[Czech linguistic validation of the Pelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire - IUGA revised]. / Ceský preklad a validace dotazníku kvality pohlavního zivota u zen s prolapsem pánevních orgánu ci inkontinencí moci nebo stolice - PISQ-IR.

OBJECTIVE: To produce a Czech version of a validated tool for sexual quality of life assessment among women with pelvic floor disorders; PISQ-IR (Pelvic organ prolapse/Incontinence Sexual Questionnaire - Internationally Revised). DESIGN: Original study. SETTING: Department of Obstetrics and Gynecology, University Hospital and Faculty of Medicine, Charles University in Pilsen. METHODS: The whole process of translation and linguistic validation of the questionnaire followed the protocol of the International Urogynecology Association developed for this purpose. The original translation was repeatedly discussed with patients with incontinence or prolapse in order to preserve the meaning and comprehensibility of the items. The resulting questionnaire was reversely translated into English by an independent translator and sent to IUGA translation working group for validation. The translation was finalized based on recommendations from the group. RESULTS: PISQ-IR is a self-administered questionnaire improved from the previous and short versions. It contains 20 questions, the first question determines whether section 1 for sexually inactive or section 2 for sexually active women is to be completed. The first section for sexually inactive women contains five questions with 12 items. The second section comprises of 14 questions with 22 items for sexually active women with a partner or 12 questions with 19 items for those without a partner. The questionnaire is evaluated separately for individual sub-scales. Compared to former PISQ-12, the PISQ-IR was improved to enable separate assessment of individual domains and its subscales, and to be useful also in non-sexually active women and women with anal incontinence. At the same time it can be also utilized in case of incompletely filled-in questionnaire. A certain disadvantage for clinical practice is its more complex evaluation. CONCLUSION: Linguistic validation of a PISQ-IR questionnaire was performed and the questionnaire is presented. We present a Czech translation of a validated tool for assessment of quality of sexual life in women with prolapse or urinary/anal incontinence. Psychometric evaluation remains yet to be performed.

[Severe postoperative bleeding after Total Prolift procedure for vaginal vault prolapse - case study]. / Závazné pooperacní krvácení po operaci prolapsu pochvy po hysterektomii s uzitím systému Total Prolift - kazuistika.

OBJECTIVE: To describe a case of a severe postoperative bleeding after Total Prolift procedure for vaginal vault prolapse. DESIGN: Case study. SETTINGS: Department of Obstetrics and Gynecology, Medical Faculty in Pilsen, Charles University in Prague. CASE: A 55-year-old woman underwent a surgery with a Prolift procedure for vaginal prolapse after hysterectomy. The surgery was carried out without any complications. In the first 24 hours after Prolift surgery we diagnosed massive bleeding and hypovolemic shock. The condition required repeated re-exploration and ligation of hypogastric artery and pelvic packing to stop the bleeding. CONCLUSION: Bleeding is a major complication in gynecological surgery. Severe hemorrhage is a rare condition after surgical treatment of vaginal prolapse after hysterectomy using a Prolift procedure.

[The impact of total abdominal and laparoscopically assisted vaginal hysterectomy on the development of urine incontinence]. / Vliv abdominální a laparoskopicky asistované vaginální gynek hysterektomie na mocovou inkontinenci.

OBJECTIVE: Evaluation of mutual relationship between different types of hysterectomy and urine incontinence. DESIGN: Retrospective comparative questionnaire study. SETTING: Department of Gynaecology and Obstetrics, Charles University and University Hospital Pilsen. METHODS: Questionnaire study of women which underwent total abdominal hysterectomy (TAH) or laparoscopically assisted vaginal hysterectomy (LAVH) for nonmalignant disease without prolapse between January 2001 and March 2003. RESULTS: The questionnare was sent to 286 patients who underwent the operation. 188 (67.6%) were completed and returned. 111 patients were after TAH and 77 after LAVH. 115 patients had no symptoms of incontinence preoperatively. In this group we revealed 20 (17%) patients with SUI a 5 (4%) patients with symptoms of urge incontinence after the operation. In the group of 73 patients with some type of UI preoperatively, 38 women registered improvement and 8 patients were permanently impaired after hysterectomy. SUMMARY: After hysterectomy, the continence status is often amended (both either positively or negatively). However, there was no difference between both types of operation. If woman had some type of incontinence preoperatively, this type of incontinence was not worsened after the operation. Contrary-wise, these women often registered improvement of their type of incontinence. Age, BMI and number of deliveries were not found statistically significant.

CD44v6 as a prognostic factor in cervical carcinoma FIGO stage IB.

The aim of our study was to clarify whether CD44v6 evaluation can serve as a universally applicable prognostic factor in patients with FIGO stage IB cervical carcinoma. A retrospective study was performed on 178 FIGO stage IB (142 IB N0, 36 IB N1) radically operated cervical carcinoma patients. The expression of CD44v6 was investigated by immunohistochemistry (IHC). The prognostic significance of established prognostic factors and CD44v6 expression was analyzed by univariate and multivariate analyses. To test the reproducibility and to account for interobserver variability, all specimens were evaluated independently at two institutions. Two different IHC scoring systems, several cut-off levels for CD44v6 positivity and several statistical methods for IHC results evaluation were used. In a univariate analysis, the most significant prognostic factor for overall survival (OS) was lymph node status (p<0.001) followed by tumor volume, LVSI, GOG score (p<0.01) and a deep stromal invasion (p = 0.06). We found a strong correlation between CD44v6 expression and squamous cell carcinoma (SCC) (SCC vs. adenocarcinoma - p<0.001) and between CD44v6 expression and deep stromal invasion, LVSI and GOG score (p<0.05). The CD44v6 expression was not a statistically significant prognostic factor for OS in a univariate analysis (p=0.39 Vienna; p=0.54 Freiburg). In a multivariate analysis, the most significant prognostic factor for OS was lymph node status (p =0.002), followed by tumor diameter and LVSI (p<0.05). CD44v6 expression was not a statistically significant prognostic factor for OS or disease-free interval (DFI) independent of the scoring method used. In conclusion, we demonstrated that CD44v6 expression is associated with LVSI, deep stromal invasion and SCC, but has no prognostic influence on OS and DFI in a population of 178 women with FIGO stage IB cervical carcinoma.