The objective: to evaluate the effectiveness of a differentiated approach in the postoperative management of patients with external genital endometriosis (EGE) to determine the regression of clinical symptoms and reduce the number of recurrences. Materials and methods. 207 patients with different forms of EGE after surgical treatment of the endometriosis foci removal were examined. After the determination of the prevalence of the pathological process (intraoperatively), the subjects were divided into three groups. A1 group (n=67) included women with severe disease who had an optimized approach for postoperative management. A2 group (n=75) included patients with moderate severity of EGE and the traditional treatment approach. B group was a comparison group (n=65) and was formed from patients with severe disease who were traditionally treated.Clinical-anamnestic, laboratory, morphological, immunohistochemical methods, gynecological examination data, ultrasound examination of the pelvic organs were used during the examination of women with EGE; magnetic resonance imaging (MRI) – if necessary. The standard approach included surgical treatment (laparoscopic method), removal of visible endometrioid heterotopias and the medical treatment from the 1st day of the next menstrual cycle after surgery (progestins (dienogest 2 mg) for 6 months or gonadotropin-releasing agonists in the presence of comorbidity of hyperplastic processes for 3-6 months in combination with add-back therapy). In the absence of reproductive plans combined oral contraceptives or intrauterine levonorgestrel-releasing system were used. Patients were observed for 1 month, 1 year after surgery, and then once a year. The optimized approach included surgery (laparoscopy or laparotomy) with the removal of endometrioid heterotopias, use of nonsteroid anti-inflammatory drugs in the postoperative period for 5 days, then dienogest 2 mg for 3-6 months was used by the cases of algomenorrhea and other manifestations of pain. The pathogenetic therapy was started on the 2nd or 3rd day of the postoperative period. Patients were observed for 2 months after surgery, then every 3 months for 1 year. The severity of pain was assessed on the Biberoglu and Behrman (B’n’B) and Numerical Rating Scale (NRS) scales. Recurrence of the disease was diagnosed in the presence of endometrioid heterotopia according to ultrasound examination and/or MRI, as well as the appearance of clinical complaints (pain) in 6 months after their absence.Results. In one year after the first surgery, recurrence of the disease was found in 13.43 % of women in A1 group, 12 % – A2 group and 24.61 % – B group. The average value of pain on the NRS scale in 12 months after treatment was 3.26 points in A1 group, 2.47 – A2 group and 1.59 – B group, on the B’n’B scale - 1.94, 1.61, and 1.40 points, respectively. Conclusions. The applying an optimized approach in the management of patients with severe and moderate external genital endometriosis (more radical surgery, the prescription at once in the postoperative period the hormonal therapy and nonsteroid anti-inflammatory drugs, more frequent observation after surgery) compared with traditional treatment lead to decrease the pain severity on 3.26 points on the Biberoglu and Behrman scale and 1.94 points – the Numerical Rating Scale, and reduce the recurrence rate by 45.4%.
Endometriosis remains one of the most studied pathologies in modern gynecology, as it is accompanied by such complications as constant pelvic pain, menstrual cycle disorders, and infertility. These complications not only prevent the implementation of a woman’s reproductive function, but also worsen the normal life of a woman in general. The early diagnosis and the right choice of treatment is the basis of prevention of disease recurrence. Therefore, most of the efforts of scientists are directed to this.The objective: to reduce the frequency of genital endometriosis recurrence and improve the implementation of reproductive functions based on the improved approaches to its diagnosis and treatment.Materials and methods. The study included two groups of patients. The 1st group included 60 women with a diagnosis of ovarian endometriosis, whose data were analyzed retrospectively based on the results of medical histories. The 2nd group was studied prospectively and included 60 women with a diagnosis of ovarian endometriosis.All patients had general clinical and laboratory examinations, specific laboratory and ultrasound examinations. In patients of the 2nd group tumor markers were additionally determined, in particular CA-125, HE4, CA 19-9, CA 72-4, CA 15-3, REA, and the level of anti-Müllerian hormone, magnetic resonance imaging was performed. Patients of both groups were operated and histological examination of the material obtained during the operation was performed.The difference in the management of the postoperative