Distal vaginal agenesis.

Cíl: Popis symptomatiky, diagnostiky a operační léčby vzácné vrozené vady ženského genitálního systému - distální vaginální ageneze. Typ studie: Kazuistika. Pracoviště: Porodnicko-gynekologická klinika, FN a LF UP Olomouc; Ústav pro péči o matku a dítě, 3. lékařská fakulta UK, Praha. Vlastní pozorování: U dvou pacientek ve věku 16,5 a 15 let byla na Porodnicko-gynekologické klinice v Olomouci v letech 2018 a 2019 diagnostikována vrozená vývojová vada pochvy - distální vaginální ageneze. Byla provedena klinická a ultrazvuková diagnostika (v jednom případě magnetická rezonance pánve) a indikována operační léčba - distální kolpoplastika (kolpostomie). Závěr: Distální vaginální ageneze je ojediněle se vyskytující chirurgicky dobře léčitelná vrozená vada vývoje pochvy s dobrou prognózou. Kombinace zobrazovacích metod umožňuje přesnou diagnostiku, adekvátní terapii a stanovení prognózy.

Laparoscopic hysterosacropexy with subsequent pregnancy and delivery by cesarean section: case report with short term follow-up.

OBJECTIVE: To report a case of laparoscopic hysterosacropexy with subsequent pregnancy complicated by car accident, and terminated by cesarean section due to gestational hypertension. DESIGN: Case report and literature review. SETTING: Department of Obstetrics and Gynecology, University Hospital and Faculty of Medicine Olomouc, Palacký University. CASE REPORT: The patient is a 38 years old woman diagnosed with prolapse of the uterus POP-Q III. She had history of three spontaneous vaginal deliveries. In 2016 she underwent laparoscopic hysterosacropexy using Alyte mesh. There were no intraoperative complications, operating time was 80 min and blood loss 60 ml. Three moths after surgery patient became pregnant spontaneously. In 30th week of gestation patient had a car accident with intact pregnancy. During the third trimester patient has developed gestational hypertension which lead in 2017 to termination of pregnancy by cesarean section at 37 weeks. Mesh was found to be intact in the lower uterine segment. Follow up at 30 months after hysterosacropexy and 18 months after cesarean section revealed well supported cervix and no vaginal prolapse. CONCLUSION: Laparoscopic hysterosacropexy is feasible and safe method for treatment of the uterine prolapse. In young women it can be used to spare reproductive function.

Sakrospinous fixation sec. Miyazaki - complications and long-term results.

OBJECTIVE: To evaluate preoperative, perioperative and postoperative data, complications and results in long-term follow-up at patients who underwent Miyazaki´s sacrospinous suspension between January 2002 and December 2018. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc. METHODS: The evaluation of results of 240 patients who underwent Myiazaki sacrospinous suspension for vaginal prolaps between January 2002 and December 2018. RESULTS: The mean age of patients operated between 2014-2018 was higher than the mean age of all patients. Perioperative and early postoperative complications were analysed in six tables and two graphs. The most common complications were transient urinary retention (5.24%), urinary tract infection (3.80%) and pelvic hematoma (7.14%). In the long-term follow-up (131 patients over 24 months) the recurrence of apical defect was recorded at 12 (9.16%), cystocele at 26 (19.85%) and rectocele/enterocele at 3 (2.29%) patients. Patients with recurrence of vaginal vault prolapse underwent Miyazaki´s sacrospinous resuspension in four, transvaginal mesh insertion in three and sacropexy in five cases. CONCLUSION: Miyazakis sacrospinous suspension is an effective and safe method how to correct vaginal apical prolapse. The introduction of new surgical methods probably explains the shift of the age of the patients to the older ones in the last years. The most frequent early postoperative complications were urinary tract infections and pelvic hematomas. In the long-term follow up they were the recurrences of the prolaps of the anterior compartment. Total recurent apical vaginal prolaps was recorded at 12 patients (9.16%.).

Laparoscopic and robotic sacropexy: retrospective review of learning curve experiences and follow-up.

OBJECTIVE: To compare conventional laparoscopic (LSC) and robotic (RSC) sacrocolpopexy in the treatment of apical pelvic prolapse during robotic surgery "learning curve". Operative characteristics, prolapse treatment outcomes, and postoperative results were assessed. DESIGN: Retrospective comparative study. SETTING: Department of Obstetrics and Gynecology, University Hospital and Palacky University, Olomouc. METHODS: We analyzed consecutive 51 patients treated with laparoscopic sacropexy and 13 women operated with robotic system. Data on patient age, body mass index (BMI), operation history, estimated blood loss, operation time, surgical outcomes (including pelvic organ prolapse quantification - POP-Q), and concomitant surgeries were retrospectively obtained from patient medical records. Subjective outcomes were measured through PGI-I and PISQ-IR questionaires when available at last follow up (n = 26). RESULTS: In both groups all procedures were performed correctly without conversion. The mean operative time was longer in robotic group: 212 (128-394) min, as compared to 164 (80-342) in the laparoscopic group. Blood loss was lower for the robotic 52 (10-200) ml compared to laparoscopic group 58 (10-350) ml. Differences in operative time and blood loss were not statistically significant. Differences between LSC and RSC groups in postoperative results were not statistically significant. Learning curve for robotic sacrocolpopexy was shorter than for laparoscopic procedure in case of experienced laparoscopic surgeons. No recurrences occurred during follow-up. Most patients were satisfied with surgical results. CONCLUSION: The present study demonstrated that RSC may be comparable in surgical safety and efficacy. The decision regarding the best surgical approach has to be individualised according to the characteristics of the patient and their preferences as well as the local clinical setting and the surgical expertise of physicians.

[Present properties of ultrasound diagnostics in urogynecology]. / Soucasné moznosti ultrazvukové diagnostiky v urogynekologii.

OBJECTIVE: The review article describes properties of sonography diagnostics in urogynecology. DESIGN: Review article. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc. MATERIAL AND METHODS: The review of sonography methods in urogynecology, their practical use for low urinary tract dysfunctions diagnostics, monitoring of surgical therapy effect and diagnostics of complications. CONCLUSION: Ultrasonography is inseparable part of urogynaecology examination, it is imaging method of the first choice to determine the exact diagnosis and indication for therapy, evaluation of postoperative conditions and solution of complications.