Pub Date : 2025-12-22DOI: 10.1016/j.ejogrb.2025.114906
Anna Tsviban , Maurizio Serati , Tal Fligelman , Hadil Hassouna , Roni Tomashev , Anna Padoa
Background
Mid-urethral slings (MUS) are the first-line surgical treatment for stress urinary incontinence (SUI). Despite their efficacy, de-novo urgency (dUU) remains a common and distressing postoperative complication. This study aimed to assess the incidence of dUU following trans-obturator MUS using the Monarc® system, and to identify risk factors associated with its development.
Methods
This retrospective study included women who underwent Monarc® MUS between 2009 and 2017 at a tertiary medical center. Patients with less than 12 months of follow-up or pre-existing urinary urgency were excluded. Data on demographics, medical history, and concomitant procedures were extracted. The primary outcome was dUU, defined as a newly reported compelling urge to void at 12 months postoperatively. Univariate logistic regression was used to identify associated risk factors.
Results
Of 305 women, 63 met inclusion criteria. At 12 months, dUU occurred in 31.7 % of patients. Preoperative diabetes mellitus (30 % vs. 2.3 %, p = 0.003) and higher BMI (median 28.7 vs. 26.0 kg/m2, p = 0.002) were significantly associated with dUU. Age, parity, and concomitant pelvic floor surgeries were not significantly associated. The subjective cure rate for SUI was 93.7 %.
Conclusions
The incidence of dUU after trans-obturator MUS was higher than previously reported. Diabetes mellitus and elevated BMI emerged as significant risk factors. These findings support the inclusion of metabolic status in preoperative counselling and highlight the potential value of weight and glycemic management in improving postoperative outcomes for women undergoing SUI surgery.
背景：中尿道吊带术（MUS）是治疗压力性尿失禁（SUI）的一线手术方法。尽管它们有效，但新生急症（de-novo urgency, dUU）仍然是一种常见且令人痛苦的术后并发症。本研究旨在使用Monarc®系统评估经闭孔MUS后dUU的发生率，并确定其发展相关的危险因素。方法本回顾性研究纳入了2009年至2017年在三级医疗中心接受Monarc®MUS的女性。随访时间少于12个月或已存在尿急的患者被排除在外。提取了人口统计学、病史和伴随手术的数据。主要结果为dUU，定义为术后12个月新报道的强烈无效冲动。采用单因素logistic回归确定相关危险因素。结果305例女性中，63例符合纳入标准。12个月时，31.7%的患者发生dUU。术前糖尿病（30% vs. 2.3%, p = 0.003）和较高BMI（中位数28.7 vs. 26.0 kg/m2, p = 0.002）与dUU显著相关。年龄、胎次和伴随的盆底手术无显著相关。主观治愈率为93.7%。结论经闭孔微创手术后dUU的发生率高于既往报道。糖尿病和BMI升高是重要的危险因素。这些发现支持将代谢状态纳入术前咨询，并强调体重和血糖管理在改善SUI手术妇女术后预后方面的潜在价值。
{"title":"Diabetes mellitus and body weight as risk factors for de-novo urgency after trans-obturator mid-urethral sling","authors":"Anna Tsviban , Maurizio Serati , Tal Fligelman , Hadil Hassouna , Roni Tomashev , Anna Padoa","doi":"10.1016/j.ejogrb.2025.114906","DOIUrl":"10.1016/j.ejogrb.2025.114906","url":null,"abstract":"<div><h3>Background</h3><div>Mid-urethral slings (MUS) are the first-line surgical treatment for stress urinary incontinence (SUI). Despite their efficacy, de-novo urgency (dUU) remains a common and distressing postoperative complication. This study aimed to assess the incidence of dUU following trans-obturator MUS using the Monarc® system, and to identify risk factors associated with its development.</div></div><div><h3>Methods</h3><div>This retrospective study included women who underwent Monarc® MUS between 2009 and 2017 at a tertiary medical center. Patients with less than 12 months of follow-up or pre-existing urinary urgency were excluded. Data on demographics, medical history, and concomitant procedures were extracted. The primary outcome was dUU, defined as a newly reported compelling urge to void at 12 months postoperatively. Univariate logistic regression was used to identify associated risk factors.</div></div><div><h3>Results</h3><div>Of 305 women, 63 met inclusion criteria. At 12 months, dUU occurred in 31.7 % of patients. Preoperative diabetes mellitus (30 % vs. 2.3 %, p = 0.003) and higher BMI (median 28.7 vs. 26.0 kg/m<sup>2</sup>, p = 0.002) were significantly associated with dUU. Age, parity, and concomitant pelvic floor surgeries were not significantly associated. The subjective cure rate for SUI was 93.7 %.</div></div><div><h3>Conclusions</h3><div>The incidence of dUU after trans-obturator MUS was higher than previously reported. Diabetes mellitus and elevated BMI emerged as significant risk factors. These findings support the inclusion of metabolic status in preoperative counselling and highlight the potential value of weight and glycemic management in improving postoperative outcomes for women undergoing SUI surgery.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114906"},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-22DOI: 10.1016/j.ejogrb.2025.114908
Marwa S. Abd Elhady , Niven R. Basyouni , Salam Bani Hani , Hala N. El Galada
Objective
Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions among women that can impact all aspects of quality of life. This study aims to compare active training (birth ball) and passive training (biofeedback) on pelvic floor muscle strength and urinary incontinence among post-hysterectomy women.
Methods
A Randomized Controlled Trial design was carried out that recruited a purposive sample of 40 women who were allocated randomly into two groups, 20 participants for each group. The intervention group received training in PFM by using biofeedback, while the control group demonstrated active PFM training using a birth ball. Data collected using a basic data structured interview schedule, the Protection, Amount, Frequency, Adjustment, Body Image (PRAFAB) questionnaire, and the Pelvic floor muscles strength test (Manometric Assisted Biofeedback-MBF).
