Importance of addition of HPV DNA testing to the cytology based cervical cancer screening and triage of findings with p16/Ki67 immunocytochemistry staining in 35 and 45 years old women LIBUSE trial data analysis.

OBJECTIVE: The study evaluates results of 2-years follow-up of patients in ages 35-36 and 45-46, who are participating in the project LIBUSE, that deals with efficacy of HPV DNA and Pap smear co-testing and p16/Ki67 dual staining in the Czech national cervical screening. DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynecology, General University Hospital and 1st Medical Faculty, Charles University, Prague. MATERIALS AND METHODS: Out of all women enrolled in the project LIBUSE only those who were at the beginning of the study 35-36 and 45-46 years old were sellected. Conventional Pap smear and HPV DNA test (Cobas 4800, Roche Diagnostics) had been collected at the baseline. Women were stratified according to their results in the three risk groups: 1. low-risk, 2. high-risk and 3. intermediate risk, who subsequently underwent p16/Ki67 dual staining. All high-risk patients and those with positive result of dual staing were refered to the expert colposcopy. The cases with biopsy proven precancers or cancers were considered as „positive findings“. RESULTS: Altogether 352 women meet the age requirements. In 26 (7.6%) women had been proven HPV DNA positivity and out of the them 9 cases were HPV 16/18 positive. Severe cytological abnormality was found only in one patient (0.3%), who was simultaneously HPV positive. Ten women (2.8%) were classified as high-risk and directly refered to colposcopy. Another 18 patients underwent p16/Ki67 dual staining and 4 positive cases were refered to colposcopy too. After one year further 9 patients were classified as intermediate risk and 6 more were identified after two years of follow-up. Within two years 9 more patient were refered to colposcopy. After the entire period of follow-up in 10 patients biopsy confirmed precancer lesions, none of them had invasive cancer. CONCLUSIONS: Addition of HPV DNA testing with selective HPV 16/18 genotyping to the cytology based screening significantly increases sensitivity and safety of our cervical screening program.

Idiopathic polyhydramnios.

OBJECTIVE: A comprehensive overview on idiopathic polyhydramnios and associated complications. DESIGN: Review article. SETTING: Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and Hospital Na Bulovce, Prague, Czech Republic; Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic. METHODS: Literature search using the databases Web of Science, Ovid, Cochrane, Medline databases and an analysis of articles published in peer-reviewed journals with impact factor in the years 1958-2020. RESULTS: Polyhydramnios occurs in 0.2-2% of pregnancies. Pregnancies with polyhydramnios are more often complicated by abnormal foetal lie or presentation and, moreover, should be associated with adverse pregnancy outcomes, particularly with the higher incidence of intrauterine foetal death, placental abruption, labour induction, caesarean sections, prolonged first stage of labor and shoulder dystocia. CONCLUSION: The moderate and severe forms of idiopathic polyhydramnios are associated with the higher risk of adverse pregnancy outcomes that implies the need for intensive monitoring of a pregnant woman and the foetus both in pregnancy and during the delivery itself.

Syndrome Mayer-Rokitansky-Küster-Hauser - uterine and vaginal agenesis: current knowledge and therapeutic options.

OBJECTIVE: Evaluation of existing knowledge of etiopathogenesis, clinical manifestations and treatment options to increase quality of life in women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH). DESIGN: Review article. SETTING: Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague. METHODS: Literature search using the Web of Science, Google Scholar and Medline databases with keywords (absolute uterine infertility factor, AUFI, Mayer-Rokitansky-Küster-Hauser syndrome, MRKH, uterine transplantation) and analysis of articles published in impact and reviewed journals. RESULTS: MRKH syndrome is defined as congenital agenesis of the upper two-thirds of vagina and uterus in women with normal secondary sexual characteristics and female karyotype (46, XX). The incidence of the syndrome is 1 : 4500 births of female sex children. It is the second most common cause of primary amenorrhea. Recent research has focused on elucidating the genetic origin of the disease, focusing on the research of candidate genes that could be participating in the genesis of Müllerian ducts and their derivatives. CONCLUSION: MRKH syndrome now appears as a multifactorial congenital developmental defect based on a combination of genetic predisposition and environmental factors. Modern medicine can help girls with MRKH syndrome to a quality sexual life. It is also able to offer different possibilities of achieving motherhood. In the future, however, further research is needed, in particular on the etiology and pathogenesis of this syndrome to detect a possible genetic basis of the disease.