period in the 2nd group was that, in addition to anti-inflammatory therapy all women received hormonal therapy (gonadotropin-releasing hormone agonist (GnRH agonist) with subsequent use of combined oral contraceptives (COCs) or simultaneous use of GnRH agonist and COCs with subsequent transition in both variants for dienogest for 6 months continuously). Recurrence of the pathology was detected after 3 and 6 months on the basis of a repeated diagnosis of ovarian endometriosis.Results. The obtained data showed that in the postoperative period, 3 months after treatment 5 (8.3 %) women in the 1st group had a recurrence of ovarian endometriosis and 4 (6.7 %) patients – pelvic adhesions. Whereas in the 2nd group, there were no cases of recurrence and adhesions.In 6 months after treatment in the 1st group 11 (18.3 %) patients were diagnosed with ovarian endometriosis recurrence, and 6 (10.0 %) women were diagnosed with pelvic adhesions. In the 2nd group recurrence of ovarian endometriosis was found only in 1 (1.7 %) woman, pelvic adhesions were not detected (p<0.05). During the year after treatment the number of pregnant women among persons who wished to become pregnant and had a history of infertility was statistically higher in the 2nd group compared to the 1st group, in particular, 10 (16.7 %) and 2 (3.3 %) women, respectively (p<0.05).Conclusions. The proposed algorithm for the diagnosis and treatment of genital endometriosis minimizes the risk of its recurrence and improves reproductive function.
The objective: to conduct a comparative analysis of the efficacy and tolerability of antigestagens (mifepristone) and gonadotropin-releasing hormone agonists (aGnRH) as part of adjuvant therapy for the prevention of the recurrence of uterine fibroids after conservative myomectomy in women of reproductive age.Materials and methods. The study included 99 patients of reproductive age (19–42 years old) with uterine myoma. The women were divided into three groups (n=33 each), which were balanced by age and the number of myomatous nodes. From the 8th day after surgical treatment, the patients of the 1st group were prescribed the antigestagen mifepristone at a dose of 50 mg daily for 4 months, the 2nd group – aGnRH (triptorelin) 3.75 mg intramuscularly once every 28 days for 6 months. The third, control group included women who had contraindications to adjuvant therapy or refused to take hormonal drugs. The effect of treatment on the uterus size was studied by ultrasound examination on the 8th day and in 1 and 4 months after surgery, the control of the recurrence was performed every 3 months for 3 years after surgery. The fact of myoma recurrence was established when at least one myomatous node more than 1 cm in diameter appeared.Results. From the second month of the therapy, 78.8% of patients in the 2d group had estrogen-deficient symptoms. In patients in the 1st group, minor side effects were registered only in 15.1%, in the 3rd group – 3–6% (p<0.05). After the completion of the therapy, the menstrual cycle restored in 3.3±1.5 weeks in the 1st and 6.2±1 weeks in the 2nd group of patients. All women in the control group had regular menstruations every month. In 1 month after surgical treatment, compared with the 8th day after operation, the volume of the uterus decreased by 14±2% in women in all three groups, in 4 months a further decrease was observed only in the 1st and 2nd groups, in the control group the indicators remained at the same level as in the first month after surgery. There was no recurrence of myoma during the first year after conservative myomectomy in patients of the 1st and 2nd groups, the further the cumulative risk was almost the same and after 24 months it was 12.5±5.2% and 13.7±8%, respectively. The cumulative recurrence rate in the 3d group was 9.1±5.6% after 6 months, 33±8.1% after 12 months, and 41.6±9.2% – 24 months. The pregnancy occurred mostly in the interval from 1 to 1.5 years after the operation, the average interval between the operation and fertilization was 13.7±5 months.Conclusions. Adjuvant therapy with mifepristone or aGnRH after conservative myomectomy leads to an equal reduction in the risk of myoma recurrence – in 4.25 times. The cumulative incidence of fibroid recurrence in 3 years after surgery is the lowest in the group of women taking mifepristone, and is the highest one in patients without adjuvant therapy. With a similar efficacy to GnRH agonists, the antiprogestins have less side effects and good tolerance, faster recovery of the menstrual function, reverse of hormonal parameters and a decrease in uterine volume. Therefore, in order to restore reproductive function and prevent early recurrence of uterine fibroids, women after conservative myomectomy can be recommended to take the adjuvant therapy with antiprogestins or GnRH agonists, the choice of which should be differentiated and individual.
