Lymph node dissection in atypical endometrial hyperplasia.

OBJECTIVE: The rate of concomitant endometrial carcinoma in patients with atypical endometrial hyperplasia is high. We aimed to investigate the role of lymphadenectomy in deciding adjuvant treatment in patients with concomitant atypical endometrial hyperplasia and endometrial carcinoma. MATERIAL AND METHODS: Women with atypical endometrial hyperplasia were enrolled in this retrospective study. Lymph node dissection was performed in only some patients who gave informed consent if their surgeon elected to do so, or if the intraoperative findings necessitated. The final histopathologic evaluations of surgical specimens were compared with endometrial biopsy results. RESULTS: Eighty eligible patients were evaluated. Seventy-two (90%) patients had complex hyperplasia with atypia, and 8 (10%) patients had simple hyperplasia with atypia. Hysterectomy and bilateral salpingo-oophorectomy were performed to all patients; 37 also underwent lymph node dissection. Lymph node dissection was extended to the paraaortic region in 9 of 37 patients. The concomitant endometrial carcinoma rate was 50%. Two patients had lymph node metastasis. Among 40 cases of carcinoma, 17 had deep myometrial invasion and/or cervical or ovarian involvement or grade 2 tumors with superficial myometrial invasion on hysterectomy specimens; 27.5% of all carcinomas were stage Ib or higher. CONCLUSION: The concomitant endometrial carcinoma rate was high in patients with atypical endometrial hyperplasia. Nearly half of these patients had risk factors for extrauterine spread. Lymph node dissection might be helpful to decide adjuvant treatment.

Ambulatory urodynamic monitoring of women with overactive bladder syndrome during single voiding cycle.

OBJECTIVE(S): To present data of standardized ambulatory urodynamic monitoring (AUM) performed in women with overactive bladder syndrome (OAB) and to evaluate the relevance of AUM data with clinical findings of the patients. STUDY DESIGN: Records of women with symptoms of OAB were retrospectively reviewed (n=249). Of women fulfilling the Overactive Bladder Awareness Tool (OAB-V8) with a score ≥8 and the 3-day voiding diary (VD) with a frequency >7/day (n=167), those who underwent urodynamic investigation were selected (n=76). The data of this study were retrieved from the records of Ankara University Cebeci Hospital and based on the AUM findings of single voiding cycle of women with OAB. AUM, which is among the institutionally approved primary urodynamic investigation methods, is performed with LUNA ambulatory monitoring recorder (MMS™) in the clinical setting with a standardized technique, in reproducing lower urinary tract symptoms of women since 2011. The relationship of the urodynamic data with the clinical findings were evaluated. RESULTS: AUM traces of women (n=76) with OAB revealed 63.1% DO, 64.4% urgency and 77.7% urinary incontinence of which were 14.4% urgency urinary incontinence (UUI), 25% stress urinary incontinence (SUI) and 38.1% mixed urinary incontinence (MUI). OAB patients with DO reported more urinary incontinence episodes/day, nocturia and mixed urinary incontinence in the voiding diary (p<0.04) and had significantly higher irritative symptom bother reflected by the questionnaires (p<0.04). Women with DO were more likely to be postmenopausal (p=0.02) and were found to have more urgency (p<0.001), urgency episodes (p=0.05) and incontinence (urge and mixed) (p<0.001). However, no association was found between the extent of pelvic organ prolapse and the presence of DO. CONCLUSIONS: AUM performed with a standardized technique during single voiding cycle seems to be a reliable method in reproducing symptoms of women with OAB. It provides both clinically relevant findings and objective documentation of urgency which is the main symptom for OAB. The detection of DO according to the ICS definition were also found to be concordant with urodynamicaly observed urgency and urinary incontinence. Objective and subjective clinical findings of OAB were found to be more severe in women with DO.

Study of uterine and fetal hemodynamics in response to labor induction with dinoprostone in prolonged pregnancies with normal amniotic fluid and oligohydramnios.

OBJECTIVE: We investigated the effects of labor induction with Dinoprostone on uteroplacental and fetal circulations with Doppler velocimetry in prolonged pregnancies with and without oligohydramnios. METHODS: We performed Doppler evaluations of Uterine A, Umbilical A and Middle Cerebral A. (MCA) in 117 patients (27 associated with oligohydramnios) just before and 6 h after the administration of Dinoprostone. We compared two groups with Mann Whitney U Test and Independent Sample T Test. RESULTS: Uterine Artery Doppler indices of both groups obtained before the medication were compared. All indices were within normal range; however Umbilical A. S/D and PI were higher in oligohydramnios group, approaching statistical significance (p=0.07 for S/D and p=0.03 for PI). All of the Uterine A. Doppler indices significantly increased after the administration of Dinoprostone ovule in normal amniotic fluid index (AFI) group (p=0.00). Doppler indices of the other arteries in this group did not change significantly. Similarly, none of the Doppler indices of all investigated arteries in oligohydramnios group changed significantly. Changes in all measured Doppler indices were minor and similar in both groups. CONCLUSIONS: Labor induction with Dinoprostone in prolonged pregnancies complicated with oligohydramnios is as safe and effective as it is in prolonged pregnancies with normal AFI.

Correlation of pelvic organ prolapse staging with lower urinary tract symptoms, sexual dysfunction, and quality of life.

INTRODUCTION AND HYPOTHESIS: To evaluate the relationship between pelvic organ prolapse (POP) staging and clinical findings, lower urinary tract symptoms (LUTS), sexual dysfunction, and quality of life (QoL) using validated questionnaires. METHODS: Women attending the urogynecology unit with LUTS and/or bulging (n = 388) were grouped according to the POP quantification (POPQ). LUTS, sexual dysfunction, and QoL were evaluated using the Urinary Distress Inventory-6 (UDI-6),the Overactive Bladder Awareness tool (OAB-V8), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the Incontinence Impact Questionnaire-7 (IIQ-7). Data regarding baseline characteristics, clinical findings, and scores of questionnaires were compared among the POP stages using the Kruskal-Wallis test. Pearson's and Spearman's correlation analyses were used to evaluate the correlation of POP staging with clinical findings, pelvic floor dysfunction related symptom severity, and QoL. RESULTS: According to the POPQ, patients were classified as: stage 0 (27.8 %), stage 1 (21.4%), stage 2 (38.9%), and stages 3 and 4 (11.8%). Irritative, stress, obstructive subscale scores of UDI-6 and physical, travel, emotional subscale scores of IIQ-7 were significantly different among POPQ stages. Weak correlations between POPQ staging and irritative, stress, obstructive subscale scores of UDI-6 (r = 0.198, r = 0.192, and r = 0.146 respectively), and physical, travel, social, emotional subscale scores of IIQ-7 (r = 0.223, r = 0.154, r = 120 and r = 0.171 respectively) were found (p < 0.05). Clinical findings (Q-tip and stress test positivity, post-void residual volumes) showed moderate to weak correlations with POPQ stages (r = 0.425, r = 0.117, r = 0.163 respectively; p < 0.05). CONCLUSIONS: The correlation of lower urinary tract dysfunction and POP staging was shown to be best represented by UDI-6 and IIQ-7.