Journal of the Turkish German Gynecological Association最新文献

Objective: To evaluate patients who underwent Burch colposuspension due to stress-type urinary incontinence (SUI) in terms of laparoscopic (L/S) and laparotomy (L/T) approaches.

Material and methods: Women aged 40-70 years who were admitted to our hospital with symptoms of SUI between 2017 and 2024, who underwent surgical treatment for SUI, and who met the inclusion criteria were included. The women were divided into two groups, those who received L/T and those who underwent L/S Burch colposuspension. To assess the impact of SUI on quality of life, several quality-of-life questionnaires, including the urinary distress inventory (UDI-6), the incontinence impact questionnaire (IIQ-7), the short-form-36 (SF-36) physical component summary, and the mental component summary (MCS), were evaluated. Post-operative pain was assessed with a Visual Analog Scale (VAS).

Results: The cohort consisted of 74 patients. The surgical time and estimated blood loss in the L/S group was significantly lower than in the L/T group (both p<0.001). The sixth and 48^th-hour VAS score in the L/S group was significantly lower than in the L/T group (both p<0.001). There was a significant decrease in UDI-6 and IIQ-7 score in patients who underwent L/S-Burch colposuspension and L/T-Burch colposuspension at the 6^th-month follow-up (p<0.001 and p<0.001, respectively). At the sixth-month follow-up, the SF-36 MCS score was significantly lower in the L/S group compared with the L/T group (p=0.014).

Conclusion: In our study, the results of Burch colposuspension methods were consistent with the literature. L/S-Burch colposuspension is superior in terms of surgical time, blood loss, hospital stay, pain management, and recovery time. The significant decrease in UDI-6 and IIQ-7 scores at the 6-month follow-up shows that both methods provide improvement in urinary incontinence symptoms and increase quality of life.

Objective: Cervical cancer is the second leading cause of cancer mortality among Mexican women aged 20-39 years, driven primarily by persistent human papillomavirus (HPV) infection. To determine the prevalence of high-grade squamous intraepithelial lesions (HSIL) in women under 40 years of age and identify associated risk factors.

Material and methods: An observational, cross-sectional study was conducted, including 359 women under 40 years old who were evaluated at the Gynecology and Obstetrics Medical Unit of Centro Médico Nacional de Occidente. Cervicovaginal cytology results indicative of HSIL were analyzed to determine prevalence and assess correlations with demographic and gynecological factors.

Results: The prevalence of HSIL was 39%, with the highest proportion of cases observed in women aged 35-39 years. The average age of sexual debut was 18.5 years, with an average of 2.93 sexual partners. Women diagnosed with HSIL were more likely to be older, married, and homemakers. HPV infection was highly prevalent across both low-grade squamous intraepithelial lesion and HSIL groups.

Conclusion: A high prevalence of HPV infection was found, mostly in a relatively young population. A significant association between infection and risk factors, like marital status and gynecological/obstetric history, was also demonstrated. The findings also confirmed a relationship between HPV and HSIL.

The phenomenon of transplacental transmission of cancer, where cancer cells pass from a pregnant mother to her fetus is an extremely rare occurrence. This phenomenon has significant implications for maternal and fetal health, challenging our understanding of cancer biology and maternal-fetal interactions. The literature on transplacental cancer transmission is sparse, consisting mainly of case reports, small cohort studies, and reviews. Examples of cancers that have been transmitted in this way include melanoma, choriocarcinoma, leukaemia, and lymphoma. Understanding this phenomenon is important because it has direct clinical implications for managing pregnant women with cancer and the infant, raises questions about the placental barrier and immune interactions between mother and fetus, and offers insights that could influence cancer biology and treatment strategies. This review aims to evaluate existing data, identify and synthesize evidence on transplacental cancer transmission cases, evaluate cancer types involved, their transmission mechanisms, and clinical outcomes for both mothers and infants. A comprehensive electronic search of databases was conducted for relevant case reports and series, using specific keywords related to vertical and transplacental transmission of cancer. The review elucidates comprehensive information from the reports to understand how cancer transmission occurred and was confirmed as vertical transmission, aiming to enhance knowledge in this critical area of maternal-fetal medicine.

Cervical fibroids (CFs) grow in the narrowest part of the uterus, which is adjacent to the ureter, uterine vessels and their branches. The ureter is at risk of being divided, thermally injured, and/or misligated when handling the vessels during total laparoscopic hysterectomy (TLH) to treat CFs We present a series of videos to detail the methods and skills required to perform blunt ureterolysis and handle the uterine vessels during TLH for CFs. This video contains three cases of CFs that underwent TLH. In Case 1, the surgeon did not separate the ureter in advance and mistook the ureter for a vessel during coagulating the vessels with bipolar forceps, which resulted in thermal injury to the ureter. Therefore, a ureteral stent was placed under cystoscopy, which was removed three months after the operation. In both Cases 2, 3, the surgeon used a curved vascular clamp to bluntly separate and fully expose the pelvic part of the ureter and then coagulated and divided the vessels. The separation started when the ureter traced the base of the posterior lobe of the broad ligament until it entered below the uterine artery. The uterine artery dissection site differed in Cases 2 and 3, with Case 2 being at the origin of the internal iliac artery and Case 3 in an area close to the CF, depending on the space between the CF and uterine artery. After six months of follow-up, all three patients were free of pyelonephrosis and ureteral dilatation, and no ureterovaginal fistulae occurred. Blunt ureterolysis procedure can effectively avoid ureter injury in TLH for CFs.

