Long-term continuations rate of ring pessary use for symptomatic pelvic organ prolapse.

PURPOSE: To evaluate long-term continuation rates, adverse events of ring pessary use at a minimum of 5 years follow-up, and factors associated with discontinuation in symptomatic pelvic organ prolapse (POP). METHODS: Women with symptomatic POP who were treated with vaginal ring pessary and had successful fittings were included. Adverse events and reasons for discontinuation of pessary use were recorded. Patients who were lost to follow-up were defined as discontinuation. RESULTS: During 12 year-period, 239 of 329 POP patients (72.6%) had successful fittings with ring pessary. The mean age was 67.8 ± 8.9 years (range 27-86) and 70% of patients had advanced stage. The cumulative probability of continued ring pessary use was 84.1%, 64.4%, 49.3%, and 33.5%, at 1, 3, 5, and 10 years, respectively. Most common reason for discontinuation was frequent expulsion (21.6%), followed by vaginal erosion (16.5%), no prolapse improvement (12.4%), and inability or inconvenience to do self-care (9.3%). However, 9 patients (9.3%) had improvement of prolapse and were able to discontinue pessary insertion. Age above 70 years, wide introitus, and incapability of self-care are independent factors associated with long-term discontinuation. Adverse events occurred in 23.4% of patients, 18.8% of them had vaginal erosion, 11.7% vaginal discharge/infection, and 18.4% de novo SUI. However, no statistical significance existed between those who continued and discontinued pessary use due to these adverse events. CONCLUSION: Ring pessary is an effective treatment in symptomatic POP, with acceptable long-term continuation rates and minor adverse events. Self-care of pessary is very important aiming to minimize adverse events. Advanced age, wide introitus and incapability of self-care were associated factors for long-term discontinuation.

ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer.

OBJECTIVE: The objective of the ConCerv Trial was to prospectively evaluate the feasibility of conservative surgery in women with early-stage, low-risk cervical cancer. METHODS: From April 2010 to March 2019, a prospective, single-arm, multicenter study evaluated conservative surgery in participants from 16 sites in nine countries. Eligibility criteria included: (1) FIGO 2009 stage IA2-IB1 cervical carcinoma; (2) squamous cell (any grade) or adenocarcinoma (grade 1 or 2 only) histology; (3) tumor size <2 cm; (4) no lymphovascular space invasion; (5) depth of invasion <10 mm; (6) negative imaging for metastatic disease; and (7) negative conization margins. Cervical conization was performed to determine eligibility, with one repeat cone permitted. Eligible women desiring fertility preservation underwent a second surgery with pelvic lymph node assessment, consisting of sentinel lymph node biopsy and/or full pelvic lymph node dissection. Those not desiring fertility preservation underwent simple hysterectomy with lymph node assessment. Women who had undergone an 'inadvertent' simple hysterectomy with an unexpected post-operative diagnosis of cancer were also eligible if they met the above inclusion criteria and underwent a second surgery with pelvic lymph node dissection only. RESULTS: 100 evaluable patients were enrolled. Median age at surgery was 38 years (range 23-67). Stage was IA2 (33%) and IB1 (67%). Surgery included conization followed by lymph node assessment in 44 women, conization followed by simple hysterectomy with lymph node assessment in 40 women, and inadvertent simple hysterectomy followed by lymph node dissection in 16 women. Positive lymph nodes were noted in 5 patients (5%). Residual disease in the post-conization hysterectomy specimen was noted in 1/40 patients-that is, an immediate failure rate of 2.5%. Median follow-up was 36.3 months (range 0.0-68.3). Three patients developed recurrent disease within 2 years of surgery-that is, a cumulative incidence of 3.5% (95% CI 0.9% to 9.0%). DISCUSSION: Our prospective data show that select patients with early-stage, low-risk cervical carcinoma may be offered conservative surgery.

Gynecologic Surgery during the COVID-19 Pandemic: Is Universal Screening Mandatory?