Findings
Following 6 weeks and 3 months of interventions, there was a statistically significant difference in the two groups concerning pelvic floor muscle strength. Regarding the degree of urinary incontinence, a statistically significant difference was found between the two study groups after 6 weeks and 3 months following the intervention, with p-values of 0.048 and 0.024, respectively. In favor of the control group, where most participants (75 %) had mild urinary incontinence compared to only 50 % of the intervention group.
Conclusion
The study found that pelvic floor exercises improved strength and reduced incontinence, with active birth ball training yielding better outcomes and lower recurrence than passive biofeedback.
{"title":"Rehabilitation of pelvic floor muscle for women with urinary incontinence post hysterectomy: A randomized controlled trial","authors":"Marwa S. Abd Elhady , Niven R. Basyouni , Salam Bani Hani , Hala N. El Galada","doi":"10.1016/j.ejogrb.2025.114908","DOIUrl":"10.1016/j.ejogrb.2025.114908","url":null,"abstract":"<div><h3>Objective</h3><div>Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions among women that can impact all aspects of quality of life. This study aims to compare active training (birth ball) and passive training (biofeedback) on pelvic floor muscle strength and urinary incontinence among post-hysterectomy women.</div></div><div><h3>Methods</h3><div>A Randomized Controlled Trial design was carried out that recruited a purposive sample of 40 women who were allocated randomly into two groups, 20 participants for each group. The intervention group received training in PFM by using biofeedback, while the control group demonstrated active PFM training using a birth ball. Data collected using a basic data structured interview schedule, the Protection, Amount, Frequency, Adjustment, Body Image (PRAFAB) questionnaire, and the Pelvic floor muscles strength test (Manometric Assisted Biofeedback-MBF).</div></div><div><h3>Findings</h3><div>Following 6 weeks and 3 months of interventions, there was a statistically significant difference in the two groups concerning pelvic floor muscle strength. Regarding the degree of urinary incontinence, a statistically significant difference was found between the two study groups after 6 weeks and 3 months following the intervention, with p-values of 0.048 and 0.024, respectively. In favor of the control group, where most participants (75 %) had mild urinary incontinence compared to only 50 % of the intervention group.</div></div><div><h3>Conclusion</h3><div>The study found that pelvic floor exercises improved strength and reduced incontinence, with active birth ball training yielding better outcomes and lower recurrence than passive biofeedback.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114908"},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145826987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-22DOI: 10.1016/j.ejogrb.2025.114905
Sara Cortés-Amador , Amanda Vidal-Chaparro , David Hernández-Guillén , Fernando Domínguez-Navarro , Laura Fuentes-Aparicio
Purpose
Gender reassignment surgery is the surgical option for many transgender populations. However, there is little information about the gender reassignment process, especially the role that pelvic floor physiotherapy has in this process. The purpose of this study was to analyze the knowledge that the participants had about the gender reassignment process, about the experience of those who had gone through it, and about the knowledge they had about the role of pelvic floor physiotherapy in this process.
Methods
This was a cross-sectional study. A self-developed online survey b was developed consisting of 3 sociodemographic questions and 23 questions on participants’ knowledge and perception of pelvic floor physical therapy and the reassignment surgery process.
Results
Of the 35 participants aged 19–52 in the study, 22 identified as female, and 13 as male. Only 37.1 % were aware of the post-surgery role of pelvic floor physiotherapists. Additionally, 25.7 % considered consulting a physiotherapist, and 22.8 % had contemplated doing so. Just 11.4 % of those who had surgery sought pelvic floor physiotherapy. Common post-surgery issues included urethral stenosis, vaginal elasticity problems, and difficulty reaching orgasm, aligning with previous research. Notably, individuals receiving physiotherapy reported greater improvement in post-surgery sequelae.
Conclusion
Gender reassignment is a complex process that affects all aspects of the person and requires greater humanization of health professionals. Physiotherapy has shown significant barriers in terms of accessibility and knowledge of the benefits that physiotherapy can bring to this population. It is important to include in the curricula of different health professions the implications of a sex reassignment process to offer adequate support to the needs of the population.
{"title":"An overview of the transgender population’s knowledge of the role of physical therapy during the transitioning process: a cross-sectional survey study","authors":"Sara Cortés-Amador , Amanda Vidal-Chaparro , David Hernández-Guillén , Fernando Domínguez-Navarro , Laura Fuentes-Aparicio","doi":"10.1016/j.ejogrb.2025.114905","DOIUrl":"10.1016/j.ejogrb.2025.114905","url":null,"abstract":"<div><h3>Purpose</h3><div>Gender reassignment surgery is the surgical option for many transgender populations. However, there is little information about the gender reassignment process, especially the role that pelvic floor physiotherapy has in this process. The purpose of this study was to analyze the knowledge that the participants had about the gender reassignment process, about the experience of those who had gone through it, and about the knowledge they had about the role of pelvic floor physiotherapy in this process.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study. A self-developed online survey b was developed consisting of 3 sociodemographic questions and 23 questions on participants’ knowledge and perception of pelvic floor physical therapy and the reassignment surgery process.</div></div><div><h3>Results</h3><div>Of the 35 participants aged 19–52 in the study, 22 identified as female, and 13 as male. Only 37.1 % were aware of the post-surgery role of pelvic floor physiotherapists. Additionally, 25.7 % considered consulting a physiotherapist, and 22.8 % had contemplated doing so. Just 11.4 % of those who had surgery sought pelvic floor physiotherapy. Common post-surgery issues included urethral stenosis, vaginal elasticity problems, and difficulty reaching orgasm, aligning with previous research. Notably, individuals receiving physiotherapy reported greater improvement in post-surgery sequelae.</div></div><div><h3>Conclusion</h3><div>Gender reassignment is a complex process that affects all aspects of the person and requires greater humanization of health professionals. Physiotherapy has shown significant barriers in terms of accessibility and knowledge of the benefits that physiotherapy can bring to this population. It is important to include in the curricula of different health professions the implications of a sex reassignment process to offer adequate support to the needs of the population.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114905"},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cervical incompetence is a major cause of preterm birth. The primary treatment is cerclage (McDonald, Shirodkar or cervico-isthmic one). First recommended cerclage is the McDonald one. In case of an unsuccessful Mc Donald cerclage, a cervico-isthmic cerclage is recommended, which can be performed through different approaches. This study specifically focuses on transvaginal cervico-isthmic cerclage.
