High Frequency of Chronic Bacterial and Non-Inflammatory Prostatitis in Infertile Patients with Prostatitis Syndrome Plus Irritable Bowel Syndrome

Although prostatitis syndrome (PS) and irritable bowel syndrome (IBS) are common disorders, information on the prevalence of IBS in infertile patients with PS is relatively scanty. Therefore, this study was undertaken to estimate the frequency of PS and IBS and to evaluate the prevalence of the various diagnostic categories of prostatitis.This study enrolled 152 patients with PS, diagnosed by the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) in an andrological setting, and 204 patients with IBS, diagnosed according to the Rome III diagnostic criteria in a gastroenterological setting. The patients with PS were asked to fulfill the Rome III questionnaire for IBS, whereas patients with IBS were asked to complete the NIH-CPSI. The simultaneous presence of PS and IBS was observed in 30.2% and 31.8% of the patients screened by andrologists and gastroenterologists, respectively. Altogether, 111 patients had PS plus IBS (31.2%). They had a total NIH-CPSI and pain subscale scores significantly higher than patients with PS alone. Gastrointestinal symptoms in patients with PS plus IBS were similar to those reported by patients with IBS alone and significantly greater in patients with PS alone. Patients with PS plus IBS had a significantly higher frequency of chronic bacterial prostatitis (category II) and lower of non-inflammatory prostatitis (category IIIB), compared to patients with PS alone. The frequency of inflammatory prostatitis (category IIIA) resulted similar.Prostatitis syndromes and IBS are frequently associated in patients with PS- or IBS-related symptoms. These patients have an increased prevalence of chronic bacterial and non-inflammatory prostatitis

Urokinase-type plasminogen activator and insulin-like growth factor-binding protein 3 mRNA expression in endometriotic lesions and eutopic endometrium: Implications for the pathophysiology of endometriosis

The peritoneal fluid of women with endometriosis contains an increased insulin-like growth factor 1 (IGF-1) bioavariability, which is produced by limited hydrolysis of urokinase-type plasminogen activator (uPA) on IGF-binding protein 3 (IGFBP-3). Recently, IGF-1 was shown to inhibit apoptosis of endometrial-like cells in vitro, suggesting that a microenvironment of increased IGF-1 bioavailability can optimize the survival of endometrial cells grown ectopically. Here the expression of mRNA of IGFBP-3 and uPA in tissue biopsies from eutopic endometrium and endometriotic lesions obtained at laparoscopy from women with endometriosis have been analyzed, and it is documented that both IGFBP-3 and uPA mRNA expression are increased from 3- to 10-fold in endometriotic lesions versus eutopic endometrium. Consequently, the necessary components (uPA and IGFBP-3 expression) of endocrine/autocrine/paracrine enhancement of local IGF bioavailability mediated by uPA hydrolysis of the IGFBP-3 were present in endometriotic lesions. These data possibly explain the origin of the increased content of uPA activity, IGF-1 bioavailability, and NH2-truncated forms of IGFBP-3 in the peritoneal fluid of women with endometriosis

Laparoscopic treatment of ovarian dermoid cysts: Eleven years' experience

Study Objective. To compare laparoscopic and open approaches in the management of benign ovarian teratomas (dermoid cysts) with regard to operative outcome, complications, and postoperative follow-up. Factors that predispose to rupture of dermoid cysts during laparoscopic removal and rates of adhesion formation in women with and without cyst rupture during laparoscopic surgery also were considered. Design. Review of cases of women with dermoid cysts who underwent cystectomy either by laparoscopy or laparotomy in our department from 1992 through 2002 (Canadian Task Force classification III). Setting. The Infertility and Operative Laparoscopy units of the First Department of Obstetrics and Gynecology of the University of Athens, Alexandra Maternity Hospital, Athens, Greece. Patients. Two hundred twenty-two women with an ovarian mass requiring surgical management. Of these, 787 women with benign cystic teratomas underwent laparoscopic cystectomy, and 35 underwent cystectomy by laparotomy. Interventions. Cystectomy either by laparoscopy or laparotomy. Measurements and Main Results. Potential benefits of operative laparoscopy include reduced blood loss, less postoperative pain, shorter hospital stay, fast recovery, and an excellent cosmetic result. Conclusion. Laparoscopy should be considered the method of choice for the removal of benign ovarian cystic teratomas as it offers the advantages of fewer postoperative adhesions, reduced pain, shorter hospital stay, and better cosmetic result. It should be performed by surgeons with considerable experience in advanced laparoscopic surgery

Leptin in human reproduction

The recent discovery of the obese (ob) gene has provided new insight into the mechanism which controls body fat mass. Leptin, a product of the ob gene, serves as the link between fat and the brain. This protein, by acting at the level of the hypothalamus, decreases food intake and increases energy expenditure. Animals that lack leptin (ob/ob mice) develop profound obesity and become infertile, Treatment of these animals with leptin reduces food intake and restores normal fertility; Although leptin is important for the control of fat stores in certain species, the role of this substance in the de development of human obesity remains obscure, However, it has been speculated that, in humans, obesity is related to leptin resistance. The relationship between fat and reproduction has been recognised for >20 Sears. This article discusses the relationship between leptin and human reproduction, Tn particular, recent knowledge about the possible role of leptin in various conditions such as puberty, polycystic ovary syndrome and pregnancy is reviewed, Also, the article discusses the possible role of leptin in ovarian function and the relationship of this protein with gonadal steroids. It is expected that future research will clarify the physiological importance of leptin in human reproductive function

