of pelvic congestion syndrome. women life work anxiety depression disorders Moraes Santo Brazil records weight height index parity complaints 433 43 3 43. old 295 2 95 2.9 gestations 2537kgm2 kgm 25 37kg m2 kg m 25.37kg/m2 pvalue p value 0.005 0005 0 005 634 6 34 6.3 726 7 26 7.2 437 4 37 4.3 456 56 4.5 afterwards comorbidity syndrome 29 9 2. 2537kgm 25.37kg/m 0.00 000 00 63 6. 72 7. 4. 45 5 0.0 0.

SUMMARY OBJECTIVE: The objective of this study was to describe the single-surgeon experience on transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension in patients with severe prolapse who had concomitant vaginal hysterectomy. METHODS: A total of 53 patients with severe uterine prolapse who underwent vaginal hysterectomy and transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension between January 2021 and March 2023 were included in the study. Operation time, intraoperative and postoperative complications, de novo urinary continence, and duration of hospitalization were obtained from the patient records. Initial postoperative follow-up visits were scheduled for the first week of the month. Patients were followed up yearly, and they had the opportunity to reach the surgical team at any time. Symptomatic prolapse beyond the hymen is defined as recurrence. RESULTS: Patients had a mean age of 61.7 years ±7.7 SD. All patients received bilateral opportunistic salpingectomy and salpingo-oophorectomy. The total operation time was 162±31 min, with transvaginal natural orifice transluminal endoscopic surgery taking 32.3±5.37 min. There were no intraoperative complications. 12 patients had recurrence; 8 anterior, 3 apical, and 1 posterior prolapse. The mean recurrence time was 11.5 months (range 5–23 months). The reoperation rate was 13.2% (n:7). Three of the patients had obliterative vaginal surgery, three of the patients had anterior, and one patient had posterior repair. Overall failure of apical surgical procedure was 5.6%. Two patients had de novo incontinence postoperatively. CONCLUSIONS: Transvaginal natural orifice transluminal endoscopic surgery uterosacral ligament suspension is a feasible technique to treat severe pelvic organ prolapse with promising results for short-term efficacy and safety in patients who had concomitant vaginal hysterectomy. Longer follow-up periods are needed to evaluate the long-term efficacy profile of transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension. OBJECTIVE singlesurgeon single surgeon METHODS 5 202 complications continence records followup follow month yearly RESULTS 617 61 7 61. 77 ±7. SD salpingooophorectomy. salpingooophorectomy salpingo oophorectomy. oophorectomy salpingo-oophorectomy 16231 162 31 162±3 min 323537 32 37 32.3±5.3 anterior 115 11 11. range 523 23 5–2 months. . months) 132 13 2 13.2 n7. n7 n (n:7) repair 56 6 5.6% postoperatively CONCLUSIONS shortterm short term longterm long 20 ±7 1623 16 162± 32353 32.3±5. 52 5– 13. (n:7 5.6 ± 3235 32.3±5 (n: 5. 323 32.3± (n 32.3 32.

Abstract Vaginal cuff dehiscence (VCD) and evisceration are rare but potentially severe complications of hysterectomy, with a significant risk for patient morbimortality. The authors report a case of transvaginal small bowel evisceration in a 91-year-old woman, 8 years after a hysterectomy, identified after the occurrence of a fall. Immediate manual bowel reduction and VCD correction were performed in the operating room. On the 3rd postoperative day, her intestinal transit was restored and seven days after surgery she developed acute pulmonary edema, which caused her death.

Resumo A deiscência da cúpula vaginal e a evisceração são complicações raras, mas potencialmente graves da histerectomia, com risco significativo de morbimortalidade da paciente. Os autores relatam um caso de evisceração transvaginal de intestino delgado numa mulher de 91 anos, 8 anos pós-histerectomia, identificada após uma queda. A redução manual do intestino e a correção da cúpula vaginal foi realizada no bloco operatório. Ao 3.º dia pós-operatório, o trânsito intestinal estava restabelecido e 7 dias após cirurgia, ela desenvolveu edema agudo do pulmão, o que provocou a sua morte.

ABSTRACT Vasa previa is a rare and infrequent prenatal finding of hemorrhage in the second half of pregnancy, in which umbilical vessels devoid of Wharton's jelly interpose between the fetal presentation and the internal cervical os. When undetected and rupture of the vessels occurs, it is associated with a high perinatal mortality rate. Three types are described; the case presented is type 1 vasa previa secondary to velamentous insertion of the cord. It was diagnosed prenatally by transvaginal ultrasound associated with color Doppler. A cesarean section was performed with favorable maternal and perinatal evolution.