Objective
To identify risk factors associated with failure of transvaginal cervico-isthmic cerclage (defined as a birth before 30 weeks of gestation), in a population of women at high risk of preterm birth or late miscarriage. Outcomes such as success rate, occurrence of complications and outcome of pregnancies of this historical cohort are also reported.
Materials and methods
This retrospective study was conducted between 2009 and 2023, including 251 women who underwent transvaginal cervico-isthmic cerclage for failure of previous McDonald cerclage. Statistical analyses, including univariate and multivariate analysis, were performed to identify factors associated with cerclage failure, defined as birth before 30 weeks of gestation.
Results
After exclusion of 41 women lost to follow-up (16.3 %), we included 210 women. Failure rate of the cerclage was 10.7 %, with rare intraoperative complications (2.5 %). Multivariate analysis revealed that gestational age at cerclage (OR = 0.49 [0.29–0.82]; p < 0.01) and having 4 or more previous fetal loss (OR = 9.54 [1.01–90.09]; p = 0.05) were significantly associated with failure of transvaginal cervico-isthmic cerclage.
Conclusion
Transvaginal cervico-isthmic cerclage is an effective technique for preventing preterm birth and late miscarriage, with a low complication rate in women with previous unfavorable obstetrical issues.
{"title":"Risk factors for failure of transvaginal cervico-isthmic cerclage: a retrospective cohort study","authors":"Maeva Renck , Célia Maheut , Nora Brouard Daudignon , Déborah Couet , Anne-Gaëlle Pourcelot , Perrine Goussault Capmas","doi":"10.1016/j.ejogrb.2025.114878","DOIUrl":"10.1016/j.ejogrb.2025.114878","url":null,"abstract":"<div><h3>Introduction</h3><div>Cervical incompetence is a major cause of preterm birth. The primary treatment is cerclage (McDonald, Shirodkar or cervico-isthmic one). First recommended cerclage is the McDonald one. In case of an unsuccessful Mc Donald cerclage, a cervico-isthmic cerclage is recommended, which can be performed through different approaches. This study specifically focuses on transvaginal cervico-isthmic cerclage.</div></div><div><h3>Objective</h3><div>To identify risk factors associated with failure of transvaginal cervico-isthmic cerclage (defined as a birth before 30 weeks of gestation), in a population of women at high risk of preterm birth or late miscarriage. Outcomes such as success rate, occurrence of complications and outcome of pregnancies of this historical cohort are also reported.</div></div><div><h3>Materials and methods</h3><div>This retrospective study was conducted between 2009 and 2023, including 251 women who underwent transvaginal cervico-isthmic cerclage for failure of previous McDonald cerclage. Statistical analyses, including univariate and multivariate analysis, were performed to identify factors associated with cerclage failure, defined as birth before 30 weeks of gestation.</div></div><div><h3>Results</h3><div>After exclusion of 41 women lost to follow-up (16.3 %), we included 210 women. Failure rate of the cerclage was 10.7 %, with rare intraoperative complications (2.5 %). Multivariate analysis revealed that gestational age at cerclage (OR = 0.49 [0.29–0.82]; p < 0.01) and having 4 or more previous fetal loss (OR = 9.54 [1.01–90.09]; p = 0.05) were significantly associated with failure of transvaginal cervico-isthmic cerclage.</div></div><div><h3>Conclusion</h3><div>Transvaginal cervico-isthmic cerclage is an effective technique for preventing preterm birth and late miscarriage, with a low complication rate in women with previous unfavorable obstetrical issues.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114878"},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-22DOI: 10.1016/j.ejogrb.2025.114909
Nicolás Fernandez-Barra , Camila A Fernández , Enzo A Muñoz , Bernardo I Cepeda , Pedro Gutierrez-Contreras , Pablo A Silva-Labarca , Jose Galaz , Paula A Vargas , Carolina P Martinovic , Juan F Prieto , Daniela P Luna , Erwin Buckel , Constanza A Godoy , Tamara A Álvarez , Rolando Rebolledo , Alejandro I Brañes , José E Ruiz , Julio E Benítez , María B García , Rose M Mege , Juan P Kusanovic
Background
Physiologic changes occurring during pregnancy lead to a higher risk for developing biliary diseases. It is estimated that for every 10,000 pregnant individuals, between 1 and 6 will require a cholecystectomy prior to delivery, most of them being done by a laparoscopic approach. Chile has one of the highest prevalence of gallbladder disease worldwide; however, the characterization of laparoscopic cholecystectomy during pregnancy in Hispanic populations has been poorly investigated.
Objective
To describe maternal and perinatal outcomes among pregnant individuals undergoing laparoscopic cholecystectomy for symptomatic gallbladder disease at a tertiary care center in Chile, across different gestational ages.
Study Design
A retrospective cohort study was conducted including all pregnant patients who underwent laparoscopic cholecystectomy between January 2002 and August 2023 in the High-Risk Pregnancy unit at the Sótero del Río hospital in Santiago, Chile. Information related to surgery, early postoperative evolution and perinatal outcomes were analyzed.
Results
A total of 158 pregnant patients who underwent laparoscopic surgery were included. The median gestational age at the time of surgery was 20 + 6 weeks (range 5–37 weeks). Most surgeries (61 %) were performed during the midtrimester, while 18 % were at the third trimester. The median admission-to-surgery interval was three days (range: 0–13), and the median hospitalization time was five days (range: 1–22). The mean gestational age at delivery was 38 weeks, and the rate of preterm birth < 37 weeks was 13.5 %. There were three cases of surgical complications (1.9 %) and five pregnancy losses (3.6 %). There were no cases that required admission to an intermediate/intensive care unit after surgery.
Conclusion
In this single-center case series, laparoscopic cholecystectomy for symptomatic gallbladder disease during pregnancy was associated with acceptable maternal and perinatal outcomes across a wide range of gestational ages. Laparoscopic cholecystectomy appears feasible at different trimesters of pregnancy. Further studies are needed to determine if this alternative is better than conservative management.
