Importance of addition of HPV DNA testing to the cytology based cervical cancer screening and triage of findings with p16/Ki67 immunocytochemistry staining in 35 and 45 years old women LIBUSE trial data analysis.

OBJECTIVE: The study evaluates results of 2-years follow-up of patients in ages 35-36 and 45-46, who are participating in the project LIBUSE, that deals with efficacy of HPV DNA and Pap smear co-testing and p16/Ki67 dual staining in the Czech national cervical screening. DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynecology, General University Hospital and 1st Medical Faculty, Charles University, Prague. MATERIALS AND METHODS: Out of all women enrolled in the project LIBUSE only those who were at the beginning of the study 35-36 and 45-46 years old were sellected. Conventional Pap smear and HPV DNA test (Cobas 4800, Roche Diagnostics) had been collected at the baseline. Women were stratified according to their results in the three risk groups: 1. low-risk, 2. high-risk and 3. intermediate risk, who subsequently underwent p16/Ki67 dual staining. All high-risk patients and those with positive result of dual staing were refered to the expert colposcopy. The cases with biopsy proven precancers or cancers were considered as „positive findings“. RESULTS: Altogether 352 women meet the age requirements. In 26 (7.6%) women had been proven HPV DNA positivity and out of the them 9 cases were HPV 16/18 positive. Severe cytological abnormality was found only in one patient (0.3%), who was simultaneously HPV positive. Ten women (2.8%) were classified as high-risk and directly refered to colposcopy. Another 18 patients underwent p16/Ki67 dual staining and 4 positive cases were refered to colposcopy too. After one year further 9 patients were classified as intermediate risk and 6 more were identified after two years of follow-up. Within two years 9 more patient were refered to colposcopy. After the entire period of follow-up in 10 patients biopsy confirmed precancer lesions, none of them had invasive cancer. CONCLUSIONS: Addition of HPV DNA testing with selective HPV 16/18 genotyping to the cytology based screening significantly increases sensitivity and safety of our cervical screening program.

[What is the risk of pelvic organ prolapse recurrence after vaginal hysterectomy with colporrhaphy?] / Jaké je riziko recidivy sestupu pánevních orgánu po vaginální hysterektomii s posevními plastikami?

OBJECTIVE: To determine the risk of prolapse recurrence in patients after vaginal hysterectomy with colporrhaphy. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague. METHODS: The trial involved 220 women who underwent vaginal hysterectomy with anterior and posterior kolporrhaphy at our department for uterine prolapse at least grade 2. It was the first vaginal surgery in all of the patients. Subjective feeling of pressure in the vagina and/or palpable mass in the vagina or in front of the vaginal entrance and/or objective finding decline of the vaginal walls or fundus at lest the second degree or repeated surgery for prolapse were considered as a prolapse recurrence. RESULTS: The mean age at the time of vaginal hysterectomy was 66.7 years (range 37-88). Only 11 patients were premenopausal (5%), the others were postmenopausal, a mean time of posmenopause was 16.9 years. The average parity rate of the study group was 2.1. The average duration of the surgery was 68 minutes. Postoperative urinary retention was observed in one patient (0.45%). 156 women were enrolled in the study. The average length of follow-up was 47 months (minimum 24 months). Recurrence of prolapse based on subjective assessment occured in 24 patients (15.4 %) with pressure and resistance in the vaginal introitus. According to objective criteria, the recurrence of prolapse was diagnosed in 33 (21.2%) patients, of which 16 had prolapse of the anterior vaginal wall, three of the posterior vaginal wall (two rectocoele, one rectoenterocoele), eight combination prolapse of anterior and posterior vaginal wall and vaginal vault prolapse was diagnosed in six women. Eight patients (5. 1%) underwent surgery because of prolapse recurrence. The mean interval from primary surgery to the time of reoperation was 24.4 months (range 6-62). CONCLUSION: Patients have to be preoperatively informed about the risk of the prolapse recurrence with the recommendation of appropriate preventive arrangements.

