Effect of routine pre-operative urethral catheterization of women undergoing minor gynaecological surgeries on urinary symptoms and urinary infections: a randomized control study

Background: The prevalence of urinary tract infection increases in young sexually active women, and women with previous UTI. Routine urethral catheterization performed for bladder evacuation before minor gynecological procedures and it is not clear whether this routine urethral catheterization associated with increased incidence of bacteriuria or UTIs or not. This study designed to detect the effect of routine uretheral catheterization for women undergoing minor gynecological surgeries on urinary symptoms and urinary infections.Methods: Two hundred and forty women infertile women scheduled for uterine assessment by diagnostic hysteroscopy before in-vitro fertilization in assisted reproduction unit of Ahmadi Hospital, Kuwait Oil Company were included in this study. Participants were randomized into; group I (catheterized group) and group II (non-catheterized group). Participants’ urine samples compared pre-operatively and post-operatively and they asked to complete about their pre and post-operative urinary symptoms.Results: Post-operative dysuria, frequency and urgency were significantly higher in catheterized group (22 (18.33%), 26 (21.66%) and 18 (15%); respectively) compared to non- catheterized group [5 (4.16%), 7 (5.83%) and 4 (3.33%); respectively]. Relative risk of dysuria, frequency and urgency after catheterization were 4.4, 3.7 and 4.5; respectively (95% CI; 1.7-11.2, 1.67-8.22 and 1.56-12.9; respectively). Asymptomatic bacteriuria, UTIs and subsequent need for antimicrobial therapy were also significantly high in catheterized group [15 (12.5%), 18 (15%) and 18 (15%); respectively) compared to non-catheterized group (3 (2.5%), 2 (1.96%) and 2 (1.96%); respectively]. Relative risk of asymptomatic bacteriuria and UTIs after catheterization in women undergoing minor gynecological procedures were 5 and 9; respectively (95%CI; 1.48-16.8 and 2.1-37.9).Conclusions: Catheterization in women undergoing minor gynecological surgery was associated with increased risk of dysuria, frequency, urgency, ASB, UTIs and subsequent antimicrobial therapy. Surgeons should revise the practice of routine preoperative catheterization for women undergoing minor gynecological procedures

Evaluation of infertile women: Mini-review

Evaluation of infertility indicated for women failed to conceive after one year of unprotected intercourse and for women over 35 years failed to conceive after 6 mo of unprotected intercourse, because the fertility decline as women approach 40 years. Evaluation of infertile couple should begin with semen analysis of male partner. If the semen analysis is within normal range, evaluation then move on to female partner. Evaluation of the infertile woman should be carried in cost-effective manner to identify the causes of infertility using the least invasive methods. Methods of evaluation of infertile women include: 1) history and physical examination; 2) evaluation of the male partner; 3) documentation of ovulation; 4) evaluation of the ovarian reserve; 5) evaluation of cervical causes of infertility; 6) evaluation of uterine causes of infertility; 7) documentation of the tubal patency; and 8) exclusion of peritoneal causes of infertility. Evaluation of infertile couple should include evaluation of both partners. Semen analysis for the male partner, followed by documentation of ovulation and evaluation of genital tract patency. PCT is not used as routine evaluation of infertile women. Laparoscopy is not used as routine evaluation of infertile women unless there is suspected peritoneal factors of infertility or endometriosis or tubal occlusion. Ovarian reserve should only be done for infertile women with diminished response to external gonadotropins (not routine)

Heme iron polypeptide (proferrin®-ES) versus iron saccharate complex (ferrosac) for treatment of iron deficiency anemia during pregnancy

Objectives: Anemia is one of the world's leading causes of considerable perinatal morbidity and mortality. This study designed to compare the efficacy and safety of Heme iron polypeptide (Proferrin®-ES) versus iron saccharate complex (Ferrosac) in treatment of iron deficiency anemia during pregnancy. Methods: Two hundred and sixty (260) pregnant women with hemoglobin level below 10 gm/dl due to iron deficiency anemia were included in this study and randomized to receive either; intravenous Iron Saccharate (IV group) or oral Proferrin®-ES (PO group) for correction of iron deficiency anemia during pregnancy. Treatment efficacy checked by comparing pre-treatment values of hemoglobin, serum ferritin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and reticulocytes count by the 3-months` post-treatment values. Results: The 3-months` post-treatment hemoglobin level increased compared to the pre-treatment level without any significant difference between the two studied groups (from 8.5 ± 3.5 to 11.3 ± 1.3 gm/dl in PO group and from 8.7 ± 2.5 to 11.7 ± 0.9 gm/dl in IV group). In addition; the 3-months` post-treatment ferritin level, increased compared to the pre-treatment level without any significant difference between the two studied groups (from 19.4 ± 4.9 to 118.8 ± 7.1 ug/l in PO group and from 15.3 ± 5.6 to 122.3 ± 6.4 ug/l in IV group). 1.6% (2/124) of the studied women developed gastrointestinal intolerance and upset with oral Proferrin®-ES (insignificant difference and excluded from the study) and no other side effects recorded with oral Proferrin®-ES. Conclusion: HIP (Proferrin®-ES) is an effective, safe, well tolerable oral iron preparation as well as intravenous iron saccharate complex for treatment of iron deficiency during pregnancy; it increases the hemoglobin and replaces the depleted iron store