Gynecologic and Obstetric Investigation最新文献

Background: Bowel endometriosis is one of the more severe manifestations of deep endometriosis; it may cause pain and intestinal symptoms. The noninvasive diagnosis of bowel endometriosis is of crucial importance in planning the management of patients affected by this condition.

Objectives: This review aims to describe how transvaginal ultrasonography (TVS) is performed in patients with suspicion of rectosigmoid endometriosis, the diagnostic performance, and the strengths and limitations of this technique.

Methods: To identify relevant literature, a literature search was performed across the PubMed and Google Scholar databases up to July 2024.

Outcome: Numerous meta-analyses have demonstrated that TVS has high diagnostic accuracy in diagnosing rectosigmoid endometriosis. Rectosigmoid nodules can present with different morphological characteristics, but they are typically described as irregular, hypoechoic nodules located in the anterior wall of the rectosigmoid colon. The presence of "soft markers," such as a negative sliding sign and kissing ovaries, can further reinforce the diagnosis of this condition. Posterolateral parametrial involvement often coexists with large rectal nodules. Introducing water contrast into the rectosigmoid does not improve the performance of TVS in diagnosing rectosigmoid endometriosis.

Conclusions and outlook: TVS should be the first-line investigation in women suspected of having rectosigmoid endometriosis. The widespread use of TVS for the diagnosis of intestinal endometriosis can reduce diagnostic delays and facilitate the treatment of patients affected by this condition.

Introduction: Primary dysmenorrhea (PD) is one of the most common gynecological pathologies in women. The aim was to determine the differences in coping with PD in women who practice high-intensity sport, compared to women who are less physically active.

Methods: This was a cross-sectional observational study. A total of 476 women were recruited and administered a Google Form multiple-choice questionnaire divided into six sections. The following scales were used: Numerical Pain Rating Scale (NPRS), Pain Catastrophizing Scale (PCS), Menstruation-related Quality of Life Questionnaire (MQOL-22), Tampa Scale for Kinesiophobia (TSK), and Borg scale.

Results: The 389 participants meeting the inclusion criteria were divided into three groups according to their score in Borg test: high-intensity physical activity group (n = 178), moderate-intensity physical activity group (n = 101), and low-intensity physical activity group (n = 110) for those scoring under 4. ANOVA analysis showed statistical significance only for PCS (p = 0.024). Tukey group per group comparison determined differences between high-intensity physical activity group and low-intensity physical activity group regarding PCS (p = 0.018). Spearman correlation analysis showed a high relation between PCS and NPRS (r = 0.664) and between MQOL-22 and NPRS (r = -0.562).

Conclusion: The intensity of the exercise training does not influence PD-related pain perception nor kinesiophobia. High-intensity exercise reduces catastrophizing when compared with sedentary or low-intensity exercise. Level of catastrophizing is highly related with perceived pain and quality of life in menstruation in these PD patients.

Introduction: Pelvic floor dysfunction (PFD) is a pathological condition that significantly impacts women's health. It is therefore necessary to correctly diagnose it and offer the most appropriate treatment for her. Patient-reported outcomes (PROs) have been established, which include questionnaires measuring quality of life (QoL) and symptoms. Although several English-language questionnaires are available to assess PFDs and QoL concerns, relatively few have been validated for use in Italian. With a focus on validated PROs in Italian for assessing PFDs, this article aimed to provide a systematic overview of the literature with useful information on references and advice on how to access each unique questionnaire.

Methods: Up until March 1, 2024, a systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The PubMed/MEDLINE databases and websites were utilized to locate validated Italian-language PFD surveys. The text provides instructions on how to receive a copy of the questionnaire if it has been identified and confirmed to be possible.

