Aim. To evaluate the anatomical effectiveness and safety of hybrid pelvic floor reconstruction using a vaginal flap with unilateral apical fixation in women with post-hysterectomy prolapse. Materials and methods. This retrospective study included 62 female patients with stage II–IV vaginal vault prolapse (according to the POP-Q classification) who underwent a novel surgical technique. The primary endpoint was anatomical success; secondary endpoints included changes in quality of life (PFDI-20, ICIQ-SF questionnaires) and patient satisfaction with treatment outcomes. Results. The mean follow-up period was 14.86 months. Anatomical success was achieved in 93.5% of cases. No cases of implant erosion or chronic pelvic pain were reported. Significant improvement in pelvic floor dysfunction symptoms was observed across all PFDI-20 subscales (p0.001). Vaginal length significantly increased postoperatively. Recurrence of prolapse occurred in 6.5% of cases and required reoperation. Two cases of intraoperative bladder injury were noted, which did not affect the final outcomes. Conclusion. Hybrid pelvic floor reconstruction using a vaginal flap with unilateral apical fixation demonstrated high anatomical efficacy and safety in the correction of post-hysterectomy prolapse. However, further prospective studies with control groups and longer follow-up are needed to confirm these findings.

Background. Women living in the territories of the Russian Federation contaminated with radionuclides as a result of the accident at the Chernobyl nuclear power plant are exposed to a complex of environmental, psychological, and socio-economic factors. The high prevalence of hyperproliferative diseases (HPD) reported in this population may be due to, among other things, the oxidative stress, which initiates carcinogenesis. In these settings, the search for drugs that adjust the antioxidant system can be not only an effective strategy for non-hormonal accompanying therapy, but also the key to the pathogenetic prevention of malignant neoplasms. Aim. To study the effectiveness of liposomal glutathione in the correction of oxidative stress in women living in radiation-contaminated areas and the possibility of its use in the supportive therapy of HPD of the reproductive system and thyroid gland. Materials and methods. The study included 25 women living in radionuclide-contaminated areas of the Russian Federation with HPD of the reproductive system and thyroid gland: benign mammary dysplasia, adenomyosis, uterine fibroids, chronic autoimmune thyroiditis, etc. All patients received supportive therapy with liposomal glutathione (Smartlife LLC) at 150 mg daily for 60 days. During the therapy, the clinical and radiological change of the pathological process, as well as indicators of the oxidative system of the body – malonic dialdehyde and general antioxidative activity – were studied. Results. It was shown that during the therapy with the drug, in the blood plasma, there was a decrease in elevated concentrations of the oxidative stress marker, malonic dialdehyde (p=0.000036), and an increase in total antioxidant activity (p=0.022), which was associated with a decrease in the number of cases of chronic autoimmune thyroiditis (p=0.021), diffuse benign mammary dysplasia (p0.001), as well as partial regression of internal endometriosis (p0.001). Conclusion. The use of liposomal glutathione in women with combined thyroid and breast diseases, with and without estrogen-dependent gynecological diseases, contributed to a decrease in the level of inflammation, which led to a favorable treatment outcome. The data obtained show the prospects of further research to assess the effectiveness of such universal antioxidants in cases of oxidative stress: involutive changes, obesity, adverse environmental conditions, chronic anovulatory conditions, persistent infection of the human papillomavirus, chronic stress, etc.

Uterine fibroid (UF) is the most common benign tumor in the structure of gynecological diseases of the female reproductive system, accounting for 45–70% of the total cases. Special attention should be paid to the rare cases with gigantic UFs. The management approach to patients with gigantic UFs is determined by the age of the patient, her desire to bear a pregnancy and realize reproductive function, as well as the presence of comorbidities. Therefore, an individualized approach is essential. The paper describes a clinical case of a patient with a gigantic UF that grew due to the lack of proper medical care for a long time. The patient underwent panhysterectomy, resection of the greater omentum, and ligation of the internal iliac arteries. This case is a clear example of the forced extension of the surgical procedure due to the tumor size, which is associated with an increased risk of surgical complications

