Induction of labor with cervical ripening balloon associated with oral misoprostol: an observational study comparing sequential and concurrent administration.

Background: The association of cervical ripening balloons (CRB) and misoprostol for induction of labor (IoL) is frequently used, although there is poor evidence about the optimal timing and protocol for their combination. The aim of this study was to compare a concurrent and a sequential scheme for administration of oral misoprostol in association with CRB, in terms of mode and timing of delivery and rate of adverse events.

Methods: This was an observational study comparing two consecutive cohorts of women with unfavorable cervix undergoing IoL by means of double-balloon CRB combined with oral misoprostol, with either a sequential scheme (retrospective cohort, N.

Intravaginal prasterone for urinary urgency in postmenopausal women without urodynamic detrusor overactivity.

Objectives: Symptoms of an overactive bladder are frequently reported in women with genitourinary syndrome of menopause. Despite a frequent association with detrusor overactivity, urodynamic assessment does not always reveal this condition, which suggests a leading role for increased bladder mucosal sensitivity due to hormone deprivation in producing urinary symptoms. The present study assessed the effects of intravaginal prasterone on urgency symptoms in those patients receiving treatment for concurrent vulvovaginal atrophy.

Nodal staging in high and high-intermediate risk endometrial cancer surgery: Which role in the molecular classification era?

Objectives: Nodal staging contributes to risk group definition and the indication to adjuvant treatment in endometrial cancer (EC) patients. However, the role of nodal assessment evolved and requires redefinition. Primary outcome of the study was to assess the impact of surgical nodal staging in defining high-risk (HR) EC.

Ultrasonographic diagnosis of adnexal masses: interobserver agreement in the interpretation of videos, using IOTA terminology.

Objectives: Aim of this study is to estimate interobserver agreement in classifying adnexal tumors using IOTA terms, simple rules and subjective assessment. In addition, we related observers' accuracy with their experience in gynecological ultrasonography and the year of IOTA certification.

Methods: Eleven observers with three different levels of experience evaluated videoclips of 70 adnexal masses, defining tumor type according to IOTA terms and definitions, classifying the mass using IOTA Simple rules and Subjective assessment as well as providing Color Score evaluation.

Straining to void at preoperative urodynamic study as a risk factor for prolapse recurrence after surgery.

Objectives: Straining to void is the need to make a muscular effort in order to initiate, maintain or improve the urinary stream, through an increase in abdominal pressure. This pattern of bladder emptying is frequently observed in women with pelvic organ prolapse causing urinary obstruction, to overcome the increased resistance to urine flow. However, frequent increases in abdominal pressure are a risk factor for developing pelvic organ prolapse, and might play a role in its recurrence after surgery.

Clinical, Sonographic, and Hysteroscopic Features of Endometrial Carcinoma Diagnosed after Hysterectomy in Patients with a Preoperative Diagnosis of Atypical Hyperplasia: A Single-Center Retrospective Study.

Background: atypical endometrial hyperplasia (AEH) is a precancerous condition implying a high risk of concurrent endometrial cancer (EC), which might be occult and only diagnosed at postoperative histopathological examination after hysterectomy. Our study aimed to investigate potential differences in preoperative clinical, sonographic, and hysteroscopic characteristics in patients with AEH and postoperative diagnosis of EC.

Methods: a retrospective single-center study was carried out on a case series of 80 women with AEH undergoing diagnostic workup, including ultrasonography and hysteroscopy, with subsequent hysterectomy.

End-to-end versus side-to-end anastomosis after bowel resection for deep infiltrating endometriosis: A retrospective study.

Objective: Deep infiltrating endometriosis(DIE) of the bowel may require segmental bowel resection. The subsequent reconstruction can be performed through an end-to-end(E-E) or a side-to-end (S-E)anastomosis, the latter being used in low resection due to the reduced risk of anastomotic leakage. This study aims at comparing those two anastomosis techniques in women submitted to bowel resection for DIE, in terms of post-operative morbidity and functional outcomes.

Fixation of uterosacral ligaments to anterior vaginal wall during modified McCall culdoplasty after vaginal hysterectomy.

Objectives: McCall culdoplasty is a commonly performed procedure for pelvic organ prolapse surgical repair; despite its good efficacy, however, anterior prolapse recurrence frequently occurs. The aim of our study was to verify whether fixation of utero-sacral ligaments (USLs) to anterior vaginal wall during a modified McCall culdoplasty (MMC) could reduce the rate of anterior recurrence of prolapse.

