Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques.

PURPOSE: During the second and the third trimesters of pregnancy and in the first 3 months following childbirth, about one-third of women experience urinary incontinence (UI). During pregnancy and after delivery, the strength of the pelvic floor muscles may decrease following hormonal and anatomical changes, facilitating musculoskeletal alterations that could lead to UI. Pelvic floor muscle training (PFMT) consists in the repetition of one or more sets of voluntary contractions of the pelvic muscles. By building muscles volume, PFMT elevates the pelvic floor and the pelvic organs, closes the levator hiatus, reduces pubovisceral length and elevates the resting position of the bladder. Objective of this review is to evaluate the efficacy of PFMT for prevention and treatment of UI during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. METHODS: The largest medical information databases (Medline-Pubmed, EMBASE, Lilacs, Cochrane Library and Physiotherapy Evidence Database) were searched using the medical subject heading terms "pelvic floor muscle training", "prevention", "urinary incontinence", "urinary stress incontinence", "objective measurement techniques", "pregnancy, "exercise", "postpartum" and "childbirth" in different combinations. RESULTS AND CONCLUSIONS: Overall, the quality of the studies was low. At the present time, there is insufficient evidence to state that PFMT is effective in preventing and treating UI during pregnancy and in the postpartum. However, based on the evidence provided by studies with large sample size, well-defined training protocols, high adherence rates and close follow-up, a PFMT program following general strength-training principles can be recommended both during pregnancy and in the postnatal period.

Complication and recurrence rate in laser CO2 versus traditional surgery in the treatment of Bartholin's gland cyst.

PURPOSE: The treatment of Bartholin's gland cysts by traditional surgery is characterized by some disadvantages and complications such as hemorrhage, postoperative dyspareunia, infections, necessity for a general anesthesia. Contrarily, CO2 laser surgery might be less invasive and more effective as it solves many problems of traditional surgery. The aim of our study is to describe CO2 laser technique evaluating its feasibility, complication rate and results vs traditional surgery. METHODS: Among patients treated for Bartholin's gland cyst, we enrolled 62 patients comparing traditional surgical excision vs CO2 laser surgery of whom 27 patients underwent traditional surgery, whereas 35 patients underwent CO2 laser surgery. Mean operative time, complication rate, recurrence rate and short- and long-term outcomes were assessed. RESULTS: The procedures required a mean operative time of 9 ± 5.3 min for CO2 laser surgery and 42.2 ± 13.8 for traditional surgery. Two patients (5.7 %) needed an hemostatic suture for intraoperative bleeding in the laser CO2 laser technique against 14.8 % for traditional surgery. Carbon dioxide allows a complete healing in a mean time of 22 days without scarring, hematomas or wound infections and a return to daily living in a mean time of 2 days. Instead, patients undergone traditional surgery required a mean time of 14 days to return to daily life with a healing mean time completed in 28 days. CONCLUSIONS: The minimum rate of intra- and post-operative complications, the ability to perform it under local anesthesia in an outpatient setting make CO2 laser surgery more cost-effective than traditional surgery.

Satisfactory sampling in cytological cervical diagnosis: comparison between a conventional and a new sampling device.

AIM: Inadequate cervical sampling is the most frequent cause of misdiagnosis in cervical cancer screening. The aim of this study was to test the ability of PapCone® versus the conventional sampling method (Ayre's spatula plus cytobrush) to collect ectocervical and glandular cells. MATERIALS AND METHODS: In 18 healthy women, two ecto-endocervical samples, obtained by two different methods, were obtained at a three-month interval. Qualitative and quantitative parameters were evaluated. Ultrastructure features of sampling devices were analyzed by scanning electron microscopy (SEM) before and after sampling. RESULTS: The χ(2) test revealed a statistically significant difference between the two methods: PapCone® caused less cell overlap and sampled less white blood cells (p<0.05) and more metaplastic cells (p<0.01). SEM evaluation highlighted the porous and spongy structure of PapCone® that was responsible for the large number of glandular cells on its surface. CONCLUSION: Cervical smears performed by PapCone® were adequate and generally easier to screen than conventionally performed ones.

