Gynecologic and Obstetric Investigation最新文献

{"title":"Outcomes Post-laparoscopic Intervention for Accessory and Cavitated Uterine Masses: A Review and a Molecular Insight.","authors":"Ella Barrett-Chan, Karim Alomar, Esra'a Bukannan, Kristy Cho, Jessica A Pilsworth, C Blake Gilks, Paul Yong, David G Huntsman, Mohamed Bedaiwy","doi":"10.1159/000543762","DOIUrl":"https://doi.org/10.1159/000543762","url":null,"abstract":"<p><strong>Background: </strong>Accessory and cavitated uterine masses (ACUM) are rare Mullerian anomalies, defined as an isolated accessory cavitated mass lined with endometrial epithelium.</p><p><strong>Objectives: </strong>This article explores ACUM lesions from two aspects and integrates a case report of a successful laparoscopic-assisted intervention for ACUM in a 24-year-old woman with refractory dysmenorrhea with a review of current literature on laparoscopic surgical techniques. Unique to this case was the process of undergoing targeted genetic sequencing via the Find ITTM Panel Version 3.4 on the ACUM, looking for mutations in KRAS, PIK3CA, and FGFR2. A process that was inspired by recent reports that indicate that even normal endometrium can harbor cancer-associated mutations.</p><p><strong>Methods: </strong>A comprehensive search of Ovid MEDLINE and Embase was performed. Studies were selected if they explored laparoscopic surgery's impact on ACUM patients' outcomes related to fertility, menorrhagia, or dysmenorrhea. Risk of bias assessment was performed using the JBI Critical Appraisal Checklist.</p><p><strong>Outcome: </strong>From 160 articles identified, 25 full-text articles were analyzed with a total of 75 unique patients discussed. Dysmenorrhea was present in 100% of cases (n=75/75), and laparoscopic resection improved patient symptoms in 84% (n=63/75) of cases. The mass excised in the case was positive for somatic missense mutations in RET (R813W) and HRAS (G12S) genes, identified at low variant allele frequencies.</p><p><strong>Conclusions and outlook: </strong>These results demonstrated that laparoscopic surgical approaches are effective and frequently the first surgical approach chosen for the treatment of ACUM, but that techniques to treat these conditions are not standardized. This case is the first to demonstrate mutations in ACUM, suggesting a potential role for cancer-associated somatic mutations in their genesis. Future developments in this area may include sending more of these samples for genetic analysis, improving our understanding of how these lesions are formed, while also working to standardize how they are removed.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-16"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Artificial Intelligence in Gynecologic Oncology Decision Making: A Feasibility Study.","authors":"Iason Psilopatis, Nadezda Sipulina, Frederik A Stuebs, Felix Heindl, Patrik Poeschke, Simon Bader, Annika Krueckel, Peter A Fasching, Matthias W Beckmann, Julius Emons","doi":"10.1159/000544751","DOIUrl":"https://doi.org/10.1159/000544751","url":null,"abstract":"<p><strong>Objective: </strong>To examine the potential of artificial intelligence (AI) in gynecologic oncology decision making.</p><p><strong>Design: </strong>Feasibility study.</p><p><strong>Setting: </strong>Fictive.</p><p><strong>Participants: </strong>Fictitious case vignettes of gynecologic carcinomas.</p><p><strong>Methods: </strong>Fictitious case vignettes of gynecologic carcinomas were created and evaluated by physicians with varying levels of professional experience, as well as by language models including Chat-GPT 4.0, Google Gemini, and Bing-Copilot. Treatment approval decisions were based on standardized clinical and laboratory criteria.</p><p><strong>Results: </strong>Two cases of breast cancer, one case of ovarian cancer, one case of cervical cancer and one case of endometrial cancer were evaluated. All three language models were able to evaluate all clinical cases and make therapy-relevant suggestions, with Chat-GPT providing the most clear and concise recommendations that were in three cases totally consistent with physician assessments.