Robotic surgery in endometrial cancer: first Polish experience.

In Poland, robotic surgery is nowadays perceived as a new method of surgical treatment in endometrial cancer patients. We aim to present the first Polish group of endometrial cancer patients treated using robotic surgery. The analysis was based on 79 patients with mean age of 59.72 ± 11.709 (range 27-83) years and endometrial cancer scheduled for surgical treatment. Mean BMI was 31.38 ± 8.78 (range 19.03-65.97) kg/m2. The data were collected based on a questionnaire consisting of 19 questions concerning the patient's perception of robotic surgery before the procedure. Patients with a family history of neoplastic diseases indicate precision of movements as the most important reason for choosing robotic surgery (p = 0.0035). Patients after surgery procedures in the past named shorter hospitalization as a major benefit (p = 0.0037). Patients who chose robotic surgery for financial reasons stressed the cosmetic effect as a priority (p = 0.0319). Shorter length of hospital stay, less blood loss, enlarged view, and good visualization were statistically significant reasons for choosing robotic surgery (p < 0.05). Women who consider work, good material status, and well-being as the most important aspects of their lives cited the cosmetic effect as a benefit of robotic surgery (p = 0.0029 vs. p = 0.0074 vs. p = 0.01745, respectively). In the follow-up after operations, no patients regretted choosing robotic surgery. Good visualization, precise movements, less blood loss, and cosmetic effects are the most frequent reasons for choosing robotic surgery. Even patients after other types of surgery in the past decided on robot-assisted radical hysterectomy because of the clear benefits of this approach.

Registration of a pregnant woman in the maternity hospital (optimally at 36th-37th weeks) at the Olomouc University Hospital in 2022.

OBJECTIVE: The aim of the study was to analyse the results of the implementation of the new health service Registration of a pregnant woman in the maternity hospital (optimally at 36th-37th weeks) provided as part of outpatient/ambulatory health care at Olomouc University Hospital (OUH). MATERIALS AND METHODS: A prospective cohort study. In 2022, a total of 2,271 women gave birth in OUH, and 2,010 of them were Registered in the maternity hospital, defined specific risks were identified and a pregnancy termination strategy was established/determined. RESULTS: The health service was provided to 88.5% of women giving birth (2,010/2,271). The age of the mothers was 15-56 years (mean 31.3 years; median 31 years), their body mass index was 13.4-53.1 kg/m2 (mean 24.6 kg/m2; median 23.2 kg/m2). 43.6% of them (877/2,010) were Low-risk pregnancies and 56.4% (1,133/2,010) were Pregnancies with a defined specific risk. The most frequently identified risks were as follows: RhD negative blood group (18.4%), diabetes mellitus (13.9%), history of caesarean section (12.0%), hypertensive disorders (6.5%), small fetus/fetal growth restriction (6.3%), risk the development of hemolytic disease in the fetus and the newborn (2.5%), multiple pregnancy (1.6%), congenital malformation of the fetus (1.3%) and placentation disorders (0.5%). In 63.4% of them (1,275/2,010), the pregnancy termination strategy was determined by spontaneous vaginal delivery, in 18.0% (361/2,010) by pre-induction of vaginal delivery and in 14.2% (285/2,010) by caesarean section. In 4.4% (89/2,010) the health service was not implemented correctly because no strategy was established. CONCLUSION: The implementation of the new health service will make it possible to replace activity (more frequent antenatal care contacts/visits and routine antenatal cardiotocography) with efficiency (risk identification, determination of the optimal strategy for outpatient/ambulatory antenatal care and timing and mode of delivery) and thereby provide better and safer health care (from a medical, organizational, legislative and economic points of view).

Prenatal detection of copy number variants in fetuses with detected congenital devolpmental disordes, from 2015 to 2020 by Multiplex Ligation-Dependent Probe Amplification and microarray analysis.

