Immunohistochemical expression of hormonal receptors, collagen, elastin, and proteoglycans in genuine urinary incontinence

PURPOSE

To study the expression of hormonal receptors, collagen, elastin, proteoglycans, and VIP in the vaginal wall of women with stress urinary incontinence (SUI).

MATERIALS AND METHODS

Fifty-eight specimens of the anterior vaginal wall (28 women with SUI) were processed by Ventana immunostaining method.

RESULTS

Both groups were compatible for age, BMI, and obstetric history. Positive ER-α and ER-β immunoreaction was observed in 46.4% and 3.6% of SUI (43.3% and 33.3% of controls) (p < 0.05), respectively, and PR immunoreaction in 39.3% of SUI (46.7% of controls). Collagen I and III immunoreaction was observed in 28,6% and 21.4% of SUI (30.% and 36.7% of controls), respectively, and elastin, decorin, and fibromodulin immunoreaction in 10.7%, 10.7%, and 10.7% of SUI (50%, 33.3%, 33,.3% of controls) (p < 0.05), respectively. VIP immunoreaction was observed in 7.1% of SUI (36.7% of controls).

CONCLUSION

Imunoexpression of ER-P, elastin, decorin, fibromodulin, and VIP was significantly lower in SUI than controls, showing that the ER-β dependent re-modeling of the extracellular matrix of vaginal tissues is the main mechanism of SUI.

Secondary hypoparathyroidism during pregnancy--a case report and review of the literature

Secondary hypoparathyroidism is seldom seen during pregnancy. Usually, it presents with hypocalcemia. Even if there is no established therapeutic treatment, vitamin D or its analogues are required. In the present case, a 36-year-old, second gravida, with known hypoparathyroidism for the last ten years, was admitted in the prenatal clinic of "Aretaieion" University Hospital in Athens at her 39 weeks of pregnancy. She was treated with calcitriol and calcium and she was monitored monthly. She had a cesarian section and delivered a healthy female baby of 3,380 gr at 39 weeks and 1 day.

Tension-free vaginal tape obturator versus Ajust adjustable single incision sling procedure in women with urodynamic stress urinary incontinence

OBJECTIVE

To assess the efficacy and complications of inside-out transobturator tension-free vaginal tape (TVT-O) in comparison with a single incision sling procedure (Ajust) for the treatment of urodynamic stress urinary incontinence.

STUDY DESIGN

Prospective closely matched controlled study. In total, 171 patients were included in the study: 86 women underwent the TVT-O procedure, while in other 85 cases the Ajust procedure was performed. Subjective and objective cure, improvement and failure rates, mean operative time, hospital stay and incidence of complications were assessed.

RESULTS

There was no statistically significant difference between the two groups for age, body mass index, parity, menopausal status and severity of prolapse. No major intraoperative complications occurred. There was no significant difference in the mean operative time and the duration of hospital stay between the two groups. The mean follow-up time of the study was 22.3 months (range 12-36 months). For the TVT-O group the objective cure rate was 86%, the improvement rate was 5.9% and the failure rate was 8.1%, while the subjective cure rate was 82.6%. For the Ajust group the objective cure rate was 84.7%, the improvement rate was 4.7%, 10.6% of patients showed no change in their symptoms and the subjective cure rate was 81.2%.

CONCLUSIONS

The Ajust sling procedure presents success rates, at 22 months' mean follow up, comparable to the TVT-O method. Both techniques seem to be safe and effective for the treatment of urodynamic stress urinary incontinence.

Second-trimester miscarriage and umbilical cord knot. Case report and review of the literature

PURPOSE OF INVESTIGATION

The present study presents a case with an umbilical cord knot along with extensive literature review.

MATERIALS AND METHODS

Presentation of a rare case of second-trimester abortion which was attributed to a tight umbilical cord knot. Furthermore the authors reviewed the literature from 1952 to 2012 in order to compare impact of knots on intrapartum and perinatal outcomes.

RESULTS

Four large retrospective studies assessed several predisposing factors. Long umbilical cords, male embryos, and multiparity were correlated with knots in three of these studies. Data regarding perinatal effects of true knots from three studies were summarized and compared.

CONCLUSION

Umbilical cord true knots during the second trimester could be a very rare cause of abortion. The presence of knots during the third trimester and labor do not seem to be associated with increased perinatal and intrapartum morbidity and mortality, although there is still some controversy in the literature on this topic.

Clinicopathological changes of uterine leiomyomas after GnRH agonist therapy

OBJECTIVE

Gonadotrophin-releasing hormone agonist (GnRHa) has been commonly used for the medical treatment of prostate cancer, precocious puberty, endometriosis, adenomyosis and uterine leiomyomas. GnRHa therapy in cases of symptomatic uterine leiomyomas aims for the reduction of their size and remission of symptoms such as menometrorrhagia, causing a state of hypoestrogenemia. This is considered to be a helpful preoperative strategy in cases of large myomas, or anemia because of abnormal vaginal bleeding. The aim of this retrospective study was to examine the clinicopathological changes in uterine leiomyomas exposed to preoperative GnRHa therapy for two up to six months.

