Vaginal Wall Thickness Research Articles

A novel suturing technique for natural tissue repair in cystocele treatment

BackgroundRecently, natural tissue repair has become popular in the treatment of pelvic organ prolapsed. In this study, we compared patients who underwent cystocele repair with the rug-weaving plication technique, a natural tissue repair method implemented since 2022 for anterior prolapse, with those treated using conventional colporrhaphy.MethodsWe retrospectively reviewed the data of 65 patients who underwent anterior vaginal wall repair with the rug-weaving plication technique (n = 33, Group 1) or conventional colporrhaphy (n = 32, Group 2). We recorded the patients’ clinicodemographic and surgical data. At the 6-month postoperative follow-up, we assessed patients’ complaints, degree of prolapse (using the simplified Pelvic Organ Prolapse Quantification system), and pelvic floor muscle strength (using the Modified Oxford Score). Anterior vaginal wall thickness was measured using transvaginal ultrasonography. We compared clinicodemographic and surgical data and postoperative outcomes between the two groups.ResultsThe two groups were comparable in terms of age (p = 0.326), number of pregnancies (p = 0.307), number of parities (p = 0.555), preoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p = 0.380), preoperative apical prolapse simplified Pelvic Organ Prolapse Quantification grade (p = 0.518), postoperative Modified Oxford Score (p = 0.857), operation time (p = 0.809), postoperative haemoglobin (p = 0.674), and amount of bleeding (p = 0.951). Compared with Group 2, Group 1 had significantly higher postoperative anterior vaginal wall thickness (p < 0.001) and significantly lower postoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p < 0.001).ConclusionsThe rug-weaving plication technique may offer a viable alternative for cystocele repair without mesh, using natural tissue and potentially reducing mesh-related complications and recurrence rates.Clinical trial numberNCT06410469 (03/05/2024).

The study of vaginal wall thickness in adults based on histopathological measurements

To accurately measure the vaginal mucosa thickness across different age groups using histopathologic techniques and investigate the factors that may influence the thickness changes. This study aims to provide clinicians with objective evidence of variations in vaginal mucosal thickness, facilitating personalized medical decisions for patients. A retrospective analysis was conducted on clinical data from 348 patients who underwent local vaginal wall resection at the West China Second University Hospital, Sichuan University, from January 2021 and May 2022. The thickness of vaginal mucosa, epithelium and lamina propria was measured precisely under the microscope. And the 10th, 25th, 50th, 75th, and 90th percentile values of vaginal mucosa thickness across different age groups were counted and charted a dot-line plot. The percentile values for vaginal mucosa thickness exhibited a decreasing trend with increasing age; vaginal mucosa thickness showed significant correlations with times of delivery (P = 0.031) and age (P < 0.001), both of which were negatively associated. And vaginal mucosa thickness demonstrated no significant correlation with body mass index (BMI) (P = 0.325), times of abortions (P = 0.511), times of gestation (P = 0.101), menstrual cycle (P = 0.533), or types of delivery (P = 0.056); epithelial thickness showed significant associations with age (P < 0.001) and types of delivery (P = 0.017), both of which were negative correlations. Moreover, BMI (P = 0.429), times of abortions (P = 0.764), delivery (P = 0.079), gestation (P = 0.475), and menstrual cycle (P = 0.950) were nonassociated with epithelial thickness; lamina propria thickness displayed a significant correlation only with age (P = 0.002), and there were no obvious correlations observed between lamina propria thickness and BMI (P = 0.374), times of abortion (P = 0.417), delivery (P = 0.053), gestation (P = 0.101), types of delivery (P = 0.132) and menstrual cycle (P = 0.495). Moreover, when the age segmentation was thresholded at 35 and 50 years, both epithelial thickness and vaginal mucosa thickness were significantly correlated with age (P < 0.05). Lamina propria thickness was associated with age when the age threshold was set at 35 years (P = 0.007), whereas it showed no strong link with age when the age threshold was 50 years (P = 0.072). This study has innovatively established percentile reference values for vaginal mucosa thickness based on histopathology, furnishing clinicians with objective evidence of variations in vaginal mucosal thickness to facilitate personalized medical decisions for patients. The findings demonstrated a strong link between vaginal mucosa thickness and age, with epithelium likely playing a predominant role, while the association with lamina propria appeared to be less significant. Further research involving a larger sample size is warranted to elucidate the potential relationship with the lamina propria.