This study is aimed at evaluating the results of the universal preoperative screening for COVID-19 in gynecologic cases operated on during its outbreak in a tertiary care hospital in Bangkok, Thailand. A retrospective descriptive study was done on all patients who underwent elective or emergency gynecologic surgeries during the pandemic period in Thailand (April 15 to June 5, 2020). The COVID-19 screening results by symptom-based screening, risk-based screening, and RT-PCR for COVID-19 were collected from the electronic medical records. Among 129 patients who underwent gynecologic surgeries, none had a positive RT-PCR for COVID-19. Symptom-based screening found no patients with positive symptoms for COVID-19. Risk-based screening found 4 patients (3.1%) who were in contact with suspected or confirmed COVID-19 cases and 4 patients (3.1%) who were healthcare personnel. In conclusion, routine preoperative RT-PCR for COVID-19 may need to be reconsidered among asymptomatic individuals in a low-prevalence country during the well-controlled COVID-19 situation. Larger studies are required to ascertain the benefit of universal preoperative COVID-19 testing.

High-risk epithelial ovarian cancer patients for hereditary ovarian cancer.

AIM: Risk assessment to identify patients at risk for hereditary ovarian cancer is important. The objectives of this study were to evaluate the frequency of high-risk epithelial ovarian cancer (EOC) patients and the frequency of germline mutation in these patients. METHODS: A total of 335 patients with histologically confirmed non-mucinous EOC were included. High-risk patients were defined as patients who had: (i) significant family history of breast/ovarian/colorectal/endometrial cancers; (ii) synchronous breast/endometrial/colorectal cancer; or (iii) high-grade serous carcinoma. Germline mutation was evaluated by Next Generation Sequencing system with the 27-genes panel. RESULTS: A total of 94 patients (28.1%) were high-risk patients, 5.1% had significant family history of cancers, 4.2% had synchronous primary cancers, and 22.1% had high-grade serous carcinoma. Germline mutation was detected in 10 of 35 patients (28.6%). Six germline mutations (17.1%) occurred in homologous recombination (HR) genes; these included three (8.6%) in BRCA1, one (2.9%) in BRCA2, and two (5.7%) in other HR genes (CHEK2 and RAD1C). Three patients (8.6%) had MMR gene mutations (one MLH1 and two MSH2) and one patient (2.9%) had other gene mutation (MUTYH). Of the 10 patients with germline mutation, 40% of patients had no significant family history of cancer. CONCLUSION: Up to 30% of EOC patients had risk factors for hereditary ovarian cancer. Germline mutation was identified in 28.6% of patients (11.4% BRCA mutation, 5.7% other HR genes mutation, 8.6% MMR mutation, and 2.9% mutation in other gene). The high cost of genetic testing is an important barrier. Selected patients with high-risk factors might be initially considered for genetic testing in a limited-resource setting.

Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients.

OBJECTIVE: To compare the efficacy between acupuncture and ondansetron in the prevention of delayed chemotherapy induced nausea and vomiting (CINV). METHODS: 70 patients were randomized to receive either 1) acupuncture at P6 point before chemotherapy infusion or 2) ondansetron 8 mg intravenously 30 min before chemotherapy infusion in their first cycle with cross-over of antiemetic regimen in the consecutive cycle. All patients received dexamethasone 5mg orally twice a day for 3 days. Patients were given additional does of ondansetron 4 mg orally every 12h if they experienced emesis. Emetic episode, severity of nausea score of 0-10 and adverse events were recorded. Complete response was defined as no nausea, no vomiting and no requirement of additional antiemetic drugs. FACT-G scale was used to evaluate quality of life (QOL) 7 days after each cycle of chemotherapy. RESULTS: The acupuncture group had a significantly higher rate of complete response in the prevention of delayed CINV (52.8% and 35.7%, P = 0.02). Compared to another group, the acupuncture group reported significantly lower delayed nausea (45.7% and 65.7%, P = 0.004), nausea score (P < 0.001) and fewer dosages of additional oral ondansetron (P = 0.002). Adverse effects were also significantly lower in the acupuncture group with less frequent constipation (P = 0.02) and insomnia (P = 0.01). Overall FACT-G scores were significantly higher in the acupuncture group. CONCLUSION: Acupuncture is effective in preventing delayed CINV and in promoting better QOL. With fewer adverse effects, it may be used as an alternative treatment option for CINV.

