Revised FIGO staging systems for gynecologic malignancies – 2009 update

Abstract Neoplasm staging system was created to facilitate making diagnoses and planning treatment for cancer patients. Since medical research and practice in the field of oncology have shown explosive growth, the staging of some of the gynecologic cancers did not give a good spread of prognostic groupings. In the light of these breakthroughs, the following changes to the staging of gynecological cancers were proposed and approved by the FIGO Committee. In vulvar cancer Stage IA remained unchanged but Stage I and II have been combined. The number and morphology of the involved nodes have been taken into account, and the bilaterality of positive nodes has been discounted. In cervical cancer Stage 0 has been deleted and substages in Stage IIA have been included. In endometrial cancer Stage IA and IB have been combined so that now Stage IA involves the endometrium and/or less than one-half myometrial invasion and IB is equal to or greater than the outer one-half of the myometrium. Stage II no longer has a subset A and B. Involvement in the endocervical glandular portion of the cervix is now considered Stage I. Pelvic and para-aortic node involvement have been separated. The committee has also established a sarcoma staging system based on the criteria used in other soft tissue sarcomas

Foreign body in vagina – polyurethane foam. Case report

Abstract This report presents the case of a 40-year-old woman hospitalized in the Department of Gynecology and Oncological Gynecology, Military Institute of the Health Services, who was found to have had a foreign body (polyurethane foam) of significant amount for three days in her vagina. The foreign body was successfully removed during surgery and did not lead to any negative health consequences for the patient

Risk factors of pelvic organ prolapsed in women qualified to reconstructive surgery – the Polish multicenter study

To evaluate the prevalence rate of various pelvic floor disorders among patients treated in 8 academic centers in Poland due to pelvic organ prolapse (POP). Results: The mean age of affected women with POP was 61,25 years (median 61), and mean BMI – 27.62 (median – 27.29). 80% of women were menopausal. Mean time of symptoms related to disease was 65,6 months; whereas the time relapsed from first doctor diagnosis of POP to hospital admission was 50.6 months. 97.4% affected women were multiparous. Only 1.21% women with POP were nulliparous. Family history of prolapse was found in 13.4% of patients, whereas familial positive history of urinary incontinence was 10%. Lower urinary tract symptoms (LUTS) among the analyzed group were as follows: frequency – almost 50%, urgency 32.2%, feeling of improper voiding – 29,6% and voiding difficulty – 17.7%. Functional disorders of lower bowel were found in 43% of patients and the most prevalent symptom was constipation (31%), followed by empting difficulty (12%), dyschesia (9%), and urge stool empting (7.7%). Cardiovascular diseases were found among 43% of respondents, whereas pulmonary diseases with chronic coughing were present in 20% of the analyzed population. Subjective POP symptoms reported by women were as follows: feeling of heaviness in lower abdomen – 37.8%, perineal pain – 27.8%, lumbosacral pain – 34.2%, and abdominal pain – 28.4%. Female sexual disorders were reported by 9,8% women and dyspareunia was found in 7.6% of responders. POP was the main reason for sexual abstinence only in 1 out of 10 patients. More than 30% of patients from the study group underwent previously pelvic surgery due to various reasons. POP related quality of life measured by VAS (Visual Analogue Scale) was 61.4 points (median – 60). The most common finding during gynecological examination was cystocele – 96.5%, followed by rectoenterocele – 92.7%, and central defect – 79%. Mean POP quantification was stage III in POP-Q scale. LUTS symptoms (urinary incontinence, urgency and voiding difficulties) were present among 81% of patients whereas lower gastrointestinal disorders (constipation, fecal incontinence, dyschesia) were found in 43% of women affected by POP

Histeroskopia ambulatoryjna - Nowa technika diagnostyczno-lecznicza

The presented paper describes a novel hysteroscopic technique (mini-hysteroscopy) which can be performed without any analgesia or anaesthesia, so this procedure can be easily performed as an ambulatory office hysteroscopy. The first part of the review presents in detail the methodology of mini-hysteroscopy. New generation hysteroscopic telescopes measure only 3.5, 4 or 5 millimetres of outer diameter with operation channel and single flow sheath. Technical parameters of complete hysteroscopic set (special hysteroscopic pump, bipolar coagulation tools and surgical forceps, scissors, graspers, etc) are also presented in detail. Indications and potential contraindications as well as criteria of patients selection for office hysteroscopy are analysed. Major technical improvements like vaginoscopy instead of speculum use, gentle penetration of cervical canal without use of tenaculum, and surgical procedure inside the uterine cavity performed without touching the myometrial tissue, markedly diminish or even eliminate the pain for patients during this procedure. The effectiveness, feasibility and high rate of acceptability of mini-hysteroscopy by patients make this procedure the first line approach in diagnosis and treatment of abnormal uterine bleeding, uterine congenital and acquired abnormalities (adhesions, septum, small submucous myomas). Simultaneous use of laparoscopy and mini-hysteroscopy in sterility diagnosis and treatment is also presented. According to literature data and own experience of the authors, it can be stated that mini-hysterscopy is an effective, minimally invasive and very safe procedure for diagnosis and surgery of cervical canal and uterine cavity disorders. This review also demonstrates the advantages of mini-hysteroscopy over classical hysteroscopy or other procedures (D&C, hysterosalpingography) in the diagnosis and treatment of the pathologies mentioned above

