Benign Uterine Disease Research Articles

Comparison of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and Laparoendoscopic Single-Site (LESS) Hysterectomy on PostoperativePain Reduction: A Randomized Pilot Study.

IntroductionVaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy has shown benefit in postoperative pain and operation time compared to laparoscopic hysterectomy in recent studies. However, no prospective studies comparing laparoendoscopic single-site (LESS) and vNOTES hysterectomy have been performed. This study aims to evaluate postoperative pain and safety of vNOTES hysterectomy compared to LESS hysterectomy for benign uterine disease.MethodsThis study is a prospective, investigator-initiated randomized controlled pilot trial. A total of 26 patients were randomized and allocated to vNOTES group (n = 13) and LESS group (n = 13). The primary outcome was postoperative abdominal and vaginal pain evaluated 24 h after surgery. Secondary outcomes included the number of additional analgesics administered and the maintenance rate of patient-controlled analgesia (PCA).ResultsNo differences were shown in baseline characteristics between the two groups. Operation time was longer in the LESS group (median, 55 vs. 75 min; P = 0.027), and there were no differences in estimated blood loss, postoperative hemoglobin level, surgical indications, and hospitalization days. Postoperative abdominal pain intensity did not differ between the two groups, while the vNOTES group showed higher postoperative vaginal pain than the LESS group at 16 and 24 h after surgery (median, 3 vs. 1 and 2 vs. 0, P = 0.007 and P = 0.010, at 16 and 24 h respectively). No differences were shown in the number of additional analgesics and PCA use between the two groups.ConclusionsvNOTES hysterectomy can be safely performed for benign uterine disease requiring hysterectomy. However, vNOTES hysterectomy might be associated with higher postoperative vaginal pain intensity compared to LESS hysterectomy.Trial RegistrationCRIS identifier KCT0004605.

P–497 Anxiety, depression and sexual dysfunction among women with genital diseases

Abstract Study question How is the prevalence of anxiety, depression and sexual dysfunction among Chinese women who is suffering from genital diseases? What is the relationship among their anxiety, depression and sexual dysfunction? Summary answer Anxiety, depression and sexual dysfunction symptoms were self-reported by the participants. Besides, their anxiety, depression and sexual dysfunction were inter-correlated. What is known already Reduced sexual activity and dysfunctional problems are highly prevalent in females. Approximately 43% of American women reported experiencing sexual problems. Women who are facing pressure on childbirth, may be more likely to have mental health problems. Some studies have shown that having gynecological disease can lead to anxiety, depression and sexual dysfunction. However, the mental health of females who are suffering from genital diseases has been little studied. Study design, size, duration The investigation was carried out from March to November, 2020. Participants were recruited in the Hong Kong University-Shenzhen Hospital, located in Shenzhen, China. 135 patients were approached while 116 agreed to join the survey. Participants/materials, setting, methods 116 women (35.42±8.19 years old) with a diagnosis of fallopian tube disease, ovarian benign disease or uterine disease voluntarily filled a questionnaire which contains the Female Sexual Function Index–6 Items (FSFI–6) and the Hospital Anxiety and Depression Scale (HADS). Descriptive analysis and stepwise regression were used to present participants’ self-reported anxiety, depression, and sexual dysfunction problems, as well as the relationship among their anxiety, depression, and sexual dysfunction. Main results and the role of chance 25% of the participants reported anxiety symptoms; 9.5% of the women reported depressive symptoms; while 37.3% reported sexual dysfunction problems. Anxiety (p < 0.001) was significantly associated with depression. Depressive symptom can significantly predict sexual dysfunction (p < 0.05) while anxiety was not associated with sexual dysfunction (p > 0.05). Targeted interventions are needed to improve the mental health status of women with genital diseases in China. Limitations, reasons for caution This study can only present mental health status of this population. To better show the odds ratio of mental health problems, a case-control study design is needed. Besides, future qualitative or longitudinal studies are needed to detect the risk factors for the poor mental health of women with genital diseases. Wider implications of the findings: Reduced sexual activity and dysfunctional problems are highly prevalent in females with genital diseases. Sexuality is an important element in patients’ quality of life. For female patients with genital diseases, we should not only treat their physical symptoms, but also guide and treat patients in mental ways. Trial registration number ChiCTR2000031343

Outcome assessment of total abdominal hysterectomy vs ascending vaginal hysterectomy

Introduction
 Hysterectomy is a reasonably safe, common and routine surgical procedure which rarely leads to perioperative death. Minor complications including postoperative infections, fever, wound hematomas or wound separation occur in approximately 25% of patients. 
 
