Gynecology and Minimally Invasive Therapy-GMIT最新文献

Objectives: To delineate the hysteroscopic findings of placental site nodule and plaque (PSNP) and determine its association with secondary infertility and chronic endometritis (CE).

Materials and methods: We performed a retrospective cohort study of seven patients diagnosed with PSNP among women with secondary infertility mainly treated by assisted reproduction due to the variety of indications who underwent office mini-hysteroscopy with resection (MHR) followed by endometrial aspiration biopsy (EAB). Clinical backgrounds, specific hysteroscopic findings, and the sampling methods for the diagnosis of PSNP were analyzed. The presence of CE was diagnosed by CD138 immunostaining and relationship between PSNP and CE were evaluated. The clinical outcomes were recorded.

Results: Multiple yellow-white colored protuberant lesion, micro polyps, and stalkless polyp were found and were resected under direct hysteroscopic observation. In five patients where PSNP was detected in both MHR and EAB samples, targeted biopsy using MHR within yellow-white colored protuberant lesion revealed PSNP. CD138 immunostaining showed marked plasma cell infiltration around the PSNP nodules in six patients and clinical CE were diagnosed in five patients. All women conceived spontaneously or with frozen-thaw embryo transfer after the procedures.

Conclusion: Yellow-white colored protuberant lesion is likely to be specific hysteroscopic findings of PSNP. However, the possibility of PSNP covered by superficial endometrium or with nonspecific appearances should be considered. The presence of PSNP may interfere with fertility and that hysteroscopic detection and resection of these lesions may have clinical significance in women with secondary infertility. Inflammatory reaction caused by PSNP may provoke secondary CE in surrounding endometrium.

Objectives: There is still ongoing debate regarding the surgical approach for early-stage cervical cancer. We aimed to compare the outcomes of abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer and compare our results with those of previous studies.

Materials and methods: This study included patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics ≤ stage IIA) who received treatment from January 2002 to December 2022. Clinical, surgical, pathological, recurrence, and survival data were collected and analyzed using suitable statistical methods.

Results: Of the 71 patients, 54 underwent ARH and 17 underwent LRH. The median follow-up durations were 117.0 months for the ARH group and 64.4 months for the LRH group. The average age of patients was 53.7 years, with a mean body mass index of 24.2 kg/m². Most patients had stage IB1 disease, and squamous cell carcinoma was the most common histological type. ARH was performed in 76.1% of patients, while 23.9% underwent LRH. LRH patients had significantly less blood loss (180 ml vs. 871.7 ml) and shorter hospital stays (6 days vs. 14 days). No significant differences in disease recurrence, cervical cancer-related mortality, or overall survival were observed between the two groups.

Conclusion: Early-stage cervical cancer patients who received LRH had survival and recurrence outcomes comparable to those who underwent ARH.

Objectives: Prompt diagnosis and management of ectopic pregnancy help prevent major morbidity and mortality in the first trimester. While studies frequently describe the general locations of ectopic pregnancies, there is less emphasis specifically on left- versus right-sided dominance. Understanding the lateralization patterns could enhance diagnostic accuracy and treatment strategies, thereby reducing the morbidity and mortality associated with this condition. We investigated the lateralisation patterns of ectopic pregnancies and to investigate any significant patterns associated with the ectopic side.

Materials and methods: This was a hospital-based, retrospective analytical cohort study conducted at the tertiary care hospital of North India from January 2021 to July 2024. The primary objective of the study was to determine the laterality of ectopic pregnancies.

Results: Among the 202 cases, 130 (64.4%) ectopic pregnancies were located in the right fallopian tube, whereas 72 (35.6%) cases were in the left fallopian tube (P < 0.0001). Among the 84 pregnancies that were found to have ruptured at diagnosis, 44.4% of the left-sided pregnancies ruptured, whereas 39.2% of the right-sided pregnancies ruptured (P < 0.47). A greater incidence of corpus luteum on the contralateral side was observed in the left-sided ectopic group (7.2% vs. 1.6% for the right-sided ectopic group, P < 0.001). The majority (99.8%) of the right-sided ectopic pregnancies had corpus luteum documented on the right side; however, only 86.1% of the left-sided pregnancies had a left-sided corpus luteum.