Histeroskopia ambulatoryjna - Nowa technika diagnostyczno-lecznicza

The presented paper describes a novel hysteroscopic technique (mini-hysteroscopy) which can be performed without any analgesia or anaesthesia, so this procedure can be easily performed as an ambulatory office hysteroscopy. The first part of the review presents in detail the methodology of mini-hysteroscopy. New generation hysteroscopic telescopes measure only 3.5, 4 or 5 millimetres of outer diameter with operation channel and single flow sheath. Technical parameters of complete hysteroscopic set (special hysteroscopic pump, bipolar coagulation tools and surgical forceps, scissors, graspers, etc) are also presented in detail. Indications and potential contraindications as well as criteria of patients selection for office hysteroscopy are analysed. Major technical improvements like vaginoscopy instead of speculum use, gentle penetration of cervical canal without use of tenaculum, and surgical procedure inside the uterine cavity performed without touching the myometrial tissue, markedly diminish or even eliminate the pain for patients during this procedure. The effectiveness, feasibility and high rate of acceptability of mini-hysteroscopy by patients make this procedure the first line approach in diagnosis and treatment of abnormal uterine bleeding, uterine congenital and acquired abnormalities (adhesions, septum, small submucous myomas). Simultaneous use of laparoscopy and mini-hysteroscopy in sterility diagnosis and treatment is also presented. According to literature data and own experience of the authors, it can be stated that mini-hysterscopy is an effective, minimally invasive and very safe procedure for diagnosis and surgery of cervical canal and uterine cavity disorders. This review also demonstrates the advantages of mini-hysteroscopy over classical hysteroscopy or other procedures (D&C, hysterosalpingography) in the diagnosis and treatment of the pathologies mentioned above

Usefulness of Cryoprobe in Office Hysteroscopy for Removal of Polyps and Myomas

Hysteroscopy is a gold standard in 21st-century gynaecology for both diagnosis and treatment procedures of intrauterine pathologies. Miniaturisation of the equipment and better techniques of performing this procedure allowed it to become the gold standard. Nevertheless, hysteroscopy has its limitations, which is the size of the endometrial polyps or submucous myomas. We have invented a new device for the 5Fr working channel hysteroscopes for possessing and resecting intrauterine structures: the cryoprobe. The retrospective cryobiopsy study presented here was conducted at the Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine in Warsaw, Poland, from October 2017 to January 2018. Its purpose was to assess the usefulness of the new device in office hysteroscopy for the removal of polyps and myomas with a diameter over 10 mm. Thirteen patients with an initial diagnosis of an endometrial polyp or submucous myoma were enrolled in the trial. All procedures took place in day-surgery settings, with a total resection of the pathological intrauterine structure, without complications. The application of the cryoprobe may enhance the usefulness of office hysteroscopy, without extending the procedure. The cryoprobe efficiency is still under research in a bigger group

An Open Multicenter Study of Clinical Efficacy and Safety of Urolastic, an Injectable Implant for the Treatment of Stress Urinary Incontinence: One-Year Observation

The prevalence of stress urinary incontinence rises and affects up to 30% of women after 50 years of age. Midurethral slings are currently the mainstay of surgical anti-incontinence therapy. Some patients experience recurrent SUI (RSUI) which is defined as a failure of anti-incontinence surgery after a period of time or persistence of SUI after the procedure aimed at correcting it. The urethral bulking agent application decreases invasiveness of treatment and meets patients requirements. The objective of this study was to assess the safety and clinical efficacy of Urolastic injection. One hundred and five patients with SUI (including 91 patients with RSUI) were treated with Urolastic in three tertiary gynecological clinics. The efficacy of the procedure was assessed objectively at each follow-up visit by means of cough test and a standard 1-hour pad test. Objective success rate after 12 months after primary procedure in RSUI patients was found in 59.3% of patients. In 14 patients with primary SUI improvement after 1 year was found in 71.4% of patients. Although cure rates after MUS are up to 90% there is still place for less invasive treatment option like periurethral injection of bulking agents, especially in patients with previous SUI surgical management

Clinical Study An Open Multicenter Study of Clinical Efficacy and Safety of Urolastic, an Injectable Implant for the Treatment of Stress Urinary Incontinence: One-Year Observation

The prevalence of stress urinary incontinence rises and affects up to 30% of women after 50 years of age. Midurethral slings are currently the mainstay of surgical anti-incontinence therapy. Some patients experience recurrent SUI (RSUI) which is defined as a failure of anti-incontinence surgery after a period of time or persistence of SUI after the procedure aimed at correcting it. The urethral bulking agent application decreases invasiveness of treatment and meets patients requirements. The objective of this study was to assess the safety and clinical efficacy of Urolastic injection. One hundred and five patients with SUI (including 91 patients with RSUI) were treated with Urolastic in three tertiary gynecological clinics. The efficacy of the procedure was assessed objectively at each follow-up visit by means of cough test and a standard 1-hour pad test. Objective success rate after 12 months after primary procedure in RSUI patients was found in 59.3% of patients. In 14 patients with primary SUI improvement after 1 year was found in 71.4% of patients. Although cure rates after MUS are up to 90% there is still place for less invasive treatment option like periurethral injection of bulking agents, especially in patients with previous SUI surgical management