 Objective 
 A comparative assessment of the post-operative outcomes of Sri Lankan patients subjected to Total Abdominal Hysterectomy and Ascending Vaginal Hysterectomy for benign uterine diseases.
 Methods
 A randomized controlled trial was conducted on 60 patients who underwent hysterectomy from July 2013 to June 2014, in a tertiary care hospital. Women those who were waiting for hysterectomy for benign uterine diseases within age 35-55yrs were included for the study.30 patients were underwent abdominal hysterectomy and 30 patients were underwent vaginal hysterectomy. Five main variables were measured such as operative time in minutes, blood loss, post operative pain, pyrexia, hospital stay in days. Data entered and analyzed by SPSS 25.0. 
 
 Result 
 Age of participants was between 37 years of age to 51 years of age. Mean age was 44.87 years among Vaginal Hysterectomy group (SD 3.4 years) and 44.71 among Abdominal Hysterectomy group (SD 3.756 years). 
 The average time duration for two procedures (t=10.4: p

Frequency and Spectrum of Non-Malignant Lesions in Abdominal Hysterectomy Specimens

Objective: To determine the histological spectrum of non-malignant lesions in abdominal hysterectomy specimens from women of reproductive age group. Study Design and Setting: This was a descriptive cross-sectional study carried out at a private hospital in Karachi from December 2018 to December 2019. Methodology: The uterine specimens of patients (n=262) between the ages of 24 to 55 years were collected. Hysterectomies done due to any benign uterine disease were included in the study. Hysterectomies due to malignant causes were excluded. Pathological diagnosis was done on light microscopy using routine hematoxylin and eosin staining technique. Data collected during the study period included patient's age, clinical history/diagnosis and histological diagnosis. On receiving the hysterectomy specimens as per protocol, specimens were immediately put in 10% formalin, appropriately labeled for patient’s name, gender, age and procedure. In histopathology lab, grossing of the specimens was done using standard protocols. Frequency and variables were analyzed by using descriptive statistics of SPSS-version 22. Results: Total n=262 hysterectomies were received. Mean age of all the patients was 34.7 years ±7.8. Non-malignant uterine pathologies on histopathology included 124(47.7%) leiomyomas, 52(20%) adenomyosis, 32(12.3%) endometrial polyps, 16(6.2%) endometrial hyperplasia, 6(2.3%) endometritis, 3(1.2%) disordered proliferative endometrium and 1(0.4%) endometrial stromal nodule. Rest of the cases showed normal phases of endometrial cycle. Only two cases (0.76%) out of 262 received as clinically benign uterine disease, were diagnosed as malignant on histopathology. Conclusion: Leiomyoma is the most common uterine pathology diagnosed in clinical setting as well as encountered at histopathological examination followed by Adenomyosis and endometrial polyps in women of reproductive age group in Pakistan.

The effect of prophylactic bilateral salpingectomy on ovarian reserve in patients who underwent laparoscopic hysterectomy