[Lymphedema after vulvar cancer surgery. A prospective study]. / Lymfedémy po operacích karcinomu vulvy. Prospektivní studie.

INTRODUCTION: Prospective detection of postoperative lymphedema of the lower limbs (LLL) in patients after surgery for vulvar cancer using different examination methods and their comparison. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and Gynecology, 2nd Medical Faculty of the Charles University and University Hospital Motol, Prague. METHODS: Totally 36 women were followed after surgery for vulvar cancer. Due to the radicality of surgery the patients were divided into conservative (sentinel lymph node biopsy) and radical (inguinofemoral lymphadenectomy) group. Lower limbs were preoperatively and 3, 6 and 12 months after surgery assessed for the presence of lymphedema by measuring of circumferences, multifrequency bioelectrical impedance analysis (MFBIA) and subjective evaluation of patients. RESULTS: The prevalence of lower limb lymphedema 12 months after surgery diagnosed by subjective evaluation reached 19,44%, by circumference measurement 38,89% and with MFBIA 66,67%. The prevalence of lymphedema after inguinofemoral lymphadenectomy diagnosed by circumference measurement was in 12 months after surgery higher (45.83%) than after the conservative surgery (25%). Risk factors were evaluated 12 months after surgery (age, BMI, adjuvant radiotherapy, type of surgery) and none of them were found to be statistically significant for the development of the lower limbs lymphedema. CONCLUSION: The prevalence of lymphedema significantly depends on the diagnostic method, because they capture lymphedema in its various stages. Due to the high sensitivity MFBIA can be used for the detection of early stages of lymphedema. Preoperative measurement of the lower limbs is important for early detection of postoperative lymphedema.

[The effectiveness of recurrent stress urinary incontinence treatment after Burch colposuspension failure with transobturatory tape procedure]. / Efektivita lécby recidivující stresové inkontinence moci pomocí transobturatorní pásky po seláhní kolposuspenze podle Burche.

OBJECTIVE: To evaluate the safety and efficacy of the transobturatory tape (TOT) procedure in the treatment of female recurrent stress urinary incontinence after the Burch colposuspension failure. DESIGN: Retrospective clinical trial. SETTING: Obstetrics and Gynecology Department, Charles University, 2nd Medical School and Faculty Hospital Motol, Prague. METHODS: The group of fifteen women was treated for recurrent stress urinary incontinence with TOT procedure. Preoperative evaluation consisted of complete urogynecological examination. The cure rate and complications were determined in postoperative follow up 6 weeks and 12 months after the surgery. RESULTS: The mean age was 58.7 (46-64) years. Burch colposuspension was performed 6.4 (1-13) years before current TOT procedure. The cure rate in 12 month follow-up was 86.6% (13 of 15 patients), one patient was improved (6.7%). Postoperative complications occurred in 2 (13.4%) cases--one lower urinary tract infection and one overactive bladder symptomatology cured by anticholinergic therapy. CONCLUSION: The study showed that the TOT procedure is a safe and effective minimally invasive method in the treatment of recurrent stress urinary incontinence after Burch colposuspension.

[Czech version of EORTC QLQ-CX24 questionnaire for patients with cervical cancer]. / Ceská verze dotazníku EORTC QLQ-CX24 pro pacientky s karcinomem delozního hrdla.

OBJECTIVE: Translation and validation of the EORTC QLQ-CX24 questionnaire on quality of life into the Czech language and literature. TYPE OF STUDY: Prospective study. SETTING: Dept. of Obstetrics and Gynaecology, 2nd Medical Faculty, Charles University and Faculty Hospital Motol, Prague. METHODS: In concordance with the EORTC guidelines a questionaire for patients with cervical cancer was translated and validated. A group of 14 women who underwent the treatment for cervical cancer filled in the questionaire. T-test was used for the evaluation of the patient's characteristics and the differences in quality of life. RESULTS: We present a Czech version of the questionaire EORTC QLQ-CX24 and the description how to evaulate it. In comparison of the two treatment groups no statistically significant differences have been found. CONCLUSION: EORTC QLQ-CX24 is an internationally accepted questionnaire focused on patients with cervical cancer which should be incorporated into the projects dealing with women undergoing treatment for this disease.

