Many functional noncommunicating horns present during or after the third decade of life with acute obstetric uterine rupture. Surgical removal before pregnancy is recommended. Rates of prerupture diagnosis remain disappointingly low.

Objective To determine whether digital assessment of pelvic floor contraction strength is as reliable as Design A blinded, two-assessor protocol, prospectively testing a volunteer sample of women.Population Two hundred and sixty-three women (from a total of 278), aged 16-75 years, attending a general gynaecological clinic with nonurinary symptoms.Methods Participants answered a questionnaire regarding urinary symptoms and practice of pelvic floor exercises. History and examination was carried out by the clinician, and pelvic floor strength scored digitally using the Oxford Scale. Pelvic floor strength was then assessed by the physiotherapist, using a PFX perineometer. The physiotherapist was blinded to the woman's history, examination findings and digital assessment score. Both the clinician and physiotherapist were blinded to the questionnaire responses.Main outcome measures Digital pelvic floor contraction assessment, according to the Oxford Scale, was compared with perineometric assessment as the gold standard -examined against the background of the questionnaire findings.Results Of 263 patients, 53 were nulliparous (20%), and 210 parous (80%). Only 49 women carried out regular pelvic floor exercises (19%), and all were parous and admitted to troublesome urinary symptoms. Stress urinary incontinence was reported by 28% of all women (38.1% of parous women and 10.5% of nulliparous women). For both methods, there was no difference in the range of results when parity was taken into account. Concordance studies showed good agreement between digital and perineometric assessment of pelvic floor strength. The kappa value of 0.73 (95% confidence interval 0.67-0.79) indicated substantial agreement between the two methods.There is good agreement between digital assessment of pelvic floor contraction strength and vaginal perineometry. Assessment during gynaecological examination may help to identify women with fascial defects of the pelvic floor, as well as those at risk of genital prolapse or urinary symptoms.vaginal perineometry and to assess the practice of pelvic floor exercises by women. Conclusion

The use of Ligasure, a computer-controlled bipolar diathermy system is proven beneficial in a wide range of surgical procedures. This study was to evaluate its application to vaginal hysterectomy. Over forty patients underwent vaginal hysterectomy with (n = 32) or without (n = 12) Ligasure using standard surgical techniques. The main diagnoses, the age of patients, time for surgery, hospital stay and estimated blood loss during operation were compared. The average operating time was shorter in the Ligasure vaginal hysterectomy group (30 mins (24-48) P < 0.05), the estimated blood loss was less in the Ligasure hysterectomy group (39 mins (25-60) P < 0.05), and the hospital stay was shorter in the Ligasure hysterectomy group (1.2 days (1-2) vs 3 days (3-5) P < 0.05). There were no postoperative complications or re-admissions in either group. Vaginal hysterectomy using Ligasure reduced operating time and blood loss, and therefore shortened hospital stay.

PCOS patients are not always markedly overweight but PCOS is strongly associated with abdominal obesity and insulin resistance. Effective approaches to nutrition and exercise improve endocrine features, reproductive function and cardiometabolic risk profile--even without marked weight loss. Recent studies allow us to make recommendations on macronutrient intake. Fat should be restricted to < or =30% of total calories with a low proportion of saturated fat. High intake of low GI carbohydrate contributes to dyslipidaemia and weight gain and also stimulates hunger and carbohydrate craving. Diet and exercise need to be tailored to the individual's needs and preferences. Calorie intake should be distributed between several meals per day with low intake from snacks and drinks. Use of drugs to either improve insulin sensitivity or to promote weight loss are justified as a short-term measure, and are most likely to be beneficial when used early in combination with diet and exercise.

To compare the safety and efficacy of the transobturator tape (Monarc) with the retropubic tape (tension-free vaginal tape, TVTR) for the treatment of urodynamic stress incontinence (USI) a prospective, single-blinded, multi-centre randomised clinical controlled trial was undertaken in four urogynaecology units in Australia. One hundred and eighty-seven women with USI were randomly allocated to undergo surgery with either the Monarc sling (n = 80) or TVT (n = 107). Outcome measures were intra-operative complications (especially bladder injury), as well as peri-operative complications, symptomatology, quality of life and urodynamic outcomes. At 3 months, data were available on 140 women, 82 (59%) TVT and 58 (42%) Monarc. The TVT group was significantly more likely to be complicated by bladder injury (7 TVT, 0 Monarc, p < 0.05). Blood loss and operative time were significantly less in the Monarc group, which was 49 mls (31) vs that of the TVT group, which was 64 mls (41) p < 0.05; 18.5 min (6.5) TVT vs 14.6 min (6) Monarc (p < 0.001). The subjective and objective stress incontinence cure rates were 86.6% (71) vs 72.4% (42) p = 0.77 and 79.3 vs 84.5%, p = 0.51 for the TVT and Monarc groups, respectively. Both groups reported similar improvement in incontinence impact and satisfaction with their operation, although return to activity was significantly quicker with the transobturator route (p = 0.029). The transobturator tape appears to be as effective as the retro-pubic tape in the short term, with a reduction in the risk of intra-operative bladder injury, shorter operating time, decreased blood loss, and quicker return to usual activities.