[Antibiotical prophylaxy in gynecology]. / Profylaktické uzití antiinfekcních léciv v gynekologii.

Gynecological surgery is considered to be clear with possible contamination by gram-positive cocci from the skin, gram-negatives from the perineum or groins or polymicrobial biocenosis from vagina, depending on the surgical approach. Antibiotical prophylaxy enforces the natural mechanisms of immunity and helps to exclude present infection. There were presented many studies comparing useful effect of prophylaxis in gynecological surgery. The benefits of antibiotical prophylaxy before IUD insertion, before the cervical surgery and before hysteroscopies were not verified. On the other hand the prophylaxy of vaginal surgery including vaginal hysterectomy decreases the number of postoperative febrile complications. The positive influence of prophylaxis before the simple laparoscopy and laparoscopy without bowel injury or the opening of the vagina was not evidently verified. In abdominal hysterectomy the antibiotical prophylaxy decreases the incidence of postoperative complications significantly. The administration of 2 g of cefazolin can be recommended. In procedures taking more than 3 hours the repeated administration of cefazolin is suitable. New urogynecological procedures, using mesh implants, were not sufficiently evaluated as for postoperative infections and the posible antibiotical effect. The presence of implant in possibly non sterile area should be considered as high risc of postoperative complications.

[The injury of bladder without penetrate during the TVT surgery for stress incontinence]. / Nepenetrující poranení mocového mechýre pri antiinkontinencní operaci (TVT).

OBJECTIVE: The aim of this article is alert to possibile of non-penetrating injury of bladder and risk of extraperitoneal bleeding during the TVT surgery when the tape is inserted by retropubic path. This type of injury can't be find by cystoscopy and there can be a serious blood loss in to the interstitial space. According this fact, there is a great importance of this injury and there is an urgent need to prompt reaction on this situation. In this way, we do prevent serious risk of health damage. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 3rd Faculty of Medicine, Charles University, Faculty Hospital Královské Vinohrady, Prague. METHODS: The different authors presents various percentage of complications in the case of TVT surgery. The differences follow from size of patient´s group, type of surgical procedure, type of the tape and the way of tape insertion. Nevertheless, differences between these results are statistically nonsignificant. CONCLUSIONS: The operation´s complications and early after operation´s complications can arise in the course of any surgery and iatrogenic complications also belong to this group. Minimally invasive surgery is certainly make not an exception. The most often signs of these complications are abdominal pain, presence of blood in urine, anemia, malfunction of bladder and possible breakdown of intestinal activity. If the conservative methods failed, we have to perform operating inspection. The cooperation with surgeon or urologist is certainly needed.

[Reproductive functions in women after cancer therapy]. / Reprodukcní funkce u onkologických pacientek.

Improvement in early diagnostics and treatment options led to an increase in the number of young oncological patients in reproductive age. These young oncological patietns have life-long consequences of treatment, such as infertility, early menopause and sexual dysfunctions. There is the possibility of maintening fertility by assisted reproduction methods. So far, ovarian stimulation followed by ICSI and cryopreservation of embryos seem to be the most successful method. Unfortunately, this method is suitable only for patients with a stable partner where there is no risk of delay because of necessary stimulation of ovulation. For patients without a partner, it is possible to freeze stimulated oocytes. Cryopreservation of immature oocytes followed by in vitro maturation seems to be a very promising method. Freezing ovarial tissues followed by transplantation is at this point only an experimental procedure. The authors present their experience with in vitro maturation of oocytes of 28 women with pregnancy rate 14.3%. Twenty-seven cases of infertility with a high risk of ovarial hyperstimulation syndrome and one case of breast cancer patient before chemotherapy were chosen for IVM.

[Medical, legal and ethical aspects of fertility preservation in cancer survivor]. / Medicínské, právní a etické aspekty zachování fertility u onkologických pacientek.

In recent years the number of the young women in fertile age which are oncologically treated is increasing. For these women chemotherapy and radiotherapy introduces potential risk of reproductive dysfunctions. Present techniques of assisted reproduction are offering possibilities to save reproductive functions even after the oncological treatment. As a perspective outlook seems to be frozen premature oocytes with IVM and fertilisation. With these fertility savings methods are naturally coming up some of the ethical and legal issues.

[Registry of the urogynaecologic procedures involving implant in the Czech Republic during the year 2007]. / Registr urogynekologických výkonu s implantáty v Ceské republice za rok 2007.

OBJECTIVE: The aim of this paper is to report the outcomes of the registry of the urogynaecologic procedures involving implant in the Czech Republic during the year 2007. SUBJECT: Retrospective registry analysis. SETTING: Czech Urogynaecological Association, Prague. SUBJECT AND METHOD: We performed a retrospective analysis of all urogynaecologic procedures involving implant registered in the Czech Registry during the year 2007. CONCLUSION: We report the results of 2557 urogynaecologic procedures involving implant from the 33 referring centres from the Czech Republic. 2232 (87%) implants were intended to treat the stress urinary incontinence and 325 (13%) were used to treat the pelvic organ prolapse. Intraoperative complications were reported in 36 (1.41%) cases, early postoperative complications intervened in 117 cases (4.58%) and the late complications were found in 121 females (4.73%).

