Clinicoprognostical features of endometrial cancer patients with somatic mtDNA mutations

Somatic mitochondrial DNA (mtDNA) mutations have been found in a subset of endometrial cancers (EC) from different populations. We have investigated the relationship between mtDNA changes and clinical and pathological variables of women affected by EC. mtDNA mutations were detected both in early (3/32; 9%) and in advanced (1/8; 12%) stages of uterine tumors. However, patients carrying the mtDNA mutations or the normal mtDNA sequence had indistinguishable clinicopathological data, including age, clinical stage, histological grade and type or depth of myometrial invasion. It is noteworthy that mtDNA mutations were not detected in hyperplastic endometrial tissues or in ECs coexisting with hyperplasia, nor in a single case of endometrial stromal sarcoma. LOH at the tumor suppressor genes RB1 and TP53 as well as p16INK4A alterations (LOH, gene deletion) were found in tumors carrying mtDNA mutations. These results suggest that somatic mtDNA mutations are detected in a subset of ECs, although they are unrelated to clinicopathological variables of cancer

Biological markers with potential clinical value in endometrial cancer — review of the literature

Endometrial carcinoma (EC) is the most common malignancy of the female genital tract encountered in western countries, making it the fourth most common cancer in women. The incidence of uterine cancer is on the rise throughout the developed world where diagnosis is increasingly observed among younger patients. With regard to this, attention has been focused on conducting more studies to achieve a better understanding of the molecular genetics related to endometrial carcinogenesis. Over the years, EC has been classified into two broad histopathological subtypes based on the mechanism of development, and we can therefore observe specific biomarkers related to the respective subtype. Based on this idea, more research has been carried out in the last decade, using biotechnological methods, with the aim to identify new potential tumor markers. By translating these findings into clinical use one may facilitate accurate diagnosis and prognostic prediction, and contribute to individualized treatment. Without a doubt, there is a demanding need to identify biomarkers that can be adopted in clinical practice in order to reduce the time needed to obtain diagnosis. Such markers may be of great value in improving patient outcome. However, a number of problems remain to be solved before this becomes a reality. This paper briefly reviews the current status of rising biomarkers in EC

When and how should we treat cesarean scar defect — isthmocoele?

The reported number of cesarean sections in Poland is approximately 30% and is associated with increasing number of early and late complications. The myometrial discontinuity at the site of previous cesarean section is known in the literature as “isthmocoele”, “niche”, “pouch” or cesarean scar defect. In most cases presence of isthmocoele has no clinical significance, but in some patients it may cause abnormal uterine bleeding, dysmenorrhea, dyspareunia, pelvic pain or be associated with secondary infertility. This defect may be treated by laparoscopy, hysteroscopy or vaginal surgery

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

Bladder injury during sling operation in the treatment of SUI – review of literature and case report

Introduction: Sling operations have been performed for over 15 years. In recent years these operations have become the gold standard in the treatment of stress urinary incontinence (SUI) due to their efficacy, safety and low invasiveness. Approximately 4% of women will undergo a surgery for SUI in the course of their life. As with any surgical intervention, there may be some technical problems, as well as intra- and postoperative complications, the most common of which is bladder injury. Other complications encountered during mid-urethral slings procedures include bleeding (retropubic or vaginal hematomas), urethral perforation, urinary tract infections, postoperative vaginal or urethral erosions, bowel perforation, chronic pelvic pain, wound infection, nerve injury, transient and persistent voiding dysfunction such as de novo urgency, incomplete bladder emptying or urinary retention. Below we present a case of a patient with diagnosed vesicovaginal fistula after sling operation (TVT-tension-free vaginal tape). Upon admission the patient reported dysuria, persistent urinary leakage and abnormal, abundant vaginal discharge. Objectives: Case report and review of literature concerning surgical treatment of stress urinary incontinence and its complications. Materials and Methods: Analysis of medical documentation of the patient treated at the Second Department of Gynecology, Medical University of Lublin. Review of abstracts or papers in the Medline database related to surgical treatment of urinary incontinence and its complications. Conclusions: Bladder perforation is one of the most common complications of the retropubic approach for MUS placement. The presence of mesh within the bladder may arise from direct bladder perforation or from subsequent erosion of the sling. Such lesions do not cause any serious health consequences for patients on condition they are detected intraoperatively and appropriately repaired, but when unrecognized, they results in the development of considerable symptoms and negatively influence the quality of patient life. Improperly treated, it can lead to development of an abnormal communication between the urinary bladder and the anterior wall of the vagina - vesicovaginal fistula. We should suspect unrecognized bladder injury in case of patients with any persistent voiding symptoms after a sling procedure such as long lasting dysuria, persistent urinary leakage, hematuria, recurrent infections, chronic pain and voiding difficulties. Diagnosis and treatment of vesicovaginal fistula is long lasting and difficult for the patient and the surgeon. Futh-Mayo operation is an effective treatment method for the majority of vesicovaginal fistulas. During this operation we suture all layers of fistula separately (bladder, perivesical fascia and vaginal wall). Although with this operation we solve one problem, the patient still might suffer from recurrent SUI. Alternative methods of treatment which can be offered to patients after unsuccessful SUI operation are periurethral injections with bulking agents or electrical stimulation of the pelvic floor muscles. Both methods are effective in the therapy of recurrent SUI. In our case periurtehral injection of BulkamidR did not provide a total cure. Therefore, we completed the treatment with electrical stimulation of the pelvic floor muscles using patient-controlled electrodes placed in the vagina to stimulate muscles with current frequency of 50 Hz, amperage between 0-60 mA and duration of 250 μs. This procedure produced a series of changes in the stimulated area and enabled to cure the incontinence