Objective: To compare history-indicated cervical cerclage (HICC), ultrasound-indicated CC (UICC) and physical examination-indicated CC (PEICC) in terms of obstetric outcomes and to compare the outcomes related to braided and non-braided suture materials (Prolene suture vs. Mersilene tape).

Material and methods: We retrospectively evaluated 173 transvaginal CC procedures performed in a single center. Cases were classified based on procedure indications and the type of suture material used.

Results: Of the 173 cases reviewed, 103 (59.5%), 45 (26.0%) and 25 (14.4%) cases were in the HICC, UICC and PEICC groups, respectively. Patients in the PEICC group underwent cerclage at significantly later gestational weeks, had higher hospitalization rates, longer hospital stays following the procedure, a shorter interval between cerclage and delivery, and a higher rate of procedure-related pregnancy loss compared to the other groups (p<0.05 for all). Both the gestational age at delivery and the take-home baby rate were lower in this group compared to the other groups (p<0.05 for both). There were no significant differences identified in terms of suture materials used. Subgroup analyses revealed similar obstetric outcomes between different suture materials.

Conclusion: PEICC had worse perinatal outcomes compared to HICC and UICC procedures. CC indication was the major determinant of perinatal outcome in this cohort while suture material had no significant effect on perinatal outcomes.

Objective: The aim of this study was to investigate the timing of recurrence in patients with early-stage endometrial cancer and to determine the optimal postoperative follow-up protocol for the detection of recurrence.

Material and methods: Patients with stage 1 and 2, grade 1-3 endometrioid type endometrial cancer who underwent follow-up for at least two years were included. The diagnostic method for recurrence was analyzed for each patient. Analysis of risk factors for recurrence were done using SPSS. Sensitivity analyzes were performed comparing the diagnostic methods.

Results: A total of 303 patients were included and recurrence was diagnosed in 17 (5.61%). Cumulative risk of recurrence was 3.06% in the first 23 months, rising to 7.52% in the first 33 months. Sensitivity of physical examination (PE) was 50.00%, specificity 99.52%, positive predictive value 88.89%, negative predictive value 96.30% and accuracy rate 96.00% respectively. It was found that each step increase of grade increased recurrence odds by 2.549 times [95% confidence interval (CI): 1.078-6.027; p=0.033] while each step increase of stage increased recurrence odds by 2.943 times (95% CI: 1.270-6.820; p=0.012).

Conclusion: It is notable that recurrence rate increased after 25 months and the risk of recurrence increased as the tumor stage and grade worsened. Symptoms in patients with high-grade and deep myometrial invasion, especially after the first two years, should be considered risky and patients should be informed about seeking medical care when symptoms occur. PE and symptoms of patients are key factors in detecting reccurence while other diagnostic methods can be used according to clinical findings.

Objective: Current evidence concerning the possible clinical effects of coronavirus disease-2019 (COVID-19) vaccines on vulvar lesions is limited. The aim was to describe the effect of vaccines against COVID-19 on the progression of vulvar condylomas.

Material and methods: The data of patients diagnosed with condylomata acuminate and treated with trichloroacetic acid (TCA) between January 2021 and January 2023 in the gynecological oncology surgery clinic were evaluated. The patients were divided into groups based on their vaccination status; vaccinated or unvaccinated. The number/area of condylomas and symptom degrees of the patients before and after TCA treatment were compared.

Results: A total of 202 patients, 102 vaccinated and 100 unvaccinated, were included. There was no significant difference between the groups in terms of age, parity, smoking, oral contraceptive use, amount of condyloma and symptom degree (all p>0.05). There was no significant difference in the amount of condyloma between the groups after six months [p=0.589, 95% confidence interval (CI)=0.238-1.566]. Moreover, there was no difference in the degree of symptoms after six months between the groups (p=0.467, 95% CI=1.113-1.799).

Conclusion: The systemic effects caused by COVID-19 vaccines are still not fully understood. Considering that this vaccine, like many vaccines, elicits a strong immunogenic reaction, the possible clinical impact of this non-specific systemic inflammatory response on vulvar condyloma is a matter of curiosity. This study showed there was no difference in the amount of condyloma and the degree of symptoms six months after TCA treatment in the unvaccinated and vaccinated group. The low number of patients is the biggest limitation of this study. Larger studies may provide more robust information.

Objective: To evaluate the rate, cytology and histopathological findings of multiple-type human papillomavirus (HPV) positive women referred to a tertiary colposcopy center. To compare the role of multiple- and single-type HPV infections in women with high-grade squamous intra epithelial lesion and cervical cancer (HSIL+).

Material and methods: The cytological and histopathological results of 2070 HPV positive women were evaluated. Infection with more than one type was defined as multiple-type HPV infection. Patients were divided into single or multiple HPV groups and subgroups in terms of HPV types; and also examined in three age groups. Age-stratified HSIL and cervical cancer rates of the study groups were compared.

Results: The women with multiple HPV subtypes accounted for 24.9% of the study population. Multiple-type HPV infection rates in normal cytology, atypical glandular cells, low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells, cannot exclude HSIL and HSIL were 28.2%, 26.8%, 19.3%, 22.6%, and 21.8%, respectively. Age stratified multiple-type HPV infection rates in under 30 years, 30-49 years and ≥50 years were 27.8%, 24.1%, and 27.3%, respectively. The multiple-type HPV infection rates in LSIL, HSIL, and cancer patients were 31.4%, 19%, and 12.5%, respectively.

Conclusion: Multiple-type HPV infections were statistically less common in HSIL and cancer patients than single type HPV infection. However, multiple type infection rates were remarkable in older HSIL and cervical cancer patients.