</p><p><strong>Conclusions: </strong>The study demonstrates that AI models, such as Chat-GPT, can to some extent evaluate clinical cases, recognize clinical and/or laboratory abnormalities and make therapy-related suggestions. Despite high overall agreement, differences were predominantly noted in the more complex cases, rendering human interpretation necessary. The findings underscore the benefits of AI in terms of clarity, time efficiency, and cost-effectiveness. Future research should further explore the application of AI to real patient data and development of hybrid decision models to optimize integration into clinical practice.</p><p><strong>Limitations: </strong>Feasibility study with five fictitious case vignettes.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-15"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of potential diagnostic biomarkers and drug targets for endometriosis from a genetic perspective: a mendelian randomization study.","authors":"Yingjia Zhu, Feng Cheng, Linling Zhu, Xinyun Yang, Mingjie He, Wenhui Wang","doi":"10.1159/000543707","DOIUrl":"https://doi.org/10.1159/000543707","url":null,"abstract":"<p><strong>Introduction: </strong>Endometriosis (EM) is a chronic disease severely impacting reproductive health, with its exact cause still unclear. In-depth understanding of the etiology and pathogenesis of EM from the perspective of genetics and exploring individualized treatment strategies can improve the health and quality of life of patients.</p><p><strong>Methods: </strong>In this study, whole blood cis- expression quantitative trait loci (eQTL) data were used as exposure data, and data from the FinnGen database EM1-2 and EM3-4 were used as outcomes. Summary-data-based mendelian randomization (SMR) methods were used to select genes with causal relationship to the disease. These genes were validated through bioinformatics analysis and real-time quantitative polymerase chain reaction (RT-qPCR) analysis of clinical samples, and potential diagnostic and drug targets were screened through co-localization and molecular docking.</p><p><strong>Results: </strong>Through SMR analysis, seven genes were selected as potential diagnostic markers of EM, namely Eukaryotic Elongation Factor, Selenocysteine-TRNA Specific (EEFSEC), INO80 complex subunit E (INO80E), RAP1 GTPase activating protein (RAP1GAP), Lipid Droplet Associated Hydrolase (LDAH), Ring Finger And SPRY Domain Containing 1 (RSPRY1), HLA Complex Group 22 (Non-Protein Coding) (HCG22) and Adenosine Kinase (ADK). Colocalization analysis showed that EEFSEC, HCG22, INO80E and RSPRY1 could be used as potential drug targets.</p><p><strong>Conclusions: </strong>The study identifies potential diagnostic markers and drug targets for EM from a genetic perspective, providing new directions for drug development and precision medicine for EM treatment.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-22"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics of women with surgical signs of superficial peritoneal endometriosis but a negative histology: A nested case-control study.","authors":"Fernando M Reis, Pietro Santulli, Louis Marcellin, Mathilde Bourdon, Chloé Maignien, Charles Chapron","doi":"10.1159/000543910","DOIUrl":"https://doi.org/10.1159/000543910","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the clinical characteristics of women with superficial peritoneal endometriosis (SUP) diagnosed by surgery and not confirmed by histology, compared with histologically proven SUP.</p><p><strong>Design: </strong>Single-center, nested case-control study. Participants/Materials: Patients with a surgical report of SUP (n = 390), comprising a subgroup with histological confirmation of endometriosis (n = 245) and a subgroup without it (n = 145). In addition, we enrolled a control group (n = 390) among non-pregnant patients submitted to a laparoscopy or laparotomy for a benign gynecologic condition without any macroscopic sign of endometriosis.</p><p><strong>Setting: </strong>University hospital.</p><p><strong>Methods: </strong>Data synthesis, descriptive statistics, chi-square test and one-way analysis of variance followed by Tukey's test.