OBJECTIVE: Analysis of prenatal samples from 2015 to 2020. Comparison detection rates of clinically relevant variants by cytogenetic karyotype analysis and cytogenomic MLPA (Multiplex Ligation-Depent Probe Amplification) and microarray methods (CMA - chromosomal microarray). MATERIAL AND METHOD: 1,029 prenatal samples were analyzed by cytogenetic karyotyping (N = 1,029), cytogenomic methods - MLPA (N = 144) and CMA (N = 111). All unbalanced changes were confirmed by MLPA or CMA. RESULTS: From the analyzed set of fetuses, after subtraction of aneuploidies - 107 (10.40%, N = 1,029), 22 structural aberrations (2.39%, N = 922) - nine unbalanced changes (0.98%), 10 balanced changes (1.08%), one case of unclear mosaicism (0.09%), one case of presence of a marker chromosome (0.09%) and one case of sex discordance (0.09%) - were detected by karyotype analysis. A total of eight (7.21%, N = 111) pathological variants were detected by CMA in 255 samples with physiological karyotype indicated for cytogenomic examination. Five (3.47%, N = 144) of eight pathogenic variants were detected by MLPA method. The total capture of pathogenic variants by MLPA and CMA methods was 14 (5.14%) and 17 (6.25%) (N = 272), including confirmatory pathological karyotype testing. Detection of pathological variants in the isolated disorders group was lower than in the multiple disorders group (5.08 vs. 21.42%). CONCLUSION: A higher success rate for the detection of pathological copy number variation variants by the microarray method than by the MLPA method was confirmed.

Tissue expression analysis of cervical mucus proteome.

Cervical mucus is a viscous fluid functioning as a cervix plug. Products of the endometrial and cervical glands can be detected in the cervical mucus. Cervical mucus is further enriched with transudate originating from the fallopian tubes and proteins originating from the ovaries, peritoneum and distant tissues. With increasing levels of ovarian estrogens, the properties of cervical mucus for possible collection and processing change appropriately. For these reasons, we chose a group of 10 patients treated in the center of assisted reproduction by controlled ovarian stimulation for in vitro fertilization. This study focuses on the proteomic characterization of cervical mucus and localizes the possible sources of the identified proteins. The most abundant proteins were extracellular proteins, mainly mucins; however, most of the identified proteins, present usually in lower quantities, were of intracellular origin. The tissue analysis revealed that proteins from female reproductive organs are also expressed in other tissues in addition to female reproductive organs, but also proteins specific to the testis, liver, placenta, retina, and cerebellum. This study confirms the suitability and high potential of cervical mucus as a source of proteomic bio-markers not only for the dia-gnosis of the female reproductive tract.

Preterm premature rupture of membranes.

OBJECTIVES: The aim of the presented work is to summarize the current knowledge about the pathophysiology of preterm birth in connection with premature amniotic fluid. METHODS: To analyze current knowledge and our own experiences regarding of preterm prelabour rupture of membranes. CONCLUSION: The most important factor influencing neonatal morbidity and mortality is gestational age. Early neonatal sepsis occurs with high risk after premature amniotic fluid outflow, associated with inflammatory complications.

Proteome Mapping of Cervical Mucus and Its Potential as a Source of Biomarkers in Female Tract Disorders.

Cervical mucus (CM) is a viscous fluid that is produced by the cervical glands and functions as a uterine cervix plug. Its viscosity decreases during ovulation, providing a window for non-invasive sampling. This study focuses on proteomic characterization of CM to evaluate its potential as a non-invasively acquired source of biomarkers and in understanding of molecular (patho)physiology of the female genital tract. The first objective of this work was to optimize experimental workflow for CM processing and the second was to assess differences in the proteomic composition of CM during natural ovulatory cycles obtained from intrauterine insemination (IUI) cycles and in vitro fertilization (IVF) cycles with controlled ovarian hyperstimulation. Proteomic analysis of CM samples revealed 4370 proteins involved in processes including neutrophil degranulation, cellular stress responses, and hemostasis. Differential expression analysis revealed 199 proteins enriched in IUI samples and 422 enriched in IVF. The proteins enriched in IUI were involved in phosphatidic acid synthesis, responses to external stimulus, and neutrophil degranulation, while those enriched in IVF samples were linked to neutrophil degranulation, formation of a cornified envelope and hemostasis. Subsequent analyses clarified the protein composition of the CM and how it is altered by hormonal stimulation of the uterus.

Medical Termination of Pregnancy (MToP) in the 1st trimester - the role of human chorionic gonadotropin and ultrasound in pregnancy diagnosis and MToP follow-up.

