METABOLOMIC MARKERS OF ENDOMETRIOSIS: PROSPECTS.

Endometriosis is a widespread pathology among women of reproductive age. The pathophysiological mechanisms of the disease aren't enough understood yet. In addition, the "gold" standard of diagnosis is still laparoscopy. Worldwide, patients may experience a delay in the diagnosis of endometriosis by approximately 6 to 12 years. Aim of the study - to conduct a systematic analysis of the data presented in modern literature on the metabolomic diagnosis of endometriosis in general and endometrioid cystadenomas in particular. The review includes data from world studies over the past 7 years regarding metabolomic screening for endometriosis. Metabolomic changes characteristic of endometriosis, noted in the metabolism of amino acids, organic acids, lipids, purines, are presented. The described disorders reflect the processes of oxidative stress, mitochondrial dysfunction, endothelial dysfunction, and active angiogenesis. The identified metabolomic changes may improve and speed up the process of diagnosing endometriosis in general and endometrioid cystadenomas in particular in a non-invasive way. Certain detailed violations of metabolic processes can become a promising point of application for the correction of symptoms and the treatment of this pathology.

[INVESTIGATION OF SURGICAL CORRECTION OF ANTERIOR APICAL PROLAPSE OF THE PELVIC ORGANS USING A COMBINED TECHNIQUE, MONOLATERAL CYRENE POSTERIOR IN COMBINATION WITH ANTERIOR COLPORRHAPHY].

Objective - to evaluate the results of surgical correction of anterior apical prolapse of the pelvic organs with a combined technique monolateral CYRENE posterior (using monofilament polypropylene tape CYRENE) in combination with anterior colporrhaphy. A prospective cohort study included 240 patients with urogenital prolapse. The subjects were followed up for three months, and the anatomical outcome according to the POP-Q System classification, intra- and postoperative complications, absence or presence of relapse, quality of life and sex life were assessed. A relapse was considered to be grade 3 or more anterior prolapse, grade 2 or more central prolapse. Quality of life and sex life were assessed using the PFDI-20, PFIQ-7 and PSIQ-12 questionnaires. The average age of women was 57.8 years. All 240 patients had grade 3 cystocele, prolapse of the anterior vaginal wall, and prolapse of the uterus. In 23 (9.6%) patients, de novo urinary incontinence developed, 8 patients had stress urinary incontinence before surgery, 6 of them persisted stress urinary incontinence after surgery, 2 of them stress urinary incontinence was arrested without the simultaneous use of a mid-urethral sling. According to questionnaires, the quality of life improved in 225 (96.9%) women according to PFDI-20 and in 210 (90.5%) according to PFIQ-7. There were no changes in the quality of sex life. Anatomically, 235 (96.9%) achieved the desired result (Ba≤ II, C≤ I according to the POPQ System). At the same time, in 36 (15%), 3 months after the operation, cystocele of the 2nd degree was revealed. In all cases, there was minimal blood loss, in 9 cases (3.75%) there was a hematoma of the anterior vaginal wall that did not require additional intervention, at discharge had signs of organization and was completely stopped 6 weeks after surgery; 3 (1.25%) patients had urinary retention after surgery. Dyspareunia was not identified in any patient. The study of the treatment of urogenital prolapse using a combined technique, monolateral CYRENE posterior in combination with anterior colporrhaphy, demonstrates high efficiency and relative safety. The technique showed excellent anatomical results for apical prolapse and good for anterior prolapse. A small number and low significance of postoperative complications were revealed. Longer postoperative follow-up is needed to assess long-term results and long-term prospects in order to form a more complete understanding of this technique.

[ROLE OF UTERINE ARTERY EMBOLIZATION IN ORGAN-PRESERVING TREATMENT OF ADENOMYOSIS (REVIEW)].

The aim of this work is to review current trends in the minimally invasive treatment of adenomyosis, in particular uterine artery embolization (UAE). Adenomyosis is an unsolved problem in modern gynecology, its clinical manifestations and associated infertility lead to a decrease in the quality of life of women. Advances in imaging are making it possible to diagnose adenomyosis in young women. Today, conservative methods of treating adenomyosis and maintaining fertility are an urgent problem. Uterine artery embolization is a common treatment for uterine fibroids and is gaining popularity as a treatment for adenomyosis. The data reviewed report minimal side effects of UAE and indicate the effectiveness of this method for the treatment of adenomyosis in the short and long term. Despite the promising results, the issue of using UAE for the treatment of adenomyosis requires more detailed study.