Prediction of clinical outcome using p16INK4a immunocytochemical expression in low-grade squamous intraepithelial lesions and high-risk HPV-positive atypical squamous cells of undetermined significance in patients with and without colposcopic evident cervical disease.

p16INK4a as a diagnostic marker of a cervical intraepithelial neoplasia of grade 2+ (CIN2+) in atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) cytological samples has been analyzed, but has not yet been included in clinical routine practice. One hundred and ninety-one patients with an abnormal Pap test (84 ASC-US and 107 LSILs) who underwent colposcopy were selected for this study. At enrollment, 96 patients (Group 1) had a positive colposcopy and therefore underwent a cervical biopsy, while 95 (Group 2) had a negative colposcopy and were followed up for up to 1 year. Both groups were tested for p16INK4a using immunocytochemical methods, and the p16INK4a results were correlated with histology or follow-up outcome. In Group 1 ASC-US cases, 82% of lesions less than CIN2 were p16INK4a-negative and all CIN2 cases were p16INK4a-positive (p=0.00044). In Group 1 LSIL cases, 71% of lesions less than CIN2 were p16INK4a-negative and 87% of CIN2/3 were p16INK4a-positive (p=0.00033). Seventy-seven percent of Group 2 ASC-US patients with a negative 1-year follow-up (NF-U) were p16INK4a-negative at enrollment, while all patients with positive follow-up (PF-U) were p16INK4a-positive (p=0.00113). In Group 2 LSIL cases, 83% of patients with NF-U were p16INK4a-negative, while 65% of patients with PF-U were p16INK4a-positive at enrollment (p=0.0014). In fact, 39% of the positive p16INK4a LSIL patients had CIN2+ histological lesions. The positive predictive value of p16INK4a for CIN2+ was 50% in ASC-US and 52% in LSIL cases; the negative predictive value was 100 and 94%, respectively. In conclusion, in our patients, a negative p16INK4a appears to be a marker of the absence of CIN3, while a positive p16INK4a can be correlated with the presence of histological CIN2+ found at enrollment or during the subsequent follow-up. Thus, its clinical predictive value is independent from the colposcopic aspect at enrollment.

Verrucous carcinoma of the cervix: detection of carcinogenetic human papillomavirus types and their role during follow-up.

BACKGROUND: Verrucous carcinoma is a rare variant of well-differentiated squamous cell carcinoma of the uterine cervix. Infection with high-risk human papillomavirus (HPV) is the main cause of intraepithelial and invasive neoplasias of the female genital tract, but the aetiology of verrucous carcinoma is still unknown. The aim of this study was to evaluate the presence of HPV in verrucous carcinomas of the cervix and to investigate the persistence and the role of high risk HPV types in follow-up. PATIENTS AND METHODS: Three patients, with atypical cytologies, were observed. All the patients underwent cytology and colposcopy followed by direct biopsy. The Hybrid Capture II microplate method was used for molecular detection of pre-surgical low- and high-risk HPV types. HPV tests were performed during the follow-up, annually. RESULTS: The cytological findings revealed that atypical squamous cells "cannot rule out high-grade lesion" (ASC-H) in one case and high grade squamous intraepithelial lesion (H-SIL) in two cases. The HPV test detected high risk HPV types. Colposcopic findings showed cervical exophytic lesions. The histology revealed a well-differentiated verrucous carcinoma Ib stage, according to FIGO classification, in every case. Following radical hysterectomy, the post-operative course was uneventful. The mean follow-up time was 4.6 years. The follow-up HPV tests of the H-SIL patients were consistently negative as to cytological and colposcopical findings and no relapse was observed. At one-year follow-up the ASC-H patient who had shown postoperative histological features of koilocytosis associated with CIN2 and VAIN 3 had a persistence of high-risk HPV types with negative cytological and colposcopical findings. The HPV test was positive for two years and colposcopic and histological findings of VAIN degree 2 were revealed three years after surgery. Following vaginal laser CO2 vaporization the subsequently cytological and colposcopic checks were negative as was molecular detection of HPV. CONCLUSION: Follow-up colposcopy, cytology and molecular detection of HPV is recommended in all verrucous carcinoma patients since carcinogenic HPV DNA detection could represent a valuable diagnostic tool as an adjunct to cytology, for monitoring HPV infections with transforming potential.