[Pregnancy in women with solid-organ transplants]. / Tehotenství u zen po transplantacích solidních orgánu.

OBJECTIVE: Evaluation of pregnancies and deliveries in women after solid organ transplantations with respect to the maternal and fetal risks. DESIGN: Overview article. SETTING: Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague. METHODS: Literature search using the Web of Science, Ovid, Cochrane, Google Scholar and Medline databases with keywords (transplantation, pregnancy, immunosuppression) and analysis of articles published in impact and reviewed journals from 1958 to 2017. RESULTS: Pregnancy in patients after solid organ transplantions is associated with the higher risk of complications, particularly preeclampsia, and high incidence of comorbidities. Women after transplantation have an increased risk of premature deliveries and low birth weight newborns. The highest risk of complications is documented after lung transplantation. For immunosuppression in pregnancy inhibitors of calcineurin, azathioprine and prednisone are used. CONCLUSION: Pregnancies and deliveries in women after solid organ transplants are in a high risk. With early transplantation, adequate patient health compensation, properly planned pregnancy, adequate immunosuppressive therapy and specialized prenatal and obstetric care, women can give birth to healthy newborns after transplantation.

[What is the risk of pelvic organ prolapse recurrence after vaginal hysterectomy with colporrhaphy?] / Jaké je riziko recidivy sestupu pánevních orgánu po vaginální hysterektomii s posevními plastikami?

OBJECTIVE: To determine the risk of prolapse recurrence in patients after vaginal hysterectomy with colporrhaphy. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague. METHODS: The trial involved 220 women who underwent vaginal hysterectomy with anterior and posterior kolporrhaphy at our department for uterine prolapse at least grade 2. It was the first vaginal surgery in all of the patients. Subjective feeling of pressure in the vagina and/or palpable mass in the vagina or in front of the vaginal entrance and/or objective finding decline of the vaginal walls or fundus at lest the second degree or repeated surgery for prolapse were considered as a prolapse recurrence. RESULTS: The mean age at the time of vaginal hysterectomy was 66.7 years (range 37-88). Only 11 patients were premenopausal (5%), the others were postmenopausal, a mean time of posmenopause was 16.9 years. The average parity rate of the study group was 2.1. The average duration of the surgery was 68 minutes. Postoperative urinary retention was observed in one patient (0.45%). 156 women were enrolled in the study. The average length of follow-up was 47 months (minimum 24 months). Recurrence of prolapse based on subjective assessment occured in 24 patients (15.4 %) with pressure and resistance in the vaginal introitus. According to objective criteria, the recurrence of prolapse was diagnosed in 33 (21.2%) patients, of which 16 had prolapse of the anterior vaginal wall, three of the posterior vaginal wall (two rectocoele, one rectoenterocoele), eight combination prolapse of anterior and posterior vaginal wall and vaginal vault prolapse was diagnosed in six women. Eight patients (5. 1%) underwent surgery because of prolapse recurrence. The mean interval from primary surgery to the time of reoperation was 24.4 months (range 6-62). CONCLUSION: Patients have to be preoperatively informed about the risk of the prolapse recurrence with the recommendation of appropriate preventive arrangements.

[Lymphedema after vulvar cancer surgery. A prospective study]. / Lymfedémy po operacích karcinomu vulvy. Prospektivní studie.