[ENDOMETRIOSIS AND PREGNANCY (REVIEW)].

The purpose of this review was to systematize the data on the effect of endometriosis on the fertility index, the course of pregnancy, and the modern diagnosis of changes the endometriotic implants during pregnancy. There are many factors that can potentially affect fertility in patients with endometriosis: anatomical changes in the pelvic floor, impaired transport function of the fallopian tubes due to the formation of adhesions, impaired steroid and folliculogenesis, anovulation and peritoneal changes that contribute to the formation of a harmful prooxidant microenvironment, which can affect the quality and quantity of oocytes and cause a violation of the susceptibility of the endometrium. If the patient with endometriosis still managed to get pregnant, then the problem of maintaining this pregnancy arises even more. The data indicate that pregnancy has a positive effect on the symptoms of endometriosis, and also has a beneficial effect on the growth rate and relapse rate of endometriosis, and may also cause a regression of the formed endometriotic implants. However, data on the effect of pregnancy on endometriosis are contradictory, and pregnancy in women with endometriosis does not always lead to the disappearance of symptoms and a decrease in the size of endometrioid lesions. Moreover, there is growing evidence that endometriosis can affect pregnancy outcomes. Currently, it is impossible to predict changes in the endometriotic implants due to insufficient knowledge about the pathogenesis of this disease. A deeper understanding of the pathogenesis should help prevent hasty obstetric decisions that can lead to iatrogenic diseases in newborns, and patients should be informed about possible complications during pregnancy when planning a birth.

[TOTRP EXPERIENCE IN TREATING WOMEN'S STRESS CONTINUITY IN WOMEN].

The aim of the study was to evaluate the efficacy and safety of the TOTRP (tension-free vaginal tape-obturator retropublic) methodology, as well as the frequency of de novo urgency symptoms. A retrospective study included 32 women with stressful and mixed urinary incontinence with a predominance of the stress component without concomitant genital prolapse, as well as without surgical intervention for a history of urinary incontinence and pelvic prolapse. Patients underwent surgical intervention according to the TOTRP method using Lintex UroSling® polypropylene tape from February to October 2018. According to the results of the ICIQ-SF and OAB awareness Tool questionnaires, 14 (43.7%) patients were registered prior to surgical treatment. with an average degree of stress urinary incontinence, 18 (56.3%) - severe; 19 (59%) patients with mild bladder hyperactivity, 4 (12.5%) - moderate. Through surgical intervention, stress urinary incontinence was completely stopped in 26 (81.25%) and transferred to mild degree in 2 (6.25%), in 5 (15.6%) - moderate degree. So, the effectiveness of the TOTRP technique was 87.5%. Postoperative urgency was 8 (25%), of which de novo - 5 (15.63%). The treatment was characterized by the complete absence of intraoperative complications.

[NON-RESECTOSCOPIC ABLATION OF ENDOMETRY IN BENIGN UTERINE DISEASES (REVIEW)].

Objective - to conduct a systematic analysis of the data available in the modern literature on non-rectoscopic endometrial ablation (NRAE). MATERIALS AND METHODS: The review includes data from world studies for the last 7 years. RESULTS: second generation systems based on different surgical energies and parameters of their performance. Presents the results of evaluating the effectiveness of devices and patient satisfaction; studies of possible complications, frequency of repeated operations, contraception. CONCLUSION: Analysis of the literature data showed that the devices have high efficiency indicators, in particular, up to 97.1%, undesirable consequences are rare. NRAE in case it is an alternative to hysterectomy. It is necessary to introduce NRAE into practical health care as a method capable of providing organ-preserving treatment to a woman.

[POSSIBILITIES OF MAGNETIC RESONANCE IMAGING IN THE DIAGNOSTICS OF ENDOMETRIOSIS].

The purpose of the study was to conduct a systematic review of the literature on the use of MRI in the diagnosis of endometriosis of various localizations. The review includes research data from the last 7 years. The analysis of modern literature showed that, in comparison with ultrasound, MRI has the widest diagnostic field of view and allows to identify lesions of rather rare localizations (for example: intraspinal endometriosis). It is also necessary to note the high contrast resolution of MRI, which allows the use of this method for accurate preoperative topography of lesions, which in turn determines the radicality of surgical treatment.