Abstract OBJECTIVE: To evaluate the safety and feasibility of enhancement balloon vaginoplasty (EBV) in cases with blind vagina due to androgen insensitivity syndrome. DESIGN: Case series with description of the technique. SETTING: Women's Health Center, Assiut University, and Sohage Teaching Hospital, Sohage University. PATIENT(S): Three X,Y females (two cases presenting with apareunia and the third presenting with severe dyspareunia). INTERVENTION(S): Laparoscopy-assisted EBV. MAIN OUTCOME MEASURE(S): Operative time, complications, depth and width of neovagina, and functional status. RESULT(S): Our cases were currently married phenotypical females and had 46,X,Y karyotypes. They had well developed secondary sexual characters, but they presented with failure of intravaginal intercourse. EBV was performed successfully for three X,Y females. The total operative time was 38-45 minutes. No operative complications were reported, and there were no reported postoperative complications as a result of moving the direction of traction. The resultant neovagina's depths were 10, 11, and 12 cm, respectively. Sexual intercourse was set off on the day of discharge. Penetration and satisfaction scores increased up to 90 points for both partners. CONCLUSION(S): It was feasible and safe to move centrally the direction of traction and to move the point of catheter exit up with apparently better outcomes than conventional balloon vaginoplasty for treatment of blind vagina due to androgen insensitivity syndrome. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Abstract OBJECTIVE: To evaluate the safety and feasibility of enhancement balloon vaginoplasty (EBV) in cases with blind vagina due to androgen insensitivity syndrome. DESIGN: Case series with description of the technique. SETTING: Women's Health Center, Assiut University, and Sohage Teaching Hospital, Sohage University. PATIENT(S): Three X,Y females (two cases presenting with apareunia and the third presenting with severe dyspareunia). INTERVENTION(S): Laparoscopy-assisted EBV. MAIN OUTCOME MEASURE(S): Operative time, complications, depth and width of neovagina, and functional status. RESULT(S): Our cases were currently married phenotypical females and had 46,X,Y karyotypes. They had well developed secondary sexual characters, but they presented with failure of intravaginal intercourse. EBV was performed successfully for three X,Y females. The total operative time was 38-45 minutes. No operative complications were reported, and there were no reported postoperative complications as a result of moving the direction of traction. The resultant neovagina's depths were 10, 11, and 12 cm, respectively. Sexual intercourse was set off on the day of discharge. Penetration and satisfaction scores increased up to 90 points for both partners. CONCLUSION(S): It was feasible and safe to move centrally the direction of traction and to move the point of catheter exit up with apparently better outcomes than conventional balloon vaginoplasty for treatment of blind vagina due to androgen insensitivity syndrome. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Abstract OBJECTIVE: To study the operative and postoperative outcomes of anterior abdominal wall cervicopexy (AWC) for treatment of stage III and stage IV uterine prolapse. METHODS: AWC was performed by anchoring the supravaginal cervix to the anterior abdominal wall. This was done following obliteration of the pouch of Douglas via laparotomy. RESULTS: Among 37 patients, AWC was performed in 21 women with stage III and 16 women with stage IV uterine prolapse. Overcorrection was observed in 3 women. Postoperatively, 2 women experienced febrile morbidity and 5 had urinary retention. Thirteen women complained of urinary frequency, but all reported improvement at 3-month follow up. Among 24 women who became pregnant, 14 delivered vaginally, 5 delivered by cesarean, and 5 had an ongoing pregnancy. Four recurrences occurred: 2 stage II and 2 stage III prolapses. Three of these women had delivered by cesarean, while the fourth recurrence occurred after the patient's third vaginal birth. CONCLUSIONS: AWC is a simple and effective procedure to treat stage III and stage IV uterine prolapse. However, some surgical modifications and more studies are required to ascertain its validity. Copyright 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Abstract OBJECTIVE: To study the operative and postoperative outcomes of anterior abdominal wall cervicopexy (AWC) for treatment of stage III and stage IV uterine prolapse. METHODS: AWC was performed by anchoring the supravaginal cervix to the anterior abdominal wall. This was done following obliteration of the pouch of Douglas via laparotomy. RESULTS: Among 37 patients, AWC was performed in 21 women with stage III and 16 women with stage IV uterine prolapse. Overcorrection was observed in 3 women. Postoperatively, 2 women experienced febrile morbidity and 5 had urinary retention. Thirteen women complained of urinary frequency, but all reported improvement at 3-month follow up. Among 24 women who became pregnant, 14 delivered vaginally, 5 delivered by cesarean, and 5 had an ongoing pregnancy. Four recurrences occurred: 2 stage II and 2 stage III prolapses. Three of these women had delivered by cesarean, while the fourth recurrence occurred after the patient's third vaginal birth. CONCLUSIONS: AWC is a simple and effective procedure to treat stage III and stage IV uterine prolapse. However, some surgical modifications and more studies are required to ascertain its validity. Copyright 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Abstract OBJECTIVE: To compare the efficacy of clomiphene citrate (CC) plus tamoxifen with that of laparoscopic ovarian drilling in clomiphene-resistant women with polycystic ovary syndrome (PCOS). METHOD: We randomly allocated 150 women with CC-resistant PCOS to a combined medication group (group 1) or a laparoscopic surgery group (group 2). The primary outcome was the live birth rate in each group; secondary outcomes were the rates of ovulation, clinical pregnancy and miscarriage. RESULTS: There were no significant differences between the groups regarding rates of ovulation (81.3% vs 85.3%), pregnancy (53.3% vs 50.7%), or live births (49.3% vs 44.0%), but the mean endometrium thickness was significantly greater on the day of human chorionic gonadotropin administration in group 1 (P0.001). CONCLUSION: Clomiphene citrate plus tamoxifen was as effective as laparoscopic ovarian drilling in promoting ovulation and pregnancy.

