Uterosacral Nerve Ablation and Presacral Neurectomy in the Treatment of Chronic Pelvic Pain in Women

Chronic pelvic pain affects 2–24% of women in the reproductive period. There are various causes of chronic pelvic pain in women including gynecologic, urologic, gastrointestinal, and musculoskeletal problems. The treatment of pain is directed toward the underlying pathology. However, in some cases, no pathology can be found, and sometimes, more than one underlying pathology may be found in the same patient. Surgical denervation methods may be used in the treatment of chronic pelvic pain in women including uterosacral nerve ablation and presacral neurectomy. Uterosacral nerve ablation has been used as a treatment method for uterine causes of pelvic pain. It has been used widely in the treatment of dysmenorrhea- and endometriosis-related pain. But recent randomized studies and meta-analysis have questioned the effect of uterosacral nerve ablation in the treatment of chronic pelvic pain. Presacral neurectomy involves damage of the uterine sympathetic innervation at the level of superior hypogastric plexus. It is effective in the treatment of midline pelvic pain. It has been found to be more effective than laparoscopic uterosacral nerve ablation in a randomized study. The method, effect, and studies evaluating uterosacral nerve ablation and presacral neurectomy will be discussed in this chapter

Adjustable Midurethral Slings in the Treatment of Female Stress Urinary Incontinence

Midurethral slings have become the gold standard in the surgical treatment of stress urinary incontinence (SUI). However, despite the high cure rates with these procedures, nearly 20% of the patients are incontinent after surgery. On the other hand, in a small percentage of women, voiding dysfunction may develop after surgery. Adjustable slings have been advocated in patients who fail an anti-incontinence surgery or have intrinsic sphincter deficiency (ISD) or in order to prevent postoperative voiding dysfunction. There are various options of adjustable slings according to the surgical route or the type of mesh used

A Rare Dermatologic Disease in Pregnancy: Rosacea Fulminans- Case Report and Review of the Literature

BACKGROUND: Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Skin involvement primarily affects the central face, with findings such as persistent centrofacial redness, papules, pustules, flushing, telangiectasia, and phymatous skin changes. The pathways that lead to the development of rosacea are not well understood. The relationship of pyoderma faciale (also known as rosacea fulminans) to rosacea also is uncertain. We aimed to write this article with the aim of showing how a pregnant patient who has been aggravated by the degree of lesions on the face during the first trimester of pregnancy is treated and to show what is in the literature in this issue.CASE REPORT: A 22-year-old woman complained of painful erythema, papules and pustules on the face. She had fever and malaise during the sixth week of her first pregnancy and a history of the mild eruption and seborrhea before her pregnancy with flaring over the preceding 4 weeks. Dermatologic examination revealed red erythema of all involved facial areas; the lesions consisted of papules, pustules and nodules. The case was diagnosed as rosacea fulminans (pyoderma faciale) by these findings. In the literature, there are some effective therapeutic options such as retinoids, tetracyclines, antiandrogenic contraceptives, and dapsone and these were not used because they are contraindicated in pregnancy. Amoxicillin-clavulanic acid 1 gr/day, wet compresses, and a fusidic acid cream were started. After the activity of the disease had been suppressed for 10 days, antibiotic was stopped, and the other treatment options were applied topically for the next month. One month after cessation of treatment, the lesions had disappeared with only mild erythema remaining. There was minimally flushing on the face and no telangiectasia.CONCLUSION: In conclusion, there is no substantial evidence as to the mechanism by which pregnancy may trigger this conditioner whether the gender of the fetus influences the development of rosacea fulminans, but is generally accepted that hormonal changes in pregnancy play an important role. The pathogenesis of rosacea fulminans remains uncertain, but it is obvious that the further basic and clinical research is required to optimise the management of this rare facial dermatosis

Contraception counselling during gynecology visit — does a questionnaire help?