MATERIALS AND METHODS

The study group consisted of 10 premenopausal patients who were treated with GnRHa prior to surgery.

RESULTS

In all cases the size of leiomyomas was reduced after GnRHa therapy. A microscopic review of the surgical specimens showed increased cellularity and ischemic type of necrosis.

CONCLUSION

Morphological changes of uterine leiomyomas are often associated with preoperative GnRH agonist therapy. The differential diagnosis from uterine leiomyosarcomas includes absence of mitotic activity.

Clinicopathological characteristics of adnexal lesions diagnosed during pregnancy or cesarean section

OBJECTIVE

The diagnosis of an incidental adnexal lesion during pregnancy has become more common after the widespread use of routine ultrasonography (US). The aim of this study was to examine the diagnostic approach, management strategy and the pathological findings in cases of adnexal lesions that were diagnosed and treated during pregnancy in our department.

MATERIALS AND METHODS

This was a 15-year retrospective study. Cases of adnexal lesions detected during routine prenatal care by US or while performing cesarean section, between January 1996 and December 2010 at Aretaieion Hospital of the National University of Athens, were analyzed.

RESULTS

In this study period 39 cases of adnexal lesions were diagnosed during pregnancy or cesarean section. The age of the women was between 21 and 40 years (mean age 32.4). Surgical excision of the lesions was decided in 32 cases and conservative treatment was followed in the remaining seven cases. Surgical removal of the lesions was performed during cesarean section in 13 cases of term gestations and in four cases of preterm gestations in which pregnancy termination was considered necessary. Laparotomy during the antepartum period led to excision of adnexal lesions in 15 cases. Histology revealed benign ovarian lesions in 25 cases (78.1%), borderline ovarian tumors in two cases (6.3%), malignant ovarian tumors in four cases (12.5%) and adenocarcinoma of the appendix in one case (3.1%) presenting as an ovarian mass.

DISCUSSION

The management of cases diagnosed with adnexal lesions during pregnancy remains controversial. According to the literature, the estimated risk of malignancy for adnexal masses during pregnancy is low (2-3%) and complications of these lesions are extremely rare. These data suggest that adnexal masses could be managed conservatively if possible with US follow-up. On the other hand, the results of this study showed a higher incidence of malignancy among adnexal lesions that were surgically treated (15.6%).

CONCLUSION

Surgical intervention and histological examination in cases suspicious for malignancy at US and clinical findings remain the treatment of choice even during pregnancy.

Advantages of radio frequency (RF) cone biopsy compared to large loop excision of the transformation zone (LLETZ) in patients with high-grade squamous intraepithelial lesions: a retrospective study

OBJECTIVE

The aim of this study was to compare radio wave cone biopsy to the LLETZ method in patients with high-grade squamous intraepithelial lesions. METHOD-RESULTS: This was a retrospective study of 186 patients diagnosed with HGSIL who underwent cone biopsy either with the LLETZ method (82/186) or with the radio wave method (104/186) in the 2nd Obstetrics and Gynecology Department, University of Athens, Aretaieion Hospital, Athens, Greece during the period January 1999 to December 2008. The mean age of the patients was 31 years (range 23 to 53 years). The volume of cone ranged from 1.2 x 2 cm up to 3 x 3.6 cm in both techniques. Histopathological analysis revealed focal or extensive high-grade squamous intraepithelial neoplasia extending into the underlying endocervical glands in 128/186 patients. Concomittent low-grade squamous intraepithelial lesions were observed in 160/186 patients and coilocytic atypia was observed in 172/186 patients. The endocervical margins were free of disease in 172/186 cases. In seven cases the neoplastic lesions were at least 0.1 cm from the margin and in seven cases they extended to the margin. In all cases a degree of tissue coagulative change was observed, but not extensive to the point of obscuring the diagnosis.

CONCLUSION

4.0 MHz radio wave surgery is an excellent alternative in the treatment of HGSIL. Clear surgical margins due to decreased heat and tissue damage, controlled hemostasis, faster healing, and patient and doctor satisfaction are notable advantages.