OBJECTIVE: In the Czech Republic, it is possible, to carry out Medical Termination of Pregnancy (MToP) in the 1st trimester up until the 49th day of secondary amenorrhea. The aim of the study is to analyse the significance of serum/urine human chorionic gonadotropin (hCG) assessment and ultrasound (US) examination in pregnancy diagnosis and MToP follow-up. METHODS: In 2017-2018, MToP was carried out in a total of 109 women by administering a combination of mifepristone (600 mg orally) and misoprostol (400 mcg orally). Serum/urine (LSUP - low sensitivity urine pregnancy test) hCG assessment and US examination were performed at pregnancy diagnosis and MToP follow-up. RESULTS: At pregnancy diagnosis, there was a positive and medium strong correlation between serum hCG and size of the gestational sac - GS (R = 0.711; P  1,000 IU/L and LSUP test was always positive). In 5.5% of women (6/109), a subsequent surgical intervention was carried out including those with ongoing pregnancy (N = 5); missed abortion (N = 1) was treated by additional misoprostol, where surgical intervention was not necessary. CONCLUSION: At pregnancy diagnosis, there is a positive and medium strong correlation between serum hCG and CRL. In MToP follow-up, a negative LSUP test enables reliable exclusion of ongoing pregnancy and missed abortion. In case of a positive LSUP test, US examination should be performed; however, surgical intervention should not be indicated solely on the basis of uterine cavity dilatation.

Osteogenesis imperfecta/ Ehlers-Danlos overlap syndrome (COL1-related disorder) and pregnancy.

Ehlers-Danlos syndrome is in a group of connective tissue disorders that can result in a range of complications during pregnancy. Clinical manifestations include skin hyperextensibility, atrophic scarring, poor wound healing, hyperflexibility or higher risk of organ ruptures (uterine rupture, aortal dissection). The combination of Ehlers-Danlos syndrome and osteogenesis imperfecta is very rare (< 1/1,000,000 according to Orphanet). We are presenting a case of woman with osteogenesis imperfecta/Ehlers-Danlos overlap syndrome and her pregnancy complicated by aortal dilatation. Our case has attempted to highlight the potential obstetric complications and to attract the attention of clinical physicians to the rare but extremely dangerous syndrome.

Selected pathological conditions affecting endometrial receptivity.

OBJECTIVE: A summary of new knowledge on embryo implantation in dependence on quality of the endometrium. METHODS: Literature review from August 2022 of the relevant publications in Web of Science, Scopus and PubMed/Medline databases, focused on "endometrial receptivity", "polycystic ovary syndrome", "endometriosis", "SARS-CoV-2". RESULTS: The receptive state of the endometrium is a result of physiological remodeling and immune system activity modulated by the microbio-me. This balance can be disturbed by myomas, polyps, sactosalpings, adenomyosis, endometriosis, polycystic ovary syndrome, infections. The effect of SARS-CoV-2 infection is being discussed. For a successful implantation, timing of transfer is crucial. The ultrasound examination is used conventionally. In specific cases, hysteroscopy and endometrium bio-psy are recommended. Histological and immunohistochemical evaluation is performed together with examination of microbio-me or transcriptome. To support the implantation, gestagenes are used, or metformin in the patients with polycystic ovary syndrome. In cases of a repeated implantation failure, the intrauterine infusion of mononuclear cells or platelet rich plasma is used, subcutaneous application of granulocyte colony stimulating growth factor, intravenous application of atosiban or intrauterine application of human chorionic gonadotropin. CONCLUSION: Recent research in the field of transcriptomics, proteomics and reproductive immunology uncovers the process of implantation more deeply and opens a new stage of the assisted reproduction.

Metastatic involvement of inguinal lymph nodes as the first sign of endometroid carcinoma of the fallopian tube.

