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Van Steijvoort E, Peeters H, Vandecruys H, Verguts J, Peeraer K, Matthijs G, Borry P. Experiences of nonpregnant couples after receiving reproductive genetic carrier screening results in Belgium. Eur J Hum Genet 2023; 31:696-702. [PMID: 36788144 PMCID: PMC9928592 DOI: 10.1038/s41431-023-01310-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
Reproductive genetic carrier screening (RGCS) allows for the identification of couples who have an increased likelihood of conceiving a child with a particular autosomal recessive or X-linked condition. The aim of this study was to assess the level of satisfaction, anxiety, knowledge retention, psychosocial and counseling-related aspects among couples who chose to have RGCS. Participants were initially informed about their screening results by telephone. After obtaining a written report of test results, participants were asked to complete an individual self-administered questionnaire. All participants (n = 67) felt they had enough information to make an informed choice. None of the participants regretted their choice to have RGCS. Test results were most often shared with parents (61%) or siblings (37%). Our findings demonstrate that the information/counseling and reporting strategy that was used in the context of this study led to high participant satisfaction, an increase in knowledge over time and favorable psychosocial and counseling-related outcomes.
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Affiliation(s)
- Eva Van Steijvoort
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Hilde Peeters
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Hilde Vandecruys
- Department of Gynecology and Obstetrics, Jessa Ziekenhuis Hasselt, Hasselt, Belgium
| | - Jasper Verguts
- Department of Gynecology and Obstetrics, Jessa Ziekenhuis Hasselt, Hasselt, Belgium
| | - Karen Peeraer
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Gert Matthijs
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Sänger N, Menabrito M, Di Spiezo Sardo A, Estadella J, Verguts J. Fertility preservation counselling for women with endometriosis: a European online survey. Arch Gynecol Obstet 2023; 307:73-85. [PMID: 35829767 DOI: 10.1007/s00404-022-06616-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital is a strategy to preserve fecundity. METHODS An online survey was sent to reproductive specialists and gynecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients. RESULTS Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis. CONCLUSIONS To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis.
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Affiliation(s)
- Nicole Sänger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marco Menabrito
- Gedeon Richter Plc/PregLem S.A., 41A Route de Frontenex, 1207, Geneva, Switzerland
| | - Attilio Di Spiezo Sardo
- Department of Public Health, University Federico II of Naples, Corso Umberto I, 80131, Naples, Italy
| | - Josep Estadella
- Department of Obstetrics and Gynecology, Hospital de La Santa Creu I Sant Pau-Universitat Autònoma de Barcelona, Carrer de Sant Quintí 89, 08025, Barcelona, Spain
| | - Jasper Verguts
- Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium. .,University Hasselt, Martelarenlaan 42, 3500, Hasselt, Belgium.
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3
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Van Steijvoort E, Peeters H, Vandecruys H, Verguts J, Peeraer K, Matthijs G, Borry P. Exploring informed choice in preconception reproductive genetic carrier screening by using a modified Multidimensional Measure of Informed Choice. Patient Educ Couns 2022; 105:3313-3318. [PMID: 35906131 DOI: 10.1016/j.pec.2022.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/08/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To explore informed choice in reproductive genetic carrier screening (RGCS). METHODS Women visiting a gynaecologist practice in Flanders (Belgium) were asked to consider participation in a study where RGCS was offered for free to them and their male partner. A modified Multidimensional Measure of Informed Choice was used to determine whether couples who opted for RGCS made an informed choice. In addition, we assessed risk perception, feelings towards RGCS, anxiety and decisional conflict. RESULTS Most participants (82 %, n = 63/77) made an informed choice with regard to RGCS according to our modified MMIC. Thirteen participants made an uninformed choice due to insufficient knowledge and one participant because of insufficient knowledge and value-inconsistency. Anxiety scores were elevated for three participants. Two participants presented with decisional conflict. CONCLUSION Our results show high rates of informed choice among non-pregnant couples who were offered RGCS in a research study and received up to 30 min of pre-test counseling. PRACTICE IMPLICATIONS Limited resources outside a research context may impact informed choice. Pre-test counselling initiatives for RGCS should ideally be organized in such a way that information can be provided at multiple time points to avoid information overload and to allow for a reflection period.
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Affiliation(s)
- Eva Van Steijvoort
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Hilde Peeters
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Hilde Vandecruys
- Department of Gynaecology and Obstetrics, Jessa Ziekenhuis, Hasselt, Belgium
| | - Jasper Verguts
- Department of Gynaecology and Obstetrics, Jessa Ziekenhuis, Hasselt, Belgium
| | - Karen Peeraer
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Gert Matthijs
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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4
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Van Steijvoort E, Demuynck R, Peeters H, Vandecruys H, Verguts J, Peeraer K, Matthijs G, Borry P. Reasons affecting the uptake of reproductive genetic carrier screening among nonpregnant reproductive-aged women in Flanders (Belgium). J Genet Couns 2022; 31:1043-1053. [PMID: 35385167 DOI: 10.1002/jgc4.1575] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/26/2022] [Accepted: 03/05/2022] [Indexed: 11/07/2022]
Abstract
Reproductive genetic carrier screening (RGCS) allows to identify couples who have an increased likelihood of conceiving a child affected with an autosomal recessive or X-linked monogenic condition. Multiple studies have reported on a wide and fragmented set of reasons to accept or decline RGCS. Only a few studies have been performed to assess the uptake of RGCS. Nonpregnant women visiting their gynecologist were invited to complete a questionnaire assessing perceived susceptibility, the acceptability of offering RGCS, attitudes, the intention to participate in RGCS, reasons to accept or decline RGCS, and sociodemographic characteristics. Women who showed the intention to have RGCS were asked to consider a free RGCS offer. Most women (n = 127) were between 25 and 34 years old (60%), in a relationship (91%), and wanted to have children (65%). Study participants had positive attitudes towards RGCS and the intention to consider RGCS in the future. Reasons to accept RGCS were being able to share genetic information with children or relatives (n = 104/127, 82%), to prevent the birth of a child affected with a hereditary condition (n = 103/127, 81%), and/or to know the chance of conceiving a child with a hereditary condition (n = 102/127, 80%). Reasons for declining RGCS were the possible concerns that could arise when receiving test results (n = 27/127, 21%), having no family history of hereditary disorders (n = 19/127, 15%), and not wanting to take action based on test results (n = 13/127, 10%). Among test intenders that met the inclusion criteria, 53% decided to participate in RGCS together with their male reproductive partner. More in-depth research on the decision-making process behind the choice to accept or decline an RGCS offer would be highly valuable to make sure couples are making informed reproductive choices.
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Affiliation(s)
- Eva Van Steijvoort
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Remke Demuynck
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Hilde Peeters
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Hilde Vandecruys
- Department of Gynecology and Obstetrics, Jessa Ziekenhuis Hasselt, Hasselt, Belgium
| | - Jasper Verguts
- Department of Gynecology and Obstetrics, Jessa Ziekenhuis Hasselt, Hasselt, Belgium
| | - Karen Peeraer
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Gert Matthijs
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Schallmoser A, Verguts J, Allam JP, Sänger N. P–001 Effect of mild α -chymotrypsin treatment of highly viscous semen samples on fertilization rates. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
The main objective of this study was to examine the influence of mild α -chymotrypsin treatment of highly viscous semen samples on the fertilisation rate after artificial reproductive treatment (ART).
Summary answer
The use of mild α -chymotrypsin treatment of semen samples in case of hyperviscosity does not appear to impact negatively on the fertilization rates after ART.
What is known already
Highly viscous semen reduces sperm motility significantly and can contribute to infertility. When processing semen samples, few techniques exist to induce liquefaction in case of seminal hyperviscosity such as different washing steps and mechanical treatment. The use of α -chymotrypsin seems controversial due to possible negative effects on fertilisation rates after IVF.
Study design, size, duration
All patients were recruited at the Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Germany from July first 2018 till June first 2019. Anonymized data on age, number of previous pregnancies and deliveries were retrospectively collected. The study group consisted of a cohort of 52 couples meeting the inclusion criteria of highly viscous semen and were compared to a cohort control group of 88 couples.