Noninvasive bipolar radiofrequency - vaginal application on swine model

The aim of the study was to evaluate the concentration of collagen and elastin fibers, the number of fibroblasts/fibrocytes and vessels, as well as depth of action in the vaginal wall in a swine model before and after intravaginal 480 kHz bipolar radiofrequency heating created by a 360-degree intravaginal applicator (Berger and Kraft Medical). Three swine’s were treated with a bipolar radiofrequency vaginal probe. Exposure to RF was administered twice, every 4 weeks, and then the vaginas were removed after slaughter, four weeks after the last RF exposure. Histology specimens were obtained from control and exposed areas. Tissue samples were stained by hematoxylin-eosin, orcein, and Mallory trichrome. The concentration of elastin and collagen fibers increased distinctly after a treatment protocol: elastin, on average, was 52.8%, and collagen, on average, was 103.6%. After the treatment protocol, we revealed a significant dispersion of fibroblasts-fibrocytes nuclei for particular animals in segmented areas, with a slightly marked falling trend. A degree of data variability cannot lead to a conclusion concerning the influence of RF heating on several vessels in evaluated areas. The depth of action of the RF heating, measured by collagen concentration, reached up to 1.3 mm of the vaginal wall thickness. Results imply that heating of the vaginal wall, created by radiofrequency, induces neocollagenogenesis and neoelastogenesis, leading to a distinctive rise of collagen and elastin fibers concentration at a depth of up to 1.3 mm of the thickness of the vaginal wall in the animal model.

A Novel Method for the Measurement of the Vaginal Wall Thickness by Transvaginal Ultrasound: A Study of Inter- and Intra-Observer Reliability.

Background and Objectives: A consensus regarding the optimal sonographic technique for measuring vaginal wall thickness (VWT) is still absent in the literature. This study aims to validate a new method for measuring VWT using a biplanar transvaginal ultrasound probe and assess both its intra-operator and inter-operator reproducibility. Material and Methods: This prospective study included patients with genitourinary syndrome of menopause-related symptoms. Women were scanned using a BK Medical Flex Focus 400 with the 65 × 5.5 mm linear longitudinal transducer of an endovaginal biplanar probe (BK Medical probe 8848, BK Ultrasound, Peabody, MA, USA). Vaginal wall thickness (VWT) measurements were acquired from the anterior and posterior vaginal wall at three levels. Results: An inter-observer analysis revealed good consistency between operators at every anatomical site, and the intra-class coefficient ranged from 0.931 to 0.987, indicating high reliability. An intra-observer analysis demonstrated robust consistency in vaginal wall thickness measurements, with an intra-class coefficient exceeding 0.9 for all anatomical sites. Conclusions: The measurement of vaginal wall thickness performed by transvaginal biplanar ultrasound was easy and demonstrated good intra- and inter-operator reliability.

Assesing The Thickness Of Vaginal Wall And Vaginal Mucosa In Early Adolescent, Newly-Married Young Adult And Postmenopausal Women By Transabdominal Ultrasound

Assesing The Thickness Of Vaginal Wall And Vaginal Mucosa In Early Adolescent, Newly-Married Young Adult And Postmenopausal Women By Transabdominal Ultrasound

EP34.09: Sonographic measurement of vaginal wall thickness: a proposal for a standardised methodology

EP34.09: Sonographic measurement of vaginal wall thickness: a proposal for a standardised methodology

Assessing vaginal wall indexes in premenopausal versus postmenopausal women by transrectal linear array high-frequency probe

ObjectiveThis study aimed to verify the feasibility of 2D measurement of full-layer thickness of vaginal wall and evaluation of its elasticity by shear wave elastic imaging using transrectal linear array high-frequency ultrasound and to investigate the differences of vaginal wall indexes in premenopausal versus postmenopausal women.MethodFrom September to November 2022, a total of 87 women in the Department of Gynecology, Nanjing First Hospital were examined by a sonographer using transrectal linear array high-frequency ultrasound, including 34 women of reproductive age and 53 postmenopausal women. The vagina was divided into upper, middle, and lower segments, and the full-layer thickness of each part was measured. Then shear wave elastography (SWE) was used, and the average value of Young's modulus was used to evaluate the degree of vaginal elasticity.ResultsTransrectal linear array high-frequency ultrasound can clearly display structures of vaginal wall; measurement of the full thickness of the vaginal wall and evaluation of the degree of vaginal elasticity were feasible. There was a statistically significant difference in the thickness of each part of the vaginal wall between pre- and postmenopausal women (P < 0.001); there was no significant difference in the vaginal Young's modulus of pre- and postmenopausal women (P = 0.073). ConclusionTransrectal linear array high-frequency ultrasonography is a non-invasive and feasible method to measure vaginal wall thickness (VWT) and elasticity. There are significant differences in VWT between pre- and postmenopausal women.

