Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review.

INTRODUCTION AND HYPOTHESIS: The aims were to review the literature from the last two decades and analyze treatment efficacy and findings of the studies on colpocleisis. METHODS: A systematic search was conducted within the MEDLINE/PubMed and ClinicalTrials.gov databases, using the following keywords: pelvic organ prolapse (POP), colpocleisis, obliterative, and LeFort. All English full-text prospective and retrospective observational and interventional studies were included. Anatomical and subjective success, surgical techniques, concomitant procedures, complication rates, anesthesia methods, and decision regret were analyzed. RESULTS: A total of 237 papers were identified and 49 met the inclusion criteria. Mean patient age was 69.0 ± 8.0 to 84 ± 3.1. Over 90.2% of patients undergoing colpocleisis were diagnosed with POP stage ≥ 3. The follow-up ranged from 30 days to a median of 5 years. Anatomical success, defined as POP-Q stage ≤ 1 and no prolapse beyond the hymen, was achieved in 62.5 to 100% and 87.5 to 100% of all patients respectively. Subjective success ranged from 88% to 100%. Regret over the loss of coital ability ranged from 0% in many studies to 12.9%, general decision regret from 0% to 13.8%. After concomitant midurethral sling surgery, 86.8% to 94% of all patients were continent, with a 0-14% sling revision rate due to urinary retention. Urinary tract infection was the most common postoperative complication (4.3 to 9% confirmed with urine culture, 34.7% based on symptom definition). Bowel (0 to 2.7%) and urinary tract (0 to 9.1%) injuries were the consequences of concomitant procedures. The mortality rates were up to 1.3%. CONCLUSIONS: Colpocleisis is a heterogeneous procedure, characterized by high subjective and objective success, low coital ability regret, and a low risk of complications.

International Urogynecology Consultation: Patient Reported Outcome Measures (PROs) use in the evaluation of patients with pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Patient-reported outcome measure instruments include patient-reported outcomes (PROs) and patient-reported goals (PRGs), which allow practitioners to measure symptoms and determine outcomes of treatment that matter to patients. METHODS: This is a structured review completed by the International Urogynecology Consultation (IUC), sponsored by the International Urogynecological Association (IUGA). The aim of this working group was to evaluate and synthesize the existing evidence for PROs and PRGs in the initial clinical work-up/evaluation and research arena for patients with pelvic organ prolapse (POP). RESULTS: The initial search generated 3589 non-duplicated studies. After abstract review by 4 authors, 211 full texts were assessed for eligibility by 2 writing group members, and 199 studies were reviewed in detail. Any disagreements on abstract or full-text articles were resolved by a third reviewer or during video meetings as a group. The list of POP PROs and information on PRGs was developed from these articles. Tables were generated to describe the validation of each PRO and to provide currently available, validated translations. CONCLUSIONS: All patients presenting for POP should be evaluated for vaginal, bladder, bowel and sexual symptoms including their goals for symptom treatment. This screening can be facilitated by a validated PRO; however, most PROs provide more information than needed to provide clinical care and were designed for research purposes.

Responsiveness of two sexual function questionnaires: PISQ-IR and FSFI in women with pelvic floor disorders.

