Background and objective: To assess the impact on the quality of life in patients with genuine stress urinary incontinence (GSUI) following a tension-free vaginal tape (TVT) procedure. Materials and methods: Twenty cases of GSUI managed surgically with TVT were assessed postoperatively at 1, 3, 6, and 12 months using two validated disease-specific quality of life questionnaires named incontinence impact questionnaire (IIQ-7) and urogenital distress inventory (UDI-6). The preoperative and postoperative scores were analyzed using the Wilcoxon signed ranks test. Results: The results showed significant improvement in the median scores of both IIQ-7 and UDI-6 questionnaires. The median score of IIQ-7 improved to 10.00 at 12 months as compared to 71.00 preoperatively. Similarly, the median scores of UDI-6 improved to 16.00 at the end of 12 months as compared to 55.00 preoperatively. The improvement in both the scores was found to be statistically significant by applying the Wilcoxon signed ranks test with p < 0.01. Analyzing the stress and urge subscale of UDI-6 at 12 months, an improvement of 97.2% and 45.8 % was shown respectively. Interpretations: The statistically significant decrease in the IIQ-7 and UDI-6 scores suggest definite improvement in the quality of life (QoL) of the patients at a medium-term follow up of 12 months. Conclusion: Tension-free vaginal tape is an effective method for improving the QoL in patients with GSUI.

Aim: Although hysterectomy is considered to be a safe operation, there are possible long-term effects of this procedure including urinary incontinence (UI) that has not been discussed much in the literature. This study investigated the effect of the hysterectomy on UI using Wilcoxon ranking and the Chi-square test of independence. Materials and methods: Urinary incontinence symptoms of 52 patients who underwent abdominal hysterectomy (AH) and 34 patients who underwent laparoscopic hysterectomy (LH) were compared before and after the operation. Results: The results indicated that preoperatively the participants who had LH developed higher levels of irritative symptoms, obstructive symptoms, and urogenital distress than that of participants who had AH. After the operation, UI symptoms of the participants decreased in both of the groups, and there were no significant differences between patients who underwent AH and those who underwent LH. Conclusions: While this study provides significant information about the effects of hysterectomy on UI, the analysis of the results suggests that it is important to inform patients with evidence-based research studies about the effects of hysterectomy on UI. The findings indicated that the UI symptoms decreased after the hysterectomy and that there were no significant differences in UI symptoms for patients who had LH and AH. The result revealed that both of the procedures were effective in decreasing symptoms. Clinical significance: While this study provides significant information about the effects of hysterectomy on UI, the analysis of the results suggests that it is important to inform patients with evidence-based research studies about the effects of hysterectomy on UI. Both of the procedures can be applied. However, physicians using their clinical and medical investigations and examination skills should decide which procedure is more appropriate for the patients and inform the patients about the possible outcomes of both procedures.

Aim: This study was aimed to find the relationship between the lifestyle factor (smoking, physical activity), the body mass index, and the dietary component with the equol-producing phenotype. Our work can be useful as basic data to modify lifestyle and nutrition to improve the metabolism of equol production, which is needed for women's health. Materials and methods: Data were collected using the interview and the semi-quantitative food frequency questionnaire. Equol was measured in urine and was collected after a 3-day soy challenge to determine equol-producing phenotypes. Results: The correlation analysis among lifestyle factors, the dietary component, with the equol-producing phenotype was performed. Data show that equol producers accounted in 60.7% of the participants. Smoking was significantly correlated to the equol-producing phenotype (p = 0.030; r = 0.224). Carbohydrate and dietary fiber were positively correlated with equol-producing phenotypes (p = 0.011; r = 0.202) and (p = 0.004; r = 0.218). No significant correlation was found between physical activity, BMI, dietary protein, and fat intake with equol-producing phenotypes (p = 0.677; r = 0.035), although we observed a lower dietary fat intake in equol producer compared to non-equol producer. Conclusion: These findings suggest that smoking habit, carbohydrate, and dietary fiber significantly influence equol-producing phenotypes. Clinical significance: Our study may be useful as basic data to modify lifestyle and nutrition to improve the metabolism of equol production, which is needed for women's health.

