Effects of Combined Laparoscopic Cystectomy and Leuprolide Acetate Therapy on Anti-Mullerian Hormone Level and Antral Follicle Count Profile in Endometriosis

Objective: This study examines the effectiveness of combined laparoscopic cystectomy and leuprolide acetate therapy on AMH level and AFC profile in endometriosis.Method: This study is a randomized controlled clinical trial with open label form. The subjects were divided into control and therapy groups, with the therapy group receiving leuprolide acetate injection following laparoscopic cystectomy. In both groups, the AMH levels and AFC were examined prior to the surgery and six weeks after before they were compared.Results: There were significant pre-post differences of AMH levels(p = 0.000) and AFC (p = 0.000) in the therapy group but not in the control group. In the therapy group, the mean increases of AMH level and AFC were 0.94 (95% CI: 0.63-1.25) and 9.53 (95% CI: 6.83-12.24), respectively. Linear regression model found that AFC level prior to intervention was a significant predictor of endometriosis ASRM grade (p = 0.001) with an R-value of 0.633, suggesting strong correlation.Conclusion: The combined therapy of laparoscopic cystectomy and leuprolide acetate injection for endometriosis provided better outcome concerning ovarian reserve, as opposed to the therapy with laparoscopic cystectomy alone. Peran Kombinasi Laparoskopi Kistektomi dan Terapi Leuprolide Asetat Terhadap Kadar Hormon Anti-Mullerian dan Profil Jumlah Folikel Antral pada Penderita EndometriosisAbstrakTujuan:Studi ini bertujuan menguji keefektifan kombinasi kistektomi laparoskopi dan terapi leuprolide acetate terhadap kadar AMH dan profil AFC pasien endometriosis.Metode: Penelitian ini merupakan uji klinis terkontrol acak dengan bentuk open label. Subjek dibagi menjadi kelompok kontrol dan terapi, dengan kelompok terapi menerima injeksi leuprolide acetate setelah kistektomi laparoskopi. Pada kedua kelompok, kadar AMH dan AFC diperiksa sebelum pembedahan dan enam minggu setelahnya sebelum kemudian dibandingkan.Hasil: Terdapat perbedaan bermakna kadar AMH (p = 0,000) dan AFC (p = 0,000) sebelum dan sesudah pada kelompok terapi tetapi tidak pada kelompok kontrol. Pada kelompok terapi, rata-rata peningkatan kadar AMH dan AFC adalah masing-masing 0,94 (95% CI: 0,63-1,25) dan 9,53 (95% CI: 6,83-12,24). Model regresi linier menemukan bahwa kadar AFC sebelum intervensi merupakan prediktor signifikan derajat endometriosis sesuai ASRM (p = 0,001) dengan nilai R sebesar 0,633 yang menunjukkan korelasi yang kuat.Kesimpulan: Terapi kombinasi kistektomi laparoskopi dan injeksi leuprolide acetate untuk endometriosis memberikan hasil yang lebih baik terhadap cadangan ovarium, dibandingkan dengan terapi dengan kistektomi laparoskopi saja.Kata kunci: endometriosis; leuprolide acetate; kistektomi; hormon anti-mullerian; jumlah folikel antra

Diagnosis and Management of Vesicouterine Fistula (Youssef’s Syndrome): A Case Report

Background. Vesicouterine fistula (VUF) is a rare pathological communication between the uterus or cervix and the bladder. Youssef's syndrome is an atypical presentation of a patient with a vesicouterine fistula, characterized by a triad of cyclic hematuria, amenorrhea, and absence of urinary incontinence. Because of this atypical presentation, the patient may go undiagnosed and patient management will be delayed. Case presentation. A 39-year-old woman complained of hematuria. The patient underwent a second caesarean section in 2008 and a few weeks after the procedure the patient complained of leakage of urine from her vagina. Six months later the patient complained hematuria on her menstrual cycle and amenorrhea, with absence of urinary incontinence. Ultrasound examination found adhesions between the uterus and vagina, and irregular bladder mucosa. Patient  underwent cystoscopy with endometriosis were suspected on vesicovaginal repair scars and a bladder biopsy was also performed with the results of no endometrial stroma and glands then followed by hysteroscopy. Hysteroscopy result showed a 20 mm diameter hole with irregular margins. Subsequently, the patient was treated with hysterorrhaphy laparotomy and fistula repair. Conclusion. One type of vesicouterine fistula is Youssef's syndrome, which is a complication following a lower segment caesarean section with undiagnosed bladder injury. The diagnosis can be confirmed by cystoscopy, intravenous pyelography, hysterosalpingogram, sonography, and other types of imaging tests. Management of patients with VUF can be conservative, medical, or surgical

The Role of Vitamin D and Vitamin D Receptor in Placenta Accreta Spectrum: A Literature Review

Objective: This study aims to review the role of vitamin D and vitamin D receptor in Placenta Accreta Spectrum Disorder (PASD)Method: This review used several databases, namely Google Scholar, Science Direct, Elsevier, Medline, PubMed, Proquest, dan Wiley Online Library to search original and review articles in English about placenta accreta spectrum, placenta accreta, vitamin D, and vitamin D receptor in the last 10 years. Other reference sources used were guidelines and textbooks.Results: A total of four articles were included in this review.Discussion: Placenta accreta spectrum disorder is becoming more common around the world, owing to the rise in cesarean deliveries. It is linked to several risk factors, including a lack of vitamin D. Vitamin D and its receptor stimulate endometrial decidualization, which aids implantation. Vitamin D receptors in human placental trophoblasts create and respond to 1,25(OH)2D3, which promotes the conversion of endometrial cells to decidual cells. Women with PASD are mostly suffering from vitamin D deficiency. Conclusion: Vitamin D levels may influence trophoblast invasion in PASD and can be a potential diagnostic marker.Peran Vitamin D dan Reseptor Vitamin D dalam Spektrum Plasenta Akreta: Suatu Tinjauan PustakaAbstrakTujuan: Penelitian ini bertujuan untuk meninjau peran vitamin D dan reseptor vitamin D dalam Spektrum Plasenta Akreta (SPA)Metode: Tinjauan pustaka ini menggunakan beberapa sumber data yaitu Google Scholar, Science Direct, Elsevier, Medline, PubMed, Proquest, dan Wiley Online Library untuk mencari artikel penelitian dan tinjauan pustaka dalam Bahasa Inggris mengenai plasenta akreta, vitamin D, dan reseptor vitamin D dalam 10 tahun terakhir. Sumber referensi lain yang digunakan adalah pedoman dan buku teks.Hasil: Sebanyak empat artikel dimasukkan dalam ulasan ini.Diskusi: Spektrum Plasenta Akreta terjadi lebih sering di seluruh dunia karena meningkatnya persalinan sesar. Plasenta akreta terkait dengan beberapa faktor risiko termasuk kekurangan vitamin D. Vitamin D dan reseptornya merangsang desidualisasi endometrium dan berperan dalam implantasi. Reseptor vitamin D pada trofoblas plasenta membuat dan merespons 1,25(OH)2D3 yang mendorong konversi sel endometrium menjadi sel desidua. Mayoritas wanita dengan SPA mengalami kekurangan vitamin D.Kesimpulan: Kadar vitamin D dapat mempengaruhi invasi trofoblas pada SPA dan berpotensi menjadi penanda diagnostik.Kata kunci: spektrum plasenta akreta, reseptor vitamin D, vitamin