Lower urinary tract dysfunction and quality of life in cervical cancer survivors after concurrent chemoradiation versus radical hysterectomy.

INTRODUCTION AND HYPOTHESIS: Lower urinary tract dysfunction (LUTD) is a common morbidity. Due to the different pathophysiology of LUT injury, we compared LUTD between patients who received concurrent chemoradiation (CCRT) and radical hysterectomy (RH). METHODS: Seventy cervical cancer survivors were evaluated with multichannel urodynamic studies. The CCRT group received a total dose of 54 Gy pelvic radiation with 2-3 high-dose-rate brachytherapy, concurrent with platinum-based chemotherapy. The RH group underwent type III RH without pre- or postoperative radiation. RESULTS: Overall, LUTD was insignificantly different between CCRT and RH (60 % and 68.6 %). Voiding dysfunction was significantly higher in RH, particularly high postvoid residual urine and void with abdominal straining. However, storage dysfunction, particularly low bladder compliance and increased bladder sensation, were significantly more prevalent in CCRT; urinary incontinence was not significantly different between groups. CONCLUSION: LUTD was prevalent in cervical cancer survivors. Different profiles of dysfunction were demonstrated. Voiding dysfunction was higher followng RH, but storage dysfunction was higher following CCRT.

Knowledge and acceptance of Thai women toward the pelvic floor muscle training.

BACKGROUND: Pelvic floor muscle training (PFMT) is considered as an effective management for relieving pelvic organ prolapse (POP) and urinary incontinence (UI). Although the benefits of PFMT are known among the health care professionals, the benefits from PFMT among the Thai women are not known. OBJECTIVE: To evaluate the basic knowledge and acceptance of PFMT in women who visited the gynecologic out-patient clinic. MATERIAL AND METHOD: A cross-sectional survey was conducted by administering a brief anonymous 2-part questionnaire to 415 women who visited the gynecologic out-patient clinic at King Chulalongkorn Memorial Hospital between November 2010 and January 2011. A questionnaire, consisting of 24 questions, was divided into two parts where part one, made up of 10 questions, collected demographic data and the remaining 14 questions in part 2 gathered more information about the knowledge and acceptance towards PFMT. These questionnaires required approximately five minutes for completion. RESULTS: Mean age of all women was 42.9 years. The percentage of patients having stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI) were 21.9%, 5.3%, and 15.2%, respectively. Overactive bladder (OAB) and pelvic organ prolapse (POP) were found in 19.5% and 9.9%, respectively. Half of the respondents were unaware of PFMT efficacy. Most of them (80.2%) never received instruction from their health care providers. However 52.8% of women expressed interest for requesting PFMT instruction while 84.6% were willing to practice if they were made aware of benefits. CONCLUSION: A limited understanding and acceptance of PFMT exists among Thai women. However if informed, most women express interest in practicing PFMT after clinic visit.

Prevention of blood transfusion with intravenous iron in gynecologic cancer patients receiving platinum-based chemotherapy.

OBJECTIVES: To compare the efficacy of intravenous iron and oral iron for prevention of blood transfusions in gynecologic cancer patients receiving platinum-based chemotherapy. MATERIALS AND METHODS: Sixty-four non anemic gynecologic cancer patients receiving adjuvant platinum-based chemotherapy were stratified and randomized according to baseline hemoglobin levels and chemotherapy regimen. The study group received 200mg of intravenous iron sucrose immediately after each chemotherapy infusion. The control group received oral ferrous fumarate at a dose of 200mg three times a day. Complete blood count was monitored before each chemotherapy infusion. Blood transfusions were given if hemoglobin level was below 10mg/dl. RESULTS: There were 32 patients in each group. No significant differences in baseline hemoglobin levels and baseline characteristics were demonstrated between both groups. Nine patients (28.1%) in the study group and 18 patients (56.3%) in the control group required blood transfusion through 6 cycles of chemotherapy (p=0.02). Fewer median number of total packed red cell units were required in the study group compared to the control group (0 and 0.5 unit, respectively, p=0.04). Serious adverse events and hypersensitivity reactions were not reported. However, constipation was significantly higher in the control group (3.1% and 40.6%, p=<0.001). CONCLUSIONS: Intravenous iron is an effective, well-tolerated treatment for primary prevention of blood transfusions in gynecologic cancer patients receiving platinum-based chemotherapy, associated with less constipation than the oral formulation.

