[Analysis of urinary tract injury during gynecological surgery performed with preoperative ureter catheterization or intraoperative ureter control]. / Analiza czestosci wystepowania uszkodzen ukladu moczowego w czasie wybranych operacji ginekologicznych po zastosowaniu przedoperacyjnego cewnikowania moczowodów oraz sródoperacyjnego ustalania ich umiejscowienia.

DESIGN: To analyze urinary tract injuries during gynecological surgery performed with preoperative ureter catheterization or intraoperative ureter control. MATERIAL AND METHODS: Retrospective analysis of 1986 chosen gynecological operations performed between 1990-1998 in Dept. of Gynecological Surgery Polish Mother's Health Center Institute. RESULTS: The overall frequency of urinary injuries was 2.15%. It was less during gynecological surgery performed with ureter catheterization compared to intraoperative ureter control only (ureter: 0.30% vs. 0.55%, p = 0.22; urinary bladder: 0.40% vs. 0.90%, p < 0.05). CONCLUSION: 1/ urinary injury was twice as frequent during ureter control than during ureter catheterization, 2/ urinary injury was the most frequent complication during hysterectomy with adnexa, 3/ the results of our analysis should be treated as a vote "for" ureter catheterization before gynecological surgery.

[Colposuspension during abdominal hysterectomy--own modification]. / Wlasna modyfikacja podwieszania pochwy w czasie zabiegu usuniecia macicy droga brzuszna.

OBJECTIVES: The aim of our study was to evaluate the clinical effectiveness of own modification of colposuspension using the musculofascial flap during abdominal hysterectomy. MATERIAL AND METHODS: The study group consisted of 57 patients operated on uterine and/or vaginal prolapse; 45 of them had also others pelvic gynecological disorders. Prolapsed or lowered vaginal walls were corrected by colposuspension or cervical suspension using musculofascial flap (made of the rectus abdominis muscle sheet and pyramidal muscle). The flap was sharply separated from the anterior wall of rectus abdominis muscle sheet going up from pyramidal muscle to umbilical region where it ended. Its end was sutured to vaginal vault and uterosacral ligaments. This gave a flattening of rectovaginal pouch and shortage of rectovaginal distance. RESULTS: The incidence of usual complaints as: hypogastric pain, uterine/vaginal prolapse feeling and vaginal dryness was significantly decreased after the operation. The quality of sexual functions was also improved. The incidence of urine incontinence and polyuria didn't change after the operation. CONCLUSION: The own modification of colposuspension during abdominal hysterectomy is an effective method of treatment in cases of uterine/vaginal prolapse with other pelvic gynecological disorders.

[Laparoscopy and laparotomy in the operative treatment of ovarian cysts]. / Leczenie operacyjne lagodnych guzów jajnika: laparotomia i laparoskopia.

OBJECTIVES: The purpose of our study was to compare operative procedures, histologic types of tumours, and intra- and postoperative complications of patients operated for benign ovarian cysts by laparotomy or laparoscopy. MATERIALS AND METHODS: 257 patients with different types of ovarian cysts underwent operations by laparoscopy (51 cases) or laparotomy (206 cases). Careful selection for operative treatment was made on the basis of clinical findings, ultrasound scans (using colour Doppler), patient's age and history. Operative laparoscopies were performed in patients with "unsuspected" ovarian cysts with diameter < or = 8 cm. During every operation, a histologic examination of tumour was performed. RESULTS: In 42 patients the cysts were found in both ovaries. Remaining 215 women had unilateral ovarian tumours. Adnexectomy was carried out in 142 cases, cystectomy in 131, ovariectomy in 18, and aspiration and electrocoagulation of ovarian cysts in 8 cases. The most common laparoscopic procedures were cystectomy (41) and aspiration and electrocoagulation of ovarian cysts (8); while by laparotomy: adnexectomy (142) and cystectomy (131); p < 0.0001. The histopathological assessment showed as follows: serous cysts in 98 cases, dermoid cysts in 75, endometrial cysts in 63, mucous cyst in 23, and others (mainly haemorrhagic, functional cysts and fibrothecomas) in 40 cases. The incidence of operative complications (3/257--all due to insufficient hemostasis) and postoperative complications (infection--7/257, anaemia--4/257, peritonitis--1/257) was rather low and similar in patients operated by laparoscopy and laparotomy. Patients were generally discharged from the hospital on the fourth (median) postoperative day after laparoscopies and the seventh (median) day after laparotomies (p < 0.0005). CONCLUSIONS: Operative treatment of ovarian benign cysts is connected with a very low risk for intra- and postoperative complications. The operative laparoscopy brings better cosmetic effects and seems to be safe and effective method of treatment of ovarian benign cysts.