Vaginal wall thickness as potential biomarker of vaginal health. A proposal for standardized ultrasound measurement using three-dimensional transvaginal ultrasound.

Vaginal wall thickness could be used as a biomarker of vaginal health. We propose a standardized method using three-dimensional (3D) ultrasound for measuring vaginal wall thickness. Fill the vagina with gel. Insert the endovaginal transducer into the vagina up to the middle third. In the sagittal plane, visualizing the cervix and vaginal fornices, capture a 3D volume of the upper third of the vagina. Using tomographic ultrasound imaging function in the sagittal plane and the posterior vaginal fornix as the reference obtain at least three axial planes of the vagina, separated by 1 cm. Measure the vaginal wall thickness at a distance of 2 cm from the posterior vaginal fornix at 12, 3, 6, and 9 o'clock. The reproducibility of measurements was high. Measurements of vaginal wall thickness can be reliably performed.

Applicator-guided proton therapy versus multichannel brachytherapy for vaginal vault irradiation.

To dosimetrically compare applicator-guided intensity-modulated proton therapy(IMPT) and multichannel brachytherapy (MC-BRT) for vaginal vault irradiation(VVI) with special focus on dose to organs at risk (OARs) and normal tissues. Ten patients with uterine confined endometrial cancer who received adjuvant vaginal cuff brachytherapy were included in this study. For each patient an additional IMPT treatment plan was created using the same computed tomography dataset and contours segmented for MC-BRT plans. Clinical target volume (CTV) was defined as the proximal 3.5 cm of the vagina including the entire thickness of vaginal wall. Planning target volume for IMPT plans was generated from the CTV with an addition isotropic 3 mm margin. OARs included rectum, bladder, sigmoid, small bowel and femoral heads. The prescribed dose was 21 Gy in 3 fractions. For simplicity, all doses were expressed in Gy and a constant relative biological effectiveness of 1.1 was used for IMPT plans. Plan comparison was performed using dose-volume histogram and treatment planning parameters. A significant improvement of the D98% coverage for CTV was reached by the applicator-guided IMPT plans (p < 0.01). IMPT also provided a dose reduction in all OARs except for femoral heads due to the lateral beam direction, especially significant reduction of V5Gy, D2cc, D0.1 cc, Dmean, V95% values for the rectum and Dmean, D0.1 cc to bladder, sigmoid, small bowel. Additionally, IMPT plans showed a significant reduction of integral dose to normal tissue with respect to MC-BRT (221.5 cGy.L vs. 653.6 cGy.L, p < 0.01). Applicator-guided IMPT has the potential for improving plan quality in VVI while maintaining the high conformity afforded by the state-of-the-art intracavitary brachytherapy.

(Potential) Mishaps of High-Dose-Rate Vaginal Cuff Brachytherapy

Considering how commonly vaginal cuff brachytherapy is used, there is relatively little literature regarding the potential, albeit low, risk for complications. We present 3 potentially serious mishaps involving cylinder misplacement, dehiscence, and excessive normal tissue irradiation due to unique anatomy. Three patients with potentially serious treatment errors were encountered in the authors’ usual clinical practice. Each patient's records were reviewed for this report. For patient 1, computed tomography (CT) simulation revealed grossly inadequate cylinder insertion, which was most obvious on the sagittal view. For patient 2, CT simulation revealed that the cylinder extended beyond the perforated vaginal cuff and was surrounded by bowel. For patient 3, CT images were used only to verify cylinder depth. A standard library plan based on cylinder diameter and active length was used. In retrospect, the images revealed an unusually thin rectovaginal septum, with the lateral and posterior vaginal wall thickness estimated to be <2 mm. This patient's fractional normal tissue doses were calculated for this report, revealing a rectal maximum dose (per fraction) of 10.8 Gy, maximum dose that 2 cc of the organ receives of 7.4 Gy, and volume of the organ that receives the prescription dose or higher of 2.8 cc. All doses were far in excess of those anticipated for a minimal 0.5-cm vaginal wall depth. Vaginal cuff high-dose-rate brachytherapy is a high-volume, routine procedure. Even in experienced hands, however, it carries a risk of improper cylinder placement, cuff dehiscence, and excessive normal tissue dose, all of which could seriously affect outcomes. These potential mishaps would be better appreciated and avoided with more extensive use of CT-based quality assurance measures.