AIMS: To assess responsiveness of sexual function questionnaires: Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) and Female Sexual Function Index (FSFI) in women with pelvic floor disorders (PFD). METHODS: The study included 261 subjects who completed PISQ-IR and FSFI at baseline and after treatment (median: 8 months). Standardized response mean (SRM) and effect size (ES) were calculated for sexually active (SA) and not-SA (NSA) women. Patient Global Impression of Improvement (PGI-I) was applied to assess treatment outcomes. RESULTS: A total of 184 women reported "very much better"/"much better" on the PGI-I scale posttreatment and were enrolled for further study. After treatment, 21.7% of the NSA women resumed sexual activity, 13.9% of the initially SA-abstained, and no change was reported for 152 (82.6%) subjects (87-SA and 65-NSA). Significant improvement in PISQ-IR SA domains was observed, with mild responsiveness for Arousal/Orgasm (SRM = 0.34, ES = 0.29, p = .003) and good responsiveness for Condition Specific, Global Quality and Summary Score (SRM = 0.51, ES = 0.50; SRM = 0.54, ES = 0.47; SRM = 0.75, ES = 0.63, p < .001). The Condition Impact domain demonstrated excellent responsiveness (SRM = 1.13, ES = 1.17, p < .001). In NSA, PISQ-IR had good responsiveness in Condition Impact (SRM = -0.76, ES = -0.59, p < .001), and mild in Condition Specific (SRM = -0.30, ES = -0.28, p < .03) domains. In FSFI, posttreatment sexual function in SA was improved in Desire, Arousal, Orgasm, Satisfaction, Pain domains and Total score, proving mild responsiveness (SRM, 0.24-0.48; p < .04). In NSA, FSFI proved nonresponsive. CONCLUSION: PISQ-IR and FSFI are responsive tools, useful to investigate the effects of treatment on sexual function in SA (both questionnaires) and NSA (only PISQ-IR) women with PFD.

Identification of the Urogenital Distress Inventory-6 and the Incontinence Impact Questionnaire-7 cutoff scores in urinary incontinent women.

PURPOSE: Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7) and The International Consultation on Incontinence (ICIQ-SF) Short Form are used to diagnose individuals with urinary incontinence (UI) and to assess the impact of the dysfunction on patient quality of life. While ICIQ-SF has fixed cutoff values-UDI-6 and IIQ-7 do not. We aimed to find the cutoff scores for UDI-6 and IIQ-7 in women with UI. METHODS: The study involved 205 women aged between 31 and 83 years-155 with, and 50 without UI symptoms. All participants completed all three questionnaires: ICIQ-SF, UDI-6 and IIQ-7. Patients were categorized according to their ICIQ-SF scores, as symptomatic ICIQ-SF ≥ 6 (n = 134) and asymptomatic ICIQ < 6 (n = 60). The Receiver Operating Characteristics (ROC) curve was used to test how well UDI-6 allowed a discrimination between patients suffering from UI and those who do not. Area under Curve (AUC) statistic was calculated to measure the UDI-6 and IIQ-7 Total Score efficiency. RESULTS: The cutoff values were selected. On the basis of the ROC curve analysis, the UDI-6 Total Score of 33.33 and IIQ-7 Total Score of 9.52 were determined to be the optimal cutoff for distinguishing between symptomatic and asymptomatic women (AUC = 0.94-UDI-6 and 0.91-IIQ-7). CONCLUSIONS: For UDI-6 scores more than 33.33 indicate higher distress caused by UI symptoms. Moreover, the higher impact of UI on health- related quality of life is seen in women who scored 9 or more in the IIQ-7 questionnaire, and such women felt impaired quality of life. Trial registration number NCT04433715, 11.06.2020 "retrospectively registered".

Comparison of laparoscopic techniques for apical organ prolapse repair - a systematic review of the literature.

AIMS: Apical defect is a pelvic organ prolapse disorder, with 5%-15% prevalence. The aim of the study was to investigate methods of laparoscopic repair of apical defect and compare them with other techniques (open, vaginal, and robotic). METHODS: A systematic search of the literature was conducted in MEDLINE/PubMed and ClinicalTrials.gov databases using the following key words: apical prolapse and treatment procedures. The search was limited by using the humans filters. Only articles published in English between 2010 and 2018 were considered. Two independent authors reviewed the publications for inclusion on the basis of the following criteria: (a) use of laparoscopic techniques, and (b) apical support loss as indication for surgery. RESULTS: A total of 1002 papers were initially identified; 24 studies fulfilled the inclusion criteria. Four main laparoscopic procedures were found. The reported anatomical success rate (POP-Q < II stage) was 77%-100%, with patient satisfaction for pectopexy, laparoscopic sacropexy (LS), lateral ligament suspension and laparoscopic uterosacral ligament suspension (LUSLS) of 96.4%-97.6%, 71.0%-100%, 66.7%-87.8%, and 95%-95.5%, respectively. Major complications included hemorrhage, bladder, ureter, and/or bowel injuries were rare. Prolapse recurrences after LUSLS and LS were reported in 13.2% and 10.4% of patients, respectively; with reoperation rate for LS 2.2%-12.8%. CONCLUSIONS: Most studies reported anatomical and subjective outcomes, with follow-up ranging from 1 month to >7 years. Success rates for laparoscopic and abdominal corrections of apical defect were similar; laparoscopy was superior in terms of perioperative blood loss, length of hospital stay, and recovery.

