Genitourinary syndrome, local oestrogen therapy and endometrial pathology: a single-centre, randomised study.

The objective of this study was to assess the endometrial pathology developed (EP) in postmenopausal women with genitourinary syndrome during and after vaginal oestrogen therapy. The 67 patients included were randomly grouped into group I underwent local oestrogen (oestriol) therapy and group II, underwent no therapy. Each patient's medical history was taken and clinical and gynecological examination, with transvaginal ultrasound at the time of inclusion and during the control visits, was done. The study results show no statistically higher risk of EP for vaginal oestrogen therapy of genitourinary syndrome users compared to the non-users in menopause. No one atypical endometrial hyperplasia and endometrial intraepithelial neoplasia case during the study period was found.Impact statementWhat is already known on this subject? Treatment of genitourinary syndrome with oestrogens in menopausal women is the most commonly used and affordable method. Topical vaginal oestrogens do not have the same stimulating effect on the endometrium as oral ones, and therefore the association between them and endometrial hyperplasia or cancer has not been established categorically.What do the results of this study add? This single-center, randomised study found no statistically higher risk of endometrial pathology for vaginal oestrogen (oestriol) therapy of genitourinary syndrome users compared to the non-users in menopause. No one atypical endometrial hyperplasia and endometrial intraepithelial neoplasia case during the study period was found.What the implications are of these findings for clinical practice and/or further research? This study confirms the safety of local oestrogen (oestriol) therapy of genitourinary syndrome in menopausal women with regards to the development of endometrial pathology and especially atypical endometrial hyperplasia and endometrial intraepithelial neoplasia or well-differentiated carcinoma.

The role of perioperative ureteral stenting for urologic complications in radical surgery of cervical cancer.

INTRODUCTION: This study aimed to establish the urologic complications of radical type C2 hysterectomy in cervical cancer patients with or without ureteral stenting. METHODS: This prospective randomized study included 76 (100%) patients with clinically and pathologically established cervical cancer stages I and II treated with radical type C2 hysterectomy with pelvic lymph node dissection for the last 5 years (2014-2019). Patients were randomized into two groups (2:1 ratio): group II received perioperative ureteral stenting (n = 24, 31.6%) and group I did not (n = 52, 68.4%). Urologic complications observed during follow-up include intraoperative ureter and urinary bladder lesions and postoperative ureterovaginal and vesicovaginal fistulas. RESULTS: Of the 52 patients in group I who underwent surgery for cervical cancer, urologic complications were observed in 8 (10.5%) patients, 2 (2.6%) of whom underwent preoperative radiation therapy. In group II, urologic complications were observed in 2 (2.6%) patients, of which 1 (1.3%) received preoperative radiation therapy. Intraoperative urologic complications in group I (6.6%) included 3 (3.9%) ureteral lesions cases and 2 (2.6%) cases of urinary bladder lesions, wherein 1 patient received preoperative radiation therapy. One case of (1.3%) urinary bladder lesion was observed in group II. Postoperative complications were observed in 3 patients (3.9%) in group I, including 2 (2.6%) ureterovaginal fistula cases, wherein 1 (1.3%) patient received preoperative radiation therapy, and 1 (1.3%) case of vesicovaginal fistula. In group II, 1 (1.3%) patient who received perioperative radiotherapy developed postoperative vesicovaginal fistula. DISCUSSION: Urologic complications are extremely common during and after radical surgery (hysterectomy type C2) for cervical cancer. The cervical cancer stage had a significant effect on intra- and postoperative urologic complication rates in this study; however, no such effect was observed for preoperative radiation therapy and ureteral stenting, and significant differences were observed between the two study groups.