Participants/materials, setting, methods: The fertilization rate of 52 ART cycles was examined following IVF using a low dose of α -chymotrypsin to induce liquefaction of highly viscous semen and was compared to a control group of 88 ART cycles. Data was analyzed using SPSS version 25. A Mann Whitney U test was used to compare continuous parameters between groups.
Main results and the role of chance
The study group consisted of a cohort of 52 couples meeting the inclusion criteria of highly viscous semen and were compared to a cohort control group of 88 couples. The Fertilization rate between the two groups was not significant (p < 0.146, Mann-Whitney U test), with a rate of 57.95 in the study group compared to 57.53 in the control group. Our analysis showed no significant differences in male and female age, male abstinence period, semen volume, sperm concentration, total sperm count, and total progressive sperm count between the two groups. We observed a significant difference [p = 0.025] in the progressive motility and a borderline significance in the total progressive sperm count [p = 0.052] between α -chymotrypsin treated samples and the non α -chymotrypsin treated samples. Analyzing the clinical and biochemical pregnancy parameters of the study group (n = 41) and the control group (n = 66) per fresh embryo transfer procedures (n = 107) we found no significant differences. Freeze all cycles were excluded from the study. No significant differences concerning previous pregnancies and childbirth were detected.
Limitations, reasons for caution
The study is a pilot study as the majority of the studies using α -chymotrypsin was conducted up to three decades ago, comparison of data must be interpreted in the light of the fact that since then, IVF has seen a rapid evolution of technology and culture techniques.
Wider implications of the findings
The use of mild α -chymotrypsin treatment of semen samples in case of hyperviscosity does not appear to impact negatively on the fertilization rates after ART and could be regarded as an additional method to induce liquefaction of highly viscous semen samples in IVF...
Trial registration number
not applicable
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Affiliation(s)
- A Schallmoser
- University WHospital Bonn- Germany, Reproductive Medicine, Bonn, Germany
| | - J Verguts
- Jessa Hospital- Hasselt- Belgium, Department of Gynecology, Hasselt, Belgium
| | - J P Allam
- University WHospital Bonn- Germany, Reproductive Medicine, Bonn, Germany
| | - N Sänger
- University WHospital Bonn- Germany, Reproductive Medicine, Bonn, Germany
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van Wessel S, Hamerlynck T, Schutyser V, Tomassetti C, Wyns C, Nisolle M, Verguts J, Colman R, Weyers S, Bosteels J. Anti-adhesion Gel versus No gel following Operative Hysteroscopy prior to Subsequent fertility Treatment or timed InterCourse (AGNOHSTIC), a randomised controlled trial: protocol. Hum Reprod Open 2021; 2021:hoab001. [PMID: 33623830 PMCID: PMC7886624 DOI: 10.1093/hropen/hoab001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/09/2021] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTIONS Does the application of anti-adhesion gel, compared to no gel, following operative hysteroscopy to treat intrauterine pathology in women wishing to conceive increase the chance of conception leading to live birth? WHAT IS KNOWN ALREADY Intrauterine adhesions (IUAs) following operative hysteroscopy may impair reproductive success in women of reproductive age. Anti-adhesion barrier gels may decrease the occurrence of IUAs, but the evidence on their effectiveness to improve reproductive outcomes is sparse and of low quality. STUDY DESIGN SIZE DURATION This multicentre, parallel group, superiority, blinded and pragmatic randomised controlled trial is being carried out in seven participating centres in Belgium. Recruitment started in April 2019. Women will be randomly allocated to treatment with anti-adhesion gel (intervention group) or no gel (control group). Sterile ultrasound gel will be applied into the vagina as a mock-procedure in both treatment arms. The patient, fertility physician and gynaecologist performing the second-look hysteroscopy are unaware of the allocated treatment. Power analysis, based on a target improvement of 15% in conception leading to live birth using anti-adhesion gel, a power of 85%, a significance level of 5%, and a drop-out rate of 10%, yielded a number of 444 patients to be randomised. The baseline rate of conception leading to live birth in the control group is expected to be 45%. PARTICIPANTS/MATERIALS SETTING METHODS Women of reproductive age (18-47 years), wishing to conceive (spontaneously or by fertility treatment) and scheduled for operative hysteroscopy to treat intrauterine pathology (endometrial polyps, myomas with uterine cavity deformation, uterine septa, IUAs or retained products of conception) are eligible for recruitment. Women may try to conceive from 3 to 6 weeks after receiving allocated treatment with follow-up ending at 30 weeks after treatment. If the woman fails to conceive within this timeframe, a second-look hysteroscopy will be scheduled within 2-6 weeks to check for IUAs. The primary endpoint is conception leading to live birth, measured at 30 weeks after randomisation. The secondary endpoints are time to conception, clinical pregnancy, miscarriage and ectopic pregnancy rates, measured at 30 weeks after receiving allocated treatment. The long-term follow-up starts when the patient is pregnant and she will be contacted every trimester. STUDY FUNDING/COMPETING INTERESTS This work is funded by the Belgian Healthcare Knowledge Centre (KCE). The anti-adhesion gel is supplied at no cost by Nordic Pharma and without conditions. Dr. Tomassetti reports grants and non-financial support from Merck SA, non-financial support from Ferring SA, personal fees and non-financial support from Gedeon-Richter, outside the submitted work. None of the other authors have a conflict of interest.
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Affiliation(s)
- S van Wessel
- Women’s Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - T Hamerlynck
- Women’s Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - V Schutyser
- Centre for Reproductive Medicine, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - C Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - C Wyns
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - M Nisolle
- Département de Gynécologie-Obstétrique, CHU Site, CHR Citadelle, Boulevard du Douzième de Ligne 1, 4000 Liège, Belgium
| | - J Verguts
- Department of Obstetrics and Gynaecology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - R Colman
- Biostatitics Unit, Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000 Gent, Belgium
| | - S Weyers
- Women’s Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - J Bosteels
- Women’s Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Department of Gynaecology, Imelda Hospital, Imeldalaan 9, 2820 Bonheiden, Belgium
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Schallmoser A, Bakjaji F, Königsberger S, John J, Färber C, Schmidt E, Breitenbach-Koller H, Allam JP, Verguts J, Sänger N. Effect of mild α-chymotrypsin treatment of highly viscous semen samples on fertilization rates. Transl Androl Urol 2021; 10:448-454. [PMID: 33532332 PMCID: PMC7844487 DOI: 10.21037/tau-20-1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Highly viscous semen reduces sperm motility significantly and can contribute to infertility. When processing semen samples, few techniques exist to induce liquefaction in case of seminal hyperviscosity such as different washing steps and mechanical treatment. The use of α-chymotrypsin seems controversial due to possible negative effects on fertilisation rates after in vitro fertilization (IVF). The main objective of this study was to examine the influence of mild α-chymotrypsin treatment of semen samples on the fertilisation rate after artificial reproductive treatment (ART). Methods The fertilization rate of 52 ART cycles was examined following IVF using a low dose of α-chymotrypsin to induce liquefaction of highly viscous semen and was compared to a control group of 88 ART cycles. Results There was no significant difference in the fertilization rates of α-chymotrypsin treated semen samples compared to the control group; pregnancy rates were unaffected. Conclusions The use of mild α-chymotrypsin treatment of semen samples in case of hyperviscosity does not appear to impact negatively on the fertilization rates after ART and could be regarded as an additional method to induce liquefaction of highly viscous semen samples in IVF.
