Distal vaginal agenesis.

Cíl: Popis symptomatiky, diagnostiky a operační léčby vzácné vrozené vady ženského genitálního systému - distální vaginální ageneze. Typ studie: Kazuistika. Pracoviště: Porodnicko-gynekologická klinika, FN a LF UP Olomouc; Ústav pro péči o matku a dítě, 3. lékařská fakulta UK, Praha. Vlastní pozorování: U dvou pacientek ve věku 16,5 a 15 let byla na Porodnicko-gynekologické klinice v Olomouci v letech 2018 a 2019 diagnostikována vrozená vývojová vada pochvy - distální vaginální ageneze. Byla provedena klinická a ultrazvuková diagnostika (v jednom případě magnetická rezonance pánve) a indikována operační léčba - distální kolpoplastika (kolpostomie). Závěr: Distální vaginální ageneze je ojediněle se vyskytující chirurgicky dobře léčitelná vrozená vada vývoje pochvy s dobrou prognózou. Kombinace zobrazovacích metod umožňuje přesnou diagnostiku, adekvátní terapii a stanovení prognózy.

Sakrospinous fixation sec. Miyazaki - complications and long-term results.

OBJECTIVE: To evaluate preoperative, perioperative and postoperative data, complications and results in long-term follow-up at patients who underwent Miyazaki´s sacrospinous suspension between January 2002 and December 2018. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc. METHODS: The evaluation of results of 240 patients who underwent Myiazaki sacrospinous suspension for vaginal prolaps between January 2002 and December 2018. RESULTS: The mean age of patients operated between 2014-2018 was higher than the mean age of all patients. Perioperative and early postoperative complications were analysed in six tables and two graphs. The most common complications were transient urinary retention (5.24%), urinary tract infection (3.80%) and pelvic hematoma (7.14%). In the long-term follow-up (131 patients over 24 months) the recurrence of apical defect was recorded at 12 (9.16%), cystocele at 26 (19.85%) and rectocele/enterocele at 3 (2.29%) patients. Patients with recurrence of vaginal vault prolapse underwent Miyazaki´s sacrospinous resuspension in four, transvaginal mesh insertion in three and sacropexy in five cases. CONCLUSION: Miyazakis sacrospinous suspension is an effective and safe method how to correct vaginal apical prolapse. The introduction of new surgical methods probably explains the shift of the age of the patients to the older ones in the last years. The most frequent early postoperative complications were urinary tract infections and pelvic hematomas. In the long-term follow up they were the recurrences of the prolaps of the anterior compartment. Total recurent apical vaginal prolaps was recorded at 12 patients (9.16%.).

[Elevated levels of TFF3 in endometrial cancer patients]. / Zvýsení hladin TFF3 u zen s karcinomem endometria.

AIM: Trefoil peptides are a family of small proteins that are expressed in a site-specific fashion by certain epithelial tissues. These peptides might be used as markers for neoplastic uterine disease. DESIGN: Experimental study. SETTING: Department of Obstetrics and Gynaecology, University Hospital, Medical Faculty, Palacký University, Olomouc; Department of Laboratory Biochemistry, Central Moravian Hospital Trust, Member of Agel holding, Prostejov. METHODS: During the time period from 2012 to 2015 eighty-nine women underwent hysteroscopy and endometrial biopsy for postmenopausal bleeding. Fifty three patients, at the age of (mean ± standard deviation) 63,4 ± 9,5 (33-80) years were diagnosed with endometrial cancer, six patients at the age of 62,9 ± 6,4 (55-74) years were diagnosed with endometrial hyperplasia and thirty patients at the age of 63,3 ± 9,3 (48-62) years diagnosed with endometrial atrophy represented control group. At the day of surgery the venous blood was sampled and subsequently examined for the levels of TFF1, TFF2 and TFF3. RESULTS: TFF3 levels were significantly higher in patients with endometrial carcinoma but not in endometrial hyperplasia subgroup. The levels of TFF1 and TFF2 were not different in selected histopathological subgroups. CONCLUSION: We have shown elevated levels of TFF3 but not of TFF1 and TFF2 in patients with endometrial cancer. TFF1, TFF2 and TFF3 levels were not elevated in patients with endometrial hyperplasia.

[The importance of sonography and hysteroscopy at suspected findings on endometrium of menopausal women]. / Význam sonografie a hysteroskopie u suspektních nálezu na endometriu menopauzálních zen.

