Oncofertility for gynecologic and non-gynecologic cancers: fertility sparing in young women of reproductive age.

About ten percent of all female cancer survivors is younger than 40 years of age. For these young women the primary goal is to ensure the highest possibility of cure and to maintain the reproductive functions as well. Oncofertility is a new concept including both oncology and reproductive medicine. By this recently defined concept young women will have maximal chance to make an optimal decision without any significant impact and delay in oncologic outcome. Oncofertility concept could be applied for genital cancer as well as non-genital cancer of reproductive age. Currently sperm and embryo banking are the standard methods used for young patients with cancer whose future fertility is under risk. In contrary oocyte banking, ovarian tissue cryopreservation are all controversial procedures and still accepted as experimental by many authors although American Society of Reproductive Medicine (ASRM) consideres oocyte cryopreservation "no longer experimental". For genital cancers procedures for oncofertility depends on the type of the cancer and the treatment of choice. In this review the current data and concepts regarding oncofertility concept including the gynecologic oncologic perspective is reviewed.

Reconstruction of vaginal agenesis.

Vaginal ageneses are by no means rare anomalies. Complete Mullerian agenesis is the most common reason for vaginal agenesis requiring reconstruction. Patients usually present with pain, hematocolpos, or hematometra in puberty, and later with amenorrhea and dyspareunia. Detailed information is given here regarding etiologies, timing of surgery, and current treatment options for vaginal agenesis. Outcomes and short- and long-term complications of recent treatment options are also discussed.

Clinical outcome of transobturator tape concomitant with vaginal hysterectomy plus anterior posterior colporrhaphy.

OBJECTIVE: Transobturator tape (TOT) is a newly described procedure for the treatment of female stress urinary incontinence. The success of TOT operation along with prolapsed surgery has not been well described. The aim of this study is to determine the complication and success rates of TOT concomitant with pelvic prolapse surgery. STUDY DESIGN: Totally, 72 women who had TOT operation along with vaginal hysterectomy, anterior posterior colporrhaphy were re-evaluated with UDI6 and IIQ7 forms 1 year of surgery. Preoperatively, all patients had clinically pure stress incontinence. RESULTS: At 1 year, 80.6% of patients were cured with only 16.7% presenting de novo urge incontinence, while 2.8% of women retaining stress urinary incontinence. The patients with lower gravida and number of vaginal delivery had significantly higher operation success rates. The IIQ7 score significantly increased by increase in urinary catheter stay day. The women with the history of cesarean delivery and lower hospital stay had significantly higher satisfaction scores. Of the factors only, the number of gravida could be used to predict treatment failure in the entire group. CONCLUSION: Transobturator tape procedure could be accompanied safely with prolapse surgery.

Repeat LEEP conization in patients with cervical intraepithelial neoplasia grade 3 and positive ectocervical margins.

OBJECTIVE: To evaluate the effectiveness of repeat loop electrosurgical excision procedure (LEEP) conization in patients with cervical intraepithelial neoplasia (CIN) grade 3 and positive ectocervical margins. METHOD: A retrospective study of 56 women who underwent repeat LEEP conization for CIN 3 and positive ectocervical margins. RESULTS: Final diagnosis after repeat LEEP conization revealed 6 women (10.7%) with microinvasive squamous cell carcinoma (Stage IA1); 1 (1.8%) with CIN 1; 1 (1.8%) with CIN 2; 21 (37.5%) with CIN 3; and 27 (48.2%) with chronic cervicitis. Ectocervical or endocervical margins were negative after repeat LEEP conization in the majority of women, except for 2 patients (3.6%) with CIN 3 and positive ectocervical margins. Recurrence rate for the median follow-up time of 2 years was 6.1% (3 patients). CONCLUSION: Repeat LEEP conization can reveal undiagnosed microinvasive cervical carcinoma in women with positive ectocervical margins.

Testosterone versus clobetasol for maintenance of vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia.

OBJECTIVE: To evaluate the therapeutic regimens and symptomatic response rates in patients with vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia (mixed disease). MATERIAL AND METHODS: Eighty-three women with biopsy-proven vulvar mixed disease were evaluated for this retrospective study. All patients were initially treated with topical fluorinated corticosteroids, and then 2% testosterone propionate in petrolatum or 0.05% clobetasol 17-propionate (44 (53%) versus 39 (47%)). RESULTS: The remission rates were 82 and 93% in the testosterone and clobetasol subgroups at the end of 6 months (p=0.112), respectively. The disease recurred in 8% of the patients. The recurrence rates in the testosterone and clobetasol arms were 13 and 5%, respectively (p=0.163). The histopathological review of the repeat vulvar biopsies of the patients without symptomatic relief revealed 6 (60%) patients with persistent disease, 2 (20%) with lichen sclerosus, 1 (10%) with atypical squamous hyperplasia, and 1 (10%) with VIN1. Two patients with recurrent disease and 2 patients with vulvar intraepithelial neoplasia I-II or atypical squamous hyperplasia were treated with skinning vulvectomy. CONCLUSIONS: Clobetasol resulted in higher remission and lower recurrence rates than those in testosterone therapy, although statistically significant differences were not obtained. In the evaluation of patients without symptomatic relief, the first step should be a vulvar biopsy to exclude the presence of atypical components.