BackgroundBilateral salpingectomy has been proposed to reduce the risk of ovarian cancer, but it is not clear whether the surgery affects ovarian reserve. This study compares the impact of laparoscopic hysterectomy for benign disease with or without prophylactic bilateral salpingectomy on ovarian reserve.MethodsRecords were reviewed for 373 premenopausal women who underwent laparoscopic hysterectomy with ovarian reserve for benign uterine diseases. The serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and three-dimensional antral follicle count (AFC) were assessed before surgery and 3 and 9 months postoperatively to evaluate ovarian reserve. Patients were divided into two groups according to whether they underwent prophylactic bilateral salpingectomy. The incidence of pelvic diseases was monitored until the ninth month after surgery.ResultsThere was no significant difference between the two surgery groups in terms of baseline AMH, E2, FSH, LH, and AFC (all P > 0.05). There was no difference in potential bias factors, including patient age, operative time, and blood loss (all P > 0.05). There was also no significant difference between the two groups 3 months after surgery with respect to AMH (P = 0.763), E2 (P = 0.264), FSH (P = 0.478), LH (P = 0.07), and AFC (P = 0.061). Similarly, there were no differences between groups 9 months after surgery for AMH (P = 0.939), E2 (P = 0.137), FSH (P = 0.276), LH (P = 0.07) and AFC (P = 0.066). At 9 months after the operation, no patients had malignant ovarian tumors. The incidences of benign ovarian tumors in the salpingectomy group were 0 and 2.68 % at 3 and 9 months after surgery, respectively, and the corresponding values in the control group were 0 and 5.36 %. The incidences of pelvic inflammatory disease in the salpingectomy group were 10.72 and 8.04 % at 3 and 9 months after surgery, respectively, while corresponding values in the control group were 24.13 and 16.09 %.ConclusionsProphylactic bilateral salpingectomy did not damage the ovarian reserve of reproductive-age women who underwent laparoscopic hysterectomy. Prophylactic bilateral salpingectomy might be a good method to prevent the development of ovarian cancer. Larger clinical trials with longer follow-up times are needed to further evaluate the risks and benefits.

Sacrospinous hysteropexy - an alternative in primary surgical treatment of apical compartment prolapse

To present a surgical treatment of pelvic organ prolapse and its outcomes according to the literature. PubMed database search. Pelvic organ prolapse is a common diagnosis with prevalence around 40% of female population. Vaginal delivery, especially with levator ani trauma, increasing age and obesity are the basic risk factors. Native tissue repair is a possible surgical treatment. Unfortunately, concomitant hysterectomy is still a very common procedure. It is established that uterus plays a passive role in pelvic organ prolapse. Sparing of the uterus keeps the original fixation structures and compartments intact and provides a solid tissue to anchor the stitches. Patients with benign and malign uterine diseases cannot have their uterus spared. In sacrospinous hysteropexy, nonabsorbable sutures are passed through the namesaked ligament on one or both sides to elevate the uterus. Several studies and their metaanalyses show comparable anatomical and functional outcomes with shorter operation time, decreased blood loss, faster recovery and lower complication rates in comparison with hysterectomy and uterosacral ligament fixation. In a prospective randomized control trial, sacrospinous hysteropexy provides significantly lower reoperation rate for apical compartment prolapse in a long-term follow-up. It is a safe and effective procedure for patients who wish to keep their uterus in place. Sacrospinous hysteropexy is an alternative in primary surgical treatment of pelvic organ prolapse.

Feasibility of ovarian preservation as a stage in correcting the quality of life in young patients after gynecologic surgeries.

e17560 Background: The purpose of the study was to analyze the structure and activity of the blood flow in the preserved ovaries after gynecologic surgeries. Methods: We monitored 50 patients (mean age 35.8±0.5 years) using sonography after ovary-sparing hysterectomy for benign, precancerous and preinvasive malignant uterine diseases. For revascularization, the preserved ovaries were attached to the lateral wall of the small pelvis or to the base of round ligaments of the uterus. Results: Ovarian hypertrophy was recorded in 3 women during the first year of the follow-up; the ovaries returned to the initial size without correction by 24 months. By the third year of observation, 94% of women had normal gonadal sizes, and only 2 women had ovarian hypoplasia. During the entire observation period (3 years), in 91% of cases, we could visualize the regular maturation of follicles in the preserved ovaries, which indicated the preservation of ovulatory function. The use of Doppler techniques during 24 months of the follow-up demonstrated that the blood circulation in the attached ovaries after hysterectomy was decreased on the average by 20.3%, compared to the intact ovaries. Conclusions: After the critical period of hysterectomy, the blood flow in the ovaries in almost all patients remains sufficient during the first 2-3 years, stimulating the regular growth of follicles and maintaining the gonadal activity. The quality of life of the operated patients during the first three years of follow-up remains optimal without additional correction with hormone replacement therapy.

Hysterectomy and bilateral adnexectomy using transvaginal natural orifice transluminal endoscopic surgery: The role of multichannel abdominal PORT and vaginal support ring.

