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O36 Prospective 3-step treatment of endometriotic ovarian cysts
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
and objective cure of cystocele repair was 162/172 (94%) and 153/172 (89%), respectively. Subjective cure of SUI was 78/91 (86%) in OSUI vs. 68/76 (90%) in non OSUI and objective cure was 85/89 (96%) vs. 73/75 (97%), respectively. One year postoperative multichannel urodynamic testing on a subset of patients showed statistical significance for cure of SUI: 32/51 (63%) in OSUI vs. 40/47 (85%) in control group. Conclusion: Primary cystocele repair with a suburethral sling is safe, effective in preventing recurrence, and has a role in preventing post operative SUI. In patients who had postoperative urodynamic testing, those with preoperative OSUI had high initial cure rates which then decreased to 63% but the control group showed persistent success at 85%. O35 Spontaneous ovarian hyperstimulation syndrome (OHSS) N. Al-Mandhari1 , K. Al-Hattali1 , S. Al-Mahrizi1 , M. Irhayim1 . 1 Royal Hospital, Muscat, Oman Objective: To report 2 cases of OHSS, resulting from: 1. Severe Hypothyroidism. 2. Pituitary macroadenoma. Design: Case report. Setting: Tertiary Hospital. Patients: 1. A 19 year old healthy single lady. 2. A 24 year old healthy single lady. ResultsL There was completed resolution of the ovarian hyperstimulation & associated symptoms after treatment with thyroxin in patient (1), and after treatment with bromocriptine in patient (2). Conclusion: OHSS is usually a complication of ovulating inducing drugs. In patients with similar presentation it is crucial to perform thyroid function test & to assess prolactin levels since abnormalities of these tests can cause spontaeous OHSS. These large ovarian masses can mimic ovarian malignancy leading to unnecessary & fatal surgery to these patients who are usually young. O36 Prospective 3-step treatment of endometriotic ovarian cysts H. Al-Sultan, F. Kady. Aleppo University Hospital of Obst & Gyn Introduction: Endometriosis is a common gynecologic disease affects the female pelvic structures, but endometriotic ovarian cysts affect ovarian tissue directly. Any treatment for those cysts should be curative and conservative in the same time. Mainly cystectomy done by laparotomy or laparoscopy was until now the standard treatment, but it doesn’t prevent the recurrence and the adhesions, which have negative effect on ovarian reserve and fertility. For these reasons we conduct a new objective practice characterized by easy, rapid, safe, and effective, three steps treatment for Endometriotic ovarian cysts. Releasing principles aims: • Effective and less invasive treatment. • Prevent recurrence of endometriotic cyst. • Save ovarian reserve. • Prevent adhesions and achieve higher rates of pregnancy and delivery. Materials and Methods: The study took place in period: Feb 2004 – Feb 2008, at Aleppo university hospital of Obst. & Gyn. – Department of A.R.T. & endoscopy, Nafea, and Ashtar Private Hospitals. Our study included 32 infertile patients with endometriotic ovarian cysts: Mean diameter (70±20 mm), Mean age (28±3 years). All 32 patient were treated by 3 steps treatment of endometriotic ovarian cysts: • 1st step: Transvaginal ultrasound guided needle (16 gauge) aspiration + Cytological examination + Alcohol (95%) injection (30–50 ml) for 5 min.