OBJECTIVE: To evaluate the reliability of vaginal sonography and hysteroscopy based on the histopathologic finding in menopausal women. To compare the findings in a group of asymptomatic women with the findings in patients with a clinical symptomatology of endometrial disease. DESIGN: A retrospective study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: Diagnostic hysteroscopy with targeted biopsy was performed in 186 menopausal women who were referred to our department either on the basis of clinical symptoms or only on the basis of a suspected ultrasound finding. The ultrasound and hysteroscopic findings were compared with the final histopathologic diagnosis and their reliability was evaluated. The findings were evaluated separately for asymptomatic and symptomatic patients. RESULTS: In all asymptomatic and in 88% symptomatic patients vaginal sonography showed endometrial thickness higher than 5 mm. In 10 patients (14%) sonographic finding suggested possibility of a malignant process. The most frequent finding at hysteroscopy was endometrial polyp, which was found in more than a half of asymptomatic women. In two patients (5%) hysteroscopic findings were suspected for malignancy. Histopathologic examination confirmed malignant tumour in 6 patients (7%). Accordance with the histopathologic finding was more often seen in hysteroscopy than in vaginal sonography. CONCLUSION: The main advantage of vaginal sonography in menopausal women is a relatively easy detection of suspicious findings on the endometrium, especially in asymptomatic patients. Hysteroscopy, on the contrary, enables to visualize the endometrial cavity and mainly the targeted biopsy. Even if the number of malignant endometrial diseases is not high (6% in asymptomatic patients) the combination of vaginal sonography and hysteroscopy is optimal for the detection of pathological findings on the endometrium.

[Does the detection of disease in asymptomatic period improve the prognosis of patients with endometrial carcinoma?]. / Zlepsuje záchyt onemocnení v asymptomatickém období prognózu pacientek s karcinomem endometria?

OBJECTIVE: To analyse factors which led to the diagnosis of endometrial carcinoma in patients still in asymptomatic stage and to find out if such early diagnosis has an impact on further prognosis of this carcinoma. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynecology, Medical Faculty of the Palacký University and University Hospital, Olomouc. METHODS: The analysis of reasons which made the patients with endometrial carcinoma to see a gynecologist and estimate the proportion of preventive measures in the diagnosis malignant diseases of uterine corpus. RESULTS: The study included 110 patients with diagnosis of endometrial carcinoma. The Common symptoms of endometrial carcinoma, e.g. most often irregular bleeding, brought 87 (79%) patients to gynecologists while in remaining 23 (21%) of patients the disease was found in asymptomatic stage at the preventive oncogynecologic examination or incidentally at the examination for other illnesses. Both groups differed in staging and grading. CONCLUSIONS: The asymptomatic patients where the disease was diagnosed incidentally or during preventive oncogynecologic examination had, in the beginning of treatment, markedly lower staging and more favorable grading than symptomatic patients, what generates preconditions for a better prognosis of these patients.

[Etiopathogenesis of the prolapsed vaginal vault after hysterectomy]. / Etiopatogeneze prolapsu pochvy po hysterektomii.

OBJECTIVE: To determine the main etiopathogenic factors which may participate in the development of vaginal prolapse after hysterectomy. DESIGN: A retrospective study. SETTING: Department of Obstetrics and Gynecology, Medical Faculty of the Palacký University and University Hospital, Olomouc. METHODS: The analysis of relevant factors which can participate in the origin and development of vaginal prolapse was carried out on the group of 51 patients treated for vaginal prolapse after hysterectomy performed in the years 2002 to 2005. The data were retrieved retrospectively from medical documentation and appended by the information obtained from questionnaires send to the patients. RESULTS: Factors participating in the development of vaginal prolapse can be divided into 3 groups: 1. Mistakes in surgical technique and complications in the post-operative period, 2. inherited qualities of patients, and 3. impact of adverse external factors. CONCLUSIONS: Several factors are involved in the etiopathogenesis of vaginal prolapse, the most important of which are the inherited qualities of patients, incorrect surgical technique and adverse outcome in the post-operative period.

[Sacrospinous fixation of the prolapsed vagina after the Miyazaki hysterectomy procedure]. / Sakrospinální fixace prolabovaného posevního pahýlu po hysterektomii sec. Miyazaki.

OBJECTIVE: Implementation of a new surgical method for treatment of vaginal prolapse after hysterectomy. DESIGN: The description of a new surgical method. The results in the first 16 patients. SETTING: Department of Obstetric and Gynecology, Medical Faculty of the Palacký University and University Hospital, Olomouc. METHODS: The description of a new surgical method, pointing out the advantages and possibilities of the use in clinical practice. Presentation of the results in the group of 16 patients treated. CONCLUSIONS: Sacrospinous fixation of vaginal prolapse after hysterectomy sec. Miyazaki is a modification of sacrospinous fixation sec. Amreich-Richter. Contrary to the classical procedure this new method has several advantages. It makes easier the exact placement of the stitches to the sacrospinous ligament which decreases the danger of bleeding often substantially complicating the classical procedure. The procedure requires a special instrument, namely the so called Miyazaki hook. The results in the first 16 patients operated on by this method are presented.