Objectives: Women are at risk of unplanned pregnancy and inappropriate choice of contraception if not given effectivecontraception counselling. We aimed to understand the contraceptive needs of women, improve effective contraceptioncounselling promoting modern contraception methods during gynecology outpatient visit using a contraception counsellingquestionnaire.Material and methods: All reproductive-age women over 18 were given Contraception Counselling Project Form to fill inwhile in the waiting room. The form consisted of 15 questions evaluating patients’ characteristics and contraceptive methodused. Physicians evaluated these forms during the examination and an appropriate method was chosen. Forms of pregnant,postmenopausal and sexually inactive patients as well as forms with more than one answer missing were excluded.Results: 778 questionnaires were accepted for evaluation. 340 women (43.8%) used modern contraception, 112 (14.4%)used interrupted coitus, 3 (0.4%) used calendar method. 738 women could be given adequate contraception counsellingby the physicians. 215 women among 323 women (66.5%) who did not use modern contraception and did not desirepregnancy, were convinced to use modern contraception and 103 (91.9%) among 112 women who used interruptedcoitus for contraception were convinced to use modern contraception. There was a significant relationship between age,education, working state, parity, number and type of delivery, previous OCP usage, resources of contraception and thepreferred contraception method.Conclusions: More than half the women preferred to use modern contraception methods by means of contraceptioncounselling questionnaire. Women’s backgrounds significantly affected their choice of contraception method

COMPLICATIONS OF MIDURETHRAL SLING OPERATIONS

Midurethral sling operations are the most commonly performed surgeries in the treatment of stress urinary incontinence. Midurethral sling surgeries are minimally invasive with high success rate and rare complications. However; the type of complications encountered are different than other incontinence surgeries. The complications may be classified as intraoperative, early, and late complications. In this review, the complications encountered, preventive measures and management will be discussed

External validation of a model predicting de novo stress urinary incontinence after pelvic organ prolapse surgery

Aims De novo stress urinary incontinence (SUI) may develop after surgical correction of advanced pelvic organ prolapse (POP) in otherwise continent women. Prediction of which women with POP will develop SUI after the prolapse is corrected is difficult. We aimed to externally validate a previously described prediction model for de novo SUI after performing vaginal surgery for POP and to assess its clinical performance when used as a diagnostic test

THOUGHTS AND ATTITUDES TOWARD URINARY INCONTINENCE IN TURKEY

Objective: Our aim is to evaluate the thoughts and attitudes toward urinary incontinence in Turkey

MEDICAL TREATMENT OF LEIOMYOMAS

Leiomyomas are the most common benign gynecological tumors observed during the reproductive period. Although, they are exceedingly common, not all are symptomatic. Leiomyomas are of genetic or hormonal origin and have estrogen and progesterone receptors, making them sensitive to hormones. The main treatment for leiomyomas is surgery, but in women who are not willing to undergo surgery or who want to preserve their fertility, medical treatment options may be used. The main basis of medical treatment in leiomyomas are hormones due to positive response to anti-hormonal therapies. Medical treatment options comprise gonadotropin-releasing-hormone agonists and antagonists, aromatase inhibitors, and selective progesterone receptor modulators. In addition to controlling bleeding, these treatment regimens cause a decrease in the volume of the tumor. In this review, treatment options are discussed

The Effectiveness Of Trigger Point Treatment In Chronic Pelvic Pain; A Pilot Randomised Controlled Trial

Objective:To investigate the effectiveness of ischemic compression and low-level laser therapy methods combined with exercise on the myofascial trigger points in women with Chronic Pelvic Pain and to determine which method is more effective. Methods:It was a parallel designed, single-blind pilot randomized clinical trial. Patients were recruited at physiotherapy laboratory of the Istanbul University from September 2017 to June 2019. Twenty-eight women patients with Chronic Pelvic Pain were included into the trial. Patients were randomized into two groups. Group 1 received ischemic compression and Group 2 received low-level laser therapy twice a week for 6 weeks. Both groups received the same standard exercise program. Pain, range of motion, pelvic floor symptom severity, quality of life, satisfaction, anxiety, and depression were assessed after 6 weeks, and 1-year follow up. Results:Following the treatment, significant differences were observed within both group subjects in pain, range of motion, symptom severity, quality of life, and anxiety-depression (p < 0.05). This significant improvement in pain, symptom severity, symptoms related quality of life and pain subgroup of Short Form 36, continued after 1-year follow up (p < 0.05). In comparison between group, Group 1 have more significant improvement than Group 2 in terms of symptoms related quality of life (p < 0.05). Conclusion:Both methods have shown efficacy and can be used safely in chronic pelvic pain patients. Because it is more effective on symptoms related quality of life, the ischemic compression method may be preferred for primary use