The use of cabergoline in addition to metformin had more favorable effect on cycle regularity and prolactin level in patients with polycystic ovarian syndrome with hyperprolactinemia than the use of metformin alone.

Original Research ArticleTension-free transobturator vaginal tape and autologous rectus fascia transobturator vaginal sling for the treatment of urinary stress incontinence: a prospective clinical study Mervat A. Elsersy* INTRODUCTIONStress urinary incontinence (SUI) is a common disorder affecting adult females due to weak mechanisms of urethral closure. 1,2 Behavioral changes and pelvic floor muscle training are considered conservative nonsurgical options for treatment. [3][4][5] Tension-free vaginal tape has become a popular method for surgical treatment of urodynamically proven stress incontinence (USI), since it was introduced by Ulmsten in 1995. The retro pubic approach of tension-free vaginal tape (RT-TVT) procedure was widely accepted worldwide as the standard surgical treatment for SUI. 6 Tension free vaginal sling procedures had achieved good long-term success together with lower complication rates; but they had some failure rate due to either excessive or failure to achieve the desired tension, which resulted in voiding difficulties or urinary leakage persistence, respectively. 7Transobturator route (TVT-O) was considered as the second-generation, utilizing either outside-in or inside-out approaches, so avoiding the passage into the retro pubic ABSTRACT Background: A large proportion of adult women complain of urinary incontinence, which has considerable drawbacks on their quality of life and social incorporation in the community. Conservative measures had been tried for several decades but with limited efficacy in huge proportion of patients. Vaginal sling procedures, since it was introduced in medical field had achieved good success rates with low complication rates. However, they still cause problems. Since Ulmsten introduced the tension-free vaginal tape in 1995, it has become a popular method for surgical treatment of urodynamically proven USI. In this study, we are going to compare between tension-free Trans obturator vaginal tape (TVT-O) using synthetic polypropylene macro porous monofilament mesh and autologous rectus fascia Trans obturator sling. Methods: 80 patients had stress urinary incontinence were randomly assigned to either group (1) who underwent insertion of synthetic tension free vaginal tape using (Aris-Transobturator Sling System) or group to (2) to whom autologous rectus fascia transobturator vaginal sling was applied. Results: Objective and subjective cure rates were comparable in both groups, but patients in group (1) had shorter operative time and less duration of post-operative catheterization. Patients in group (1) were statistically more satisfied than patients in group (2). Conclusions: Both techniques are effective in the treatment of female stress incontinence.

Background: There are various different methods of performing a caesarean section. With the increasing rate of repeat cesarean sections, it is necessary to recognize evidence based techniques to improve outcomes and minimize complications. Dissection of a bladder flap was an integral step in standard cesarean section. Cancelation of the bladder dissection is one the modifications that showed to be safe and cost effective. The aim of this study is to perform a randomized controlled clinical trial to evaluate the effects of cancelling the bladder dissection. Methods: 1674 patients were enrolled in the study from May 2013 until October 2015. The patients were assigned for non-emergent cesarean section above 32weeks. They were randomly allocated in the 2 groups.Group1:838 patients to whom uterine incision made without incision or dissection of the bladder peritoneum. Group 2: 836 patients to whom incision and dissection of a bladder peritoneum done prior to uterine incision. Results: Significant reduction of the total operating time, skin to delivery time, micro hematuria, dysuria, urinary retention, blood loss in group 1. The were insignificant difference between the groups as regards hospital days, febrile morbidity, wound infection rate, admission to neonatal intensive care unit and readmission rate. Conclusions: Non dissection of the bladder peritoneum achieved short-term advantages as regards reduction of operating time, incision-delivery duration and decreased blood loss; long-term effects still to be studied.

Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 -49 yrs. 81.2% of patients have body mass index above 25 kg/m 2 .Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS); they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.

Perforation of the uterus usually results from either iatrogenic or, less frequently, spontaneous occurrences. Iatrogenic etiologies include perforations occurring during dilation and curettage, hysteroscopy and insertion of intrauterine contraceptive devices. Spontaneous etiologies include pyometra, gestational trophoblastic disease, placenta accrete and rarely degeneration of a myoma and uterine infarction. Procedure-related uterine perforation is usually considered and diagnosed clinically at the time of injury, hence the relative sparse literature regarding the imaging findings associatedwith uterine perforation. We report an unusual case in which uterine perforation was confirmed by sonography after pregnancy termination at 10weeks' gestation. We discuss the diagnosis and treatment.