Results: Thirty-five Italian-validated questionnaires were included: 17 out of 35 (48.6%) questionnaires focused on lower urinary tract symptoms, 1 (2.8%) on genital prolapse symptoms, 8 (22.8%) on sexuality, 3 (8.6%) on bowel symptoms, and 6 (17.2%) on pelvic dysfunctions. The literature search turned up seven more. Italian PRO validation documents compared to the last analysis. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), the Sexual Desire and Erotic Fantasies (SDEF) Questionnaire, the Sexual Inhibition/Sexual Excitation Scales (SIS/SES), the 12-Item Sexual Distress Scale (SDS) and 5-Item Sexual Distress Scale-Short Form (SDS-SF), the questionnaires from Vaizey and Wexner and the fecal incontinence severity index (FISI), the Pelvic Floor Distress Inventory (PFDI-20), and the Intermittent Catheterization Acceptance Test (I-CAT) are among the specifically newly validated PROs.

Conclusions: In order to encourage the use of suitable PROs while examining PFDs in Italian patients, this systematic review is meant to be a useful tool.

Objectives: The aim of our study was to analyze the percentage of acute urinary retention (AUR) after midurethral sling (MUS) surgery for stress urinary incontinence). The results of our study directed us to conduct a systemic review (SR) because of the need to consolidate existing knowledge on the incidence and management of postoperative urinary retention (UR).

Design: The first part of the article presents the SR, which was conducted after the retrospective analyses of our data. Participants/Materials: This article presents a retrospective study conducted on a sample of 55 patients who underwent three different types of MUS surgery: TVT-Abbrevo, TVT-O, and single-incision Ophira Mini Sling.

Setting: The study analyzes outcomes at a median 8-year follow-up, focusing on the significance of AUR after MUS surgery.

Methods: SR was conducted using Medline, Cochrane, and Clinical Trials databases, following PRISMA guidelines. The retrospective study involved 55 patients who underwent three types of MUS surgery (TVT-Abbrevo, TVT-O, and Ophira) at our clinic, with a median follow-up of 8 years. Postoperative outcomes, including AUR and residual urine, were assessed using ultrasound, and success was evaluated through the Patient Global Impression of Improvement (PGI-I) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).

Results: The SR has shown that the reported percentage of patients with acute postoperative UR after MUS procedures varies between 1.5% and 6.6%. In our retrospective analyses, 5 patients had AUR after the procedure (9.1%) and required the use of a Foley catheter for several days. All three surgical procedures resulted in similar levels of patient satisfaction at follow-up, as indicated by the PGI-I scores and patients' ICIQ-SF scores. The type of procedure and the patients' ICIQ-SF or PGI-I scores do not significantly correlate with the post-void residual volume.

Limitations: One of the major limitations in our analyses is the lack of any possibility to compare all TVT approaches, including retropubic. A larger sample size would be necessary to draw more definitive conclusions from these observations.

Conclusions: Our SR provides a comprehensive synthesis of previous research on UR after MUS surgery. We noted that many studies fail to consider the possibility of preexisting UR. Clinically significant long-term UR in our cohort of patients was below 100 mL, was not specifically correlated with any type of procedure, and was not statistically correlated with AUR after operation.

Introduction: Endometriosis is a condition that leads to a chronic inflammatory state, which has been associated with pelvic pain and infertility. Ovarian endometriomas are commonly treated via laparoscopic cystectomy; however, there is some debate on the degree of ovarian damage after cystectomy. The aim of this systematic review and meta-analysis is to conduct a thorough assessment of postoperative anti-Müllerian hormone levels, a marker of ovarian reserve, after laparoscopic cystectomy for endometriomas.

Methods: We conducted a search of PubMed, EMBASE, Web of Science, Google Scholar, and Science Direct from inception to March 31, 2024. We included randomized and non-randomized studies that assessed pre- and postoperative anti-Müllerian hormone levels after ovarian cystectomy for endometriomas. Outcomes of interest included the differences in anti-Müllerian hormone levels assessed within 1 month prior to surgery and up to 18 months postoperatively. These outcomes were categorized as short term (up to 6 weeks), medium term (7 weeks to 6 months), and long term (6 months to 18 months). Randomized and observational studies were pooled together for analysis as only the intervention arm from the randomized trials was included in the meta-analysis. Continuous variables were extracted as means and standard deviations to produce a pooled weighted mean difference with 95% confidence intervals were calculated using a random-effects model.

