Robot-assisted donor hysterectomy in uterus transplantation — a modality to increase reproducibility

Uterus transplantation is a non-lifesaving vascularized composite allotransplantation procedure requiring immunosuppression until removal of the graft. The focus of uterus transplantation is changing regarding refining individual treatment procedures included in this complex treatment of absolute uterine factor infertility, such as robot-assisted donor hysterectomy. The inferior hypogastric nerve plexus should be preserved during robotic dissection of the ureter and uterine vessels to prevent postoperative complications such as urine and fecal evacuation disturbances and sexual disorders. As most uterus transplantations have been performed in living donor concepts, robot-assisted donor hysterectomy should contribute to increased availability of uterus transplantation, particularly because it uses the precise blood-less technique of surgical dissection in the deep pelvis and has cosmetic benefits among living donors

Reproductive and Psycho-sexual Aspects of Female Congenital Genital Defects and their Genetic Context.

The aim of the dissertation was a retrospective-prospective analysis of the anatomical and functional effect of a neovagina creation using Vecchietti vaginoplasty, including the evaluation of quality of life, sexuality and interest in motherhood in women with Mayer- Rokitansky-Küster-Hauser syndrome (MRKHS). The study group included 70 women with MRKHS who underwent this surgery at the Department of Gynecology and Obstetrics, Second Medical Faculty, Charles University and University Hospital Motol in 2003-2022 and agreed with the participation in the study. The control group consisted of age-matched women without congenital anomalies of the genitals. The cause of MRKHS with agenesis of the uterus and the upper two-thirds of the vagina is the incorrect development of the paramesonephric (Müllerian) ducts. The ovaries are normal, oogenesis proceeds as usual and the production of female sex hormones is also normal. MRKHS is detected during adolescence due to primary amenorrhea at the age of 16 or impossibility of sexual intercourse. In the atypical form of MRKHS, simultaneous malformations of the kidneys, skeleton and cardiovascular organ system may occur. The dissertation is divided into theoretical and empirical parts. The theoretical part presents current knowledge about the history, etiology and...Cílem disertační práce byla retrospektivně-prospektivní analýza anatomického a funkčního efektu vytvoření neovaginy pomocí vaginoplastiky podle Vecchiettiho u žen se syndromem Mayer-Rokitansky-Küster-Hauser (MRKHS). V rámci studie byla hodnocena zejména kvalita života, sexuality a zájem žen o mateřství. Studovaný soubor zahrnoval 70 žen s MRKHS, které byly operovány na Gynekologicko-porodnické klinice 2. LF UK a FN Motol v letech 2003-2022 a souhlasily s účastí ve studii. Kontrolní skupinu tvořily ženy odpovídající věkové kategorie bez vrozené vady pohlavních orgánů. MRKHS vzniká na základě poruchy vývoje paramesonefrických (Müllerových) vývodů. Tato porucha vede k agenezi dělohy a horních dvou třetin pochvy. Ovaria jsou vyvinuta normálně, oogeneze probíhá obvyklým způsobem a tvorba ženských pohlavních hormonů rovněž. MRKHS je nejčastěji diagnostikován v období adolescence na podkladě primární amenorrhoe v 16. roce života nebo kvůli nemožnosti koitálních sexuálních aktivit. U atypické formy MRKHS se mohou vyskytovat přidružené orgánové malformace renálního, skeletálního nebo kardiovaskulárního systému. Disertační práce je rozdělena na teoretickou a empirickou část. V teoretické části jsou prezentovány současné znalosti o historii, etiologii a genetickém pozadí MRKHS, jeho diagnostice, možnostech...Gynekologicko - porodnická klinikaFaculty of Medicine in PilsenLékařská fakulta v Plzn

Reproductive and Psycho-sexual Aspects of Female Congenital Genital Defects and their Genetic Context.

The aim of the dissertation was a retrospective-prospective analysis of the anatomical and functional effect of a neovagina creation using Vecchietti vaginoplasty, including the evaluation of quality of life, sexuality and interest in motherhood in women with Mayer- Rokitansky-Küster-Hauser syndrome (MRKHS). The study group included 70 women with MRKHS who underwent this surgery at the Department of Gynecology and Obstetrics, Second Medical Faculty, Charles University and University Hospital Motol in 2003-2022 and agreed with the participation in the study. The control group consisted of age-matched women without congenital anomalies of the genitals. The cause of MRKHS with agenesis of the uterus and the upper two-thirds of the vagina is the incorrect development of the paramesonephric (Müllerian) ducts. The ovaries are normal, oogenesis proceeds as usual and the production of female sex hormones is also normal. MRKHS is detected during adolescence due to primary amenorrhea at the age of 16 or impossibility of sexual intercourse. In the atypical form of MRKHS, simultaneous malformations of the kidneys, skeleton and cardiovascular organ system may occur. The dissertation is divided into theoretical and empirical parts. The theoretical part presents current knowledge about the history, etiology and..