[Non-steroidal anti-inflammatory drugs in pregnancy]. / Nesteroidní protizánetlivé léky v gravidite.

Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic (lowering an elevated body temperature and relieving pain without impairing consciousness) and, in higher doses, with anti-inflammatory effects (reducing inflammation). As inhibitors of cyclooxygenase NSAIDs given during pregnancy have the potential to cause adverse maternal and fetal effects. Maternal effects include prolongation of pregnancy and labour, whereas constriction of the ductus arteriosus, renal dysfunction and haemostatic abnormalities can occur in the fetus and neonate. As weak acids, NSAIDs are excreted in small amounts into human breast milk with little risk for adverse effects in the suckling infant.

[Pneumonia in pregnancy]. / Pneumonie v tehotenství.

OBJECTIVE: Review of the latest informations about etiology, patophysiology and management of pulmonal infections in pregnant women. DESIGN: Review. SETTING: Clinic of Obstetrics and Gynecology, 1st Medical Faculty of Charles University and Teaching Hospital Na Bulovce, Praque. METHODS: Summary of datas from articles in scientific press and textbooks, self experience. CONCLUSION: Acute pneumonia of various etiology can be a serious complication in pregnancy. An X-ray photograph has still an unsubstituable part in diagnosis.

[Dynamic tests of the urethral sphincter closure and pelvic floor function]. / Dynamische Tests des urethralen Verschlussmechanismus und Beckenbodens.

In the group of stress incontinent women (n = 54) the values of cough leak point pressure (CLPP) and Valsalva leak point pressure (VLPP) were studied together with urethral stress profiles. So as to evaluate the function of the pelvic floor during stress manoeuvers the electromyographic potentials were simultaneously recorded. It was verified, that the values of CLPP were significantly increased in comparison with VLPP (p < 0.01), while electromyographic potentials obtained by CLPP test were more powerful than those recorded by VLPP (p < 0.01-p < 0.005) in different subgroups. According to the results mentioned above it can be concluded, that the reaction of the pelvic floor differs significantly due to various stress manoeuvers, like coughing, Valsalva etc. These findings should be considered in evaluation of the type of dysfunction and of the appropriate surgical treatment.

[The changes of electromyographic activity of the pelvic floor after the delivery]. / Anderungen der EMG-Aktivität des Beckenbodens nach der Geburt.

The urodynamics of the lower urinary tract, the clossure urethral mechanism and EMG activity of the pelvic floor, were studied in the group of patient (n = 14) in consequence with the vaginal delivery. Approximately 6-9 weeks after the delivery a slight decrease of the functional urethral length (P < 0.05) and the transmission factor (P < 0.05) were observed. On the contrary, EMG activity of the pelvic floor was significantly increased (P < 0.05) after the puerperium. - The authors suppose, that the decrease of pelvic floor contractility seems to be a physiological phenomenon given by mechanical, vascular and hormonal factors, that should facilitate the normal vaginal delivery. The relations between the changes of EMG activity and parity, birth weight or labour injury were not verified.

[Vaginal electrostimulation with the CONTERG apparatus in the treatment of urinary incontinence]. / Vaginální elektrostimulace prístrojem CONTERG v lécbe inkontinence moci.

The authors submit their initial clinical experience with vaginal electrostimulation in the treatment of urinary incontinence, using a CONTERG apparatus made in Czechoslovakia. Treatment was applied in 26 women with stress incontinence, incl. 8 (31%) who had moreover symptoms of sensory urgent micturition. A favourable clinical effect was recorded in 11 patients (42%), a partial effect in 9 (34%), treatment failed in six patients (24%). The direct effect of stimulation of the pelvic diaphragm was verified by profilometric examination which proved a rise of the maximum and clossure pressure of the urethra (P less than 0.05) and values of the transmissive factor (P less than 0.01). The indirect inhibitory effect on the detrusor was confirmed by cystometric examination which indicated a rise of values of the volume of the first desire to void (P less than 0.01) and higher values of the detrusor coefficient--compliance (P less than 0.01) in the investigated group.

[Urodynamic results before and following vaginal electrostimulation in the treatment of urinary incontinence in the female]. / Urodynamische Resultate vor und nach vaginaler Elektrostimulation zur Behandlung der Harninkontinenz der Frau.

In this study we demonstrate our first experience with vaginal electrostimulation in the treatment of stress incontinence in women. In the group of 26 incontinent female patients there was described a very good effect in all cases (42%) and a slight improvement was noted in 9 cases (34%) at the same time. Our results correspond with other similar presented studies. The clinical improvement was verified in the urodynamic study. There were noted: the increase of maximal (P less than 0.05) and closure pressure (P less than 0.05) of the urethra, the increase of transmission factor (P less than 0.01) and of maximum of EMG activity of the sphincter (P less than 0.005), as well as an improvement of compliance of the bladder (P less than 0.01) and of volume in the first desire to void (P less than 0.01). We can conclude that this method of intermittent vaginal electrostimulation is suitable in the treatment of female stress incontinence.