S103
• 2nd step: GnRH therapy for 3 months + 2 months GnRH therapy for residual disease (discovered by laparoscopy). • 3rd step: Laparoscopy suction of fluctuating mud contained of the ovarian cysts ± adhesiolysis + biopsy from residual endocystic focal endometriosis and bipolar cauterization. After 2 normal menses from this treatment, each patient has been given the choice between spontaneous pregnancy or IVF program. Results: • No recurrence was found after following up all 32 patients by vaginal ultrasound examination every 6 months. (1–4 years) • No malignancy discovered in any cytological examinations or biopsies from small focal endocystic disease (3/32 patients), CA125 was normal. • Ovarian reserve has been saved: – Basal hormonal assay was the same before and after 3 steps treatment. – Normal ovarian volume. – Good response for stimulation and sufficient pick up oocytes number. • 21 patients were pregnant (65.62%) and delivered by cesarean section which revealed normal adenexa without adhesions at the time of cesarean section, (except 7 cases which ovaries were partially adherent to the posterior leaf of the broad ligament because of natural evolution of the endometriotic cyst disease): – 12 patients of 18 had undergone 1–3 I.V.F cycles were pregnant and delivered. – 6 patients of 21 have spontaneous normal pregnancy and delivery. – 1/21 early ectopic pregnancy cured by laparoscopic salpigectomy. – 1/21 missed abortion. – 1/21 special case: the patient has a recurrence endometriotic cyst after 11 years of open surgical cystectomy and GnRH therapy. She has got a spontaneous pregnancy by our three steps treatment. – Early pregnancy which finished by spontaneous abortion, has not been taken in consideration. Conclusions: 3 steps treatment: • Is effective and safe management of endometriotic ovarian cysts. • Is curative treatment with no recurrence. • Saves ovarian reserve. • Resulting higher rates of pregnancy. • Is easily repeated if recurrence happens later. • Laparoscopic suction of fluctuating mud has role in preventing adhesions and controlling of focal residual endometriosis lesions localized in cyst cavity by bipolar cauterization which assure prevention of the recurrence. O37 Prospective randomized comparative study evaluating the adhesions post total abdominal hysterectomy done by two teams H. Al-Sultan, H. Nawfal. Aleppo University Hospital of Obs&Gyn Aims of study: • To Evaluate the adhesions degree depending on the surgical technique of total abdominal hysterectomy which will be done by two teams. • To evaluate the adhesions degree post total abdominal hysterectomy by laparoscopy for other indications such as: Ovarian cyst, Severe Pelvic Pain, Appendectomy; Cholecysectomy, hernia repair. Materials and Methods: • The study has took place in Al-Tawleed Governmental Hospitals in Aleppo – Raqqa cities during period 1997–2004 by two teams: – Junior team: 3–4–5 years specialists. – Senior teams: 9–10–11 years specialists.
and objective cure of cystocele repair was 162/172 (94%) and 153/172 (89%), respectively. Subjective cure of SUI was 78/91 (86%) in OSUI vs. 68/76 (90%) in non OSUI and objective cure was 85/89 (96%) vs. 73/75 (97%), respectively. One year postoperative multichannel urodynamic testing on a subset of patients showed statistical significance for cure of SUI: 32/51 (63%) in OSUI vs. 40/47 (85%) in control group. Conclusion: Primary cystocele repair with a suburethral sling is safe, effective in preventing recurrence, and has a role in preventing post operative SUI. In patients who had postoperative urodynamic testing, those with preoperative OSUI had high initial cure rates which then decreased to 63% but the control group showed persistent success at 85%. O35 Spontaneous ovarian hyperstimulation syndrome (OHSS) N. Al-Mandhari1 , K. Al-Hattali1 , S. Al-Mahrizi1 , M. Irhayim1 . 1 Royal Hospital, Muscat, Oman Objective: To report 2 cases of OHSS, resulting from: 1. Severe Hypothyroidism. 