Placenta accreta spectrum (PAS) is a rare complication that can lead to life-threatening postpartum hemorrhage. PAS can sometimes occur unexpectedly, without placenta previa; such cases can lead to higher maternal mortality and morbidity than expected cases. Here, the authors report a case of unexpected PAS caused by assisted reproductive technology (ART) in a woman with adenomyosis. The patient was a 37-year-old Japanese primipara woman who presented to our hospital at 11 weeks gestation, later returning to her parents’ house to give birth. The woman had adenomyosis and underwent adenomyomectomy, which was followed by an ART pregnancy. The patient was admitted to our hospital because of a life-threatening preterm birth, with a short cervix and no evidence of placenta previa. Despite strict perinatal management, preterm rupture of the membrane (PROM) occurred. During laparotomy, the small intestine, rectum, and both right and left ovaries were clumped together and severely adhered to the surface of the uterus. After delivery, manual partial removal of the placenta was performed, resulting in heavy bleeding from the implantation site, which was diagnosed as an unexpected PAS. Following several uterine compression efforts, we successfully preserved the uterus.

in the L6 spinal cord, as markers of glial activation and central sensitization, were also evaluated by RT-PCR and immunohistology.RESULTS: OAB mice showed bladder overactivity and inefficient voiding (Fig 1-a) with increased M2, M3, P2X2, P2X3, P2X4, and P2X7 levels in the bladder and increased CCL2 and CCR2 in DRG, indicating afferent hyperexcitability (Fig 1-b). CX3CR1, GFAP, and CCR2 in the L6 spinal cord were upregulated in the OAB group (Fig 1-c). However, CON mice exhibited improvements of all these parameters of afferent hyperexcitability and central sensitization. Also, CON mice showed better voiding efficiency and reduced CNS changes compared with CES mice.CONCLUSIONS: Central sensitization may be an important pathophysiological mechanism of OAB. Continuous treatment of OAB with mirabegron seems to prevent the process of central sensitization via improvement of CNS neural remodeling. Therefore, continuous OAB medication may be desirable for long-term disease control.

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between 2007 and 2020. A similar cohort of men who underwent AUS placement without erosion were randomly selected from the same database for comparison. Risk factors for cuff erosion e pelvic radiation, androgen deprivation therapy (ADT), high-grade prostate cancer (Gleason score ! 8) e were recorded for each patient. Presenting signs and symptoms of erosion were grouped into three categories: obstructive symptoms, worsening incontinence, and localized scrotal inflammation (SI).RESULTS: Of 893 men who underwent AUS placement during the study interval, 61 (6.8%) sustained cuff erosion. Most erosion patients (40/61, 66%) presented with scrotal inflammatory changes including tenderness, erythema, and swelling (Figure 1). Fewer men reported obstructive symptoms (26/61, 43%) and worsening incontinence (21/61, 34%). The average length of time to cuff erosion was 22.2 months AE 33.7. Men with SI or obstructive symptoms presented significantly earlier than those with worsening incontinence (SI 14 AE 18 vs. obstructive symptoms 15 AE 16 vs. incontinence 37 AE 48 months after AUS insertion, p<0.01). Relative to the non-erosion control group (n[61), men who suffered erosion had a higher prevalence of pelvic radiation (71 vs 49%, p[0.02), hypertension (87 vs 64%, p[0.003), coronary artery disease (54 vs 12 %, p<0.00001), and smoking history (71 vs 51%, p[0.03).CONCLUSIONS: AUS cuff erosion most commonly presents as scrotal inflammatory symptoms. Obstructive voiding symptoms and worsening incontinence are also common. Any of these symptoms should prompt further investigation of cuff erosion.