Too big? A review of methods for removing large endometrial polyps in office minihysteroscopy - broadening the indications for the procedure in the COVID-19 pandemic.

Hysteroscopy is the gold standard for the diagnosis and treatment of endometrial polyps. For small polyps (less than 2 cm) minihysteroscopy can be performed in an office setting. Patients with polyps larger than 2 cm are usually referred for a standard resectoscope procedure in the operation room (OR) under general anaesthesia. Those patients are exposed to longer hospital stay and possible complications of the anaesthesia. Furthermore, they usually have longer contact with many medical staff members. Limiting the time of contact as well as the number of staff involved in the procedure is particularly important during the COVID-19 pandemic. For this reason, minihysteroscopy in an office setting should be the first choice in every possible indication. We present the methods that may be useful for removing even large polyps in minihysteroscopy. The advantages and disadvantages of every procedure are discussed.

Symptoms and Quality of Life Changes after Hysteroscopic Treatment in Patients with Symptomatic Isthmocele-Preliminary Results.

Due to an increasing number of cesarean section deliveries, the common consequences of that surgery are observed more often in the population. One of them is the uterine cesarean scar defect known as niche or isthmocele. Most patients with that aliment are asymptomatic, but some of them can report abnormal uterine bleeding, pelvic pain, subfertility which can be the reason for reduced quality of life (QoL) of the patients. In our study, we analyzed the subjective feelings of changes in the severity of symptoms and quality of life of women with niche after diagnostic and operative hysteroscopy. The patients n = 85 included in the study group completed a follow up questionnaire six months after the procedure. Patients after operative hysteroscopy in comparison to patients after diagnostic procedure reported statistically significant reduction in post-menstruation bleeding/spotting and improvement in the quality of sexual activity. We have also noticed a higher pregnancy rate in the operative group, however, the difference was not statistically significant. According to our study, most women reported a positive effect of hysteroscopy on their QoL in social, psychological, environmental, and health domains.

Is every patient eligible to have an office hysteroscopy? A retrospective analysis of 1301 procedures.

INTRODUCTION: Hysteroscopy is the gold standard for diagnosis and treatment of uterine pathologies. The office setting seems to be safe, reducing the anesthesia risks and also decreasing the overall costs of the procedure. Recent literature suggests that hysteroscopy performed without anesthesia may not be as painless as it was previously considered. Moreover, not every patient can be referred for a hysteroscopy in an office setting. AIM: To analyze the factors correlated with a successful hysteroscopy in an office setting. MATERIAL AND METHODS: We analyzed the documentation of 1301 patients who underwent hysteroscopy at our department in the period 2013-2016. The impact of the type of the procedure and the various demographic factors on the need for general anesthesia was assessed. RESULTS: Almost 80% of all hysteroscopies were performed without analgesia in an office setting. The remaining patients underwent a hysteroscopy in general anesthesia. The key aspect for successful office hysteroscopy is the scope of the performed surgery. Over 91% of diagnostic hysteroscopies have been done without analgesia, but only about 30% of extensive endometrial scratching procedures were performed in an office setting. A previous vaginal delivery increases the chances for a successful office hysteroscopy by about 21%, and in the case of diagnostic procedures, multiparous patients were at an about 79% lower risk of analgesia necessity. CONCLUSIONS: It is possible to perform nearly all diagnostic hysteroscopies in an office setting. In the case of operative hysteroscopy, the most crucial factor is the scope of the procedure.

Usefulness of Cryoprobe in Office Hysteroscopy for Removal of Polyps and Myomas.

Hysteroscopy is a gold standard in 21st-century gynaecology for both diagnosis and treatment procedures of intrauterine pathologies. Miniaturisation of the equipment and better techniques of performing this procedure allowed it to become the gold standard. Nevertheless, hysteroscopy has its limitations, which is the size of the endometrial polyps or submucous myomas. We have invented a new device for the 5Fr working channel hysteroscopes for possessing and resecting intrauterine structures: the cryoprobe. The retrospective cryobiopsy study presented here was conducted at the Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine in Warsaw, Poland, from October 2017 to January 2018. Its purpose was to assess the usefulness of the new device in office hysteroscopy for the removal of polyps and myomas with a diameter over 10 mm. Thirteen patients with an initial diagnosis of an endometrial polyp or submucous myoma were enrolled in the trial. All procedures took place in day-surgery settings, with a total resection of the pathological intrauterine structure, without complications. The application of the cryoprobe may enhance the usefulness of office hysteroscopy, without extending the procedure. The cryoprobe efficiency is still under research in a bigger group.

Hysteroscopic Patterns in Women on Treatment With Ulipristal Acetate 5 mg/day: A Preliminary Study.

