Bladder deep endometriosis is an uncommon but clinically significant phenotype of deep infiltrating endometriosis (DIE), and the coexistence of full-thickness detrusor disease with deep myometrial infiltration of the anterior uterine wall is infrequently documented in a stepwise, reproducible surgical format. We describe a case of a 30-year-old nulligravid female with two years of infertility, cyclical pelvic pain since menarche, severe urinary urgency, dysuria, and persistent microscopic haematuria, in whom magnetic resonance imaging demonstrated an hourglass-shaped fibrotic nodule of the anterior compartment with 16 mm involvement of the bladder dome and 18 mm of myometrial infiltration. Notably, preoperative cystoscopic biopsy had been reported as interstitial cystitis, underscoring the well-recognised tendency of superficially sampled detrusor lesions to be misclassified because endometriosis progresses from the serosa towards the mucosa. The patient was treated by a systematic laparoscopic transmural excision and layered reconstruction. The technique is presented as a teaching framework organised around the mastery of avascular pelvic spaces: development of the prevesical (Retzius) and paravesical spaces, restoration of the vesicouterine plane, retroperitoneal identification and lateral mobilisation of both ureters, complete transmural resection of the bladder nodule together with the infiltrated myometrium while preserving the ureteric orifices, and tension-free two-layer closure of the bladder and uterine wall with barbed (self-anchoring) suture, followed by an intravesical methylene-blue test to confirm a watertight repair. The procedure was completed without intraoperative or postoperative complications, with histological confirmation of endometriosis in both the detrusor and the myometrium. At 12 months of follow-up, the patient had complete resolution of urinary and pain symptoms, with all visual analogue scale (VAS) scores reduced to zero and free histological resection margins. We discuss the anatomical rationale, the diagnostic pitfalls, the correlation with infertility, and the available comparative evidence, and we summarise practical, transferable surgical tips intended to make complete excision safe and reproducible for surgeons developing experience in urinary tract endometriosis.

This video-article describes a laparoscopic cervico-isthmic cerclage technique for managing cervical insufficiency in both pregnant and non-pregnant patients, utilizing a port-site closure device for precise suture placement. Two cases-one non-pregnant and one at 12 weeks gestation-underwent the procedure, with details on trocar placement, dissection, and suture passage documented. Both surgeries were completed successfully, with minimal blood loss and no complications. The use of the port-site closure device allowed for precise suture placement near the uterine vessels, contributing to favorable postoperative outcomes. This laparoscopic approach offers a minimally invasive alternative to the open technique in specialized centers.

Objetivo: Determinar la frecuencia, las causas y los factores asociados de suspensión de cirugías programadas en un hospital de alta complejidad en un periodo de 5 años. Materiales y métodos: Se realizó un estudio descriptivo transversal, en un hospital terciario del sur de Chile durante los años 2014 a 2018. Se describe la frecuencia de suspensión quirúrgica del establecimiento y por especialidad, especificando sus principales causas. Además, se identificaron aquellas suspensiones evitables y sus factores asociados mediante regresión logística. Resultados: La tasa de suspensión en los 5 años de estudio fue de 11,2%. Neurocirugía y Traumatología tuvieron la mayor tasa de suspensión (18,8% y 13,9%, respectivamente), mientras que Ginecología y Obstetricia la menor (4,1%). Las causas más frecuentes fueron la inasistencia del paciente (16,9%), la prolongación de la cirugía anterior (16,4%) y la paralización de actividades por motivos gremiales (7,9%). Un 80,1% de las causas fueron evitables. La especialidad quirúrgica y la edad del paciente fueron los factores asociados más relevantes. Discusión: Se evidenció una alta tasa de suspensiones quirúrgicas y la mayoría por causas evitables. Su disminución puede ser la intervención más costo efectiva para contribuir a reducir las extensas listas de espera quirúrgica posterior a la crisis sanitaria por COVID 19, ya que sólo requiere optimizar los recursos existentes. Conclusiones: La suspensión quirúrgica es un problema frecuente en el proceso quirúrgico. Nuestros resultados permiten identificar a los grupos de mayor riesgo de suspensión, asignar responsabilidades a los equipos quirúrgicos y desarrollar estrategias efectivas para su prevención.