Insulin-like growth factor-1 isoform mRNA expression in women with endometriosis: Eutopic endometrium versus endometriotic cyst

Pathogenesis of endometriosis involves growth factors, which are synthesized locally. Insulin-like growth factor-1 (IGF-1) prevents apoptosis and has mitogenic action on endometrial cells. The IGF-1 gene undergoes alternative splicing and results in three isoforms (IGF-1Ea, IGF-1Eb, and IGF-1Ec or MGF). We analyzed the mRNA expression of IGF-1 isoforms in tissue samples of eutopic endometrium and endometriotic cyst obtained during laparoscopy from women with endometriosis. We documented that all three IGF-1 isoforms are expressed in both eutopic endometrium and ovarian endometrioma. Furthermore,we documented a significant decrease in all IGF-1 isoform expression in endometriotic cyst compared to endometrium of women with endometriosis. The reduction may correlate with the disease status and presence of fibrotic inactive tissue found in late stages of the disease. © 2006 New York Academy of Sciences

Hydrosalpinx treatment: Comparison between laparoscopy and laparotomy

Distal tubal obstruction continues to be a common cause of infertility. The choice of surgical or in vitro fertilization approach is still ambiguous. During the period January 1990 to June 1999, 144 cases of bilateral neosalpingostomy and restoration of the tubal-ovarian anatomy were carried out in our institution. In 61 cases, the neosalpingostomies were performed laparoscopically and, in the remaining 83, by microsurgery. After treatment, all patients attempted to conceive, and at the end of the 24-month follow-up, 21 (25%) and seven (8.4%) from the laparotomy group and 14 (23%) and two (3.3%) from the laparoscopy group have, respectively, achieved intrauterine and extrauterine pregnancies. In both groups, most pregnancies occurred during the first postoperative year. Pregnancies were achieved in all stages of the disease in the laparotomy group, while in the laparoscopy group no pregnancy was achieved in the severe stage. Hysterosalpingographies performed 2 years after in non-pregnant patients showed that both tubes were patent in all women with mild tubal disease without adhesions in both groups. In women with mild disease and adhesions, 80% and 70% of the operated by laparoscopy and microsurgery, respectively, had patent tubes. In the group of moderate disease, 60% and 70% of the treated by laparoscopy and laparotomy had one or both of their tubes patent. All women with severe disease had, after the laparoscopy, closed tubes, and only in 20% of the operated with microsurgery had one or both tubes patent. Reconstructive surgery of the hydrosalpinges of mild or even moderate stage either laparoscopically or by microsurgery is an effective approach in treating infertility due to distal tubal occlusion. Moreover, the opening of the tubes may improve the IVF results

Laparoscopic management of patients with endometriosis and chronic pelvic pain

Endometriosis has been traditionally included among the most important causes of chronic pelvic pain (CPP) in women of reproductive age. The main clinical manifestations of endometriosis are dysmenorrhea, dyspareunia, and chronic nonmenstrual pain. Despite the high prevalence of endometriosis in women suffering from CPP, controversy still exists regarding the true association between the stage and extent of this peculiar disease and the severity of pain. Over the last decade, advances in endoscopic technology have enabled gynecologic surgeons to recognize many atypical appearances of the endometriotic implants not known to exist before, thus allowing their complete excision or destruction. Laparoscopic surgery may offer considerable relief in patients with endometriosis and CPP. Although cases with advanced endometriosis seem to benefit the most, we also support surgical treatment in patients with early endometriosis diagnosed using laparoscopy, as many will experience improvement in their symptoms

Current and future status of ovulation induction in polycystic ovary syndrome

Great progress has been achieved during the last 20 years in the field of ovulation induction in patients with polycystic ovary syndrome (PCOS). Clomiphene citrate remains the first line of treatment for all anovulatory women with PCOS, since in properly selected patients the cumulative pregnancy rate approaches that in normal women, Human urinary gonadotrophins have been used extensively for ovulation induction, but the development of low-dose regimens has opened a new era in the management of anovulation related to PCOS, This article discusses the main advantages and disadvantages of the principal methods and regimens currently used for ovulation induction in patients with PCOS including clomiphene citrate, gonadotrophins, pulsatile gonadotrophin-releasing hormone (GnRH) and GnRB agonists, It also discusses new drugs discovered recently, particularly recombinant gonadotrophins and GnRH antagonists, and provides some thoughts regarding their use in future protocols, Finally, based on the discovery of new ovarian substances which specifically control luteinizing hormone (LH) secretion, this article develops assumptions on possible implications of these substances in the pathophysiology of PCOS and their potential use in the management of the syndrome