Polish translation and validation of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR).

INTRODUCTION AND HYPOTHESIS: The aim of the study was to translate into Polish the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), which evaluates sexual function in sexually active (SA) and not SA (NSA) women with pelvic floor disorders (PFD), and to validate the Polish version. METHODS: After translation, back-translation and cognitive interviews, the final version of PISQ-IR was established. The study group included 252 women with PFD (124 NSA and 128 SA). All women underwent clinical evaluation and completed the PISQ-IR. For test-retest reliability, the questionnaire was administered to 99 patients twice at an interval of 2 weeks. The analysis of criterion validity required the subjects to complete self-reported measures. Internal consistency and criterion validity were assessed separately for NSA and SA women for the PISQ-IR subscales. RESULTS: The mean age of the women was 60.9 ± 10.6 years and their mean BMI was 27.9 ± 4.9 kg/m2. Postmenopausal women constituted 82.5% of the study group. Urinary incontinence (UI) was diagnosed in 60 women (23.8%), pelvic organ prolapse (POP) in 90 (35.7%), and UI and POP in 102 (40.5%). Fecal incontinence was reported by 45 women (17.9%). The PISQ-IR Polish version proved to have good internal consistency in NSA women (α 0.651 to 0.857) and SA women (α 0.605 to 0.887), and strong reliability in all subscales (Pearson's coefficient 0.759-0.899; p < 0.001). Criterion validity confirmed moderate to strong correlations between PISQ-IR scores and self-reported measures in SA subscales, as well the SA summary score, and weak to moderate correlations in NSA women. CONCLUSIONS: The PISQ-IR Polish version is a valid tool for evaluating sexual function in women with PFD.

24/7 usage of continence pads and quality of life impairment in women with urinary incontinence.

AIMS: To compare quality of life (QoL) in women with urinary incontinence (UI) using continence pads during the day versus all day and night; to identify risk factors for a 24-hour pad use; to calculate quality-adjusted life years (QALY). METHODS: A cross-sectional study in 331 women with lower urinary tract symptoms referred to urogynaecologic examination was conducted. Main outcome measures were the scores of King's Health Questionnaire (KHQ), clinical data, and KHQ-derived utility values. RESULTS: A total of 270 women with UI were recruited: 176 (57.3%) using continence pads only during the day (group I) and 94 (30.6%) for 24 hours (group II). The groups did not differ in terms of age, menopause, parity, type of UI, stage of POP-Q, and percentage of sexually active subjects. Group II had significantly higher body mass index (BMI) and lower education than group I (P < 0.05). QoL was significantly deteriorated in group II in KHQ Global score and in all domains except one (General Health). Risk factors for 24 hours pad use were as follows: BMI ≥ 30 vs BMI 25-30 (OR = 2.02 (1.09-3.73), P = 0.037), higher scores in KHQ Severity measures (OR = 1.03 (1.02-1.04), P < 0.001), KHQ Global score (OR = 1.03 (1.02-1.05), P < 0.001) and primary compared to secondary (OR = 0.4 (0.19-0.84)) or higher education (OR = 0.41 (0.18-0.94), P < 0.05). Annual QALY was significantly lower in group II (0.9288 ± 0.03 vs 0.9432 ± 0.03, P < 0.001). CONCLUSION: One-third of women with UI used continence pads for 24 hours. Among these patients QoL and QALY were found lower compared to women using continence pads only during the day. KHQ Severity measures domain was an independent predictor for a 24-hour usage of continence pads.