</p><p><strong>Results: </strong>All groups had similar age, body mass index, smoking prevalence, serum AMH levels and menstrual cycle patterns. However, the two SUP subgroups had the same prevalence and intensity of endometriosis symptoms. The SUP/histology-negative subgroup was more likely to have a familial history of endometriosis (14% vs. 1%) or a personal history of primary infertility (29% vs. 19%) or primary dysmenorrhea (50% vs. 33%) compared to the control group (all p values <0.01). The intensity scores for dysmenorrhea, deep dyspareunia and non-cyclic chronic pelvic pain were severer in both SUP subgroups than in the control group (p<0.05).</p><p><strong>Limitations: </strong>The participants underwent surgery, so their symptoms may not represent groups with initial or mild disease that responded to medical treatments. Due to the retrospective design, performance bias cannot be ruled out.</p><p><strong>Conclusions: </strong>Patients with suspected SUP lesions and a negative histology had clinical characteristics resembling those with proven endometriosis. Further characterization with molecular biomarkers is needed to explain why these women are so symptomatic in the absence of histological hallmarks of the disease.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation analysis of serum vitamin C and pelvic organ prolapse in middle-aged and elderly women: based on NHANES database.","authors":"Zexuan Zhou, Qiao Wei, Jiashou Luo, Junchao Zheng, Qian Ye, Xin Fan, Meixian Fang","doi":"10.1159/000544539","DOIUrl":"https://doi.org/10.1159/000544539","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the association between serum vitamin C and pelvic organ prolapse (POP) in middle-aged and elderly women.</p><p><strong>Method: </strong>The 2005-2006 National Health and Nutrition Examination Survey (NHANES) database was used for cross-sectional study. The quartile method was employed to stratify the concentration of vitamin C. A serum vitamin C and POP weighted logistic regression model was constructed by adjusting for different confounding factors. All confounding factors were adjusted for interaction tests. Subgroup analysis was conducted to delve into the correlation of confounding factors with significant interaction term P-values.</p><p><strong>Results: </strong>A total of 760 samples were included in this study. There was a negative correlation between serum vitamin C and POP (OR=0.48, 95%CI: 0.23-0.99, P<0.05), showing that as the concentration of vitamin C increased, the risk of POP tended to decrease. Race, poverty-to-income ratio (PIR), alcohol consumption, hysterectomy, and diabetes can greatly influence the association between the two (P for interaction <0.05). Especially in populations with a PIR of 1.3-3.5 (OR=0.05, 95%CI: 0.01-0.28, P＜0.001), no alcohol consumption (OR=0.17, 95%CI: 0.07-0.46, P＜0.001), and no hysterectomy (OR=0.27, 95%CI: 0.08-0.85, P＜0.05), there was a strongly negative correlation between serum vitamin C and the risk of POP.</p><p><strong>Conclusion: </strong>In middle-aged and elderly women, there is a strong negative correlation between serum vitamin C and the risk of POP, especially in populations with a PIR of 1.3-3.5, no alcohol consumption, and no hysterectomy.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-16"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Ketogenic Diet on Weight, Metabolic, and Endocrine Parameters in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.","authors":"Camilla Turetta, Andrea Giannini, Maria Grazia Tarsitano, Daniele Gianfrilli, Antonio Paoli, Evangelos Kontopantelis, Emanuele De Angelis, Marianna Minnetti, Eleonora Poggiogalle, Andrea Colizza, Marco De Vincentiis, Antonio Simone Laganà, Giorgio Bogani, Innocenza Palaia, Ludovico Muzii, Violante Di Donato","doi":"10.1159/000543941","DOIUrl":"https://doi.org/10.1159/000543941","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Introduction Polycystic ovary syndrome (PCOS) is a widespread disease among women of childbearing age. This pathology embraces a complex spectrum of clinical manifestations. An altered secretion of gonadotropins and high levels of androgens determine menstrual irregularities and ovulatory dysfunction, infertility, hirsutism, alopecia and acne. Moreover, hyperinsulinemia and insulin-resistance (IR) are common, leading to an increased metabolic risk. Whilst various pharmacological strategies have been studied to manage PCOS, the role of lifestyle should be emphasized. Numerous studies highlight the fundamental