Assisted reproductive methods - current status and perspectives.

OBJECTIVE: Evaluation of the development of assisted reproduction methods and their success from the time of their origin to the present. 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 PubMed databases with keywords (assisted reproduction, in vitro fertilization, infertility, ICSI, ovarian hyperstimulation syndrome, OHSS, uterine transplantation) and analysis of articles published in impact and reviewed journals. RESULTS: At present children born using assisted reproduction methods are not considered as a miracle of modern medicine, but as a  more difficult way of human reproduction. Reproductive medicine helps to fulfill the desires of infertile couples for their own child and thus improve the quality of their life. Since its introduction into clinical practice it has made extraordinary progress. Robert Edwards and Patrick Steptoe, thanks to systematic scientific research and clinical work, contributed to the birth of the first „test tube“ baby in 1978. Edwards received the 2010 Nobel Prize in Physiology and Medicine for his discoveries in the field of assisted reproduction. The first child of assisted reproduction in the Czech Republic was born in 1982 in Brno. In 1986, the worlds first cryoembryotransfer was performed. 1990 was the beginning of preimplantation genetic examination. In 1992, the first pregnancy was achieved using intracytoplasmic sperm injection. The work of specialists in reproductive medicine results in more than 8 million births worldwide. CONCLUSION: Despite the fact that around 4000 children are born in the Czech Republic each year using assisted reproduction methods, its methods are rejected by part of the society. Assisted reproduction brings a number of controversies, but the spread of information smog around it should not suppress a  rational view of the professional and general public. Indications for assisted reproduction vary, often are on the male side, but the age of the infertile woman is the most important determinant of the success of the process. The question is whether the continuous improvement of medical technologies and scientific discoveries threatens to inadequate manipulation of human gametes or embryos. The society should monitor these controversial aspects through its legislative and control mechanisms and ensure that these methods are not misused for other than strictly medical purposes.

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.

Prenatally diagnosed patent urachus with umbilical cord cyst and early surgical intervention.

OBJECTIVE: Description of rare diagnosis of patent urachus. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, 2nd Faculty of Medicine and Faculty Hospital Motol Prague. CASE REPORT: Patent urachus is a rare diagnosis, which in this case was detected prenatally by ultrasound. Involution of the urachus is not fully completed upon birth, therefore in cases of small persisting communication between the urinary bladder and the umbilicus conservative approach and waiting for spontaneous closure is usually chosen. In our case surgery treatment has chosen as a prevention of urinary infection because of patent urachus manifested as a wide communication. CONCLUSION: This congenital defect usually manifests itself early after birth as a visible structural anomaly of the umbilicus and/or as urine leakage in the umbilicus opening area. It is important to keep in mind that urachus irregularities may be accompanied by other urinary system defects. Every child presenting with such an anomaly should therefore be thoroughly examined. If the procedure is performed by an experienced surgical team postoperative complications are uncommon and overall long-term prognosis for patients is excellent.

[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.

Deceased donor uterus retrieval - The first Czech experience.

INTRODUCTION: Uterus transplantation is the youngest solid organ transplantation described in the literature. This procedure is the only treatment method for congenital or acquired Absolute Uterine Factor Infertility. METHOD: The method is not recognised as standard clinical care yet, there were only some 13 cases performed worldwide so far. There is only one clinical trial worldwide, which has proven both feasibility and also healthy child delivery. RESULTS: Czech Republic Ministry of Health permitted the uterus transplant clinical trial in 2015. The first phase of the surgical part includes performance and description of the uterus retrieval from a deceased donor. CONCLUSIONS: The first uterus retrieval from a deceased donor as a part of multi-organ retrieval was performed in the Czech Republic on January 13th, 2016; the case is described in the paper. KEY WORDS: uterus - transplantation - deceased - donor - retrieval.

De novo Prograf versus de novo Advagraf: are trough level profile curves similar?

BACKGROUND: According to the clinical trials, Advagraf (ADV) has efficacy and safety profile similar to Prograf (PROG). The aim of this study was to compare the graft functions, dosages, and tacrolimus (TAC) trough level profile curves of patients on de novo PROG and ADV therapy. METHODS: The ADV group included 39 de novo renal cases who had received initial immunosuppression (IS) with once-daily TAC (1 × 0.2 mg/kg from day1 after transplantation). We compared them with a PROG group of 38 transplant patients who received equivalent IS with twice-daily TAC (2 × 0.1 mg/kg from day1). In both groups, the IS was combined with antimetabolites and steroids. The mean follow-up time was similar (13.5 ± 7 days) in both groups after renal transplantation until the emission of the patients from our clinic. RESULTS: TAC mean total daily dose was reduced and whole-blood trough levels decreased over the time in early postoperative days. Only on day 3 and day 4 after transplant, a significant higher adjustment in the ADV dosage was necessary to achieve sufficient TAC trough levels. The average TAC trough level profile curves were similar in PROG and ADV groups, but the individual curves were very different. Mainly in patients on ADV therapy, the initial concentrations were often >30 ng/mL, and in some cases on the 9th posttransplant day decreased to <5 ng/mL, then slowly increased into the required therapeutic range. CONCLUSIONS: The results demonstrate that patients after renal transplantation can be safely treated de novo with ADV. Setting the required therapeutic TAC blood levels may require more attention to avoid the "fluctuations" of trough level profile curve during the early postoperative period. Our data suggest that dose adjustment of ADV can be carried out more carefully compared with PROG on the basis of clinical symptoms and the value of TAC blood levels to avoid acute rejection and toxicity.