Coital incontinence: a factor for deteriorated health-related quality of life and sexual function in women with urodynamic stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: To assess the impact of coital incontinence (CI) on health-related quality of life (HRQoL) and quality of sexual function (QSF) in women with urodynamic stress urinary incontinence (SUI). METHODS: Women were recruited for this cross-sectional study from among 289 patients with lower urinary tract symptoms, underwent clinical and urodynamic evaluation. Of these 289 women, 127 sexually active women with SUI completed the King's Health Questionnaire (KHQ) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), of whom 97 were enrolled for the study. The study group comprised 53 women with CI occurring 'sometimes', 'usually' or 'always', and the control group comprised 44 women without CI. Total and individual domain scores were evaluated. RESULTS: CI was reported by 65.35 % of the women. The frequency of CI was correlated with lower educational level and higher body mass index (r = 0.22 and r = 0.23, respectively; p = 0.01). The KHQ results showed significantly lower HRQoL in women with CI in all domains (p < 0.05) apart from Sleep/energy' (p = 0.054). PISQ revealed no significant differences in QSF in the Behavioral/emotive and Partner-related domains (34.3 ± 10.0 vs. 33.0 ± 12.2 and 18.0 ± 2.9 vs. 18.2 ± 3.6, respectively). Women with CI reported a significantly lower QSF in the Physical domain (29.1 ± 6.6 vs. 35.0 ± 4.6, p = 0.001), and the total PISQ score was lower but the difference was not significant (81.4 ± 14.3 vs. 86.2 ± 16.5). Total PISQ score was correlated with age (r = -0.28, p = 0.001). Women with CI were significantly more likely to admit that fear of incontinence or fear of embarrassment restricted their sexual activity (p < 0.001). CONCLUSIONS: A large percentage (65.35 %) of women with SUI reported CI, which had a negative impact on HRQoL and QSF in the Physical domain, but no significant impact on overall QSF.

Validation of the Polish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to develop a Polish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) to evaluate sexual function in patients with stress urinary incontinence (SUI) and pelvic organ prolapse (POP) versus a control group. METHODS: Before the validation study, a pilot study of the Polish version of the PISQ was performed in 22 women with pelvic floor dysfunctions. The respondents completed the questionnaire at recruitment and 2 weeks later. Test-retest reliability and internal consistency were determined. The validation study was performed in 249 sexually active women (123 with urodynamic SUI and POP; 126 healthy controls). The study group reported urinary incontinence (UI) at the urogynecological ambulatory clinic, where they underwent urogynecological and urodynamic examinations. All participants completed the questionnaire. PISQ results from both groups were compared and correlated with those of the King's Health Questionnaire (KHQ) and patient age. RESULTS: Test-retest reliability was good according to Pearson's correlation coefficient (r = 0.89, p < 0.001). PISQ had high internal consistency (Cronbach's α = 0.878). The total PISQ score was significantly lower in the study group compared with the controls (83.6 ± 14.9 vs 95.7 ± 10.3, p < 0.001), as were scores for individual domains: Behavioral/Emotive, Physical, Partner-Related (33.9 ± 10.2 vs 39.8 ± 7.8, 31.7 ± 6.9 vs 37.1 ± 2.8, and 18.0 ± 3.1 vs 19.4 ± 2.6 respectively; p < 0.001), confirming the lower quality of sexual function in women with SUI and POP. A correlation between PISQ and KHQ scores and patient age was confirmed. CONCLUSIONS: The Polish version of the PISQ is a reliable tool for evaluating sexual function in women with POP and UI.

Analysis of the usage of continence pads and help-seeking behavior of women with stress urinary incontinence in Poland.