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Affiliation(s)
- Andreas Schallmoser
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Bonn, Germany
| | - Fadi Bakjaji
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Bonn, Germany
| | | | - Julia John
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Bonn, Germany
| | - Cara Färber
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Bonn, Germany
| | | | | | | | - Jasper Verguts
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - Nicole Sänger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital of Bonn, Bonn, Germany
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Verguts J, Godin PA, De Vree B, Donnez O, Cosyns S, Luyckx M, Nisolle M. Effect on surgical decisions: Ulipristal acetate as key player in Belgian phase
IV
registration trial. Int J Gynaecol Obstet 2019; 147:339-343. [DOI: 10.1002/ijgo.12968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/19/2019] [Accepted: 09/06/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Jasper Verguts
- Department of Obstetrics and GynecologyJessa Hospital Hasselt Belgium
| | | | - Bart De Vree
- Department of Obstetrics and GynecologyZNA Middelheim Antwerp Belgium
| | - Olivier Donnez
- Department of Obstetrics and GynecologyICA Polyclinique Urbain V Avignon France
| | - Stefan Cosyns
- Department of Obstetrics and GynecologyUZ Brussel Brussels Belgium
| | - Mathieu Luyckx
- Department of Obstetrics and GynecologyUCL Bruxelles Brussels Belgium
| | - Michelle Nisolle
- Department of Obstetrics and GynecologyCHR de la Citadelle Liege Belgium
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Verguts J, Sänger N, Koninckx P. Authors' reply re: Towards painless and adhesion-free laparoscopy. BJOG 2019; 126:1402-1403. [PMID: 31392838 DOI: 10.1111/1471-0528.15865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jasper Verguts
- Department of Obstetrics and Gynaecology, Jessa Hospital, Hasselt, Belgium
| | - Nicole Sänger
- Obstetrics and Gynaecology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Philippe Koninckx
- Department of Obstetrics and Gynaecology, Emeritus KU Leuven, Leuven, Belgium
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10
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Affiliation(s)
- J Verguts
- Department of Obstetrics and Gynaecology, Jessa Hospital, Hasselt, Belgium
| | - N Sänger
- Department of Obstetrics and Gynaecology, University Hospital Bonn, Bonn, Germany
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Tjalma W, Bosteels J, Cooremans I, Cosyns S, De Greve M, De Vree BP, Debruyne D, De Jonge ET, Desmedt E, Dubois P, Faes T, Francx M, Hamerlynck T, Makar AP, Maryns AS, Michiels I, Orye G, Platteeuw L, Pouseele B, Schutyser V, Segaert A, Stevens M, Tomassetti C, Trinh XB, Tummers P, van Calenbergh S, van Dam PA, Van Herendael B, Vanspauwen R, Vergote IB, Verguts J, Watty K, Weyers S. The rationale of opportunistic bilateral salpingectomies (OBS) during benign gynaecological and obstetric surgery: a consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG). Facts Views Vis Obgyn 2019; 11:177-187. [PMID: 31824638 PMCID: PMC6897518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ovarian cancer (OC), is a disease difficult to diagnose in an early stage implicating a poor prognosis. The 5-year overall survival in Belgium has not changed in the last 18 years and remains 44 %. There is no effective screening method (secondary prevention) to detect ovarian cancer at an early stage. Primary prevention of ovarian cancer came in the picture through the paradigm shift that the fallopian tube is often the origin of ovarian cancer and not the ovary itself. Opportunistic bilateral salpingectomy (OBS) during benign gynaecological and obstetric surgery might have the potential to reduce the risk of ovarian cancer by as much as 65 %. Bilateral risk-reducing salpingectomy during a benign procedure is feasible, safe, appears to have no impact on the ovarian function and seems to be cost effective. The key question is whether we should wait for a RCT or implement OBS directly in our daily practice. Guidelines regarding OBS within our societies are therefore urgently needed. Our recommendation is to inform all women without a child wish, undergoing a benign gynaecological or obstetrical surgical procedure about the pro's and the con's of OBS and advise a bilateral salpingectomy. Furthermore, there is an urgent need for a prospective registry of OBS. The present article is the consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG) regarding OBS.
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Affiliation(s)
- Waa Tjalma
- Antwerp University Hospital - University of Antwerp, Antwerpen
| | | | | | - S Cosyns
- Vrije Universiteit Brussel - Universitair Ziekenhuis Brussel, Brussel
| | | | - B P De Vree
- Antwerp University Hospital - University of Antwerp, Antwerpen
- ZNA Middelheim, Antwerpen
| | | | | | | | | | - T Faes
- AZ Sint Blasius Dendermonde, Dendermonde
| | | | | | - A P Makar
- ZNA Middelheim, Antwerpen
- Universitair Ziekenhuis Gent, Gent
| | | | | | - G Orye
- Jessa Ziekenhuis, Hasselt
| | | | | | - V Schutyser
- Vrije Universiteit Brussel - Universitair Ziekenhuis Brussel, Brussel
| | | | - M Stevens
- AZ Rivierenland campus Bornem, Bornem
| | | | - X B Trinh
- Antwerp University Hospital - University of Antwerp, Antwerpen
| | | | | | - P A van Dam
- Antwerp University Hospital - University of Antwerp, Antwerpen
| | | | | | | | - J Verguts
- OLV van Lourdes Ziekenenhuis, Waregem
| | - K Watty
- AZ Delta campus Roeselare, Roeselare, Belgium
| | - S Weyers
- Universitair Ziekenhuis Gent, Gent
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Rusch P, Ind T, Kimmig R, Maggioni A, Ponce J, Zanagnolo V, Coronado PJ, Verguts J, Lambaudie E, Falconer H, Collins JW, Verheijen RHM. Recommendations for a standardised educational program in robot assisted gynaecological surgery: Consensus from the Society of European Robotic Gynaecological Surgery (SERGS). Facts Views Vis Obgyn 2019; 11:29-41. [PMID: 31695855 PMCID: PMC6822956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The Society of European Robotic Gynaecological Surgery (SERGS) aims at developing a European consensus on core components of a curriculum for training and assessment in robot assisted gynaecological surgery. METHODS A Delphi process was initiated among a panel of 12 experts in robot assisted surgery invited through the SERGS. An online questionnaire survey was based on a literature search for standards in education in gynaecological robot assisted surgery. The survey was performed in three consecutive rounds to reach optimal consensus. The results of this survey were discussed by the panel and led to consensus recommendations on 39 issues, adhering to general principles of medical education. RESULTS On review there appeared to be no accredited training programs in Europe, and few in the USA. Recommendations for requirements of training centres, educational tools and assessment of proficiency varied widely. Stepwise and structured training together with validated assessment based on competencies rather than on volume emerged as prerequisites for adequate and safe learning. An appropriate educational environment and tools for training were defined. Although certification should be competence based, the panel recommended additional volume based criteria for both accreditation of training centres and certification of individual surgeons. CONCLUSIONS Consensus was reached on minimum criteria for training in robot assisted gynaecological surgery. To transfer results into clinical practice, experts recommended a curriculum and guidelines that have now been endorsed by SERGS to be used to establish training programmes for robot assisted surgery.
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Affiliation(s)
- P Rusch
- Department of Obstetrics and Gynaecology, University Hospital Duisburg-Essen; Hufelandstr. 55, 45147 Essen, Germany. .
| | - T Ind
- Department of Gynaecological Oncology, The Royal Marsden, London, UK;,St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London,
| | - R Kimmig
- Department of Obstetrics and Gynaecology, University Hospital Duisburg-Essen; Hufelandstr. 55, 45147 Essen, Germany. .
| | - A Maggioni
- Division of Gynaecology, European Institute of Oncology, Via Ripamonti, 435,
20141 Milano, Italy. .
| | - J Ponce
- Department of Gynaecological Oncology, Hospital Universitari de Bellvitge, c/ Feixa Llarga, sn, 08907 L’ Hospitalet de Llobregat. Barcelona, Spain.
| | - V Zanagnolo
- Division of Gynaecology, European Institute of Oncology, Via Ripamonti, 435,
20141 Milano, Italy. .
| | - PJ Coronado
- Department of Gynaecological Oncology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Avda. de Séneca, 2, Ciudad Universitaria, 28040 Madrid, Spain.
| | - J Verguts
- Division of Gynaecology, European Institute of Oncology, Via Ripamonti, 435,
20141 Milano, Italy. . ;,Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium;,Department of
Obstetrics and Gynaecology, Jessa Hospital, 3500 Hasselt, Belgium,
| | - E Lambaudie
- Department of Gynaecologic Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France;,Aix Marseille Université, Site Timone, Timone 27, boulevard Jean Moulin, 13385 Marseille cedex 5, France.
| | - H Falconer
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/University Hospital, 171 76 Stockholm, Sweden.
| | - JW Collins
- Department of Urology, Karolinska University Hospital, Karolinska Universitetssjukhuset, Solna, D1:01 171 76 Stockholm, Sweden.
| | - RHM Verheijen
- Department of Gynaecological Oncology, UMCU Cancer Center,
University Medical Center, Utrecht, Netherlands.