Objective: To investigate and ascertain the rate of and risk factors for vaginal pessary expulsion after vaginal pessary use among pelvic organ prolapse (POP) patients in Southern Thailand. Materials and methods: The retrospective medical records’ review and telephone interview were conducted in 140 patients with POP managed by vaginal pessary insertion as the first-line treatment during the period between March 2015 and January 2018. Factors influencing pessary expulsion, pessary discontinuation, and adverse event after pessary use were investigated. Results: Of the 482 POP patients, vaginal pessaries were offered to 140 patients. The prolapse was in advanced stage (stage III–IV) in most of the patients (77.1%), according to POP quantification (POP-Q) system. All of the pessaries offered were of ring type, without support in any prolapse stage. After vaginal pessary insertion, the expulsion rate was 22.1%. The mean of the pessary continuation period in all patients were 20.5 ± 8.2 months. During the study period, the discontinuation rate was 22.8%. Factors associated with pessary expulsion from logistic regression analysis were high body mass index [(BMI; relative risk (RR) 3.491, 95% confidence interval (CI) 1.302–9.356; p = 0.013]; history of previous hysterectomy (RR 37.68, 95% CI 4.508–315.098; p = 0.001); age more than 65 years (RR 3.71, 95% CI 0.078–0.929; p = 0.038); advanced degree of prolapse (RR 4.842, 95% CI 4.842–1.008; p = 0.049); and adverse effects related to pessary insertion were vaginal discharge (5%), vaginal discomfort (13.5%), vaginal erosion (7.1%), vaginal bleeding (1.4%), and constipation (0.7%). Conclusion: The expulsion and discontinuation rates of vaginal ring pessary in POP patients in any degree of prolapse were acceptable based on our experience from Southern Thailand. Factors associated with expulsion in this population were high BMI, history of previous hysterectomy, advanced age, and advanced degree of prolapse.

Aim: To evaluate the efficacy and safety of the vaginal-specific lactobacilli strain in management of bacterial vaginosis (BV). Materials and methods: A nonrandomized, open-labeled, noncomparative, multicentric study was conducted in a total of 58 female patients suffering from BV. Each patient was administered a combination of four strains of lactobacilli. Vaginal pH, discharge, odor, itching, and painful urination were performed at baseline, week 2, and week 4 as assessment parameters. Results: At the end of the study, data were extractable in only 56 females (mean age was 34.57 ± 11 years). Associated BV symptoms like vaginal discharge, odor, and painful urination reduced significantly at week 4 as compared to baseline. The most frequently encountered symptoms were vaginal discharge, vaginal pH, odor, and itching. With a shift in pH < 4.5, at the end of week 4 all females showed improvement in the vaginal microbiota. Tolerability of fixed-dose combination was found to be good and none of the subjects discontinued the treatment. Conclusion: Probiotic combination of vaginal-specific probiotic strains was found to be effective and safe for use in females who suffer from BV. Clinical significance: Lactobacilli have been found in very low numbers in women suffering from BV. After supplementing probiotic, mere fall in pH < 4.5 indicates probable colonization of the vagina with a specific strain of lactobacilli has helped in production of lactic acid and restoration of the vaginal microflora.

Ovarian tumors present with vague pelvic, abdominal, and menstrual symptoms. The lack of histological diagnosis beforehand with no definite evidence of malignancy intraoperatively may put the surgeon at the crossroads, whether to proceed with a complete surgical staging or conservative approaches, such as a fertility sparing procedure or a simple ovariectomy. Frozen section done intraoperatively in the aforementioned setting may help in differentiating benign and invasive ovarian tumors and help in proceeding with an optimal surgical procedure. But the reliability of frozen is limited in borderline and mucinous ovarian tumors.

Aim and objective: Adnexal torsion is a rare gynecological emergency. It involves females of all age groups. It requires early diagnosis and intervention in order to save the adnexa from irreversible injury. Our study elaborates on the clinical presentation, diagnosis, and management of adnexal torsion in a tertiary care center in India. Study design: Prospective study. Materials and methods: This is a clinical study conducted at Sri Ramachandra Medical Centre, Chennai, over a period of 1 year—January 2018 to January 2019. Results: Most cases of adnexal torsion presented with diffuse pain abdomen (64.2%), nausea, and vomiting (42.8%). About 60% were mainly found in the reproductive age group of 20–30 years. Five antenatal cases with adnexal torsion were observed (11%). Polycystic ovaries (21.4%) and hypothyroidism (50%) were the notable risk factors associated. Size more than 5 cm were increasingly associated with adnexal torsion. Ultrasound was used as a primary imaging modality although in few cases like pregnancy, large masses in which ultrasound was inconclusive computed tomography (CT) and magnetic resonance imaging (MRI) were more convincing. Laproscopy was the preferred mode of intervention with an attempt to conserve the ovary in childbearing age group. However, 24% of cases were converted to laparotomy in view of large size of the mass or hemodynamic instability. Conclusion: Adnexal torsion is one of the rare emergencies, which requires an expertise team for early diagnosis using imaging and clinical symptoms. Prompt surgical intervention is required to preserve the ovarian tissue especially in younger age group.