Assessing vaginal wall thickness by transvaginal ultrasound in breast cancer survivors: A pilot study

AimThere is need for a straightforward objective measure to evaluate vaginal wall changes related to hypoestrogenism. The aim of this pilot study was to evaluate a transvaginal ultrasound procedure for the quantification of vaginal wall thickness in order to differentiate between healthy premenopausal women and postmenopausal women with genitourinary syndrome of menopause using ultra-low-level estrogen status as a model. MethodsWe performed a prospective, two-arm, cross-sectional pilot study comparing vaginal wall thickness measured by transvaginal ultrasound in postmenopausal breast cancer survivors using aromatase inhibitors with genitourinary syndrome of menopause (GSM group) and healthy premenopausal women (control or C group) from October 2020 to March 2022.After intravaginal introduction of 20 cm3 of sonographic gel, vaginal wall thickness was measured by transvaginal ultrasound in the anterior, posterior, and right and left lateral walls (four quadrants). The study methods followed the STROBE checklist. ResultsAccording to the results of a two-sided t-test, the mean vaginal wall thickness of the four quadrants in the GSM group was significantly less than that of the C group (2.25 mm vs 4.17 mm, respectively; p < 0.001). Likewise, the thickness of each of the vaginal walls (anterior, posterior, right and left lateral) statistically differed between the two groups (p < 0.001). ConclusionTransvaginal ultrasound with intravaginal gel may be a feasible objective technique to assess genitourinary syndrome of menopause, showing clear differences in vaginal wall thickness between breast cancer survivors using aromatase inhibitors and premenopausal women.Possible correlations with symptoms or treatment response should be assessed in future studies.

Ultrasonographic measurement of vaginal thickness: Relation to menopausal status and genitourinary syndrome of menopause.

To compare the total vaginal wall thickness (TVT) and total mucosal thickness (TMT) measurements of premenopausal and postmenopausal women measured by ultrasonography and to determine the association of these measurements to findings and symptoms of genitourinary syndrome of menopause METHODS: Healthy volunteers, 80 postmenopausal and 80 premenopausal, were included. Ultrasonographic TVT and TMT measurements, vaginal health index (VHI) scores and pH values were recorded. The daily impact of vaginal aging (DIVA) scale was administered to women in the postmenopausal group. TVT measurements of the postmenopausal group (6.55 ± 2.00 mm) were lower than the premenopausal group (10.37 ± 2.11 mm) (p: 0.000). TMT measurements of the postmenopausal group (1.46 ± 0.50 mm) were lower than the premenopausal group (2.19 ± 0.60 mm) (p: 0.000). The VHI scores of the postmenopausal group were significantly lower than the premenopausal group, the pH value was higher (p < 0.05). Considering all women TVT and TMT measurements were inversely correlated with pH values and positively correlated with total VHI scores. There was no significant correlation between any component scores of the DIVA scale and TVT, TMT, pH, and VHI total (p > 0.05). TVT and TMT measurements in postmenopausal women are significantly lower than premenopausal women. Examination findings and thickness measurements are correlated. Transabdominal ultrasonography is a method that can be used in the evaluation of vaginal thickness which is not painful for the patient, is easy to apply and gives results consistent with the examination findings. However, measurements and examination findings do not correlate with the DIVA scores in postmenopausal women.

Measurement of the vaginal wall thickness by transabdominal and transvaginal ultrasound of women with vaginal laxity: a cross-sectional study.