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Van Dijck C, Rex S, Verguts J, Timmerman D, Van de Velde M, Teunkens A. Venous Air Embolism during Hysteroscopic Myomectomy: An Analysis of 7 Cases. Gynecol Obstet Invest 2017; 82:569-574. [DOI: 10.1159/000455044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/07/2016] [Indexed: 11/19/2022]
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14
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Donders G, Bellen G, Janssens D, Van Bulck B, Hinoul P, Verguts J. Influence of contraceptive choice on vaginal bacterial and fungal microflora. Eur J Clin Microbiol Infect Dis 2016; 36:43-48. [PMID: 27638008 DOI: 10.1007/s10096-016-2768-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
Abstract
The influence of contraception on vaginal microflora can have a major impact on the risk of developing acute or recurrent vaginal infections, but also may influence the risk of acquiring sexually transmissible infections (STI) such as HIV. A cohort of 248 women presenting for levonorgestrel-releasing intrauterine system (LNG-IUS) insertion or reinsertion were stratified according to their current contraceptive method. Information concerning their menstrual pattern and data about the medical history were collected. The composition of their vaginal microflora was studied by detailed phase contrast microscopy of fresh vaginal fluid, and aerobic cultures were taken to detect enteric bacterial growth and fungal colonisation. LNG-IUS and progesterone-only-pill (POP) users had significantly lower blood loss (p < 0.001) than other women. Regardless of the type of contraception used, all women reported similar rates of symptomatic lower genital tract infection during the preceding year. Women using combined oral contraception (COC) and long-term LNG-IUS had the same bacterial composition of vaginal microflora as non-contraceptive users, even when infections were combined. Both hormonal and non-hormonal intrauterine device users had an increased tendency to have more vaginal colonisation with Candida. Women on POPs or subcutaneous implants had a tendency towards increased vaginal atrophy, but had a lower Candida carriage rate compared to IUCD users (LNG-IUS and Copper-IUCD, p = 0.037). Women with an increased risk of acquiring STIs or recurrent BV could benefit from LNG-IUS or COC due to a well-preserved vaginal bacterial flora. Women with a susceptibility for RVVC should prefer POPs, and avoid intrauterine contraception.
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Affiliation(s)
- G Donders
- Femicare vzw, Clinical Research for Women, Gasthuismolenstraat 31, B-3300, Tienen, Belgium. .,Departments of Obstetrics and Gynaecology, General Regional Hospital Heilig Hart Tienen, Tienen, Belgium. .,General Regional Hospital Heilig Hart Tienen, Tienen, Belgium. .,University Hospital Antwerpen, Antwerp, Belgium.
| | - G Bellen
- Femicare vzw, Clinical Research for Women, Gasthuismolenstraat 31, B-3300, Tienen, Belgium
| | - D Janssens
- Private gynaecological practice, Turnhout, Belgium
| | | | - P Hinoul
- Algemeen Ziekenhuis St Jan, Genk, Belgium
| | - J Verguts
- University Hospital Gasthuisberg, Leuven, Belgium.,Algemeen Ziekenhuis Virga Jesse, Hasselt, Belgium
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15
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Verguts J, Corona R, Timmerman D, Craessaerts M, Koninckx PR. Clearance Rates of Ringer's Lactate and Adept and the Effect of Full Conditioning: A Randomized Controlled Trial. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jasper Verguts
- Department of Obstetrics and Gynecology, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Jessa Hospital, Hasselt, Belgium
| | - Roberta Corona
- Department of Obstetrics and Gynecology, Katholieke Universiteit Leuven, Leuven, Belgium
- Centre for Reproductive Medicine, Free University Brussels, Belgium
| | - Dirk Timmerman
- Department of Obstetrics and Gynecology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marleen Craessaerts
- Department of Obstetrics and Gynecology, Katholieke Universiteit Leuven, Leuven, Belgium
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Gaspard U, Verguts J, Simon P, Depypere H, Merckx M, Loquet P, Walravens F, Firquet A, Poppe W, Leunen M, Donders G, Squifflet J, Grandjean P. [The use of intrauterine device in nulliparous over 18 years: a Belgian consensus]. J Pharm Belg 2014:28-35. [PMID: 25562925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Under the presidency of prof. H. Depypere (UZ Ghent) and Prof. P. Simon (ULB Erasme) a Belgian panel of thirteen experts (gynecologists, representatives of universities and scientific associations for gynecology-obstetrics) reached a consensus on the use of intrauterine systems, both copper IUDs as hormone IUDs, in nultiparous women.
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17
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Grammen C, Baes M, Haenen S, Verguts J, Augustyns K, Zydowsky T, La Colla P, Augustijns P, Brouwers J. Vaginal Expression of Efflux Transporters and the Potential Impact on the Disposition of Microbicides in Vitro and in Rabbits. Mol Pharm 2014; 11:4405-14. [DOI: 10.1021/mp5005004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Carolien Grammen
- Department
of Pharmaceutical and Pharmacological Sciences, Drug Delivery and
Disposition, KU Leuven—University of Leuven, Leuven, Belgium
| | - Myriam Baes
- Department
of Pharmaceutical and Pharmacological Sciences, Laboratory for Cell
Metabolism, KU Leuven—University of Leuven, Leuven, Belgium
| | - Steven Haenen
- Department
of Pharmaceutical and Pharmacological Sciences, Drug Delivery and
Disposition, KU Leuven—University of Leuven, Leuven, Belgium
| | - Jasper Verguts
- Department
of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Augustyns
- Laboratory
of Medicinal Chemistry, University of Antwerp, Antwerp, Belgium
| | - Thomas Zydowsky
- The Population Council, New York, New York 10017, United States
| | - Paolo La Colla
- Department
of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Patrick Augustijns
- Department
of Pharmaceutical and Pharmacological Sciences, Drug Delivery and
Disposition, KU Leuven—University of Leuven, Leuven, Belgium
| | - Joachim Brouwers
- Department
of Pharmaceutical and Pharmacological Sciences, Drug Delivery and
Disposition, KU Leuven—University of Leuven, Leuven, Belgium
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18
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Koninckx PR, Corona R, Timmerman D, Verguts J, Adamyan L. Peritoneal full-conditioning reduces postoperative adhesions and pain: a randomised controlled trial in deep endometriosis surgery. J Ovarian Res 2013; 6:90. [PMID: 24326155 PMCID: PMC4029570 DOI: 10.1186/1757-2215-6-90] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/06/2013] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To translate the concept of full-conditioning (FC) from animal experiments to the human, and to evaluate the efficacy for adhesion prevention. FC consisted of decreasing acute inflammation by 86% CO2+ 10% N2O + 4% O2 for the pneumoperitoneum, cooling of the peritoneal cavity, humidification, heparinized rinsing solution and 5 mg of dexamethasone as demonstrated in animal models. METHODS A randomized controlled trial (RCT: NCT01344486) comparing standard laparoscopy with full conditioning together with a barrier in a 2/3 ratio in 44 women undergoing deep endometriosis surgery at KULeuven. The primary aim was reduction of adhesions. Secondary aims were CO2 resorption, postoperative pain and recovery. Randomization was performed after signing informed consent. Adhesion scoring during second look laparoscopy and pain scoring were done blindly. RESULTS In the FC group (n = 16) adhesions were completely prevented in 12/16 women whereas in the control group (n = 11) all women had severe adhesions (P < 0.0005). Also the area, density and severity of adhesions were less. (P <0.001). In the control group, severity, density and area of adhesions were strongly interrelated (P = 0.0001 for all areas) suggesting a common enhancing factor. In the FC group CO2 resorption (P < 0.001), postoperative pain (P < 0.001), and CRP concentrations (P < 0.01) were lower while clinical recovery was faster (P < 0.0001) and time to first flatus (P < 0.002) shorter. IN CONCLUSION This translational research confirms in the human the efficacy of FC in reducing CO2 resorption and adhesions with in addition less postoperative pain, lower postoperative CRP concentrations and an accelerated recovery.