Manifestation of ovarian carcinoma in the form of inguinal lymph node involvement represents a rare clinical situation described only by a limited number of case reports. Similarly, extraperitoneal dissemination of the tumor in the absence of advanced abdominal disease is uncommon. We report a 58-year-old female patient with a positive family history of ovarian cancer referred for lymph node enlargement in the left groin and elevation of CA 125. An ultrasound examination of the patients left groin revealed an enlarged lymph node of a size 4 × 3cm, the bio-psy of which confirmed a metastatic adenocarcinoma with origin in the female genital area (müllerian epithelium). The finding was suggestive of high-grade endometroid carcinoma. The patient subsequently underwent a PET/CT, with lesions suspect for the presence of viable malignant tissue in the left ovary (which was of normal size) and a lymph node conglomeration in the left groin. The patient was indicated for a radical cytoreductive surgery resulting in no macroscopic residual disease. Definitive histological examination confirmed high-grade endometroid adenocarcinoma of the left fallopian tube of histopathological stage FIGO IVB pT2b pN0 (17/0) pM1 (inguinal lymph node). The patient was dia-gnosed with somatic BRCA1 mutation. The patient was indicated for adjuvant chemotherapy with paclitaxel/carboplatin, 16 cycles were administered, and for subsequent maintenance therapy with PARP inhibitor. Currently, one year after the primary cytoreductive procedure, the patient is in complete remission of the disease.

Triple pregnancy - etiology and early diagnosis.

OBJECTIVE: To provide an overview of the etiology and early dia-gnosis of triple pregnancy, with emphasis on the possibilities of ultrasound and magnetic resonance (MR) imaging. METHODOLOGY: Processing of data from the available literature on the issue of triple pregnancy. CONCLUSION: Spontaneous triple pregnancy conception is rare. In most cases, it is a concept associated with assisted reproduction methods. Multiple pregnancy is associated with a higher incidence of complications during pregnancy and childbirth, but it also has its own specific complications. Chorionicity and amnionicity of multiple pregnancies are two important parameters in determining the strategy of dispensary care in pregnancy and management of childbirth. The use of ultrasound and MR imaging is crucial for their accurate determination in early pregnancy.

Amniotic fluid embolism - review and multicentric case analysis.

Amniotic fluid embolism (AFE) is a rare and often fatal obstetric complication, characterized by sudden cardiovascular collapse, dyspnea, seizures, mental alteration or coma and laboratory and clinically dia-gnosed disseminated intravascular coagulation (DIC). Patients reaction is typically biphasic with initial pulmonary hypertension and right ventricular failure, followed by left ventricular failure during or immediately right after labor. Early recognition of AFE is critical to a successful survival. Aggressive shock management is needed in collaboration with an anesthesiologist. Several aspects of the condition remain a controversy. This review critically examines, from the best available evidence, the current knowledge regarding the epidemiology, pathophysiology, dia-gnosis, and available treatment of AFE. This dia-gnosis still determines perinatal morbidity and mortality and potential permanent neurological symptoms for surviving patients.

A patient with primary adenocarcinoma of the appendix metastasizing to the ovary.

OBJECTIVE: The aim of this work is to draw attention to the difficulty of differential dia-gnosis of rare adenocarcinoma of the appendix and the histological diversity of ovarian tumors. CASE REPORT: We present a case of a 62-year-old patient sent by an attending gynecologist for the finding of an asymptomatic adnextumor diagnosed during a routine preventive examination. Based on preoperative examinations, a malignant ovarian tumor was suspected. Standard surgery was performed including hysterectomy with bilateral adnexectomy, total omentectomy, appendectomy, pelvic and paraaortic lymphadenectomy. Definitive histopathological analysis revealed a secondary ovarian tumor, with the adenocarcinoma of the appendix appearing to be the primary site. CONCLUSION: Up to 25% of all ovarian tumors are secondary metastatic tumors. Appendix neoplasia should be considered in the differential diagnosis of right-sided adnextumors. Due to their localization, they can only mimic an ovarian tumor during imaging examinations, or they can be the primary origin of an already metastatic ovary, as in our case.

Relationship between urethrovesical junction mobility changes and postoperative progression of stress urinary incontinence following sacrospinous ligament fixation - a subanalysis of a multicentre randomized study.