INTRODUCTION: Prospective detection of postoperative lymphedema of the lower limbs (LLL) in patients after surgery for vulvar cancer using different examination methods and their comparison. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and Gynecology, 2nd Medical Faculty of the Charles University and University Hospital Motol, Prague. METHODS: Totally 36 women were followed after surgery for vulvar cancer. Due to the radicality of surgery the patients were divided into conservative (sentinel lymph node biopsy) and radical (inguinofemoral lymphadenectomy) group. Lower limbs were preoperatively and 3, 6 and 12 months after surgery assessed for the presence of lymphedema by measuring of circumferences, multifrequency bioelectrical impedance analysis (MFBIA) and subjective evaluation of patients. RESULTS: The prevalence of lower limb lymphedema 12 months after surgery diagnosed by subjective evaluation reached 19,44%, by circumference measurement 38,89% and with MFBIA 66,67%. The prevalence of lymphedema after inguinofemoral lymphadenectomy diagnosed by circumference measurement was in 12 months after surgery higher (45.83%) than after the conservative surgery (25%). Risk factors were evaluated 12 months after surgery (age, BMI, adjuvant radiotherapy, type of surgery) and none of them were found to be statistically significant for the development of the lower limbs lymphedema. CONCLUSION: The prevalence of lymphedema significantly depends on the diagnostic method, because they capture lymphedema in its various stages. Due to the high sensitivity MFBIA can be used for the detection of early stages of lymphedema. Preoperative measurement of the lower limbs is important for early detection of postoperative lymphedema.

[The effectiveness of recurrent stress urinary incontinence treatment after Burch colposuspension failure with transobturatory tape procedure]. / Efektivita lécby recidivující stresové inkontinence moci pomocí transobturatorní pásky po seláhní kolposuspenze podle Burche.

OBJECTIVE: To evaluate the safety and efficacy of the transobturatory tape (TOT) procedure in the treatment of female recurrent stress urinary incontinence after the Burch colposuspension failure. DESIGN: Retrospective clinical trial. SETTING: Obstetrics and Gynecology Department, Charles University, 2nd Medical School and Faculty Hospital Motol, Prague. METHODS: The group of fifteen women was treated for recurrent stress urinary incontinence with TOT procedure. Preoperative evaluation consisted of complete urogynecological examination. The cure rate and complications were determined in postoperative follow up 6 weeks and 12 months after the surgery. RESULTS: The mean age was 58.7 (46-64) years. Burch colposuspension was performed 6.4 (1-13) years before current TOT procedure. The cure rate in 12 month follow-up was 86.6% (13 of 15 patients), one patient was improved (6.7%). Postoperative complications occurred in 2 (13.4%) cases--one lower urinary tract infection and one overactive bladder symptomatology cured by anticholinergic therapy. CONCLUSION: The study showed that the TOT procedure is a safe and effective minimally invasive method in the treatment of recurrent stress urinary incontinence after Burch colposuspension.

[Thrombotic thrombocytopenic purpura in pregnancy. Case report]. / Trombotická trombocytopenická purpura v tehotenství. Kazuistika.

OBJECTIVE: Description of case of patient with rare thrombotic thrombocytopenic purpura in pregnancy. SUBJECT: Case report. SETTING: Department of Gynecology and Obstetrics, Charles University and University Hospital Motol, Prague. CONCLUSION: Thrombotic thrombocytopenic purpura (TTP) is a rare and substantial disorder characterized with combination of microangiopathic haemolytic anemia, consumption trombocytopenia and symptoms of organs dysfunction--especially kidneys and neurological deficiency. It's caused by production of microthrombi affecting small blood vessels. These palatelets-rich microtrombi are formed due to deficiency of the enzyme ADAMTS13--metalloprotease which is responsible for cleaving of ultralarge multimers of von Willebrand factor into smaller units. In our case report we describe patient with TTP in pregnancy. Therapy with corticosteroids and immunoglobulines was not effective, improvement of thrombocytopenia appeared after plasmapheresis (total count 14). The delivery was induced at term without complications. Target examination confirmed diagnosis of secondary TTP.

[Czech version of EORTC QLQ-CX24 questionnaire for patients with cervical cancer]. / Ceská verze dotazníku EORTC QLQ-CX24 pro pacientky s karcinomem delozního hrdla.

