Journal of pediatric and adolescent gynecology最新文献

Study objective: Isolated tubal torsion (ITT) is a surgical emergency that is less well characterized than ovarian torsion and presents with its own diagnostic challenges. We retrospectively examined patients with ITT and compared them to patients with ovarian torsion to better understand the unique features of this pathophysiologic process.

Methods: The medical records of patients who were identified as having ITT or ovarian torsion intraoperatively between January 2019 and November 2022 were reviewed. Patient demographics, clinical documentation, diagnostic imaging reports, operative reports, and pathology results were collected.

Results: A total of 82 patients met inclusion criteria of which 62 (75.6%) had ovarian torsion and 20 (24.4%) had ITT. Most patients (63.4%) underwent 2 or more imaging studies prior to the operating room. A diagnosis of torsion occurred more often on preoperative imaging for the ovarian torsion group (67.7% ovarian torsion vs 35.0% ITT, p=0.01). Doppler flow to the ovary was expectedly absent in 65.9% of ovarian torsion patients but interestingly also absent in 25% of ITT patients (p=0.01). Patients with ovarian torsion were more likely to have ovarian cysts (56.5% vs 10.0%, p<0.001), while patients with ITT were significantly more likely to have a paratubal cyst (90.0% vs 38.7%, p<0.001).

Conclusion: ITT is a surgical emergency that poses a risk to future fertility. Ultrasound studies, including doppler, may not be as definitive in patients with ITT and early cross-sectional imaging should be considered. When there is a high clinical suspicion for ovarian torsion or ITT, there should be a low threshold for diagnostic laparoscopy.

Study objective: To estimate the 1-year continuation rate of the levonorgestrel-releasing intrauterine device (LNG-IUD) in adolescents with endometriosis, and the frequency at which additional systemic hormonal treatment (HT) is utilized.

Methods: A retrospective cohort study was performed of patients aged 12 - 21 years who underwent laparoscopy for endometriosis and LNG-IUD insertion at a single tertiary care institution between 2018 and 2021.

Results: We evaluated 224 adolescents (mean age=17.0, SD=1.8 years) who underwent LNG-IUD placement during laparoscopic evaluation for endometriosis. Stage I endometriosis was most common (84.4%), followed by stage II (13.0%). Of 221 with follow-up, 208 (94.1%) had HT added or continued post-surgery. The most common additional HT was norethindrone acetate (42.5%), followed by combined hormonal contraceptives (34.8%). The 1-year LNG-IUD continuation rate was 92.0%. There were 18 IUD removals (8%) by 1 year, and the median time to removal was 118 days (IQR=159; range 8-293). Use of additional HT was associated with a lower hazard of IUD removal within the first year of use (HR = 0.19, 95% CI: 0.06-0.56, p<0.001).

Conclusion: The majority of adolescents used the LNG-IUD with additional systemic HT for endometriosis management. While overall continuation was high, adolescents who were using LNG-IUD and HT were more likely to continue LNG-IUD than those who were not utilizing additional HT.

Objective: To evaluate oophorectomy rates in pediatric and adolescent patients who presented to a United States (U.S.) emergency department (ED) with adnexal torsion.

Methods: This study is a retrospective, cross sectional analysis utilizing the National Emergency Department Sample (NEDS) data from 2016 to 2018. It includes patients who are younger than 20 years old and female sex. International Classification of Diseases Version 10 (ICD-10) and ICD 10 Procedure Coding System (ICD-10 PCS) codes were utilized to define patients with adnexal torsion who underwent adnexal surgery. Descriptive statistics and multivariate logistic regression were utilized to compare oophorectomy rates by patient demographics.

Results: There were 263 sampled patients less than 20 years old who presented to a U.S. Emergency Department with a diagnosis of adnexal torsion and underwent adnexal surgery. Of those, 177 had an oophorectomy (67.3%). 85 had a minimally invasive surgery (48%). 15- to 19-year-olds were 2.54 times more likely to have an oophorectomy compared to 10- to 14-year-olds (95% CI: 1.42 to 4.71, Table 2).

Conclusions: Despite standards for ovarian sparing surgery since 2016 and data suggestive of safety since the 1990s, oophorectomy rates remain high in pediatric and adolescent patients with torsion who present to U.S. emergency departments for care. Continued efforts should identify barriers to ovarian sparing surgeries and better quantify specific clinical nuances when oophorectomies are performed.

Objective: We aim to evaluate the long-term outcomes of ovarian preserving surgery for neonatal ovarian cysts.

