Transperitoneal vs extraperitoneal approach for aortic sentinel node detection in endometrial cancer.

BACKGROUND: Although the sentinel lymph node technique in endometrial cancer is currently replacing pelvic and aortic lymphadenectomy for the evaluation of lymph node status in endometrial cancer, its performance is not yet standardized. OBJECTIVE: This study aimed to describe the detection rates and locations of aortic sentinel lymph node detection after dual cervical and fundal indocyanine green injection in patients with endometrial cancer, using the transperitoneal and extraperitoneal approaches. STUDY DESIGN: Between June 26, 2014 and December 31, 2019, 278 patients underwent laparoscopic surgery for endometrial cancer at our institution. In all cases, we performed sentinel lymph node biopsy with dual cervical and fundal indocyanine green injection, and back-up lymphadenectomy in high-risk cases. A post hoc analysis was performed to evaluate differences between the transperitoneal and extraperitoneal approach to aortic sentinel lymph nodes. RESULTS: The detection rates were as follows: overall detection rate: 93.2% (259/278); pelvic detection rate: 90.3% (251/278); bilateral pelvic detection rate: 68.0% (189/278); aortic detection rate: 66.9% (186/278); and isolated aortic detection rate: 2.88% (8/278). Transperitoneal and extraperitoneal aortic detection rates were similar (65.0% and 69.6%, respectively), with no significant differences (P=.441). Isolated aortic metastases were similar in both groups (2% vs 4.7%, respectively; P=.185). The laterality of aortic sentinel lymph node detection was influenced by the surgical approach (P=.002), but not its location above or below the inferior mesenteric artery (P=.166 and P=.556, respectively). CONCLUSION: The detection rates at the aortic level were similar between the transperitoneal and extraperitoneal approaches, with no impact on subsequent pelvic detection. The transperitoneal approach detected more laterocaval, precaval, and interaortocaval nodes, whereas the extraperitoneal approach detected more preaortic and left lateroaortic nodes.

Risk factors associated with stress urinary incontinence 12 years after first delivery.

INTRODUCTION AND HYPOTHESIS: This study was aimed at investigating risk factors involved in stress urinary incontinence (SUI) 12 years after first delivery. We also evaluated cumulative incidence, severity, and impact on quality of life (QoL) of SUI. We hypothesized that changes during the first pregnancy might be associated with SUI long after delivery. METHODS: A longitudinal cohort study was undertaken including primigravid women who delivered in our hospital during 2007. SUI was assessed following definitions of the International Continence Society. Severity was evaluated using the Incontinence Severity Index and impact on QoL with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Comparisons between continuous variables were performed using Student's t test and between qualitative variables using Chi-squared tests. A logistic regression model was constructed including variables that reached statistical significance (p < 0.05) in the univariate analysis. RESULTS: During the inclusion period, 479 pregnant women were interviewed, 381 attended the 6-month follow-up, and 318 completed the questionnaires 12 years after and formed the study group. The cumulative incidence of SUI at 6 months and 12 years postpartum was 14.2% and 39.6% respectively. Generally, SUI severity was slight (73.0%) or moderate (28.9%) and its impact on QoL was low. Pregnancy SUI (OR: 2.14; 95% CI: 1.29-3.55) was independently associated with SUI 12 years postpartum. CONCLUSION: The cumulative incidence of SUI increases markedly from 6 months to 12 years postpartum, being slight or moderate in severity and having a low impact on QoL in most cases. Developing SUI during pregnancy doubled the risk of SUI 12 years postpartum.

Factors involved in the persistence of stress urinary incontinence from postpartum to 12 years after first delivery.

AIMS: The aim of this study was to investigate constitutional-, pregnancy-, labor-, and delivery-related factors involved in the long-term persistence of stress urinary incontinence (SUI) from 6 months postpartum to 12 years after first delivery. We also evaluated severity and impact on quality of life of persistent SUI. METHODS: This was a longitudinal study including primigravid women who gave birth at our Public Health Hospital during 2007. Urinary symptoms were investigated at inclusion, 6 months and 12 years after delivery. Persistent SUI was defined as SUI reported both at 6 months postpartum and 12 years after first delivery. The International Consultation on Incontinence-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the Incontinence Severity Index (ISI) were used to evaluate SUI. RESULTS: During the inclusion period, 479 pregnant women were interviewed, 381 attended the 6-month follow-up visit, and 315 formed the study group. SUI persisted in 36 out of 44 (81.8%) women. With the ISI, 52.8% of these women were categorized as having slight, 41.7% moderate, and 5.6% severe incontinence. The mean ICIQ-UI-SF score was 7.13 (SD 3.51). Pregnancy SUI (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.10-9.80) and active second stage of labor more than or equal to 1 hour (OR, 3.68; 95% CI, 1.21-11.14) were independently associated with persistent SUI. CONCLUSIONS: Women who reported SUI during pregnancy, and those who had pushed for more than or equal to 1 hour in the second stage of labor were at greater risk of SUI persisting from 6 months postpartum to long after delivery. We found this independent association after controlling for several constitutional-, pregnancy-, labor-, and delivery-related variables.