背景：怀孕期间发生的生理变化导致患胆道疾病的风险增加。据估计，每1万名孕妇中，就有1到6人需要在分娩前进行胆囊切除术，其中大多数是通过腹腔镜方法完成的。智利是世界上胆囊疾病发病率最高的国家之一；然而，在西班牙裔人群中，怀孕期间腹腔镜胆囊切除术的特征调查很少。目的：描述在智利三级保健中心接受腹腔镜胆囊切除术治疗症状性胆囊疾病的孕妇的产妇和围产期结局，跨越不同胎龄。研究设计：对2002年1月至2023年8月期间在智利圣地亚哥Sótero del Río医院高危妊娠病房接受腹腔镜胆囊切除术的所有孕妇进行回顾性队列研究。分析与手术、术后早期进展和围产儿结局相关的信息。结果：共纳入158例行腹腔镜手术的孕妇。手术时的中位胎龄为20 + 6周（范围5-37周）。大多数手术（61%）在妊娠中期进行，而18%在妊娠晚期进行。入院至手术间隔中位数为3天（范围：0-13），住院时间中位数为5天（范围：1-22）。结论：在这个单中心病例系列中，在大范围的胎龄范围内，腹腔镜胆囊切除术治疗妊娠期症状性胆囊疾病与可接受的孕产妇和围产期结局相关。腹腔镜胆囊切除术在妊娠的不同阶段似乎是可行的。需要进一步的研究来确定这种替代方法是否比保守治疗更好。
{"title":"Laparoscopic surgical resolution of symptomatic biliary pathology during pregnancy: An early therapeutic approach at any gestational age","authors":"Nicolás Fernandez-Barra , Camila A Fernández , Enzo A Muñoz , Bernardo I Cepeda , Pedro Gutierrez-Contreras , Pablo A Silva-Labarca , Jose Galaz , Paula A Vargas , Carolina P Martinovic , Juan F Prieto , Daniela P Luna , Erwin Buckel , Constanza A Godoy , Tamara A Álvarez , Rolando Rebolledo , Alejandro I Brañes , José E Ruiz , Julio E Benítez , María B García , Rose M Mege , Juan P Kusanovic","doi":"10.1016/j.ejogrb.2025.114909","DOIUrl":"10.1016/j.ejogrb.2025.114909","url":null,"abstract":"<div><h3>Background</h3><div>Physiologic changes occurring during pregnancy lead to a higher risk for developing biliary diseases. It is estimated that for every 10,000 pregnant individuals, between 1 and 6 will require a cholecystectomy prior to delivery, most of them being done by a laparoscopic approach. Chile has one of the highest prevalence of gallbladder disease worldwide; however, the characterization of laparoscopic cholecystectomy during pregnancy in Hispanic populations has been poorly investigated.</div></div><div><h3>Objective</h3><div>To describe maternal and perinatal outcomes among pregnant individuals undergoing laparoscopic cholecystectomy for symptomatic gallbladder disease at a tertiary care center in Chile, across different gestational ages.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study was conducted including all pregnant patients who underwent laparoscopic cholecystectomy between January 2002 and August 2023 in the High-Risk Pregnancy unit at the Sótero del Río hospital in Santiago, Chile. Information related to surgery, early postoperative evolution and perinatal outcomes were analyzed.</div></div><div><h3>Results</h3><div>A total of 158 pregnant patients who underwent laparoscopic surgery were included. The median gestational age at the time of surgery was 20 + 6 weeks (range 5–37 weeks). Most surgeries (61 %) were performed during the midtrimester, while 18 % were at the third trimester. The median admission-to-surgery interval was three days (range: 0–13), and the median hospitalization time was five days (range: 1–22). The mean gestational age at delivery was 38 weeks, and the rate of preterm birth < 37 weeks was 13.5 %. There were three cases of surgical complications (1.9 %) and five pregnancy losses (3.6 %). There were no cases that required admission to an intermediate/intensive care unit after surgery.</div></div><div><h3>Conclusion</h3><div>In this single-center case series, laparoscopic cholecystectomy for symptomatic gallbladder disease during pregnancy was associated with acceptable maternal and perinatal outcomes across a wide range of gestational ages. Laparoscopic cholecystectomy appears feasible at different trimesters of pregnancy. Further studies are needed to determine if this alternative is better than conservative management.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114909"},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-22DOI: 10.1016/j.ejogrb.2025.114904
Ivo Vukasović , Držislav Kalafatić , Maja Banović , Vladimir Banović
Introduction
The perineal body (PB) is a pyramidal fibromuscular structure located in the anterior part of the perineum, between the rectum and the vagina. It serves as a crucial component of the pelvic floor support system, particularly at levels II and III. Current understanding of pelvic floor anatomy is largely derived from cadaveric dissection and magnetic resonance imaging (MRI). However, ultrasound offers a promising alternative due to its ability to provide dynamic, non-invasive assessment, along with broad availability and cost-effectiveness. Importantly, ultrasound has the potential to reveal new insights into the anatomy of the perineal body and its functional role in both the static and dynamic support of the female pelvic floor.
Material and methods
This review followed the PRISMA-ScR guidelines. A comprehensive literature search was conducted in MEDLINE, Scopus, Web of Science, and grey literature sources. Eligible studies included English-language publications involving ultrasound visualization or measurement of the PB in women. Data extraction and screening were conducted independently by two reviewers, with discrepancies resolved through consensus. Data extraction encompassed a comprehensive set of variables, including study number, study design, total sample size, subgroup sample sizes, ultrasound approach, probe type, parameters measured, imaging position, and main findings.
Results
A total of 22 studies were included in the scoping review, with publications ranging from 1997 to 2025. The majority of studies were observational, and sample sizes varied from 22 to 1340 (mean 154) participants. In most studies published before 2012, endoanal ultrasound (EAUS) was the most commonly used modality. With advances in transvaginal ultrasound technology and the introduction of transperineal ultrasound, detecting and measuring the perineal body has become more accessible and precise. The perineal body can now be measured in three dimensions—depth, height, and width—rather than relying solely on the traditional measurement of perineal body thickness.