An objective diagnostic method to understand vaginal laxity (VL) is still missing. The aim of our study is to determine whether vaginal wall thickness (VWT) measured by ultrasound may differ according to the abdominal or vaginal techniques and to assess whether clinical variables are associated with vaginal measurements of women with VL. A cross-sectional study conducted at a tertiary hospital included 82 women aged ≥ 18 years with VL complaints assessed by the Vaginal Laxity Questionnaire. Women who reported severe comorbidities or vulvovaginal disorders, previous treatment for VL, and use of vaginal estrogen in the last 6 months were excluded. Participants reporting VL underwent transabdominal (TAUS) and transvaginal ultrasound (TVUS) and physical examination and answered validated questionnaires. Descriptive data were given as mean and standard deviation, median (range), and absolute and relative frequency. The significance level adopted for this study was 5%. Sample size calculation was not performed for the present study. Mean age was 41.20 ± 8.64 years, and most participants were multiparous, with previous vaginal delivery and having vaginal intercourse. A statistically significant difference (up to 3 mm) between TAUS and TVUS measurements of the VWT was found in the proximal, middle-third, and distal compartments. A significant correlation was found between VWT and TAUS or TVUS in the mid-third and distal compartments. A significant correlation was found between the VWT measurements in TVUS and TAUS. Our findings might give the health professional more possibilities for investigating VWT according to patient characteristics.

Effects of oxytocin versus promestriene on genitourinary syndrome: a pilot, prospective, randomized, double-blind study

In this pilot, prospective, randomized, double-blind study, the authors compared the efficacy of oxytocin with promestriene in improving vaginal atrophy of Genitourinary Syndrome of Menopause (GSM). A total of51postmenopausal women with symptoms of GSM were evaluated. They were randomized into two groups: oxytocin (25patients) and promestriene (26patients) and were evaluated before and after90days of treatment; the evaluation was based on the domains of the Female Sexual Function Index (FSFI) (lubrication, satisfaction, and pain during sexual intercourse), clinical visual examination, and vaginal wall thickness. After the use of the medications, both groups showed significant improvement in the three evaluated FSFI domains (p < 0.05) and there was no significant difference between the groups (p > 0.05). On clinical examination, the medications improved all the evaluated parameters but without statistical significance (p > 0.05). The evaluation of the thickness of the vaginal epithelium showed that both treatments led to increase in the vaginal epithelium (p < 0.05); however, the efficacy of promestriene was higher than that of oxytocin (p < 0.05). Both medications were effective, however, studies with larger samples and longer follow-ups are needed to confirm the clinical applicability.

Relationship Between Genitourinary Syndrome of Menopause and 3D High-Frequency Endovaginal Ultrasound Measurement of Vaginal Wall Thickness

To date, there is no certain method for diagnosis of genitourinary syndrome of menopause (GSM) and vaginal atrophy. We aim to evaluate vaginal wall thickness (VWT) using 3D high frequency endovaginal ultrasound (3D EVUS) in GSM and also to investigate whether there is any association between VWT and postmenopausal sexual dysfunction. Postmenopausal women applied for routine gynecologic examination were assessed at the Outpatient Clinic of Gynecology, Maltepe University Hospital. After pelvic examination, GSM symptoms were questioned for all women and vaginal health scoring tool was applied. Twenty women with GSM and 20 women without GSM were included in the study. All patients filled in the Female Sexual Function Index (FSFI) and underwent 3D EVUS to evaluate VWT. The women with GSM had significantly lower anterior and posterior VWT (P=.007 and P=.049, respectively). The total FSFI score, lubrication and pain sub-scores in patients with GSM was significantly lower than the patients without GSM. Anterior VWT was positively correlated with BMI and pain sub-score of FSFI (r=0.279, P=.047; r=0.344, P=.013, respectively). A significant negative correlation was detected between anterior vaginal VWT and age, time since menopause and satisfaction sub-score of FSFI (r=-0.332, P=.017; r=-0.354, P=.011; r=-0.301, P=.032, respectively). Posterior VWT was positively correlated with FSFI total score, arousal, lubrication and pain sub-scores (r=0.451, P=.001; r=0.437, P=.001; r=0.415, P=.002; r=0.335, P=.016; respectively). Based on our results, measurement of VWT using 3D EVUS can be a useful non-invasive tool for the objective diagnosis of GSM. Considering that only total vaginal thickness can be measured with traditional transabdominal and transvaginal techniques, the main strength of the study is the use of 3D EVUS for separate measurement of anterior and posterior VWT. The study has sufficient statistical power. The small sample size of study is the main limitation. The 3D EVUS can be used for objective diagnosis of GSM and can also shed light on the causes of various sexual dysfunction symptoms in postmenopausal women, as it enables measuring the anterior and posterior walls of the vagina separately.

