Dina M. Habib

Hybrid septate uterus, coexistence of bicornuate and septate varieties: A genuine report

Aim:  To highlight the coexistence of a uterine septum in cases diagnosed as bicornuate uterus on the basis of the external shape of the uterine fundus and to present the outcomes of its hysteroscopic management.

Successful canalization of a noncommunicating uterine horn by horn-vaginal anastomosis: preliminary findings of a novel approach for an unclassified anomaly ☆

PURPOSE The aim of this study was to present the preliminary results of a new technique for horn-vaginal anastomosis. METHODS Horn-vaginal anastomosis without any dissection at the lower pole of the horn or vaginal apex at the site of anastomosis. This was followed by dilation and silicone stent retention for 4 months. RESULTS The patient was a 14-year-old presenting with primary amenorrhea and severe recurrent cyclic lower abdominal pain. The total operative time was 115 minutes. No operative complications were reported. The patient developed stenosis of the tract after 2 successive menstrual periods (MP). The third period was retained. Transvaginal dilatation of the communication tract was successfully accomplished, and a silicon stent was left in place for 5 successive MP. The patient is now menstruating in a regular pattern for 15 successive MP, and an office hysteroscopic examination showed a patent tract with a normal hemicavity leading to a normal tubal ostia. CONCLUSIONS Communication between a well-developed noncommunicating uterine horn and vagina was accomplished with successful establishment of the menstrual outflow tract. Regular menstrual pattern was successfully reestablished for 15 consecutive menstrual periods.

A rescue management plan for ruptured balloons during balloon vaginoplasty

OBJECTIVES To present the first repeat procedure and a simple way for management of balloon rupture during balloon vaginoplasty (BV) procedures. STUDY DESIGN Repeat BV (reBV) procedure was done for one case, and a ruptured catheters end to new catheters end (ENE) procedure was done for two cases. The anatomic and functional outcomes of reBV and ENE are presented. RESULTS Balloon rupture and deflation were encountered in a total of 3/45 cases who had undergone BV procedures. Replacement time was 22 min for reBV, and 9 and 10 min for ENE. General anesthesia was needed in the reBV case. Post-operative course and final outcomes were generally good but objectively less favorable in the ENE than in the reBV case (neovaginal depths were 8.5 and 9.4 cm versus 11 cm, respectively). Penetration and satisfaction scores were increased up 85 points for both couples. CONCLUSIONS Balloon ruptures were reported in 3/45 cases undergoing balloon vaginoplasty. End to new catheter end replacement was a very fast and simple rescue procedure but its preliminary anatomical outcomes were less favorable than the outcomes obtained with the original or repeat procedure.

Preoperative evaluation of patients with ovarian masses using the risk of malignancy index 4 model

Objective: To evaluate the performance of the RMI 4 in discriminating benign from malignant

Laparo endoscopic single site balloon vaginoplasty (LESS-BV).

OBJECTIVE To evaluate feasibility, advantages, and disadvantages of the laparo-endoscopic single site surgery (LESS) technique for balloon vaginoplasty (BV). STUDY DESIGN Cohort study. SETTING Tertiary care facility. RESULTS LESS-BV was successfully performed in 6 patients with Mullerian aplasia and one with androgen insensitivity syndrome (AIS). Patients presented with failure of intravaginal intercourse and/or dyspareunia. The procedure was performed successfully in conjunction with gonadectomy for the AIS case. The total operative time was 50-75 minutes. No operative complications were reported. Postoperative pain scores ranged from 0 to 2 points at rest and from 20 to 60 points during dressing change, increasing distension, and traction. The depths of the constructed neovaginas measured up to 12.8 cm. Sexual intercourse was initiated on the day of catheter removal. Penetrations and satisfactions scores increased to up 90 points for both partners. CONCLUSIONS LESS-BV is technically feasible. LESS-BV allows better, stronger midline and long traction pass along the anatomic longitudinal axis of the hypoplastic vagina. Surgical outcomes should be compared prospectively to conventional laparoscopic BV.