HPV testing as an effective triage strategy in the follow-up after fertility-sparing treatment for glandular lesions of the uterine cervix.

OBJECTIVE: The management and surveillance of glandular pre-cancerous lesions of the uterine cervix present distinct challenges compared with squamous lesions, primarily attributed to the lower effectiveness of diagnostic methods such as cytology or colposcopy. This study aimed to investigate the long-term safety of fertility-sparing treatment for adenocarcinoma in situ and microinvasive adenocarcinoma of the cervix, while identifying factors associated with recurrence, with a particular emphasis on the role of human papillomavirus (HPV) testing. METHODS: We retrospectively reviewed data from all patients with histopathologically confirmed adenocarcinoma in situ or microinvasive cervical adenocarcinoma who received treatment at a single center between 2002 and 2023. The study involved the examination of consecutive surgical specimens and the follow-up details. Factors associated with recurrence were assessed in a subgroup of patients with available long-term follow-up data (at least 6 months). RESULTS: In total, 143 patients (112 with adenocarcinoma in situ and 31 with adenocarcinoma) were included in the analysis. Among the 86 patients who underwent fertility-sparing treatment, the recurrence rate was 9% (12% for adenocarcinoma in situ and 4% for adenocarcinoma) during a median follow-up period of 56.6 months (range 7-179). No patients who were HPV negative experienced recurrence during the follow-up period. In contrast, among patients who were HPV positive, the recurrence rate was 38%. Additionally, HPV 16/18 positivity displayed a notable association with a higher risk of recurrence compared with the other high-risk genotypes, although this difference did not reach statistical significance (83% vs 10%; p=0.083, log-rank). CONCLUSION: Our retrospective study demonstrated a significant association between the risk of recurrence and HPV status during the follow-up period. Consequently, long-term follow-up utilizing HPV testing and genotyping appears to be a secure alternative to a hysterectomy.

Effect of pelvic floor status on the outcome of pelvic organ prolapse surgery.

Pelvic organ prolapse (POP) is a common diagnosis with an incidence in the population of up to 50%. POP causes restrictions in everyday life and reduces patients' quality of life. Therapy is either conservative in the form of physiotherapy or the use of different types of pessaries, possibly. in case of inappropriateness or failure of conservative treatment, an operative solution is chosen. Avulsion injury of the levator ani muscle (MLA) is a strong factor in the development of POP. Some patients undergo repeated surgeries for POP, negatively impacting their quality of life. Studies show that the stage of POP and avulsion injury is associated with an increased risk of recurrence after index prolapse surgery. Ultrasound diagnosis of MLA injuries might help in predicting the risk of recurrence. Assessment of pelvic floor function is crucial for the success of surgical management of POP.

Pelvic neuropathic pain (differential diagnosis).

OBJECTIVE: General practitioners, surgeons, neurologists, urologists and gynecologists all encounter patients suffering from neurogenic pelvic pain. Correct management demands knowledge from all above mentioned specialties. The primary goal is to help patients suffering from chronic or acute pelvic pain coupled with functional disorders like dysuria, urgency, dyspareunia, mobility disorders orhypoesthesia. Neurogenic defects are not the most common etiology for either of listed symptoms. However, after exclusion of the more common ones and failure to respond to basic therapeutic methods such as physiotherapy or analgotheraphy doctors tend to mark the illness as idiopathic and incurable. The goal of this review is to show the most common nosological units and a robust dia-gnostic algorithm to describe the type and level of the damage. METHODS: Review of literature using databases Pubmed, Science direct, Medline and sources of the international school of neuropelveology. CONCLUSION: Over a lifetime, one in seven women will suffer from chronic pelvic pain. Outside of the cases where a clear postoperative etiology is established, the time to make a correct dia-gnosis is often long for the unspecific and varied symptomatology. Neuropelveological dia-gnostic algorithm is demonstrably efficient in shortening the time to dia-gnosis and more importantly to the treatment.