Urinary incontinence in women

Urinarna inkontinencija definira se kao nevoljno otjecanje mokraće i predstavlja zdravstveni, higijenski i socijalni problem. Raspon tegoba je raznolik, od vrlo oskudnog i povremenog nevoljnog gubitka mokraće do potpune nemogućnosti kontrole mikcije. Stresna inkontinencija uz urgentnu te mješovitu najčešći su tipovi urinarne inkontinencije u žena. U članku su prikazane osnove dijagnostike i liječenja urinarne inkontinencije u žena. Urinarna inkontinencija predstavlja značajan zdravstveni problem brojnim našim pacijenticama, koji je još uvijek prečesto zapostavljen. Pacijentice se ustručavaju same prve postaviti pitanje i zatražiti medicinsku pomoć, najčešće zbog osjećaja srama, straha od stigmatizacije i neinformiranosti o mogućnostima liječenja.Urinary incontinence is defined asinvoluntary leakage of urine and represents medical, hygienic, social problem. Symptoms range from occasional discreate urinary incontinence to compleate inability to control micturition. Stress urinary incontinence along with urge and mixed are the most common types of urinary incontinence in women. Urinary incontinence represent significant yet underdiagnosed and underreported health problem to huge number of our patients which are still reluctant to seak professional medical treatment due to embarrassment, fear of stigmatisation and unawareness of therapy options

Pouzdanost urodinamske obrade u potvrdi stresne inkontinencije mokraće u odnosu na Bonney test

According to the International Continence Society, stress (static) urinary incontinence is defined as any involuntary loss of urine on effort or physical exertion, due to which intravesical pressure overcomes urethral pressure, with no detrusor activity. Urodynamic testing accurately assesses the function of the bladder and urethra. The urodynamic assessment includes three tests: cystometry, uroflowmetry and profilometry (determination of urethral pressure profile). Prior to urodynamic assessment, it is mandatory to rule out urinary tract infection since it is an invasive test. Urethral profilometry is a technique that measures pressure in the urethra and bladder at rest, during stressful actions, and during the act of miction. Its main purpose is to evaluate the sphincter mechanism. During the examination, a special catheter is used, which is being slowly pulled out from the bladder neck throughout the urethra, with continuous recording of intraurethral pressure. In addition to measuring urethral pressures, stress urinary incontinence is also very successfully proven by the cough test and Bonney test. If, on forced cough, the urine escapes uncontrollably, and continence is restored by finger lifting the neck of the bladder, the diagnosis of static incontinence is confirmed. At our urogynecologic clinic, urodynamic examination is being routinely performed. In the present study, we included patients previously treated for urinary stress incontinence and compared their results of urodynamic assessment to the results of Bonney test. Of the 43 subjects in whom stress incontinence was proven with Bonney test, we recorded an appropriate profilometry result in 13 cases.Stresna (statička) inkontinencija mokraće definira se prema ICS-u kao neželjeno otjecanje mokraće kroz uretru istodobno s porastom intraabdominalnog tlaka zbog kojeg intravezikalni tlak nadvlada tlak u uretri, uz odsutnu aktivnost detruzora. Urodinamskom obradom precizno se procjenjuje funkcija mokraćnog mjehura i mokraćne cijevi. U urodinamsku obadu ubrajajmo tri metode: cistometriju, mikciometriju (uroflow) i profilometriju (određivanje profila uretralnog tlaka). Prije urodinamske obrade moramo uvijek isključiti infekciju mokraćnih kanala, jer se radi o invazivnoj pretrazi. Profilometrija uretre je tehnika kojom mjerimo tlak u uretri kod mokraćnog mjehura u mirovanju, tijekom stresnih radnja i samog akta mokrenja. Osnovna joj je namjena ispitivanje sfinkterskoga mehanizma. Pri pregledu rabi se specijalni kateter koji se malom brzinom povlači od vrata mjehura prema distalno uz kontinuirano bilježenje intrauretralnoga tlaka. Uz mjerenje tlakova uretre stresna inkontinencija mokraće se vrlo uspješno dokazuje i testom kašlja, odnosno Bonney testom. Ako kod forsiranog kašlja mokraća nekontrolirano otječe, a podizanjem vrata mokraćnog mjehura prstima ispitanica uspijeva zadržati mokraću u mjehuru, radi se o statičkoj inkontinenciji. U OB “Dr Josip Benčević’’ pri uroginekološkoj ambulanti radi se urodinamsko ispitivanje. U ovo istraživanje uključili smo samo ispitanice s liječenom stresnom inkontinencijom mokraće te smo usporedili njihove rezultate na urodinamskoj obradi u odnosu na rezultate Bonney testa. Od 43 ispitanice kojima smo stresnu inkontinenciju dokazali Bonney testom u 13 slučajeva zabilježili smo uredan nalaz profilometrije