RESUMEN La afección vasa previa es un hallazgo prenatal raro y poco frecuente de hemorragia en la segunda mitad del embarazo, en la que los vasos umbilicales desprovistos de la gelatina de Wharton se interponen entre la presentación fetal y el orificio cervical interno. Cuando no se la detecta y se produce la rotura de los vasos, se asocia a una alta tasa de mortalidad perinatal. Se describen 3 tipos; el caso presentado se trata de vasa previa de tipo 1 secundaria a inserción velamentosa de cordón. Fue diagnosticada prenatalmente mediante ecografía por vía transvaginal asociada a Doppler color. Se practicó una cesárea con evolución materno perinatal favorable.

ABSTRACT Ovarian endometrioma is a cyst with ectopic endometrial tissue associated with decreased ovarian reserve. Its management in infertility is controversial. We present the case of a 32-year-old woman with decreased ovarian reserve and endometrioma larger than 100 mm. She underwent ultrasound-guided transvaginal aspiration and subsequent sclerotherapy with ethanol, achieving a 65% reduction in size after three months. Subsequently, in vitro fertilization (IVF) was performed, and pregnancy was achieved. The excision of the endometrioma is controversial because it reduces the ovarian reserve. Sclerotherapy has been shown to preserve ovarian reserve, is associated with a low recurrence rate and facilitates ovarian accessibility. Ethanol sclerotherapy of endometrioma is a safe and effective outpatient technique that allows pregnancy in women with infertility.

RESUMEN El endometrioma ovárico es un quiste con tejido endometrial ectópico que se asocia a disminución de la reserva ovárica, siendo su manejo en infertilidad controversial. Presentamos el caso de una mujer de 32 años con reserva ovárica disminuida y endometrioma mayor de 100 mm. Fue sometida a aspiración transvaginal ecoguiada y a escleroterapia con etanol, lográndose reducción del tamaño en 65% a los tres meses. Posteriormente se realizó fecundación in vitro (FIV), consiguiéndose embarazo. La exéresis del endometrioma es controversial, debido a que reduce la reserva ovárica. La escleroterapia demuestra conservarla, se asocia a una tasa baja de recurrencia y facilita la accesibilidad ovárica. La escleroterapia con etanol del endometrioma es una técnica ambulatoria, segura y eficaz que permite el embarazo en mujeres con infertilidad.

ABSTRACT Xanthogranulomatous inflammation of the female genital tract is infrequent and is even rarer in fallopian tubes and ovaries. We present a case of xanthogranulomatous oophorosalpingitis in a 45-year-old female patient who consulted for left iliac fossa pain accompanied by fever. Bimanual examination revealed a slightly enlarged uterus with a firm, non-painful left adnexal mass, adherent to the uterus and with limited mobility. Transvaginal ultrasound evaluation showed a heterogeneous left ovarian tumor with thick and irregular walls, multiple septa and internal echoes without visualization of the ovary. During surgery, dense adhesions were found from the mass to the pelvic lateral wall, ovarian fossa, and bowel loops. The uterus was displaced by a thick-walled, grayish-white, cystic left adnexal tumor draining foul-smelling purulent fluid. The definitive diagnosis was xanthogranulomatous oophorosalpingitis. This condition is a rare inflammatory process that poses diagnostic dilemmas. Its clinical manifestations and imaging features may mimic a malignant pelvic neoplasm, so a high index of suspicion is necessary for its diagnosis, as a differential diagnosis in patients with complex cystic ovarian tumors. Histopathological examination is the gold standard for diagnosis.

RESUMEN La inflamación xantogranulomatosa del tracto genital femenino es infrecuente y es aún más rara en las trompas de Falopio y ovarios. Se presenta un caso de ooforosalpingitis xantogranulomatosa en una paciente femenina de 45 años quien asistió a consulta por presentar dolor en fosa iliaca izquierda acompañado de fiebre. La exploración bimanual mostró útero ligeramente aumentado de tamaño con masa anexial izquierda firme, no dolorosa, adherida al útero y con limitada movilidad. La evaluación ecográfica transvaginal determinó tumoración ovárica izquierda, heterogénea con paredes gruesas e irregulares con múltiples septos y ecos internos sin visualizar el ovario. Durante la cirugía, se encontraron adherencias densas desde la masa hacia la pared lateral pélvica, fosa ovárica y asas intestinales. El útero estaba desplazado por tumoración anexial quística izquierda, de color blanco grisáceo y paredes gruesas que drenaba líquido purulento fétido. El diagnóstico definitivo fue ooforosalpingitis xantogranulomatosa. Esta condición es un proceso inflamatorio poco frecuente que plantea dilemas diagnósticos. Sus manifestaciones clínicas y características de estudios por imágenes pueden simular una neoplasia pélvica maligna, por lo que es necesario un alto índice de sospecha para su diagnóstico, como diagnóstico diferencial en pacientes con tumoraciones ováricas quísticas complejas. El examen histopatológico es el estándar de oro para el diagnóstico.