Endometrial carcinoma and ovarian sex cord tumor with annular tubules in a patient with history of Peutz-Jeghers syndrome and multiple malignancies

Peutz-Jeghers syndrome is a rare syndrome which is inherited in a dominant manner. It is characterized by hamartomatous polyps of the gastrointestinal tract, hyperpigmented macules of the oral mucosa and an increased risk of developing neoplasms in the gastrointestinal tract, pancreas, breast and genital system. Women with Peutz-Jeughers syndrome often develop an ovarian sex cord tumor and cervical adenocarcinoma of minimal deviation adenoma malignum type. A case of a 58-year-old patient with Peutz-Jeghers syndrome and history of multiple malignancies (thyroid, breast and colon cancer) who presented with metrorrhagia is reported. The dilatation and curettage revealed endometrial adenocarcinoma. The patient underwent total abdominal hysterectomy with bilateral oophorectomy. The histologic examination showed an endometrioid endometrial adenocarcinoma that developed in atypical endometrial hyperplasia. The histologic examination of the right ovary revealed a sex cord tumor with annular tubules, measuring 3 cm. Sex cord tumors with annular tubules in patients with Peutz-Jeghers syndrome are usually small, bilateral tumors of the ovaries which have common characteristics with granulosa cell tumor and Sertoli cell tumor. Hyperestrogenism is a rather common finding with development of estrogen-dependent lesions.

Virilizing ovarian Krukenberg tumor in a 27-year-old pregnant woman. A case report and literature review

A case is reported of a 27-year-old pregnant woman with ovarian tumors, measuring 12 cm and 11.5 cm in the greatest diameter, discovered during investigation for virilization symptoms. Termination of the pregnancy at the 22nd week of gestation and tumorectomy with both adnexa were performed, with the provisional diagnosis of arrhenoblastoma. Pathological examination of the tumors showed typical Krukenberg neoplasms and subsequent upper GI tract endoscopy revealed a gastric cancer that was excised. The pathological examination revealed a diffuse type gastric adenocarcinoma with signet ring morphology, similar to ovarian tumors. In any case of ovarian tumor with unusual hormonal manifestations, in addition to hormonally active sex cord-stromal neoplasms, metastatic ovarian tumors must be considered as well, especially in cases of bilateral tumors.

Cervical adenocarcinoma with clear cell morphology. report of six cases and literature review

Clear cell cervical adenocarcinoma (CCA) is a rather rare malignancy of the genital tract. We report six cases of CCA, diagnosed in our laboratory during a 15-year period: five patients with sporadic primary CCA and one young patient with CCA and a history of in utero exposure to DES. The possible DES exposure, clinicopathological findings as well as the differential diagnosis and the the prognosis of such patients are presented in a mini-review of the literature.

Monodermal teratomas (struma ovarii). Clinicopathological characteristics of 11 cases and literature review

During the last 15 years in the Pathology Laboratory of Aretaieion University Hospital, 256 cases of teratomas were examined and 11 cases (4.3%) presented characteristics of struma ovarii. Eight patients aged 19-34 years and four 41-74 years (median 41 years). One 74-year-old patient presented with virilization signs but pain and a pelvic mass were the most frequent symptoms. The tumors were unilateral in 9/11 cases, the size ranged from 5-17 cm, and they were compact or microcystic in 10/11 cases and cystic in one case. Histological pattern was microfollicular in 5/11 cases, solid in 3/11 cases, pseudoglandular in 2/11 cases, with focal clear and oxyphil cell changes, and infiltration of the fibrous wall in one case. Tumorectomy was performed in 9/11 cases and total hysterectomy with adnexa in two cases with large tumors (16-17 cm in diameter). Immunohistochemistry is useful in the recognition of struma in atypical cases. No malignant struma ovarii was observed in our cases. Tumorectomy is the appropriate therapeutic approach because of the benign nature of these tumors despite atypical histological features and the young age of the patients.

Single umbilical artery: fetal and placental histopathological analysis of 24 cases

AIM

24 cases of single umbilical artery (SUA) are presented and the related histopathological findings of the fetuses and placentas examined. SUA is the most common congenital anomaly of the umbilical cord, resulting in the absence of one of the two umbilical arteries. It has an incidence of approximately 2.1% in autopsy material and there is evidence that is associated with anomalies of the fetus and placenta.

MATERIAL-METHOD

The files were reviewed of 24 cases with SUA, out of 1,570 autopsies of fetuses and placentas performed in the Pathology Laboratory of Aretaieion Hospital, due to spontaneous or induced abortions after written parental consent.

RESULTS

The incidence of SUA was 1.6%. Gestational age ranged between the 15th and 33rd week and mother's age ranged from 17-44 years. Three of 24 cases were twin pregnancies; 17/24 fetuses were male. In 21/24 cases complex congenital anomalies were observed and in five of 24 cases chromosomal anomalies were detected. In eight of 24 placentas extensive infarcts were observed; 7/24 dysmaturity, 5/24 severe chorioamnionitis, 3/24 extensive fibrin accumulation and 1/24 chorioangiosis.

CONCLUSION

SUA is an umbilical congenital anomaly associated with severe fetal congenital anomalies and once detected with ultrasound techniques, further and more detailed control of the fetus is considered mandatory.