OBJECTIVE: Translation and validation of the EORTC QLQ-CX24 questionnaire on quality of life into the Czech language and literature. TYPE OF STUDY: Prospective study. SETTING: Dept. of Obstetrics and Gynaecology, 2nd Medical Faculty, Charles University and Faculty Hospital Motol, Prague. METHODS: In concordance with the EORTC guidelines a questionaire for patients with cervical cancer was translated and validated. A group of 14 women who underwent the treatment for cervical cancer filled in the questionaire. T-test was used for the evaluation of the patient's characteristics and the differences in quality of life. RESULTS: We present a Czech version of the questionaire EORTC QLQ-CX24 and the description how to evaulate it. In comparison of the two treatment groups no statistically significant differences have been found. CONCLUSION: EORTC QLQ-CX24 is an internationally accepted questionnaire focused on patients with cervical cancer which should be incorporated into the projects dealing with women undergoing treatment for this disease.

[Effect of cranberry extract capsules taken during the perioperative period upon the post-surgical urinary infection in gynecology]. / Perioperacní podávání kapslí s brusinkovým extraktem 7 gynek v profylaxi uroinfekcí po gynekologických operacích.

OBJECTIVE: To evaluate the effect of cranberry extract capsules taken during the perioperative period upon the post-surgical urinary infection (UTI) in gynecology. DESIGN: Clinical prospective pilot trial. SETTING: Obstetrics and Gynecology Department, Merciful Brothers Hospital, Brno and Obstetrics and Gynecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. MATERIALS AND METHODS: The cohort consisted of 286 women who underwent hysterectomy and/or anterior vaginal repair (with or without anti-incontinence operation) in the above hospitals in the period 1. 9. 2006 -30. 6. 2007. 132 women from among the total were given cranberry extract capsules (equiv. 17,000 mg of fresh fruit) twice a day, 4 days before and 5 days after the surgery. The rest were the control group. The clinical state and the analysis of catheterized urine including bacteriology were determined on the day of surgery and on the 6th postoperative day. Cases with preoperative UTI and those with antibiotic therapy (due to other than urology indications) were excluded from the study. Thus the statistical analysis was made in the remaining 117 patients with prophylactic cranberry capsules and 139 controls. RESULTS: There were 30.8% of positive cultured urines, 18.0% of pyuric specimens and 6.8% symptomatic urinary infections in the group of cranberry prophylaxis. Controls had significant bacteriuria in 27.3%, pyuria in 23.7% and symptomatic UTI in 5.0%. Differences were not statistically significant. CONCLUSION: The intake of cranberry extracts in the perioperative period (4 days before and 5 days after the surgery) did not affect the number of post-surgical UTIs.

Genetic analysis of a bovine viral diarrhea virus 2 isolate from Slovakia.

The identification and genetic characterization of bovine viral diarrhea virus (BVDV) isolate 17237 detected in western Slovakia is described. The analysis of 5'-untranslated region (5'-UTR), autoprotease (Npro) gene, and structural genes (C, Erns, E1, E2) was carried out. The percentage of nucleotide and deduced amino acid identity in analyzed genes implied that the isolate was closely related to the bovine viral diarrhea virus 2 (BVDV-2). Furthermore, the phylogenetic analysis revealed that this isolate fall into BVDV-2b subtype that is sporadic in Europe. The cleavage sites between viral proteins were similar to the ones of a reference strain of BVDV-2.

[Abdominal sacrocolpopexy--simple and still actual method in the treatment of vaginal vault prolapse?]. / Abdominální sakrokolpopexe--jednoduchá a stále aktuální metoda 1écby prolapsu posevního pahýlu?

