Objective: To compare the sensitivity and specificity of two‐ (2D) and three‐ (3D) dimensional transperineal ultrasound (TPUS) and 3D endovaginal ultrasound (EVUS) with the gold standard 3D endoanal ultrasound (EAUS) in detecting residual defects after primary repair of obstetric anal sphincter injuries (OASIS).Methods: External (EAS) and internal (IAS) anal sphincters were evaluated by the four ultrasound modalities in women with repaired OASIS. 2D‐TPUS was evaluated in real‐time, whereas 3D‐TPUS, 3D‐EVUS and 3D‐EAUS volumes were evaluated offline by six blinded readers. The presence/absence of any tear in EAS or IAS was recorded and defects were scored according to the Starck system. Sensitivity, specificity and predictive values were calculated, using 3D‐EAUS as reference standard. Inter‐ and intraobserver analyses were performed for all 3D imaging modalities. Association between patients' symptoms (Wexner score) and ultrasound findings (Starck score) was calculated.Results: Images from 55 patients were analyzed. Compared with findings on 3D‐EAUS, the agreement for EAS evaluation was poor for 3D‐EVUS (κ = 0.01), fair for 2D‐TPUS (κ = 0.30) and good for 3D‐TPUS (κ = 0.73). The agreement for IAS evaluation was moderate for both 3D‐EVUS (κ = 0.41) and 2D‐TPUS (κ = 0.52) and good for 3D‐TPUS (κ = 0.66). Good intraobserver (3D‐EAUS, κ = 0.73; 3D‐TPUS, κ = 0.78) and interobserver (3D‐EAUS, κ = 0.68; 3D‐TPUS, κ = 0.60) agreement was reported. Significant association between Starck and Wexner scores was found only for 3D‐EAUS (Spearman's rho = 0.277, P = 0.04).Conclusions: 2D‐TPUS and 3D‐EVUS are not accurate modalities for the assessment of anal sphincters after repair of OASIS. 3D‐TPUS shows good agreement with the gold standard 3D‐EAUS and a high sensitivity in detecting residual defects. It, thus, has potential as a screening tool after primary repair of OASIS. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Treatment of hypertrophic scars arising as a result of thermal burns in children is still a big problem. The results of the treatment are not satisfactory for patients and parents, and new methods of treatment are still investigated. We present the use of one of the most modern carbon dioxide (CO2) lasers (Lumenis Encore laser equipped with a Synergistic Coagulation and Ablation for Advanced Resurfacing module) in the treatment of hypertrophic scars in children after burns. From March to April of 2013, a group of 47 patients aged 6 to 16 years underwent 57 laser surgery treatments. The average time from accident was 7.5 years. The results of treatment were investigated in 114 areas. The assessed areas were divided into 2 groups: 9-cm2 area 1, where the thickness of the scar measured by physician was the lowest and 9-cm2 area 2, where the thickness of the scar was the biggest. The results were considered on the Vancouver Scar Scale (VSS) independently by the surgeon and by parents 1, 4, and 8 months after the procedure. In addition, ultrasound evaluation of the scar thickness before and after laser procedure was made. VSS total score improved in all areas assessed by both the physician and parents. The biggest change in total VSS score in area 1 in the evaluation of the investigator was obtained at follow-up after the 1st month of treatment (average 7.23 points before and 5.18 points after the 1st month after surgery—a difference of 2.05 points). Scar ratings by parents and the physician did not differ statistically (P < 0.05). In the ultrasound assessment, the improvement was statistically significant, more frequently for both minimum and maximum thickness of the scars (B-mode measures) (P < 0.05). The use of a CO2 laser in the treatment of hypertrophic scars in children is an effective and safe method. The use of a CO2 laser improves the appearance and morphology of scarring assessed using the VSS by both the parents and the physician. The treatment also reduced the thickness of scars evaluated by ultrasound.

To investigate whether the position of the tape under the urethra may influence ‘outside-in’ transobturator sling (TOT) outcome.