Additional secure circular suture during sphincteroplasty — preliminary results on the efficacy of fecal incontinence surgery in urogynecological patients

Objectives: The paper is a ten case series study presenting women with complex pelvic floor disorders involving fecal incontinence (FI) with stress urinary incontinence or pelvic organ prolapse.  Our study aimed at ascertaining whether FI-induced sphincteroplasty with an additional secure circular suture around the external anal sphincter muscle (EAS) may improve long term success rates.  Materials and methods: Twelve patients had scheduled urogynecological surgery and overlapping sphincteroplasty with the placement of an additional circular suture around the EAS. Of these, the status of ten women was established by way of the Cleveland Clinic Fecal Incontinence Score/Wexner Score before and about 70 months after surgery.  Results: Statistical analysis of fecal incontinence score showed that patients were not completely cured from FI, but were significantly better (p = 0.011).  Conclusions: A circular secure suture around the external anal sphincter in FI patients may help to improve anal sphincter function. 

Hysterectomy trends for benign indications over a 15-year period in an academic teaching center in Poland: a retrospective cohort study

Objectives: The aim of the study was to evaluate changes in the operative trends for various types of hysterectomy due to benign indications, between 2001 and 2015, at the 2nd Department of Gynecology, Medical University of Lublin, as compared to the National Health Service (NHS) registry in Poland. Material and methods: A retrospective cohort study was conducted. Data from the Internal Hospital Discharge Registry and Pathological Results Registry have been compared to the NHS database, which has been available nationwide since 2009. Results: The study group included 5629 women who underwent hysterectomy due to benign indications. During the study period, the following number of procedures were performed: total abdominal hysterectomy — 344 (6.11%), total abdominal hysterectomy with bilateral salpingo-oophorectomy — 1760 (31.27%), total vaginal hysterectomy — 563 (10.00%), subtotal abdominal hysterectomy — 2536 (45.05%), and laparoscopically-assisted subtotal hysterectomy (LASH) — 426 (7.57%). The abdominal route, with the preference for subtotal abdominal hysterectomy, was the main approach to hysterectomy. Symptomatic fibroids were the most common indication for the procedure. Comparison of data collected over the last five years revealed a significant difference in the approach to hysterectomy in favor of subtotal abdominal hysterectomy (SAH) and LASH. Conclusions: Less invasive techniques of hysterectomy (LASH, SAH), which are the preferred choice at the 2nd Department of Gynecology (Lublin), are safe and effective options of treating benign conditions. We are of the opinion that these ap­proaches should be offered to patients instead of more radical techniques. Proper training of physicians may influence the decision-making process in favor of minimally invasive techniques

Power morcellation for women undergoing laparoscopic supracervical hysterectomy — safety of procedure and clinical experience from 426 cases

  Objectives: Minimally invasive gynaecological surgeries are performed for several malignant and nonmalignant indications. The aim of our study was to evaluate the rate of unexpected malignancies among women who underwent laparoscopical supracervical hysterectomy (LASH) with power morcellation. Material and methods: The retrospective analysis included clinical data of 426 consecutive female patients who underwent LASH with power morcellation due to presumed benign disorders (78.4% — symptomatic uterine fibromas, 12.7% — abnormal uterine bleeding, 8.9% — suspicion of uterine adenomyosis) between January 2011 and December 2015. Pre­malignant or malignant preoperative abnormalities in the cervix and the uterine corpus were contraindications for LASH. Results: The unexpected malignancies were found in four patients from study group: one ovarian cancer located on the inner part of simple ovarian cyst and 3 endometrial carcinomas (0.9%) were documented. All these patients underwent abdominal reoperations and no histological abnormalities were detected in the extirpated cervix and adnexa. Conclusions: The incidence of unintended endometrial carcinoma in morcellated uterus after LASH was relatively small. However, careful pre-operative counseling should be undertaken in order to exclude the possibility of any malignant disease in uteri among women scheduled to power morcellation.