Although transvaginal natural orifice transluminal endoscopic surgery (NOTES) is gaining importance, knowledge on transvaginal NOTES procedures in gynecologic practice is limited. We aimed at evaluating the feasibility and safety of performing hysterectomy and bilateral adnexectomy (or bilateral salpingectomy) via transvaginal NOTES using a self-developed multichannel abdominal port and vaginal support ring. A prospective, single-center, cohort pilot study was conducted from May to December 2017 in patients with benign uterine diseases or endometrial atypical hyperplasia or cervical intraepithelial neoplasia (n=30) scheduled for laparoscopic hysterectomy. The procedure was performed using a self-developed five-channel port and a vaginal support ring. Hysterectomy and bilateral adnexectomy (or bilateral salpingectomy) in all 30 cases (mean age: 51.43 ± 4.60 years and body mass index: 23.42 ± 1.45 kg/m2 ) were successfully performed completely under transvaginal NOTES. Mean operation time was 95.90 ± 14.60 minutes and mean blood loss during the procedure was 52.50 ± 19.20 mL. Average weight of specimen was 79.97 ± 35.48 g. Only one complication of bladder injury was noted and was rectified accordingly. Visual Analog Score (VAS) at first day after operation was 2.70 ± 0.72. After follow-up for 4.50 ± 1.85 months, all the patients' vaginal stump healed well without scar formation. Our study showed that use of multichannel abdominal port could make laparoscopic instruments easier to fix and operate wherein the vaginal support ring reduces the leakage of carbon dioxide pneumoperitoneum. There was no scar on the abdomen and VAS was much lower. This study also demonstrated cosmetic benefits and rapid postoperative recovery.

Unidirectional Barbed Suture Versus Polyglactin 910 Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy.

Introduction and objectiveLaparoscopic suturing of the vaginal cuff and knotting is the most challenging step in total laparoscopic hysterectomy (TLH) and requires surgical skill. The objective of this study was to compare the efficacy and safety of unidirectional barbed suture (V-LocTM 180; Covidien, Mansfield, MA) with the conventional polyglactin 910 suture (coated Vicryl; Covidien) for vaginal cuff closure in patients with benign uterine diseases undergoing total laparoscopic hysterectomy.Methods A prospective observational study was carried out at the department of obstetrics and gynecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, for two years. A total of 109 patients with benign uterine diseases planned for TLH were included in the study. Laparoscopic vaginal cuff closure was performed with the unidirectional barbed suture (V-Loc) in 44 patients and with the standard polyglactin 910 suture (Vicryl) in 65 patients. The primary outcome measure was vaginal cuff closure time. Secondary outcome measures included total operative time, blood loss, average number of stitches, postoperative pain perception, duration of hospital stay, vaginal cuff-related complications, and dyspareunia.ResultsDemographic variables and baseline characteristics were similar in both groups except for body mass index (BMI). The mean vaginal cuff closure time was significantly less in the V-Loc group (8.84 ± 2.18 min) than in the Vicryl group (11.66 ± 1.74 min) (p = <0.01). Mean operative time was comparable in both groups (V-Loc group - 109.36±33.02 and Vicryl group - 108.49±40.48; p = 0.91). Other intraoperative parameters, such as blood loss and number of stitches in cuff closure, and postoperative characteristics, such as pain score, duration of hospital stay, vaginal cuff-related complications (vault cuff dehiscence, hematoma, or abscess), and dyspareunia, were comparable in both the groups.ConclusionsThe unidirectional barbed suture significantly reduces vaginal cuff closure time. It is a safe, effective, and well-tolerated alternative to conventional Vicryl suture for vaginal cuff closure in TLH without increasing the risk of postoperative vaginal complications particularly where affordability is not an issue and resources are accessible.