Results: Of the 2,396 articles identified, 30 studies were included. Primary outcomes showed a statistically significant (p < 0.001) decrease in anti-Müllerian hormone in the postoperative short-term period (-1.39 ng/mL, 95% CI: -2.01 to -0.76), medium-term period (-1.13 ng/mL [95% CI: -1.4 to -0.87]), and long-term period (-2.12 ng/mL [95% CI: -2.61 to -1.63]). There was no significant difference when comparing anti-Müllerian hormone levels in the short-term versus long-term period across all groups. There was no significant difference when comparing long-term unilateral and bilateral cystectomies on anti-Müllerian hormone levels postoperatively.

Conclusions: This systematic review and meta-analysis highlights that there is a decline in serum AMH levels following laparoscopic cystectomy for endometriomas, suggesting a potential adverse impact on ovarian reserve. This outcome emphasizes the need to incorporate discussions about the implications of surgery on fertility into preoperative counseling.

Objective: Our study focused on evaluating a possible relationship between endometriosis, Raynaud's syndrome, or migraine among women.

Design: This was a cross-sectional population-based study. Participants/Materials; Setting; Methods: We used 12,684,067 hospitalized patient records in the Healthcare Cost and Utilization Project (HCUP) database between 2007 and 2014. We calculated the prevalence of endometriosis, Raynaud's syndrome, and migraine. We also evaluated the possible role of depression, anxiety, and autoimmune diseases to eliminate confounding factors. Unadjusted and adjusted multivariate logistic regressions were applied to evaluate the relationship between variables.

Results: Unadjusted analysis revealed a strong association between endometriosis and Raynaud's syndrome and migraine (OR = 2.491; 95% CI: 1.677-3.699). After adjusting for sociodemographic characteristics as well as depression and anxiety, the association remained significant (OR = 1.779; 95% CI: 1.166-2.716). Among younger patients aged 18-35 with endometriosis, the associations were stronger with Raynaud's syndrome (adjusted OR = 1.61, 95% CI = 1.20-2.16) and migraine (adjusted OR = 2.59, 95% CI = 2.47-2.72).

Limitations: The HCUP database is cross-sectional in nature, and hence, we could not establish the temporal relationship between endometriosis, Raynaud's syndrome, and migraine. Also, the severity of endometriosis and the treatment received by the patients were not included in the dataset, and it prevented us from investigating the role of potential confounding factors.

Conclusion: Our study suggests an association between endometriosis, Raynaud's syndrome, and migraine. It is possible that these conditions share a similar mechanism possibly vascular reaction and endothelial dysfunction related to chronic inflammation.

Background: No conceptually new drugs for the safe and successful cure of endometriosis are likely to become available soon. Hormonal modulation of ovarian function and suppression of menstruation remain the pillars of disease control. However, existing drugs may be used following novel modalities to limit the consequences of endometriosis progression.

Objectives: The aims of this review were to propose a pharmacological approach aimed at limiting the potential detrimental effects of the recent dramatic increase in postmenarcheal repetitive ovulatory menses and to define the type of hormones and the routes of administration that can be used to maximize safety and tolerability in the medical treatment of endometriosis.

Methods: For this narrative review, we selected the best quality evidence, prioritizing RCTs, systematic reviews, meta-analyses, network meta-analyses, and international guidelines, preferably published in the last decade.