The use of oestradiol therapy in postmenopausal women after TVT-O anti-incontinence surgery

OBJECTIVE

To investigate whether patients who were treated with TVT-O procedure for urodynamic stress incontinence had a significant improvement in their urodynamic findings and their post-operative symptoms (frequency, urgency, nocturia) if they were treated post-operatively with vaginal oestradiol for 6 months compared to the non-treated group.

METHODS

Prospective randomised study. 190 patients were asked to participate in our study. Finally, a total of 92 patients in group 1 and 91 patients in group 2 completed the study. In group 1, which was the treatment group, patients having the TVT-O procedure for urodynamic stress incontinence were instructed to use post-operatively oestradiol tablets, 25 micrograms (Vagifem, Novo Nordisk) vaginally, once daily, nocte, for 2 weeks and then twice weekly for 6 months. The patients in group 2 (control group) had the TVT-O procedure only. All patients were reviewed in 2 months and again in 6 months time.

RESULTS

There was no statistically significant difference between the two groups concerning pre-operative and post-operative haemoglobin, operative time, hospital stay or return to work. The within group analysis did not show significant differences between pre-operative and post-operative urodynamic data in both groups. Patients treated with vaginal estradiol post-operatively showed a statistically significant reduction in relation to the symptoms of urgency and frequency but not in relation to nocturia and urge incontinence compared to the non-treated group. There is no difference in relation to the efficacy of TVT-O procedure between the groups at 6 months follow-up.

CONCLUSION

It appears that vaginal oestradiol treatment could be offered to postmenopausal patients after a TVT-O procedure having the symptoms of frequency and urgency provided they are aware of the lack of evidence regarding long term benefit.

Granular cell tumor of the female genital system. Clinical and pathologic characteristics of five cases and literature review

The clinical and pathological characteristics of a rare granular cell tumor that developed in the vulva (4 cases) and the breast (1 case) offive women aged 35-52 years are reported. The differential diagnosis from skin carcinomas, melanoma and various soft tissue tumors is emphasized.

A rare case of congenital pulmonary lymphangiectasia, hydrothorax and ascites in a male embryo aborted at 20 weeks of gestation

A case of a male embryo aborted at the 20th week of gestation with extensive ascites, hydrothorax, pulmonary lymphangiectasia and pulmonary hypoplasia is presented together with the pathological findings, the etiology, differential diagnosis, course and therapy of this pathologic entity. Also a short review of the literature is discussed.

Vulvar cancer: prognostic significance of the clinicopathological characteristics

Vulvar cancer is a relatively uncommon neoplasm of the female reproductive system. The aim of this retrospective study was the analysis of the pathologic and clinical characteristics of vulvar cancer and their prognostic significance. During the period January 1996 to December 2005, 82 patients were treated for a vulvar malignancy. The management was surgical.

Primary mixed epithelial and germ cell tumors of the ovary. Two case reports and literature review

Two cases of mixed germ cell and epithelial primary ovarian tumors which developed in women 47 and 57 years of age are reported. In both cases, large teratomas measuring 20 and 21 cm were observed in combination with carcinoids and malignant mucinous neoplasms. A possible common oncogenic mechanism is discussed and a literature review is presented.

Ectopic pelvic spleen. Presentation of two cases

We present two cases of nulliparous women with ectopic pelvic spleens who were hospitalized in our department during the last decade. The clinical and laboratory characteristics and the management of such a rare entity are discussed.

Lesions of the subepithelial stromal zone of the lower female genital tract. An immunopathological study

The stroma often fibroepithelial and ten adenomatous cervical polyps, 12 fibro-epithelial vaginal polyps, 20 non neoplastic cervices, 15 cone specimens with CIN changes and five specimens with infiltrative squamous cell carcinoma was investigated. Vimentin, desmin, actin, collagen III, CD34, ER and PgR were studied using the Ventana Automatic Immunostaining System. A subepithelial stromal layer was detected in 17/20 normal specimens, 16/20 cervical polyps, 10/12 vaginal polyps and in 6/15 cone biopsies but not in neoplastic specimens. Vimentin staining was positive in all fibroepithelial polyps, normal specimens and in 6/10 adenomatous polyps. Actin was negative in the loose subepithelial zone but positive in the underlying stroma. Desmin, alpha-1-antitrypsin and CD34 were detected in isolated cells in normal specimens. ER and PgR were observed in isolated subepithelial cells, with greater density in the cells of the fibromuscular wall. In conclusion, loose mesenchymal stroma in the lower female genital tract of a fibrohistiocytic nature was observed with minimal smooth muscle participation--which is the matrix of vaginal and cervical polyps.