role that diet plays in the regulation of these hormonal imbalances. The hypothesis that a low-carbohydrate diet, such as the ketogenic diet (KD), may be beneficial in patients with PCOS has been evaluated in some clinical studies. The aim of the present systematic review and meta-analysis has been to evaluate through anthropometric, metabolic, and hormonal parameters the impact of KD in overweight or obese patients with PCOS. Methods A research question according to the PICOS framework was formulated, and a literature search following the PRISMA criteria for systematic review was performed. Studies that reported the following outcomes were included: weight loss, body mass index (BMI), circulating levels of glucose, insulin, Homeostasis Model Assessment - Insulin Resistance (HOMA-IR), LDL- cholesterol, HDL- cholesterol, triglycerides, luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH, estrogens, progesterone, anti-müllerian hormone (AMH), total-testosterone (total-T), free-testosterone (free-T), sex-hormone-binding-globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), pregnancies and live births. The extracted data were analyzed, and pooled results were expressed as standardized mean difference (SMD) with 95% Confidence Interval (CI). Results Seven studies were included in the systematic review. The results of the meta-analysis showed that after KD the patients had a significant weight loss (standard mean difference or SMD 1.31 Kg [95% CI 0.45, 2.17] p=0.003) and lower BMI (SMD 1.27 kg/m2 [95% CI 0.71, 1.83], p&lt;0.001). Blood glucose (SMD 1.36 mg/dL [95% CI 1.08, 1.64], p&lt;0.001), insulin (SMD 1.15 µU/mL 95% CI [0.60, 1.70], p&lt;0.001) and HOMA-IR (SMD 1.84 [95% CI 0.72, 2.96], p=0.001) were all decreased, and lipid profile was improved with higher HDL (SMD 0.38 mg/dL [95% IC 1.45, 0.68], p=0.48, not significant), lower LDL (SMD 0.73 mg/dL [95% CI 0.03, 1.42], p=0.04) and lower triglycerides (SMD 1.11 mg/dL [95% CI 0.53, 1.68], p&lt;0.001). Moreover, LH concentrations were significantly reduced (SMD 1.12 ng/dL [0.39, 1.84] p=0.003), FSH levels raised (SMD -0.76 ng/dL [-1.25, -0.28], p=0.002), the LH/FSH ratio decreased (SMD 2.04 (95% CI 1.04-3.03, p&lt;0.001); testosterone decreased (free-T SMD 0.57 ng/dL [95% CI 0.28, 0.86], p&lt;0.001; total-T SMD 0.54 ng/dL, 95% CI 0.28, 0.80, p&lt;0.001), and SHBG levels were significantly inc","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-22"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Potency of Adipose-Derived Mesenchymal Stem Cells to Increase Ovarian Function in Primary Ovarian Insufficiency: A Systematic Review of in vivo Studies.","authors":"Yohanes Iddo Adventa, Anita Rachmawatia, Dian Tjahyadia","doi":"10.1159/000544721","DOIUrl":"https://doi.org/10.1159/000544721","url":null,"abstract":"<p><p>Introduction Primary ovarian insufficiency (POI) that caused infertility could decrease the quality of life in women. Therefore, an effective treatment is needed. Adipose-derived stem cells (ADSCs) have been reported to have therapeutic benefits in POI. This review aims to evaluate the therapeutic effect of ADSCs in POI. Methods Literatures were searched according to PRISMA 2020 guidelines in the following databases: PubMed, ProQuest, Wiley, Emerald, and JSTOR (until July 10th, 2024). The study inclusion criteria are original articles, in vivo study with adipose-derived stem cells therapy towards POI with ovarian function as the outcome. SYRCLE's risk of bias tool was used to evaluate the quality of the studies. Results We retrieved 9 from 292 articles published in English between 2013 and 2024. Animals used in this study were mice (n=5) and rats (n=4). ADSCs were administered either systematically or directly by injection into the ovaries. Decreased apoptosis, increased follicle survival, and hormone levels were observed. These showed that ADSCs implantation could improve ovarian function in rats and mice. Overall, ADSCs in POI showed satisfactory results. Conclusion ADSCs showed benefits in increasing ovarian function in POI. Further studies, especially human studies are needed to evaluate the efficacy and side effects of the ADSCs treatment before reaching general conclusions.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-21"},"PeriodicalIF":2.