Safety of early discharge in patients undergoing laparoscopic hysterectomy in a high complexity center in Bogotá, Colombia, 2013 - 2019. Historical cohort

RESUMENObjetivo: Describir la seguridad del alta en las primeras 12 horas del posoperatorio en mujeres cometidas histerectomía por laparoscopia por patología benigna de útero.Materiales y métodos: Estudio de cohorte histórica descriptiva. Se incluyeron todas las mujeres llevadas a histerectomía laparoscópica por patología benigna, quienes fueron dadas de alta después de 12 horas del procedimiento en un hospital de alta complejidad en Bogotá, Colombia, entre enero del 2013 y abril del 2019. Se excluyeron pacientes con comorbilidades (diabetes, enfermedad cardiovascular y pulmonar obstructiva crónica), limitaciones para la movilización y aquellas que presentaron complicaciones intraoperatorias. Se realizó un muestreo consecutivo. Se evaluaron variables demográficas, y como variables de seguridad, el reingreso por urgencias y complicaciones clasificadas según la escala de Dindo a los 15 días del postoperatorio. Se hace análisis descriptivo.Resultados: Durante el período de estudio se realizaron 860 histerectomías por laparoscopia, de estas, 67 (7,8%) cumplieron con los criterios de selección. Once pacientes (16,4%) reingresaron por el servicio de urgencias, de las cuales, siete (63,6%) acudieron por dolor, una (9%) por sangrado activo, una (9%) por fiebre, y dos (18%) por síntomas urinarios. Se presentaron seis (8,9%) complicaciones postoperatorias de las cuales dos pacientes (2,9%) tuvieron hematoma de cúpula vaginal, dos (2,9%) hemoperitoneo, una (1,4%) infección urinaria y una (1,4%) lesión ureteral; cuatro pacientes (5,9%) requirieron hospitalización, estas últimas se clasificaron en el estadio IIIb de Dindo.Conclusiones: El alta temprana surge como alternativa al cuidado hospitalario para este tipo de población. Se requieren estudios con grupo control y asignación aleatoria para aportar mejor evidencia respecto a este manejo.

Evaluation of Closure versus Non-closure of Vaginal Vault after Non-descent Vaginal Hysterectomy

Introduction: Non-descent vaginal hysterectomy has been considered a valid alternative to the abdominal approach and is also preferred for benign uterine diseases without descent of uterus because it is associated with fewer complications. Vaginal vault is the enlargement of the internal end of the vagina which is usually closed during vaginal hysterectomy. This study was done to see the outcome of vault closure versus non-closure in non-descent vaginal hysterectomy in non-prolapsed uterus.&#x0D; Methods: This prospective study was done in Obstetrics and Gynae Department, Sir Salimullah Medical College and Mitford Hospital during the period of July 2011 to December 2011. A total number of 50 patients with benign gynecological disorders without descent of uterus who admitted for hysterectomy were enrolled in this study. Among them, 25 patients had the vault close (group I) whereas 25 patients had an open vault(group11). Indication for hysterectomy, complications, blood transfusion, hospital stay (day) and histopathological findings were assessed for both groups. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-20).&#x0D; Results: Majority of the patients was found in the age group of 41-45 years in both groups, which was 12(48.0%) in Group I and 18(72.0%) patients in Group II. Blood transfusion was needed in 5(20.0%) and in 6(24.0%) in Group I and Group II respectively. Post operative complications after 15 days of follow-up, pelvic abscess was found 4.0% in Group I &amp; not found in Group II. UTI was not found in Group I but 4.0% found in Group II.&#x0D; Conclusion: Outcomes were almost similar in both procedure. Ultimately the study did not show any significant difference between either group.&#x0D; J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 45-49

Enhanced Recovery after Surgery in Obese Patients Undergoing Laparoscopic Hysterectomy for Benign Uterine Diseases

Enhanced Recovery after Surgery in Obese Patients Undergoing Laparoscopic Hysterectomy for Benign Uterine Diseases

Deciding the Appropriate Route and Method of Hysterectomy for Women with Benign Diseases: A Cross-sectional Study at a Tertiary Care Hospital, India

