To determine the distances and angles that assure a safe entry into the pouch of Douglas (POD) during blind laparoscopic and robotic trocar entry. Design: Trocars were inserted into the POD of 4 intact fresh frozen female pelves. Cadaveric dissection was performed, and the distance from the POD to the sacrum at rest and with maximal pressure to POD with the trocar was measured. In addition, the optimal angle for trocar insertion and entry was evaluated.

Objective To investigate how aging and menopausal status in absence of pregnancy and childbirth affect the elasticity of the bladder and urethra. Study Design A single‐center prospective observational study including nulliparous 10 pre‐ and 12 postmenopausal women. Data collection included baseline characteristics, physical examination data, questionnaire scores, PDFI and the Pelvic Floor Impact Questionnaire, and pelvic floor sonographic measurements as well as elastography measurements. The shear wave elastography (SWE) of tissue was measured using Kilopascal (kPa). The elastography measurements were taken over the rhabdosphincter, the suburethra smooth muscle, and the trigonal areas. Results A total of 22 nulliparous subjects were enrolled in the study. The cohort's mean age was 43.5 years, the mean body mass index (BMI) was 26.8, and 86% were of Caucasian ethnicity. The postmenopausal group was older and with higher BMI (p < 0.001 and p = 0.05). They also had higher scores in all the questionnaires (p < 0.05 for all) and did not demonstrate prolapse in any compartments. The SWE results for the whole group were 35.2 kPa in the rhabdosphincter measuring point, 40.2 kPa in the sub‐urethra point, and 20.6 kPa in the trigone point. Comparing the premenopause and postmenopause groups, we found lower measurements in the rhabdosphincter area and equivocal measurements for the suburethral zone. No statistically significant differences were found between the groups Conclusions The elastic properties of the different bladder components and the urethra change with age and menopause. Using elastic properties of the tissues, we can further explore both stress urinary incontinence and overactive bladder.

OBJECTIVE: Partial and complete hydatidiform moles (PHM, CHM) are a common cause of pregnancy loss. To assess the frequency and nature of genomic imbalances, specifically polyploidy resulting in PHM and whole-genome uniparental disomy (WG-UPD) resulting in CHM, a comprehensive analysis of a large cohort of miscarriage samples was analyzed by single nucleotide polymorphism (SNP)-based chromosomal microarray (CMA). STUDY DESIGN: The CMA results for 21,342 miscarriage samples were analyzed for polyploidy and WG-UPD. DNA extracted from fresh products of conception (80%) or formalin-fixed paraffin embedded samples (FFPE, 19%) were subjected to SNP-based CMA. When available, correlation with histopathology was attempted. RESULTS: Abnormal CMA results were observed in 55.7% (11,899/ 21,342) of samples. Of these 11,899 cases, polyploidy was identified in 1641 (13.8%) and WG-UPD in 150 (1.26%). Majority of polyploid samples (1631/1641) had triploidy, of which 216 had hyper-or hypotriploidy, and 10 had confirmed or possible tetraploidy. SNP-genotype data suggested 6/150 CHM samples with WG-UPD resulted from dispermy. Histopathology was suggestive of PHM or CHM in only 236 samples (1.1%); 186 of these (79%) had abnormal CMA results (67 with polyploidy, 70 with WG-UPD) and the remainder with aneuploidy. Histopathology was more often suggestive of molar pregnancy in cases with WG-UPD (54/150, 36%) compared to polyploidy (60/1641, 3.7%). CONCLUSION: Diagnosis of polyploidy and whole-genome UPD as a cause of pregnancy loss is challenging. Implementation of SNP-based CMA provides a powerful tool enabling accurate identification of polyploidy and WG-UPD. The accurate genetic classification of PHM and CHM underscores the immense value of a genotype-first approach for accurate detection of molar pregnancies, and in particular for the identification of PHM that are unsuspected by histopathology. This study provides a comprehensive estimate of the frequency and types of genomic abnormalities that impact trophoblastic transformation of conceptions and result in partial or complete hydatidiform moles.

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