Prevention Strategy of Intrauterine Adhesions: update and future perspective

Intrauterine adhesions (IUAs) caused by endometrial injury have a serious impact on women's fertility and morbility and involves a wide range of patients. Although the first case of IUAs was published in 1984 by Heinrich Fritsch, a full description of Asherman syndrome was done by Joseph Asherman. IUAs lead to a lot of complications in women, as the partial or complete closure of the uterine cavity, which may result in symptoms including abnormal menstruation, pelvic pain, recurrent pregnancy loss, secondary infertility, and pregnancy complications. Hysteroscopy, which has relegated blind curettage, is currently considered the gold standard diagnostic and therapeutic approach also as for outpatients. However, an integrated approach, including preoperative, intraoperative and postoperative procedures is needed to improve the reproductive outcome of the complex syndrome. In the post-operative care, the patient can benefit from some therapeutic and prophylactic methods used alone or in combination with each other. In this review, authors discuss on the efficacy of traditional methods for the prevention of complications of IUAs after surgery, such as hormonal therapy, physical barriers, vasodilators and antibiotics, as well as novel strategies such as stem cell therapy and novel therapeutic agents

A Case of Retroperitoneal Fibroid and Literature Review

Uterine fibroids or leiomyomas are the most common benign female genital tumors, although this pathology can also manifest itself outside the uterus, as in the case we present, with a retroperitoneal development. In this article, authors showed a rare case of 81-year-old women, with a right pelvic mass and lower abdominal discomfort. Basing on a preoperative radiological imaging, clinicians oriented to a provisional diagnosis of mesenchymal neoplasm of an uncertain origin. During surgery in the retroperitoneal space, it was detected a huge mass close to the uterus, beneath the right broad ligament. After the opening of the retroperitoneal spaces, surgeons enucleated a well-demarcated tumor, measuring 12 x 7 cm in diameter and histopathological findings demonstrated a rare retroperitoneal uterine leiomyoma

Nutraceuticals in fibroid management after ulipristal acetate administration: An observational study on patients' compliance

AbstractObjectiveOn May 13, 2020, the Italian government Pharmaceutical Agency (AIFA) stopped ulipristal acetate (UPA) treatments for uterine fibroids (UFs), so patients shifted to other natural treatments. The authors tested the patients' compliance with UF natural treatments.MethodsThirty patients of reproductive age (30–45 years) affected by UFs stopped UPA intake and started epigallocatechin gallate (EGCG) plus vitamin D3 treatment. Patients were asked to complete the Uterine Fibroid symptoms and Quality of Life (UFS‐QOL) questionnaire, divided into symptoms severity (SS) and health‐related quality of life (HRQL), after UPA suspension and to repeat it after 3 months of natural treatment. Collected data were analyzed using paired Student's t test, considering a P value less than 0.05 to be significant.ResultsThe SS score was significantly lower (–12.19%) for natural treatment when compared with UPA administration. The HRQL score significantly improved (+11.79%) after shifting treatment from UPA to natural therapy. All the investigated parameters appeared improved by 10% after the natural treatment. No adverse effects were reported following the natural treatment.ConclusionNatural treatments showed positive compliance in patients with UFs, based on HRQL score, representing an alternative therapeutic opportunity for patients forced to stop UPA therapy

Adenoid Cystic Carcinoma of the Bartholin Gland. A Morphological and Immunohistochemical study of a rare case

Adenoid cystic carcinoma of the Bartholin gland (BG-ACC) is a rare form of vulvar cancer. Literature reported approximately 350 cases of BG-ACC since 1864. Literature data and case reports suggested an aggressive nature with protracted clinical symptoms and a tendency for local recurrence despite adequate surgical excision with or without adjuvant radiotherapy. Survival rates of 71% and 59% are reported, respectively, at five and ten years. A comparative analysis of the immunohistochemical profile was performed with the homologous tumor of the salivary glands, and it was observed that the expression of various antigen in different morphological patterns of this neoplasia allowed some considerations about on its histogenesis that was hitherto never proposed

Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome: A Systematic Review about Diagnosis and Surgical Management

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare congenital defect of the Mullerian ducts characterized by uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. The aim of this systematic review is to summarize the main symptoms and presentation of the OHVIRA syndrome, as well as the different types of management, fertility, and obstetrical outcomes. A comprehensive search was performed in PubMed, EMBASE, SCOPUS, and Web of Science databases since inception to May 1, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. After duplicate records removed, the search strategy retrieved 103 articles. The full texts of 73 articles further were assessed for eligibility, and 44 studies were finally included in the systematic review. The mainstay surgical treatment of OHVIRA syndrome is usually a minimally invasive vaginal approach to remove the septum. Ultrasound-guided hysteroscopic resection and laparoscopic resection of the septum have been described as alternatives. Considering the feasibility of minimally invasive approach for the management of the syndrome, laparotomy should be avoided as much as possible and considered only in selected cases

Practice patterns and 90-day treatment-related morbidity in early-stage cervical cancer

To evaluate the impact of the Laparoscopic Approach to Cervical Cancer (LACC) Trial on patterns of care and surgery-related morbidity in early-stage cervical cancer

Laparoscopic management of rudimentary uterine horns in patients with unicornuate uterus: a systematic review

Unicornuate uterus is a rare Müllerian anomaly. Its potential association with a rudimentary uterine horn can cause a diagnostic delay. The most common consequences are pelvic pain, hematometra and endometriosis. Diagnosis of a unicornuate uterus is usually done by imaging combining ultrasound (US) and Magnetic Resonance Imaging (MRI). The aim of this systematic review is to assess the role of laparoscopic approach in the management of this rare condition

Advances on Prevention and Screening of Gynecologic Tumors: Are We Stepping Forward?

According to 2020 comprehensive global cancer statistics published by the International Agency for Research on Cancer, gynecologic malignancies accounted overall for 16 [...]