Youssef’s Syndrome - a complication of corrective surgery for mullerian anomaly

The presence of cervicovaginal agenesis with unicornuate uterus is a very rare mullerian anomaly. Presence of functioning unicornuate uterus poses as a great challenge for gynecologist, because a successful repair could restore normal menses and may preserve the patient’s fertility. Though, a complication of this surgery (utero-vaginal anastomosis) is Youssef’s Syndrome. We, hereby report a case of 16 year old unmarried female with complete cervicovaginal agenesis with unicornuate uterus, who initially underwent vaginoplasty (McIndoe’s) along with uterovaginal anastomosis in order to preserve her uterus, but subsequently required hysterectomy due to Youssef’s Syndrome

Efficacy and safety of the trans-obturator tape for female stress urinary incontinence

Background: To assess the safety and efficacy of Trans-obturator tape (TVT-O) for female stress urinary incontinence (SUI).Methods: A cohort of 35 cases of SUI and underwent TVT-O procedure over a period of 4 years. Pre-operative evaluation included pelvic examination, one hour pad test, urodynamic study, urinary diary and baseline haematological tests. Post-operatively all women had post-void residual volume and were followed up for 3 years.Results: The mean age of the patients was 47±9.5 years. TVT-O alone was done in 58.1% of cases. 41.9% of cases had TVT-O done as a concomitant procedure. The median duration of follow-up was 48 months. The overall objective and subjective cure rate was 92.3% with failure rate of 7.7%, 12.9% of women reported post-operative thigh pain and 6.5% patients had immediate post-operative urinary retention. 16.1% of the patients had post-operative voiding dysfunction. No major complications were encountered in these patients.Conclusions: TVT-O is a safe, easy and effective minimally invasive procedure for female SUI with minimal acceptable complications

Case series of paediatric adnexal torsion: rare yet urgent entity

Ovarian torsion is a true emergency which warrants early diagnosis and timely surgical management to avoid the catastrophic consequences of further adnexal injury. In paediatric population, this is especially dangerous as the condition can go undiagnosed because of its rarity and nonspecific presentation of disease. This leads to delay in surgical exploration and loss of ovarian function. We encountered 6 cases of ovarian torsion in paediatric age group during a period of 2 years, at a tertiary care hospital in Ahmedabad. After enquiry of the symptoms and a series of investigations, a provisional diagnosis of torsion ovary was made and they were taken up for surgery. Intra-operatively all the patients were found to have non-salvageable ovary and fallopian tube on the affected side, and subsequently they underwent salpingo-oophorectomy. Diagnosis of ovarian torsion requires clinician awareness and a high degree of suspicion. Conservative surgery, in the form of ovarian detorsion can be tried in cases of ischemia but if ovarian necrosis has occurred, then salpingo-oophorectomy is performed as the last resort

Unicornuate uterus and pregnancy outcome: a case report

Mullerian duct anomalies (MDAs) are congenital defects of the female genital tract that arise from abnormal embryological development of the Mullerian ducts. Unicornuate uterus with or without rudimentary horn is developmental anomaly which occurs due to abnormal or failed development of one of the paired mullerian duct or fusion of the ducts. Women with unicornuate uterus have increased incidence of obstetric complications like spontaneous abortions, preterm delivery and intrauterine foetal demise and gynaecological complications like infertility, endometriosis and dysmenorrhoea. A 25 years old, primigravida was admitted at 38 weeks 3 days gestational age with complaints of leaking per vaginum. She was induced with PGE2 gel under antibiotic coverage to prevent chorioamnionitis. She underwent emergency caesarean section for failure to progress and intra-operatively she was incidentally found to have unicornuate uterus with contralateral fallopian tube directly getting attached to the ovary. The baby cried immediately after birth, though it was growth retarded (IUGR). If pregnancy with unicornuate uterus is managed well, it can result in favourable obstetric outcome

Uterine conserving surgery in a case of cervicovaginal agenesis with cloacal malformation