Conclusions
In conclusion, the perineal body is an important anatomical structure that can be clearly visualized and measured using ultrasound; however, significant heterogeneity in imaging approaches, probe types, and anatomical definitions underscores the need for standardized methodologies to improve reproducibility and support future clinical application in the diagnosis and management of pelvic organ prolapse.
会阴体（PB）是位于会阴前部、直肠和阴道之间的锥体状纤维肌肉结构。它是骨盆底支撑系统的重要组成部分，特别是在II级和III级。目前对骨盆底解剖学的了解主要来自尸体解剖和磁共振成像（MRI）。然而，超声提供了一个很有前途的替代方案，因为它能够提供动态的、无创的评估，以及广泛的可用性和成本效益。重要的是，超声有可能揭示会阴体的解剖结构及其在女性骨盆底的静态和动态支撑中的功能作用。材料和方法本综述遵循PRISMA-ScR指南。在MEDLINE、Scopus、Web of Science和灰色文献资源中进行了全面的文献检索。符合条件的研究包括涉及超声可视化或女性PB测量的英文出版物。数据的提取和筛选由两位审稿人独立进行，差异通过共识解决。数据提取包括一组综合变量，包括研究数量、研究设计、总样本量、亚组样本量、超声入路、探头类型、测量参数、成像位置和主要发现。结果共纳入22项研究，发表文献范围从1997年到2025年。大多数研究是观察性的，样本量从22到1340（平均154）名参与者不等。在2012年之前发表的大多数研究中，肛管超声（EAUS）是最常用的方式。随着经阴道超声技术的进步和经会阴超声的引入，会阴体的检测和测量变得更加方便和精确。会阴体现在可以用三维测量——深度、高度和宽度——而不是仅仅依靠传统的会阴体厚度测量。结论会阴体是超声能清晰显示和测量的重要解剖结构；然而，成像方法、探头类型和解剖定义的显著异质性强调了标准化方法的必要性，以提高可重复性，并支持未来盆腔器官脱垂诊断和治疗的临床应用。
{"title":"Ultrasound assessment of the perineal body: A scoping review","authors":"Ivo Vukasović , Držislav Kalafatić , Maja Banović , Vladimir Banović","doi":"10.1016/j.ejogrb.2025.114904","DOIUrl":"10.1016/j.ejogrb.2025.114904","url":null,"abstract":"<div><h3>Introduction</h3><div>The perineal body (PB) is a pyramidal fibromuscular structure located in the anterior part of the perineum, between the rectum and the vagina. It serves as a crucial component of the pelvic floor support system, particularly at levels II and III. Current understanding of pelvic floor anatomy is largely derived from cadaveric dissection and magnetic resonance imaging (MRI). However, ultrasound offers a promising alternative due to its ability to provide dynamic, non-invasive assessment, along with broad availability and cost-effectiveness. Importantly, ultrasound has the potential to reveal new insights into the anatomy of the perineal body and its functional role in both the static and dynamic support of the female pelvic floor.</div></div><div><h3>Material and methods</h3><div>This review followed the PRISMA-ScR guidelines. A comprehensive literature search was conducted in MEDLINE, Scopus, Web of Science, and grey literature sources. Eligible studies included English-language publications involving ultrasound visualization or measurement of the PB in women. Data extraction and screening were conducted independently by two reviewers, with discrepancies resolved through consensus. Data extraction encompassed a comprehensive set of variables, including study number, study design, total sample size, subgroup sample sizes, ultrasound approach, probe type, parameters measured, imaging position, and main findings.</div></div><div><h3>Results</h3><div>A total of 22 studies were included in the scoping review, with publications ranging from 1997 to 2025. The majority of studies were observational, and sample sizes varied from 22 to 1340 (mean 154) participants. In most studies published before 2012, endoanal ultrasound (EAUS) was the most commonly used modality. With advances in transvaginal ultrasound technology and the introduction of transperineal ultrasound, detecting and measuring the perineal body has become more accessible and precise. The perineal body can now be measured in three dimensions—depth, height, and width—rather than relying solely on the traditional measurement of perineal body thickness.</div></div><div><h3>Conclusions</h3><div>In conclusion, the perineal body is an important anatomical structure that can be clearly visualized and measured using ultrasound; however, significant heterogeneity in imaging approaches, probe types, and anatomical definitions underscores the need for standardized methodologies to improve reproducibility and support future clinical application in the diagnosis and management of pelvic organ prolapse.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114904"},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Overactive bladder (OAB) is a common condition among women, often impairing quality of life and frequently associated with obesity. Intradetrusor onabotulinumtoxinA (BoNT/A) is an established treatment for refractory OAB; however, the influence of body mass index (BMI) on treatment outcomes remains unclear. This retrospective cohort study examined whether obesity impacts subjective and objective treatment responses in women undergoing BoNT/A injections for refractory OAB. Data were collected from the British Society of Urogynaecology (BSUG) database for patients treated between 2013 and 2023 at a tertiary Urogynaecology Centre in the United Kingdom. Of 522 initial cases, 285 women met inclusion criteria. Patient-reported satisfaction at 6 months post-injection and changes in International Consultation on Incontinence Questionnaire – Overactive Bladder (ICIQ-OAB) scores were evaluated. Women were stratified into BMI <30 and BMI ≥30 groups. Satisfaction rates were high and nearly identical between groups (76.8 % vs. 77.0 %, p = 0.973). Likewise, mean change in ICIQ-OAB scores showed minimal and statistically insignificant differences between BMI categories (p = 0.71). Logistic and linear regression analyses, adjusting for age and BoNT/A dose, confirmed that BMI was not a significant predictor of either patient satisfaction or symptom score improvement. Neither age nor BoNT/A dose significantly influenced outcomes. These findings suggest that BMI does not affect the efficacy of BoNT/A treatment for OAB, supporting its use irrespective of weight status. Clinically, BoNT/A remains a valuable therapeutic option for women with refractory OAB, while weight loss should continue to be encouraged for its broader health benefits, including improvements in urinary continence.