Introducción: La pandemia COVID-19 ha afectado significativamente el uso de los sistemas de salud en todo el mundo y se han reducido las consultas de urgencia por patologías no relacionadas con el virus SARS-CoV-2.

Taking advantage of the multiple mechanisms involved in preeclampsia, a wide variety of candidate biomarkers for prediction and screening of preeclampsia has been found. However, there is scant scientific evidence to validate its use in clinical practice. The development of a urinary marker for the screening of preeclampsia is attractive given the simple collection and the feasible development of a point-of-care method. Our objective is to determine which biomarkers have the greatest potential to develop a urinary clinical marker for the screening and diagnosis of preeclampsia. Study designs. We will include accuracy diagnostic test studies, prospective and retrospective comparative cohort studies, case-control or nested case control studies and cross-sectional studies. Only studies examining pregnant women with gestational age between 20 weeks and 12 weeks postpartum will be included. Every urinary marker demonstrating clinical relevance for screening of preeclampsia in humans will be included. Each biomarker will be evaluated for its diagnostic performance of preeclampsia. Secondary endpoints will be (i) diagnostic performance for detection of maternal organ failure, (ii) fetal growth restriction and (iii) Interval of time between presence of the marker and development of the clinical disease. Search will be performed in MEDLINE, EMBASE, CINAHL, LILACS, Web of Science, Scopus, ProQuest, Opengrey, OTSeeker and Maternity and Infant Care Database with a predefined search strategy. Two independent reviewers will conduct the screening and eligibility process based on inclusion and exclusion criteria. We will evaluate risk of bias in diagnostic accuracy studies according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS) II instrument. Observational studies will be evaluated with the Newcastle-Ottawa Scale (NOS). We will determine which are the best candidates to focus clinical research and to design a new diagnostic urinary marker of preeclampsia.

Proteinuria assessment is key in management of many clinical conditions in adults and children. Previously, we demonstrated false positive proteinuria measurements, and falsely elevated protein:creatinine ratio (PrCr) results in dilute urine using a pyrocatechol violet red-based assay. Thus, we sought to compare random urine PrCr results using pyrocatechol violet vs. pyrogallol red dye-based assays.Urine samples were collected prospectively from 194 consecutive pregnant women attending high-risk maternity clinics. Urinary protein was measured by both pyrocatechol violet and pyrogallol red dye-based assays, and creatinine by an enzymatic method. PrCr was calculated. Samples with urinary creatinine <33.9mg/dl (<3.0mM) were considered dilute. Urine protein methods were compared using Bland-Altman analysis.Urine samples were dilute in 65 (33.5%) women. An elevated PrCr was more common with the pyrocatechol violet (69, 35.6%) compared with the pyrogallol red dye-based assay (11, 5.7%) (p<0.001). There was poor correlation of PrCr between proteinuria assays (Spearman ρ=0.40, p<0.001). The Bland-Altman plot showed a proportional bias and weak agreement between methods (limits of agreement: -0.41 and 0.64) (Fig. 1), but no such bias was evident when dilute urine samples were excluded.Pyrocatechol violet dye-based assay for proteinuria overestimates random urinary PrCr ⩾0.27mg/mg (30mg/mmol) in dilute urine, a common occurrence in pregnancy. An elevated PrCr value based on a pyrocatechol violet dye-based assay should be confirmed on more concentrated urine or by using an alternative proteinuria assay method.M.E. Correa: None. A.C. Halstead: None. A. Côté: None. D.A. De Silva: None. P. von Dadelszen: None. L.A. Magee: None.