Background. Herpes virus infection poses a serious medical and social danger both at the country and global levels, inducing severe disorders leading to pregnancy complications, reproductive losses, and proliferative diseases. Aim. To provide a clinical and immunological assessment; to analyze the state of lipid peroxidation factors and antioxidant protection in the complex therapy of recurrent genital herpes (GH) using Panavir®. Materials and methods. The study was conducted from March 2024 to March 2025 at the Medical Institute of the RUDN University. The study included 125 females with GH relapses (5.0±2 episodes per year) aged 20–45 years. Molecular genetic studies for the presence of herpes simplex virus and the absence of other sexually transmitted infections were performed using polymerase chain reaction, and the content of isopropanol- and heptane-soluble primary, secondary, and final products of lipid peroxidation in plasma and lymphocytes, as well as serum superoxide dismutase and catalase activity were tested using the extraction-spectrophotometric method. The population and subpopulation composition of leukocytes was analyzed using flow cytometry. The serum levels of cytokines were measured using an enzyme-linked immunosorbent assay. Results. In patients with GH relapse during complex therapy with Panavir® (0.04 mg/mL) intravenously 5 mL QD 2 doses, the levels of inflammatory cytokine mediators (interferon γ, interleukin-2, 8, 10, tumor necrosis factor α) were normalized, the number of receptors on the surface of lymphocytes was restored. Panavir® eliminates the effects of oxidative stress and restores the activity of antioxidant protection enzymes, which increases the effectiveness of treatment for recurrent herpes virus infection. Conclusion. Panavir® (0.04 mg/mL) intravenously 5 mL QD 2 doses contributes to a favorable course and outcome of the disease, significantly reduces the number of relapses, and prolongs the inter-relapse period.

Background. Obesity is one of the diseases with the highest rate of spread reported. Adipose tissue plays a vital role in maintaining the physiological processes of the body, but there is an imbalance in metabolic disorders, which increases the risk of hyperplastic endometrial disorders. Aim. To establish a correlation between body composition, namely the percentage of fat and its distribution, and the presence of endometrial hyperplasia (EH) in overweight or obese women of reproductive and premenopausal age. Bioimpedance analysis was used to assess body composition. Materials and methods. A prospective analysis of 61 patients with EH and BMI25 kg/m2 was conducted. Results. The risk of developing EH in patients with metabolic syndrome (MS) was 2.4 times higher compared to patients without it. Comparative lipid profiles in patients of the study groups differed significantly (p0.05). The predominance of visceral obesity and the presence of MS in 80% of the participants in the main group were associated with EH. Conclusion. The predominance of visceral obesity and the presence of MS were strongly associated with EH, pointing up the importance of assessing the BMI and waist circumference, as well as the inclusion of bioimpedance analysis of body composition in a set of diagnostic measures to predict the risk of developing hyperplastic endometrial changes in women with MS. A comprehensive analysis of blood chemistry parameters, in particular MS criteria, such as concentrations of triglycerides, high-density lipoproteins, low-density lipoproteins, and total cholesterol, is crucial. These indicators are also markers of an increased risk of hyperplastic processes in the endometrium.

Background. The primary method of treatment for severe pelvic organ prolapse (POP) is surgery. Despite the significant number of surgical interventions, the high incidence of complications and relapses makes it necessary to search for new methods of surgical treatment. Also, the search for drugs that improve tissue healing in the wound continues in order to reduce the incidence of postoperative complications and the number of relapses. Aim. To evaluate the effect of Phlogenzym® on the postoperative period in women undergoing surgical treatment of POP. Materials and methods. An open-label, single-center, prospective, comparative, randomized study enrolled 124 patients who underwent surgery for POP and divided them into two groups. In the main group (n=64), patients received traditional (infusion, antibacterial) therapy in combination with Phlogenzym® 3 tablets 3 times a day for 30 days in the pre- and postoperative period, while in the comparison group (n=60), only traditional therapy was used. The study included the assessment of medical history, daily recording of the patient’s condition by such clinical parameters as pain assessment using the Visual Analog Scale, body temperature, wound condition (edema, flushing), duration of hemorrhagic discharge, and clinical and biochemical blood tests at admission and discharge from the hospital. Results. The age of patients in the main group was 63.0 (56.8; 69.0) years versus 61.0 (54.3; 68.0) years in the comparison group; p=0.24. Patients of the main group showed more improvements for every single studied indicator of the complete blood count, except for the erythrocyte sedimentation rate. A relatively stable erythrocyte sedimentation rate was observed, indicating that enzyme therapy positively affected the wound. Patients in the study groups in the pre- and postoperative period did not differ significantly in most parameters of the blood chemistry tests. At the time of discharge, 60 (93.7%) patients in the main group and 49 (81.7%) patients in the comparison group had clinical improvement, which indicates a positive trend in wound healing (Pearson’s chi-square 3.19; p=0.08). There were no adverse events associated with the drug during the observation period. Conclusion. Phlogenzym® in the standard of care for the pre- and postoperative period in the surgical treatment of POP is able to favorably influence on the mobile mechanisms of the repair of damaged tissue and stabilize the blood chemistry parameters, which presumably should be associated with the optimization of repair processes in the vagina. The results obtained and the absence of any side effects characterize Phlogenzym® as a drug with a favorable clinical profile for use in the pre- and postoperative period.