OBJECTIVE: To evaluate the effectiveness and complications of abdominal sacrocolpopexy in the treatment of vaginal vault prolapse. DESIGN: Review article. SETTING: Obstetrics and Gynecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. METHODS: Review from biomedical database Medline from 1960 till 2006. The articles were found under the key words: vaginal vault prolaps, abdominal sacrocolpopexy, effectiveness, complications, urinary incontinence, female sexual dysfunctions. RESULTS: The effectiveness of surgery is getting near to 100 percent in the smaller groups between 11 and 21 women. The larger groups are presenting greater success rate variability from 85 to 97 percent. The studies with up to 2 years of follow up are giving representative results of the effectiveness of surgery. Prolapse recurrence and cystocele, rectocele, enterocele and stress urinary incontinence occurrance belong among the characteristic failure signs. Studies evaluating abdominal sacrocolpopexy argue low incidence of complications. Complications connected with surgery can be divided to intraoperative and early and late postoperative. Bleeding from injured medial sacral artery, cystotomy, enterotomy and ureterotomy are the most common intraoperative complications. Wound infection, ileus and urinary tract infection are the most often early postoperative complications. Stress urinary incontinence, anterior or posterior vaginal wall descent, recurrence of vaginal vault prolapse and mesh erosion through vaginal wall are characteristic late postoperative complications. CONCLUSIONS: Abdominal sacrocolpopexy can be a method of choice in the treatment of vaginal vault prolapse, mainly because of the low morbidity and high success rate. Polypropylene mesh is the prefered suspension structure but the accurate surgical technique is the most important for the abdominal sacrocolpopexy success and safety.

[Effectivity and complications rate of surgical treatment of stress urinary incontinence with tension-free vaginal tape--Uretex]. / Efektivita a komplikace chirurgické lécby stresové mocové inkontinence pomocí volne ulozene pásky pod uretrou--Uretex.

OBJECTIVE: To evaluate the safety and efficacy of the Uretex tension-free vaginal tape procedure in the treatment of female stress urinary incontinence. DESIGN: Retrospective multicenter clinical trial. SETTING: Obstetrics and Gynecology Department, The Charles University 2nd Medical School and Teaching Hospital Motol, Prague. METHODS: A group of 145 patients with stress urinary incontinence who underwent Uretex tension-free vaginal tape procedure was studied. Procedures were performed from vaginal retropubic route. Patients were operated on in one urological and five gynecological departments in Czech Republic. Preoperative evaluation consisted of complete urogynecological examination, age, parity, body mass index, history of previous pelvic surgery and hormonal status. The cure rate and complications were determined in short-term postoperative follow-up. RESULTS: The mean age was 56 (25-80) years, the median parity was 2.25 (1-4), 113 (78%) patients were slightly overweight (BMI 25-30 kg/m2) and others had normal weight (BMI 20-25 kg/m2). The cure rate after surgery was 903% (131 women). Complications occured in 22 (15.2%) cases. In two (1.4%) patients perforation of the urinary bladder wall occurred. In two (1.4%) women nonperforated injury of bladder wall was postoperatively diagnosed. Retropubic haematoma occurred in another two patients (1.4%). 16 (11%) patients had mild early postoperative complications (eight times short-term urinary retention, six lower urinary tract infections, two urgent symptomatology). Erosion of vaginal wall did not occur postoperatively. All complications were resolved and the patients were free of negative postoperative symptoms 6 month after the procedure. CONCLUSION: This study shows that Uretex tension-free vaginal tape procedure is an effective and safe minimally invasive surgical procedure in the treatment of stress urinary incontinence.

[Lower urinary tract infections in urogynaecology]. / Infekce dolních mocových cest v urogynekologii.