Introduction: Different factors may influence the route of hysterectomy for benign indications. Each of the three main approaches of hysterectomy has its own set of risks and benefits. A rational and evidence-based decision to select a right method for a particular patient is necessary to bring about the best possible outcome with least complications. Aim: To compare three groups of hysterectomy, i.e., laparotomy for Total Abdominal Hysterectomy (TAH), Non-descent Vaginal Hysterectomy (NDVH) and Total Laparoscopic Hysterectomy (TLH), with regard to the patient and clinical factors, surgical outcomes and complications, in order to decide the optimum route and method of hysterectomy in a patient with benign disease. Materials and Methods: In this hospital-based cross-sectional study, 120 women, with 40 patients each in the TAH, NDVH and TLH groups, were admitted due to benign gynaecological conditions in a tertiary care hospital in Kolkata, India from May 2013 to April 2014. They were operated, and then followed-up at 6-12 weeks after surgery. All the relevant information, e.g., clinical diagnosis, operating time, intraoperative blood loss, length of stay in hospital, postoperative pain score, intraoperative and postoperative complications, etc., were recorded. Data were analysed statistically by simple proportions and statistical tests, i.e., Chi-square test and F-test. Results: The most common indication for hysterectomy was benign diseases in all the groups, 47.5%, 40% and 37.5%, respectively in the TAH, NDVH and TLH groups. The mean operating time (minutes) was significantly higher in the TLH group (163.5) as compared to the TAH (75.03) and NDVH groups (84.88) (p=0.039). A significantly lesser mean intraoperative blood loss (mL) was observed in the NDVH (85.67) and TLH groups (98.63) as compared to the TAH group (168.47) (p=0.021). The observations in regard to other surgical outcome parameters, i.e., postoperative pain score, hospital stay, were also favourable in the NDVH or TLH group. The complication rate was higher in the TAH group (22/40 or 55%) as compared to the NDVH (14/40 or 35%) and TLH (17/40 or 42.5%) groups. Conclusion: NDVH or TLH is the preferred method over TAH in case of benign uterine disease due to lesser operative morbidity and faster recovery.

Clinical cohort study of total hysterectomy via transvaginal natural orifice transluminal endoscopic surgery and transumbilical laparoendoscopic single site surgery

Objective: To study the safety and feasibility of total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and transumbilical laparoendoscopic single site surgery (TU-LESS). Methods: The study was a retrospective cohort analysis. In West China Second University Hospital, from October 1, 2018 to June 30, 2019, the patients with an indication for hysterectomy due to benign uterine diseases were enrolled, and were grouped by the surgical procedure. Various post-operative surgical outcomes, including the success rate of operation, uterine volume, operative time, blood loss, intraoperative complications, postoperative complications, the first time of flatus, the preserved time of catheter after operation, and the length of hospitalization were measured. The data were assessed by the software of SPSS. Results: Totally 30 patients were included in the vNOTES group, and 77 patients were included in the TU-LESS group, all of the procedures were completed successfully without conversion to traditional multiport laparoscopy or laparotomy. Non differences were observed between two groups, including uterine volume [(165±36) vs (235±38) cm3, P=0.243], operation time [(150±41) vs (169±48) minutes, P=0.063], blood loss [(54±15) vs (54±14) ml, P=0.985], the rate of intraoperative complications [3% (1/30) vs 4% (2/77), P=1.000], the rate of postoperative complications [13% (4/30) vs 4% (3/77), P=0.095] and the rate of bilateral salpingo-oophorectomy [50% (15/30) vs 31% (24/77), P=0.069]. Patients in the vNOTES group had significantly less recovery time of intestine function [(1.7±0.5) vs (2.3±0.6) days, P=0.001], shorter time of indwelling catheter [(1.9±0.4) vs (2.3±0.6) days, P=0.004], and duration of hospitalization [(3.2±0.8) vs (3.6±0.9) days, P=0.045]. Conclusions: vNOTES and TU-LESS are both safe and feasible for total hysterectomy. Compared with TU-LESS, vNOTES may be a promising approach with earlier recovery, less injury and better cosmetic.

Рецептивность эндометрия у больных доброкачественными заболеваниями матки в сочетании с бесплодием до и после оперативного лечения

Рецептивность эндометрия у больных доброкачественными заболеваниями матки в сочетании с бесплодием до и после оперативного лечения

The Trained Sniffer Dog Could Accurately Detect the Urine Samples from the Patients with Cervical Cancer, and Even Cervical Intraepithelial Neoplasia Grade 3: A Pilot Study.