[Effect of cranberry extract capsules taken during the perioperative period upon the post-surgical urinary infection in gynecology]. / Perioperacní podávání kapslí s brusinkovým extraktem 7 gynek v profylaxi uroinfekcí po gynekologických operacích.

OBJECTIVE: To evaluate the effect of cranberry extract capsules taken during the perioperative period upon the post-surgical urinary infection (UTI) in gynecology. DESIGN: Clinical prospective pilot trial. SETTING: Obstetrics and Gynecology Department, Merciful Brothers Hospital, Brno and Obstetrics and Gynecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. MATERIALS AND METHODS: The cohort consisted of 286 women who underwent hysterectomy and/or anterior vaginal repair (with or without anti-incontinence operation) in the above hospitals in the period 1. 9. 2006 -30. 6. 2007. 132 women from among the total were given cranberry extract capsules (equiv. 17,000 mg of fresh fruit) twice a day, 4 days before and 5 days after the surgery. The rest were the control group. The clinical state and the analysis of catheterized urine including bacteriology were determined on the day of surgery and on the 6th postoperative day. Cases with preoperative UTI and those with antibiotic therapy (due to other than urology indications) were excluded from the study. Thus the statistical analysis was made in the remaining 117 patients with prophylactic cranberry capsules and 139 controls. RESULTS: There were 30.8% of positive cultured urines, 18.0% of pyuric specimens and 6.8% symptomatic urinary infections in the group of cranberry prophylaxis. Controls had significant bacteriuria in 27.3%, pyuria in 23.7% and symptomatic UTI in 5.0%. Differences were not statistically significant. CONCLUSION: The intake of cranberry extracts in the perioperative period (4 days before and 5 days after the surgery) did not affect the number of post-surgical UTIs.

Genetic analysis of a bovine viral diarrhea virus 2 isolate from Slovakia.

The identification and genetic characterization of bovine viral diarrhea virus (BVDV) isolate 17237 detected in western Slovakia is described. The analysis of 5'-untranslated region (5'-UTR), autoprotease (Npro) gene, and structural genes (C, Erns, E1, E2) was carried out. The percentage of nucleotide and deduced amino acid identity in analyzed genes implied that the isolate was closely related to the bovine viral diarrhea virus 2 (BVDV-2). Furthermore, the phylogenetic analysis revealed that this isolate fall into BVDV-2b subtype that is sporadic in Europe. The cleavage sites between viral proteins were similar to the ones of a reference strain of BVDV-2.

[Abdominal sacrocolpopexy--simple and still actual method in the treatment of vaginal vault prolapse?]. / Abdominální sakrokolpopexe--jednoduchá a stále aktuální metoda 1écby prolapsu posevního pahýlu?

