Rei Yokomizo

Treatment for prolapse of the sigmoid neovagina in Mayer-Rokitansky-Kuster-Hauser syndrome

BACKGROUND Colpopoiesis using the sigmoid colon may be used in treatment of patients with Mayer-Rokitansky-Kuster-Hauser syndrome. Prolapse of a sigmoid neovagina is rare and its treatment is not yet standardized. CASES Two patients developed severe prolapse of a neovagina derived from the sigmoid colon. One patient underwent resection of the redundant sigmoid and an abdominal suspension procedure; however, the prolapse has recurred. The other patient was treated by removal of the entire sigmoid artificial vagina. An alternative neovagina was reconstructed with a pudendal thigh flap. She has no signs of recurrent prolapse and is satisfied with sexual intercourse. CONCLUSION Replacement therapy by a connected skin graft may be an excellent optional method as a radical treatment for prolapse of a sigmoid neovagina.

Intraoperative injection of prostaglandin F2α in a patient undergoing hysteroscopic myomectomy

OBJECTIVE To present a case of one-step total hysteroscopic myomectomy using prostaglandin F(2alpha). DESIGN Case report. SETTING University hospital. PATIENT(S) A 38-year-old woman with a sessile submucous leiomyoma. INTERVENTION(S) Hysteroresectoscopy using an intraoperative injection of prostaglandin F(2alpha) under laparoscopic monitoring. MAIN OUTCOME MEASURES Endoscopic appearance, clinical symptoms, and imaging diagnosis. RESULT(S) After resection of the protruding portion of the myoma, injection of prostaglandin F(2alpha) was used to cause the remnant to project into the uterine cavity, allowing complete removal. CONCLUSION(S) Intraoperative use of prostaglandin F(2alpha) may allow one-step hysteroresectoscopy of a sessile submucous leiomyoma.

Risk factors for recurrence and re-recurrence of ovarian endometriomas after laparoscopic excision.

Aim:  Since ovarian endometrioma is frequently diagnosed in women of reproductive age, laparoscopic excision of the endometrioma is performed for most cases. However, endometriomas frequently recurs even after repeated surgical procedures. The aim of our study is to identify risk factors for recurrence and re‐recurrence of endometriomas after the first and second laparoscopic excision.

Predicting Outcome of One-Step Total Hysteroscopic Resection of Sessile Submucous Myoma

STUDY OBJECTIVE To analyze variables for successful 1-step hysteroscopic myomectomies of sessile submucous myomas. DESIGN Retrospective case-control study. (Canadian Task Force classification II-2). SETTING Single operators practice in a university hospital and its related hospitals. PATIENTS Twenty-eight patients with sessile submucous myomas and menorrhagia, infertility, or both. INTERVENTIONS Our strategy for hysteroscopic myomectomy is as follows. First, we scraped and/or vaporized intrauterine dome of myoma until top of myoma was even with level of wall of cavity. Next, the remnant intramural node was squeezed by uterine contractions induced by prostaglandin F2alpha injection. Finally, the newly raised myoma dome was sectioned or vaporized electrosurgically only within the space of the intrauterine cavity and/or was separated mechanically from healthy myometrium without electrosurgery. MEASUREMENTS AND MAIN RESULTS Submucous myomas in 16 (57.1%) patients were completely removed after 1 surgery. By logistic regression analysis, thickness of outer myometrial layer of myoma node (OR 3.06, p = .02), myoma size (OR 0.86, p = .04), and intramural extension degree (OR 0.91, p = .03) were significantly associated with outcome of complete resection. CONCLUSION Thickness of outer myometrial layer of myoma node, myoma size, and intramural extension degree predicted outcome of 1-step hysteroscopic myomectomy. The chance of performing successful surgery increased with increased thickness of outer myometrial layer of myoma, and decreased with larger myomas and greater degrees of intramural extension.

Prediction of Pregnancy in Infertile Women with Endometriosis

To estimate the probability of pregnancy in infertile women with endometriosis, two series of multivariate analyses were performed in Tohoku University Hospital. In the first series, from 1993 to 1997, 103 patients participated. The Cox proportional hazard regression model revealed a hazard ratio of 2.43 in patients with high ovarian adhesion scores. Bilateral ovarian adhesion was an important variable in anatomical factors, probably second only to bilateral tubal adhesion. In the next series, from 1998 to 1999, 23 patients were included, and the preoperative serum concentrations of cytokines, interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α were analyzed. Only TNF-α was selected with a forward stepwise analysis after forcing age and infertile duration. In the logistic regression model, the serum TNF-α level had a significant and negative impact on the likelihood of pregnancy.

Comparison of three surgical procedures for colpopoiesis in patients with Mayer-Rokitansky-Küster-Hauser syndrome

Mayer–Rokitansky–Kuster–Hauser (M–R–K–H) syndrome is a rare congenital anomaly of the female genital tract. A number of techniques have been described for the formation of a neovagina, however, a standardized treatment does not yet exist. To evaluate three surgical procedures for colpopoiesis in patients with M–R–K–H syndrome, we design a retrospective study based on record of clinical data in our university hospital. Eighteen patients with M–R–K–H syndrome were performed colpopoiesis by Ruges, McIndoes, and laparoscopically assisted Davydovs procedures. We compare with three surgical procedures in terms of operative success rate, operation time, total bleeding loss during operation, perioperative complication rate, and long-term complications. The postoperative vaginal depth showed no significant difference among the three procedures. Operation success rate was 50.0% in Ruges procedure, 88.9% in McIndoes procedure, and 100% in laparoscopically assisted Davydovs procedure. The duration of McIndoes ...