Simple SummaryTumor detection by dog sniffing is a possible new method in cancer diagnosis. The aim of this study is to assess whether a trained dog can distinguish urine samples from cervical cancer patients. Urine samples were collected from 34 with cervical cancer, 49 patients with CIN3, 49 with benign uterine diseases, and 63 healthy volunteers. In all 83 test runs, one positive sample among five samples were presented to the dog. The trained dog accurately distinguished the urine sample of a cancer patient from those of the controls. This study showed that cancer detection by dog sniffing can be a non-invasive, cost-effective screening technique for cervical cancer.(1) Background: Previous reports have indicated that cancers of the stomach, lung, and pancreas can be detected by dog sniffing, but results have been varied. Here, a highly trained dog was used to determine whether urine from patients with cervical premalignant lesions and malignant tumors have a cancer-specific scent. (2) Methods: A total of 195 urine samples were collected from patients with cervical cancer, cervical intraepithelial neoplasia grade 3 (CIN3), benign uterine diseases, and healthy volunteers. Each test was performed using one urine sample from a cancer patient and four samples from different controls. Each of the five urine samples was placed in a separate box. When the cancer sniffing dog stopped and sat in front of the box with a sample from a cancer patient, the test was considered as positive. (3) Results: 83 patients with cervical cancer (34 cases of cervical cancer and 49 cases of cervical intraepithelial neoplasia grade 3), 49 patients with uterine benign diseases, and 63 healthy volunteers were enrolled, and their urine samples were collected. In 83 times out of 83 runs in a double-blind test, the trained dog could correctly identify urine samples of cervical cancer patients. (4) Conclusion: A trained dog could accurately distinguish the urine of all patients with cervical cancer or CIN3, regardless of the degree of cancer progression.

The Role of Contrast-Enhanced Ultrasound in Evaluating Gestational Trophoblastic Neoplasia: A Preliminary Study.

ObjectiveWe aimed to compare the imaging features of gestational trophoblastic neoplasias (GTNs) and benign pregnancy-related uterine diseases on contrast-enhanced ultrasound (CEUS) to explore the clinical value of CEUS in differentiating these two types of uterine lesions.Materials and MethodsIn this prospective study, patients with GTNs before and after chemotherapy and benign pregnancy-related uterine lesions received conventional US and CEUS. The imaging features and parameters of CEUS of the lesions were assessed.ResultsA total of 73 patients were enrolled in this study, including 48 with GTNs and 25 with benign lesions. The enhancement pattern of newly diagnosed GTNs was mainly diffuse enhancement (70.8%), with a non-enhanced area of less than 1/3 of the entire lesion. For the benign group, the enhancement pattern was mainly ring-shaped enhancement (72.0%), and the non-enhanced area was more than 1/2 (68.0%), significantly different from that of GTNs (P = 0.000 and 0.002, respectively). Forty-one lesions demonstrated unclear boundaries on greyscale US but clearly displayed on CEUS. In both the benign and malignant groups, the measurements of lesion size on CEUS were larger than those on greyscale US (P = 0.000). The measurement differences (ΔD: D2-D1) of the malignant cases were higher than those of the benign cases (P = 0.001).ConclusionGTNs and benign pregnancy-related uterine diseases have different imaging characteristics on CEUS. The boundary and involved range of the lesion can be clearly demonstrated on CEUS. CEUS possesses clinical value in diagnosing and evaluating GTNs and benign pregnancy-related diseases.

The Interplay Between Prolactin and Reproductive System: Focus on Uterine Pathophysiology.

Over the last years, increasing evidence has focused on crucial pathogenetic role of PRL on malignant, premalignant and benign uterine diseases. Studies in animals and humans have documented that PRL receptors (PRL-Rs) are widely expressed on uterine cells and that PRL is directly synthesized by the endometrium under the stimulatory action of progesterone. Uterine PRL secretion is finely modulated by autocrine/paracrine mechanisms which do not depend on the same control factors implied in the regulation of PRL secretion from pituitary. On the other hand, PRL is synthesized also in the myometrium and directly promotes uterine smooth muscle cell growth and proliferation. Therefore, PRL and PRL-Rs appear to play an important role for the activation of signaling pathways involved in uterine cancers and preneoplastic lesions. Circulating PRL levels are reportedly increased in patients with cervical or endometrial cancers, as well as uterine premalignant lesions, and might be used as discriminative biomarker in patients with uterine cancers. Similarly, increased PRL levels have been implicated in the endometriosis-induced infertility, albeit a clear a causative role for PRL in the pathogenesis of endometriosis is yet to be demonstrated. This evidence has suggested the potential application of dopamine agonists in the therapeutic algorithm of women with malignant, premalignant and benign uterine lesions. This review focuses on the role of PRL as tumorigenic factor for uterus and the outcome of medical treatment with dopamine agonists in patients with malignant and benign uterine disease.