OBJECTIVE: To evaluate the effectiveness and complications of abdominal sacrocolpopexy in the treatment of vaginal vault prolapse. DESIGN: Review article. SETTING: Obstetrics and Gynecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. METHODS: Review from biomedical database Medline from 1960 till 2006. The articles were found under the key words: vaginal vault prolaps, abdominal sacrocolpopexy, effectiveness, complications, urinary incontinence, female sexual dysfunctions. RESULTS: The effectiveness of surgery is getting near to 100 percent in the smaller groups between 11 and 21 women. The larger groups are presenting greater success rate variability from 85 to 97 percent. The studies with up to 2 years of follow up are giving representative results of the effectiveness of surgery. Prolapse recurrence and cystocele, rectocele, enterocele and stress urinary incontinence occurrance belong among the characteristic failure signs. Studies evaluating abdominal sacrocolpopexy argue low incidence of complications. Complications connected with surgery can be divided to intraoperative and early and late postoperative. Bleeding from injured medial sacral artery, cystotomy, enterotomy and ureterotomy are the most common intraoperative complications. Wound infection, ileus and urinary tract infection are the most often early postoperative complications. Stress urinary incontinence, anterior or posterior vaginal wall descent, recurrence of vaginal vault prolapse and mesh erosion through vaginal wall are characteristic late postoperative complications. CONCLUSIONS: Abdominal sacrocolpopexy can be a method of choice in the treatment of vaginal vault prolapse, mainly because of the low morbidity and high success rate. Polypropylene mesh is the prefered suspension structure but the accurate surgical technique is the most important for the abdominal sacrocolpopexy success and safety.

[Effectivity and complications rate of surgical treatment of stress urinary incontinence with tension-free vaginal tape--Uretex]. / Efektivita a komplikace chirurgické lécby stresové mocové inkontinence pomocí volne ulozene pásky pod uretrou--Uretex.

OBJECTIVE: To evaluate the safety and efficacy of the Uretex tension-free vaginal tape procedure in the treatment of female stress urinary incontinence. DESIGN: Retrospective multicenter clinical trial. SETTING: Obstetrics and Gynecology Department, The Charles University 2nd Medical School and Teaching Hospital Motol, Prague. METHODS: A group of 145 patients with stress urinary incontinence who underwent Uretex tension-free vaginal tape procedure was studied. Procedures were performed from vaginal retropubic route. Patients were operated on in one urological and five gynecological departments in Czech Republic. Preoperative evaluation consisted of complete urogynecological examination, age, parity, body mass index, history of previous pelvic surgery and hormonal status. The cure rate and complications were determined in short-term postoperative follow-up. RESULTS: The mean age was 56 (25-80) years, the median parity was 2.25 (1-4), 113 (78%) patients were slightly overweight (BMI 25-30 kg/m2) and others had normal weight (BMI 20-25 kg/m2). The cure rate after surgery was 903% (131 women). Complications occured in 22 (15.2%) cases. In two (1.4%) patients perforation of the urinary bladder wall occurred. In two (1.4%) women nonperforated injury of bladder wall was postoperatively diagnosed. Retropubic haematoma occurred in another two patients (1.4%). 16 (11%) patients had mild early postoperative complications (eight times short-term urinary retention, six lower urinary tract infections, two urgent symptomatology). Erosion of vaginal wall did not occur postoperatively. All complications were resolved and the patients were free of negative postoperative symptoms 6 month after the procedure. CONCLUSION: This study shows that Uretex tension-free vaginal tape procedure is an effective and safe minimally invasive surgical procedure in the treatment of stress urinary incontinence.

[Contemporary potential of the mini-invasive surgical treatment of the female stress urinary incontinence]. / Soucasné moznosti miniinvazivní chirurgické lécby zenské stresové mocové inkontinence.

In 1994 DeLancey published the hammock hypothesis. According to this theory the increase of the urethral closure pressure depends on the urethral compression by the suburethral supportive tissue and the intraabdominal position of the proximal urethra and the bladder neck are not the main factors ensuring the continence. In connection with this new theory Ulmsten published (in 1996) results of the stress incontinence treatment with the tension-free polypropylene vaginal tape (TVT). This operation represents a revolution in the antiincontinent surgery. The success rate of this procedure is about 90% and it is the same in obese and in non obese women. Concomitant TVT and transvaginal procedures for prolapse do not decrease the effectiveness and do not increase the perioperative and postoperative morbidity. The procedure is connected with some peroperative (bladder perforation, retropubic haematoma), early postoperative (urinary retention) and late postoperative complications (urge incontinence, vaginal protrusion of the tape). In 2003 newly developed tape procedure--TOT (transobturator tape) was an evolutionary step in the improvement of tape procedures. The evaluation of the efficacy and complications rate of this modification is premature up to this time but hitherto positive results predetermine this surgical modality to successful expand.

