Double Approach (Laparoscopy and Hysteroscopy) Repair of Istmochele (Niche): Pendekatan Ganda (Laparoskopi dan Histeroskopi) untuk Memperbaiki Istmochele (Niche)

Objectives: Reported a case demonstrate the double approach repair of niche treatment through the hysteroscopy and laparoscopy technique.Methods: Case report. We reported a case starting from the patient admission untill 3 months postoperative condition.Case: A 33 years old woman came with abnormal uterine bleeding, already got medication and combine oral contraception pill, but the bleeding never stopped. We found a cavity (niche) filled by menstrual blood with thin lower uterine segment (just serous layer) from transvaginal ultrasound. We did hysteroscopy and laparoscopy approach. We illuminated the niche by hysteroscopy, then resected it by laparoscopy. Patient had a day hospital admission and no symptoms anymore after the procedure.Conclusion: Many treatment methods have been described for repair of niche with varies effectivities. Double approach (hysteroscopy and laparoscopy) technique was a minimal access, but optimal approach of niche resection with up to 100% effectivity.Keywords: abnormal uterine bleeding, caesarean scar defect, hysteroscopy, istmochele laparoscopy, niche   Abstrak Tujuan: Melaporkan sebuah kasus yang menggambarkan pendekatan ganda dalam memperbaiki niche dengan histeroskopi dan laparoskopi.Metode: Laporan kasus. Kami melaporkan sebuah kasus dimulai dari pasien masuk sampai dengan 3 bulan pascaoperasi.Kasus: Perempuan 33 tahun datang dengan perdarahan uterus abnormal, telah diberikan terapi obat dan pil kombinasi, namun perdarahan tidak berhenti. Dari ultrasonografi ditemukan rongga berisi darah menstrusasi dengan segmen bawah uterus yang tipis (hanya lapisan serosa). Kami melakukan pendekatan histeroskopi dan laparoskopi. Dilakukan iluminasi dengan histeroskopi, kemudian reseksi dengan laparoskopi. Perawatan pasien di rumah sakit selama satu hari, dan tidak terdapat keluhan pada pasien setelah tindakan.Kesimpulan: Terdapat banyak metode dalam tata laksana niche dengan efektivitas yang beragam. Pendekatan ganda dengan histeroskopi dan laparoskopi merupakan tehnik dengan akses minimal namun hasil optimal, dengan efektivitas hingga 100%.Kata Kunci: perdarahan uterus abnormal, defek skar sesar, histeroskopi, istmpchele, laparoskopi, niche &nbsp

The Effectiveness of Phalleria Macrocarpa Bioactive Fraction in Alleviating Endometriosis And/or Adenomyosis Related Pain

The overexpression of estrogen receptor-beta (ER-ß) and the cyclooxygenase-2 (COX-2) enzyme coupled with the absence of expression of progesterone receptors (PR) is critical to thepathogenesis of endometriosis and adenomyosis associated pain.  DLBS1442, a novel bioactiveextract of Phaleria macrocarpa, exerts its action by downregulating the overexpressed ER-ß andCOX-2 products and up-regulating PR gene expression. This pilot study was conducted to evaluatethe effectiveness of DLBS1442 treatment in alleviating endometriosis- and/or adenomyosis-relatedpain. Ten endometriosis and/or adenomyosis patients were recruited consecutively at YasminClinic Dr. Cipto Mangunkusumo General Hospital in January - March 2013. Pain associated withmenses, including pre-menstrual pain, dysmenorrhea, dyschezia and dysuria, was measuredusing the visual analog scale (VAS) at each of the next three menstrual cycles. Patients reportingone or more pain symptoms with a VAS score = 4 were given 100 mg of DLBS1442 three timesdaily for 12 weeks. VAS score reduction was noted in the first post-treatment menstrual cycle(approximately 5.3 weeks after treatment initiation) and VAS scores continued to decline overthe final two cycles. DLBS1442 was effective in alleviating endometriosis- and/ or adenomyosisrelatedpain, as demonstrated by early pain reduction as evaluated using the VAS

Terapi Laparoskopi Niche dan Asimptomatik Niche: Laporan Dua Kasus

Niche adalah gambaran hipoekoik di antara myometrium segmen bawah uterus yang menggambarkan diskontuinitas myometrium di tempat bekas operasi sesar. Angka kejadian niche meningkat seiring meningkatnya angka seksio sesarea, menimbulkan gejala Ginekologi seperti perdarahan, chronic pain, dismenorea, dan disparenea. Niche dapat diterapi secara konservatif maupun operatif. Kami melaporkan dua kasus niche dengan gejala berbeda. Kasus pertama dengan gejala perdarahan pasca menstruasi selama 3 tahun dan kasus kedua terdeteksi tanpa gejala. Pada kasus pertama dilakukan perbaikan dengan laparoskopi sedangkan pada kasus kedua tidak dilakukan intervensi. Tidak semua niche harus menjalani tindakan intervensi.A niche is a hypoechoic image between the myometrium in the lower uterine segment, illustrating myometrial discontinuity after a caesarean section. Niche incidence increases along with increasing caesarean section procedure, causing gynecological symptoms such as hemorrhage, chronic pain, dysmenorrhea, and dyspareunia. Niche is treatable, conservatively or surgery. We report two niche cases with different symptoms. The first was a woman with post-menstrual bleeding for three years, the second presented without any symptoms. The first patient was treated with laparoscopic surgery whereas the second did not receive any interventions. Not all niche cases need intervention