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progesterone vaginal gel or combined medication for luteal-phase support of frozen-thawed embryo transfer cycles: single-centre, Chinese, randomized, open-label, pilot study.","authors":"Ningning Pan, Xiumei Zhen, Yanhong Fan, Jianhuai Zheng, Yuanyuan Wang, Qiao Liu, Xun Liao, Rui Yang","doi":"10.1159/000544065","DOIUrl":"https://doi.org/10.1159/000544065","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore potential differences in efficacy between vaginal progesterone (VPG) and VPG+oral progesterone (OPG) for luteal-phase support in hormone replacement therapy-frozen embryo transfer (HRT-FET) cycles.</p><p><strong>Design: </strong>A single-centre, open-label, randomized controlled, phase IV pilot study.</p><p><strong>Participants/materials, setting, methods: </strong>Infertile women aged 20-38 years undergoing HRT-FET cycles were included. Participants were randomized to VPG (n=86) or VPG+OPG (n=86). The primary efficacy endpoint was ongoing pregnancy at 10-12 weeks. Secondary efficacy endpoints included β-human chorionic gonadotropin (β-hCG) positivity, implantation rate, and clinical-pregnancy rate. Safety analyses included adverse events (AE) and vital signs.</p><p><strong>Results: </strong>A higher ongoing pregnancy rate was observed with VPG+OPG (29.1%) versus VPG (18.8%); treatment difference 8.4% (90% confidence interval [CI] -2.2%, 19.0%). Numerical differences also favoured VPG+OPG over VPG for β-hCG positivity (0.9% [90% CI -10.8%, 12.7%]), implantation (10.4% [90% CI 0.5%, 21.3%]), and clinical pregnancy (10.1% [90% CI -0.8%, 21.1%]). Incidences of treatment-emergent AEs were comparable.</p><p><strong>Limitations: </strong>The single-centre study was limited by a relatively small sample size which could have impacted the reported outcomes. Another limitation was the open-label design, which might have increased the risk of bias for subjective endpoints, such as AE reporting.</p><p><strong>Conclusions: </strong>A higher ongoing pregnancy rate was observed with VPG+OPG vs VPG; however, a statistical conclusion cannot be reached considering the small sample size. These data suggest that a minimum daily progesterone dose, such as VPG 90 mg+OPG 20 mg reported here, or VPG 180 mg reported in other studies, may be required for successful outcomes following HRT-FET cycles.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-19"},"PeriodicalIF":2.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WHEN AND HOW IS SURGERY REQUIRED FOR LARGE ENDOMETRIOMA PRIOR TO IN VITRO FERTILIZATION (IVF): A SURVEY OF PRACTICES.","authors":"Jonas Jean Mathieu Vibert, Milena Alec, Antonio Simone Laganà, Giuseppe Benagiano, Nicola Pluchino","doi":"10.1159/000543673","DOIUrl":"https://doi.org/10.1159/000543673","url":null,"abstract":"<p><strong>Introduction: </strong>Proper management of large endometriomas in patients scheduled for IVF continues to be a matter of debate. While small endometriomas are no longer an absolute indication for surgery, the large ones present unique challenges, potentially impacting ovarian response and follicle accessibility. This study aims to evaluate current practices among gynecologists in managing large endometriomas before IVF.</p><p><strong>Methodology: </strong>An online survey with 18 questions was distributed to gynecologists through various professional societies. The survey addressed their clinical experience, type of practice, threshold size for surgery, surgical techniques used, hormonal treatment protocols, and the timing of ovarian stimulation post-surgery. Data were collected anonymously and analyzed using SPSS 29.0.2.0.</p><p><strong>Results: </strong>Of the 111 respondents, 73% practiced in academic settings, and 61% had over 15 years of experience. Laparoscopic cystectomy was the most common procedure (48.2%). The median threshold size for surgery was 50 mm (IQR 40-60). Despite the same median threshold, surgeons performing laparoscopic surgery as their main clinical activity had a significantly different distribution of thresholds (IQR 40-60 vs. 47-89, p = 0.006), with a tendency to recommend surgery for smaller endometriomas. Techniques like CO2 laser ablation and plasma energy were less commonly used. Notably, 40.5% of participants indicated they would change their practice if a CO2 laser or plasma energy device were available in their surgical armamentarium. Most participants (67.9%) adjusted their strategy based on pre-operative AMH levels. The average timing for IVF stimulation post-surgery was 6 weeks(IQR 4-8) with no difference across different experiences.