The role of cytology in preoperative assessment od primary fallopian tube carcinoma: case report

Cilj: Prikazati slučaj pacijentice s primarnim seroznim karcinomom jajovoda, opisati dijagnostički postupak te analizirati ulogu citološke dijagnostike u detekciji ovog tipa tumora. Prikaz slučaja: Pedesetogodišnja pacijentica prethodno je obrađivana u drugoj ustanovi zbog bolova u trbuhu i radiološki dokazanih uvećanih supraklavikularnih, aortokavalnih i ilijačnih limfnih čvorova. Nakon učinjene laparoskopske ekstirpacije limfnih čvorova zbog sumnje na limfoproliferativnu bolest, patohistološkom i imunohistokemijskom analizom utvrđeno je da se radi o metastatskom adenokarcinomu, vjerojatno podrijetla iz ginekološkog sustava ili dojke. Radiološkom obradom dojki nisu pronađene promjene suspektne na malignitet. PET/CT analizom (pozitronska emisijska tomografija/kompjutorizirana tomografija) uočeno je pojačano nakupljanje radiofarmaka u predjelu vrata i tijela maternice. U preoperativnoj obradi učinjena je citološka punkcija uvećanog supraklavikularnog limfnog čvora te je imunocitokemijskom analizom utvrđeno da se radi o metastatskom seroznom adenokarcinomu. U Papa-testu pronađene su maligne stanice jednake morfologije, bez tumorske dijateze, što je upućivalo na ekstrauterini adenokarcinom, a sugerirano je podrijetlo jajnika ili jajovoda. Učinjena je eksplorativna kiretaža, ali je patohistološki nalaz bio uredan. Pacijentica je predviđena za histerektomiju s obostranom adnekstektomijom. Tijekom operativnog zahvata uočeno je proširenje desnog jajovoda tumorskim tkivom koje je probijalo stijenku jajovoda. Učinjena je lavaža peritonealne šupljine u kojoj su pronađene maligne stanice adenokarcinoma. Patohistološka analiza potvrdila je da se radi o primarnom seroznom karcinomu jajovoda s metastazama u jajnicima. Zaključak: Zahvaljujući brzini i preciznosti primijenjenih citodijagnostičkih pretraga dijagnostičko-terapijski postupak pravilno je usmjeren i pravovremeno proveden. Prikazani slučaj potvrđuje da citološka analiza može pridonijeti dijagnostici tumora s neuobičajenom kliničkom prezentacijom ili tumora nejasnog podrijetla.Aim: To report a case of a patient with primary serous carcinoma of the fallopian tube, describe the diagnostic pathway and analyze the role of cytology in the detection of this tumor type. Case report: A 50-year-old patient was previously treated in another hospital for abdominal pain and radiologically confirmed enlargement of supraclavicular, aortocaval and iliac lymph nodes. A lymphoproliferative disorder was suspected and laparoscopic lymph node excision was performed. Histopathological and immunohistochemical analysis revealed a metastatic adenocarcinoma probably of gynecologic or breast cancer origin. Radiographic examination of the breast did not confirm any lesion suspicious for malignancy. Positron emission tomography/computed tomography observed increased radiotracer uptake involving the uterine cervix and corpus. Preoperative fine-needle aspiration cytology and immunocytochemical analysis of an enlarged supraclavicular lymph node was done and metastatic serous adenocarcinoma was confirmed. In the Pap smears malignant cells of equal morphology were found without tumor diathesis indicating an extra-uterine adenocarcinoma. It was suggested to consider a tumor of ovarian or fallopian tube origin. A total hysterectomy with bilateral salpingo-oophorectomy was performed. During surgery an enlargement of the was observed due to tumor growth extending through the tubal wall. The presence of malignant adenocarcinoma cells was found in the peritoneal washing. Histopathological analysis confirmed a primary serous carcinoma of the fallopian tubes with metastatic spread to the ovaries. Conclusion: Applying fast and precise cytology and immunocytochemistry techniques a correct diagnostic and therapeutic approach can be performed and implemented on time. The present case confirms that cytology is a wellestablished and widely accepted method for diagnosing tumors with unusual clinical presentation or unknown origin