Study Design: This was a retrospective study on women submitted to MMC after vaginal hysterectomy and anterior colporraphy for prolapse repair.

Could a 2D/3D US based model be helpful in the assessment of myometrial invasion at time of intraoperative frozen section? A pilot study.

Background: The assessment of myometrial invasion is a pivotal step in the preoperative staging of endometrial cancer. Intraoperative frozen section (FS) represents a reliable tool in directing surgeon's choices. Preoperative transvaginal ultrasound (US) showed high accuracy in evaluating myometrial invasion.

Estradiol/nomegestrol acetate as a first-line and rescue therapy for the treatment of ovarian and deep infiltrating endometriosis.

Purpose: Estradiol valerate/nomegestrol acetate (E2V/NOMAC) is a new combined oral contraceptive with a good tolerability profile and low drop-out rates, which was shown to improve menstrual-related symptoms. This study aims to evaluate its effectiveness in the control of symptoms and progression of disease in women with ovarian endomestriomas and deep infiltrating endometriosis (DIE).

Methods: This was a retrospective cohort study on 39 women with pelvic endometriosis treated with E2V/NOMAC.

Sonographic features of endometriosis infiltrating the lateral parametrium.

Objective: Lateral parametrium endometriosis (LPE) can be associated with infiltration of ureters and hypogastric plexus, causing severe painful symptoms and functional impairment, and requiring complex and extensive surgery. The aim of this study was to evaluate the presentation of LPE lesions at transvaginal ultrasound, identifying sonographic features for disease recognition and mapping.

Methods: This was a retrospective case-series of women with sonographic suspect of LPE confirmed at surgical exploration.

Fractional CO₂ vaginal laser for the genitourinary syndrome of menopause in breast cancer survivors.

Adjuvant chemotherapy and endocrine therapy can induce early iatrogenic menopause or worsen pre-existing menopausal symptoms in breast cancer survivors (BCS). The second most frequent menopausal symptom after hot flushes is the genitourinary syndrome (GSM). Since hormone replacement therapy is contraindicated in BCS, vaginal laser might represent a new nonhormonal option for GSM.

Potential effectiveness of Ospemifene on Detrusor Overactivity in patients with vaginal atrophy.

Objectives: To report the effects on the urinary function of ospemifene prescribed for vulvovaginal atrophy (VVA) in patients with overactive bladder (OAB) symptoms refractory to the first line of pharmacologic treatment with antimuscarinic or β3-agonists drugs. We also try to identify any predictors of response to the ospemifene treatment.

Study Design: Twenty-five patients with OAB confirmed by detrusor overactivity at urodynamics, refractory to first-line therapy for OAB, were enrolled for the study.

Predictors of response after a second attempt of pharmacological labor induction: a retrospective study.

Purpose: The aim of our study was to assess the outcomes of a prolonged induction carried out with a second sequential cycle of pharmacological stimulation after unsatisfactory response to a first attempt, and to highlight variables correlated with higher response rates.

Methods: A retrospective study was carried out on 157 women who underwent a two-step labor induction by vaginal prostaglandins followed by a second cycle of prostaglandins or intravenous oxytocin. Outcomes assessed were mode of delivery and maternal and neonatal morbidity.

Concomitant stress urinary incontinence and pelvic organ prolapse surgery: Opportunity or overtreatment?

Objectives: The association between pelvic organ prolapse (POP) and stress urinary incontinence (SUI) is very common. When POP surgery is indicated and the patient has concomitant SUI, there are two treatment strategies: the one-step strategy (concomitant correction of POP and SUI) and the two-step strategy (correction of POP with subsequent evaluation of SUI). Guidelines from the International Continence Society and International Consultation on Incontinence recommend that a urodynamic assessment (UA) should be performed before surgery as this can reveal the presence of urodynamic SUI, but the role of UA is the subject of debate as it does not seem to improve treatment decisions.

Transvaginal high uterosacral ligament suspension: An alternative to McCall culdoplasty in the treatment of pelvic organ prolapse.

Objectives: Defects in female pelvic organ support are highly prevalent. Uterosacral ligament suspension at the time of primary prolapse repair (McCall culdoplasty) is a well-established surgical option to prevent prolapse recurrences. Recently Shull's high uterosacral ligament suspension technique has gained increasing popularity among Uro-Gynaecologists.