BACKGROUND: Urinary incontinence (UI) in women is a chronic disorder which has a negative impact on health-related quality of life. Only 45 % of the affected individuals report the problem with continence to their doctor. The aim of the study was to assess the duration of stress urinary incontinence (SUI), time from disease onset to the first medical consultation and in-depth diagnosis, as well as the need for using continence pads in various grades of SUI. METHODS: We conducted a cross-sectional study in women who presented at the urogynecologic ambulatory center and reported urinary incontinence. A total of 420 subjects were interviewed and underwent urogynecologic and urodynamic examinations. A group of 147 patients with urodynamic SUI was enrolled in the study. RESULTS: All women were graded according to the Stamey severity score: grade 1 - 56 (38.1 %), grade 2 - 68 (46.3 %), and grade 3 - 23 (15.6 %). Mean time elapsed between disease onset and presentation at the urogynecologic ambulatory center was 17.4 ± 11.8 years (grades 1, 2 and 3 for 11.6 ± 11.8, 14.9 ± 10.8, and 22.2 ± 12.1 years, respectively; p = 0.0002). Patients with SUI started perceiving their condition as a problem 4.7 ± 5.4 years before referral to urodynamics; 58.3 % of the SUI patients reported their problems with continence to a physician. Average time between the onset of UI symptoms and seeking medical help was 13.28 ± 12.3 years. Mean duration of using continence pads during the day was 4.2, 5.4 and 10.2 years in grades 1, 2 and 3, respectively (p = 0.0002). The number of patients using continence pads in and outside the home, as compared to outside only, was: grade 1 - 44.6 % vs. 28.6 %, grade 2 - 77.6 % vs. 13.4 %, and grade 3 - 86.4 % vs. 9.1 % (p = 0.004). Mean use of continence pads at night was 3.3, 6.1, and 9.1 years in grades 1, 2 and 3, respectively. The differences were not statistically significant. Protective continence products were used at night by 26.7 % of the SUI patients: 16.1 %, 25 % and 59.1 % in grades 1, 2 and 3, respectively (p = 0.004). CONCLUSIONS: Women with SUI delay seeking medical help for over a decade. The severity of SUI is associated with duration and increased use of continence pads.

MiniMizer Gastric Ring displacement at 31 weeks of gestation as a life-threatening complication.

This case report describes a pregnant woman who underwent a laparoscopic MiniMizer Gastric Ring procedure for clinically severe obesity only one month before conception. At 31 weeks of gestation, the patient as admitted to the hospital with postprandial vomiting and persistent left-sided colicky abdominal pain. Maternal abdominal MRI revealed an intestinal obstruction and elective surgery was recommended. Due to the considerable risk to the fetus, antenatal corticosteroids were immediately administered to promote lung maturation and magnesium sulfate was started for fetal neuroprotection. During an exploratory laparoscopy, significantly enlarged and ischemic intestinal loops were found, leading to the decision to perform an atraumatic "en caul" cesarean delivery. After a successful "en caul" delivery, the MiniMizer ring, which had dislodged downwards and led to mesenteric ischemia, was visualized. Intraoperative esophagogastroduodenoscopy revealed a 1cm defect in the stomach wall related to gastric ring, covered with purulent exudate. Further exploration, showed a herniation of the distal alimentary loop through the Petersen foramen. Successful management included ring removal and intestinal loop reduction from the Petersen's space, without evidence of strangulation, as confirmed with indocyanine green (ICG) angiography. The postoperative course was uneventful. Women with obesity who have undergone bariatric surgery should to be informed of the increased likelihood of becoming pregnant after treatment. It is advised to notify the patient of the importance of maintaining a sufficient interval between bariatric surgery and conception. Additionally reports from the literature on various complications during pregnancy after bariatric surgery are presented.

Influence of Platelet-Rich Plasma on Recurrent Vesicovaginal Fistula-A Histological and Immunohistochemical Study.