Background. Intrauterine infection (IUI) remains an urgent obstetric problem. Aim. Identification of modern, reliable markers of intrauterine infection. Materials and methods. We conducted a retrospective analysis of 510 ultrasound (US) examinations and clinical, microbiological, and morphological data of 54 pregnant women (main group) with symptoms of placental insufficiency (PI) and IUI confirmed after childbirth. The control group included 48 patients with a normal course of pregnancy and childbirth. Results. Valuable and accessible markers of IUI and PI were identified in the main group using sonography: structural changes in the placenta [n=25 (46.3%)] and umbilical cord [n=15 (27.8%)], abnormal changes in the internal organs of the fetus (nonimmune hydrops [n=9 (16.7%)], calcifications [n=8 (14.8%)], etc.), oligohydramnios [n=26 (48.1%)], fetal growth retardation [n=11 (20.4%)], impaired fetoplacental blood flow [n=41 (75.9%)]. These changes occurred in patients with a history of pelvic inflammatory diseases [n=30 (55.6%)], mother's somatic diseases (history of urinary tract infections [n=19 (35.2%)], pregnancy complications: threatened miscarriage [n=19 (35.2%)], threatened premature birth [n=26 (48.1%)], infectious diseases in newborns. The study of afterbirth in the main group showed signs of purulent chorioamnionitis in 30 (55.6%) cases. Conclusion. Maternal infectious diseases through the transplacental and ascending pathways increase the risk of miscarriage, preterm delivery, and fetal and neonatal disease and lead to adverse perinatal outcomes. Ultrasound predictor marker of the initial complications of PI and IUI is early oligohydramnios detected using the method of maximal vertical pocket by 3D/4D echography [in the main group, n=24 (44.4%)], which precedes the development of early fetal growth retardation [n=4 (7.4%)] and decompensation of fetoplacental blood flow [n=7 (13%)]. The timely use of ultrasound markers of IUIs helps to choose the effective approach for prenatal care and delivery.

Background. Various forms of endometrioid disease affect 7–10% of women of reproductive age and are an important factor in reducing fertility and quality of life. The basis of modern comprehensive therapy is surgery and hormonal agents. Aim. To conduct a meta-analysis of the literature on using dienogest (Zafrilla) for treating pain in endometriosis. Materials and methods. The review and meta-analysis were conducted according to the guidelines of the Cochrane Society and in compliance with the recommendations for systematic reviews and meta-analyses. Data sources for the meta-analysis include publications in the PubMed database between 1997 and February 2024 and relevant research articles in Russian mentioning Zafrilla. Keywords such as "dienogest," "endometriosis surgery," "endometriosis treatment," and "endometriosis" were used to identify relevant studies. The main criterion for the primary assessment was pain relief; the additional one was endometrioma and/or pain recurrence, which indicated a disease relapse. For the meta-analysis, studies mentioning Zafrilla were selected. The study protocol is registered online in the International Prospective Registry of Systematic Reviews (CRD3034892022). Results. Based on the analyzed results of previously published studies, it was found that Zafrilla's effectiveness significantly exceeded placebo and (in some studies) was similar to that of the gonadotropin-releasing hormone agonist in reducing the severity and frequency of pain and relapse after surgery for infiltrative endometriosis and endometriomas. The weighted mean difference with the 95% confidence interval was 1.20 in reducing the pain severity and 1.17 in reducing the number of clinical and morphological relapses in endometriomas and infiltrative endometriosis. The magnitude of the effect for spontaneous pregnancy after surgery and/or endometriosis monotherapy with Zafrilla was 0.9 (relative risk with 95% confidence interval). Conclusion. Our study showed that in many medical institutions where Zafrilla was used for endometriosis both alone and with surgery, clinical improvement was achieved in improving clinical manifestations and significantly reducing the disease recurrence rate. The reduction in endometrioma diameters during non-surgical therapy with Zafrilla without surgery in the study by R. Malik et al. shows the possibilities of modern hormonal drugs and narrows the indications for surgery, allowing the preservation of ovarian reserve along with improving patients' quality of life. Dienogest (Zafrilla) was proven to be effective in pain treatment and prevention of pain recurrence after surgical treatment of endometriosis.