Aim: To evaluate pelvic organ prolapse quantification system (POP-Q) and simplified pelvic organ prolapse scoring system (S-POP) by assessing anatomical and functional outcome in women with pelvic organ prolapse after surgery and to propose a better method for preoperative assessment and planning for surgery. Materials and methods: This randomized controlled trial was conducted in 65 women of reproductive, perimenopausal, and postmenopausal age group with symptoms of pelvic organ prolapse having urinary or bowel complaints admitted to gynaecology ward of Lata Mangeshkar Hospital, Nagpur, during the period from October 1, 2016 to October 31, 2018. Women willing to participate in the study were assessed and enrolled in the study after fulfilling inclusion and exclusion criteria. Women were assessed by both the assessment systems—POP-Q and S-POP—preoperatively; following which women were divided into two groups by block randomization to be evaluated further by POP-Q or S-POP separately. All women were then subjected to various surgeries, and their postoperative findings were noted. Subsequently, anatomical and functional improvement with variation in assessment methods was gauged. Comparison of POP-Q and S-POP was done. Results: 70.97% women assessed by POP-Q and 61.77% women assessed by S-POP had marked functional improvement. A total of 93.55% women belonging to POP-Q group and 82.35% women belonging to S-POP group had considerable anatomical improvement postoperatively. Conclusion: There was significant improvement anatomically and functionally in women with pelvic organ prolapse who were treated and evaluated by POP-Q. Clinical significance: We hope to find a suitable, standardized, and user-friendly method for quantification of pelvic organ prolapse to relate the result of the test to the outcome of treatment.

Introduction: Pelvic organ prolapse (POP) has been documented in the oldest medieval literature as old as 2000 BC with its watershed moments. It affects millions of women worldwide. Since exact etiological data are not known, there is paucity of data regarding recommendations of surgeries, and apical prolapse in young women has concomitant stress urinary incontinence (SUI). Recurrences are more common in young women compared with old women, and choice of surgery thus becomes a dilemma and puts a surgeon in a quandary. Moreover, reconstructive surgeons are inspired and fascinated due to intricacies and challenges of POP in the young women. Hence, genital prolapse in young women is a topical issue. Aim: To determine the characteristics of prolapse in young women with regard to grade, complexity, and associated etiological factors. Materials and methods: This comparative descriptive study was conducted at a tertiary care hospital from June 2015 to December 2016 over a period of 18 months after obtaining adequate authorization from ethical committee. A nonprobability sampling convenience method was incorporated. All women attending gynecological outpatient department having symptoms of mass coming out of vagina were subjected to detailed history, examination, and investigations. They were divided into two groups: women less than 40 years were subjected to conservative surgery and women more than 40 years were subjected to anterior and posterior repair with concomitant hysterectomy. The results were compared. Results: The mean age of women less than 40 years was 34.54 ± 3.136 years, and mean age for women between 40 years and 45 years was 43.83 ± 1.617 years. The mean parity is less in women less than 40 years of age compared with older women, and though not statistically significant, there is a strong presence of family history of similar complaints in parents or siblings in women less than 40 years of age (15.13%). This is consistent with studies by Jackson that there may be a correlation between development of prolapse and collagen defects. On comparing the preoperative and postoperative POP quantification (POP-Q) in younger and older women, there was a significant improvement in anterior compartment and apical defects when compared with posterior defects and changes in genital hiatus, perineal body, and total vaginal length. In total, 13% of young women who underwent conservative surgery for POP had recurrence, which though statistically insignificant, it is a high percentage compared with older women undergoing surgery for POP. Older women undergoing surgery for POP had more complications (4/18–22%), kinking of ureter after a vaginal hysterectomy with high uterosacral fixation (11%), and secondary hemorrhage (11%). Conclusion: Young women have POP of low grade, usually have single-compartment defects, and are associated with low parity. A significant number of women have family history of POP contributing to low-density collagen as an etiological factor. Conservative surgeries in young women take shorter time, are associated with less complications, but are associated with more recurrence rates.