膀胱过动症（OAB）是女性的一种常见病，通常会影响生活质量，并常与肥胖有关。肌内肉毒杆菌毒素（BoNT/A）是一种治疗难治性OAB的成熟方法；然而，身体质量指数（BMI）对治疗结果的影响尚不清楚。这项回顾性队列研究探讨了肥胖是否会影响接受BoNT/A注射治疗难治性OAB的女性的主观和客观治疗反应。数据收集自英国泌尿妇科学会（BSUG）数据库，涉及2013年至2023年在英国某三级泌尿妇科中心接受治疗的患者。在522例初始病例中，285名妇女符合纳入标准。评估患者在注射后6个月报告的满意度以及国际尿失禁问卷-膀胱过度活动（ICIQ-OAB）评分的变化。将女性分为BMI <；30组和BMI≥30组。两组患者满意率高且几乎相同（76.8% vs 77.0%, p = 0.973）。同样，ICIQ-OAB评分的平均变化显示BMI类别之间的差异很小，统计学上不显著（p = 0.71）。Logistic和线性回归分析，调整年龄和BoNT/A剂量，证实BMI不是患者满意度或症状评分改善的显著预测因子。年龄和BoNT/A剂量对结果均无显著影响。这些研究结果表明，BMI不影响BoNT/A治疗OAB的疗效，支持无论体重状况如何均可使用BoNT/A。临床上，BoNT/A仍然是难治性OAB女性的一种有价值的治疗选择，同时减肥应继续受到鼓励，因为它具有更广泛的健康益处，包括改善尿失禁。
{"title":"Does BMI affect treatment outcomes following intradetrusor onabotulinumtoxinA (Botox) injection in patients with Overactive Bladder (OAB)?","authors":"Miriam O’Kane , Adith Thomas , Erin Fitzsimons-West , Lily Bracken , Ana DaSilva , Hayser Medina Lucena , Ivilina Pandeva , Smita Rajshekhar , Ashish Pradhan","doi":"10.1016/j.ejogrb.2025.114907","DOIUrl":"10.1016/j.ejogrb.2025.114907","url":null,"abstract":"<div><div>Overactive bladder (OAB) is a common condition among women, often impairing quality of life and frequently associated with obesity. Intradetrusor onabotulinumtoxinA (BoNT/A) is an established treatment for refractory OAB; however, the influence of body mass index (BMI) on treatment outcomes remains unclear. This retrospective cohort study examined whether obesity impacts subjective and objective treatment responses in women undergoing BoNT/A injections for refractory OAB. Data were collected from the British Society of Urogynaecology (BSUG) database for patients treated between 2013 and 2023 at a tertiary Urogynaecology Centre in the United Kingdom. Of 522 initial cases, 285 women met inclusion criteria. Patient-reported satisfaction at 6 months post-injection and changes in International Consultation on Incontinence Questionnaire – Overactive Bladder (ICIQ-OAB) scores were evaluated. Women were stratified into BMI <30 and BMI ≥30 groups. Satisfaction rates were high and nearly identical between groups (76.8 % vs. 77.0 %, p = 0.973). Likewise, mean change in ICIQ-OAB scores showed minimal and statistically insignificant differences between BMI categories (p = 0.71). Logistic and linear regression analyses, adjusting for age and BoNT/A dose, confirmed that BMI was not a significant predictor of either patient satisfaction or symptom score improvement. Neither age nor BoNT/A dose significantly influenced outcomes. These findings suggest that BMI does not affect the efficacy of BoNT/A treatment for OAB, supporting its use irrespective of weight status. Clinically, BoNT/A remains a valuable therapeutic option for women with refractory OAB, while weight loss should continue to be encouraged for its broader health benefits, including improvements in urinary continence.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114907"},"PeriodicalIF":1.9,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can predict pathological and clinical responses to neoadjuvant chemotherapy (NACT) in patients with advanced-stage high-grade serous ovarian carcinoma (HGSOC).
Methods
In this prospective cohort study, 80 patients with FIGO stage III–IV HGSOC received three cycles of platinum-based neoadjuvant chemotherapy. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were measured before and after the neoadjuvant treatment. Treatment response was evaluated using RECIST 1.1, chemotherapy response score (CRS), and the Completeness of cytoreduction score (CC score). The associations between these inflammatory markers and outcomes were analyzed using appropriate statistical tests.
Results
Following neoadjuvant chemotherapy, patients who achieved a good histopathological response (CRS 3) showed significantly lower baseline and post-NACT NLR and PLR values compared to those with CRS 1–2 (p < 0.001). Baseline NLR > 5.5 (Sensitivity: 94.7 %, Specificity: 86.9 %), PLR > 177 (Sensitivity: 94.7 %, Specificity: 88.5 %) predicted poor histopathological response (CRS1).
Conclusion
Pre- and post-NACT NLR and PLR may serve as valuable, non-invasive biomarkers for predicting histopathologic response to chemotherapy in advanced serous ovarian carcinoma. Incorporating these inflammatory markers into preoperative assessment may improve patient stratification and surgical planning.