Does a midurethral sling inserted at the time of pelvic organ prolapse mesh surgery increase the rate of de novo OAB? A prospective longitudinal study

Objectives: Approximately 20% of women suffer from pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Furthermore, POP and overactive bladder (OAB) symptoms often coexist. Midurethral slings and mesh surgeries are both considered to be risk factors for de novo OAB symptoms. The aim of our study was to determine whether simultaneous midurethral sling insertion at the time of pelvic organ prolapse mesh surgery further increases the risk of de novo OAB. Materials and methods: The study group consisted of 234 women who underwent surgery in our department between August 2007 and October 2009 (114 patients underwent surgery because of coexisting POP and SUI, and 120 underwent surgery because POP alone). The patients were evaluated at follow-up visits scheduled after 6-8 weeks and after 12 months. All women underwent surgery using the Gynecare ProliftR Pelvic Floor Repair System, whereas in women with additional overt or occult SUI after restoration of the pelvic anatomy, monofilament midurethral slings were simultaneously inserted. The chi-squared test was used to compare the study groups. Results: De novo OAB symptoms were significantly more pronounced among women in the ProliftR only surgery group (23.3%) compared to the ProliftR with IVS04M group (10.5%; p=0.0093). Conclusions: Midurethral sling insertion at the time of pelvic organ prolapse surgery significantly decreases the rate of postoperative de novo OAB symptoms. The lack of anatomical success of the mesh-based reconstructive surgery is a risk factor for the development of de novo OAB symptoms

Czy założenie taśmy podcewkowej jednoczasowo z korekcją zaburzeń statyki dna miednicy zwiększa częstość występowania de novo OAB? – prospektywne badanie obserwacyjne

Objectives: Approximately 20% of women suffer from pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Furthermore, POP and overactive bladder (OAB) symptoms often coexist. Midurethral slings and mesh surgeries are both considered to be risk factors for de novo OAB symptoms. The aim of our study was to determine whether simultaneous midurethral sling insertion at the time of pelvic organ prolapse mesh surgery further increases the risk of de novo OAB. Materials and methods: The study group consisted of 234 women who underwent surgery in our department between August 2007 and October 2009 (114 patients underwent surgery because of coexisting POP and SUI, and 120 underwent surgery because POP alone). The patients were evaluated at follow-up visits scheduled after 6-8 weeks and after 12 months. All women underwent surgery using the Gynecare Prolift® Pelvic Floor Repair System, whereas in women with additional overt or occult SUI after restoration of the pelvic anatomy, monofilament midurethral slings were simultaneously inserted. The chi-squared test was used to compare the study groups. Results: De novo OAB symptoms were significantly more pronounced among women in the Prolift® only surgery group (23.3%) compared to the Prolift® with IVS04M group (10.5%; p=0.0093). Conclusions: Midurethral sling insertion at the time of pelvic organ prolapse surgery significantly decreases the rate of postoperative de novo OAB symptoms. The lack of anatomical success of the mesh-based reconstructive surgery is a risk factor for the development of de novo OAB symptoms.Cel pracy: Około 20% kobiet uskarża się jednocześnie na zaburzenia statyki dna miednicy i nietrzymanie moczu. Wykazano również, że występowaniu objawów OAB towarzyszą istotne klinicznie zaburzenia statyki. Z drugiej strony zarówno slingi podcewkowe jak też operacje rekonstrukcyjne z użyciem siatek niosą ze sobą ryzyko wystąpienia de novo objawów OAB. Celem naszego badania było ustalenie, czy jednoczasowe zakładanie slingu podcewkowego podczas operacji rekonstrukcyjnej niesie ze sobą podwyższenie ryzyka wystąpienia de novo pooperacyjnych objawów OAB. Materiał i metody: Grupa badana obejmowała 234 pacjentki leczone w klinice pomiędzy sierpniem 2007 a październikiem 2009 (u 114 pacjentek wykonano operację korygującą statykę dna miednicy oraz wysiłkowe nietrzymanie moczu, a u 120 kobiet korygowano jedynie zaburzenia statyki). Pacjentki były oceniane 6-8 tygodni oraz 12 miesięcy po zabiegu. Wszystkie pacjentki operowano z użyciem monofilamentowych siatek polipropylenowych (Gynecare Prolift® Pelvic Floor Repair System), natomiast u pacjentek z objawowym bądź ukrytym nietrzymaniem moczu jednoczasowo zakładano sling podcewkowy. Obie grupy porównano wykorzystując test chi2. Wyniki: De novo objawy OAB wystąpiły częściej u pacjentek, u których korygowano jedynie statykę dna miednicy (23.3%) w porównaniu do pacjentek, u których dodatkowo zakładano sling podcewkowy (10,5%; p=0,0093). Wnioski: Jednoczasowe zakładanie slingu podcewkowego podczas operacji rekonstrukcyjnej dna miednicy nie zwiększa ryzyka wystąpienia pooperacyjnych objawów nadreaktywności mięśnia wypieracza. Jednocześnie niepowodzenie anatomiczne operacji rekonstrukcyjnej jest czynnikiem ryzyka wystąpienia de novo pooperacyjnych objawów OAB