Method: The clinical data of neonatal ovarian cysts treated in our hospital from January 2015 to December 2022 were retrospectively analyzed.

Results: Our study included 22 patients, of which 21 were unilateral and 1 was bilateral. There were 13 cases of simple cysts and 9 cases of complex cysts, and one cyst changed from simple to complex. The mean largest diameter of simple cysts was 5.7±2.1cm, and that of complex cysts was 4.6±2.0cm. There was no significant difference between the two groups (P=0.2264). Among the 22 patients, 21 underwent laparoscopic cystectomy. The only patient with bilateral cysts underwent percutaneous drainage of the right simple cyst. Twenty-one histological specimens were reviewed, of which 18(85.7%) contained viable ovarian tissues. Five cases lost follow-up after surgery, and the remaining 17 cases had a follow-up period of 6 months to 5 years. The last ultrasound follow-up showed that 9 cases had bilateral normal ovaries, and 8 cases lost the ipsilateral ovary. The ovarian preservation rate of simple cyst was 90% (9/10), which was significantly higher than that of complex cyst (12.5%, 1/8) (P=0.003).

Conclusions: Simple cysts (≥ 4cm) had an excellent prognosis, with a long-term ovarian preservation rate of 90%. The long-term ovarian preservation rate of complex cysts after surgery was relatively low. Our study suggested that surgical treatment did not increase the chances of preserving the ovaries of patients with complex cysts.

Study objective: Lower urinary tract symptoms (LUTS) can have a pronounced impact on adolescent women's overall health and quality of life, both during adolescence and across the life course. Little research has examined adolescent women's knowledge, attitudes, and beliefs about bladder health and preventing LUTS.

Methods: This study combines data from two large multi-site focus group studies of individuals born female who identified as women conducted by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. The first study included data from 8 focus groups conducted in 2018 with 44 adolescents aged 11 through 17 years. The second consisted of data from 20 focus groups conducted in 2020 with 123 adolescents aged 13 through 17 years. We used directed content analysis, including deductive and inductive approaches, to explore textual data and identify emergent insights. We present themes that emerged from analyzing coded data related to knowledge, attitudes, and beliefs.

Results: Themes included: (1) lack of information about bladder function, leading to limited knowledge, (2) hydration as a healthy behavior, (3) distinguishing healthy versus unhealthy voiding, (4) social and environmental barriers to voiding, and (5) shame and stigma of bladder related behaviors.

Conclusion: Our data suggests that adolescent women are aware of healthy and unhealthy behaviors related to bladder health, despite little exposure to formal education about the bladder. Social and environmental factors, including stigma, appear to be primary drivers of adolescents' behaviors around bladder health, suggesting that multi-level socio-ecological prevention interventions are needed to prevent LUTS in this population.

Background: Mullerian adenosarcoma of the cervix is a rare biphasic tumor composed of a benign epithelial component and a malignant stromal component. Here, we report a rare case of Mullerian adenosarcoma of the cervix in an adolescent girl treated with hysteroscopic resection.

Case presentation: A 16-year-old girl presented to the Affiliated Hospital of North Sichuan Medical College in April 2017 with a one-year history of a painless vaginal mass. 10 hours prior to presentation, she had experienced rapid enlargement of the vaginal mass and mild vaginal bleeding. 16 hours after hospitalization, a mass measuring 14 × 10 × 4 cm was spontaneously expelled from the vagina. Histopathological examination of the mass confirmed a diagnosis of Mullerian adenosarcoma. On May 10, 2017, the patient underwent hysteroscopic resection of a cervical lesion and partial cervical resection. After nearly 7 years of follow-up, the tumor has not recurred.

Conclusions: Mullerian adenosarcoma of the cervix is difficult to diagnose in adolescents. For young women affected by low-risk early-stage Mullerian adenosarcoma of the cervix, fertility preserving treatment using hysteroscopic resection with robust follow-up is a reasonable management option.

Study objective: Evidence-based menstrual health education is not mandated in any U.S. state or territory. Aspects of normal and abnormal menstruation impact quality of life and educational engagement, but many youth are not prepared to know when to seek medical help. We sought to determine which topics should be included in a 3^rd through 8^th grade school-based menstrual health curriculum.

Methods: We conducted a cross-sectional online survey of medical professionals who care for patients with menstrual problems. We asked participants to indicate the top three menstrual health topics by grade and we compared the most common responses by year. We also solicited general comments about curriculum content.