2. Pituitary macroadenoma. Design: Case report. Setting: Tertiary Hospital. Patients: 1. A 19 year old healthy single lady. 2. A 24 year old healthy single lady. ResultsL There was completed resolution of the ovarian hyperstimulation & associated symptoms after treatment with thyroxin in patient (1), and after treatment with bromocriptine in patient (2). Conclusion: OHSS is usually a complication of ovulating inducing drugs. In patients with similar presentation it is crucial to perform thyroid function test & to assess prolactin levels since abnormalities of these tests can cause spontaeous OHSS. These large ovarian masses can mimic ovarian malignancy leading to unnecessary & fatal surgery to these patients who are usually young. O36 Prospective 3-step treatment of endometriotic ovarian cysts H. Al-Sultan, F. Kady. Aleppo University Hospital of Obst & Gyn Introduction: Endometriosis is a common gynecologic disease affects the female pelvic structures, but endometriotic ovarian cysts affect ovarian tissue directly. Any treatment for those cysts should be curative and conservative in the same time. Mainly cystectomy done by laparotomy or laparoscopy was until now the standard treatment, but it doesn’t prevent the recurrence and the adhesions, which have negative effect on ovarian reserve and fertility. For these reasons we conduct a new objective practice characterized by easy, rapid, safe, and effective, three steps treatment for Endometriotic ovarian cysts. Releasing principles aims: • Effective and less invasive treatment. • Prevent recurrence of endometriotic cyst. • Save ovarian reserve. • Prevent adhesions and achieve higher rates of pregnancy and delivery. Materials and Methods: The study took place in period: Feb 2004 – Feb 2008, at Aleppo university hospital of Obst. & Gyn. – Department of A.R.T. & endoscopy, Nafea, and Ashtar Private Hospitals. Our study included 32 infertile patients with endometriotic ovarian cysts: Mean diameter (70±20 mm), Mean age (28±3 years). All 32 patient were treated by 3 steps treatment of endometriotic ovarian cysts: • 1st step: Transvaginal ultrasound guided needle (16 gauge) aspiration + Cytological examination + Alcohol (95%) injection (30–50 ml) for 5 min.
S103
• 2nd step: GnRH therapy for 3 months + 2 months GnRH therapy for residual disease (discovered by laparoscopy). • 3rd step: Laparoscopy suction of fluctuating mud contained of the ovarian cysts ± adhesiolysis + biopsy from residual endocystic focal endometriosis and bipolar cauterization. After 2 normal menses from this treatment, each patient has been given the choice between spontaneous pregnancy or IVF program. Results: • No recurrence was found after following up all 32 patients by vaginal ultrasound examination every 6 months. (1–4 years) • No malignancy discovered in any cytological examinations or biopsies from small focal endocystic disease (3/32 patients), CA125 was normal. • Ovarian reserve has been saved: – Basal hormonal assay was the same before and after 3 steps treatment. – Normal ovarian volume. – Good response for stimulation and sufficient pick up oocytes number. • 21 patients were pregnant (65.62%) and delivered by cesarean section which revealed normal adenexa without adhesions at the time of cesarean section, (except 7 cases which ovaries were partially adherent to the posterior leaf of the broad ligament because of natural evolution of the endometriotic cyst disease): – 12 patients of 18 had undergone 1–3 I.V.F cycles were pregnant and delivered. – 6 patients of 21 have spontaneous normal pregnancy and delivery. – 1/21 early ectopic pregnancy cured by laparoscopic salpigectomy. – 1/21 missed abortion. – 1/21 special case: the patient has a recurrence endometriotic cyst after 11 years of open surgical cystectomy and GnRH therapy. She has got a spontaneous pregnancy by our three steps treatment. – Early pregnancy which finished by spontaneous abortion, has not been taken in consideration. Conclusions: 3 steps treatment: • Is effective and safe management of endometriotic ovarian cysts. • Is curative treatment with no recurrence. • Saves ovarian reserve. • Resulting higher rates of pregnancy. • Is easily repeated if recurrence happens later. • Laparoscopic suction of fluctuating mud has role in preventing adhesions and controlling of focal residual endometriosis lesions localized in cyst cavity by bipolar cauterization which assure prevention of the recurrence. O37 Prospective randomized comparative study evaluating the adhesions post total abdominal hysterectomy done by two teams H. Al-Sultan, H. Nawfal. Aleppo University Hospital of Obs&Gyn Aims of study: • To Evaluate the adhesions degree depending on the surgical technique of total abdominal hysterectomy which will be done by two teams. • To evaluate the adhesions degree post total abdominal hysterectomy by laparoscopy for other indications such as: Ovarian cyst, Severe Pelvic Pain, Appendectomy; Cholecysectomy, hernia repair. Materials and Methods: • The study has took place in Al-Tawleed Governmental Hospitals in Aleppo – Raqqa cities during period 1997–2004 by two teams: – Junior team: 3–4–5 years specialists. – Senior teams: 9–10–11 years specialists.