Objective To assess urinary, sexual, and bowel function before and after laparoscopic bowel resection for rectosigmoid endometriosis.Design Prospectively collected data regarding the function of the pelvic organs.Setting Tertiary endometriosis referral unit, Aarhus University Hospital.Sample A cohort of 128 patients who underwent laparoscopic bowel resection for endometriosis.Methods The International Consultation on Incontinence Questionnaire (ICIQ), Sexual Function-Vaginal Changes Questionnaire (SVQ), and the Low Anterior Resection Syndrome (LARS) questionnaire were answered before and after surgery. Non-invasive urodynamic testing was performed.Main outcome measures Pre-and postoperative function of the pelvic organs was compared, and risk factors for improved/ impaired function were identified.Results A total of 96.1% of the women completed the 1-year follow-up. A significant decrease (P = 0.002) in bladder filling problems (F-score) was observed 1 year after surgery, primarily caused by a significant decrease in bladder pain (P = 0.0001). No change for urodynamic parameters was observed. A significant increase in overall sexual satisfaction (P = 0.0001) and decrease in worries about sexual life (P = 0.001) was seen 1 year after surgery. Frequency of defecation was significantly increased 1 year after surgery (P = 0.0001), but the overall bowel function measured by LARS score was unchanged. Patients with anastomotic leakage had a significantly higher risk (odds ratio, OR 5.40; P = 0.002) of increased incontinence problems (I-score) 1 year after surgery.Conclusion A significant and clinically relevant improvement in urinary and sexual function 1 year after laparoscopic bowel resection for endometriosis was found. Except for anastomotic leakage, this could be observed independent of any patient-or treatment-related factor. Apprehension about impairment of urinary and sexual function should not be a contraindication for bowel resection in endometriosis patients.Keywords Bowel, endometriosis, laparoscopy, LARS score, organ function, SVQ.Tweetable abstract Rectal resection for endometriosis does not impair urinary and sexual function 1 year after surgery.

Objective To evaluate whether serum relaxin (S-relaxin) can predict spontaneous delivery before 34 weeks of gestation in high risk pregnancies. Design A prospective cohort study.Setting Calculated sample size was reached over a two-year period, during which 9507 women gave birth. Of these, 157 healthy women were eligible for the study as they were admitted with symptoms of delivery before 34 weeks of gestation. Ninety-three women were included. Overall participation rate was 59%. Population Healthy women with singleton pregnancies with symptoms of delivery before 34 weeks of gestation. Methods S-relaxin was measured using a standard sandwich ELISA.Main outcome measures End points were preterm delivery before 34 weeks of gestation and delivery within three days from initiation of symptoms. The best possible prediction of preterm delivery was established using logistic regression for risk factors individually associated with preterm delivery before 34 weeks of gestation. S-relaxin was dichotomised to obtain best possible fit and then entered into the model. The same analyses were done for delivery within three days. Results Median S-relaxin levels varied significantly in the women with preterm prelabour rupture of membranes (PPROM) (316 pg/mL), contractions (222 pg/mL) or ripe cervices (203 pg/mL) ( P < 0.05). S-relaxin above the 80th centile ( ! 300 pg/mL) was associated with an increased risk of preterm delivery [crude OR ¼ 4.8; (95% CI: 1.9 -12)]. Likelihood ratio of a positive test is 2.6 (1.5 -4.9) and S-relaxin resulted in a post-test probability of preterm delivery of 0.72, compared with a pre-test probability of 0.49. S-relaxin contributed to the identification of delivery within three days [adj. OR ¼ 11 (95% CI: 1.8 -64)]. Conclusion S-relaxin may be a useful predictor in women with symptoms of delivery before 34 weeks of gestation.

1 The purpose of the study was to evaluate the importance of the Na,K-pump in relaxations induced by K ATP -channel openers in rabbit coronary small arteries. 2 Arterial segments were mounted in myographs for recording of isometric tension. Whole-cell patch clamp was used to assess K ATP -channel currents in isolated smooth muscle cells from the arteries. 3 In arteries preconstricted with the thromboxane A 2 analogue U46619 pinacidil and cromakalim induced concentration-dependent relaxations. In arteries preconstricted with potassium (124 mM) only high concentrations of pinacidil had a small relaxant effect. 4 In arteries preconstricted with U46619 pinacidil-induced relaxations were unaffected by pretreatment with N o -nitro-L-arginine (L-NNA) and only slightly reduced after mechanical removal of the endothelium. 5 Pinacidil induced relaxations were not significantly affected by 1 mM glibenclamide. However, the relaxations were partly inhibited in potassium-free media and by 1 mM ouabain. 6 In contrast, the concentration-dependent relaxation to cromakalim was partly blocked by 1 mM glibenclamide and partly by 1 mM ouabain and when both drugs were present the inhibition increased. 7 Ouabain (1 mM) and glibenclamide (1 mM) each partly inhibited an ATP-sensitive current induced by pinacidil and cromakalim. In the presence of both inhibitors a greater inhibition was seen. When the solution in the patch pipette was sodium-free the current was reduced and ouabain had no effect. 8 The study suggests that the relaxation to cromakalim and most likely pinacidil is mediated through opening of K ATP channels. Inhibition of the Na,K-pump, however, may change the local environment for the K ATP channels (i.e. increases the ATP/ADPratio and/or decreases the transmembrane potassium gradient), which partly prevents the activation of the K ATP -channel current.