Conclusion: Our findings suggest a notable predominance of occurrences on the right side. This can aid clinicians in earlier diagnosis, better diagnostic vigilance and decision-making, including surgical planning, and an overall efficient utilization of healthcare resources.

Uterine fibroids (UFs) affect 70%-80% of women by age 50. Traditional treatments include medical management and invasive surgery. Recent advancements in fibroid treatment introduce less invasive methods like radiofrequency ablation (RFA), microwave ablation, uterine artery embolization, and MR-guided focused ultrasound. Accurate fibroid mapping and electrode placement are major challenges in the case of fibroid ablation. GYIDE, a scarless technology, demonstrates the feasibility for ultrasound-guided transcervical RFA. A 40-year-old woman with multiple intramural fibroids underwent RFA using GYIDE prior to hysterectomy. The procedure involved preoperative ultrasound, three-dimensional fibroid rendering, real-time mapping, and delivering the RFA for UF. Transcervical RFA targeted a 4 cm × 3.5 cm fibroid at 115 W for 5 min under ultrasound guidance. The GYIDE system enabled safe, precise RFA without complications. Intraoperative ultrasound confirmed effective ablation. Postthysterectomy analysis revealed no serosal perforation or thermal damage. The 4 mm navigation arm avoided cervical dilation, reducing discomfort. GYIDE delivers safe and precise transcervical RFA for UFs, with promising potential for expanded applications with advancing research.

Objectives: The prolapse quality-of-life (P-QOL) questionnaire is frequently used to assess changes in symptoms before and after surgery in patients with pelvic organ prolapse (POP). This study investigated whether P-QOL scores were significantly affected by pre- and postoperative conditions in patients with surgically treated POP.

Materials and methods: The study enrolled 158 patients who underwent surgery for POP at our hospital between May 2016 and May 2023. Seventy-two patients underwent laparoscopic sacrocolpopexy (LSC), whereas 86 underwent transvaginal mesh (TVM) surgery. To evaluate the POP-related conditions, the 60-min pad test and the Japanese version of P-QOL were used before surgery and 6 and 12 months after surgery.

Results: In patients with stage 4 POP, all P-QOL component scores, except for sleep/energy, significantly declined after surgery in the LSC group. Conversely, some component scores did not show a significant difference after the surgery in the TVM group. No significant differences in the rate of urinary incontinence, mesh exposure, or prolapse recurrence (PR) were observed between the two groups; however, the rate of PR was much higher in the TVM group than in the LSC group, although no significant differences were found in patients with stage 4 POP. Accordingly, some P-QOL component scores were significantly higher in the TVM group than in the LSC group (all P < 0.05).

Conclusion: The surgical outcomes of POP have a significant effect on P-QOL. Postoperative conditions can be evaluated using P-QOL scores.

Objectives: The injection of transurethral bulking agents is an office procedure that has been used as a primary and secondary treatment to improve urethral coaptation and restore urinary continence. The treatment has been available in the US since January 2020. In this study, we aim to present our experience with the efficacy of Bulkamid transurethral injection as a primary and secondary treatment among women with stress urinary incontinence (SUI) or mixed urinary incontinence.

Materials and methods: This is a retrospective study that was performed on 100 patients who received Bulkamid as primary or secondary treatment. The data were collected by reviewing medical records. The procedure was performed in the office with the injection of local anesthesia. The patients were followed up approximately 30 days after the procedure and the efficacy of Bulkamid injection was evaluated.

Results: One hundred patients were evaluated upon returning to the office. The mean age of patients was 62 years, and the mean body mass index was 29. Forty-eight patients have received Bulkamid treatment for stress incontinence as a primary procedure and 49 as a salvage procedure. The mean satisfaction reported by the patients was 53.7% for the primary group and 69.69% for the secondary group, with a P = 0.0187 which is statistically different. There are no complications reported in the follow-up.

Conclusion: Bulkamid transurethral injection appears to be a safe and effective treatment option for women with primary and secondary SUI. There is a trend toward higher short-term satisfaction in patients with previous anti-incontinence procedures.