The influence of reduced radicality of oncosurgical treatment on urogenital tract morbidity

Cervical cancer is the fourth most common gynecological malignancy in Czech Republic. The incidence of cervical cancer in 2008 was 19.2/100000 (1021 women) and mortality reached 6/100000. Both radiotherapy and surgery have comparable results in the treatment of cervical cancer but surgical treatment is still the favoured modality especially in young female. Very succesful curability of early stages of this disease (88-97 %) based on individualized therapy currently leads to emphasize the quality of life increasing of treated women. Morbidity related to the treatment is connected with radicality of surgery. The dominant objective of the submitted study was prospective detection of preoperative and postoperative control over the micturition and urinary continence in 142 evaluated women who underwent nerve-sparing radical abdominal hysterectomy type C1, less radical surgery - laparoscopic pelvic lymphadenectomy and laparoscopic assisted vaginal hysterectomy type A or less radical fertility sparing surgery - laparoscopic pelvic lymphadenectomy and simple trachelectomy. Postoperative morbidity is connected with both pelvic lymphadenectomy and resection of the paracervix and proximal part of vagina with hypogastric nerve and inferior hypogastric plexus injury. The lower urinary tract function before and after the..

Effect of a Selective Progesterone Receptor Modulator on Induction of Apoptosis in Uterine Fibroids In Vivo

Aim. To determine if hormonal treatment induces apoptosis in uterine fibroids. Methods. Immunohistochemical examination of fibroid tissue, using avidin-biotin complex and cleaved caspase-3 antibody for detecting apoptosis, was performed in premenopausal women who underwent 12-week treatment with oral SPRM (6 patients with 5 mg and 5 patients with 10 mg of ulipristal acetate per day) or gonadoliberin agonist (GnRHa, 17 patients) and subsequent myomectomy or hysterectomy for symptomatic uterine fibroids. Ten patients with no presurgical hormonal treatment were used as controls. Results. Apoptosis was present in a significantly higher proportion of patients treated with ulipristal acetate compared to GnRHa (P=0.01) and to patients with no hormonal treatment (P=0.01). In contrast to an AI of 158.9 in SPRM patients, the mean AI was 27.5 and 2.0 in GnRHa and control groups, respectively. No statistical difference in the AI was observed between the two groups of patients treated with ulipristal acetate (5 mg or 10 mg). Conclusion. Treatment with ulipristal acetate induces apoptosis in uterine fibroid cells. This effect of SPRM may contribute to their positive clinical effect on uterine fibroids

Sexual Life of Women With Mayer-Rokitansky-Küster-Hauser Syndrome After Laparoscopic Vecchietti Vaginoplasty

Introduction: Adequate anatomic and physiologic functions of the genitalia are fundamental prerequisites for sexual well-being and reproduction. Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) compromises female sexual life and makes reproduction impossible. Aim: To assess the psychosexual effect of vaginal reconstruction using the laparoscopic Vecchietti technique in patients with MRKHS. Methods: Forty-two patients with MRKHS who underwent laparoscopic Vecchietti vaginoplasty were included. Their partners also were interviewed. A control group of 45 age-matched, childless, sexually active women were examined during the same period. Main Outcome Measures: A gynecologic examination was performed to determine the anatomic outcome. Psychosexual function was evaluated with the Female Sexual Distress Scale–Revised (FSDS-R), the Female Sexual Function Index (FSFI), and a semistructured interview. Genital self-image was evaluated using the Female Genital Self-Image Scale (FGSIS). Results: Average neovagina length (7.0 ± 9.6 cm) in the MRKHS group was significantly shorter than the vaginal length in the control group (9.3 ± 2.5 cm). Women with a neovagina reported satisfactory sexual function (FSFI score = 29 ± 2.7) that was not significantly different from the control group (P < .05); however, they also had significantly higher levels of distress (FSDS-R score = 14.5 ± 6.5) and were not satisfied with their genitals (FGSIS score = 22.0 ± 2.4) compared with the control group. Conclusion: Sexual function in women with MRKHS can be restored successfully by vaginoplasty; however, they have higher rates of distress and are less satisfied with their genitals. Pastor Z, Fronĕk J, Nováčková M, Chmel R. Sexual Life of Women With Mayer-Rokitansky-Küster-Hauser Syndrome After Laparoscopic Vecchietti Vaginoplasty. Sex Med 2017;5:e106–e113