Aims: The aim of the study was to evaluate the diagnostic ability of sonovaginography (SVG) with ultrasound gel in patients with endometriosis. Material and methods: We conducted a multicentre prospective study, which included 193 patients with symptoms highly suggestive for endometriosis. All patients were investigated by transvaginal sonography and SVG with gel and afterwards underwent laparoscopic surgery. For each category of endometriotic lesions investigated, we calculated and compared the sensitivity, specificity, positive predictive value and negative predictive value of the imagisticinvestigations used. Results: In the case of endometriotic lesions of the uterosacral ligaments, SVG with gel had a sensitivity of 78.5% and a specificity of 96% (p=ns). The lesions of the vagina and rectovaginal septum were diagnosed with a sensitivity of 79%, respectively 94% (p=ns), obtaining a specificity of 99%, respectively of 97% (p=0.007). The lesions of the Douglas pouch were identified with a sensitivity of 81% (p=0.015), and those of the rectosigmoid with a 94% sensitivity (p=0.010). We obtained lower sensitivity (67%) in detecting the lesions of the urinary bladder (p=ns). Conclusions: SGV with ultrasound gel represents a useful investigation tool for the evaluation of endometriotic lesions in the posterior pelvic compartment.
(1) Background: Endometriosis is a widespread gynecological condition that causes chronic pelvic discomfort, dysmenorrhea, infertility, and impaired quality of life in women of reproductive age. Clinical examination, transvaginal ultrasonography (TVS), and magnetic resonance imaging (MRI) are significant preoperative non-invasive diagnosis procedures for the accurate assessment of endometriosis. Although TVS is used as the primary line for diagnosis, MRI is commonly utilized to achieve a better anatomical overview of the entire pelvic organs. The aim of this systematic review article is to thoroughly summarize the research on various endometriosis diagnosis methods that are less invasive. (2) Methods: To find relevant studies, we examined electronic databases, such as MEDLINE/PubMed, Cochrane, and Google Scholar, choosing 70 papers as references. (3) Results: The findings indicate that various approaches can contribute to diagnosis in different ways, depending on the type of endometriosis. For patients suspected of having deep pelvic endometriosis, transvaginal sonography should be the first line of diagnosis. Endometriosis cysts are better diagnosed with TVS, whereas torus, uterosacral ligaments, intestine, and bladder endometriosis lesions are best diagnosed using MRI. When it comes to detecting intestine or rectal nodules, as well as rectovaginal septum nodules, MRI should be the imaging tool of choice. (4) Conclusions: When diagnosing DE (deep infiltrative endometriosis), the examiner’s experience is the most important criterion to consider. In the diagnosis of endometriosis, expert-guided TVS is more accurate than routine pelvic ultrasound, especially in the deep infiltrative form. For optimal treatment and surgical planning, accurate preoperative deep infiltrative endometriosis diagnosis is essential, especially because it requires a multidisciplinary approach.
The main objective of the this study is to compare the effectiveness of ovarian stimulation with recombinant gonadotrophins (FSHr) versus urinary gonadotrophins (hMG) within the number of oocytes obtained and the number of embryos in the two patient groups, according to age groups and associated pathologies. The study design was retrospective, monocentric. All patients (71) who have addressed the In Vitro Fertilization Clinic of the Prof. Dr. Panait Sirbu Clinical Obstetrics and Gynecology Hospital during 01.01.2010 and 31.12.2010 were included in this research. The total number of oocytes (8.5�3.9 vs 5.7�3.9, p=0.045), the number of fertilized oocytes (7.5�3.6 versus 3.6�2.8 p=0.004) and the number of embryos (6.6�3.5 versus 3.7�2.6, p=0.013) were higher in women under 35 years of age treated with recombinant FSHr compared to women treated with urinary gonadotrophins hMG. Ovarian stimulation with recombinant gonadotrophins provides a greater number of oocytes and a greater number of embryos in all patients, regardless of age and associated pathology. There are many variables that can influence the success rate, but the first variable that can be controlled is the choice of FSHr in daily clinical practice.