Outcome: Medical treatment of endometriosis should be included into all aspects of prevention. Very-low-dose combined oral contraceptives can be used for years to counteract the increased risk of ovarian cancer observed in patients with endometriosis. This primary prevention measure saves lives and can effectively integrate targeted risk-reducing surgery. Secondary pharmacological prevention, based on a working diagnosis of early onset adenomyosis-endometriosis selectively in adolescents with severe dysmenorrhea and heavy menstrual bleeding, can potentially impede the development of advanced disease forms, and reduce the need for management of complications due to a delay in diagnosis and treatment. Tertiary prevention, i.e., medical therapy of established disease, is based initially on the safest available estrogen-progestogen combinations and progestogen monotherapies. Whenever possible, ethinyl estradiol and cyproterone acetate should be avoided because of thromboembolic and meningioma risks, respectively. Estradiol can be administered transdermally. Switching to gonadotropin-releasing hormone agonists and antagonists should not be delayed when the first-line agents fail.

Conclusions and outlook: Two-thirds of symptomatic endometriosis patients can be managed satisfactorily for many years using, with the right modality, the existing safe, effective, and well-tolerated medications. Despite the constant plea for new drugs, this already appears to be an excellent clinical outcome, unsurpassed when managing other human chronic inflammatory diseases. Cohort studies are needed to verify whether turning off the recurrent inflammation caused by repeated ovulation and menstruation could also affect the risk of systemic conditions associated with endometriosis.

Background: Polycystic ovary syndrome, or endocrine metabolic syndrome (EMS) as recently proposed by the Expert Group on Inositol in basic and clinical research and on PCOS (EGOI-PCOS), manifests as a series of metabolic and hormonal alterations, which are primarily suspected to be underpinned by an underlying metabolic problem. Several of these metabolic issues are shared with metabolic syndrome (MetS), a separate but interrelated metabolic disorder typified by obesity, heightened glucose levels, dyslipidemia, and cardiovascular risk factors.

Objectives: This review sets out to expand upon the interplay between EMS and MetS, defining the key characteristics of each condition prior to discussing treatment options that may benefit both sets of patients.

Methods: A narrative review of all the relevant papers in English language was conducted.

Outcome: Both EMS and MetS share common features, such as obesity, dyslipidemia, and cardiovascular risk factors, and thus can be treated in certain circumstances with similar therapeutic approaches. However, in both women and men, does not feature alterations of androgen levels, as is the case with EMS. Furthermore, these conditions tend to occur in different age groups, with MetS primarily occurring during or after menopause, while EMS occurs in women of reproductive age.

Conclusions and outlook: These two conditions share considerable overlap, and one may trigger the other in affected patients; however, the causality is currently unclear and requires further study.

Introduction: We sought to conduct a systematic review and meta-analysis of randomized clinical trials (RCTs) to evaluate the impact of myo-inositol on oocyte and embryo quality in women undergoing assisted reproduction.

Methods: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist (registration number: CRD42023433328). Studies were identified by searching PubMed, Cochrane Library, Google Scholar, Scopus, Embase, and ClinicalTrials databases.

Results: Eight RCTs were included for qualitative analysis reporting on 820 participants. Four meta-analyses were performed. Numbers of retrieved oocytes in comparison of intervention and control group were higher in inositol group (mean difference [MD] = 0.41, 95% CI: 0.05-0.77, p = 0.02). Meta-analysis of two studies comparing numbers of oocytes among poor ovarian responder patients showed no significant difference between intervention and control group (MD = 0.50, 95% CI: 0.57-1.58, p = 0.36). Miscarriage rate has no statistically significant difference between the treatment and control groups (risk ratios [RRs] = 0.81, 95% CI: 0.20-3.32, p = 0.77). Inositol played no role in improving clinical pregnancy rates; there was no significant difference between the intervention group and the control group (RR = 1.41, 95% CI: 0.88-2.25, p = 0.15).

Conclusion: Thus, we did not find any benefits of using myo-inositol on oocyte and embryo quality in women undergoing reproductive technologies. Further studies are needed to assess efficacy, safety, and high compliance by female patients.