Gynecologic and Obstetric Investigation最新文献

Objectives: This study aimed to compare the serum endocan levels of patients with uterine fibroids and the healthy control group.

Design: A case-control study was designed. Participants/Materials: The study group includes women diagnosed with uterine fibroids, and the control group includes healthy women.

Setting: The study was conducted at a tertiary education and research hospital with 130 women (uterine fibroid group, n = 65; control group, n = 65).

Methods: Serum endocan levels were determined in the study and control groups using the ELISA method. The number of uterine fibroids was identified, and the volume of uterine fibroids was calculated with ellipsoid formula by ultrasonography. The primary outcome parameter was serum endocan levels in patients with uterine fibroids and healthy control groups. Second, it is aimed to determine the distribution of the serum endocan level of patients according to uterine fibroid number, volume, and clinical presentation.

Results: The mean serum endocan level of patient with uterine fibroid was 145.18 ± 169.86 (median: 94.10; Q25-Q75%: 54.50-116.50) pg/mL; it was 88.94 ± 54.21 (median: 76.9; Q25-Q75%: 64.20-152.65) pg/mL in the control group (p = 0.016). According to ROC analysis, cutoff value of the endocan level for uterine fibroid was determined as ≥133.1 pg/mL. For the cutoff value of 133.1 pg/mL, sensitivity was 36.92%, specificity was 89.23%, positive predictive value was 77.40%, and negative predictive value was 58.60%. Above this cutoff value, a 4.8-fold increased significant risk (OR) for uterine fibroid was detected.

Limitations: The major limitation of the study is the lack of histopathological examination.

Conclusion: Serum endocan levels were found to be higher in women with uterine fibroids compared to the control group, so endocan may be considered as a significant serum marker.

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.

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.

Background: Accessory and cavitated uterine masses (ACUM) are rare Mullerian anomalies, defined as an isolated accessory cavitated mass lined with endometrial epithelium.

Objectives: This article explores ACUM lesions from two aspects and integrates a case report of a successful laparoscopic-assisted intervention for ACUM in a 24-year-old woman with refractory dysmenorrhea with a review of current literature on laparoscopic surgical techniques. Unique to this case was the process of undergoing targeted genetic sequencing via the Find ITTM Panel Version 3.4 on the ACUM, looking for mutations in KRAS, PIK3CA, and FGFR2. A process that was inspired by recent reports that indicate that even normal endometrium can harbor cancer-associated mutations.

Methods: A comprehensive search of Ovid MEDLINE and Embase was performed. Studies were selected if they explored laparoscopic surgery's impact on ACUM patients' outcomes related to fertility, menorrhagia, or dysmenorrhea. Risk of bias assessment was performed using the JBI Critical Appraisal Checklist.

Outcome: From 160 articles identified, 25 full-text articles were analyzed with a total of 75 unique patients discussed. Dysmenorrhea was present in 100% of cases (n = 75/75), and laparoscopic resection improved patient symptoms in 84% (n = 63/75) of cases. The mass excised in the case was positive for somatic missense mutations in RET (R813W) and HRAS (G12S) genes, identified at low variant allele frequencies.

Conclusions and outlook: These results demonstrated that laparoscopic surgical approaches are effective and frequently the first surgical approach chosen for the treatment of ACUM, but that techniques to treat these conditions are not standardized. This case is the first to demonstrate mutations in ACUM, suggesting a potential role for cancer-associated somatic mutations in their genesis. Future developments in this area may include sending more of these samples for genetic analysis, improving our understanding of how these lesions are formed, while also working to standardize how they are removed.

Background: There is a paucity of studies on the association between polycystic ovary syndrome (PCOS) and endometriosis and the occurrence of venous thromboembolism (VTE).

Objective: Our study aimed to evaluate the association between PCOS, endometriosis, deep vein thrombosis (DVT), and pulmonary embolism (PE).

Methods: This was a retrospective study of prospectively collected data using the Healthcare Cost and Utilization Project databases. We examined the association between PCOS and endometriosis with DVT and PE from a cohort of 12,814,970 female patients, aged 18-49 years, who were hospitalized between 2007 and 2014.

Results: We observed increasing trends, with a relative increase of 140% (from 0.27% to 0.65%) for PCOS, 16% (from 0.43% to 0.50%) for DVT, and 39% (from 0.23% to 0.32%) for PE, whereas we observed a decline by 34% for endometriosis (from 0.85% to 0.56%). The unadjusted analysis showed an association between PCOS and VTE, which remained significant after adjustment for sociodemographic characteristics and comorbidities (OR = 2.16; 95% CI: 2.00-2.33 and OR = 2.44; 95% CI: 2.23-2.67 for DVT and PE, respectively). The association between endometriosis and VTE was age-dependent, with an increased risk of VTE among women 18-24 years whereas this risk was decreased among those 35 years and older.

Conclusion: Our study indicates an association between PCOS and VTE and an age-dependent association between endometriosis and VTE.

Objective: This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent general anesthesia (GA) or spinal anesthesia (SA) during vaginal pelvic floor surgeries.

Design: This was a retrospective cohort study.

Participants/materials, setting, methods: Women aged 18 or above who underwent vaginal pelvic floor surgery between 2019 and 2021 were included in the study. Univariate and multivariate analyses were performed separately for vaginal wall repair and stress urinary incontinence surgery.

Results: During the study period, 101 women underwent surgery under SA, and 99 women underwent surgery under GA. Intravenous analgesia administration rates were significantly lower under SA for both vaginal wall repair (20.2% vs. 38.9%, p = 0.017) and mid-urethral sling placement (20.2% vs. 37.8%, p = 0.007). Multivariate analysis revealed that intravenous analgesia requirement was significantly lower in the SA group than in the GA group after controlling for patient's age, concurrent hysterectomy, and mesh placement for vaginal wall repair (aOR = 0.33, p = 0.008) and mid-urethral sling placement (aOR = 0.37, p = 0.004).

Limitations: This is a retrospective study, thus the choice of anesthesia may be biased.

Conclusion: SA is associated with less postoperative pain and intravenous analgesia requirement in women who undergo vaginal pelvic floor surgeries. However, further research is needed to determine the preferred anesthesia method for specific types of pelvic floor surgeries.