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Affiliation(s)
- Philippe R Koninckx
- Department of Obstetrics and Gynecology, UZ Gasthuisberg, KULeuven, Leuven B-3000, Belgium.
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19
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Verguts J, Ameye L, Bourne T, Timmerman D. Normative data for uterine size according to age and gravidity and possible role of the classical golden ratio. Ultrasound Obstet Gynecol 2013; 42:713-717. [PMID: 23754297 DOI: 10.1002/uog.12538] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 05/10/2013] [Accepted: 05/29/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To document normal measurements (length, width, anteroposterior (AP) diameter) and proportions of the non-pregnant uterus according to age and gravidity. We hypothesized that uterine proportions conform to the classical 'golden ratio' (1.618). METHODS This was a retrospective study of ultrasonographic measurements of the length, width and AP diameter of non-pregnant uteri recorded in our database between 1 January 2000 and 31 July 2012. All patients for whom abnormal findings were reported were excluded and only the first set of measurements for each patient was retained for analysis. Loess (local regression) analysis was performed using age and gravidity as explanatory variables. RESULTS Measurements of 5466 non-pregnant uteri were retrieved for analysis. The mean length was found to increase to 72 mm at the age of 40 and decrease to 42 mm at the age of 80 years. Gravidity was associated with greater uterine length, width and AP diameter. Mean length/width ratio was found to be 1.857 at birth, decreasing to 1.452 at the age of 91 years. At the age of 21 years, the mean ratio was found to be 1.618, i.e. equal to the golden ratio. Increasing gravidity was associated with lower mean length/width ratio. CONCLUSIONS Uterine size in non-pregnant women varies in relation to age and gravidity. Mean length/width ratio conformed to the golden ratio at the age of 21, coinciding with peak fertility.
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Affiliation(s)
- J Verguts
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, Jessa Hospital, Hasselt, Belgium
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20
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Verguts J, Orye G, Marquette S. Symptom relief of leiomyomatosis peritonealis disseminata with ulipristal acetate. ACTA ACUST UNITED AC 2013; 11:57-58. [PMID: 24611038 PMCID: PMC3935105 DOI: 10.1007/s10397-013-0816-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/04/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Jasper Verguts
- Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Department of Obstetrics and Gynecology, University Hospital KU Leuven Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Guy Orye
- Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Sophie Marquette
- Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
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21
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Corona R, Binda MM, Mailova K, Verguts J, Koninckx PR. Addition of nitrous oxide to the carbon dioxide pneumoperitoneum strongly decreases adhesion formation and the dose-dependent adhesiogenic effect of blood in a laparoscopic mouse model. Fertil Steril 2013; 100:1777-83. [PMID: 24112528 DOI: 10.1016/j.fertnstert.2013.08.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the effect of addition of nitrous oxide (N2O) to the carbon dioxide (CO2) pneumoperitoneum (PP) and the effect of blood, plasma, or red blood cells (RBCs) on postoperative adhesions in a laparoscopic mouse model. DESIGN Prospective randomized controlled trial. SETTING University laboratory research center. ANIMAL(S) BALB/c female mice. INTERVENTION(S) The effect of adding to the 60-minute CO2 PP 5%, 10%, 25%, 50%, or 100% N2O on adhesion formation was evaluated. Subsequently the effect of adding 1 mL blood, or RBCs, or plasma and the effect of adding different concentrations of blood were studied. Finally, the effect of adding 10% N2O, 4% O2, or both to the CO2 was evaluated in a control group and after addition of blood. MAIN OUTCOME MEASURE(S) Postoperative adhesions after 7 days. RESULT(S) N2O strongly reduces adhesion formation with a full effect at a concentration of 5% or 10%. Adhesions increase linearly with 0.125 mL to 1 mL blood. In both the control group and after adding blood, 10% N2O is the most effective factor in prevention of adhesions. CONCLUSION(S) N2O, from concentrations of 5% upward, strongly prevents adhesion formation. Blood, mainly the plasma, increases adhesion formation. These data extend the concept of the role of acute inflammation and support the importance of good surgical practice with little bleeding and peritoneal cavity conditioning in adhesion prevention.
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Affiliation(s)
- Roberta Corona
- Centre for Reproductive Medicine, Free University Brussels, Brussels, Belgium.
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Corona R, Verguts J, Koninckx R, Mailova K, Binda MM, Koninckx PR. Intraperitoneal temperature and desiccation during endoscopic surgery. Intraoperative humidification and cooling of the peritoneal cavity can reduce adhesions. Am J Obstet Gynecol 2011; 205:392.e1-7. [PMID: 21872199 DOI: 10.1016/j.ajog.2011.06.091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 06/21/2011] [Accepted: 06/23/2011] [Indexed: 01/27/2023]
Abstract
This study was conducted to document quantitatively the intraperitoneal temperature and desiccation during laparoscopic surgery. The temperature, relative humidity, and flow rate were measured in vitro and during laparoscopic surgery, at the entrance and at the exit of the abdomen. This permitted us to calculate desiccation for various flow rates using either dry CO(2) or CO(2) humidified with 100% relative humidity at any preset temperature between 25 and 37°C. The study showed that desiccation, both in vitro and in vivo, varies as expected with the flow rates and relative humidity while intraperitoneal temperature varies mainly with desiccation. Temperature regulation of bowels is specific and drops to the intraperitoneal temperature without affecting core body temperature. With a modified humidifier, desiccation could be eliminated while maintaining the intraperitoneal temperature between 31 to 32°C.
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Verguts J, Corona R, Binda MM, Koninckx PR. Regarding: Carbon Dioxide Pneumoperitoneum Prevents Postoperative Adhesion Formation in a Rat Cecal Abrasion Model. J Laparoendosc Adv Surg Tech A 2011; 21:539-40. [DOI: 10.1089/lap.2011.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jasper Verguts
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium
| | - Roberta Corona
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium
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Corona R, Verguts J, Binda MM, Molinas CR, Schonman R, Koninckx PR. The impact of the learning curve on adhesion formation in a laparoscopic mouse model. Fertil Steril 2011; 96:193-7. [PMID: 21601846 DOI: 10.1016/j.fertnstert.2011.04.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/15/2011] [Accepted: 04/15/2011] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the impact of surgeon training on adhesion formation in a laparoscopic mouse model. Laparoscopic surgery and bowel manipulation was demonstrated to enhance postoperative adhesion formation. DESIGN Prospective randomized, controlled trial. SETTING University laboratory research center. ANIMAL(S) 200 BALB/c and 200 Swiss female mice. INTERVENTION(S) Adhesions were induced by opposing bipolar lesions and 60 minutes of pneumoperitoneum. Each surgeon operated on 80 mice (40 Swiss and 40 BALB/c), the only variable thus being his/her increasing experience. Some surgeons were already experienced gynecologists, others were starting their training. MAIN OUTCOME MEASURE(S) End points were the duration of surgery while performing the lesions. The adhesion formation was scored quantitatively (proportion and total) and qualitatively (extent, type, and tenacity) after 7 days. RESULT(S) With training, duration of surgery and adhesion formation decreased exponentially for all surgeons, whether experienced or not. Experienced surgeons had initially a shorter duration of surgery, less adhesion formation, and less de novo adhesions than inexperienced surgeons. CONCLUSION(S) These data suggest that laparoscopic skills improve with training, leading to a decrease in the duration of surgery and formation of adhesions. Therefore completion of a standardized learning curve should be mandatory when initiating adhesion formation studies both in laboratory or clinical setting.
