Management of pelvic abscesses complicating pelvic inflammatory diseases

Surgical Treatment of Stress Urinary Incontinence and Severe Pelvic Organ Relaxation in the Medically Compromised Elderly Patient Using Local Anesthesia Robert D. Moore, DO Northside Hospital, Atlanta, GA

Stephen Speights, MD, and John R. Miklos, MD Objective: To describe the technique and complications of vaginal repair of advanced pelvic organ prolapse and the use of tension-free vaginal tape (TVT) using intravenous sedation and local anesthesia for patients with concomitant severe vaginal prolapse and stress urinary incontinence. Methods: A retrospective review of the surgical records of 15 patients was performed. Patient demographics, surgical procedure, surgical time, estimated blood loss, complication rate, and hospital stay were examined. Results: All 15 patients reviewed had their operations completed without the need for general anesthesia. The advanced pelvic organ prolapse was repaired vaginally in all patients prior to the TVT procedure being completed. The procedures included eight Lefort partial colpocleises, four total colpocleises, and three anterior repairs with colpoectomy. General anesthesia was contraindicated in all patients. Patients had a mean age of 78 years (range 65–91 years), a mean parity of 2.7, a mean estimated blood loss of 54 mL and a mean operative time of 94 minutes. All hospital stays were less than 24 hours. One intraoperative and no postoperative complications were reported. Conclusions: All 15 patients had successful surgical repair and placement of the TVT sling under local anesthesia without the need for general induction. Surgical correction of concomitant severe pelvic organ relaxation and stress urinary incontinence can be performed rapidly and safely using local anesthesia, thus limiting the potential risks of general anesthesia.

Human Papillomavirus DNA Detection in Sperm Using Polymerase Chain Reaction Olufemi A. Olatunbosun, MD University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Harry G. Deneer, PhD, and Roger A. Pierson, PhD Objective: Because the risk of sperm donors transmitting human papillomavirus (HPV) to recipients is unknown, we investigated the presence of HPV in semen and whether sperm washing methods reduce HPV DNA to below detectable levels. 56S Tuesday Posters

Methods: Amplification by nested polymerase chain reaction (PCR) was used to detect viral DNA sequences in semen samples from 85 male volunteers. The study involved 45 men with historic or clinical evidence of genital HPV infection (study group) and 40 healthy, clinically HPV-negative semen donors (control group). Results: We detected HPV DNA in the sperm cells of 24/45 (53%) subjects with past or current HPV infection in contrast to 3 of 40 (8%) of healthy subjects (P ⫽ 0.0001). The sensitivity of a negative result in predicting the absence of HPV infection in a healthy subject was 92%. In the study group, PCR detected HPV in 21/32 (66%) subjects with identifiable lesions and in 3/13 (23%) without (P ⫽ 0.02). Swim-up washings of all 27 prewash sperm cells with HPV reduced cellular HPV DNA below detectable levels in only two cases. Conclusions: The study demonstrates that HPV is present in sperm cells from both infected and healthy subjects, and that sperm washing does not eliminate the risk of HPV transmission to recipients. We suggest that HPV DNA testing should be offered to prospective semen donors, and those with positive tests should be excluded from semen donation.

Management of Pelvic Abscesses Complicating Pelvic Inflammatory Diseases Philippe G. Judlin, MD Maternite Regionale and University of Nancy, Nancy, France

A. Zaccabri, MD, A. Koebele, MD, G. Burlet, MD, and P. Bassnagel, MD Background: Management of pelvic abscesses (PAs) has been frequently debated. Many antibiotic regimens have been proposed, and the usefulness of systematic surgical drainage has been questioned. Objective: To check the efficacy of management combining antibiotics amoxicillin/clavulanate ⫹ ofloxacin with systematic surgical drainage in a continuous series. Methods: Twenty-seven patients (1994-1998) with Pas were studied prospectively. Diagnosis was achieved by pelvic examination and sonography. Patients received amoxicillin/ clavulanate ⫹ ofloxacin by an intravenous route (4 –5 days), then orally (10 days). Surgical drainage was performed several hours after antibiotics were started to avoid septic shock. A follow-up visit took place 4 weeks after treatment completion. Results: All patients were evaluable. PA was bilateral in 17 cases. Sixty-one pathogens were isolated in the abscess and/or uterus. Surgery took place 24 to 60 hours after antibiotics were started; no significant improvement was noted in 24/27 cases. Procedures were performed by laparoscopy (21 cases) or, when not possible, by laparotomy (6 cases). It consisted of drainage (15 cases) or salpingectomy ⫾ oophorectomy. No serious adverse event occurred during the study. All pathogens were eradicated or presumed eradicated, and all patients were clinically cured at the time of the follow-up visit. Obstetrics & Gynecology

Conclusions: PAs complicating pelvic inflammatory disease are severe, multibacterial infections. Our regimen that combines broad-spectrum antibiotics, with systematic surgical drainage, seems to be safe and efficient.