Cervico-vaginal agenesis (MRKHS) with normally formed uterus along with cloacal malformation is a very rare mullerian anomaly. We report a case, of a 13-year-old girl who was admitted at our tertiary care center with complaints of primary amenorrhea and cyclical lower abdominal pain for 3 months. Clinical examination and radiological investigations revealed complete cervico-vaginal agenesis with normal uterus with hematometra with horse shoe kidney. Vaginoplasty was done by McIndoe’s method with uterovaginal anastomosis and neocervix formation. Malecot’s catheter was inserted in uterine cavity. Vaginal mould was kept in the neovagina. Mould was removed after 10 days under anaesthesia and repeat hysteroscopy with insertion of a small piece of malecot’s catheter was performed under hysteroscopic guidance into the uterine cavity through neocervix and lower end fixed to the vagina. After 3 months, the malecot’s catheter was removed. During follow up, she was menstruating normally at 6 months post-operatively and had a completely healed vaginal mucosa. Earlier hysterectomy was considered as a definitive surgery for this condition; however, it has been replaced with more conservative approach, like uterovaginal anastomosis with creation of neovagina. In literature, successful pregnancy has been reported in these patients who underwent conservative surgery

Acute kidney injury due to bilateral urolithiasis in pregnancy: a case report

Kidney stones are very common and unfortunately do not spare the pregnant population. Anatomical and pathophysiological changes occur in the pregnant females that alter the risk for development of urolithiasis. Acute renal colic during pregnancy is associated with significant potential risks to both mother and fetus. Diagnosis is often challenging because good imaging options without radiation use are limited. Management of diagnosed urolithiasis is unique in the pregnant population and requires multi-disciplinary care. Herein, we report a case of pregnancy which occurred in a state of pre-existing bilateral renal calculi with compromised renal function which subsequently developed into acute kidney injury, and requiring definitive management in the form of PCNL after termination of pregnancy

Ovarian hyperstimulation syndrome and pulmonary edema – a rare complication

Background: Ovarian Hyperstimulation Syndrome (OHSS) is a life-threatening complication of controlled ovarian stimulation almost exclusively associated with gonadotropins but occasionally with clomiphene citrate. Prevention of this syndrome lies in the recognition of risk factors and individualizing the treatment regimens. Causes of respiratory distress in patients with OHSS are pleural effusion, pulmonary embolism, and acute respiratory distress syndrome (ARDS). Pulmonary edema is rare but a grave complication of OHSS.Case report: We report, a case of severe OHSS with tense ascites and anasarca after controlled ovarian hyperstimulation (COH) for IVF. She was managed conservatively followed by paracentesis after which she developed pulmonary edema during the course of the treatment.Conclusion: OHSS is an iatrogenic complication which can be prevented by individualizing stimulation protocols and should be managed urgently with a multidisciplinary approach

Youssef's Syndrome - a complication of corrective surgery for mullerian anomaly

The presence of cervicovaginal agenesis with unicornuate uterus is a very rare mullerian anomaly. Presence of functioning unicornuate uterus poses as a great challenge for gynecologist, because a successful repair could restore normal menses and may preserve the patient’s fertility. Though, a complication of this surgery (utero-vaginal anastomosis) is Youssef’s Syndrome. We, hereby report a case of 16 year old unmarried female with complete cervicovaginal agenesis with unicornuate uterus, who initially underwent vaginoplasty (McIndoe’s) along with uterovaginal anastomosis in order to preserve her uterus, but subsequently required hysterectomy due to Youssef’s Syndrome

Forgotten Lippes loop in menopausal woman left in utero for 45 years: a case report

Intrauterine contraceptive devices are extremely effective and long lasting. They were intended for long term use and were retained for year’s altogether. Menopausal ladies often present with Lippes Loop in situ either deliberately or forgotten. We report a case of 80 years old patient who came with complaints of pain in lower abdomen and vaginal discharge and had Lippes Loop insitu, which was inserted 45 years back. The inserted Lippes Loop thread was not seen in clinical examination but visualized on Transvaginal Ultrasonography along with pyometra. It was removed under hysteroscopic guidance

Case series of paediatric adnexal torsion: rare yet urgent entity

Ovarian torsion is a true emergency which warrants early diagnosis and timely surgical management to avoid the catastrophic consequences of further adnexal injury. In paediatric population, this is especially dangerous as the condition can go undiagnosed because of its rarity and nonspecific presentation of disease. This leads to delay in surgical exploration and loss of ovarian function. We encountered 6 cases of ovarian torsion in paediatric age group during a period of 2 years, at a tertiary care hospital in Ahmedabad. After enquiry of the symptoms and a series of investigations, a provisional diagnosis of torsion ovary was made and they were taken up for surgery. Intra-operatively all the patients were found to have non-salvageable ovary and fallopian tube on the affected side, and subsequently they underwent salpingo-oophorectomy. Diagnosis of ovarian torsion requires clinician awareness and a high degree of suspicion. Conservative surgery, in the form of ovarian detorsion can be tried in cases of ischemia but if ovarian necrosis has occurred, then salpingo-oophorectomy is performed as the last resort