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Affiliation(s)
- Roberta Corona
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Corona R, Verguts J, Schonman R, Binda MM, Mailova K, Koninckx PR. Postoperative inflammation in the abdominal cavity increases adhesion formation in a laparoscopic mouse model. Fertil Steril 2011; 95:1224-8. [PMID: 21295297 DOI: 10.1016/j.fertnstert.2011.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/25/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate acute inflammation in the peritoneal cavity in adhesion formation. DESIGN Prospective randomized, controlled trial. SETTING University laboratory research center. ANIMAL(S) 9- to 10-week-old BALB/c female mice. INTERVENTION(S) In a laparoscopic mouse model, acute inflammation in the peritoneal cavity evaluated in CO(2) pneumoperitoneum enhanced adhesions, by CO(2) pneumoperitoneum plus manipulation, and in the latter group plus dexamethasone. MAIN OUTCOME MEASURE(S) Qualitative and quantitative adhesion scores and an acute inflammation score (neoangiogenesis, diapedesis, and leukocyte accumulation). RESULT(S) Adhesions at the lesion site were enhanced by the CO(2) pneumoperitoneum, further enhanced by manipulation, and decreased by the administration of dexamethasone. The acute inflammation scores (total, neoangiogenesis, diapedesis, and leukocyte accumulation) strongly correlated with the total adhesion score. Inflammation scores were similar at both the surgical lesion and the parietal peritoneum. CONCLUSION(S) Acute inflammation of the entire peritoneum cavity is an important mechanism involved in adhesion formation and enhances adhesion formation at the lesion site.
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Affiliation(s)
- Roberta Corona
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium.
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26
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Verguts J, Coosemans A, Corona R, Praet M, Mailova K, Koninckx P. Intraperitoneal injection of cultured mesothelial cells decrease CO2 pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10397-011-0658-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Binda MM, Corona R, Verguts J, Koninckx PR. Peritoneal Infusion with Cold Saline Decreased Postoperative Intra-abdominal Adhesion Formation: Letter to the Editor. World J Surg 2010; 35:242; author reply 243. [DOI: 10.1007/s00268-010-0772-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Verguts J, Timmerman D, Bourne T, Lewi P, Koninckx P. Accuracy of peritoneal fluid measurements by transvaginal ultrasonography. Ultrasound Obstet Gynecol 2010; 35:589-592. [PMID: 20229519 DOI: 10.1002/uog.7632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the accuracy of the assessment of peritoneal fluid volumes of up to 1 L by transvaginal ultrasonography and to re-evaluate the formula used to calculate total volume from the dimensions of the largest pocket. METHODS Patients (n = 13) enrolled for a minor laparoscopic procedure were prospectively recruited. At the end of the procedure, with the patient in the 30 degrees anti-Trendelenburg position, Ringer's lactate was instilled into the abdomen in discrete steps up to 1 L. Following equilibration the diameters of the single pocket of fluid were measured by transvaginal ultrasonography in order to calculate the volume, and regression models were used to determine the relationship between this and the instilled volume. The body mass index (BMI) of the patient was evaluated as a parameter for predicting the instilled volume more accurately. RESULTS The intra-abdominal fluid volume could be calculated from the measured volume using a quadratic regression equation with an overall coefficient of variation of 19%. In individual patients, changes in volume could be assessed with a coefficient of variation of 7.3%. BMI was not found to be a significant parameter in relating the measured to the instilled volume. CONCLUSION Transvaginal ultrasound in a standardized setting can accurately estimate the volume of peritoneal fluid, with the accuracy consistent for small and large volumes. Changes in peritoneal fluid volume over time in the same individual can be measured more accurately than the total volume present.
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Affiliation(s)
- J Verguts
- Department of Obstetrics and Gynecology, University Hospital Leuven, Campus Gasthuisberg, Leuven, Belgium.
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Deprest J, Klosterhalfen B, Schreurs A, Verguts J, De Ridder D, Claerhout F. Clinicopathological study of patients requiring reintervention after sacrocolpopexy with xenogenic acellular collagen grafts. J Urol 2010; 183:2249-55. [PMID: 20400143 DOI: 10.1016/j.juro.2010.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE We describe the operative and histopathological findings of patients requiring reintervention because of symptomatic vault prolapse or graft related complications following sacrocolpopexy using xenografts. MATERIALS AND METHODS A total of 13 patients underwent secondary sacrocolpopexy because of failure (8) or vaginal revision (5) because of a graft related complication after the initial sacrocolpopexy with porcine dermal collagen (9) or small intestinal submucosa (4). Outcome measures were operative findings and histology of specimens obtained at reintervention. Sections were semiquantitatively scored for the presence of infection, foreign body reaction and fibrosis by a pathologist blinded to the outcome and graft type. RESULTS Reinterventions for failure and graft related complications were performed a median of 33 and 15 months, respectively, after the initial operation. Pathology of porcine dermal collagen failures (6) revealed local degradation associated with a minimal foreign body reaction. Porcine dermal collagen remnants were surrounded by minimal fibrosis and neovascularization. Small intestinal submucosa implants of failures (2) were entirely replaced by collagen rich and moderately vascularized connective tissue. Pathology of 3 erosions (all 3 porcine dermal collagen) revealed a locally degraded implant that was surrounded by histiocytes and a polymorphonuclear infiltrate. Pathology of 2 early infections, both small intestinal submucosa, revealed a massive polymorphonuclear infiltration with the implant material remodeled and replaced by loose connective tissue. CONCLUSIONS In these clinical recurrences porcine dermal collagen implants were usually locally degraded but still recognizable several years after implantation. Small intestinal submucosa implants were fully replaced by connective tissue. Therefore, the cause of recurrence remains unclear. Porcine dermal collagen erosions displayed features of infection and degradation.
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Affiliation(s)
- Jan Deprest
- Pelvic Floor Unit, University Hospitals Leuven, Katholieke Universiteit Leuven, 3000-Leuven, Belgium.
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Claerhout F, Moons P, Ghesquiere S, Verguts J, De Ridder D, Deprest J. Validity, reliability and responsiveness of a Dutch version of the prolapse quality-of-life (P-QoL) questionnaire. Int Urogynecol J 2010; 21:569-78. [PMID: 20082065 DOI: 10.1007/s00192-009-1081-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 12/09/2009] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to test validity, reliability and responsiveness of a Dutch version of a prolapse quality-of-life questionnaire (P-QoL). METHODS P-QoL was translated into Dutch and adjusted by a panel of five experts. The scores of the final version were compared between symptomatic (n = 160) and asymptomatic (n = 80) patients and with findings on vaginal examination (pelvic organ prolapse quantification (POP-Q)). In terms of reliability, Cronbach's alpha was calculated, and a test-retest (n = 20) was performed. Responsiveness to treatment was assessed by comparing pre- and postoperative scores in 45 patients. RESULTS Total scores for each P-QoL domain were different between symptomatic and asymptomatic women (p < 0.001). Severity according to P-QoL correlated well with POP-Q findings. Cronbach's alphas showed internal consistency within the domains. Test-retest reliability was high. Pre- and postoperative scores for each domain were significantly different (p < 0.001). CONCLUSION The Dutch version of P-QoL is valid, reliable and responsive to assess quality-of-life and symptoms in Dutch-speaking patients with urogenital prolapse.