</p><p><strong>Conclusion: </strong>Managing large endometriomas before IVF involves balancing surgical benefits with risks to ovarian reserve. The survey highlights significant variability in practices, with a median surgical threshold size of 50 mm. Laparoscopic cystectomy, while common, is associated with ovarian tissue loss, whereas emerging techniques like CO2 laser ablation show promise in preserving ovarian reserve. The need for up-to-date evidence-based guidelines is essential to standardize practices and optimize outcomes for IVF patients.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-15"},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of acute or chronic post-void retention after midurethral sling surgery for women with stress urinary incontinence: a systematic review and retrospective analysis of our data.","authors":"Eva Skuk, David Lukanović, Vojka Lebar, Miha Matjašič, Mateja Lasič, Matija Barbič","doi":"10.1159/000543046","DOIUrl":"https://doi.org/10.1159/000543046","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of our study was to analyze the percentage of acute urinary retention after midurethral sling (MUS) surgery for stress urinary incontinence (SUI). The results of our study directed us to conduct a systemic review (SR) because of the need to consolidate existing knowledge on the incidence and management of postoperative urinary retention.</p><p><strong>Design: </strong>The first part of the article presents the SR, which was conducted after the retrospective analyses of our data. Participants/Materials: This article presents a retrospective study conducted on a sample of 55 patients who underwent three different types of MUS surgery: TVT-Abbrevo, TVT-O, and single-incision Ophira Mini Sling.</p><p><strong>Setting: </strong>The study analyzes outcomes at a median 8-year follow-up, focusing on the significance of acute urinary retention after MUS surgery.</p><p><strong>Methods: </strong>SR was conducted using Medline, Cochrane, and Clinical Trials databases, following PRISMA guidelines. The retrospective study involved 55 patients who underwent three types of MUS surgery (TVT-Abbrevo, TVT-O, and Ophira) at our clinic, with a median follow-up of 8 years. Postoperative outcomes, including acute urinary retention and residual urine, were assessed using ultrasound, and success was evaluated through the Patient Global Impression of Improvement (PGI-I) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).</p><p><strong>Results: </strong>The SR has shown that the reported percentage of patients with acute postoperative urinary retention after MUS procedures varies between 1.5% and 6.6%. In our retrospective analyses, five patients had acute urinary retention after the procedure (9.1%) and required the use of a Foley catheter for several days. All three surgical procedures resulted in similar levels of patient satisfaction at follow-up, as indicated by the PGI-I scores and patients' ICIQ-SF scores. The type of procedure and the patients' ICIQ-SF or PGI-I scores do not significantly correlate with the post-void residual volume.</p><p><strong>Limitations: </strong>One of the major limitations in our analyses is the lack of any possibility to compare all TVT approaches, including retropubic. A larger sample size would be necessary to draw more definitive conclusions from these observations.</p><p><strong>Conclusions: </strong>Our SR provides a comprehensive synthesis of previous research on urinary retention after MUS surgery. We noted that many studies fail to consider the possibility of preexisting urinary retention. Clinically significant long-term urinary retention in our cohort of patients was below 100 ml, was not specifically correlated with any type of procedure, and was not statistically correlated with acute urinary retention after operation.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-29"},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}