STUDY OBJECTIVE: To describe the hysteroscopic findings in women on treatment with ulipristal acetate (UPA) and to define the most common hysteroscopic patterns related to the treatment and compare them with the histologic findings. DESIGN: Preliminary study. SETTING: OB-GYN and Gynecology Oncology Clinic, Military Medical Institute, Ministry of Defense, Warsaw, Poland, and Obstetrics and Gynecology Department, University of Bari, Italy. PATIENTS: Seventy-four premenopausal patients complaining of abnormal uterine bleeding due to uterine myomas and on treatment with UPA 5 mg/day for at least 30 days. INTERVENTIONS: Women received transvaginal sonography (TVS) and then office hysteroscopy and visually guided endometrial biopsies. Video hysteroscopies were recorded in digital format. Pictures were evaluated by 2 authors off-line and compared with histologic results. MEASUREMENTS AND MAIN RESULTS: Hysteroscopic aspects and classification of progesterone receptor modulator-associated endometrial changes were measured. The most common hysteroscopic finding was the combination of a flat subtle epithelium with small glandular openings; large isolated or confluent cysts in the stroma, giving the surface a floating aspect at fluid distention; and well-evident subendometrial vascular network with a "chicken-wire" vascular pattern (44.6%). This finding accounted for 82% of cases with endometrial thickness > 10 mm at TVS. Histology confirmed a combination of epithelial secretory (vacuoles) and hypotrophic effects (small and dilated glands), whereas at stromal level the combination of cysts, dense stroma, and vascular wall thickening was found. At 3 months follow-up echographic, hysteroscopic, and histologic endometrial patterns were normal in all patients. CONCLUSIONS: In most women on UPA and with thickened endometrium at TVS, the hysteroscopy showed benign and characteristics aspects related to the ambivalent effects of UPA on progesterone receptor. These alterations took place just after 1 month of treatment but disappeared within 3 months of stopping treatment.

An Open Multicenter Study of Clinical Efficacy and Safety of Urolastic, an Injectable Implant for the Treatment of Stress Urinary Incontinence: One-Year Observation.

The prevalence of stress urinary incontinence rises and affects up to 30% of women after 50 years of age. Midurethral slings are currently the mainstay of surgical anti-incontinence therapy. Some patients experience recurrent SUI (RSUI) which is defined as a failure of anti-incontinence surgery after a period of time or persistence of SUI after the procedure aimed at correcting it. The urethral bulking agent application decreases invasiveness of treatment and meets patients requirements. The objective of this study was to assess the safety and clinical efficacy of Urolastic injection. One hundred and five patients with SUI (including 91 patients with RSUI) were treated with Urolastic in three tertiary gynecological clinics. The efficacy of the procedure was assessed objectively at each follow-up visit by means of cough test and a standard 1-hour pad test. Objective success rate after 12 months after primary procedure in RSUI patients was found in 59.3% of patients. In 14 patients with primary SUI improvement after 1 year was found in 71.4% of patients. Although cure rates after MUS are up to 90% there is still place for less invasive treatment option like periurethral injection of bulking agents, especially in patients with previous SUI surgical management.

[Revised FIGO staging systems for gynecologic malignancies--2009 update]. / Zmiany klasyfikacji zaawansowania nowotworów narzadu plciowego u kobiet--stan na 2009 rok.

Neoplasm staging system was created to facilitate making diagnoses and planning treatment for cancer patients. Since medical research and practice in the field of oncology have shown explosive growth, the staging of some of the gynecologic cancers did not give a good spread of prognostic groupings. In the light of these breakthroughs, the following changes to the staging of gynecological cancers were proposed and approved by the FIGO Committee. In vulvar cancer Stage IA remained unchanged but Stage I and II have been combined. The number and morphology of the involved nodes have been taken into account, and the bilaterality of positive nodes has been discounted. In cervical cancer Stage 0 has been deleted and substages in Stage IIA have been included. In endometrial cancer Stage IA and IB have been combined so that now Stage IA involves the endometrium and/or less than one-half myometrial invasion and IB is equal to or greater than the outer one-half of the myometrium. Stage II no longer has a subset A and B. Involvement in the endocervical glandular portion of the cervix is now considered Stage I. Pelvic and para-aortic node involvement have been separated. The committee has also established a sarcoma staging system based on the criteria used in other soft tissue sarcomas.

[Foreign body in vagina--polyurethane foam. Case report]. / Cialo obce w pochwie--pianka montazowa poliuretanowa. Opis przypadku.

This report presents the case of a 40-year-old woman hospitalized in the Department of Gynecology and Oncological Gynecology Military Institute of the Health Services, who was found to have had a foreign body (polyurethane foam) of significant amount for three days in her vagina. The foreign body was successfully removed during surgery and did not lead to any negative health consequences for the patient.

[Risk factors of pelvic organ prolapsed in women qualified to reconstructive surgery--the Polish multicenter study]. / Czynniki ryzyka defektów dna miednicy u kobiet zakwalifikowanych do operacji rekonstrukcyjnych--polskie badanie wieloosrodkowe.