[Abdominal hysterectomy--risk factor in development of urinary incontinence? Results of a questionnaire study]. / Abdominální hysterektomie--rizikový faktor vzniku mocové inkontinence? Výsledky dotazníkové studie.

OBJECTIVE: To evaluate the risk of urinary incontinence development after abdominal hysterectomy for benign gynecological disease. DESIGN: Retrospective questionnaire study. SETTING: Obstetrics and Gynecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. METHODS: Questionnaire study of women in which abdominal hysterectomy for benign gynecological disease was performed from January till December 2001 at our Department of Gynecology and Obstetrics. The questionnaire included questions about symptoms of stress, urge and mixed urinary incontinence. They were evaluated in connection with age, parity, hormonal status and body mass index. Student t-test was used for the statistical analysis. RESULTS: 114 (59.7%) from all sent-out questionnaires were obtained. In 15.8% cases (18 from 114) de novo urinary incontinence after surgery developed. 77.8% (14 from 18) from these patients suffered from genuine stress incontinence. The rest (4 from 18) of the women had symptoms of mixed incontinence. Study results draw attention to 13.1% women (15 from 114) in which preoperative stress incontinence persisted even after hysterectomy. Preoperative stress incontinence was cured in 6.1% (7 from 114) cases after hysterectomy. Age, parity, hormonal status and body mass index were not statistically different in all groups after surgery. CONCLUSIONS: The results of the study show relatively high risk of urinary incontinence development after abdominal hysterectomy in previously continent women. The results also show high persistence of the stress incontinence symptoms in women who did not inform about their incontinence even if they were asked about it. Higher quality of further health education of the women with drawing their attention to both the possibility of surgical treatment of urinary incontinence simultaneously with hysterectomy are the most important aspects how to make the current gynecological surgical therapy more effective.

[Abdominal sacral colpopexy in the treatment of posthysterectomy vaginal vault prolapse]. / Abdominální sakrokolpopexe v lécbe prolapsu posevního pahýlu po hysterektomii.

OBJECTIVE: To evaluate the safety and efficacy of the abdominal sacral colpopexy in the treatment of posthysterectomy vault prolapse. DESIGN: Retrospective clinical trial. SETTING: Obstetric and Gynecologic Department, The Charles University 2nd Medical School and Faculty Hospital Motol, Prague. METHODS: A group of 18 patients with vaginal vault prolapse after hysterectomy who underwent abdominal sacral colpopexy between July 2001 and June 2003 was studied. Ten women had undergone previous abdominal and 8 previous vaginal hysterectomy. All patients were operated on by one surgeon. Preoperative evaluation consisted of physical examination, age, parity, body mass index, history of previous pelvic surgery and hormonal status. The cure rate and complications were evaluated in follow-up. RESULTS: The mean age was 59.5 (41-72) years, the median parity was 2.05 (1-5). Seven (38.9%) patients were slightly overweight (BMI 25-30 kg/m2), one (5.6%) patient was obese (BMI 33.4 kg/m2) and 10 (55.5%) had normal weight (20-25 kg/m2). The average period of follow-up was 14.9 months (6-24). The cure rate was 94.4% (17 of 18 patients). No serious intraoperative complications occurred. Postoperative complications occurred in 2 (11.2%) cases (one urgent and one stress urinary incontinence). The complications were resolved and the patients were free of negative postoperative symptoms in the time of the last follow-up visit. CONCLUSIONS: Vaginal vault prolapse is an infrequent complication after both vaginal and abdominal hysterectomy. The study shows that abdominal sacral colpopexy is an effective and safe surgical procedure in the treatment of posthysterectomy vault prolapse. The operative technique is simple but the surgery should be performed by experienced pelvic surgeons able to resolve intraoperative complications.