Background: Hydronephrosis is frequently encountered in advanced stage cervical cancers, and may be associated with mortality. In the present study, we aimed to demonstrate the effect of hydronephrosis on survival in patients with inoperable advanced stage cervical cancer. Materials and Methods: The study data were acquired by retrospective analysis of the patient records belonging to 165 women with FIGO (International Federation of Gynecology and Obstetrics) stage-IIIB or more advanced cervical cancer, which were not surgical candidates. Parameters including patient age, pathological diagnosis, disease stage, pelvic sidewall extension, presence of hydronephrosis and administration of chemoradiation were analyzed. Further, the effects of these variables on survival were assessed. P values less than 0.05 were considered statistically significant. Results: The distribution of the study patients according to disease stage was as follows: 131 (79.4%) had stage-IIIB, 18 (10.9%) had stage-IVB and 16 (% 9.7) patients had stage-IVA disease. Hydronephrosis was not evident in 91 (55.2%) of these patients, whereas 41 (24.8%) had unilateral and 33 (20%) patients had bilateral hydronephrosis. When compared to mean survival in patients who did not have hydronephrosis, survival was significantly shortened in patients who had bilateral and unilateral hydronephrosis (p < 0.05). There was no significant survival difference between patients with unilateral and bilateral hydronephrosis (p>0.05). Although patient age, pathological type, pelvic involvement, and chemotherapy treatment rates were similar (p>0.05), radiotherapy requirement rate and disease stage were significantly different among the study groups (p<0.05). Conclusions: Hydronephrosis was found to be a significant predictor of poor survival in patients with advanced stage cervical cancer, irrespective of unilateral or bilateral involvement.While waiting for future studies with larger sample sizes, we believe that the FIGO stages in advanced cervical cancer could further be stratified into subgroups according to presence or absence of hydronephrosis.
The mini sling system can be considered an easy and effective method for treating stress urinary incontinence without major complication rates.
Abstract Introduction: Endometriosis is an estrogen-dependent, progressive inflammatory disease caused by the growth of endometrium-like tissue outside the uterine cavity. In women of reproductive age, it is a prevalent cause of pelvic pain. Surgical intervention may be required in the insufficiency of conservative treatments and laparoscopic procedures should be prioritized for surgery. The objective of our study was to compare the efficacy of laparoscopic fenestration-cauterization and cyst excision in patients with ovarian endometrioma on dysmenorrhea, non-menstrual pelvic pain, dyspareunia, and dyschezia symptoms. Materials and methods: The study comprised 112 patients with endometrioma who underwent laparoscopic surgery and whose data could be obtained. In 76.8% (n=86) of the patients, laparoscopic cystectomy was conducted, and in 23.2% (n=26) of the patients, laparoscopic fenestration+cauterization were performed. The patients' preoperative examination findings and VAS (Visual Analog Scale) pain levels were retrieved retrospectively. Patients were contacted again during the study, VAS pain scores were recalculated, and a gynecological ultrasound scan was performed to check for recurrence. The collected data were analyzed comparatively. Results: The mean age of the patients was 35.5 ± 6.8 years in the fenestration-cauterization group and 32.3 ± 5.9 years in the cystectomy group. 12.5% (n=14) of the cases were classified as stage I, 3.5% (n=4) as stage II, 32% (n=36) as stage III, and 52% (n=58) as stage IV. The operative time was significantly shorter in the fenestration+cauterization group compared to the cystectomy group (respectively/min 50.0±18.4 /61.3.±16.8, p=0.014). In both groups, the number of patients with dysmenorrhea, NMPP, dyspareunia, and dyschezia who had high VAS pain scores decreased significantly (p<0.005). In both procedures, there was no difference between recurrence rates (p=0.801). After surgical treatment, there was a significant decrease in the number of stage III-IV patients with dysmenorrhea and NMPP who had high VAS (p<0.005). Conclusion: We emphasize the significance of laparoscopy in the surgical treatment of endometriosis. Both laparoscopic fenestration + cauterization and laparoscopic cystectomy significantly reduced pain symptoms, especially in patients with advanced endometriosis. The efficacy and recurrence rates of both treatments were not significantly different. Keywords: Endometriosis, endometrioma, pelvic pain, laparoscopic surgery, recurrence
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