A giant ovarian mucinous cystic neoplasm weighing 8,500 grams with functional stroma. A case report and literature review

Large ovarian tumors weighing more than 5,000 g are rarely reported in the recent literature because of the improvement in health care systems. Such tumors present many challenges in diagnosis and in surgical approach due to severe circulatory and cardiopulmonary complications. The case of a 27-year-old unmarried patient, who complained of progressive increased abdominal girth of more than six months duration, metrorrhagia, constipation and dysuria is presented. A cystic ovarian tumor weighing 8,500 g (after preoperative fluid aspiration) proved to be a mucinous neoplasm of borderline malignancy with functional stroma. Problems in establishing a correct diagnosis are discussed together with a literature review.

Placental chorioangioma and chorioangiosis. clinicopathological study of six unusual vascular lesions of the placenta--case reports

The clinopathological features are presented of two cases of placental chorioangiomas and four cases of chorionagiosis diagnosed in a total of 2,400 placental specimens examined in our laboratory. The differential diagnosis, clinical effects and therapeutic approach are discussed.

Vascular tumors: rare neoplasms of the female genital tract

BACKGROUND

Vascular tumors of the genital tract are rare entities. METHOD-RESULTS: We conducted a retrospective study of such tumors during the period January 1993 up to December 2007. During this period we identified thirteen patients with vascular tumors of the female genital tract. Their age ranged from 28 up to 76 years. More specifically, we identified one patient with angiomyxoma, five patients with angiokeratoma, one patient with vascular malformation, two with cervical hemangioma, two with hemangioma of the uterus and two with ovarian hemangioma.

CONCLUSION

Our 15-year-old experience on the field is presented through description and images of such tumors.

Retroperitoneal ancient schwannoma presenting as an ovarian tumor in a patient with uterine cancer. A case report

Ancient schwannomas are rare tumors of neural origin. We present a case of a retroperitoneal ancient schwannoma by discussing the main symptoms, ultrasound and CT findings, treatment, and histopathological characteristics.

Noncanalized horns of uterus didelphys with prolapse: a unique case in a young woman

The authors report the unique case of a 20-year-old patient with prolapsed uterus didelphys with noncanalized horns, who complained of primary amenorrhea. Clinical examination revealed a rudimentary noncanalized cervix with a third degree prolapse and no palpable uterus. A small prolapsing remnant of a uterus didelphys with 2 noncanalized uterine horns was excised by laparotomy. Ultrastructural examination of subepithelial cervical connective tissue revealed collagen of normal structure, but of low concentration. The etiologies of both the Mullerian ducts anomalies and the genital prolapse are probably multifactorial. Low collagen concentration indicates a constitutional tissue weakness contributing to the development of genital prolapse.

Fallopian tube malignancies: A retrospective clinical pathological study of 17 cases

The aim of this study is to present a retrospective clinical pathological study of 17 cases of tubal malignancies. The 17 cases were diagnosed and treated in our department between July 1985 and July 2005. Clinical information and pathological data were obtained by review of hospital records. Carcinomas were staged according to the FIGO criteria; assignment of stage was made on the operative data and the pathological findings. Four patients had Stage I tumour (23.5%), six had Stage II (35.4%), five patients had Stage III (29.4%) and two had Stage IV (11.7%). The histological type of all our specimens was primary papillary adenocarcinoma of the fallopian tube. Initially, all patients were subjected to surgery. Primary fallopian tube cancer (PFTC) is a rare gynaecological malignancy, similar to ovarian cancer, but with poorer prognosis. The PFTC should be considered in the differential diagnosis of any pelvic mass. The treatment was surgical followed by adjuvant chemotherapy.

Long-term efficacy of tension-free vaginal tape in the management of stress urinary incontinence in women: efficacy at 5- and 7-year follow-up

The objective of the study was to obtain a prospective assessment of the efficacy and the complications associated with the use of tension-free vaginal tape (TVT) for the management of urodynamic stress incontinence at 5- and 7-year follow-up. Sixty-five female patients with stage I cystocele or less who have been operated with TVT procedure for management of urodynamic stress incontinence have been included in the study. At 5-year follow-up, the objective cure rate was 83% and failure rate 9.4%. At 7-year follow-up, the objective cure rate was 80% and the failure rate 13.5%. De novo detrusor overactivity was seen in 9.4% and 11.4% of patients at 5- and 7-year follow-up, respectively. TVT operation is an effective and safe minimally invasive procedure for the management of urodynamic stress incontinence in women without significant cystocele in the long-term follow-up. The 10- and 20-year results are awaited.

A retrospective analysis of borderline ovarian tumors in a Greek university hospital

PURPOSE

The aim of this retrospective study was to analyze the pathologic and clinical characteristics of borderline ovarian tumors.