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Affiliation(s)
- Filip Claerhout
- Pelvic Floor Unit, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
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van de Vijver A, Poppe W, Verguts J, Arbyn M. Pregnancy outcome after cervical conisation: a retrospective cohort study in the Leuven University Hospital. BJOG 2009; 117:268-73. [DOI: 10.1111/j.1471-0528.2009.02437.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Verguts J, Vergote I, Amant F, Moerman P, Koninckx P. The addition of 4% oxygen to the CO(2) pneumoperitoneum does not decrease dramatically port site metastases. J Minim Invasive Gynecol 2009; 15:700-3. [PMID: 18971132 DOI: 10.1016/j.jmig.2008.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 07/12/2008] [Accepted: 07/19/2008] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE Port site metastases (PSM) after laparoscopic surgery for advanced-stage ovarian carcinoma are a cause of concern, but the pathophysiology is unknown. Because CO(2) pneumoperitoneum was recently demonstrated to be a cofactor in adhesion formation and tumor implantation in a laparoscopic mouse model, and because both could be prevented by the addition of 4% oxygen to the CO(2) pneumoperitoneum, we wanted to test the hypothesis that PSM could be related to tumor cell hypoxia during CO(2) pneumoperitoneum. DESIGN A randomized controlled pilot trial to compare the incidence of PSM in women undergoing laparoscopy with a pure CO(2) pneumoperitoneum in comparison with women with CO(2) pneumoperitoneum with the addition of 4% oxygen (Canadian Task Force classification C). SETTING University Hospital Gasthuisberg, Leuven, Belgium. PATIENTS Since January 1, 2007, 22 consecutive women undergoing laparoscopy for suspected ovarian cancer with subsequent debulking laparotomy were included. INTERVENTIONS Diagnostic laparoscopy with 100% CO(2) versus laparoscopy with addition of 4% oxygen. MEASUREMENTS AND MAIN RESULTS In the control group, 9 (47%) PSM found in 19 port sites were excised. In the CO(2)+oxygen group, a similar incidence was found, that is, 8 (50%) PSM in 16 port sites. The incidence of PSM was higher in small women (p <.018) and in high-grade malignancies. The pathophysiology of PSM is unknown, but besides direct wound contamination, aerosolization of tumor cells and gas leaks have been suggested together with a causal relationship with the CO(2) pneumoperitoneum. Tumor cell hypoxia probably is not an important mechanism because PSM were not prevented by adding small amounts of oxygen to the CO(2) pneumoperitoneum. CONCLUSION The hypothesis of tumor cell hypoxia by the CO(2) pneumoperitoneum as a mechanism for PSM could not be confirmed.
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Affiliation(s)
- Jasper Verguts
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium.
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Dierickx I, Deraedt K, Poppe W, Verguts J. Aggressive angiomyxoma of the vulva: a case report and review of literature. Arch Gynecol Obstet 2008; 277:483-7. [PMID: 18214507 DOI: 10.1007/s00404-008-0561-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 01/03/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Aggressive angiomyxoma (AA) is a rare vulvovaginal mesenchymal neoplasm with a marked tendency to local recurrence but which usually does not metastasize. CASE REPORT We describe a case of AA in the left labium majus pudendi in a 47-year-old woman who underwent incomplete surgical excision. Follow-up 2years later revealed no recurrence. CONCLUSION In the past, most authors advocated wide excision even if genitourinary and digestive tract resection were necessary. These days, a less radical surgery is recommended, but the significance of hormonal treatment and/or radiation therapy is not clear yet. Further investigation is necessary.
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Affiliation(s)
- Inge Dierickx
- Department of Obstetrics and Gynaecology, Katholieke Universiteit Leuven, Leuven, Belgium
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Veldman J, Van Houdenhove B, Verguts J. Chronic fatigue syndrome: a hormonal origin? A rare case of dysmenorrhea membranacea. Arch Gynecol Obstet 2008; 279:717-20. [DOI: 10.1007/s00404-008-0795-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 08/28/2008] [Indexed: 10/21/2022]
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Schockaert S, Poppe W, Arbyn M, Verguts T, Verguts J. Incidence of vaginal intraepithelial neoplasia after hysterectomy for cervical intraepithelial neoplasia: a retrospective study. Am J Obstet Gynecol 2008; 199:113.e1-5. [PMID: 18456229 DOI: 10.1016/j.ajog.2008.02.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 11/14/2007] [Accepted: 02/12/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hysterectomy with concomitant cervical intraepithelial neoplasia (CIN), is often considered a definitive treatment for CIN, but development of subsequent vaginal intraepithelial neoplasia (VAIN) is known to range from 0.9% to 6.8%. STUDY DESIGN In a retrospective analysis of 3030 women with CIN2+ without history of VAIN in the University Hospital Gasthuisberg, Leuven, Belgium, from January 1989 until December 2003, we identified 125 women who underwent a hysterectomy within 6 months after diagnosis of CIN2+ and reviewed their postoperative Papanicolaou smears. RESULTS Thirty-one patients (24.8%) were lost to follow-up. Seven of the 94 women in the follow-up group (7.4%) developed VAIN2+, of which 2 were invasive vaginal cancers. Median interval between hysterectomy and diagnosis of VAIN2+ was 35 months (5-103 months). Women with recurrence were significantly older (P = .003). CONCLUSION Hysterectomy may not be considered as a definitive therapy for CIN2+ because the incidence rate of subsequent VAIN2+ is as high as 7.4%.
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Affiliation(s)
- Silke Schockaert
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium
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Corona R, De Cicco C, Schonman R, Verguts J, Ussia A, Koninckx PR. Tension-free Vaginal Tapes and Pelvic Nerve Neuropathy. J Minim Invasive Gynecol 2008; 15:262-7. [DOI: 10.1016/j.jmig.2008.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Revised: 03/07/2008] [Accepted: 03/13/2008] [Indexed: 11/30/2022]
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Van den Bosch T, Verguts J, Daemen A, Gevaert O, Domali E, Claerhout F, Vandenbroucke V, De Moor B, Deprest J, Timmerman D. Pain experienced during transvaginal ultrasound, saline contrast sonohysterography, hysteroscopy and office sampling: a comparative study. Ultrasound Obstet Gynecol 2008; 31:346-351. [PMID: 18307203 DOI: 10.1002/uog.5263] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate and compare the pain experienced by women during transvaginal ultrasound, saline contrast sonohysterography (SCSH), diagnostic hysteroscopy and office sampling. METHODS This was a descriptive study of 402 consecutive patients presenting at a 'one-stop' Bleeding Clinic between October 2004 and November 2006. Thirty-nine percent of the patients were postmenopausal. The patients underwent the following examinations transvaginally: first ultrasound with color Doppler, second SCSH, third diagnostic hysteroscopy and fourth endometrial biopsy. After completion of the examinations the patients were asked to complete a questionnaire including a visual analog scale (VAS) about their subjective appreciation of all four examinations. Two-hundred and ninety-three (72%) patients returned the questionnaire. RESULTS The median (range) VAS scores for transvaginal ultrasound, SCSH, diagnostic hysteroscopy and endometrial sampling were 1.0 (0-8.1), 2.2 (0-10), 2.7 (0-10) and 5.1 (0-10), respectively (P < 0.0001). The patients' answers to the other questions about the pain experienced, including comparison with other minor procedures such as venous blood sampling, were all concordant with the VAS scores. CONCLUSIONS Transvaginal ultrasound was the procedure best accepted, followed by SCSH, hysteroscopy and endometrial sampling. These results suggest that patients would prefer SCSH over hysteroscopy as an initial diagnostic approach in the evaluation of abnormal uterine bleeding.
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Affiliation(s)
- T Van den Bosch
- Department of Obstetrics & Gynaecology, University Hospitals, K.U.Leuven, Leuven, Belgium.
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De Cicco C, Ret Dávalos ML, Van Cleynenbreugel B, Verguts J, Koninckx PR. Iatrogenic ureteral lesions and repair: a review for gynecologists. J Minim Invasive Gynecol 2007; 14:428-35. [PMID: 17630159 DOI: 10.1016/j.jmig.2007.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 12/27/2006] [Accepted: 01/07/2007] [Indexed: 10/23/2022]
Abstract
Ureter injuries are a well-known complication of gynecologic surgery and a frequent cause of medicolegal problems. Because there are no randomized, controlled trials and the available studies are small series and case reports, the evidence on which to base treatment is weak. We therefore reviewed the complete English-language literature of ureter repair since 1990. In total, 608 ureter injuries were reported. Although it is widely believed that for laceration or section the prognosis is affected by a delay in diagnosis, we could not find evidence to substantiate this. An obstruction requires stenting only. For a laceration, stenting with suturing was more effective than stenting only (p = .006). A ureter anastomosis was successful in over 94% of cases either by laparotomy or laparoscopy. In conclusion, the literature data are scanty and heterogeneous and do not permit solid conclusions. Evidence, however, is emerging that a laceration should be treated by stenting and suturing. A ureter anastomosis over a stent could become a valid option especially when performed by laparoscopy.