{"title":"Prognostic significance of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in predicting response to neoadjuvant chemotherapy in advanced high-grade serous ovarian cancer: a prospective study","authors":"Suday Halder , Jyoti Meena , Seema Singhal , Rajesh Kumari , Sachin Khurana , Sandeep Mathur , Archana Singh , Sumit Kumar Das , Neena Malhotra","doi":"10.1016/j.ejogrb.2025.114901","DOIUrl":"10.1016/j.ejogrb.2025.114901","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can predict pathological and clinical responses to neoadjuvant chemotherapy (NACT) in patients with advanced-stage high-grade serous ovarian carcinoma (HGSOC).</div></div><div><h3>Methods</h3><div>In this prospective cohort study, 80 patients with FIGO stage III–IV HGSOC received three cycles of platinum-based neoadjuvant chemotherapy. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were measured before and after the neoadjuvant treatment. Treatment response was evaluated using RECIST 1.1, chemotherapy response score (CRS), and the Completeness of cytoreduction score (CC score). The associations between these inflammatory markers and outcomes were analyzed using appropriate statistical tests.</div></div><div><h3>Results</h3><div>Following neoadjuvant chemotherapy, patients who achieved a good histopathological response (CRS 3) showed significantly lower baseline and post-NACT NLR and PLR values compared to those with CRS 1–2 (p < 0.001). Baseline NLR > 5.5 (Sensitivity: 94.7 %, Specificity: 86.9 %), PLR > 177 (Sensitivity: 94.7 %, Specificity: 88.5 %) predicted poor histopathological response (CRS1).</div></div><div><h3>Conclusion</h3><div>Pre- and post-NACT NLR and PLR may serve as valuable, non-invasive biomarkers for predicting histopathologic response to chemotherapy in advanced serous ovarian carcinoma. Incorporating these inflammatory markers into preoperative assessment may improve patient stratification and surgical planning.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114901"},"PeriodicalIF":1.9,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.ejogrb.2025.114902
Luigi Della Corte , Mario Palumbo , Antonisia Pollio , Ilenia Nobile , Lara Cuomo , Giuseppe Bifulco
Introduction
Genitourinary syndrome of menopause (GSM) is a prevalent, progressive condition affecting more than half of postmenopausal women, often compromising vaginal and sexual health. While local estrogen therapy remains the mainstay of treatment, non-hormonal alternatives are increasingly required, particularly for women with contraindications to hormonal therapy.
Study design
To evaluate the efficacy and safety of a non-hormonal, Aloe-vera-based vaginal gel enriched with cellulose derivatives and plant extract and sugar complex in improving vaginal health and sexual function in postmenopausal women, as assessed by changes in vaginal pH, Vaginal Health Index (VHI), and Female Sexual Function Index (FSFI) over a six-month period. In this prospective observational study, 52 postmenopausal women were evaluated at baseline, 3 months, and 6 months. Vaginal pH was measured clinically, while the VHI and FSFI were assessed using instruments with established evidence of validity and reliability. Friedman and Wilcoxon tests were applied for within-subject comparisons, and linear mixed-effects models were fitted to evaluate the impact of time, age, and BMI.
Results
All parameters significantly improved over time (p < 0.0001). Mean vaginal pH decreased from 5.51 ± 0.39 at baseline to 4.75 ± 0.33 at 6 months, indicating partial restoration of vaginal acidity. VHI increased by + 5.89 ± 2.34 points, and FSFI improved by + 6.80 ± 3.15. At 6 months, 40.4 % of participants achieved FSFI scores ≥ 26.55. Linear mixed models confirmed time as a significant predictor, while age and BMI had no significant effect. No adverse events were reported.
Conclusions
Aloe-vera-based non-hormonal vaginal gel therapy significantly improved vaginal health and sexual function in postmenopausal women, independently of age and BMI. The formulation’s moisturizing, soothing, and protective properties likely underlie these benefits, offering a safe and effective non-hormonal option for the management of GSM.
{"title":"Non-hormonal vaginal gel improves vaginal and sexual health in menopausal women: results from a 6-month prospective study.","authors":"Luigi Della Corte , Mario Palumbo , Antonisia Pollio , Ilenia Nobile , Lara Cuomo , Giuseppe Bifulco","doi":"10.1016/j.ejogrb.2025.114902","DOIUrl":"10.1016/j.ejogrb.2025.114902","url":null,"abstract":"<div><h3>Introduction</h3><div>Genitourinary syndrome of menopause (GSM) is a prevalent, progressive condition affecting more than half of postmenopausal women, often compromising vaginal and sexual health. While local estrogen therapy remains the mainstay of treatment, non-hormonal alternatives are increasingly required, particularly for women with contraindications to hormonal therapy.</div></div><div><h3>Study design</h3><div>To evaluate the efficacy and safety of a non-hormonal, Aloe-vera-based vaginal gel enriched with cellulose derivatives and plant extract and sugar complex in improving vaginal health and sexual function in postmenopausal women, as assessed by changes in vaginal pH, Vaginal Health Index (VHI), and Female Sexual Function Index (FSFI) over a six-month period. In this prospective observational study, 52 postmenopausal women were evaluated at baseline, 3 months, and 6 months. Vaginal pH was measured clinically, while the VHI and FSFI were assessed using instruments with established evidence of validity and reliability. Friedman and Wilcoxon tests were applied for within-subject comparisons, and linear mixed-effects models were fitted to evaluate the impact of time, age, and BMI.</div></div><div><h3>Results</h3><div>All parameters significantly improved over time (p < 0.0001). Mean vaginal pH decreased from 5.51 ± 0.39 at baseline to 4.75 ± 0.33 at 6 months, indicating partial restoration of vaginal acidity. VHI increased by + 5.89 ± 2.34 points, and FSFI improved by + 6.80 ± 3.15. At 6 months, 40.4 % of participants achieved FSFI scores ≥ 26.55. Linear mixed models confirmed time as a significant predictor, while age and BMI had no significant effect. No adverse events were reported.</div></div><div><h3>Conclusions</h3><div>Aloe-vera-based non-hormonal vaginal gel therapy significantly improved vaginal health and sexual function in postmenopausal women, independently of age and BMI. The formulation’s moisturizing, soothing, and protective properties likely underlie these benefits, offering a safe and effective non-hormonal option for the management of GSM.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114902"},"PeriodicalIF":1.9,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.ejogrb.2025.114900
Irene Colombi , Giuseppe Vizzielli , Eugenia Costantini , Silvia Pisaneschi , Federica Perelli , Anna Biasoli , Stefano Restaino , Francesca Ciccarone , Gabriele Centini , Francesco Giuseppe Martire , Martina Pacifici , Alberto Mattei , Errico Zupi , Lucia Lazzeri
Background
Accurate preoperative assessment of endometrial cancer is crucial for tailoring surgical and therapeutic management. Identifying correlations between ultrasonographic features and tumor histopathological and molecular profiles may help improve the accuracy of presurgical staging.
Objectives
This multicenter retrospective study aimed to evaluate the association between ultrasonographic features, histopathological characteristics and molecular profiles in endometrial cancer to improve preoperative assessment and risk stratification.