THE INCIDENCE OF PERIPARTAL HYSTERECTOMY IN FIVE CROATIAN HOSPITALS DURING SIXTEEN-YEAR PERIOD

Uvod: Peripartalna histerektomija (PPH) najdramatičniji je kirurški zahvat u modernoj opstetriciji i obično se obavlja kada se konzervativnim mjerama nije uspjela postići kontrola krvarenja. Navodi se trend porasta učestalosti u razvijenim zemljama. Cilj rada: Odrediti učestalost PPH u pet hrvatskih bolnica tijekom dvaju osmogodišnjih razdoblja u odnosu prema načinu dovršenja porođaja. Metode: Retrospektivnom analizom prikupljeni su podaci iz pismohrana pet hrvatskih bolnica. U istraživanje su uključeni svi porođaji podijeljeni u dva osmogodišnja razdoblja, od 1998. do 2013. Rezultati: Od ukupno 153.302 porođaja tijekom obaju promatranih razdoblja u 70 (0,46‰) slučajeva učinjen je hitni PPH. PPH nakon vaginalnog porođaja u prvom razdoblju iznosio je 0,21‰, a u drugom razdoblju 0,16‰. Učestalost PPH nakon carskog reza u prvom razdoblju iznosio je 1,91‰, a u drugom razdoblju 2,04‰. Rasprava i zaključak: Nema porasta pojavnosti PPH usporedbom dvaju osmogodišnjih razdoblja premda postoji statistički značajan porast učestalosti carskog reza (s 14,2% na 16,0%). Carski je rez čimbenik rizika za PPHIntroduction: Peripartal hysterectomy (PPH) is a life saving surgical procedure that is performed when conservative measures fail to control bleeding. According to literature data there is an increase in incidence among developed countries. Aim: To define the rate of PPH during two eight-year periods in five Croatian hospitals in respect to mode of delivery. Methods: Patients data were collected retrospectively from the medical records of the five Croatian hospitals. We analyzed data from 1998 to 2013, and divided them in two eight-year periods. Results: In 70 cases out of 153,302 deliveries urgent PPH was performed. PPH after vaginal deliveries was found in 0.21‰ and 0.16‰ and PPH after caesarean section was 1.91‰ and 2.04‰ in the first and second period, respectively. Discussion and conclusion: There is no increase of PPH rate in the two analyzed periods, although there is a statistically significant increase of caesarean section rate. Caesarean section presents higher risk for PPH

