Possible deferral of diagnostic and therapeutic procedures for patients with abnormal screening tests results in cervical cancer secondary prevention in current SARS-CoV-2 pandemic Interim guidelines of the Polish Society of Gynecologists and Obstetricians and the Polish Society of Colposcopy and Cervical Pathophysiology

The Polish Society of Gynecologists and Obstetricians and Polish Society of Colposcopy and Cervical Pathophysiology Interim Guidelines goal at aiding gynecologists in providing a cervical cancer prevention care during the evolving SARS-CoV-2 pan-demic. Presented guidelines were developed on a review of limited data and updated when new relevant publications were revealed. Timing for deferrals of diagnostic-therapeutic procedures were mostly covered in the guidelines. Also, a support for the existing Polish recommendations on abnormal screening results in a subject of minor and major screening abnor-malities terminology were given. The guidelines are obligatory for the specified COVID-19 pandemic period only and they might be changed depending on the new available evidence

Ovarian reserve assessment in women with different stages of pelvic endometriosis

Introduction: Endometriosis is defined as the appearance of ectopic endometrial cells outside the uterine cavity. Ectopic cells demonstrate functional similarity to eutopic cells, but structural and molecular differences are significant and manifest themselves in gene expression of the metalloproteinase genes, integrin or the Bcl-2 gene. Pelvic pain remains to be the main symptom of the disease. Endometriosis may cause dysfunction of the reproductive system and lead to infertility. Pathogenesis of infertility in endometriosis is based on its influence on the hormonal, biochemical and immunological changes in the eutopic endometrium, as well as structural damages of the ovaries and the fallopian tubes. Objectives: The aim of the study was to assess the ovarian reserve in patients with endometriosis. Material and methods: A total of 39 patients (aged 22-34 years) with different stages of endometrial changes were recruited for the study. The number of antral follicles was rated by vaginal ultrasonography and the level of FSH was measured between days 1-3 of the menstrual cycle. The stage of the disease was established after laparoscopy with the rASRM scale. Results:No statistically significant correlation between the number of follicles(AFC), the level of FSH and the stage of endometriosis was found. Conclusions: Evaluation of the number of antral follicles and measurements of the FSH level do not allow to predict the ovarian reserve in women with endometriosis

Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO_{2} laser ablation

Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach—among others, laser application—are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO(2) laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22–42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in all patients, followed by either laser ablation or electroablation of the endometriotic foci. The results of the laparoscopic treatment were monitored after 3 and 6 months postoperatively. p value of 0.05 was considered to be statistically significant. Patients from both groups reported less intensive pain before/during menstruation (dysmenorrhea) 6 months postoperatively, with more distinct tendency in the electroablation group (p = 0.004) as compared to the laser ablation group (p = 0.025). Despite the initial improvement reported at the 3-month checkup (p = 0.008), 6 months postoperatively, a statistically significant increase in pain intensity was noted in both groups (p = 0.016 and p = 0.032 for CO(2) laser ablation and electroablation, respectively). Both surgical methods seem to be effective only in the treatment of endometriosis-related dysmenorrhea, whereas the intensity of other pain complaints (dyspareunia, dysuria, dyschezia, pelvic pain syndrome (PPS)) has remained on the same level

Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty

STUDY QUESTION: Can morphologic measurements (width, length and surface area) of the uterine septum predict healing-dependent abnormal anatomic results [ARs; residual septum (RS) and intrauterine adhesions in other locations (IUA-OLs)] after complete hysteroscopic metroplasty (HM)? SUMMARY ANSWER: Significant predictors of ARs are the septal width and, to a lesser extent, septal surface area. WHAT IS KNOWN ALREADY: Anatomic results after hysteroscopic metroplasty have very large variation. A RS >1 cm and IUA-OLs can aggravate reproductive outcomes, resulting in the need for reoperation. New criteria for diagnosing a uterine septum according to the European Society of Human Reproduction and Embryology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE) have been suggested (ESHRE-ESGE criteria). Autocross-linked hyaluronic acid gel (autocross-linked polysaccharide) has an antiadhesive effect. STUDY DESIGN, SIZE, DURATION: A prospective, observational cohort study was performed with 96 women consecutively enrolled between 2007 and 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women who had uterine septum and previous miscarriage or infertility presented for evaluation at a university hospital, private hospital or private medical center were included. Preoperative septal width, length and surface area were determined with three-dimensional sonohysterography. Women were treated by hysteroscopy in a standardized manner with three- or four-dimensional transrectal ultrasound guidance (complete resection). Patients received either no adhesion barrier (49 patients) or adhesion barrier with autocross-linked polysaccharide (47 patients). Anatomic results were assessed with three-dimensional sonohysterography and second-look hysteroscopy. Healing-dependent ARs were reported using both American Society of Reproductive Medicine (ASRM) criterion of RS length >1 cm (ASRM>1 cm criterion) and ESHRE-ESGE criteria. Univariate and multivariate logistic regression were used to identify predictors of RS, IUA-OLs and ARs. MAIN RESULTS AND ROLE OF CHANCE: In patients who had no adhesion barrier, ARs were diagnosed in 11 of 49 patients (23%) using the ASRM > 1 cm criterion and in 20 of 49 patients (41%) using the ESHRE-ESGE criteria for RS [odds ratio (OR)(ESHRE-ESGE:ASRM), 2.4, P = 0.05]. In the patients who had autocross-linked polysaccharide, ARs(ASRM) (>) (1 cm) were diagnosed in 2 of 47 patients (4%) and ARs(ESHRE-ESGE) in 4 of 47 patients (9%). RS(ESHRE-ESGE) was diagnosed significantly more often than RS(ASRM) (>) (1 cm) 19 of 96 (20%) versus 5 of 96 (5%) in all patients (OR(ESHRE-ESGE:ASRM) (>) (1 cm) = 4.5, P < 0.01). In patients who had no adhesion barrier, logistic regression with ASRM > 1 cm and ESHRE-ESGE criteria showed that the width and surface area were predictors of ARs. Models adjusted by patient group confirmed the significance of width as a predictor of ARs(ASRM) (>) (1 cm) [OR for width, 3.5 (P < 0.01); OR for group, 0.22 (P < 0.01)], width as a predictor of ARs(ESHRE-ESGE) [OR for width, 2.2 (P < 0.01); OR for group, 0.26 (P < 0.01)] and surface area as a predictor of ARs(ASRM) (>) (1 cm) [OR for surface area, 1.5 (P < 0.01)]; OR for group, 0.32 (P < 0.01). In patients who had autocross-linked polysaccharide, these predictors were not significant. Receiver-operating characteristic curves showed cutoff values for ARs(ASRM) (>) (1 cm) (septal width, 3.42 cm; septal surface area, 4.68cm(2)) and ARs(ESHRE-ESGE) (septal width, 3.42 cm; septal surface area, 3.51cm(2)). LIMITATIONS AND REASONS FOR CAUTION: Patients were enrolled in the adhesion barrier group in a time-dependent, consecutive and non-randomized manner. WIDER IMPLICATIONS OF THE FINDINGS: A wide septum and large surface area may be indications for adhesion barrier. The use of autocross-linked polysaccharide reduces the risk of ARs. The ESHRE-ESGE criteria may cause greater frequency of recognition of RS than the ASRM > 1 cm criterion, which could result in more frequent reoperations with use of the ESHRE-ESGE criteria, possibly without any significant effect on reproductive performance. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by Jagiellonian University (grant no. K/ZDS/003821). The authors have no competing interest to declare

Ocena jakości życia kobiet w 2 i 4 lat po transplantacji komórek pochodzących z mięśni w leczeniu wysiłkowego nietrzymania moczu

Introduction: Regenerative medicine for the treatment of urinary incontinence has become a popular area of focus in the search for therapies for this disease. The paper focused on women’s quality of life assessment who were subjected to transplantation of MDSC (autologous muscle derived stem cells) to the urethral sphincter. Methods: The procedure was conducted in 16 female patients who completed the observation stage. Assessment of quality of life before and after the treatment (two and four years post-operation) was conducted based on the validated I-QOL questionnaire (the Polish language version). Results: The questionnaire study showed that autologous cell therapy significantly improves quality of life in female patients suffering from stress urinary incontinence (SUI). The total I-QOL score increased from 49 (SD ± 7.7) before therapy to 77 (SD ± 5.4) two years post-operation. Four years after the procedure, quality of life remained at a higher level than before therapy, although quality of life decreased by several points when compared with the results from the two-year follow-up – 63 (SD ± 7.2). Patients reported significantly less concern related to their ability to reach the toilet to avoid incontinence, improved sleep at night, a higher level of satisfaction with life, and more satisfaction with their sexual lives (p&lt;0.05). Conclusion: The MDSC injection procedure for SUI treatment has significant improved quality of life in the majority of our patients in 2 and 4 year follow-up  Cel pracy: Medycyna regeneracyjna w leczeniu nietrzymania moczu stała się popularnym obszarem zainteresowania w poszukiwaniu metod leczenia tej choroby. Celem niniejszej pracy była ocena jakości życia u kobiet poddanych transplantacji autologicznych dojrzałych komórek pochodzących z mięśni (MDSC) do zwieracza cewki moczowej. Materiał i metody: Badanie zostało przeprowadzone w grupie 16 pacjentek, które ukończyły etap obserwacji. Do oceny jakości życia przed i po leczeniu (w dwa i cztery lata po zabiegu) wykorzystano kwestionariusz I-QOL (polska wersja językowa). Wyniki: Badania ankietowe wykazało, że terapia z wykorzystaniem autologicznych komórek mięśniowych w znacznym stopniu poprawia jakość życia pacjentek cierpiących z powodu wysiłkowego nietrzymania moczu (WNM). Całkowity wynik I-QOL wzrósł z 49 ± 7,7 (SD) przed leczeniem do 77 (SD ± 5,4) dwa lata po zabiegu. Cztery lata po zabiegu, jakość życia pozostał na poziomie wyższym niż przed leczeniem, chociaż zmniejszyła się o kilka punktów w porównaniu z wynikami z dwóch lat obserwacji - 63 (SD ± 7,2). Pacjentki zgłaszały znacznie mniej objawów związanych z ich możliwością dotarcia do toalety, wyższy poziom zadowolenia z życia i więcej satysfakcji z życia seksualnego (p &lt;0,05). Wnioski: Zastosowana procedura MDSC do leczenia wysiłkowego nietrzymania moczu skutecznie poprawiła jakość życia u większości analizowanych pacjentek po 2 i 4 latach od zbiegu.