Study design
A total of 156 women from three Italian centers underwent standardized transvaginal or transrectal ultrasound following IETA criteria prior to hysterectomy. Ultrasonographic parameters, including endometrial thickness, echogenicity, junctional zone integrity, and vascularity assessed by Doppler, were analyzed. Postoperative histopathology and molecular classification (p53, MMR, POLE, NSMP) were performed. Statistical analyses evaluated correlations among ultrasound features, pathology, and molecular data.
Results
Endometrioid histotype was detected in 88.46 % of cases, mostly low-grade and early-stage. Cases in the early stage (i.e. lesions confined to the uterine corpus) accounted for 77.27 % of all cases. Ultrasound staging was consistent with the final staging in 65.5 % of cases, with errors primarily involving the overestimation of p53-abnormal tumors and the underestimation of MMRd tumors. Increased endometrial thickness was associated with a higher stage and grade (median 20 mm for stage III, p = 0.007). An irregular junctional zone was associated with high-grade tumors (p = 0.016). Complex and multifocal vascular patterns were significantly linked to advanced stages, high grade, and molecular aggressiveness, such as p53 mutations and MMR deficiency. Tumors with scattered vessels showed a higher risk of extensive lymphovascular space invasion.
Conclusions
Ultrasound features, particularly vascularity, junctional zone irregularity, and endometrial thickness, are significantly associated with tumor stage, grade, and molecular profiles. Incorporating detailed ultrasonographic assessment into preoperative evaluation can help identify high-risk endometrial cancers and guide personalized management strategies.
Larger prospective studies are needed to validate these findings.
背景准确的子宫内膜癌术前评估是调整手术和治疗管理的关键。确定超声特征与肿瘤组织病理学和分子特征之间的相关性有助于提高手术前分期的准确性。目的本多中心回顾性研究旨在探讨子宫内膜癌超声特征、组织病理特征和分子特征之间的关系，以改进术前评估和风险分层。研究设计来自意大利三个中心的156名妇女在子宫切除术前按照IETA标准接受了标准化的经阴道或经直肠超声检查。超声参数，包括子宫内膜厚度，回声性，连接区完整性和血管多普勒评估，进行分析。术后进行组织病理学检查和分子分型（p53、MMR、POLE、NSMP）。统计分析评估超声特征、病理和分子数据之间的相关性。结果88.46%的患者检出子宫内膜样组织型，多为低分级和早期。早期病变（即病变局限于子宫体）占77.27%。65.5%的病例超声分期与最终分期一致，错误主要包括高估p53-异常肿瘤和低估MMRd肿瘤。子宫内膜厚度增加与更高的分期和分级相关（III期中位数为20 mm， p = 0.007）。不规则交界区与高级别肿瘤相关（p = 0.016）。复杂和多灶性血管模式与晚期、高级别和分子侵袭性（如p53突变和MMR缺乏）显著相关。血管分散的肿瘤显示广泛淋巴血管浸润的风险较高。结论超声特征，特别是血管分布、连接带不规则性和子宫内膜厚度与肿瘤分期、分级和分子特征有显著相关性。在术前评估中结合详细的超声检查有助于识别高危子宫内膜癌，指导个性化的治疗策略。需要更大规模的前瞻性研究来验证这些发现。
{"title":"Correlation between ultrasonographic findings and histopathological and molecular characteristics in endometrial cancer: A multicenter study","authors":"Irene Colombi , Giuseppe Vizzielli , Eugenia Costantini , Silvia Pisaneschi , Federica Perelli , Anna Biasoli , Stefano Restaino , Francesca Ciccarone , Gabriele Centini , Francesco Giuseppe Martire , Martina Pacifici , Alberto Mattei , Errico Zupi , Lucia Lazzeri","doi":"10.1016/j.ejogrb.2025.114900","DOIUrl":"10.1016/j.ejogrb.2025.114900","url":null,"abstract":"<div><h3>Background</h3><div>Accurate preoperative assessment of endometrial cancer is crucial for tailoring surgical and therapeutic management. Identifying correlations between ultrasonographic features and tumor histopathological and molecular profiles may help improve the accuracy of presurgical staging.</div></div><div><h3>Objectives</h3><div>This multicenter retrospective study aimed to evaluate the association between ultrasonographic features, histopathological characteristics and molecular profiles in endometrial cancer to improve preoperative assessment and risk stratification.</div></div><div><h3>Study design</h3><div>A total of 156 women from three Italian centers underwent standardized transvaginal or transrectal ultrasound following IETA criteria prior to hysterectomy. Ultrasonographic parameters, including endometrial thickness, echogenicity, junctional zone integrity, and vascularity assessed by Doppler, were analyzed. Postoperative histopathology and molecular classification (p53, MMR, POLE, NSMP) were performed. Statistical analyses evaluated correlations among ultrasound features, pathology, and molecular data.</div></div><div><h3>Results</h3><div>Endometrioid histotype was detected in 88.46 % of cases, mostly low-grade and early-stage. Cases in the early stage (i.e. lesions confined to the uterine corpus) accounted for 77.27 % of all cases. Ultrasound staging was consistent with the final staging in 65.5 % of cases, with errors primarily involving the overestimation of p53-abnormal tumors and the underestimation of MMRd tumors. Increased endometrial thickness was associated with a higher stage and grade (median 20 mm for stage III, p = 0.007). An irregular junctional zone was associated with high-grade tumors (p = 0.016). Complex and multifocal vascular patterns were significantly linked to advanced stages, high grade, and molecular aggressiveness, such as p53 mutations and MMR deficiency. Tumors with scattered vessels showed a higher risk of extensive lymphovascular space invasion.</div></div><div><h3>Conclusions</h3><div>Ultrasound features, particularly vascularity, junctional zone irregularity, and endometrial thickness, are significantly associated with tumor stage, grade, and molecular profiles. Incorporating detailed ultrasonographic assessment into preoperative evaluation can help identify high-risk endometrial cancers and guide personalized management strategies.</div><div>Larger prospective studies are needed to validate these findings.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114900"},"PeriodicalIF":1.9,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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