Pelvic floor disorders including stress urinary incontinence and pelvic organ prolapse represent a challenge for gynecologist or urogynecologist even nowadays. Conservative treatment for these conditions proves its effectiveness only in few cases selected from early forms of incontinence or prolapse the most cases being solved surgically. The introduction of the procedure imagined by Petros and Ulmsten, known as TVT (Trans Vaginal Tape) in which the medium urethra is supported by a synthetic tape produced in 1996 a revolution in the surgical treatment of stress urinary incontinence. Radical changes also appeared in pelvic organ prolapse surgery extrapolating the hernia repair procedure by using synthetic mesh. After nearly 20 years of experience the mesh surgery is today a common practice in urogynecology. Between 2011 and 2015 we operated in private practice a total number of 297 cases of which 187 cases of stress urinary incontinence and 110 cases of pelvic organ prolapse. From these 86 (78,1%) cases were represented by cystoceles, associated with early apical prolapse or rectoceles, 18 (16,3%) cases by apical prolapse (grade III-IV) and 6 (5,4%) cases by posterior compartment prolapse alone. We performed mesh surgery in 32 (29%) cases represented mainly by anterior compartment prolapse. In 6 (18,7%) cases we founded mesh extrusion which required partially resection. In two cases we performed large resection of anterior vaginal wall required grafting with acellular second generation graft. In all cases with mesh extrusion the biomechanical analysis revealed significant decrease in effective porosity of the mesh due to excessive tensioning or folding of the mesh. The use of mesh in stress urinary incontinence and pelvic organ prolapse represent a justified alternative in selected cases. The specific complications due to meshes are more frequent in prolapse surgery compared to stress urinary incontinence. In all cases altered effective porosity due to technical defects in surgery represents the leading cause.
Pelvic surgery addresses congenital malformations like Mullerian anomalies, pelvic organ prolapse or after radical intervention, while constructive surgery involves treatment of congenital/iatrogenic absence of organs: uterus or vagina. Intuitively, inert and nondegradable biomaterials appear ideal for this purpose, but surgical reality is that the persistence of a permanent foreign body in the wound has a lot of clinical postoperative disadvantages. This paper aims to discuss the properties of the biologic grafts, detailing the structure of biologic extracellular matrix, the biomechanical properties of biological grafts and the use of extracellular matrix in reconstructive pelvic surgery. A biologic graft used in pelvic surgery is a tridimensional extracellular matrix, acellular and of animal origin. It has as a low risk of transmission of viral and prionic infections and determines reduced inflammatory reaction and a low risk of rejection. The absence of crosslinking facilitates the colonization of the mesh by the host´s cells, thus avoids the foreign body reaction represented by the encapsulation of the mesh by the host. Our experience with clinical use of biological acellular grafts in reconstructive pelvic surgery includes oncoplastic surgery like in cases of vulvar cancer or neovagina reconstruction for Rokintansky syndrome, complications after prolapse surgery treated with polypropylene meshes or relapsing recto-vaginal fistulas. The biomechanical properties evaluated by tensile stress and elastic modulus revealed that biologic grafts with moderate collagen infiltration are the strongest. The degree of cross-linkage influences the rate of degradation and the degree of the inflammatory response triggered by the host organ. Cross-linked collagenous matrices induce little cell infiltration hence there is limited collagen remodeling and graft degradation. On the other hand, in non-cross- linked xenografts cell infiltration is greater with faster degradation rate and collagen production. The decrease in the mechanical strength of the graft materials is related to the lack of collagen infiltration into the material. In conclusion, taking into account the biomechanical properties of biologic grafts, these may be used in reconstructive pelvic surgery and oncoplastic surgery with little complications and good clinical results. They can be attached to large mucosal defects and on potentially septic tissue, they are mechanically resistant and they can be sutured on surrounding healthy tissue.
Introduction. Besides the improvement of the survival rate in young patients with musculoskeletal cancer, we should always consider that infertility and premature menopause due to treatment might dramatically affect their quality of life. Material and methods. This article is a review of literature. Results. After puberty, the first option should be ovarian controlled hyperstimulation (COS) resulting in oocytes that are consequently fertilized using FIV or ICSI and the cryopreservation of the embryos. If the patient does not have a partner at that moment, the next method is the vitrification of the oocytes resulting from the COS. The disadvantages of using COS are the need to postpone the radio and chemotherapy for at least 2-3 weeks and high oestradiol levels, but there are very few hormone dependent musculoskeletal tumors that may be affected. Ovarian tissue cryopreservation (OTC), with ovarian tissue transplantation (OTT) is the only method used if the patient is before puberty, plus, this technique allows patients to spontaneously conceive, if they do not have any other fertility pathology, but this freezing/ thawing procedure may have success or not. There is currently no evidence to suggest that OTT causes reseeding of the original cancer, and the restoring of the ovarian endocrine function was reported in about 95% of the cases. Conclusions. The success of fertility preservation techniques is related to the cryopreservation methods used and the age of the patient. The reproductive cells with the best survival are the embryos, the next are oocytes, or ovarian tissue may be cryopreserved. For best outcomes, the fertility preservation must be pluridisciplinary discussed, involving the ART specialist gynecologist, the oncologist and the surgeon of the musculoskeletal tumor.
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