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Background Pelvic Floor Dysfunction (PFD) is a global health problem affecting millions of women worldwide and comprises a broad range of clinical dysfunctions such as urinary incontinence (UI), fecal incontinence (FI), pelvic organ prolapse (POP) vaginal laxity (VL), vaginal wind (VW), and overactive bladder (OAB). This study aims to estimate the prevalence of PFD among Saudi women attending primary health care centers (PHCCs) across 13 regions of Saudi Arabia and their characteristics along with associated factors. Methods A cross-sectional study was conducted on 2,289 non-pregnant women. The probability population proportional sampling technique was employed followed by a convenient sampling technique to recruit eligible women. Types of PFD were assessed using a self-administered electronic questionnaire. Pelvic Floor Distress Index (PFDI-20) was used to assess the primary study outcomes (FI, VL, POP, VW, and OAB). A multivariate logistic regression model was used to identify independent associated factors for PFD. Results The findings showed that 830 women (36.3%) had any type of UI. Stress UI affected726 (31.7%) women, whilst 525 women (22.9%) had urge UI. VL occurred in 505 women (22.1%), whilst POP occurred in 536 women (23.4%). VW occurred in 733 participants and (32%) 1238 women (54.1%) had OAB. The multivariate analysis suggested that region, location, parity, and assisted birth were significantly associated with UI, VL, FI and PFD (P < 0.001). Conclusion PFD is a common condition among Saudi women. UI, VL, VW, OAB, POP and FI increased consistently among urban women with increased age, greater parity, assisted birth, and post-menopausal status.

Objective To evaluate the prevalence of vaginal laxity (VL) and its correlates in a cohort of women attending a urogynecology clinic in a tertiary referral center in Saudi Arabia. Methods In this retrospective study, demographic information, clinical characteristics, and POP‐Q system measurements for women attending the King Fahad Medical City Urogynecology Clinic (January 2013 to April 2015) were analyzed. Women with and without VL were compared across these variables. Results Out of 376 women attending the clinic for various reasons, 135 (35.9%) reported VL. VL was more common in younger women (P<0.001). Parity, menopausal status, and diabetes were not associated with this symptom. A history of cesarean delivery was protective (aOR 0.39; 95% CI, 0.17–0.90). A bulge symptom and “vaginal wind” were predictors (aOR 3.25; 95% CI, 1.46–7.23 and aOR 15.48; 95% CI, 6.93–34.56, respectively). There was no correlation between VL and POP‐Q measurements. VL was not associated with the presence of clinically significant prolapse (stage 2–4), compared with nonsignificant prolapse (stage 0–1) (P=0.869, P=0.152, and P=0.783 for anterior, posterior, and central vaginal compartment, respectively). Conclusions In this cohort, VL was common, more prevalent in younger women, and had poorly defined clinical correlates.

Objectives:To review the etiology and management of urogenital fistulas at a tertiary care referral center.Methods:We retrospectively identified all patients with urogenital fistula referred to the King Fahad Medical City, Riyadh, Saudi Arabia, between January 2005 and July 2016 from electronic records. We collected data on age, parity, etiology and type of fistula, radiologic findings, management, and outcome.Results:Of the 32 patients with urogenital fistula identified, 17 (53.1%) had vesicovaginal fistula. The mean parity was 5.9 (0-15). Obstetric surgery was the most common etiology, accounting for 22 fistulas (68.8%). Twenty of these (90.9%) were complications of cesarean delivery, of which 16 (80%) were repeat cesarean delivery. Forty surgical repair procedures were performed: 20 (50%) via an abdominal approach, 11 (27.5%) via a vaginal approach, 7 (17.5) via a robotic approach, and 2 (5%) using cystoscopic fulguratizon. The primary surgical repair was successful in 23 patients (74%), the second repair in 5 (16.1%), and the third repair in one (3.1%). One fistula was cured after bladder catheterization, and 2 patients are awaiting their third repair.Conclusion:Unlike the etiology of urogenital fistulas in other countries, most fistulas referred to our unit followed repeat cesarean delivery: none were caused by obstructed labor, and only a few occurred after hysterectomy. Most patients were cured after the primary surgical repair.

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Fowler's syndrome, although rare, may occur post routine oocyte retrieval; Successful restoration of voiding and resolution of symptoms is possible with SNM installation in similar patients.

Heterotopic pregnancy is defined as multiple gestation in which one gestational sac is intrauterine while the other is extra uterine-most commonly tubal ectopic pregnancy. An interstitial ectopic pregnancy is one of the most lifethreatening types of ectopic gestations, with a mortality rate that can reach 6-7 times higher than that of the ectopic pregnancies in general. In our case report, heterotopic pregnancy occurs after a spontaneous conception cycle. A 34-year-old Gravid 3 Para 1 + Abortion 1 woman with a gestational age of 8 weeks + 3 days by LMP. She was diagnosed and managed laparoscopicaly by right salpingectomy with preservation of intrauterine pregnancy. She was discharged on the second postoperative day and followed-up regularly at the obstetrics clinic with uneventful antenatal follow up. This might be the first case to be presented from Middle east with such scenario. Careful evaluation of the adnexa is mandatory not only in women undergoing assisted reproduction, but also with spontaneous pregnancy to avoid delayed diagnosis in such cases.