Introduction. One of the leading problems of modern reproductive surgery is treatment of adhesive disease, and in turn, prevention of intrauterine adhesions after intrauterine interventions is of particular interest. Purpose: to evaluate the effectiveness and safety of anti-adhesive gel “Antiadgesin” for intrauterine use in patients with a combination of pathology of the uterine cavity and severe forms of endometriosis. Materials and methods. The study included 24 patients aged 23 to 39 years with a combination of pathology of the uterine cavity and severe forms of genital endometriosis. The main group consisted of 12 patients to whom the anti-adhesive gel “Antiadhesin” was applied at the end of the laparoscopic and hysteroscopic stages on the region of the ovaries, pelvic peritoneum in the areas of separation of the adhesions, and also inside the uterine cavity. The comparison group included 12 patients who received 0.9% sodium chloride solution (5 ml) on the surgical area. Patients of both groups underwent treatment with gonadotropin-releasing hormone agonists (GnRH-a) 3.75 mg for 4 months after the operation. We performed gynecological ultrasound 4 weeks after operation, 4 weeks after the last injection of GnRH-a, and after the first menstrual bleeding. Assessment of the state of the uterine cavity, diagnosis of intrauterine synechia was performed by hydrosonography. Results. The duration of the operation, the amount of intraoperative blood loss did not differ significantly between the groups. In all patients, no complications of the postoperative period, no allergic or inflammatory reactions associated with the use of “Antiadhesin” were detected. The duration the uterine bleeding after the operation did not differ significantly between the groups. In 2 patients of the comparison group hydrosonography confirmed the adhesive pathology of the uterine cavity. In the main group there were not identified any signs of intrauterine adhesions by ultrasound. Within 12 months after the treatment, pregnancy occurred in 50% of the patients in the main group and in 33.3% of the patients in the comparison group. Conclusion. The results of the study showed that the introduction of the anti-adhesive gel “Antiadgesin” in the uterine cavity after hysteroresectoscopy is a safe and effective method for preventing the formation of intrauterine synechia.
Introduction. Anterior and apical prolapse is the most common type of pelvic organ prolapse. The insufficient effectiveness of native tissue repair in the pelvic organs leads to the search of new methods of the pelvic floor reconstruction. Objective. The current analysis was undertaken to evaluate the efficiency of the use of the Pelvix anterior mesh system (Lintex) with sacrospinous fixation of the apex in the treatment of anterior and apical prolapse. Methods. This study involved 150 women suffering from anterior-apical prolapse (stages III and IV). Reconstruction with the use of the mesh was performed in all the patients. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, and validated questionnaires (PFDI-20, PFIQ-7, PISQ-12) were used. All the listed parameters were determined before the surgery and on follow-up visits in 1, 6, 12, and 24 months after the treatment. Results. Mean operation time was 47 minutes. No cases of intraoperative clinically significant bleeding were reported. Anatomical cure rate (< stage II / asymptomatic stage II, according to the Baden-Walker system) at 12 months was found to be 94.4%, and at 24 months — 92.7%. Within the first month of follow-up, de novo stress urinary incontinence and de novo urgency occurred in 8.0% and 7.2% of patients, respectively. Statistically significant (p < 0.05) improvement in uroflowmetry parameters and decreased post-voiding urine volume were achieved after the surgery and did not change by 24 months. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period. Conclusion. The use of the Pelvix anterior mesh system in the surgical correction of the anterior and apical prolapse is a safe uterus-sparing technique. At two-year follow-up, it provides a high anatomical efficiency, normalizes urodynamic parameters and improves quality of life.
AIM: The aim of this study was to analyze reproductive function, pregnancy and labor in women after laparoscopic myomectomy and in women with unoperated myoma. MATERIALS AND METHODS: The main group consisted of 60 patients aged 25-46 years with a scar on the uterus who had laparoscopic myomectomy. Inclusion criteria were full-term pregnancy, uterine scar after laparoscopic myomectomy for subserosal or intramural uterine myoma (3-10 cm), and myomatous nodules (one to three). The comparison group included 30 women aged 25-46 years who were not surgically treated. Inclusion criteria were full-term pregnancy, subserosal or intramural uterine myoma (3-10 cm), and myomatous nodules (one to three). All patients in the main group underwent laparoscopic myomectomy. In all cases, the myomatous nodule was removed intracapsularly, leaving the leiomyoma pseudocapsule, which, with a deep arrangement of the transmural myomatous nodules, avoided opening the uterine cavity; myomatous nodule morcellation being used. With a deep intramural arrangement of the leiomyoma, the myometrial defect was sutured layer by layer with the application of several rows of endosutures. RESULTS: Six months after myomectomy, the patients underwent MRI of their pelvic organs with contrast. In 95% of cases, the uterine scar had no anatomical insolvency. In assessing the anamnesis, gynecological diseases occurred two times more often in women in the main group: 22 (36.7%) patients resorted to the use of the in vitro fertilization method for pregnancy, while among the patients in the comparison group, there were only two (6.7%) of them (2 = 12.8; р 0.001). In the main group, moderate preeclampsia and gestational diabetes mellitus were twice as common. In the main group, all patients were delivered by caesarean section, of which 83.3% were planned and 16.7% were emergency. In the comparison group, 73.3% of patients were delivered through the natural birth canal and 26.7% by caesarean section (2 = 149, p 0.0001). The most unfavorable signs predisposing to obstetric complications and operative delivery were the presence of multiple nodules (OR = 5.96 (1.09-32.72), p 0.05), the location of the nodule or scar in the uterine bottom (OR = 2.52 (1.00-6.33), p 0.05), and their combination with IVF (OR = 9.09 (2.42-34.07), р 0.01). CONCLUSIONS: In 95% of women, the scar on the uterus after myomectomy was consistent, but all these pregnant women were delivered by cesarean section, mainly for combined indications. However, they carried out the pregnancy safely, with a good outcome for the fetus. In women with uterine myoma and its conservative management, there was a lower rate of aggravated gynecological history and obstetric complications, and 73.3% of them were delivered through the natural birth canal. Despite the increased risk of caesarean section, the presence of uterine fibroids, even of a large size (more than 4 cm), should not be considered as a contraindication to vaginal delivery.