Proteinuria assessment is key in management of many clinical conditions in adults and children. Previously, we demonstrated false positive proteinuria measurements, and falsely elevated protein:creatinine ratio (PrCr) results in dilute urine using a pyrocatechol violet red-based assay. Thus, we sought to compare random urine PrCr results using pyrocatechol violet vs. pyrogallol red dye-based assays. Urine samples were collected prospectively from 194 consecutive pregnant women attending high-risk maternity clinics. Urinary protein was measured by both pyrocatechol violet and pyrogallol red dye-based assays, and creatinine by an enzymatic method. PrCr was calculated. Samples with urinary creatinine <33.9 mg/dl (<3.0 mM) were considered dilute. Urine protein methods were compared using Bland–Altman analysis. Urine samples were dilute in 65 (33.5%) women. An elevated PrCr was more common with the pyrocatechol violet (69, 35.6%) compared with the pyrogallol red dye-based assay (11, 5.7%) (p < 0.001). There was poor correlation of PrCr between proteinuria assays (Spearman ρ = 0.40, p < 0.001). The Bland–Altman plot showed a proportional bias and weak agreement between methods (limits of agreement: −0.41 and 0.64) (Fig. 1), but no such bias was evident when dilute urine samples were excluded. Pyrocatechol violet dye-based assay for proteinuria overestimates random urinary PrCr ⩾0.27 mg/mg (30 mg/mmol) in dilute urine, a common occurrence in pregnancy. An elevated PrCr value based on a pyrocatechol violet dye-based assay should be confirmed on more concentrated urine or by using an alternative proteinuria assay method. M.E. Correa: None. A.C. Halstead: None. A. Côté: None. D.A. De Silva: None. P. von Dadelszen: None. L.A. Magee: None.

Dipstick urinalysis is widely used for screening of proteinuria in pregnancy. Conflicting results have been reported for diagnostic accuracy between visual and automated methods. We compared semi-quantitative visual and automated dipstick methods with protein:creatinine ratio (PrCr, ⩾30 mg/mmol defined as elevated) in high risk pregnancy. As part of routine clinical care, 517 random midstream urine samples were collected prospectively from consecutive outpatient (N = 136) and inpatient (N = 203) pregnant women attending high-risk maternity clinics. Samples were split into two aliquots. The first underwent point-of-care proteinuria testing using visual test strips (Multistix 10SG, Siemens Healthcare Diagnostics, Inc., Tarrytown NY). The second aliquot was sent to the hospital laboratory for analysis by each of two automated dipstick test strips (Multistix 10SG strip, Bayer Clinitek 50; Chemstrip®10 MD, and Urisys 1100®) and PrCr. For PrCr, urinary protein was measured by a pyrogallol red dye-binding method, and creatinine by an enzymatic method. For each of the dipstick methods, positive test thresholds (see Table) were used to determine diagnostic accuracy for PrCr ⩾ 30 mg/mmol. Included were 470 (91.7%) urine samples tested by all dipstick methods. The prevalence of proteinuria was low. All dipstick proteinuria methods showed low sensitivity and high specificity for detection of PrCr ⩾ 30 mg/mmol, although visual dipstick urinalysis had lower sensitivity than either automated method. For all dipstick methods, the positive likelihood ratio (LR) was good-excellent, but the negative LR was poor-fair. Automated dipstick methods are more sensitive than visual urinalysis for detection of proteinuria, but diagnostic test performance is still poor-fair as a ‘rule-out’ test for proteinuria. Whether the enhanced sensitivity would be worth the cost and training is to be determined. Table 1. AUC (area under the curve), CI (confidence interval), LR (likelihood ratio).Group 1 Visual Multistix 10SG stripGroup 2 Automated Multistix 10 SG, Bayer Clinitek 50Group 3 Automated Chemstrip® 10 MD, Urisys 1100®Positive test threshold+1 (0.3 g/l)+1 (0.3 g/l)+1 (0.25 g/l)Proteinuria present36 (7.7%)83 (17.7%)59 (12.6%)Sensitivity (%, 95% CI)50 (38–62)71 (59–81)63 (50–74)Specificity (%, 95% CI)98 (97–99)91 (87–93)95 (93–97)Positive LR (95% CI)40.8 (16.49–100.96)7.42 (5.30–10.41)12.83 (8.04–20.49)Negative LR (95% CI)0.51 (0.40–0.65)0.32 (0.22–0.47)0.39 (0.28–0.54)AUC (95% CI)0.74 (0.66–0.83)0.81 (0.74–0.88)0.79 (0.72–0.87) M.E. Correa: None. A.C. Halstead: None. A. Côté: None. D.A. De Silva: None. L. Wang: None. P. von Dadelszen: None. L.A. Magee: None.