Impact on quality of life after ring pessary use for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to evaluate symptoms associated with pelvic organ prolapse (POP) and quality of life (QOL) improvement in patients who continue ring pessary use at 1 year. METHODS: Seventy-seven symptomatic POP patients had successful fitting, and 64 patients (83.1%) continued use at 1 year. The Thai version of Prolapse Quality of Life (P-QOL) questionnaire was used to evaluate symptoms associated with POP and impact on QOL. A higher score represents a greater impairment on the QOL, whereas a lower score represents a better QOL. RESULTS: Mean age was 66.7 ± 8.6 years, median parity was 4 (range 0-10), 59 patients (92.2%) were menopausal, and none had received hormone treatment. Only nine patients (14.1%) were sexually active. Most patients were in the advanced stage of POP - 32.8% stage 3 and 29.7% stage 4. Improvement of prolapse symptoms and voiding difficulty were reported in 100% and 85.7% of the patients, respectively. Among patients who had lower urinary tract symptoms at pre-treatment, about half of patients improvement in frequency, urgency, and urgency urinary incontinence. Only 9.1% of the patients had improvement in stress urinary incontinence (SUI), and 23.8% of the patients reported new onset of SUI (de novo SUI). The median score from all P-QOL domains except personal relationships were significantly decreased after 1 year of ring pessary use. The median total scores at baseline and at 1 year were 40 and 8, respectively (P < 0.001). CONCLUSIONS: Ring pessary is an effective non-surgical treatment to alleviate symptoms associated with POP. It can improve QOL in symptomatic POP patients.

Rectal balloon training as an adjunctive method for pelvic floor muscle training in conservative management of stress urinary incontinence: a pilot study.

BACKGROUND: Pelvic floor muscle training (PFMT) is currently considered as the first line conservative management for women with stress urinary incontinence (SUI). However, it is difficult for some women to self-identify the contraction of the pelvic floor muscle after they were trained by verbal instruction. Various techniques including rectal balloon probe have been developed to improve PFMT. OBJECTIVE: To compare vaginal squeezing pressure, one-hour pad test, leakage episodes, rating scores about severity of SUI, and patient satisfaction between traditional PFMT and rectal balloon training (RBT). MATERIAL AND METHOD: Twenty-eight patients with SUI were randomized into two groups, PFMT, and RBT groups. The PFMT group was verbally instructed to perform exercise as the traditional technique. In the RBT group, a Foley catheter filled with tap water to create balloon was inserted into the rectum in combination with the same exercise as in the PFMT group. The vaginal squeezing pressure before and after 6-week exercise program was measured by biofeedback machine model MYO420. RESULTS: One patient in each group was lost to follow-up. This left 13 patients in each group. Both groups had statistically significant gained in vaginal squeezing pressure after exercise. The different pressure between pre and post exercise were 9.9 mmHg and 9.2 mmHg in PFMT and RBT group respectively (p = 0.84). Significant improvement of leakage episodes and self-rating scores assessed the severity of SUI after exercise was reported in both groups, although there was no significant difference between both groups. The number of patients wearing protection after exercise was lowered in both groups, which were 75% in PFMT group and 80% in RBT group. However satisfaction was greater after completing exercise in both groups. CONCLUSION: PFMT is an effective conservative treatment of SUI. PFMT combined with rectal balloon training did not provide greater strength of the pelvic floor muscle than isometric contraction.

Bethanechol chloride for the prevention of bladder dysfunction after radical hysterectomy in gynecologic cancer patients: a randomized controlled trial study.