Urinary tract infections belong among the most common infectious diseases in adult women. Sporadic infection is usually not a diagnostic and therapeutic problem. Recurrent lower urinary tract infections significantly decrease the quality of life of the affected women. Colonisation of the vagina, vulva and the perineum by the uropathogens is the main risk factor of any urinary infection, but only concomitant action of some other factor (e.g. immunosuppression, urethral stenosis, urolithiasis, urethral diverticulum, diabetes and urinary incontinence) can induce the recurrent infection. Correct primary treatment and proper used preventive method is highly advantageous not only from the individual but also from the global point of view (high diagnostic and therapeutic expenses, increase of resistance and imminent success decrease of the modern treatment). Continuous low dose antimicrobial treatment is the most common prophylactic modality. Postcoital antimicrobial prophylaxis and immunomodulative therapy are the other used modalities. Local vaginal estrogen therapy is recommended in postmenopausal women. Estrogens improve the symptoms of the urogenital atrophy and decrease the vaginal pH, which is very important in prevention of the pathological bacterial colonisation of the vagina. Decision about the individual therapy and prophylaxis must be preceded by the evaluation of the risk factors with positives and negatives of the used drug.

[Conservative therapy of female urinary incontinence--potential and effect]. / Konzervativní terapie zenské mocové inkontinence--moznosti a efektivita.

Non-surgical treatment of female stress urinary incontinence is not as effective as surgical methods but it is very successful in indicated cases. Rehabilitation of the pelvic floor muscles (Kegel exercises, vaginal cones, and electrostimulation of the pelvic floor muscles), drug treatment (alfa-mimetics, tricyclic antidepressives, estrogens, duloxetin), pessarotherapy and uretral obturator devices represent possibilities of conservative therapy of the stress incontinence. Conservative therapy is the method of choice in the treatment of urge incontinence. The most successful are anticholinergic drugs but they have very frequent serious side effects (dryness of the mucous membranes, accommodation disorders, constipation). Spasmolytics, estrogens and tricyclic antidepressives are the other popular used drugs. Life style modification, bladder training and electrostimulation represent very important parts of the conservative treatment. Effectiveness of the non-surgical treatment of both urge and stress urinary incontinence can not reach 100 percent but it helps very much in the quality of life improvement of incontinent women.

[Contemporary potential of the mini-invasive surgical treatment of the female stress urinary incontinence]. / Soucasné moznosti miniinvazivní chirurgické lécby zenské stresové mocové inkontinence.

In 1994 DeLancey published the hammock hypothesis. According to this theory the increase of the urethral closure pressure depends on the urethral compression by the suburethral supportive tissue and the intraabdominal position of the proximal urethra and the bladder neck are not the main factors ensuring the continence. In connection with this new theory Ulmsten published (in 1996) results of the stress incontinence treatment with the tension-free polypropylene vaginal tape (TVT). This operation represents a revolution in the antiincontinent surgery. The success rate of this procedure is about 90% and it is the same in obese and in non obese women. Concomitant TVT and transvaginal procedures for prolapse do not decrease the effectiveness and do not increase the perioperative and postoperative morbidity. The procedure is connected with some peroperative (bladder perforation, retropubic haematoma), early postoperative (urinary retention) and late postoperative complications (urge incontinence, vaginal protrusion of the tape). In 2003 newly developed tape procedure--TOT (transobturator tape) was an evolutionary step in the improvement of tape procedures. The evaluation of the efficacy and complications rate of this modification is premature up to this time but hitherto positive results predetermine this surgical modality to successful expand.

[Epidemiological aspects of the female urinary incontinence]. / Epidemiologické aspekty zenské mocové inkontinence.

Urinary incontinence is defined as an involuntary loss of urine, which makes social and hygienic problem. It is a symptom with different causes. According to the typical clinical manifestation it is classified as stress, urge, reflex and paradox urinary incontinence. Loss of small amount of urine related to the increase of intraabdominal pressure (during coughing, sneezing or running) is characteristic for stress urinary incontinence. Sudden and uncontrollable voiding with loss of greater amount of urine is typical for urge incontinence. Reflex incontinence means that urinary bladder is emptying without voiding. Paradox incontinence is caused by an acquired smooth muscle weakness of the bladder and it manifests with incomplete emptying and with growing residual urine. Prevalence of urinary incontinence increases with age. Significant increase of female urinary incontinence symptoms is found in fifth and sixth decade. Urinary incontinence in young women is more a dynamic than a permanent symptom but the postmenopausal incontinence obviously does not disappear spontaneously. Urge and mixed incontinence are less frequent than stress symptomatology (between 10 and 15%). According to the prevalence studies only 1,5 to 6% of incontinent women are looking for a medical help. Because the urge symptoms are more limiting, the patients with urge incontinence are searching treatment possibilities more often than those with stress incontinence.