METHODS/RESULTS

During the period from January 1993 up to December 2002 we found 93 cases of borderline ovarian tumors. The mean age of patients was 44.3 years (range 28.9-59.7 years); 77.4%, 10.8% and 11.8% of patients had Stage I, II and III, respectively. The histological outcomes revealed 52.7% of serous and 41.9% of mucinous origin; 44.1% underwent radical surgery, whereas 55.9% had unilateral salpingo-oophorectomy or cystectomy. The mean follow-up was 84 +/- 22 months. The overall five-year survival was 97.4% and 98% for mucinous and serous tumors, respectively. The survival rate was 100%, 90% and 81.8% in Stages I, II and III, respectively.

CONCLUSION

From our results it can be concluded that borderline ovarian tumors have a favorable prognosis even after conservative management.

Synchronous ovarian and endometrial carcinoma: a strong link to endometriosis?

PURPOSE

To further study the clinicopathological features of synchronous ovarian and endometrial carcinomas.

METHODS

We retrospectively studied all cases of synchronous ovarian and endometrial carcinomas diagnosed in our laboratory over the last 15-year period. The pathological findings were correlated with the clinical records of the patients.

RESULTS

Seven cases of synchronous primary ovarian and endometrial carcinomas were retrieved. The most common presenting symptom was abnormal vaginal bleeding (5 cases, 71.4%). Five patients (71.4%) were postmenopausal and two (28.6%) were nulliparous. All seven patients had Stage I ovarian and endometrial carcinomas of endometrioid histology. Moreover, in all seven ovarian carcinomas endometriosis foci were observed, while atypical endometriosis was found in four of them. With the exception of one patient, who received adjuvant postoperative radiation, all remaining patients were treated with surgery alone. All patients were alive and free of disease at completion of the study.

CONCLUSION

The correct classification of synchronous primary ovarian and endometrial carcinomas is often problematic because of the frequent confusion with their metastatic counterparts. Although the exact etiology remains unclear, endometriosis seems to be a major risk factor for their development.

The role of ovarian transposition in patients with early stage cervical cancer--two case reports

The aim of the study is to present two cases of premenopausal women with early stage cervical carcinoma who underwent ovarian transposition. The role and the advantages of this technique are discussed.

Thermal balloon endometrial ablation: a systematic review

OBJECTIVE

The aim of our study is to review the role of thermal balloon endometrial ablation (TBEA) as an alternative in treating abnormal uterine bleeding.

METHODS

Articles relevant to our review and relevant references from the initially identified articles on the field that were archived by May 2007, were retrieved from Pubmed.

RESULTS

Success rates ranged from 83 up to 94%, with patient's satisfaction ranging from 57 up to 94%. Persisted menorrhagia could reach 17% in some studies.

CONCLUSION

TBEA is an effective alternative method used in the treatment of menorrhagea which results in a significant reduction in menstrual bleeding and high satisfaction rates. However, a longer follow-up is required to determine the role of such a treatment.

Monarc vs TVT-O for the treatment of primary stress incontinence: a randomized study

The aim of the study was to compare the efficacy and complications of the Transobturator tape (Monarc) vs the tension-free vaginal tape obturator (TVT-O) in women with urodynamic stress incontinence. A prospective, randomized study was conducted. One-hundred and twenty patients were included in the study, and 114 of them were available at 12 months follow-up. Sixty-one patients were subjected to the TVT-O procedure and 53 to the Monarc procedure. Subjective and objective cure and improvement rate and complications incidence were assessed. The objective cure rate was 87% for the TVT-O procedure and 90% for the Monarc group. The subjective cure rate was 80% for the TVT-O group and 77% for the Monarc group. The improvement was 13 and 11.5% for the TVT-O and Monarc groups, respectively. There was one accidental injury to the urethra with the Monarc technique. The Monarc technique presents success rates and complications comparable to the TVT-O method at 1 year follow-up.

Assessment of TVT efficacy in the management of patients with genuine stress incontinence with the use of epidural vs intravenous anesthesia

Our aim was to validate the use of intravenous anesthesia as an alternative to epidural anesthesia for the placement of tension-free vaginal tape (TVT) in patients with urodynamic stress incontinence. Eighty-six patients participated in this prospective study. Forty-five patients were operated with intravenous anesthesia and 41 patients with epidural anesthesia. All patients had a full history taken and a complete gynecological examination performed at initial visit. Preoperative and postoperative urodynamic investigations included filling and voiding cystometry, urethral profilometry, uroflow, and cough stress test. Genuine stress incontinence diagnosis was based on the findings of urodynamic investigations. Patients with prolapse more than first degree or detrusor instability were excluded from the study. The objective success rate for patients operated with intravenous anesthesia was 86.6%, whereas for patients operated with epidural anesthesia was 88% at 12 months of follow-up. We had no cases of postoperative bleeding or hematoma development. Postoperative urinary tract infection developed in three cases (3 of 74). Application of TVT procedure with intravenous anesthesia provides comparable results with the use of epidural anesthesia and could be a very good alternative.