The number of overall hysterectomies per population with the perimenopausal status is increasing in Japan: A national representative cohort study.

This study aimed to investigate the trends in overall hysterectomy and other alternative therapies for benign uterine diseases per population aged 40-54 years in Japan. We conducted a national representative cohort study in Japan. We obtained data from 'The National Database of Health Insurance Claims and Specific Health Checkups of Japan' Open Data. The primary outcome was the number of overall hysterectomies for benign gynecologic diseases per population aged 40-54 years, from 2014 to 2017 in Japan. The secondary outcome was the number of alternative surgical and drug therapies to hysterectomy per population. We also analyzed the correlation between the number of laparoscopy-qualified gynecologists and the number of overall hysterectomies per population among 47 prefectures in 2017. The number of overall hysterectomies for benign gynecological diseases per 100 000 females aged 40-54 years gradually increased from 320 in 2014 to 344 in 2017 (7.5% increase overall). Moreover, there was a significant increase in the use of levonorgestrel intrauterine systems. We could not explain the reason for this increase in the rate of overall hysterectomies by summarizing the increase or decrease of alternative therapies to hysterectomy. Multiple regression analysis showed a significant correlation between the number of laparoscopy-qualified gynecologists and the number of overall hysterectomies among 47 prefectures. Despite the spread of alternative therapies to hysterectomy, there was an increasing trend for overall hysterectomies in Japan. The reason was not clear but may be related to the spread of laparoscopic hysterectomy.

Risk Factors for Bowel Injury in Hysterectomy for Benign Indications.

To estimate the incidence and risk factors for bowel injury in women undergoing hysterectomy for benign indications. A retrospective cohort study was conducted among women undergoing hysterectomy for benign indications from 2012 to 2016 at institutes participating in the American College of Surgeons National Surgical Quality Improvement Program, including both inpatient and outpatient settings. Bowel injury was identified using Current Procedural Terminology codes as patients who underwent bowel repair at the time of hysterectomy or postoperatively within 30 days. Multivariate logistic regression models were used to control for patient clinical factors and perioperative factors. Bowel injury occurred in 610 of 155,557 (0.39%) included women. After bivariate analysis, factors associated with bowel injury included age, race, body mass index, American Society of Anesthesiologists classification, increased operative time, surgical approach, type of hysterectomy, lysis of adhesions, and operative indication. After adjusting for potential confounders, bowel injury was found associated with older age, surgical indication of endometriosis, and abdominal surgical approach. Compared with the surgical indication of endometriosis (n=63/10,625), the surgical indications of menstrual disorder (odds ratio [OR] 0.33, 95% CI 0.23-0.47; adjusted odds ratio [aOR] 0.33, 95% CI 0.23-0.48; n=67/34,168), uterine leiomyomas (OR 0.80, 95% CI 0.61-1.05; aOR 0.44, 95% CI 0.33-0.59; n=243/51,232), and genital prolapse (OR 0.30, 95% CI 0.20-0.45; aOR 0.41, 95% CI 0.25-0.67; n=36/20,384) were each associated with lower odds of bowel injury. Compared with the vaginal approach to hysterectomy (n=27/27,434), the abdominal approach was found to have significantly increased odds of bowel injury (OR 10.80, 95% CI 7.31-15.95; aOR 10.49 95% CI 6.42-17.12; n=401/38,106); the laparoscopic approach had smaller but significantly increased odds (OR 2.06, 95% CI 1.37-3.08; aOR 2.03 95% CI 1.24-3.34; n=182/90,017) as well. Increased risk of bowel injury is associated with endometriosis and the abdominal surgical approach to hysterectomy. These findings have implications for the surgical care of women with benign uterine disease.