AIM OF STUDY: To evaluate the prevalence rate of various pelvic floor disorders among patients treated in 8 academic centers in Poland due to pelvic organ prolapse (POP). MATERIAL AND METHODS: The study group consisted of 717 women scheduled for reconstructive surgery due to POP. Risk factors, functional abnormalities along with symptoms affecting quality of life, were assessed by means of disease specific questionnaire. The stage of the disease was assessed after gynecological examination using POP-Q score. RESULTS: The mean age of affected women with POP was 61,25 years (median 61), and mean BMI--27.62 (median--27.29). 80% of women were menopausal. Mean time of symptoms related to disease was 65,6 months; whereas the time relapsed from first doctor diagnosis of POP to hospital admission was 50.6 months. 97.4% affected women were multiparous. Only 1.21% women with POP were nulliparous. Family history of prolapse was found in 13.4% of patients, whereas familial positive history of urinary incontinence was 10%. Lower urinary tract symptoms (LUTS) among the analyzed group were as follows: frequency--almost 50%, urgency 32.2%, feeling of improper voiding -29,6% and voiding difficulty -17.7%. Functional disorders of lower bowel were found in 43% of patients and the most prevalent symptom was constipation (31%), followed by empting difficulty (12%), dyschesia (9%), and urge stool empting (7.7%). Cardiovascular diseases were found among 43% of respondents, whereas pulmonary diseases with chronic coughing were present in 20% of the analyzed population. Subjective POP symptoms reported by women were as follows: feeling of heaviness in lower abdomen--378%, perineal pain--27.8%, lumbosacral pain-34.2%, and abdominal pain--28.4%. Female sexual disorders were reported by 9,8% women and dyspareunia was found in 7.6% of responders. POP was the main reason for sexual abstinence only in 1 out of 10 patients. More than 30% of patients from the study group underwent previously pelvic surgery due to various reasons. POP related quality of life measured by VAS (Visual Analogue Scale) was 61.4 points (median--60). The most common finding during gynecological examination was cystocele--96.5%, followed by rectoenterocele--92.7%, and central defect--79%. Mean POP quantification was stage III in POP-Q scale. LUTS symptoms (urinary incontinence, urgency and voiding difficulties) were present among 81% of patients whereas lower gastrointestinal disorders (constipation, fecal incontinence, dyschesia) were found in 43% of women affected by POP. CONCLUSIONS: Mean delay time from objective POP diagnosis until decision concerning surgical treatment was more than 5 years. The most common risk factors associated with POP were: multiparity with vaginal deliveries, obesity and aging. The most common defect found among patients with POP was cystocele, followed by rectoenterocele and central defect however most patients presented with advanced combined defects.

[The estimation of the results of the treatment patients with failed back surgery syndrome]. / Wstepna ocena wyników leczenia operacyjnego chorych po niepowodzeniach discektomii w czesci ledzwiowej kregoslupa.

The authors present the reasons failed lumbar disc operations among 51 patients, 53% of them were womae and 47% were mae. Age of the patients was from 30 to 73 years (average 49 years). Most of them have had some operations. They complained of constant, strong lumbar pain with sciatic pain, restriction of lumbar spine mobility and paresis. The results were compared after 12 months from final operation with applying 3 methods: decopmpression, transpedicular fixation with decompression and decompession conected with transpedicular fixation and inerbody fusion. Intraoperatively considerable amount of instability (60%) was found. The best results of treatment was gained in decompression conected with transpedicular fixation and interbody fusion. The good result came up 41% in this group and in the other 20%.

[Operative treatment of sacral tumors]. / Leczenie chirurgiczne guzów kosci krzyzowej.

The paper presents posterior access to sacrum according to Gennari used for resection of sacral tumors. Technique was compared with other operative techniques described in literature. The advantage of this method is the low risk of postoperative infection and limited operative technique.

Treatment procedure in spinal metastases: the orthopedic dimension.

Background. The authors have presented the results of the medical treatment of patients with metastatic disease of the spine. The aim of this treatment was to improve the patients quality of life through spinal stabilisation, maintaining neurological functions and the maximum pain relief.
Material and methods. Surgical indications included progressive, neurological deficit, fracture of vertebra, spine instability and histologic diagnosis. The patients underwent anterior, posterior or combined decompression and stabilisation procedures with the use of implants. Neurological examination of the patients has been carried out by means of Frankel grade whereas the tool for measurement of vertebra destruction was Harrington classification.
The results and the treatment for spinal metastatic tumors of the 86 patients were treated from 1997 to 2002.
There were 55 men and 33 women with a median age of 56 years. The mean survival time after surgery was 7,5 months.
Results. The improvement in neurological state of 28 in 59 patients was recorded. 11 patients have died of health conditions during the medical treatment as a consequences of the metastases.
Conclusions. The full decompression and stabilisation of the spine should be carried out in order to avoid the consequences and enable the patients to continue oncological treatment. The early diagnostic and good health conditions have been stressed. The can help in patient's qualification to surgical treatment, improve the general results of the treatment while giving the full satisfaction to the surgeon and the patient, prolonging the patient's life and improving his comfort of life by pain restriction and the protection of neurological consequences.