Stężenie wybranych czynników angiogennych w płynie otrzewnowym i surowicy krwi pacjentek z endometriozą

Introduction: Endometriosis is a sex hormone-dependent and successively progressing gynecological disease, characterized by the presence of endometrial tissue outside the uterus. The etiology of endometriosis is known to be multifactorial, and its growth depends on immunological, hormonal, genetic and environmental factors. Angiogenesis plays a key role in implantation and growth of endometriotic lesions, as well as in adhesion formation. Physiologically angiogenesis is responsible for neoangiogenesis and recruitment of new capillaries from the already existing capillaries. It is well-documented that altered angiogenesis provokes improper follicular maturation, infertility, recurrent miscarriages, ovarian hyperstimulation syndrome, and carcinogenesis. Factors stimulating angionesis include angiogenin, vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF). Objectives: The aim of the study was to analyze angiogenic factor concentration (angiogenin, VEGF, FGF) in blood serum and peritoneal fluid in patients with diagnosed endometriosis and idiopathic infertility. Material and methods: A total of 39 patients were recruited for the study, including 19 patients (study group) diagnosed with endometriosis during the laparoscopic procedure and 20 patients (control group) with idiopathic infertility and no morphologic changes within the pelvis revealed during the laparoscopic procedure. All patients underwent laparoscopy during the follicular phase of the menstrual cycle. Vein blood sample was obtained before the procedure and during laparoscopy the entire peritoneal fluid was aspirated for further measurement of VEGF, FGF and angiogenin concentrations. Results: Angiogenin concentration in peritoneal fluid was statistically higher in patient with idiopathic infertility in comparison to endometriosis (p0.05). There were no significant differences between serum and peritoneal fluid in case of VEGF, FGF and angiogenin in any of the groups. Conclusions: Angiogenic factors concentration (VEGF, FGF, agiogenin) in the peritoneal fluid and blood serum during the follicular phase of the menstrual cycle is not a diagnostic criterion for endometriosis.Wstęp: Endometrioza jest hormonozależną, przewlekłą i postępującą chorobą charakteryzującą się występowaniem funkcjonującej tkanki endometrialnej poza jamą macicy. Etiologia endometriozy jest wieloczynnikowa, a rozwój jej zależy od czynników immunologicznych, hormonalnych, genetycznych i środowiskowych. Jednym z kluczowych procesów odpowiedzialnych za implantację i wzrost zmian endometriotycznych oraz tworzenie zrostów jest angiogeneza. Fizjologicznie proces ten odpowiada za powstawanie nowych naczyń oraz przebudowę już istniejących. Udowodniono związek pomiędzy występowaniem zaburzeń procesu angiogenezy a brakiem owulacji, niepłodnością, nawracającymi poronieniami, zespołem hiperstymulacji jajników oraz nowotworzeniem. Do czynników pobudzających angiogenezę możemy zaliczyć między innymi angiogeninę, naczyniowy czynnik wzrostu śródbłonka (VEGF) oraz czynnik wzrostu fibroblastów (FGF). Cel pracy: Celem pracy była ocena stężenia czynników angiogennych (angiogenina, VEGF, FGF) w surowicy krwi żylnej oraz płynie otrzewnowym pacjentek z endometriozą i niepłodnością idiopatyczną. Materiały i metody: Do badania włączono 39 pacjentek. Grupę badaną stanowiło 19 pacjentek, u których w trakcie laparoskopii zdiagnozowano endometriozę, natomiast do grupy kontrolnej włączono 20 pacjentek z niepłodnością o niewyjaśnionej etiologii, u których w trakcie laparoskopii nie stwierdzono zmian morfologicznych w obrębie narządów miednicy mniejszej. Pacjentki zostały poddane laparoskopii w fazie folikularnej cyklu miesiączkowego. Przed zabiegiem od wszystkich pacjentek pobrano krew z żyły łokciowej, a podczas operacji, bezpośrednio po wprowadzeniu trokarów aspirowano całą widoczną objętość płynu otrzewnowego w celu oznaczenia stężenia VEGF, FGF i angiogeniny. Wyniki: W grupie pacjentek z niewyjaśnioną niepłodnością stwierdzono istotnie statystycznie (p0,05). Stężenie VEGF i FGF w surowicy krwi oraz w płynie otrzewnowym było podobne u pacjentek z endometriozą i z niepłodnością idiopatyczną. (p>0,05). Nie wykazano istotnych różnic między surowicą a płynem otrzewnowym dotyczących stężeń VEGF, FGF i angiogeniny w każdej z grup. Wniosek: Stężenie czynników angiogennych (VEGF, FGF, angiogenina) w płynie otrzewnowym i w surowicy krwi kobiet w folikularnej fazie cyklu nie jest markerem odzwierciedlającym występowanie endometriozy

Collagen type III biosynthesis by cultured pubocervical fascia fibroblasts surrounding mono and multifilament polypropylene mesh after estrogens and tamoxifen treatment

