Ajay Rane

The presentation and early diagnosis of the rudimentary uterine horn

OBJECTIVE: The key to successful management of the rudimentary uterine horn is early detection. This review of the literature seeks to illustrate important aspects of diagnosis and management of this anomaly. DATA SOURCES: An English language MEDLINE search from 1966 to 2003 was performed, using the search terms “rudimentary uterine horn,” “accessory horn,” “uterus bicornis unicollis,” “hematometra,” “unicornuate or bicornuate uterus,” and “müllerian anomaly.” References from previously published sources were also obtained. METHODS OF STUDY SELECTION: One hundred thirty letters, case reports, case series, and review articles featuring rudimentary uterine horn were found. Reports before 1966 were excluded because outcomes before the advent of modern diagnostic techniques were not relevant to this study. TABULATION, INTEGRATION, AND RESULTS: Three hundred sixty-six rudimentary horn presentations (210 gynecologic and 156 obstetric) were found. Noncommunicating horns accounted for 92% of cases (95% confidence interval [CI] 88–95%, P < .001), and renal anomaly was found in 36% (95% CI 29–44%). Contrary to the American Fertility Society classification of uterine anomalies, rudimentary horns may occur without a corresponding unicornuate uterus. The mean age of presentation was similar for gynecologic and obstetric presentations (23 and 26 years, 95% CIs 21.2–24.6 and 124.9–27.3 years, respectively). Presentation in the third decade of life or later occurred in 78% of patients (95% CI 70–84%, P < .001). Sensitivity of ultrasound examination for diagnosis was 26% (95% CI 18–36%). Diagnosis before clinical symptoms occurred in 14% (95% CI 7–23%). CONCLUSION: Many functional noncommunicating horns present during or after the third decade of life with acute obstetric uterine rupture. Surgical removal before pregnancy is recommended. Rates of prerupture diagnosis remain disappointingly low.

Suburethral slingplasty evaluation study in North Queensland, Australia: The SUSPEND trial

Objective:  To compare the safety and efficacy of three types of suburethral slings for the treatment of urodynamic stress incontinence.

Two-dimensional and three-dimensional ultrasound imaging of suburethral slings

Suburethral slings have become the most commonly performed anti‐incontinence procedures in many developed countries. Three types of implant account for the majority of such surgery in Australia: tensionless vaginal tape (TVT), suprapubic arc procedure (SPARC) and intravaginal slingplasty (IVS). The aim of this study was to determine differences in position and mobility of these implants, and to determine whether such differences explain variations in clinical outcome.

Use of Ligasure™ Bipolar Diathermy System in vaginal hysterectomy

The use of Ligasure™, a computer-controlled bipolar diathermy system is proven beneficial in a wide range of surgical procedures. This study was to evaluate its application to vaginal hysterectomy. Over forty patients underwent vaginal hysterectomy with (n = 32) or without (n = 12) Ligasure™ using standard surgical techniques. The main diagnoses, the age of patients, time for surgery, hospital stay and estimated blood loss during operation were compared. The average operating time was shorter in the Ligasure™ vaginal hysterectomy group (30 mins (24 – 48) P < 0.05), the estimated blood loss was less in the Ligasure™ hysterectomy group (39 mins (25 – 60) P < 0.05), and the hospital stay was shorter in the Ligasure™ hysterectomy group (1.2days (1 – 2) vs 3 days (3- 5) P < 0.05). There were no postoperative complications or re-admissions in either group. Vaginal hysterectomy using Ligasure™ reduced operating time and blood loss, and therefore shortened hospital stay.

Transobturator mesh for cystocele repair: a short- to medium-term follow-up using 3D/4D ultrasound

Anterior colporrhaphy has been shown to have limited medium‐term success rates in cystocele repair. Many clinicians use mesh implants, but their safety and efficacy are controversial. We therefore performed an external surgical audit using three‐ and four‐dimensional pelvic floor ultrasound to study the short‐ to medium‐term results of transobturator mesh placement.

Prospective study of the Perigee system for the management of cystocoeles – Medium-term follow up

Objectives:  The Perigee transobturator cystocoele repair system (AMS) was designed and first used in Townsville, Australia. This prospective study evaluates the efficacy and safety of this device for the management of cystocoeles.

Thyroid function and pregnancy: before, during and beyond.

Thyroid disturbances are common in women during the reproductive years of their lives. Autoimmunity and altered iodine status together account for a high proportion of the abnormalities. Autoimmune thyroid disease is present in around 4% of young females, and up to 15% are at risk because they are thyroid antibody-positive. There is a strong relationship between thyroid immunity on the one hand and infertility, miscarriage, and thyroid disturbances in pregnancy and postpartum on the other hand. Suboptimal iodine status affects a large proportion of the worlds population, and pregnancy further depletes iodine stores. There is controversy surrounding the degree to which iodine should be supplemented and the duration of supplementation. Recent studies have helped to clarify the relationship between maternal thyroid status and neuropsychological development of the child. The role of other environmental factors including smoking and selenium status is also now recognised. Universal screening for thyroid hormone abnormalities is not routinely recommended at present. However, measurement of thyroid function and autoantibodies should certainly be considered in those who are at high risk of thyroid disease and in those whose pregnancy is otherwise high risk. The practicing clinician needs to be aware of the thyroid changes which accompany pregnancy.

Magnetic resonance imaging findings following three different vaginal vault prolapse repair procedures: A randomised study

Objective:  To compare the vaginal configuration on magnetic resonance imaging following transvaginal sacrospinous fixation (SSF), posterior intravaginal slingplasty (PIVS) (infracoccygeal sacropexy) and sacrocolpopexy (SCP).

Is levator avulsion a predictor of cystocele recurrence following anterior vaginal mesh placement

Levator avulsion has been shown to be a predictor of cystocele recurrence following anterior colporrhaphy. The aim of this study was to determine if levator avulsion is a risk factor for prolapse recurrence following anterior colporrhaphy with mesh.

Transobturator tape for stress incontinence: The North Queensland experience

A prospective observational study of 96 patients undergoing insertion of the MONARC transobturator tape (American Medical Systems, Minnetonka, USA) for treatment of urodynamic stress incontinence was conducted to investigate its’ the safety and efficacy. Although there were no major intraoperative complications, sling protrusion was observed in 11/91 patients (12.1%) at early follow up visits. At these visits, 80 women (87.9%) were either completely or substantially continent and 74 women (81.3%) were satisfied with the operation. Objectively, 74 women (81.3%) were cured on urodynamic assessment and only one woman (1.1%) was found to have voiding dysfunction. As a conclusion, it would appear that this new technique is effective for the treatment of stress incontinence; but further studies are needed to investigate its long‐term results and complications.