[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.

Examination of carbohydrate metabolism parameters after simultaneous pancreas-kidney transplantation.

End-stage renal failure, a frequent complication of type 1 diabetes mellitus, requires renal replacement therapy. Our team examined the laboratory parameters of carbohydrate metabolism in 18 patients with type 1 diabetes at 10 to 89 months after simultaneous pancreas-kidney transplantation. We compared these results with those of 17 patients with type 1 diabetes who had formerly received kidney-alone transplantations, and were undergoing insulin treatment, as well as with those of 16 metabolically healthy controls. The hemoglobin A1c (HbA1c) and blood glucose levels of the pancreas-kidney transplant recipients were within the normal ranges, not differing significantly from those of the healthy controls. In contrast, the HbA1c and glucose levels were significantly elevated among kidney transplanted diabetic subjects. However, fasting and 2-hour insulin levels of pancreas-kidney transplant patients were significantly higher than those of the controls, indicating insulin resistance. According to these results, the insulin secretion by the pancreas graft sufficiently compensated for insulin resistance. Thus 10 to 89 months after successful pancreas-kidney transplantation, carbohydrate metabolism by type 1 diabetic patients was well controlled without antidiabetic therapy.

[Pregnancy and multiple sclerosis -outcomes analysis 2003-2011]. / Tehotenství a roztrousená skleróza - analýza výsledku z let 2003-2011.

OBJECTIVE: The analysis of perinatal results in pregnant women with multiple sclerosis (MS) and the assessment of the influence of pregnancy on this chronic disease in the population of pregnant women in our hospital in the years 2003-2011. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology and Department of Neurology, 2nd Faculty of Medicine, Charles University and the Motol Hospital, Prague. METHODS: Sixty-six women with the diagnosis of MS were included in our study in the years 2003-2011. All these women delivered at our clinic and were neurologically followed until the end of six months post partum. We evaluated the influence of pregnancy on the activity of the disease during the pregnancy and 6 months after delivery, the impact on the disability progression, the influence of the mode of delivery, the analgesia used, and breastfeeding, on the relapse rate post partum. We also assessed the impact of multiple sclerosis on the course of the pregnancy, where we looked for pregnancy complications in patients with multiple sclerosis, differences in the management of labor, and the results of newborns of mothers with this disease. We performed a statistical analysis. RESULTS: Relapse during pregnancy occurred in 4 of the 66 women (6.1%, relapse rate - RR 0.1);17 women experienced a post partum relapse in the first six months after delivery (25.7%, RR 0.5). From our sample of 44 women breastfed (66.7%), 10 had relapse (10/44, 22.7%) in comparison with the 7 women out of a total of 22 who did not breastfed (7/22, 31.8%). No statistical significance was established, OR = 0.6 (0.2-2.0), p = 0.5518. Epidural analgesia (EDA) was used by 16 women (24.2%). Post partum relapse experienced 3 women that used EDA (3/16, 18.8%) and 14 women that did not use EDA (14/50, 28 %). OR = 0.6 (0.1-2.4), p = 0.5325. Neither breastfeeding, nor epidural analgesia correlated with presence of a post partum relapse. Pregnancy did not influence disability progression, EDSS (Disability status scale, Kurtzke`s scale) before pregnancy and after delivery was stable (EDSS 1.5 or EDSS 1.6). Vaginal delivery had 77% women, post partum relapse had 15 of them (15/50, 30%), 12 women (18.1%) had a caesarean section, relapse occure at 2 of them (2/16, 12.5%), three births (4.5%) were completed by vaginal extraction operations. Five women (7.6%) delivered before 37th week of pregnancy. Birth weight under 2500 g was found in 9 women (13.6%). The incidence of serious pregnancy complications was not increased, intrauterine growth retardation (IUGR) was confirmed in 4 births (6%). CONCLUSION: There is no need to worry about pregnancy in patients with multiple sclerosis. Therapy provides long-term remission of the disease, and during pregnancy itself due to hormonal changes it is stabilized and the relapse rate decreases. In the post partum period relapse rate increases, however, the pregnancy did not influence disability progression. The mode of delivery in women with this disease is not different from the general population. Neither breastfeeding, nor epidural analgesia correlated with presence of a post partum relapses. The number of complications in pregnancy is not increased and the overall perinatal outcomes are comparable with the general population.

Decrease in cold ischemic times as a result of protocol changes of urgent immunogenetic testing during cadaveric kidney transplantation in Hungary.