Abstract Aim: Surgical procedures using synthetic implants are currently considered as the most efficient therapy for stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Insertion of the tape or mesh causes enhanced collagen synthesis that largely affects the biomechanical property of the implant. This process is significantly modulated by estrogens and improper wound healing and treatment failure may result in hypoestrogenism. The aim of the study was to assess the rate of collagen type III synthesis by pubocervical fascia fibroblasts cultured with polypropylene meshes in the presence of estrogens and tamoxifen. Material and Methods: Fibroblasts were obtained from pubo-cervical fascia sampled from a 52-year-old premenopausal woman who underwent surgical treatment for SUI and cultured with monofilament or multifilament polypropylene meshes in the presence of 17β-estradiol, estriol, daidzein or tamoxifen. The cultures were run for 216hr and the media were replaced every 72hr. N-terminal propeptide of type III procollagen (PIIINP) was used as a marker of collagen type III synthesis. Its concentration in the media was measured by radioimmunoassay. Pubocervical fascia fibroblast cultured with monofilament or multifilament meshes are capable of collagen type III synthesis. Following treatment with estradiol or tamoxifen, the highest PIIINP concentrations were observed after 72hr, whereas in case of estriol, daidzein or no treatment after 144hr of culture, regardless of the type of mesh used. Results: Only in cultures containing monofilament mesh and stimulated with estriol the high rate of collagen type III synthesis persisted until the end of the experiment. Paradoxically, the highest total production of PIIINP was observed in culture treated with tamoxifen, both for multifilament and monofilament meshes. Conclusion: The rate of collagen type III synthesis by pubocervical fascia fibroblast cultured with polypropylene meshes is subjected to modulation by estrogens and antiestrogens

Urogynecological and Sexual Functions after Vecchietti Reconstructive Surgery

Hypothesis/Aims of Study. Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is the second most common cause of primary amenorrhea. The ESHRE/ESGE categorizes this disorder within the class 5 uterine malformation of the female genital tract anomalies. It is characterized by congenital absence of the uterus, cervix, and upper part of the vagina in otherwise phenotypically normal 46XX females. These patients have normal ovaries, biphasic ovarian cycle, and female psychosexual identification. Laparoscopic Vecchietti’s operation—surgical method in which the vagina increases in size by gradually applying traction to the vaginal vault—is one of the methods used to treat MRKH. The aim of this study was to establish the urogynecological and sexual functions after Vecchietti’s operation. Study Design, Materials and Methods. Fifteen patients with MRKHS who underwent laparoscopic Vecchietti’s operation were included. A control group of 15 age-matched, childless, sexually active women were examined during the same period. All patients underwent the basic evaluation of anatomical outcomes. Sexual outcomes were established by the Polish validated Female Sexual Function Index (FSFI) questionnaire. Continence status was assessed by Polish validated Urinary Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Results. Mean age of MRKH group was 22.06±5.13 yrs. Mean follow-up after surgery was 8.02±3.43 yrs. Mean age of women from control group was 22.4±4.35. Mean FSFI scores show good quality of sexual life in both groups. UDI-6 scores showed that patients after Vecchietti surgery have urogynecological problems significantly more often than healthy women do. Based on the IIQ-7, it is evident that one patient from the MRKH group (6,6%) suffers from stress urinary incontinence and the rest (20%) have rather irritative problems with the functioning of the lower urinary tract. Conclusion. Quality of sexual life after the Vecchietti’s operation in long-term follow-up does not differ from that of healthy women, but these patients suffer more frequent from urogynecological complaints. The trial is registered with NCT03809819

Hyperprolactinaemia – a problem in patients from the reproductive period to the menopause

Hyperprolactinaemia especially affects women in reproductive age (90/100,000) but also often is diagnosed in menopause age and leads to disturbances in functioning of LH-RH neurons and, as a consequence, to a decrease of FSH and LH, which causes inhibition of oestradiol production. Prolactin is a peptide hormone, phylogenetically one of the oldest, stimulating cells of various organs, which is produced and secreted mainly by lactotrophic acidophilic cells of the anterior lobe of the pituitary. It influences the increase in the mass of the mammary glands, and stimulation and maintenance of lactation after delivery. There are a number of factors apart of pregnancy, delivery, and lactation than can influence secretion of the hormone in other physiological and pathological circumstances, like high-protein diet, stress, REM sleep, or neoplastic tumours, inflammatory diseases, chronic systematic diseases, thyroid hormonal changes, and drug intake. The purpose of this review is to summarise the current knowledge regarding the proper diagnosis and possible influence of hyperprolactinaemia on fertility and menopause symptoms and current treatment method