A reduction of Wharton's jelly is frequently present in cases of single umbilical artery. The increased perinatal morbidity and mortality observed in cases of single umbilical artery, even in the absence of congenital or chromosomal abnormalities, could be in part the consequence of a reduced amount of Wharton's jelly.

We report two women who presented with a recurrent, mildly painful, bluish nodule in the umbilicus. Both patients complained of local tenderness and occasional bleeding that increased during menstruation. Neither patient had had previous pelvic surgery. Excision of the lesions revealed a primary umbilical endometriosis; in one case, a simultaneous laparoscopy showed a pelvic endometriosis. We review the current literature and discuss the possible etiopathogenesis and when a laparoscopy is indicated to diagnose a concomitant pelvic endometriosis. Umbilical endometriosis is a very rare disease but should be considered in the differential diagnosis of umbilical lesions.

The results of the operative treatment of 425 women with severe stress incontinence grade II and grade III according to Ingelman-Sundberg are reported. The following types of operation were used: diaphragmaplasty (DP), urethrovesicosuspension Marshall-Marchetti-Krauz (MK), lyoduraslings (LDS), and puborectalisplasty of Franz-Ingelman-Sundberg (PRP). The choice of the operative method and the evaluation of the results of the operation were done by history, clinical examination and radiological examination. The urodynamic investigation with a microtransducer which we used since 1977 prior and after each operation for stress incontinence does have little influence on the choice of the operation. The value of urodynamic studies on a quantitative evaluation of the type of operation is at present doubtful. Our definitive evaluation of the result of the operation was done not earlier than one year following the operation in a prospective stress incontinence clinic. Because of our individual treatment plan from the onset by different methods 89% of the 425 patients were cured or markedly improved.

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