[Abdominal hysterectomy--risk factor in development of urinary incontinence? Results of a questionnaire study]. / Abdominální hysterektomie--rizikový faktor vzniku mocové inkontinence? Výsledky dotazníkové studie.

OBJECTIVE: To evaluate the risk of urinary incontinence development after abdominal hysterectomy for benign gynecological disease. DESIGN: Retrospective questionnaire study. SETTING: Obstetrics and Gynecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. METHODS: Questionnaire study of women in which abdominal hysterectomy for benign gynecological disease was performed from January till December 2001 at our Department of Gynecology and Obstetrics. The questionnaire included questions about symptoms of stress, urge and mixed urinary incontinence. They were evaluated in connection with age, parity, hormonal status and body mass index. Student t-test was used for the statistical analysis. RESULTS: 114 (59.7%) from all sent-out questionnaires were obtained. In 15.8% cases (18 from 114) de novo urinary incontinence after surgery developed. 77.8% (14 from 18) from these patients suffered from genuine stress incontinence. The rest (4 from 18) of the women had symptoms of mixed incontinence. Study results draw attention to 13.1% women (15 from 114) in which preoperative stress incontinence persisted even after hysterectomy. Preoperative stress incontinence was cured in 6.1% (7 from 114) cases after hysterectomy. Age, parity, hormonal status and body mass index were not statistically different in all groups after surgery. CONCLUSIONS: The results of the study show relatively high risk of urinary incontinence development after abdominal hysterectomy in previously continent women. The results also show high persistence of the stress incontinence symptoms in women who did not inform about their incontinence even if they were asked about it. Higher quality of further health education of the women with drawing their attention to both the possibility of surgical treatment of urinary incontinence simultaneously with hysterectomy are the most important aspects how to make the current gynecological surgical therapy more effective.

[Prevalence of the female urinary incontinence. Results from a questionnaire study]. / Prevalence zenské mocové inkontinence. Výsledky dotazníkové studie.

OBJECTIVE: To evaluate the prevalence of urinary incontinence in patients of gynecological practise aged 31-60. DESIGN: Prospective questionnaire study. SETTING: Obstetric and Gynecologic Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. METHODS: Questionnaire study of 561 women aged 31-60 examined with gynecological problems (not for the symptoms of urinary incontinence) from November 2001 till October 2002 in standard gynecological practise. The questionnaire included history, evaluation of urinary continence, lasting of the symptoms, body mass index, obesity, age, parity. Stress, urgent and mixed incontinence and influence on the sexual life were also evaluated. Cochran Mantel-Haenszel test and chi2 test were used for the statistical analysis. RESULTS: The incontinence rate in the group of 533 evaluated patients (95% completed questionnaires from 561) of gynecological practise was 23.8%. 81.1% of incontinent patients in the study suffered from stress urinary incontinence. For an easy survey and analysis the patients were divided into three age groups (31-40, 41-50, 51-60). Prevalence of the urinary incontinence rised with age. Statistically significant lower prevalence of urinary incontinence was in the age group 31-40 (p<0.0005). Influence of parity on the prevalence of incontinence was statistically significant only in the age group 31-40 (p=0.002). Obesity had no statistical impact on prevalence of urinary incontinence (p=0.79). 5.5% of incontinent women suffered from negative effect of urinary incontinence on sexuality; the differencies among the age groups were not statistically significant. CONCLUSIONS: The results of the study show high prevalence of urinary incontinence in population of healthy women of gynecological practise. Low interest for the treatment is in contrast with high prevalence of this symptom. Higher quality of the enlightenment with attention to the prevention and therapy of urinary incontinence in population is the way how to improve quality of lives of the afflicted women.