THE INCIDENCE OF PERIPARTAL HYSTERECTOMY IN FIVE CROATIAN HOSPITALS DURING SIXTEEN-YEAR PERIOD

Uvod: Peripartalna histerektomija (PPH) najdramatičniji je kirurški zahvat u modernoj opstetriciji i obično se obavlja kada se konzervativnim mjerama nije uspjela postići kontrola krvarenja. Navodi se trend porasta učestalosti u razvijenim zemljama. Cilj rada: Odrediti učestalost PPH u pet hrvatskih bolnica tijekom dvaju osmogodišnjih razdoblja u odnosu prema načinu dovršenja porođaja. Metode: Retrospektivnom analizom prikupljeni su podaci iz pismohrana pet hrvatskih bolnica. U istraživanje su uključeni svi porođaji podijeljeni u dva osmogodišnja razdoblja, od 1998. do 2013. Rezultati: Od ukupno 153.302 porođaja tijekom obaju promatranih razdoblja u 70 (0,46‰) slučajeva učinjen je hitni PPH. PPH nakon vaginalnog porođaja u prvom razdoblju iznosio je 0,21‰, a u drugom razdoblju 0,16‰. Učestalost PPH nakon carskog reza u prvom razdoblju iznosio je 1,91‰, a u drugom razdoblju 2,04‰. Rasprava i zaključak: Nema porasta pojavnosti PPH usporedbom dvaju osmogodišnjih razdoblja premda postoji statistički značajan porast učestalosti carskog reza (s 14,2% na 16,0%). Carski je rez čimbenik rizika za PPHIntroduction: Peripartal hysterectomy (PPH) is a life saving surgical procedure that is performed when conservative measures fail to control bleeding. According to literature data there is an increase in incidence among developed countries. Aim: To define the rate of PPH during two eight-year periods in five Croatian hospitals in respect to mode of delivery. Methods: Patients data were collected retrospectively from the medical records of the five Croatian hospitals. We analyzed data from 1998 to 2013, and divided them in two eight-year periods. Results: In 70 cases out of 153,302 deliveries urgent PPH was performed. PPH after vaginal deliveries was found in 0.21‰ and 0.16‰ and PPH after caesarean section was 1.91‰ and 2.04‰ in the first and second period, respectively. Discussion and conclusion: There is no increase of PPH rate in the two analyzed periods, although there is a statistically significant increase of caesarean section rate. Caesarean section presents higher risk for PPH

Innate Immunity in Autoimmune Thyroid Disease during Pregnancy

Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disorder clinically presented as Hashimoto thyroiditis (HT) and Graves’ disease (GD). The pathogenesis of AITD is caused by an inappropriate immune response related to genetic, non-genetic, and environmental factors. Pregnancy is one of the factors that have a great influence on the function of the thyroid gland because of the increased metabolic demand and the effects of hormones related to pregnancy. During pregnancy, an adaptation of the maternal immune system occurs, especially of the innate immune system engaged in maintaining adaptive immunity in the tolerant state, preventing the rejection of the fetus. Pregnancy-related hormonal changes (estrogen, progesterone, hCG) may modulate the activity of innate immune cells, potentially worsening the course of AITD during pregnancy. This especially applies to NK cells, which are associated with exacerbation of HD and GD. On the other hand, previous thyroid disorders can affect fertility and cause adverse outcomes of pregnancy, such as placental abruption, spontaneous abortion, and premature delivery. Additionally, it can cause fetal growth retardation and may contribute to impaired neuropsychological development of the fetus. Therefore, maintaining the thyroid equilibrium in women of reproductive age and in pregnant women is of the highest importance

Expression of CD133 and CD117 in 64 Serous Ovarian Cancer Cases

The cancer stem cells (CSCs) represent a minority of tumor cells that are able to proliferate and self-renew and might be responsible for tumor initiation and maintenance. The CD133 and CD117 are the most commonly used markers for putative CSCs, especially for ovarian CSCs, but its clinical significance remains uncertain. The aim of this study was to compare the immunohistochemical expression of CD133 and CD117 in 69 primary ovarian serous carcinoma and peritoneal metastasis, and to examine their potential clinical role. CD133 expression was mainly seen in the apical/endoluminal cell surface of tumor cells and was found in 58% of carcinoma samples and 42% of metastasis. The median of CD133 positive cells in tumors was 1 (0.1-7) %, and in metastases was 0.55 (0.1-6) %. CD117 expression appeared as a cytoplasmic and/or membranous stain and was found in 81% of carcinoma samples and 77% of metastasis. The median of CD117 positive cells in tumors was 1 (0.1-8) %, and in metastases was 0.1 (0.1-6) %. Multivariate analysis showed that patients with high CD133 expression in tumor have significantly shorter time to progression and time to survival (P=0.004 and P=0.016, respectively). Patients with high CD117 expression in tumor have significantly shorter time to progression (P=0.034). Cox´s proportional hazards model identified expression of CD133 protein in tumor as independent prognostic factor. Our study indicates that the immunohistochemical assessment of CD133 and CD117 expression may have potential clinical value in predicting disease progression and prognosis in serous ovarian cancer. CD133 proved to be an independent prognostic factor in serous ovarian cancer patients