Role of Elastin Expression in Thickening the Postpartum Vaginal Wall in Virgin and Postpartum Rat Models

Childbirth induces a number of alterations, including ligament weakening and increased vaginal distensibility. The occurrence of vaginal laxity or distensibility is associated with the vaginal wall and introitus overstretching during vaginal parturition while the pathophysiology is due to increased levator dimension and trauma to the levator ani muscle through avulsion (macrotrauma) or overdistension (microtrauma). Elastin is an extracellular matrix protein that confers elastic properties to organs and tissues, particularly those requiring elasticity. Elastin plays a vital role in the functioning of numerous tissues, such as the lungs, blood vessels, heart valves, ligaments, tendons, and skin. It is also a component of the vaginal mucosa. The aim of the present was to evaluate the role of elastin in the thickening of the postpartum vaginal wall composed of epithelial mucosa, and to understand the mechanism underlying vaginal laxity or distensibility within parous and nulliparous animal models. A total of 32 female white rats (Rattus norvegicus) were used in the present study. They were divided into two groups, each group consisting of 16 rats. The control group (C0) consisted of virgin nulliparous rats, which were sacrificed on the second day after vaginal parturition. Pregnant rats (group C1) were sacrificed on the second day after vaginal parturition. The median elastin expression in group C1 was higher (3 ± 0.56) than group C0 (2.85 ± 0.75). The mean thickness of the vaginal mucosal epithelium in group C0 (56,8 931µm) was greater than group C1 (44,98 349µm). The comparison of vaginal mucosal epithelium thickness between the two groups indicated a significant difference between groups C0 and C1. Elastin levels were significantly correlated with epithelial thickness. The expression of elastin significantly affects the vaginal wall thickness, which further affects vaginal laxity or vaginal distensibility.

Vaginal dose-surface maps in cervical cancer brachytherapy: Methodology and preliminary results on correlation with morbidity

PurposeThe purpose of the study was to develop a methodology for vaginal dose-surface maps (DSMs) in patients with cervix cancer and to investigate dose-surface histogram metrics as predictors for vaginal stenosis (St) and mucositis (Muc). Methods and MaterialsThirty-one patients with locally advanced cervix cancer with no vaginal St/Muc (CTCAE-v3) G ≥ 2 at baseline were analyzed. Patients were divided in four morbidity groups: 15 with St/Muc G0/1, 6 with St G ≥ 2, 4 with St/Muc G ≥ 2, and 6 with Muc G ≥ 2. Patients received external beam radiotherapy and 4-fraction intracavitary/interstitial high-dose-rate brachytherapy using tandem and ovoids. DSMs were generated from inner/outer vaginal surfaces. DSMs of external beam radiotherapy and brachytherapy (Gy EQD23) were added based on a system of homologous points, to generate cumulative DSMs. Dose-surface histogram/dose-volume histogram parameters, location of high/intermediate-dose regions, rectovaginal reference point, vaginal lateral 5 mm point doses, and vagina/implant dimensions were investigated for St and Muc prediction. Average/difference DSMs and one-way analysis of variance were used to compare between groups. ResultsBest predictors of stenosis were D15–25cm2 and upper-vagina S65–120Gy(%). Cutoffs of ∼90 Gy EQD23 for D20cm2 and ∼80% for S65Gy to top 3 cm inner vaginal surface suitably discriminated for stenosis. Spatial dose location on average/difference DSMs showed significantly higher doses (by > 20 Gy, p < 0.001) over longer parts of the dorsolateral vagina and higher rectovaginal reference point doses for any G ≥ 2 morbidity, over the whole circumference of the upper vagina for G ≥ 2 stenosis. Dose-volume histogram parameters were dependent on vaginal wall thickness. An increase of wall thickness from 2 to 4 mm resulted in an increase of D2cm3 (D4cm3) of 16% (32%). ConclusionsA novel method was developed to generate vaginal DSMs and spatial-dose metrics. DSMs were found to correlate with vaginal stenosis. The findings of this study are promising and should be further validated on a larger patient cohort, treated with different applicators.

A diagnostic model of idiopathic central precocious puberty based on transrectal pelvic ultrasound and basal gonadotropin levels.