BACKGROUND: Bethanechol chloride is considered as a treatment in patients with high postvoid residual urine (PVR). It enhances detrusor muscle contraction, resulting in higher maximum flow rate, higher detrusor pressure at maximum flow, and lower PVR. The efficacy of this agent in patients after radical hysterectomy is unclear. We aim to evaluate the efficacy of bethanechol chloride compared with placebo for the prevention of bladder dysfunction after type III radical hysterectomy. METHODS: Gynecologic cancer patients who underwent type III radical hysterectomy were randomized by computer-generated schedule to assign patients in a 1:1 ratio into 2 groups. The treatment group received bethanechol chloride (Ucholine 20 mg 3 times a day on the third to seventh postoperative day), and the control group received placebo. Patients and physicians were masked to treatment allocation. The primary end point was the rate of urethral catheter removal at 1 week postoperatively. If PVR was more than 30% of voided volume, the urethral catheter was reinserted, and medication would be continued but not for more than 1 month. This study was registered as ISRCTN92687416. FINDINGS: There were 31 patients in each group without significant difference in baseline characteristics. Twenty-one patients (67.7%) in the treatment group and 12 patients (38.7%) in the control group had the urethral catheter removed at 1 week postoperatively (P = 0.04). Median duration of urethral catheterization was shorter in the treatment group (7 and 14 days, P = 0.03). However, the PVR and the incidence of urinary tract infection at 1 month postoperatively were not significantly different. Nine patients (29%) in the treatment group had adverse events such as nausea, abdominal distension, and abdominal cramping, which was higher than the control group (1 patient, 3.2%; P = 0.01). However, no patients required any medical treatments. CONCLUSIONS: Bethanechol chloride decreases the duration of urethral catheterization in patients who underwent type III radical hysterectomy with manageable adverse events.

Ring pessary for all pelvic organ prolapse.

PURPOSE: To evaluate the risk factors of unsuccessful fitting of ring pessary in pelvic organ prolapse (POP), continuation rate, and adverse events. METHODS: The ring pessary was offered to 100 symptomatic POP patients. POP was staged according to Pelvic Organ Prolapse Quantification (POP-Q) system. A successful fitting was defined as when patients continued pessary use for more than 2 weeks. Adverse events were evaluated in patients who had a successful fitting. RESULTS: Most patients (71%) were in POP-Q stage III-IV and 77 patients were fitted at the initial visit. Successful fitting was reported in 62 patients (62%). However, 52 patients (52%) continued to use the pessary at 13 months median follow-up. The most common reason for discontinuation was frequent pessary expulsion. Short vaginal length ≤ 6 cm and wide introitus > 4 fingerbreadths were the significant risk factors for unsuccessful fitting. New onset of stress urinary incontinence (SUI) developed in 28.2% of patients. One third and 21% of patients had vaginal discharge and vaginal erosion, respectively. Only half of the patients could manage the pessary either by themselves or with their caregivers. CONCLUSION: The ring pessary fitting can be attempted in all POP cases irrespective of stage. Short vaginal length <6 cm and wide introitus >4 fingerbreadths were the risk factors for unsuccessful fitting. It has an acceptable continuation rate and manageable adverse events. The self-care of pessary is an important strategy to minimize adverse events.

Targeted therapies for rare gynaecological cancers.

Some gynaecological cancers are uncommon, such as sex cord-stromal tumours, malignant germ-cell tumours, vulvar carcinoma, melanoma of the female genital tract, clear-cell carcinoma of the ovary and endometrium, neuroendocrine tumours of the cervix, and gestational trophoblastic neoplasia. All these cancers have different clinicopathological characteristics, suggesting different molecular biological pathogeneses. Despite aggressive treatment, some cancers recur or respond poorly to therapy. Comprehensive knowledge of the molecular biology of each cancer might help with development of novel treatments that maximise efficacy and minimise toxic effects. Targeted therapy is a new treatment strategy that has been investigated in various tumours in clinical and laboratory settings. Since these cancers are rare and large clinical trials are difficult to do, molecular biological techniques might allow rapid proof-of-principle experiments in few patients. Novel targeted agents either alone or in combination with other treatments offer promising therapeutic options.

Adherence to follow-up in women with cervical intraepithelial neoplasia grade 1.