The aim: To determine the role of infectious diseases as the cause of the Cervical, Ovarian and Breast hyperplasia in Ukraine. Materials and methods: We conducted a retrospective multicenter cohort study from January 1st, 2020 to December 31st, 2022. This study included patients aged 20-59 years with a diagnosis of hyperproliferative pathology of the women reproductive organs without atypia, who sought medical care for hyperplastic processes admitted to the 12 hospitals from 9 regions of Ukraine. Results: We had examined 4,713 women; out of which 81.1% met the clinical definition of female reproductive organs hyperplasia. Of all hyperplasia cases, most frequently recorded types were breast hyperplasia (41,7%), followed by cervical hyperplasia (31,1%) and ovarian hyperplasia (27,2%). History of Cervicitis (p<0.001), Vaginal cuff infection (p<0.001), Oophoritis (p<0.001), and Mastitis (p<0.001) were identified as independent risk factors of Cervical, Ovarian and Breast hyperplasia. Conclusions: This study showed that surgical site infections after obstetric and gynecological operations are is the cause of Cervical, Ovarian and Breast hyperplasia. Therefore, early detection and treatment SSIs can reduce the risk of hyperplasia these organs.
The objective: a study of the risk factors and the frequency of recurrence of uterine fibroids (UF) after conservative myomectomy. Materials and methods. A clinical and statistical retrospective analysis of the long-term outcomes of surgical treatment of 40 patients in reproductive age (from 19 to 42 years) with UF was carried out based on the data of case histories, outpatient cards and data from a questionnaire/telephone survey. All women had a complicated gynecological and reproductive history. In the postoperative period, the patients received hormonal therapy with progestogens (in cyclic regime) and oral contraceptives for 6–12 months. For the diagnosis of UF recurrence, clinical examination, bimanual examination, transvaginal echography were performed every 3 months during the first 3 years, then every six months. The fact of UF recurrence was ascertained of the appearance at least of one myomatous node more than 1 cm in diameter. Results. The long-term results were studied in 36 out of 40 patients after conservative myomectomy. At the time of assessment, the average age of patients after surgery was 39.7±6.17 years, 4 (11 %) women of them were in active reproductive age, 11 (33.3 %) – late reproductive age, and 10 (27.7 %) – premenopausal period. The mean period of observations was 6.22±1.71 years. Recurrence of UF was diagnosed in 22 (55 %) patients, 3 (7.5 %) of them required repeated surgery (2 women after supravaginal amputation of the uterus, 1 – transcervical resection of the submucous node).The cumulative (accumulated) percentage of UF recurrence within 7 years after surgery was 67.4±8 % with the maximum increase of recurrence frequency in the 2nd and 3rd years after surgery (up to 31.7 6 % and 51.2±7 %, respectively). After conservative myomectomy, pregnancy occurred in 11 (27.5 %) women, including 2 out of 5 persons with infertility before surgery, and 4 out of 9 patients who had miscarriage in anamnesis. The maximum number of pregnancies (5) occurred in the interval from 1 to 1.5 years after surgery. Pregnancy ended in timely delivery in 7 patients, spontaneous abortion – 3 (7.5 %), induced abortion – 1 (2.5 %). All 7 pregnant women were delivered by caesarean section.Conclusions. A retrospective analysis of long-term outcomes of organ-preserving surgical treatment of patients of reproductive age with uterine fibroids determined a high frequency of myoma recurrence after conservative myomectomy, reaching 67.4±8 % in7 years after the operation. The greatest increase in recurrence was observed in the 2nd and 3rd years after surgery. The statistically significant risk factors for the development of recurrence of the disease were the number of myomatous nodes and the patient’s age (30–40 years). The use of hormonal therapy (norethisterone or oral contraceptives) after surgery did not lead to a decrease in the rate of recurrence of uterine fibroids. And although conservative myomectomy made it possible to increase the frequency of pregnancy in operated patients, the level of reproductive losses after surgery remained high (36.3 %).
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