Vesicovaginal fistula is a cause of deterioration in the quality of life. It is a communication between the bladder and vagina resulting in the uncontrollable leakage of urine through the vagina. Recently, regenerative methods have been used more frequently, and platelet-rich plasma is one of these methods. The functional properties of platelet-rich plasma are based on the synthesis and secretion of multiple growth factors released after platelet activation. The aim of this study was to investigate how platelet-rich plasma influences the condition of the tissue and the healing ability of the urothelium, vaginal epithelium and tissues surrounding the fistulous canal. The study included eight patients who had undergone the Latzko procedure aimed at closing the vesicovaginal fistula. Samples were collected during primary surgery without platelet-rich plasma and after failed surgery, during a second attempt. The specimens were subjected to histological and immunohistochemical evaluation. The histology demonstrated that in platelet-rich plasma patients, greater vascularization and wider subepithelial mucosa layering was observed. Inflammatory infiltration in the subepithelial layer was increased in platelet-rich plasma patients. No localization differences in growth factor proteins were found in either group, but in platelet-rich plasma-patients, the reactions were stronger. It can be concluded that the use of platelet-rich plasma improves the morphological structure of the injected tissues.

Women's Knowledge about Pharmacological and Non-Pharmacological Methods of Pain Relief in Labor.

This study aimed to assess knowledge about non-pharmacological pain-relief methods in labor among women who have given birth at least once. This cross-sectional study was conducted using an online survey among 466 adult women. The minimum sample size was estimated based on the number of labor admissions in the year before the study in Poland. The survey included questions about respondents' sociodemographics and knowledge of pain-relief methods. The knowledge score was calculated using the sum of correct answers. Non-parametric Spearman's correlation, Kruskal-Wallis and Wilcoxon variance tests were used. Antenatal classes (313/68.9%) and the Internet (248/54.6%) were the most common sources of knowledge. The most popular pharmacological pain-relief methods included epidural anesthesia (386/85.0%) and nitrous oxide (301/66.3%). Massage and breathing techniques were the most commonly known non-pharmacological methods (405/89.2% and 400/88.1%, respectively). The knowledge score about non-pharmacological methods was significantly higher as compared to the pharmacological methods score (rc = 0.85; p < 0.001). Respondents' age correlated with knowledge about non-pharmacological methods (rs = -0.10,p = 0.026) but did not correlate with knowledge about pharmacological methods. Educational level correlated with knowledge about pharmacological (rs = -0.13,p = 0.007) and non-pharmacological (rs = 0.14, p = 0.003) methods concerning pain relief in labor. No correlation was found between respondents' knowledge and gravidity, number of vaginal or cesarean deliveries, and hospital referral levels for previous deliveries. Our findings support the need to implement educational programs to increase evidence-based knowledge about pain-relief methods during labor in women.

The Use of Capacitive and Resistive Energy Transfer in Postpartum Pain Management in Women after Perineal Trauma.

Perineal pain occurs in 97% of women with episiotomy or first- and second-degree perineal tears on the first day after delivery. The study aimed to assess the impact of capacitive and resistive energy transfer (TECAR) on perineal pain and discomfort in the first two postpartum days. The prospective randomized double-blind study was performed with the pain and discomfort assessment using the Visual Analogue Scale at baseline and after both TECAR interventions. Characteristics data, delivery information, and the number of painkillers taken were collected. The assumed significance level was α < 0.05. The study included 121 women with a mean age of 30.7 ± 4.2 years and a median BMI of 26.1 kg/m2 (24.1; 28.9). Pain reduction at rest, when walking, and discomfort reduction when walking were significantly higher in the TECAR group compared to the sham group (p < 0.05). After the first TECAR intervention, significant reduction in all measured parameters was observed in the study group (p < 0.03), whereas in the control group, it was observed in pain and discomfort while sitting (p < 0.04). The amount of ibuprofen taken on the second day was significantly reduced in the study group compared to the first day (p = 0.004). TECAR has been shown to provide more immediate and significant reduction in perineal pain and discomfort.

A Cross-Sectional Survey of Labor Pain Control and Women's Satisfaction.