The combined regimen of mifepristone and misoprostol is effective in the second trimester, and the interval between the drugs can be reduced allowing individualised patient care.

AimSecondary sphincter repair has been the conventional management of anal incontinence (AI) when a structural defect in the sphincter is recognized. However, disappointing long‐term results have contributed to a tendency towards an increasing use of alternative treatment methods. This study aimed to assess the long‐term functional outcomes following a secondary sphincter repair in women with AI after obstetric sphincter injury.MethodThis is a questionnaire study of women who underwent a secondary sphincter repair in Denmark between January 1990 and December 2005. Patients were identified through the Danish National Patient Registry. Functional outcomes were assessed by a self‐administered questionnaire in 2010 and 2018. Primary outcomes were Wexner and St. Mark's scores. Impact on quality of life was assessed using the Fecal Incontinence Quality of Life Scale.ResultsFunctional outcome was assessed in 370 women in 2010 and 255 women in 2018. At 18.3 [interquartile range (IQR 15.0–22.0)] years of follow‐up, the mean ± SD Wexner score was 8.8 ± 4.8 and the mean St. Mark's score was 11.7 ± 5.0. Flatus incontinence was the most frequent symptom, reported by 97%. Incontinence for liquid and solid stools was reported by 75% and 54%, respectively. There were no significant changes in incontinence frequencies over time. Women with a Wexner score of ≥ 9 had a significantly lower quality of life score in all domains than did women with a Wexner score of < 9 (P < 0.001).ConclusionAt long‐term follow‐up, few patients are fully continent following a secondary sphincter repair. However, it appears that the functional results remain stable at very long‐term follow‐up.

Introduction and Hypothesis The paravaginal defect has been a topic of active discussion concerning 1) what it is; 2) how to diagnose it; 3) its role in anterior vaginal wall prolapse; and 4) if and how to repair it. The aim of this article is to review the existing literature on the paravaginal defect and to discuss its role in the anterior vaginal wall support system, with an emphasis on anatomy and imaging. Methods Articles related to paravaginal defects were identified through a PUBMED search ending July 1, 2015. Results The support of the anterior vaginal wall is a complex system involving the levator ani muscle, the arcus tendineus fascia pelvis (ATFP), the pubocervical fascia, and the uterosacral/cardinal ligaments. Studies conclude that physical examination is inconsistent in detecting paravaginal defects. Ultrasound (US) and magnetic resonance imaging (MRI) have been used to describe patterns in the appearance of the vagina and bladder when a paravaginal defect is suspected. Different terms have been used (e.g. “sagging of bladder base,” “loss of tenting”), which all represent changes in the support of the pelvic floor but which could be due to both paravaginal defects and levator ani defects. Conclusion Paravaginal support plays a role in the support of the anterior vaginal wall, but we still do not know the degree to which it contributes to the development of prolapse. Both MRI and US are useful in the diagnosis of paravaginal defects, but further studies are needed to evaluate their use.

CPB seems to induce pulmonary endothelial dysfunction in pulmonary but not peripheral resistance arteries in neonatal piglets.

Objectives Simple prolapse operations can be performed using local anesthesia. However, this has not been the case for advanced pelvic organ prolapse operations. The aim of this study was to investigate the patient-reported feasibility and acceptability of local anesthesia and light sedation for sacrospinous fixation (SSF). Methods This is a prospective observational study on 105 women who underwent SSF in a public outpatient setting from April 2016 to October 2017. They received infiltration anesthesia with mepivacaine or lidocaine together with a pudendal nerve block with Marcaine. Local anesthesia was supplemented by intravenous light sedation and pain reliever. A Local Anesthetic Intraoperative Experience Questionnaire was used to evaluate patient experience. Results One patient was converted to general anesthesia. Eighty-eight women answered the questionnaires. Ninety-nine percent defined themselves as satisfied or very satisfied with the anesthesia. Little or no pain during the operation was reported by 92% and 92% would choose the same type of anesthesia again. No adverse effect of the anesthetic procedure was observed. The median (range) admission time was 12 (4.5–48) hours, and 81% of the patients could be discharged on the day of surgery. At follow-up after 8 weeks and 6 months, no patients reported adverse events to the anesthesia. Conclusions The SSF can be performed using local anesthesia and light sedation with high degree of patient satisfaction. These preliminary data indicate that the concept of ambulatory surgery might be implemented more widely if the use of local anesthesia is also applied to more advanced surgical procedures.