Abstract OBJECTIVE: To compare the efficacy of clomiphene citrate (CC) plus tamoxifen with that of laparoscopic ovarian drilling in clomiphene-resistant women with polycystic ovary syndrome (PCOS). METHOD: We randomly allocated 150 women with CC-resistant PCOS to a combined medication group (group 1) or a laparoscopic surgery group (group 2). The primary outcome was the live birth rate in each group; secondary outcomes were the rates of ovulation, clinical pregnancy and miscarriage. RESULTS: There were no significant differences between the groups regarding rates of ovulation (81.3% vs 85.3%), pregnancy (53.3% vs 50.7%), or live births (49.3% vs 44.0%), but the mean endometrium thickness was significantly greater on the day of human chorionic gonadotropin administration in group 1 (P0.001). CONCLUSION: Clomiphene citrate plus tamoxifen was as effective as laparoscopic ovarian drilling in promoting ovulation and pregnancy.

Abstract OBJECTIVE: To compare the efficacy of clomiphene citrate (CC) plus tamoxifen with that of laparoscopic ovarian drilling in clomiphene-resistant women with polycystic ovary syndrome (PCOS). METHOD: We randomly allocated 150 women with CC-resistant PCOS to a combined medication group (group 1) or a laparoscopic surgery group (group 2). The primary outcome was the live birth rate in each group; secondary outcomes were the rates of ovulation, clinical pregnancy and miscarriage. RESULTS: There were no significant differences between the groups regarding rates of ovulation (81.3% vs 85.3%), pregnancy (53.3% vs 50.7%), or live births (49.3% vs 44.0%), but the mean endometrium thickness was significantly greater on the day of human chorionic gonadotropin administration in group 1 (P0.001). CONCLUSION: Clomiphene citrate plus tamoxifen was as effective as laparoscopic ovarian drilling in promoting ovulation and pregnancy.

Abstract We studied the feasibility of performing balloon vaginoplasty (BV) with conventional laparoscopic instruments through 2 modified techniques aiming at providing BV for open use. Three of 6 cases with vaginal aplasia were offered modified laparoscopically assisted balloon vaginoplasty (LAB-V) and the other 3 cases underwent modified retropubic balloon vaginoplasty (RBV). We measured operative time, complications, anatomical outcomes, functional outcomes, and re-intervention rates. Modified RBV and LAB-V were performed successfully in the 6 cases within 9-12 and 29-38 min, respectively. The neovagina depths were 8-10 and 9-12 cm, respectively. Anterior rectal wall needle puncture was encountered in 1 case of LAB-V group and posterior urethral wall puncture in an abnormally dilated urethra in 1 case of the RBV group; both cases passed uneventfully. Intercourse was initiated after removal of all catheters. The neovagina was a cosmetically appealing mimic to nature and stained with iodine up to its apex. It was feasible to perform balloon vaginoplasty operations without specialized instrument sets with comparable outcomes.

Abstract We studied the feasibility of performing balloon vaginoplasty (BV) with conventional laparoscopic instruments through 2 modified techniques aiming at providing BV for open use. Three of 6 cases with vaginal aplasia were offered modified laparoscopically assisted balloon vaginoplasty (LAB-V) and the other 3 cases underwent modified retropubic balloon vaginoplasty (RBV). We measured operative time, complications, anatomical outcomes, functional outcomes, and re-intervention rates. Modified RBV and LAB-V were performed successfully in the 6 cases within 9-12 and 29-38 min, respectively. The neovagina depths were 8-10 and 9-12 cm, respectively. Anterior rectal wall needle puncture was encountered in 1 case of LAB-V group and posterior urethral wall puncture in an abnormally dilated urethra in 1 case of the RBV group; both cases passed uneventfully. Intercourse was initiated after removal of all catheters. The neovagina was a cosmetically appealing mimic to nature and stained with iodine up to its apex. It was feasible to perform balloon vaginoplasty operations without specialized instrument sets with comparable outcomes.

Abstract We studied the feasibility of performing balloon vaginoplasty (BV) with conventional laparoscopic instruments through 2 modified techniques aiming at providing BV for open use. Three of 6 cases with vaginal aplasia were offered modified laparoscopically assisted balloon vaginoplasty (LAB-V) and the other 3 cases underwent modified retropubic balloon vaginoplasty (RBV). We measured operative time, complications, anatomical outcomes, functional outcomes, and re-intervention rates. Modified RBV and LAB-V were performed successfully in the 6 cases within 9-12 and 29-38 min, respectively. The neovagina depths were 8-10 and 9-12 cm, respectively. Anterior rectal wall needle puncture was encountered in 1 case of LAB-V group and posterior urethral wall puncture in an abnormally dilated urethra in 1 case of the RBV group; both cases passed uneventfully. Intercourse was initiated after removal of all catheters. The neovagina was a cosmetically appealing mimic to nature and stained with iodine up to its apex. It was feasible to perform balloon vaginoplasty operations without specialized instrument sets with comparable outcomes.