Laparoscopic Burch and Paravaginal Repair and Incidence of Lower Urinary Tract Injury Steven E. Speights, MD Northside Hospital, Atlanta, GA

Robert D. Moore, DO, and John R. Miklos, MD Objective: This study was undertaken to determine the rate of injury to the lower urinary tract during laparoscopic Burch urethropexy and/or paravaginal repair. Methods: The charts of 159 consecutive patients from January 1997 to July 1999 who underwent laparoscopic Burch and/or paravaginal repair were reviewed. All patients had intraoperative transurethral video cystoscopy performed with intravenous injection of indigo carmine dye to assess potential injury to the bladder or ureter. Results: Lower urinary tract injury was diagnosed in 4 of 159 (2.5%) patients having laparoscopic Burch and/or paravaginal repair. All 4 injuries were cystotomies with 3 occurring during Burch urethropexy and 1 during a paravaginal repair. Two of these patients had previous open retropubic urethropexies (1 MMK and 1 prolene mesh urethropexy). No ureteral ligations or intravesical suture placement were diagnosed. No statistical differences in demographics or surgical parameters were found when comparing patients with and without injuries. Conclusions: Despite most patients in this study having both Burch urethropexy and paravaginal repair, the lower urinary tract injury rate of 2.5% is much lower than the reported injury rate of 10% for patients who have Burch urethropexy alone performed via laparotomy. The reported benefits of laparoscopy, including less blood loss and better visualization may explain the lower incidence of injury. The authors believe the laparoscopic approach, performed by experienced surgeons, may reduce lower urinary tract injury during anterior vaginal wall reconstruction.

Interferon-␣2b on Endometrioma Cell In Vitro Shawky Z. A. Badawy, MD State University of New York, Upstate Medical University, Syracuse, NY

Amr E. Etman, MD, Violeta Cuenca, BS, Anthony Montante, BS, and Lydia Kaufman, BS Objective: Interferon-␣2b has been shown to have an antineoplastic effect on renal carcinoma, bladder cancer, conjunctival

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and corneal neoplasia, and oncohematologic malignancies. It also was shown in a recent study to reduce the size of the endometriosis implants in an in vivo rat model. In the present study, interferon-␣2b was used in vitro to evaluate its effect on the growth of endometrioma cells. Methods: Cells from four separate endometrioma cell lines were seeded at known concentrations into 6-well plates in M199 medium and given 24 hours to adhere to the plate. At 24 hours, the medium was exchanged for experimental media containing increasing levels of interferon-␣2b as follows: 0 units/mL, 50 units/mL, 100 units/mL, 500/mL, 1,000 units/mL, and 2,000 units/mL. All cells were counted on days 0, 3, 6, and 9 in quadruplicate, and counts were averaged for each condition. Results: Interferon-␣2b suppressed the growth of endometrioma cells in culture, in direct proportion to the concentration of interferon-␣2b. Conclusions: Interferon-␣2b inhibits the growth of endometrioma cells in culture. This finding may have prospects in the treatment of endometriosis.

Transvaginal Ultrasound Findings in Women with Chronic Pelvic Pain Dale W. Stovall, MD Virginia Commonwealth University, Richmond, VA Objective: To determine the prevalence of anatomic abnormalities as diagnosed by transvaginal ultrasonography in women with chronic pelvic pain whose pelvic examination did not demonstrate an anatomic abnormality. Methods: Transvaginal ultrasonography was performed in premenopausal women who were diagnosed with chronic pelvic pain, had a speculum and bimanual pelvic examination that revealed no evidence of gynecologic pathology, and were subsequently referred to the gynecologic ultrasound unit for pelvic ultrasonography. Women with known chronic medical or gynecologic diseases that are associated with lower abdominal pain were excluded from the study. The overall prevalence of abnormal ultrasound findings was recorded. The abnormal findings were further categorized into uterine, adnexal, and other. Results: Ultrasonography was performed on 50 women who met the entry criteria for the study. Four women (8%) had at least one abnormal anatomic finding demonstrated by pelvic ultrasonography. Of these four women, three had uterine pathology only and one had both uterine and adnexal pathology. The abnormal uterine findings were all either intramural or subserosal myomas. The only adnexal abnormality was a single unilocular fluid-filled ovarian cyst. Conclusions: Women with chronic pelvic pain who have no anatomic abnormalities as assessed by a routine gynecologic examination also are unlikely to have pelvic pathology when evaluated by transvaginal ultrasonography. Tuesday Posters 57S