BACKGROUND: Based on national ethics committee permission, the procedure of urgent immunogenetics testing prior to cadaveric kidney transplantation was changed in Hungary from January 1, 2011 allowing HLA typing of the donor and prospective crossmatching using peripheral blood samples from the donor prior to the definitive declaration of brain death. The aim of the current study was to compare key indicators of transplantation primarily cold ischemic time [CIT], between time periods with outcomes. METHODS: The following indicators were systematically collected prospectively and retrospectively for each deceased heart-beating donor transplantation between January 1, 2010 and October 31, 2010 (n = 114) versus January 1, 2011 and October 31, 2011 (n = 91): CIT for the first and second kidney; laboratory turnaround times (TAT), and time for final preparation of the selected recipient. RESULTS: As a result of the new procedure, the CIT for the first kidney decreased from 16.5 ± 3.5 to 12.4 ± 3.2 hours (P < .001). Similarly, for the second kidney the parameters were a 19.8 ± 3.4 versus 16.0 ± 3.8 hours (P < .001). As a consequence of more hands-on time in the laboratory, the TAT increased from 5.6 ± 0.8 hours to 7.2 ± 1.1 hours (TAT1) followed by an additional 4.2 ± 1.0 hours (TAT2). We also compared the times necessary for preparation of immunologically suitable recipients for transplantation, namely, 9.5 ± 2.3 hours in the earlier system, increasing to 15.5 ± 4.3 hours during the new procedure. CONCLUSION: As a consequence of the procedural change, the CIT parameter decreased significantly for both kidneys, which may have contributed to improved short-term outcomes of transplantation. The time available for final preparation of selected recipients was increased allowing improvements in CIT.

[Gynaecological precanceroses from the clinical perspective - today and tomorrow]. / Gynekologické prekancerózy z pohledu klinika dnes a zítra.

During the last twenty-five years an enormous shift in our knowledge of cancerogenesis in all gynaecological precancerous and cancerous diseases can be seen. Early diagnosis of these lesions of the lower genital tract (vulva, vagina and cervix) is enabled mainly due to easy access. The major role in the pathogenesis of most precancerous lesions can be accounted to high risk human papillomavirus. Recently, new information about HPV genotypisation of single precancerous lesions and single histological cancer types were revealed. Thus we can better estimate the effect of vaccines on different age groups of women in relation to different types of cancer. The development and introduction of prophylactic vaccines into clinical practice was one of the major improvements of current medicine. Precancerous and cancer lesions of endometrium make themselves known by early symptoms such as perimenopausal and postmenopausal bleeding. Optimal diagnostic and therapeutic procedures have to be based on close cooperation between the clinician and pathologist.

[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.

[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%).

[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.

[Bioimpedance analysis--a new method in prediction and early detection of ovarian hyperstimulation syndrome?]. / Analýza bioimpedance--nová metoda v predikci ovariálního hyperstimulacního syndromu?

OBJECTIVE: The aim of the study was to establish a new method of the multiple-frequency bioimpedance analysis (MFBIA) for patients with controlled ovarian hyperstimulation (COH) and to determine the significance of this method in prediction and early diagnosis of severe forms of ovarian hyperstimulation syndrome (OHSS). DESIGN: Prospective case control study. SETTING: Department of Obstetrics and Gynecology, 2nd Medical Faculty, Charles University and University Hospital Motol, Prague. METHODS: 53 patients were recruited into the case control study. The surface body impedances for the frequencies of the current 1, 5, 50 and 100 kHz were measured. Study group included 13 patients with developed OHSS grade III.-V. according Golans classification. The control group included 40 women undergoing COH without developed OHSS. Measurements of impedances were performed by MFBIA device. RESULTS: The decrease of the values of impedance between the day of oocyte retrieval and the day of embryotransfer significantly increases relative risk of OHSS grade III.-V. development. The best correlation was found for the frequency of 5 kHz (9.08 p<0.0001). The study suggests, the predictive value of MFBIA in OHSS development might be higher than the number of retrieved oocytes (>20 oocytes-RR 5,71). CONCLUSION: Patients in risk of OHSS development are those with decreasing impedances. The highest predictive value of OHSS development is for the impedances at frequency of 5 kHz. Greater multicenter studies should be done to confirm our preliminary results.

[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.

[Treatment of recurrent ovarian cancer]. / Lécba recidivujícího ovariálního karcinomu.

OBJECTIVE: The description of current treatment possibilities in recurrent ovarian cancer. DESIGN: Review article. SETTING: Obstetrics and Gynecology Department, Charles University 2nd Medical Faculty and University Hospital Motol, Prague. METHODS: The review of literature on treatment of recurrent ovarian cancer. Current data on chemotherapy, surgery and targeted biological therapy in recurrent ovarian cancer. CONCLUSIONS: Chemotherapy is indicated in most cases of recurrent ovarian cancer, surgery does not play an important role. Standard treatment of platinum-sensitive recurrent ovarian cancer is based on platinum combination chemotherapy. Standard treatment of platinum-refractory ovarian cancer represents non-platinum monotherapy. Targeted biological therapy should be still used only in the studies.

[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.