Tension-free vaginal tape for elderly women with stress urinary incontinence

OBJECTIVE

To investigate the efficacy of the tension-free vaginal tape (TVT) procedure for the management of stress urinary incontinence (SUI) in elderly women.

METHOD

A total of 55 women aged between 65 and 86 years underwent a TVT procedure for urodynamic SUI. Of these, 15 (27%) had undergone previous surgery for treatment of SUI. Before the TVT procedure, a complete medical history was taken and a gynecologic examination performed.

RESULTS

Operating time ranged between 11 and 35 min (excluding the time of concomitant surgery, if any); hospitalization time ranged between 1 and 5 days; and no severe intraoperative or postoperative complications occurred. Cure occurred in 39 (76%) of 51 evaluable patients and its rate was positively associated with bladder neck mobility. Among patients in whom the angle of displacement on the Q-tip test was less than 30 degrees , 42% became continent whereas among those in whom it was 30 degrees or higher, 90% became continent (P<.001). Among those in whom the angle was between 20 degrees and 30 degrees, 57% became continent, and among those in whom it was less than 10 degrees, 80% remained incontinent.

CONCLUSION

The TVT procedure in elderly women with SUI offers a satisfactory cure rate; however, in patients with significantly decreased bladder neck mobility (an angle <20 degrees on the Q-tip test), the results are not encouraging.

Colpopexy: a modification of Shaw's technique

The efficacy of colpopexy using an autograft is assessed. The method was used in patients with post-hysterectomy vaginal vault prolapse and/or suffering from uterine prolapse complicated by ovarian pathology. Thirty-five patients were subjected to a modified operative procedure based on Shaw's original method and completed with a posterior colporrhaphy. All patients are now free of urinary and/or pelvic symptoms with a functional vagina, after a 48 to 60 months post-operative follow-up. Pelvic cellulitis was observed in two patients and low abdominal pain in three others for a period of 1 month.

Tension-free vaginal tape in the management of recurrent stress incontinence

METHODS

Thirty-three patients with failed previous incontinence surgery had a Tension-free vaginal tape (TVT) inserted. Preoperative evaluation included uroflow, filing and voiding cystometry, urethral profilometry and a Q-tip test. Factors assessed postoperatively included cure, improvement or failure rates at 20.5 months follow-up, complications, and preoperative and postoperative values of a Q-tip test.

RESULTS

The overall success rate was 70% at a mean of 20.5 months follow up (range 12-29 months). In patients with sufficient preoperative mobility of urethra the success rate was 90%, while in patients with a fixed urethra preoperatively the success rate was 33%.

Tension-Free Vaginal Tape Efficacy in Relation to Collagen Quantity of Pubocervical Fascia

OBJECTIVE(S)

To investigate whether the quantity of collagen types I and III in the pubocervical fascia of women with genuine stress incontinence (GSI) affects the efficacy of the tension-free vaginal tape (TVT) procedure.

METHODS

Sixty-three patients participated in the study and were divided in 2 groups as follows: 37 patients with GSI and pelvic organ prolapse stage I (group 1), and 26 patients with pelvic organ prolapse stage I but not GSI (control group). Urodynamic studies confirmed the diagnosis of GSI. Biopsies were obtained during surgery from the pubocervical fascia.

RESULTS

The quantity of collagen types I and III was statistically significantly reduced in patients with GSI compared to the control group. The efficacy of the TVT procedure in patients with a significant reduction in collagen type I was an 82.1% cure. In patients with a significant reduction in collagen type III, the TVT efficacy was an 85.1% cure. The efficacy of the TVT procedure was not statistically significantly different between patients with GSI and a significant reduction in collagen types I and III, and patients with no reduction in collagen types I and III.

CONCLUSIONS

The significantly reduced quantity of collagen types I and III in the pubocervical fascia of women with GSI does not affect the efficacy of the TVT procedure at an average of 25 months of follow-up.

Malignant neoplasms arising in endometriosis: clinicopathological study of 14 cases

During the last 15-year period in our laboratory, 14 cases of malignant change of endometriosis were diagnosed in women 37-70 years of age. Seven cases were adenocarcinomas, one case was an adenosarcoma and six cases presented the morphology of endometrial stromal sarcoma. Eleven cases developed in various sites of the genital system (5/11 in the ovaries, 3/11 in the uterus 2/11 in the vagina, 1/11 in the tubal wall) and three cases in extragenital sites (1/3 in the omentum, 1/3 in the pelvis, 1/3 in the colon). Immunohistochemical investigation for the expression of cytokeratines, vimentin, hormonal receptors, E-cadherin, desmine and smooth muscle actin was performed by a streptavidin-biotin method. The immunopathology profile and follow-up results after therapy are presented.