Background. Rheumatoid arthritis (RA) is one of the most common and severe immune-inflammatory diseases in humans and is associated with a great medical and socio-economic burden. RA can have a significant impact on family planning and fertility; women with RA have fewer children than expected, and patients with RA tend to take longer to achieve the desired pregnancy. Measuring anti-Müllerian hormone (AMH) levels is important in assessing ovarian reserve (OR). There are many studies on OR, but no generally accepted tools are available to identify adolescent girls with reduced OR. There is little data on "normal OR" and the factors that affect it. Aim. To study the markers of the OR status in adolescent girls with juvenile arthritis and to establish their prognostic significance for the reproductive function. Materials and methods. The study was conducted at the Samara Regional Clinical Cardiology Dispensary named after V.P. Polyakov with the support of the medical company INVITRO. It included 42 girls aged 11–17 with a diagnosis of juvenile idiopathic arthritis (main group) and 9 somatically healthy girls (comparison group). Patients completed a questionnaire, medical history data were reviewed, and blood sampling for AMH testing was performed. Results. The AMH measurements showed statistically significant differences between all groups; in particular, in group 1, the levels were lower (p=0.000334, the Mann–Whitney test was used). Boxplots were plotted to visualize the differences between the analyzed parameters. Conclusion. According to the literature and authors' observations, the role of AMH as a sensitive and specific biomarker of ovarian reserve in girls with diseases that impair steroidogenesis (including juvenile idiopathic arthritis) has been established. AMH level can help make therapeutic decisions, have prognostic significance, and help to identify risk groups of adolescent girls at an early stage.

Aim. To compare the effectiveness of the kGoal vaginal trainer combined with the intimate non-hormonal phytocomplex with hyaluronic acid, Estrogial, for the non-surgical treatment of the early stages of pelvic prolapse in women with surgical menopause. Materials and methods. We examined 65 patients who came for an outpatient consultation 6–12 months after surgery (extirpation and/or amputation of the uterus with appendages). All study subjects were diagnosed with POP-Q grade 1 pelvic organ prolapse at the time of the first visit. In addition, some patients complained of urge urinary incontinence and various symptoms typical for the genitourinary menopausal syndrome. The mean age of study patients was 48.7±6.5 years (99% confidence interval 46.62–50.78); the mean age of surgical menopause was 50.1±2.8 years (99% confidence interval 49.21–50.99); the duration of surgical menopause was 6 months to 1 year. Symptoms in patients at outpatient Visit 1 included dysuria in 29 (44.62%), stress urinary incontinence in 23 (35.39%), sexual dysfunction in 26 (40.00%), sensations of vagina dryness in 45 (69.23%), splashing sounds in the vagina during sexual intercourse or sports in 18 (27.69%), loss of vagina sensitivity in 12 (18.46%). The treatment effectiveness was assessed in 3, 6, and 9 months. Results. After 9 months of treatment, dysuria persisted in 2 (3.33%) patients. Stress urinary incontinence persisted in 5 (8.33%) patients and sexual dysfunction in 3 (5.00%) patients. Five (8.33%) patients still reported splashing sounds in the vagina during sexual intercourse or sports. The sensation of vagina dryness and loss of vagina sensitivity after treatment were not reported in any of the patients. The significance of the association of the surgical menopause sequelae with individual clinical signs of pelvic organ prolapse was relatively high and very high (p0.05). Conclusion. The study on kGoal vaginal trainer combined with the local non-hormonal phytocomplex with hyaluronic acid in patients with surgical menopause showed statistically significant, good, and satisfactory clinical efficacy, reducing the clinical manifestations of pelvic organ prolapse and the severity of the symptoms of surgical menopause-related genitourinary menopausal syndrome.