Abstract Objective To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. Materials and Methods In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. Results There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. Conclusion Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth. (IUD hospital study 201 2019 US (US 6weeks collected 6months contact analysis ttest, ttest t test, test t-test distribution Chisquared Chi squared 3728 3 728 3,72 35 94 9 4 9.4% 651 65 1 65.1 cases 108 10 8 10.8 85 5 8.5 23 744 74 74.4 256 25 25.6% 68.4% 684 68 (68.4 316 31 31.6 respectively 0.031. 0031 0.031 . 0 031 0.031) age parity index weight longterm long term high shortinterval short interval birth 20 372 72 3,7 9.4 65. 10. 8. 2 7 74. 25.6 68.4 (68. 31. 003 0.03 03 37 3, 9. 25. 68. (68 00 0.0 (6 0. (

Resumo Objetivo Avaliar as taxas de expulsão e continuação do dispositivo intrauterino (DIU) de cobre inserido no pós-parto imediato em um hospital universitário brasileiro. Materiais e Métodos Neste estudo de corte transversal, foram incluídas parturientes submetidas à inserção de DIU de cobre no pós-parto imediato entre março de 2018 e dezembro de 2019. Foram coletados dados clínicos e da ultrassonografia (US) transvaginal realizada após seis semanas. As taxas de expulsão e de continuação foram avaliadas após seis meses por meio de dados do prontuário ou por contato telefônico. O resultado principal foi a proporção de DIUs expelidos em seis meses. Para análise estatística, utilizaram-se o teste t de Student, a distribuição de Poisson, e o teste do Qui quadrado. Resultados Houve 3,728 nascimentos no período, e foram inseridos 352 DIUs, em uma taxa de 9,4%. Com 6 semanas, o DIU estava bem posicionado em 65,1% dos casos, em 10,8%, houve expulsão parcial, e, em 8,5%, fora totalmente expelido. Aos 6 meses de pós-parto, foram obtidas informações de 234 mulheres, 74,4% das quais usavam DIU, com uma taxa de expulsão geral de 25,6%. A taxa de expulsão foi maior após o parto vaginal do que após cesariana (68,4% versus 31,6%, respectivamente; p = 0,031). Não houve diferenças quanto à idade, paridade, idade gestacional, índice de massa corpórea final, e peso do recém-nascido. Conclusão Apesar da baixa taxa de inserção e alta taxa de expulsão, a taxa de continuação em longo prazo da contracepção intrauterina com DIU de cobre foi elevada, o que indica que se trata de intervenção útil para prevenir gestações indesejadas em curto intervalo de tempo. (DIU pósparto pós brasileiro transversal 201 2019 US (US semanas telefônico estatística utilizaramse utilizaram Student Poisson quadrado 3728 3 728 3,72 período 35 94 9 4 9,4% 651 65 1 65,1 casos 108 10 8 10,8% parcial 85 5 8,5% expelido pósparto, parto, 23 mulheres 744 74 74,4 256 25 25,6% 68,4% 684 68 (68,4 316 31 31,6% respectivamente 0,031. 0031 0,031 . 0 031 0,031) paridade gestacional final recémnascido. recémnascido recém nascido. nascido recém-nascido elevada tempo 20 372 72 3,7 9,4 65, 10,8 8,5 2 7 74, 25,6 68,4 (68, 31,6 003 0,03 03 37 3, 9, 10, 8, 25, 68, (68 31, 00 0,0 (6 0, (

Abstract Objective Pelvic floor dysfunction can manifest as a spectrum including anorectal dysfunction, vaginal prolapse, and urinary incontinence. Sacrospinous fixation is a procedure performed by gynecologists to treat vaginal prolapse. The present study aims to evaluate the impact of transvaginal prolapse surgery on anorectal function. Materials and Methods We conducted a retrospective review of patients undergoing sacrospinous fixation surgery for vaginal prolapse between 2014 to 2020. Those with anorectal dysfunction who had also been evaluated by the colorectal service preoperatively and postoperatively were included for analysis. These patients were assessed with symptom-specific validated questionnaires. The effect of surgery on constipation and fecal incontinence symptoms was analyzed. Results A total of 22 patients were included for analysis. All patients underwent transvaginal sacrospinous fixation, and 95.4% also had posterior colporrhaphy for vaginal prolapse. There were a statistically significant improvements in the Fecal Incontinence Severity Index (FISI), the St. Mark’s Incontinence Score (Vaizey), the embarrassment and lifestyle components of the Fecal Incontinence Quality of Life Score, the Constipation Scoring System, the Obstructed Defecation Score, and components of the Patient Assessment of Constipation Quality of Life score. Conclusion Transvaginal prolapse surgery leads to a favorable effect on anorectal function, with improvements in both obstructed defecation and fecal incontinence scores in this small series. function 201 2020 analysis symptomspecific symptom specific questionnaires analyzed 2 954 95 4 95.4 FISI, FISI , (FISI) St Marks Mark s Vaizey, Vaizey (Vaizey) System score series 20 202 9 95. (FISI (Vaizey