Reconstructive surgery for congenital atresia of the uterine cervix: a systematic review

Fedele, Francesco; Parazzini, Fabio; Vercellini, Paolo; Bergamini, Valentino; Fedele, Luigi

doi:10.1007/s00404-022-06825-5

Cited by 2 publications

(5 citation statements)

References 89 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…52,53 However, cervical occlusion and revision surgery are reported using non-degradable grafts loaded with cells or growth factors that may pose complications associated with reconstruction and restoration of cervical abnormalities. 54,55 Herein, the material selection and associated design can heavily influence cervical stent performance and efficacy while considering biodegradable polymer grafts for this application. One crucial prerequisite is to permit infiltration of neighboring cells and tissue integration to facilitate substantial holding at the uterovaginal junction.…”

Section: Discussionmentioning

confidence: 99%

“…This may facilitate lowering the incidence of life-threatening ascending infections along with the option of controlled drug release as per the requirement. 55,61 For cervical tissue compatibility, primary squamous and columnar epithelial cells from the cervical mucosa as well as endometrial stromal cells were effectively cultured ex vivo on SF /PCL stent with significant cytocompatibility. So far, cervical squamous and columnar epithelial cells studies are mainly limited to squamous cell carcinomas, 3D model regeneration, reconstruction, and organoid models' studies.…”

Section: Discussionmentioning

confidence: 99%

“…To eliminate Foley catheters, clinicians employ surgical grafts for needy patients. Usually, reconstruction of the cervical region following canalization and anastomosis has been performed using commercially available Gore-tex, WallFlex, and Nitinol TM . , However, cervical occlusion and revision surgery are reported using non-degradable grafts loaded with cells or growth factors that may pose complications associated with reconstruction and restoration of cervical abnormalities. , …”

Section: Discussionmentioning

confidence: 99%

“…Overall, combining these above-mentioned crucial surface properties guide the graft by promoting cell infiltration and healing. , Over time, the body will absorb the stent, reducing the risk of complication, infection, and associated tissue damage. This may facilitate lowering the incidence of life-threatening ascending infections along with the option of controlled drug release as per the requirement. , …”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Biodegradable Multi-layered Silk Fibroin-PCL Stent for the Management of Cervical Atresia: In Vitro Cytocompatibility and Extracellular Matrix Remodeling In Vivo

Ojha,

Rajasekaran,

Hansda

et al. 2023

ACS Appl. Mater. Interfaces

View full text Add to dashboard Cite

Cervical atresia is a rare congenital Mullerian duct anomaly that manifests as the absence or deformed nonfunctional presence of the cervix. Herein, a multi-layered biodegradable stent is fabricated using a homogeneous blend of silk fibroin with polycaprolactone using hexafluoroisopropanol as a common solution. Briefly, a concentric cylinder of 3D honeycomb layer is sandwiched within electrospun sheets for fixing at the cervico-uterine junction to pave the way of cervical reconstruction. An average length of 40 mm with 3 mm diameter is fabricated for the hybrid stent design. SEM evidences an evenly distributed pore architecture of the electrospun layer, and mechanical characterization of stent reveals a tensile strength of 1.7 ± 0.2 MPa, with a Young's modulus of 5.9 ± 0.1 MPa. Physico-chemical characterization confirms the presence of silk fibroin and poly caprolactone within the engineered stent. Following 14 days of pepsin enzymatic degradation, 18% degradation and a contact angle measurement of 97°are observed. In vitro cytocompatibility studies are performed using site-specific primary human cervical squamous, columnar epithelial cells, and human endometrial stromal cells. The study demonstrates non-cytotoxic cells' viability (no significant toxicity), improved cell anchoring, adherence among the stent layers, and proliferation in the 3D microenvironment. Furthermore, in vivo subcutaneous studies in the rodent model indicate that the implanted stent undergoes constructive remodeling, neo-tissue creation, neo-vasculature formation, and re-epithelialization while maintaining patency for 2 months.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Biodegradable Multi-layered Silk Fibroin-PCL Stent for the Management of Cervical Atresia: In Vitro Cytocompatibility and Extracellular Matrix Remodeling In Vivo

Ojha,

Rajasekaran,

Hansda

et al. 2023

ACS Appl. Mater. Interfaces

View full text Add to dashboard Cite

show abstract

“…Hysterectomy has traditionally been a widely accepted and effective treatment option for CCM [ 8 ]. Although advances in surgical techniques and reconstructive expertise led to other viable conservative options, such as canalisation [ 9 , 10 ], such methods may cause serious complications [ 11 , 12 ]. Currently, treatment selection is primarily based on the type of cervical malformation and presence of the vagina.…”

Section: Introductionmentioning

confidence: 99%

A new magnetic resonance imaging-based PUMCH classification system for congenital cervical malformations: devising a standardised diagnosis pathway

Yuan,

Ren,

Huang

et al. 2024

Insights Imaging

View full text Add to dashboard Cite

Objectives To develop an innovative magnetic resonance imaging (MRI)-based PUMCH (Peking Union Medical College Hospital) classification system aimed at standardising the diagnosis of congenital cervical malformations (CCMs) by identifying their distinctive MRI features. Methods Seventy-nine consecutive patients with CCM underwent pre-treatment pelvic MRI; three experienced gynaecological radiologists retrospectively analysed these images. Qualitative assessments included Rock et al’s classification; PUMCH classification; haematometra; cervical signal features; ovarian endometriosis; haematosalpinx; and uterine, vaginal, urinary, and musculoskeletal malformations. Quantitative assessments involved the uterine volume, sagittal cervical length, and maximum ovarian cross-sectional area. The surgical treatment types were also recorded. Statistical methods were used to incorporate differences in clinical features and surgical methods into our classification. Results Morphologically, CCMs were categorised into three types: type I (53%) was characterised by the presence of a cervix with visible cervical canals; type II (23%) featured an existing cervix with concealed cervical canals; and type III (24%) indicated cervical aplasia, which involves a blind end in the lower part of the uterine corpus. Haematometra was significantly more prevalent in patients with type I CCM than in those with type II (p < 0.001). There were three cervical signal patterns: no signal (27%), no evident layer differentiation (21%), and multi-layer differentiation with haematocele (52%). Most patients (94%) had complete vaginal atresia. Type I CCM patients had a higher likelihood of regaining normal uterovaginal anatomy compared to types II and III. Conclusions Our proposed PUMCH classification system has a high potential for enhancing the efficiency of clinical diagnosis among patients with CCM. Critical relevance statement The proposed new PUMCH classification promised to elevate the conventional diagnostic trajectory for congenital cervical malformations, offering a valuable framework to refine the selection and planning of surgical interventions, thereby enhancing overall clinical efficacy. Key Points Effective classification of congenital cervical malformations is desirable to optimise the diagnostic process. We presented a PUMCH classification of congenital cervical malformations using pelvic MRI. The new classification significantly aids clinical triage for congenital cervical malformations. Graphical Abstract

show abstract

Reconstructive surgery for congenital atresia of the uterine cervix: a systematic review

Cited by 2 publications

References 89 publications

Biodegradable Multi-layered Silk Fibroin-PCL Stent for the Management of Cervical Atresia: In Vitro Cytocompatibility and Extracellular Matrix Remodeling In Vivo

Biodegradable Multi-layered Silk Fibroin-PCL Stent for the Management of Cervical Atresia: In Vitro Cytocompatibility and Extracellular Matrix Remodeling In Vivo

A new magnetic resonance imaging-based PUMCH classification system for congenital cervical malformations: devising a standardised diagnosis pathway

Contact Info

Product

Resources

About