G Rubattu

Sonovaginography is a new technique for assessing rectovaginal endometriosis

OBJECTIVE To evaluate the efficacy of a new technique, the sonovaginography, for the assessment of rectovaginal endometriosis. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Forty-six women were scheduled for laparotomic or laparoscopic surgery because of rectovaginal endometriosis suspected on the basis of patient history and/or clinical examination. INTERVENTION(S) Before surgery, all the women underwent transvaginal ultrasonography and then sonovaginography. The latter is based on transvaginal ultrasonography combined with the introduction of saline solution to the vagina that creates an acoustic window between the transvaginal probe and the surrounding structures of the vagina. Ultrasound findings were compared with the results of surgical exploration and histological examination. MAIN OUTCOME MEASURE(S) We assessed the accuracy of transvaginal ultrasonography and of sonovaginography for the detection and the location and extension assessment of rectovaginal endometriotic lesions, as well as compared patient compliance between the procedures. RESULT(S) Sonovaginography diagnosed rectovaginal endometriosis more accurately than did transvaginal ultrasonography, with a sensitivity and specificity of 90.6% and 85.7%, respectively, whereas the transvaginal ultrasonography has shown a sensitivity and specificity of 43.7% and 50%, respectively. Patient discomfort did not differ significantly between the procedures. CONCLUSION(S) Sonovaginography is a reliable and simple method for the assessment of rectovaginal endometriosis and provides information on location, extension, and infiltration of the lesions, which are important factors in selecting the kind of surgery.

Efficacy of low-dose intravaginal estriol on urogenital aging in postmenopausal women

Objective To assess the efficacy and safety of intravaginal estriol administration on urinary incontinence, urogenital atrophy, and recurrent urinary tract infections in postmenopausal women. Design Eighty-eight postmenopausal women with urogenital aging symptoms were enrolled in this prospective, randomized, placebo-controlled study. Participants were randomly divided into two groups, with each group consisting of 44 women. Women in the treatment group received intravaginal estriol ovules: 1 ovule (1 mg) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy. Women in the control group received inert placebo vaginal suppositories in a similar regimen. We evaluated urogenital symptomatology, urine cultures, colposcopic findings, urethral cytologic findings, urethral pressure profiles, and urethrocystometry before as well as after 6 months of treatment. Results After therapy, the symptoms and signs of urogenital atrophy significantly improved in the treatment group in comparison with the control group. Thirty (68%) of the treated participants, and only seven (16%) of the control participants registered a subjective improvement of their incontinence. In the treated participants, we observed significant improvements of colposcopic findings, and there were statistically significant increases in mean maximum urethral pressure, in mean urethral closure pressure as well as in the abdominal pressure transmission ratio to the proximal urethra. Urethrocystometry showed positive but not statistically significant modifications. Conclusions Our results show that intravaginal administration of estriol may represent a satisfactory therapeutic choice for those postmenopausal women with urogenital tract disturbances who have contraindications or refuse to undergo standard hormone therapy.

Side effects and complications of sonohysterosalpingography

OBJECTIVE To evaluate the side effects and complications of, difficulties with, and possible solutions to the problems associated with sonohysterosalpingography. DESIGN Prospective study. SETTING University hospital. PATIENT(S) One thousand, one hundred fifty-three patients who underwent sonohysterosalpingography to investigate abnormal uterine bleeding, infertility, thick endometrium at transvaginal ultrasonography, müllerian abnormalities, or the Asherman syndrome. MAIN OUTCOME MEASURE(S) Side effects and complications of and difficulties related to the procedure. Tolerance was assessed by using a pain-rating scale. RESULT(S) Ninety-three percent (1,074 of 1,153) procedures were performed correctly. Investigation was not completed in 79 (7%) women; a second attempt was successful in 60 of these patients. Side effects, such as moderate or severe pelvic pain, vasovagal symptoms, nausea, and vomiting, occurred in 102 (8.8%) women. Such complications as fever and peritonitis occurred in 0.95% of patients. CONCLUSION(S) Sonohysterosalpingography is a simple, safe, and well-tolerated technique that has a low rate of side effects and rare complications.

P108: Transvaginal sonohysterography for the assessment of postpartum residual trophoblastic tissue: is a safe procedure?

cases (16.2%). Resolution occurred in 94.5% of the cases with a primary success rate of 91.8%. Only one case required multiple doses (2.8%). The mean time of resolution was 21.03 ± 8.95 days. Surgical treatment (salpingectomy) was necessary in 2 cases (5.4%). As for the reproductive outcome, 27 cases were eligible for the analysis. The overall pregnancy rate was 44.4% (12/27) with a 3.7% rate of recurrent ectopic pregnancy. Tubal patency was assessed in 19 cases. It was preserved in 84.2% (16/19). Conclusion: According to the studies in literature, our results support the use single dose MTX for the treatment of unrupted tubal pregnancy in carefully selected cases.