Journal of pediatric and adolescent gynecology最新文献

Background: Gonadal dysgenesis, a genetic condition characterized by incomplete of defective formation of the gonads, can present with vaginal agenesis in individuals with 46, XY karyotype.

Case: We report an innovative intervention in the management of vaginal agenesis in a 19-year-old female with gonadal dysgenesis. Despite initial attempts with vaginal dilators, the patient presented unresponsive, leading to the adoption of a neovaginoplasty using Nile Tilapia Fish Skin (NTFS) as graft. The procedure, based on the McIndoe technique, involved the creation of a 10 cm x 3 cm vaginal canal with an NTFS-wrapped acrylic mold without complications.

Conclusion: The use of NTFS as a graft for neovaginoplasty in gonadal dysgenesis, a novel approach not previously reported in medical literature for this diagnosis, demonstrated favorable outcomes in terms of functionality and patient well-being.

Minimally invasive surgery (MIS) techniques, including vaginoscopy, laparoscopy and robotic-assisted surgery (RAS), have revolutionized the field of gynecology, offering numerous benefits such as reduced postoperative pain, shorter hospital stays, and faster recovery. While these techniques are widely employed in adult gynecologic surgery, their application in pediatric and adolescent patients requires careful consideration due to anatomical differences, patient size, and specific surgical requirements in children. Various aspects of MIS in pediatric and adolescent gynecology, including patient positioning, laparoscopic and robotic instrument choices, trocar placement, surgical techniques, and perioperative pediatric adaptations to MIS are discussed. The findings highlight the unique challenges and opportunities in performing MIS for pediatric and adolescent patients undergoing gyn surgery, emphasizing the need for specialized training and multidisciplinary collaboration.

Study objectives: Our aim was to review the evidence concerning the non-invasive diagnosis of endometriosis in adolescents.

Methods: A systematic review was written following the SWiM reporting guidelines. The study research was made across three databases (MEDLINE/PubMed, Scopus, and Web of Science) to identify articles about the adolescent population and the diagnosis of endometriosis through non-invasive methods. The search included the keywords "endometriosis," "adolescents," "diagnosis," "ultrasound," and "MRI." Only English-language articles were considered, and those published prior to 2000 were excluded. The established outcomes focused on clinical symptoms, ultrasound (US), and magnetic resonance imaging (MRI) findings suggestive of endometriosis.

Results: We included 26 articles, mostly comprising case series and cross-sectional studies. The pooled analysis involved 2,299 female adolescents (age range 8-25 years old) with clinically suspected, imaged, and/or surgically confirmed endometriosis. The most frequently reported symptom was dysmenorrhea, followed by chronic pelvic pain. Among adolescents clinically suspected of endometriosis undergoing ultrasound (US), 32.8% exhibited at least one sign of endometriosis. Of the 167 patients with ultrasound-diagnosed endometriosis, 48.5% had deep infiltrating endometriosis (DIE), and 45.5% had an endometrioma detected. Three studies assessed MRI findings, revealing that 49.8% presented with signs of endometriosis.

Conclusions: Dysmenorrhea and chronic pelvic pain stand out as key symptoms of adolescent endometriosis. Although their diagnostic accuracy varies, US and MRI have emerged as valuable tools for diagnosing the disease. While the US may have limitations, especially in detecting subtle lesions, MRI shows promise, even in cases with normal previous ultrasounds. Early recognition and proactive diagnosis are crucial for improving the management of endometriosis in adolescents.

Objectives: This study aimed to assess the practical application of conventional two-dimensional (2D) pelvic ultrasound in conjunction with three-dimensional (3D) ultrasound for evaluating obstructive Müllerian abnormalities.

Design: Respective study in tertiary referral hospital METHOD: Computerized stored data was used to collect surgical confirmed obstructive Müllerian anomalies cases between December 2022 and October 2023 with presurgical imagings being evaluated. Acute presentation with abdominal pain and clinical suspicion of obstructive Müllerian abnormality were required for inclusion. All study participants underwent pelvic ultrasound prior to the definitive surgery, with or without a repeat MRI if one was performed previous to admission. Those situations where both MRI and ultrasound were not conducted were excluded, such as the transverse vaginal septum, imperforate hymen, iatrogenic cervical injury or Müllerian malformation alone without obstructive outflow anomalies like didelphys, bicornuate, or septate uterus.

Main outcomes measures: The concordance between the surgically confirmed diagnosis and the pelvic ultrasound was reported in 27 of 29 women (93.1%). In contrast, only 24 of 29 cases were correctly diagnosed with MRI in this study (82.8%). This pilot study presents a comparison of two techniques, with a specific focus on obstructive Müllerian anomalies. The use of pelvic ultrasound not only assisted in our surgical practice but also significantly improved patient-doctor counseling.

Conclusion: In managing obstructive Müllerian abnormalities, 3D-enhanced conventional pelvic ultrasound was found effective in diagnosis and was comparable to MRI.