OBJECTIVES: Adherence to follow-up is crucial for cervical intraepithelial neoplasia grade 1 (CIN1) because these women have a chance of progression to high-grade premalignant cervical lesions and cervical cancer. This study aimed to evaluate the rate of adherence to follow-up in women who were initially diagnosed with CIN 1 over a period of 24 months and to evaluate the regression and progression rate of CIN 1. MATERIAL AND METHODS: Of 1050 women who visited a colposcopy clinic from October 2013 through March 2017, 138 with histologically proven as CIN 1 were recruited. Adherence to follow-up, the regression and progression rate of CIN 1 were retrospectively assessed. RESULTS: Of the 138 women, 86 (62.3%) followed regularly until the study endpoint at 24 months. During the study period, 10 women received ablative treatment. The regression rate in women who had surveillance with cervical cytology was 69.7%, persistent disease of 18.4%, and progression to CIN 2-3 of 11.8%. In contrast, 80% of women who received ablative treatment had regression, 20% of them had persistent disease but none had progression. CONCLUSIONS: Nearly 40% of women with CIN 1 were lost to follow-up at 24 months. Adherence to the follow-up should be emphasized to all women. Intensive interventions to improve adherence and clinical outcome might be an option, particularly among women with poor compliance.

Lynch Syndrome in Thai Endometrial Cancer Patients.

BACKGROUND: Lynch syndrome increases lifetime risk of endometrial cancer to 40-60%. Screening with molecular tumor testing for mismatch repair (MMR) proteins have been recommended. This study aims to evaluate the incidence of MMR deficiency and germline mutation in endometrial cancer Thai patients. METHODS: Immunohistochemistry for MMR proteins, including MLH1, MSH2, MSH6 and PMS2 were tested in 166 surgical specimens. Patients who had MMR deficiencies were offered genetic counseling and a germline testing using gene-panel next generation sequencing. RESULTS: Fifty-eight of 166 patients (34.9%) had one or more MMR deficiencies which were: MLH1 and PMS2 in 42 patients (25.3%), MSH2 and MSH6 in 11 patients (6.6%), and MSH6 in 5 patients (3.0%). Of the 40 patients (24.1%) who met the revised Bethesda guidelines, 19 patients (47.5%) had MMR deficiency. In contrast, MMR deficiency was found in 39 of the 126 patients (31.0%) who did not meet the revised Bethesda guidelines. A total of 27 patients with MMR deficiencies agreed to have germline genetic testing. Germline MMR mutations were detected in 5 patients (18.5%) including MSH6 (n=2), PMS2 (n=2), and MLH1 mutations (n=1). Incidental germline mutations in other genes were detected in 3 patients (1 BRCA1, 1 PTEN, and 1 BARD1). Among 5 Lynch syndrome patients, 2 patients (40%) did not meet the revised Bethesda guidelines. Eight patients who met the revised Bethesda Guidelines but having MMR proficiency had genetic testing, but no germline mutation was detected. CONCLUSION: MMR deficiencies were detected in 34.9% of the endometrial cancer patients. Germline mutations were diagnosed in 3.0% of this cohort (5/166 patients). Lynch syndrome screening with MMR immunohistochemistry should be considered in all patients regardless of personal or family history of Lynch syndrome-related cancers.

Blood transfusion reduction with intravenous iron in gynecologic cancer patients receiving chemotherapy.

OBJECTIVE: To compare the incidence of repeated red blood cell (RBC) transfusion in anemic gynecologic cancer patients receiving platinum-based chemotherapy comparing intravenous and oral iron. MATERIALS AND METHODS: Forty-four anemic gynecologic cancer patients (hemoglobin level below 10 mg/dl) who required RBC transfusion were stratified and randomized according to baseline hemoglobin levels and chemotherapy regimen. Study group received 200 mg of intravenous iron sucrose and control group received oral ferrous sulphate 600 mg/day. RBC transfusion requirement in the consecutive cycle of chemotherapy was the primary outcome. Quality of life was evaluated by validated Thai version of the Functional Assessment of Cancer Therapy-Anemia (FACT-An). RESULTS: In a total of the 44 patients, there were 22 patients in each group. Five patients (22.7%) in the study group and 14 patients (63.6%) in the control group required RBC transfusion in consecutive cycle of chemotherapy (p=0.01). No significant difference in baseline hemoglobin and hematocrit levels was demonstrated in both groups. Significantly higher mean hemoglobin and hematocrit levels after treatment were reported in the study group (10.0+/-0.8 g/dl and 30.5+/-2.4%) than the control group (9.5+/-0.9 g/dl and 28.4+/-2.7%). No significant change of total FACT-An scores was noted between before and after treatment in both groups. No serious adverse events were reported and there was no significant difference among adverse events between both groups. CONCLUSION: Intravenous iron is an alternative treatment for anemic gynecologic cancer patients receiving platinum-based chemotherapy and reduces the incidence of RBC transfusion without serious adverse events.