Hypothesis/aims of study. Ovarian endometriomas are a great danger to the female reproductive function. In addition to the negative impact of the disease itself on ovarian reserve, the reproductive capabilities of women are influenced by surgery on the ovaries and subsequent hormonal therapy. Ovarian reserve after cystectomy of the endometriomas suffers more than after removal of other benign ovarian tumors. The solution of the problem can be obtained using sclerotherapy during laparoscopy. The aim of this study was to assess the impact of sclerosing endometriomas during laparoscopy on the ovarian reserve. Study design, materials and methods. The study involved 36 patients aged 2535 years. Inclusion criteria were genital endometriosis, endometrioma of one of the ovaries with a volume of 15100 cm3, and pregnancy planning. Exclusion criteria were uterine fibroids, endometrial hyperplasia, polycystic ovary syndrome, and the previous operations on the ovaries and uterine tubes. The main group consisted of 18 patients who underwent sclerotherapy of an endometrioma during laparoscopy with a 70% ethanol solution. The comparison group comprised 18 patients who underwent cystovariectomy with bipolar coagulation of the tumor lining. Within 4 months after surgery, gonadotropin-releasing hormone agonists were administered. An ultrasound examination of the pelvic organs and determination of anti-Mllerian hormone (AMH) level were performed before surgery, after surgery, and after hormonal treatment. Results. In both study groups, AMH level decreased immediately after surgery: in the main group, it reduced by 1.4 times, in the comparison group by 2.4 times. After termination of therapy with gonadotropin-releasing hormone agonists and recovery of the menstrual cycle, AMH level increased slightly (it was 2.9 0.40 ng/ml in the main group, and 1.8 0.24 ng/ml in the comparison group). Within 12 months after surgery, pregnancy occurred in 44.4% of patients in the main group and in 33.3% of patients in the comparison group. Over 16 months of follow-up, not a single case of recurrence of the disease was subsequently detected. Conclusion. Sclerotherapy of endometriomas during laparoscopy is supposed to be an effective and promising technique aimed at preserving the ovarian reserve in this category of patients.
This article summarizes data on the prevalence, risk factors and the role of external genital endometriosis in the development of ectopic pregnancy. The existing algorithms for the use of conservative therapy of ectopic pregnancy of rare localizations are discussed. The authors presented a clinical case of using methotrexate in the treatment of a patient with infiltrative endometriosis and trophoblast persistence after laparoscopic removal of interstitial tubal pregnancy.
Hypothesis/aims of study. Nowadays a sacrospinous ligament fixation is one of the most studied and popular methods of colpo- and hysteropexy. Despite the high effectiveness against apical compartment defect, this technique has a number of specific side effects: chronic pain syndrome, dyspareunia, and а high rate of postoperative cystocele de novo. This study aimed to evaluate the efficacy and safety of unilateral sacrospinous ligament fixation with use of a modern synthetic monofilament mesh combined with the original technique of pubocervical fascia reconstruction using subfascial colporrhaphy. Study design, materials and methods. This study involved 174 women suffering from anterior/apical prolapse. All patients were operated with the proposed method. Postoperative assessment was performed at 1, 6 and 12 months after surgery and included vaginal examination with evaluation of pelvic organ prolapse by standardized POP-Q system, uroflowmetry, bladder ultrasound with post-void residual urine volume measurement, and filling in validated questionnaires (PFDI-20, PFIQ-7, PISQ-12). Results. Mean operation time was 26 ± 7.8 min. No cases of damage to the bladder or intraoperative clinically significant bleeding were noted. During a postoperative period, most of the patients showed a significant improvement in POP-Q points while maintaining the total vaginal length. Within 12 months of follow-up, the recurrence was observed in 1 (0.7%) patient in the apical compartment and in 10 (6.8%) patients in the anterior compartment. It should be mentioned that only in 3 cases of cystocele recurrence did the vaginal wall descend beyond the hymen. There were no cases of mesh erosion and pelvic pain syndrome through 12 months postoperatively. In the postoperative period, an improvement in urination was observed in all women. Most of the patients after the treatment showed a significant improvement in the quality of life. Only one patient complained of dyspareunia de novo. According to the questionnaires, satisfaction with the result of treatment was 96.5%. Conclusion. A unilateral sacrospinous fixation using a synthetic mesh combined with pubocervical fascia reconstruction (subfascial colporrhaphy) provides a high efficiency, while significantly reducing the rate of complications related to the traditional sacrospinous fixation.
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