Aim: Pelvic organ prolapse (POP) is commonly associated with lower urinary tract dysfunction The preoperative urodynamics as a standard investigation for urinary incontinence (UI) has been a subject of debate.We aimed to compare the clinical impact of urodynamics versus office clinical evaluation only before surgical management of POP. Study Design: prospective comparative study. Patients and Methods: 60 women in Shatby Maternity hospital with (POP) and lower urinary tract dysfunction have been thoroughly evaluated by history, examination and standardized questionnaire. 30 of them group (1) were subjected to pre-operative urodynamic studies. Post-operative urological dysfunction were compared and analyzed. Results: Urodynamic study identified urinary dysfunction in 80% of women in group 1. However in group (2), 6 patients out of 16 (37.5%) had stress urinary incontinence post-surgery that was not diagnosed preoperatively. These patients were POP stage 3. In group (1); no occult stress incontinence was observed in any of the patients of this group postoperatively. Conclusions: Urological profile of patients whose surgical management of pelvic organ prolapse was planned according to urodynamics finding had been improved. So we recommend urodynamics to be an integral part of diagnostic work up of pelvic organ prolapse patients.

Background: Meconium stained amniotic fluid could be seen in 12-16 % of deliveries. Meconium is toxic to the newborn lung. Its presence during labour increases the risk to develop neonatal respiratory distress by about 100 times more. Meconium aspiration syndrome (MAS) occurs in about 5% of deliveries with meconium-stained amniotic fluid and death occurs in about 12% of infants with MAS. Intrapartum amnioinfusion was described as a way to dilute meconium or act as a mechanical cushioning of the umbilical cord to prevent its compression .The aim of this study is to perform a randomized controlled clinical trial to test the hypothesis that amnioinfusion can reduce the incidence of caesarean deliveries and perinatal morbidity associated with meconium stained amniotic fluid.Methods: An interventional randomized study was conducted in Hai Jamaa hospital. 360 patients were enrolled in the study. The patients were in labour with meconium stained liquor above 37 weeks. They were randomly allocated in two groups. Group 1: amnioinfusion group and Group 2: non amnioinfusion group.Results: Significant reduction of cesarean section rate due to fetal distress. Also significant reduction of prevalence of variable fetal heart rate decelerations, and significant reduction of incidence of MAS in patients received amnioinfusion.Conclusions: Amnioinfusion is an easy, safe and inexpensive procedure useful in patients with meconium stained liquor.

Background: Patients with endometrial cancer are mostly diagnosed at an early stage. But unfortunately 10% to 15% of endometrial cancer patients will present with advanced-stage disease, and hence poorer prognosis. When disease is primarily intraperitoneal, cytoreduction to <2 cm has also been correlated with better survival, with the maximum benefit in patients who can be reduced to no visible disease remaining. Aim: Of the work is to detect the survival rate benefits of primary surgery in patients with advanced endometrial cancer at gynecologic oncology unit in El Shatby Maternity University Hospital. Methods and Materials: Retrospective study was conducted on 102 patients diagnosed to have advanced endometrial cancer FIGO (stage III/IV) in a duration of 4 years between 2016 and 2020 and had undergone cytoreductive surgery. The patients were further subdivided into two groups: group 1 who underwent optimal cytoreduction with residual disease less than or equal 1 cm visible lesion, and group 2 who had residual disease more than 1 cm visible lesion and they were followed to check the survival benefits. Results: The mean of disease free survival in group: 1) patients was 2 years which was significantly longer than those in group; 2) those who had residual disease > 1 cm, p < 0.001. Also cases with type I endometrial cancer had significantly longer (DFS) than those diagnosed to have type II endometrial cancer, p = 0.046. Conclusion: Primary complete cytoreductive (upfront) surgery when possible has a favorable impact on overall survival in patients with advanced endometrial cancer.