Validation of the Prolapse Quality of Life (P-QOL) questionnaire in Thai version.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to validate the Thai version of the Prolapse Quality of Life (P-QOL) questionnaire. METHODS: The P-QOL questionnaire was translated into Thai. Test-retest reliability and internal consistency were tested. All patients who visit the gynecologic outpatient clinic of King Chulalongkorn Memorial Hospital between March 2008 and September 2009 completed the P-QOL questionnaires. RESULTS: One hundred fifteen patients with symptomatic pelvic organ prolapse and 60 asymptomatic patients were included. There was a significant correlation between P-QOL domain scores and vaginal examination findings (POP-Q stage). A higher POP-Q stage and a higher impact on quality of life were detected in symptomatic patients. The total scores from all domains were significantly higher in symptomatic patients. CONCLUSION: The Thai version of the P-QOL questionnaire is a valid, reliable, and simple instrument to assess the symptoms' severity and the quality of life in Thai-speaking patients with pelvic organ prolapse.

Long-term lower urinary tract dysfunction after radical hysterectomy in patients with early postoperative voiding dysfunction.

INTRODUCTION AND HYPOTHESIS: To compare long-term lower urinary tract dysfunction after radical hysterectomy in patients with or without early postoperative voiding dysfunction. METHODS: Thirty patients at least 2 years after radical hysterectomy were evaluated with multichannel urodynamic studies. Fifteen patients (group A) had early postoperative voiding dysfunction (required urethral catheterization more than 1 month), and 15 patients (group B) had no early postoperative voiding dysfunction. RESULTS: Overall voiding dysfunction was more prevalent in group A than group B (73.3% versus 33.3%, p > 0.05). In particular, high postvoid residual urine and abdominal straining increased significantly in group A (40% versus 0% and 60% versus 13.3%, respectively). Total and all domains scores from Urogenital Distress Inventory and Incontinence Impact Questionnaire were not different between both groups. CONCLUSION: High postvoid residual urine and abdominal straining increased significantly in patients with early postoperative voiding dysfunction without impairment on quality of life.

Assessment of medical ethics of fourth-year medical students.

From 2005 to 2008, the authors assessed the medical ethics of 779 medical students in the Department of Obstetrics and Gynecology at the Faculty of Medicine, Chulalongkorn University by using the Chula Method. This was conducted through a written examination asking the students to express their opinions about ethical issues. Their answers were rated as either Satisfactory (S) or Unsatisfactory (U). It was found that 750 students (96.3%) earned S while 29 students (3.7%) earned U. The results from this study can not be compared with the results from studies published in medical journals. Thus, knowledge about medical ethics is not complete even though it is intensively taught in medical schools and has been practiced for a long time. The authors would like to propose a new assessment of the medical ethics so that it can be systematically applied.

Management of endometrial cancer in Asia: consensus statement from the Asian Oncology Summit 2009.

Endometrial cancer is one of the gynaecological cancers that carries good overall prognosis because it is often detected at early stages of disease. The International Federation of Gynecology and Obstetrics replaced clinical staging with surgical staging in 1988 and updated the system in 2009. Controversies remain regarding the recommended screening protocol for women with a high risk of endometrial cancer, the role and benefit of retroperitoneal lymph-node dissection, the necessity of ovarian resection, the benefit and type of adjuvant radiation therapy, and the safety of hormone-replacement therapy after treatment. This article reviews the available evidence for optimum management of endometrial cancer and how management strategies can be applied in Asian countries with different levels of health-care resource availability and economic development. An overview of the literature for endometrial-cancer screening, diagnosis, and management is discussed. Consensus statements are formulated on the basis of basic, limited, enhanced, and maximum health-care resource availability, using the framework provided by the Breast Health Global Initiative.