ObjectiveTo establish a diagnostic model of idiopathic central precocious puberty on the basis of transrectal pelvic ultrasound and basal gonadotropin.MethodsA total of 669 girls with Tanner breast development stage II were enrolled in this study from January 2015 to December 2018. The participants were divided into the ICPP group and the premature thelarche group. We analyzed various variables, including age at initial diagnosis, basal luteinizing hormone levels, the long diameter of the uterus, the transverse diameter of the uterus, the anterior–posterior diameter of the uterus, the volume of the uterus, maximum ovarian diameter, average ovarian volume, maximum ovarian volume, number of follicles (≥4 mm), maximum follicular diameter, endometrial thickness, and vaginal wall thickness.ResultsThe following diagnostic model was established: Y=−14.123 + 0.630 × age at initial diagnosis + 1.119 × transverse diameter of the uterus + 1.278 × anterior–posterior diameter of the uterus + 0.637 × average ovarian volume + 1.316 × maximum ovarian diameter + 0.146 ×number of follicles ≥4 mm + 2.925 × endometrial thickness + 0.559 × basal luteinizing hormone value. The area under curve was 0.922, sensitivity was 84.9%, and specificity was 86.2%.ConclusionBasal LH levels and transrectal pelvic ultrasound should be applied together to improve the accuracy of diagnosis in ICPP.

Adjuvant vaginal cuff brachytherapy: dosimetric comparison of conventional versus 3-dimensional planning in endometrial cancer.

PurposeTo evaluate dosimetric differences between point-based 2-dimensional (2D) vaginal brachytherapy (VBT) treatment planning technique and volume-based 3-dimensional (3D) VBT method for endometrial cancer (EC).Material and methodsTen patients with uterine-confined EC treated with VBT were included in this study. All patients received 27.5 Gy in 5 fractions. Three different treatment plans were performed for each patient: plan A for dose prescribed to the entire vaginal wall thickness delineated via computed tomography guidance, plan B for dose prescribed to the vaginal mucosa/cylinder surface, and plan C for dose prescribed to 5 mm beyond the vaginal mucosa/cylinder surface. Dose-volume histograms (DVH) of treatment volumes and organs at risk (OARs) were evaluated and compared.ResultsDVH analysis of target volume doses (D100, D95, and D90) showed a significant difference between plan A and plan B (p = 0.005), and plan B was found lower. D100 for plan C was significantly higher than plan A (p = 0.009), but for D95 and D90, no statistically significant difference was found (p = 0.028 and p = 0.028, respectively). In terms of OARs doses, including vagina, rectum, bladder, and sigmoid, D2cm3 doses were significantly higher in plan A than plan B (p = 0.009, p = 0.009, p = 0.005, and p = 0.005, respectively). All these doses were also significantly lower than in plan C (p = 0.005, p = 0.012, and p = 0.013, respectively), except for sigmoid (p = 0.155).ConclusionsIn this dosimetric analysis, we have shown that the volume-based 3D VBT technique provides the ability to balance the target dose against the sparing of OARs. Therefore, in the new modern 3D treatment era, instead of normalization of the dose to standard reference points, customized 3D volume-based VBT planning should be recommended.

Safety and mechanism of action of noninvasive radiofrequency treatment for vaginal laxity: Histological study in the swine vaginal model.

Structural changes in collagen and elastin fiber density have been previously evaluated by qualitative histological studies; however, quantitative evaluations are lacking. Toevaluate quantitative changes in collagen and elastin fibers in the vaginal wall in a porcine model after volumetric radiofrequency heating with an intravaginal applicator. An animal model was used (domestic pig, multipara: 5.67±0.94 deliveries, 3years of age). Three pigs under general anesthesia were treated (8-minute, vaginal canal area) once per week for the course of three weeks. There were 2 follow-up evaluations at one and four weeks. Histology specimens were obtained via punch biopsy under ultrasound control. Ultrasound video measurements of the vaginal wall thickness were also obtained. Tissue samples were stained by H&E as well as stains for collagen and elastin fibers. Elastin (P<.001) and collagen (P<.01) fiber density increased after every treatment. The measured increase in fibers was highest at the one-week follow-up. Elastin accounted on average for 51.46±16.86% of the tissue examined (increase of 36.8% points), while collagen accounted on average for 44.83±18.92% (increase of 17.1% points). The number of synthetically active cells was increased by 16%. While vaginal wall thickness did show an increase of 1.66mm (32%), this tendency was not statistically significant (P>.05). Results suggest that volumetric heating of vaginal tissue produced quantitative improvement in the connective tissue organization in a porcine study. Neocollagenesis and neoelastogenesis were observed with an increased number of synthetically active cells.