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Affiliation(s)
- Carlo De Cicco
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Verguts J, Schockaert S, Moerman P, Poppe W. Re: "Pathologic risk factors for predicting residual disease in subsequent hysterectomy following LEEP conization". Gynecol Oncol 2007; 106:273. [PMID: 17477960 DOI: 10.1016/j.ygyno.2007.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 03/27/2007] [Indexed: 11/22/2022]
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Verguts J, Amant F, Moerman P, Vergote I. HPV induced ovarian squamous cell carcinoma: case report and review of the literature. Arch Gynecol Obstet 2007; 276:285-9. [PMID: 17333225 DOI: 10.1007/s00404-007-0333-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 01/22/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ovarian squamous cell carcinoma is usually derived from a teratoma, a Brenner tumour or endometriosis. Association with an HPV infection is rare. CASE A fourth case of ovarian squamous cell cancer associated with HR-HPV is presented. Debulking for stage IIIc ovarian squamous cell cancer was performed and she received adjuvant combination chemotherapy. She developed bone metastases and received radiotherapy. The Progression of these metastases and the newly developed metastases did not respond to an oral tyrosine kinase inhibitor (gefitinib). CONCLUSION The development of bone metastases in association with an ovarian squamous cell carcinoma is a rare finding, and it did not respond to treatment with a tyrosine kinase. A review of literature is presented.
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Affiliation(s)
- J Verguts
- Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
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Verguts J, Roovers JP, De Ridder D, Coremans G, Deprest J. Posterior intravaginal slingplasty with preservation of the uterus: a modified surgical technique in a young myelomeningocele patient. Gynecol Obstet Invest 2006; 63:203-4. [PMID: 17159352 DOI: 10.1159/000097846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 09/21/2006] [Indexed: 01/25/2023]
Abstract
We report a case of uterine prolapse in a young woman, treated by posterior intravaginal slingplasty with preservation of the uterus as a feasible and safe surgical procedure. Posterior intravaginal slingplasty is commonly used to correct vaginal vault prolapse, but may be a valuable alternative to correct uterine prolapse. We compare this technique to other techniques to correct uterine prolapse.
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Affiliation(s)
- Jasper Verguts
- Bekkenbodemcentrum, University Hospital Gasthuisberg, Leuven, Belgium.
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Arbyn M, Tulunay G, Ozgul N, Yalvac S, Verguts J, Poppe W, Sankaranarayanan R. European Union support for a Turkish reproductive health project to assess alternative cervical cancer screening methods in Sanliurfa (rural south-east Turkey). Eur J Cancer Prev 2006; 15:552-3. [PMID: 17106338 DOI: 10.1097/01.cej.0000215615.82885.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Verguts J, Bronselaer B, Donders G, Arbyn M, Van Eldere J, Drijkoningen M, Poppe W. Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation. BJOG 2006; 113:1303-7. [PMID: 16978225 DOI: 10.1111/j.1471-0528.2006.01063.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to examine the accuracy of the presence of high-risk human papillomavirus (HR-HPV) DNA (HR-HPV DNA test) postconisation as prediction of recurrent or residual cervical intraepithelial neoplasia (CIN) after treatment of high-grade cervical intraepithelial lesions (CIN2+) in a prospective study and to compare this with follow-up cytology and the marginal status of the excised tissue. DESIGN Prospective follow-up study. SETTING Unselected women presenting at colposcopy clinic of University Hospital Gasthuisberg, Leuven. POPULATION Seventy-two women treated with conisation for CIN2 or CIN3. METHODS Women were followed by HR-HPV DNA test (Hybrid Capture II test of Digene) every 3 to 6 months. The same vial was used for cytology and the HR-HPV DNA test (SurePath). All women were further followed by colposcopy and cytology for 24 months at 6-month intervals. The outcome of the study was presence of >CIN2, proven with colposcopy-directed biopsy occurring within 24 months after treatment. HR-HPV status was correlated with recurrent or residual CIN2+. MAIN OUTCOME MEASURES Sensitivity, specificity, predictive values and diagnostic odds ratios to predict treatment failure or cure were computed for HR-HPV testing, marginal status and follow-up cytology. HR-HPV status was also correlated with section margins postconisation and with the first cervical smear. RESULTS In 6 of the 72 treated women (8%), residual or recurrent CIN occurred. Women with recurrence were significantly older than women without a recurrence (51.5 +/- 9.6 versus 39.8 +/- 12.2 years, P= 0.007). All six women with recurrence were HR-HPV positive, four had a positive follow-up smear (>or=atypical squamous cells of uncertain significance = ASCUS+) and only two had involved section margins. Among the 66 cured women, 15 were HR-HPV positive, 6 had an abnormal smear and 12 had positive section margins. Sensitivity of cytology, positive section margins and HR-HPV DNA positivity was 66.7, 33.3 and 100% to predict treatment failure. Specificity of the three tests was, respectively, 90.9, 81.8 and 77.3%. Women with HR-HPV DNA at 3 to 6 months showed recurrent or residual CIN in 15% (2/13) if they had normal follow-up Pap smears and in 50% (4/8) if they had abnormal Pap smears. Margin status was not statistically significantly associated with human papillomavirus status. CONCLUSION Persistence or clearance of HR-HPV DNA is an early valid prognostic marker of failure or cure after treatment for CIN2+ and is more accurate than cytology or section margin status at the time of conisation. The absence of HR-HPV DNA has a 100% negative predictive value. Higher age at conisation may be a previously unrecognised risk factor for recurrence.
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Affiliation(s)
- J Verguts
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium.
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Koninckx PR, Verguts J, Timmerman D. Assessment of measurement validity. Fertil Steril 2006; 85:268; author reply 268. [PMID: 16412776 DOI: 10.1016/j.fertnstert.2005.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Indexed: 10/25/2022]
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Timmerman D, Verguts J, Konstantinovic ML, Moerman P, Van Schoubroeck D, Deprest J, van Huffel S. The pedicle artery sign based on sonography with color Doppler imaging can replace second-stage tests in women with abnormal vaginal bleeding. Ultrasound Obstet Gynecol 2003; 22:166-171. [PMID: 12905512 DOI: 10.1002/uog.203] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Unenhanced transvaginal sonography is not accurate in the detection of endometrial polyps. Currently, second-stage tests such as saline contrast sonohysterography and office hysteroscopy are used to diagnose endometrial lesions, but both have limitations and side effects. We proposed visualization of the pedicle artery on color Doppler imaging as a sign of polyps. METHODS This was a prospective observational study involving 3099 consecutive patients referred for assessment of the endometrium and myometrium. The uterus was assessed in sagittal and coronal planes using color Doppler sonography. Patients with suspected endometrial pathology on sonography were noted and the volume of the focal lesion was calculated. Patients with a clearly visible pedicle artery reaching the central part of the endometrium were regarded as test-positive. The gold standard was defined as the presence or absence of an endometrial polyp at hysterectomy, hysteroscopy and/or endometrial histology on dilatation and curettage within 1 year of sonography. RESULTS Of the 3099 women, no gold standard was available in 2230. Only 28 of the 199 patients who were test-positive did not have a gold standard. In the 869 patients in whom a gold standard was available, 182 had one or more endometrial polyps. The pedicle artery test had an apparent sensitivity for detection of endometrial polyps of 76.4%, specificity of 95.3%, positive predictive value (PPV) of 81.3%, and negative predictive value of 93.8%. When extending the test to the prediction of any focal intracavitary pathology the PPV was 94.2%. CONCLUSIONS The pedicle artery test has a very high PPV for intracavitary pathology. We expect that in the majority of patients with an endometrial polyp this test may replace more invasive established second-stage tests, such as saline contrast sonohysterography and office hysteroscopy.
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Affiliation(s)
- D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals, Katholieke Universiteit Leuven, Belgium.
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