[Ovarian cancer. I. Epidemiology, symptoms, FIGO staging]. / Rak jajnika w materiale Kliniki Chirurgii Ginekologicznej Instytutu CZMP. I. Epidemiologia, objawy, stopnie zaawansowania.

OBJECTIVES: The purpose of our study was to analyse the epidemiological data, signs and symptoms, FIGO staging in patients operated for the first time for ovarian cancer. MATERIALS AND METHODS: A retrospective review of patients' charts with ovarian cancer operated at the Department of Gynaecological Surgery of Polish Mother's Memorial Hospital-Research Institute in 1990-1999 was conducted. We analysed the data of women operated for the first time for this disease. FIGO staging was performed due to operational and histologic findings. RESULTS: Between January 1990 and December 1999, 107 patients were operated for the first time for ovarian cancer. The mean patients' age was 54 years (range: 25-82); 31.8% of patients were aged from 41 to 50 years, 24.8% 51-60, 27.1% 61-70%, 7.5% above 70 years, and 9.3% were below 40 years. The main symptoms were: abdominal pain (61.7%), increasing abdominal circumference (35.5%), urination and bowel problems (14.0%), weight loss (8.4%), dyspeptic problems (7.5%), slightly elevated temperature (4.7%) and abnormal vaginal bleeding (3.7%). No symptoms were reported by 16.8% of patients (frequency similar in I/II and III/IV stage by FIGO). There were no statistical differences in the incidence of reported symptoms in I/II vs III/IV FIGO stage. FIGO staging was as follows: I--13.1%, II--14.95%, III--59.8%, IV--12.15%. CONCLUSIONS: Our data showed that ovarian cancer is very rare below the age of 40 and above 70 years. There is a great need to improve screening for ovarian cancer because the development of the disease is clinically silent or nonspecific and almost 70% of patients with ovarian cancer is diagnosed in the late stages of illness.

[Ovarian cancer. II. Procedures, histology, and complications]. / Rak jajnika w materiale Kliniki Chirurgii Ginekologicznej Instytutu CZMP. II. Operacje pierwotne, histopatologia, powiklania.

OBJECTIVES: The purpose of our study was to analyse the operative procedures and complications in patients operated for the first time for ovarian cancer. MATERIALS AND METHODS: A retrospective review of patients' charts with ovarian cancer operated at the Department of Gynaecological Surgery of Polish Mother's Memorial Hospital-Research Institute in 1990-1999 was conducted. We analysed the data of women operated for the first time for this disease. In every case we tried to perform radical operation consisted of hysterectomy with bilateral adnexectomy, omentectomy, appendectomy (if needed), and additionally optimal debulking in advanced cancer. RESULTS: Between January 1990 and December 1999, 107 patients were operated for the first time for ovarian cancer. FIGO staging was as follows: I--13.1%, II--14.95%, III--59.8%, IV--12.15%. The most frequent findings on histology were serous (39.3%), endometrioid (26.2%), undifferentiated (11.2%) and clear cell cancers (10.7%). In 60.7% of cases we performed hysterectomy with bilateral adnexectomy, in 15.0% bilateral adnexectomy, in 4.7% of patients cytoreductive tumorectomy, and in 19.6% of cases only excisions for histology were taken. 69.0% of patients underwent also omentectomy and 42.6% appendectomy. In 58.9% of patients we performed radical operation; its incidence significantly decreased with the increase of FIGO staging: I--100%, II--87.5%, III--51.6%, IV--15.4% (p < 0.0005). We noted 5 cases of intraoperative complications, all in patients with the stage III, connected with intestinal or urinary bladder lesions. The most common postoperative complication was anaemia (23.4%) and fever (4.7%). Four patients died in 8-27 postoperative day due to circulatory insufficiency. CONCLUSIONS: The most common was serous and endometrioid ovarian cancer. The great majority of patients was diagnosed to late and operated in III and IV stage of the disease, but in almost 60% of cases radical operation was performed.