Background: Hysterectomy is the surgical removal of the uterus. It may involve removal of the ovaries, fallopian tube, cervix, and the surrounding structures. The objective of the study was to assess the level of knowledge regarding hysterectomy among women attending obstetrics and gynecological area in a tertiary care hospital in Kochi. Materials and methods: A descriptive design was used to select 40 participants from obstetrics and gynecology area in a tertiary care hospital in Kochi. These subjects were to undergo hysterectomy. The subjects was selected using nonprobability convenience sampling technique. A semi-structured knowledge questionnaire was designed and administered. Results: Of the 40 women who participated in the study, 42.5% woman had poor knowledge, 57.5% had average knowledge, and none of them had good knowledge about hysterectomy. The mean knowledge score obtained by the women was 10.1500 with a standard deviation of 4.04177. About the various aspects of hysterectomy knowledge, majority were having inadequate knowledge regarding exercise (85%), diet (80%), management (75%), investigations (82.5%), and complications (56.25%). However, 52.5% of subjects showed adequate knowledge regarding hysterectomy. Conclusion: The majority of women attending gynecological area were not sufficiently knowledgeable about hysterectomy and its management. This underlines the need for the involvement of health personnel in hysterectomy and care to provide information for women undergoing hysterectomy.

Objective: The objective of this paper is to evaluate the effectiveness of the transobturator vaginal tape (TOT) in the management of female stress urinary incontinence (SUI) and to analyze complications after 6 months of follow-up. Materials and methods: The study included women with SUI who had a TOT procedure in which the sling passes from the obturator foramen from outside to the inside, under regional anesthesia from January 2013 to December 2015. All women had a minimal follow-up of 6 months. The women were prospectively evaluated, and assessment was done by physical examination including pelvic examination, urinalysis, the cough stress test, and the Bonney's test. Results: Twenty-two consecutive women who fulfilled the inclusion criteria underwent the TOT procedure by a single surgeon. The mean age was 44.8 ± 4.2 years (range 37–53 years) and minimal follow-up was 6 months. The mean operative time was 25 ± 5 minutes (range 15–31 minutes), with an average amount of blood loss in all cases. Our results demonstrate a 90.90% cure or improvement rate after 6 months. Conclusion: The transobturator approach from outside to inside is an effective modality of treating SUI with low morbidity. However, longer follow-up in larger populations is needed to assess the reliability of this procedure.

Aim: To highlight the shortcomings of obstetric care in Indonesia. Background: Wandering intrauterine devices (IUDs) is often asymptomatic, but it may also generate significant complaints. While preventable, negligence and human errors could worsen patient outcomes. Management of such cases is usually straightforward but could be hampered in low-resource settings. Case description: A 44-year-old para 2 abortus 2 (P2A2) woman with multiple wandering IUDs presented with acute urinary retention and a radiating left lower abdominal pain. A Lippes loop was inserted 19 years ago, which mistakenly was assumed to have been expelled during a miscarriage. A copper IUD was inserted 8 years ago, but she underwent no follow-ups. Abdominal radiograph revealed a copper IUD and another radiopaque foreign body. The copper IUD was successfully removed. Ultrasound revealed no intrauterine Lippes loop. Lack of on-site obstetricians/gynecologists led to her referral. Exploratory laparotomy was performed. The loop was in the rectovaginal pouch embedded to the posterior uterine wall with significant adhesions. An uneventful recovery ensued. Conclusion: The lack of on-site specialists and low-resource setting presented unique challenges to this case and underlines the importance of emergency physicians being adept at point-of-care ultrasound (POCUS) in specialist poor low-resource settings. Clinical significance: Emergency physicians should receive additional training, e.g., ultrasound, to better provide obstetric care in low-resource and specialist poor settings.

Ovarian cystadenofibroma of a rare benign tumor of the ovary often mimicking as a malignant ovarian tumor. Cystadenofibroma of the ovary affects females in the fifth decade, usually a benign tumor. Their presentation often mimics a malignant tumor posing a difficult management decision for the clinicians. It has epithelial and fibrous stromal components; they represent less than 2% of benign ovarian tumors. We report here a case of a postmenopausal woman with clinical presentation of a mass per abdomen, suspicious of malignant ovarian tumor based on imaging of complex cysts with thick septa and a raised CA-125. She underwent exploratory laparotomy for the same, and histopathology revealed it to be a benign serous cystadenofibroma of the ovary. We report this case for its rarity as well as for certain features that may help a clinician to suspect this entity intraoperatively, and optimize management for this benign condition.