Results: Surveys from 55 medical professionals met criteria for analysis. The most frequent topics to be selected were normal and abnormal menstruation, reproductive anatomy, puberty timeline, and menstrual products. A majority recommended the topics of puberty timeline (38, 69.1%) and reproductive anatomy (34, 61.8%) for 3^rd grade, introducing normal menstruation (31, 56.4%) and menstrual products (24, 46.3%) in 4^th grade, and abnormal menstruation (27, 49.1%) in 6^th grade. More complex topics such as world cultures around menstruation (14, 25.5%) and period poverty (11, 20.0%) were preferred for 8^th grade. Many providers emphasized the importance of teaching normal versus abnormal menstruation in a school health curriculum.

Conclusion: Medical professionals provide recommendations for a school-based menstrual health curriculum that introduces topics at developmentally appropriate ages from a medical perspective, teaches basic menstrual symptom management, and instructs on warning signs for abnormal menstruation.

Objective: Patients with anorectal malformations (ARMs) may have concurrent gynecologic abnormalities. As patients grow, they typically transition from pediatric subspeciality care and seek adult OB/GYN related services. We aimed to assess adult OB/GYN physicians' knowledge, competency, and comfort meeting the sexual and reproductive health care needs of patients with ARM.

Methods: We performed a cross-sectional observational survey-based study of graduates from a single academic OB/GYN residency program from 2013-2022. Physicians were surveyed on experience, comfort, and challenges caring for patients with ARMs and given a knowledge assessment. Descriptive and comparative statistics between those who did and did not complete a pediatric and adolescent gynecology (PAG) rotation were generated.

Results: There were 59 respondents (53.6%). Fewer than half (39.0%) report caring for a patient with ARM, an appendicovesicostomy (12.3%) or an appendicostomy (5.4%). Most felt uncomfortable (80.4%) or felt they lacked competence caring for these patients (81.8%). The majority (64.3%) felt ARMs should be discussed in residency. Only one physician (1.7%) answered all questions in the knowledge assessment correctly; 33.9% did not answer any question correctly. On subgroup analysis, more physicians completing a PAG rotation recalled learning about ARMs (83.3 vs 51.9%, p=0.03); however, there were no differences in experience, comfort, competence, or willingness to learn.

Conclusion: OB/GYN providers report lack of knowledge and comfort in caring for patients with ARMs. Development of a standardized OB/GYN residency curriculum and education for practicing OB/GYN physicians is necessary to allow access to knowledgeable sexual and reproductive health for this patient population.

Study objective: In an increasing number of states, parents must provide permission for their daughters under 18-years-old to start contraception. We sought to understand perceptions among mother-daughter dyads about sources of information, and to describe dyadic interactions when discussing contraception.

Methods: Dyads were recruited from an adolescent medicine clinic in Dallas, TX. A semi-structured joint interview was conducted with each dyad. Interviews were recorded, transcribed, and coded through an iterative approach.

Results: There were 11 dyadic interviews (22 participants). Sources of information about contraception included mothers, healthcare providers (HCPs), friends/family, school, and individualized learning. Dyads identified distinct purposes and limitations of each source. Mothers noted the importance of supporting their daughter's development and specific needs. Often these conversations began with a discussion of menstrual management. Information from friends/family was overwhelmingly anecdotal. Schools and HCPs were viewed as trusted sources, and the internet/social media as possibly inaccurate or misleading. Dyads described several risks and benefits of different methods. Minimal conflict was noted.

Conclusion: These results provide rich information about how mother-daughter dyads view contraception in joint discussion. It is important to ensure that accurate stories about contraception are accessible and teaching health literacy would be helpful. Menstrual management appears to be an acceptable starting point to discuss contraception. Schools and HCPs are trusted sources and measures should be taken to ensure teaching is accurate, developmentally appropriate and teaches evaluation of online information. Regardless of parental consent laws for adolescent contraception, engaging caregivers in the process can help support adolescent contraceptive decision-making.

Today it is globally recognized that sexual and reproductive health is a human rights issue critical to economic growth and stability, ending poverty, and fostering sustainable development. Calls for improving sexual and reproductive health, including a spotlight on adolescents and young women, are highlighted in the Sustainable Development Goals (SDGs) adopted by the United Nations in 2015. In this commentary, we aim to (1) briefly review the history and objectives of global development goals (2) review the adolescent health related SDG targets and indicators with focus on sexual and reproductive health (3) discuss global progress and challenges in achieving target measures and (4) examine action steps that clinicians can take to accelerate progress.