Introduction: Pain experienced during labor is a symptom of contractile activity and is a physiological feature of the uterus that occurs at the appropriate stages of labor. For the majority of women, labor pain is the most severe pain they will ever experience, and therefore should be relieved. OBJECTIVE: (1) To evaluate labor pain intensity before and after using non-pharmacological and pharmacological interventions; (2) to assess women's satisfaction of labor pain management. METHODS: A multicenter cross-sectional survey study was performed on 500 women who gave birth in different reference level hospitals (i.e., I, II, III). Pain intensity was assessed according the Numeric Rating Scale (range 0-10), whereas women's satisfaction was measured with a 5 point Likert scale. RESULTS: The use of both non-pharmacological (median 6.7 (5; 8) vs. 4.5 (3.3; 5.5)) and pharmacological methods (median 8 (7; 9) vs. 5 (3; 6)) resulted in a significant reduction in pain (p < 0.01). Water immersion and epidural anesthesia proved to be the most effective non-pharmacological and pharmacological methods, respectively. In hospitals of reference I, analgesic management was based primarily on the use of non-pharmacological techniques, less often mixed, i.e., non-pharmacological and pharmacological techniques (27.5%). On the other hand, in hospitals with higher referentiality, mixed methods were used more often (level II-65.8%; level III-81.2%). Pain intensity was significantly higher (p < 0.0001) in hospitals with reference level I (median 5 (4; 6)) than in the hospitals with reference level II (median 4.2 (3; 5)) or level III (median 4.2 (3.3; 5.4)). Epidural anesthesia was most often performed (60%) in the hospital of reference II. Women's satisfaction (median 4 (3; 5)), inter alia, was associated with the effectiveness of applied methods. CONCLUSIONS: The study findings suggest that women giving birth in hospitals of higher referentiality have better control of labor pain due to access to pharmacological methods. Epidural anesthesia remains the gold standard for relieving labor pain. The choice of a specific method is determined by the degree of hospital and associated with the pain referentiality.

Platelet Rich Plasma in Gynecology-Discovering Undiscovered-Review.

Regenerative medicine combines elements of tissue engineering and molecular biology aiming to support the regeneration and repair processes of damaged tissues, cells and organs. The most commonly used preparation in regenerative medicine is platelet rich plasma (PRP) containing numerous growth factors present in platelet granularities. This therapy is increasingly used in various fields of medicine. This article is a review of literature on the use of PRP in gynecology and obstetrics. There is no doubt that the released growth factors and proteins have a beneficial effect on wound healing and regeneration processes. So far, its widest application is in reproductive medicine, especially in cases of thin endometrium, Asherman's syndrome, or premature ovarian failure (POF) but also in wound healing and lower urinary tract symptoms (LUTS), such as urinary incontinence or recurrent genitourinary fistula auxiliary treatment. Further research is, however, needed to confirm the effectiveness and the possibility of its application in many other disorders.

Perioperative and Long-Term Anatomical and Subjective Outcomes of Laparoscopic Pectopexy and Sacrospinous Ligament Suspension for POP-Q Stages II-IV Apical Prolapse.

The aim of this paper was to analyze perioperative and long-term outcomes in 114 women undergoing surgery for POP-Q ≥ 2 apical prolapse: sacrospinous ligament colpo/hysteropexy (SSLF/SSHP)­61; laparoscopic pectopexy (LP)­53. Validated questionnaires (PGI-I, ISI, #35 EPIQ, PFIQ-7, PFDI-20) were completed at baseline and follow-up. POP-Q stages II, III and IV were diagnosed in 1 (0.9%), 84 (73.7%) and 29 (25.4%) patients, respectively. Mean operative time and hospital stay were 151.8 ± 36.2 min/2.6 ± 1.1 days for LP and 69 ± 20.4 min (p < 0.001)/2.7 ± 1.0 days for SSLF. Severe intraoperative complications occurred in two (1.8%) patients. Mean follow-up was 26.9 ± 12 and 37.3 ± 17.5 months for LP and SSLF, respectively. At follow-up, significant improvement for all POP-Q points was observed in both groups (p < 0.001). Shortening of total vaginal length was found in both groups, but predominantly in SSLF patients (p = 0.01). The sensation of vaginal bulge (EPIQ) was reduced, and total PFDI-20 and PFIQ-7 scores improved (p < 0.04) in both groups. Subjective success was reported by 40 (75.5%) LP and 44 (72.1%) SSLF patients. ISI detected no deterioration in urinary incontinence. PGI-I, PFDI-20, #35 EPIQ, PFIQ-7 and ISI did not differ between the groups. In conclusion both, SSLF and LP for apical prolapse generate good anatomical and subjective outcomes, with protective effect on the anterior compartment observed for LP.