Decreased osteonectin and fibronectin gene expression in endometrial cancer cancer as a prognostic marker

Abstract Objectives: The aim of this study was to investigate, by means of cDNA macroarrays, the expression profile of genes coding the ECM proteins in endometrial cancer. Material and methods: Tissue specimens were collected during surgical procedures. 40 patients were operated due to endometrial cancer and 9 patients because of uterine myomas. RNA was isolated and reverse transcriptase reaction with radioisotope labeling of cDNA were performed. PCR reaction was performed with labeled cDNA. All steps of macroarray hybridization were done according to the protocol. Statistical analysis was done with different tests, including artificial neural network method. Results: The level of ECM protein genes expression in normal endometrial tissue was compared to the expression of these genes in endometrial cancer specimens. Statistical significances were found only for fibronectin and osteonectin genes and for both genes decreased expression was observed in cancer tissues (p=0.009, p=0.0003, respectively). Moreover, fibronectin and osteonectin genes expression decreased along with increase of clinical staging and histological grading of the endometrial cancer but no statistical significance for this trend was found. Conclusions: Decreased expression of fibronectin and osteonectin genes, when compared to normal endometrial tissue expression, in endometrial cancer may play an important role as a stimulus for disease development and, on the other hand, may be used as an additional marker for the progression of the disease

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.

Zmiany w sposobie leczenia operacyjnego wysiłkowego nietrzymania moczu u kobiet – obserwacje ostatnich dwudziestu dwóch lat

Objectives: The aim of this study was to analyze the changing trends in surgical treatment of female urinary incontinence (UI). Material and methods: Medical records of all women admitted to II Department of Gynecology from 1985 to 2006 were analyzed in order to find out how the female SUI treatment changed over these years. Results: During analyzed time 36819 patients were hospitalized in our Department and 77.6% (28568) of them were operated because of various indications. The number of SUI surgeries among all hospitalized women steadily rose from 1.93% in 1985 to 10.96% in 2006 reaching maximum in 2005 (13.73%). Clinical effectiveness of SUI surgeries markedly improved from 35% for anterior colporrhaphy to almost 90 % for suburethral slings. Conclusions: Introduction into clinical practice modern suburethral slings improved clinical efficacy of SUI treatment. The percentage of women admitted and treated surgically because of SUI steadily increased over the last years.Cel pracy: Celem pracy było przeprowadzenie retrospektywnej analizy metod operacyjnego leczenia wysiłkowego nietrzymania moczu (WNM) u kobiet na przestrzeni ostatnich dwudziestu dwóch lat. Materiał i metody: Dane do analizy pozyskano z archiwum medycznego II Kliniki Ginekologii i na ich podstawie przedstawiono zmiany w operacyjnym leczeniu WNM u kobiet od 1985 do 2006 roku. Wyniki: W analizowanym okresie, w II Klinice hospitalizowanych było 36819 kobiet, z czego 77,6% (28568) było operowanych z powodu różnych wskazań. Liczba pacjentek operowanych z powodu WNM stale rosła od 1,93% w 1985r. do 10,96% w 2006r. ze szczytem w 2005r. (13,73%). Również skuteczność zabiegów znacznie wzrosła z 35% w przypadku różnych modyfikacji plastyki przedniej ściany pochwy do niemal 90% przy zastosowaniu taśm podcewkowych. Wnioski: Wprowadzenie nowoczesnych, małoinwazyjnych taśm podcewkowych znacząco zwiększyło efektywność operacyjnego leczenia WNM. Wydaje się to być jedną z przyczyn stałego wzrostu liczby kobiet decydujących się na tą metodę leczenia tej dolegliwości