Mucinous tumors of the appendix presenting as primary tumors of the ovary. Report of two cases

Primary tumors of the appendix are rare and most of them are unrecognized preoperatively, presenting as appendicits, pelvic masses or with no typical abdominal pain. Two cases of mucinous tumors of the appendix presenting as primary ovarian tumors are described. It is important for the gynecologist-oncologist to include mucinous tumors of the appendix into the differential diagnosis of any case of mucinous ovarian tumor and peritoneal pseudomyxoma, especially when these tumors are associated with extraovarian disease.

Primary fallopian tube cancer--a ten year review. Clinicopathological study of 12 cases

Primary fallopian tube cancer is the rarest of all gynecologic cancers, presenting as benign pelvic disease or more often as ovarian cancer and almost all cases are diagnosed at operation or autopsy. Primary adenocarcinoma is the most common histological type of primary tube cancer which has traditionally been managed and treated in the same manner as epithelial ovarian cancer. However, unlike ovarian cancer, fallopian tube cancer is not routinely suspected and treatment may be delayed and also seems to have a worst prognosis than ovarian cancer. We present a retrospective study involving 12 patients with primary fallopian tube cancer treated in our department. The clinicopathologic characteristics and treatment are reviewed.

Q-tip test and tension-free vaginal tape in the management of female patients with genuine stress incontinence

INTRODUCTION

To compare the Q-tip test before and after performance of the tension-free vaginal tape (TVT) procedure in women with genuine stress incontinence, and to determine the value of the Q-tip test in order to predict the outcome of TVT.

METHODS

Thirty-one patients with a diagnosis of stress incontinence but without previous anti-incontinence surgery (group I) and 10 patients with stress incontinence and a history of previous anti-incontinence surgery (group II) participated in the study. None of these patients had an anterior vaginal wall prolapse of greater than stage I according to the International Continence Society Classification and, therefore, the TVT procedure was the only operation performed on these patients. Urethral mobility using the Q-tip test was assessed by the same examiner at the initial physical examination and at the 6-month follow-up examination. Cure was defined as no leakage of urine postoperatively either subjectively or objectively, while failure was defined the objective loss of urine during the stress test.

RESULTS

The mean preoperative and postoperative Q-tip measurement in patients without previous operation (group I) was 43.5 +/- 5.84 and 33.38 +/- 4.77 degrees, respectively (mean difference 10.12 degrees), while the cure rate was 87.1%. The mean preoperative and postoperative Q-tip measurement in patients with previous operation (group II) was 17.5 +/- 4.44, and 11.1 +/- 6.88 degrees, respectively (mean difference 6.4 degrees), while the cure rate was 40%.

CONCLUSIONS

Adequate mobility of the proximal urethra is associated with a high success rate of the TVT procedure.

Burch colposuspension and tension-free vaginal tape in the management of stress urinary incontinence in women

OBJECTIVE

Objective of the study was to compare the efficacy and the complications of tension-free vaginal tape (TVT) and Burch colposuspension in the treatment of female genuine stress incontinence (GSI).

METHODS

In this controlled, prospective, randomized study, participated 35 patients who underwent Burch colposuspension and 36 patients that underwent TVT procedure. Patients with prolapse more than first degree, previous surgical treatment of stress urinary incontinence (SUI) and detrusor instability were excluded from the study.

RESULTS

The operative time for TVT was significantly shorter compared to BC. The severity and duration of postoperative pain for TVT was significantly less compared to BC. The necessary time for return to normal activity was 10 days for TVT and 21 days for BC. The cure rate after 24 months of follow-up was as follows: TVT: 84% and BC: 86%, while the improvement was 7% for TVT and 6% for BC.

CONCLUSIONS

TVT and Burch colposuspension are equally effective in the management of female GSI at two years follow-up. TVT procedure requires much less operative time, has much shorter hospitalization time, with significantly less postoperative pain and faster return to normal daily activities than Burch colposuspension.

Ureteral injuries during gynecological surgery

The purpose of this study was to review the cases of ureteric injuries during major pelvic surgery that occurred in our department over the last 15 years, in relation to possible predisposing factors and patient management according to the type of injury. From 5,122 major gynecologic operations we found 18 cases of ureteric injury, including 4 cases of urinoma. Parameters that were examined included the indication for surgery and the type of operation, coexisting pathological conditions, the position of and the delay in recognition of the ureteric damage. The incidence of ureteric injury was 0.35%. The time of recognition of injury in 9 cases was during primary surgery and end-to-end anastomosis was performed, whereas in the other 9 cases the injury was recognized after surgery and repair of the ureter was performed, with reimplantation into the bladder in 4 cases and end-to-end anastomosis in 5. Action to prevent the development of iatrogenic ureteral injury must be taken in advance, and the management of ureteric injuries could be improved with prompt recognition and repair by a skilled surgeon.