Effect of Manual Therapy Compared to Ibuprofen on Primary Dysmenorrhea in Young Women-Concentration Assessment of C-Reactive Protein, Vascular Endothelial Growth Factor, Prostaglandins and Sex Hormones.

BACKGROUND: The study aimed to assess if manual therapy, compared to ibuprofen, impacts the concentration of inflammatory factors, sex hormones, and dysmenorrhea in young women Methods: Thirty-five women, clinically diagnosed with dysmenorrhea, were included in the study. They were divided into group A-manual therapy (n = 20) and group B-ibuprofen therapy (n = 15). Inflammatory factors such as vascular endothelial growth factor (VEGF), C-reactive protein (CRP), prostaglandin F2α (PGF2α), E2 (PGE2) and sex hormones levels were measured. Dysmenorrhea assessed with the numerical pain rating scale (NPRS), myofascial trigger points, and muscle flexibility were examined before and after the interventions. RESULTS: The difference in the level of 17-ß-estradiol after manual and ibuprofen therapy was significant, as compared to baseline (p = 0.036). Progesterone levels decreased in group A (p = 0.002) and B (p = 0.028). The level of CRP was negatively correlated with sex hormones. Decrease in dysmenorrhea was significant in both groups (group A p = 0.016, group B p = 0.028). Non-significant differences were reported in prostaglandins, VEGF and CRP levels, in both groups. CONCLUSIONS: There were no significant differences in CRP, prostaglandins and VEGF factors after manual or ibuprofen therapy. It has been shown that both manual therapy and ibuprofen can decrease progesterone levels. Manual therapy had a similar effect on the severity of dysmenorrhea as ibuprofen, but after manual therapy, unlike after ibuprofen, less muscles with dysfunction were detected in patients with primary dysmenorrhea.

Potentilla chinensis aqueous extract attenuates cyclophosphamide-induced hemorrhagic cystitis in rat model.

Cyclophosphamide (CYP) damages all mucosal defence lines and induces hemorrhagic cystitis (HC) leading to detrusor overactivity. Patients who undergo combined chemio-radiotherapy are at higher risk of HC. Potentilla chinensis extract (PCE) prevent oxidative stress-dependent diseases. Thus, the aim of the study was to investigate the effect of PCE on urinary bladder function in CYP-induced HC in preclinical study. 60 rats were divided into 4 groups, as follows: I-control, II-rats with CYP-induced HC, III-rats received PCE in dose of 500 mg/kg, and IV-rats with CYP-induced HC which received PCE in dose of 500 mg/kg. PCE or vehicle were administered orally for 14 days. The cystometry was performed 3 days after the last dose of the PCE. Next, urothelium thickness and oedema measurement and biochemical analyses were performed. Cyclophosphamide induced hemorrhagic cystitis. PCE had no influence on the urinary bladder function and micturition cycles in normal rats. PCE diminished the severity of CYP-induced hemorrhagic cystitis. In the urothelium the cyclophosphamide induced the elevation of CGRP, TNF-α, IL-6, IL-1ß, OTC3, NIT, and MAL. Also, the level of T-H protein, HB-EGF, and ZO1 was decreased. Moreover, the level of ROCK1 and VAChT in detrusor muscle increased. cyclophosphamide caused an increased concentration of BDNF and NGF in the urine. In turn, PCE in cyclophosphamide-induced hemorrhagic cystitis caused a reversal of the described biochemical changes within urothelium, detrusor muscle and urine. PCE attenuates detrusor overactivity. In conclusion, our results revealed that PCE attenuates detrusor overactivity in case of cyclophosphamide-induced hemorrhagic cystitis. The potential properties of PCE appear to be important in terms of preventing of oxidative stress-dependent dysfunction of urinary bladder. PCE may become a potential supportive treatment in patient to whom cyclophosphamide-based chemotherapy is used.