OBJECTIVES: The study aimed to assess the relationship between urethrovesical junction (UVJ) descent and development of de novo stress urinary incontinence (SUI) and postoperative progression of preexisting SUI following surgery for pelvic organ floor prolapse using the method of sacrospinal fixation (SSF). This was a secondary analysis of the SAME prospective randomized multicentre study (reg. no. NCT03053479) comparing three approaches to surgery for apical defects - sacropexy, SSF and transvaginal mesh. METHODS: The subanalysis included 81 patients with apical defects managed by SSF, either right-sided (N = 14, 17.3%) or bilateral (N = 67, 82.7%). Postoperative follow-up was assessed at 3 months (N = 59), 12 months (N = 47) and 24 months (N = 30). UVJ mobility at rest and with maximum effort, the Valsalva manoeuvre was determined using a standardized 3D/ 4D transperineal ultrasound protocol proposed by Dietz et al. De novo SUI and postoperative progression of preexisting SUI were ascertained from history. RESULTS: Preoperative demographic data (N = 81) were as follows: BMI 27.3 kg/ m2 (16.8-44.5), age 67.0 years (31-85), and parity 2 (1-6). Concomitant anterior repair was performed in 65.4%. Postoperative progression of SUI was 45.8% at 3 months, 21.3% at 12 months, and 23.3% at 24 months. There were significant differences between preoperative and postoperative UVJ descent values at 3, 12 and 24 months (P < 0.0001). Correlations between UVJ descent at 3, 12 and 24 months postoperatively and de novo SUI or progression of preexisting SUI at 3, 12 and 24 months postoperatively were not statistically significant (P = 0.051-0.883). Correlations between differences (preoperative UVJ descent minus UVJ descent at 3, 12 and 24 months postoperatively) and de novo SUI or progression of preexisting SUI at 3, 12 and 24 months postoperatively were not statistically significant (P = 0.691-0.779). CONCLUSIONS: The study showed significant changes in UVJ descent values preoperatively and at 3, 12 and 24 months after SSF. There were no significant correlations between UVJ descent and de novo SUI and postoperative progression of preexisting SUI following surgery for pelvic organ floor prolapse at 3-, 12- and 24-month follow-up. There were no signifi cant correlations between differences (preoperative UVJ descent minus UVJ descent at 3, 12 and 24 months postoperatively and de novo SUI and postoperative progression of preexisting SUI following surgery for pelvic organ floor prolapse at 3-, 12- and 24-month follow-up.

Screening for congenital defects and genetic diseases of the fetus at University Hospital in Olomouc and sending/ reporting to the National register of reproductive health in the Czech Republic.

OBJECTIVE: The aim of the study was to analyze the results of the screening for congenital defects (CD) and genetic diseases (GD) of the fetus in the Fetal Medicine Centre at the Department of Obstetrics and Gynecology, University Hospital in Olomouc. MATERIALS AND METHODS: Prospective cohort study. In the period from 1 January 2020 to 31 December 2021, a total of 14,460 health services were performed on 4,916 pregnant women. Within the screening of CD and GD of the fetus, 501 pregnant women were found to have an abnormality requiring further clinical management, 170 of them were diagnosed with a CD of the fetus and in 20 cases a GD of the fetus was diagnosed by a laboratory genetic examination. All diagnosed fetal CD and GD were sent/ reported according to the valid methodology of the National health information system (NHIS) to the National register of reproductive health (NRRH) to the CD Module. RESULTS: An increased calculated individual risk of genetic fetal disease was diagnosed in the first trimester of pregnancy in 10.7% of fetuses (319/ 2,968), and in the second trimester in 0.9% of fetuses (27/ 2,948). Nuchal translucency (NT) > 3.5 mm was diagnosed in 0.9% of fetuses by ultrasound examination in the first trimester of pregnancy (26/ 2,968). In fetal CD and GD screening, 501 pregnant women were found to have an abnormality requiring further clinical management, 72.1% of women (361/ 501) had an increased risk of genetic fetal disease, and diagnostic examination of the fetal genetic material obtained by invasive procedure (chorionic villus sampling or amniocentesis) was indicated. A total of 31.3% of them (113/ 361) refused the invasive procedure and 2.5% (9/ 361) did not attend the planned procedure; the invasive procedure was performed in 66.2% (239/ 361). CONCLUSION: Comparing the results of CD and GD fetal screening in our medical facility with other specialized medical facilities in the Czech Republic is currently difficult to do, but information from the NRRH could allow objective and transparent comparisons in the future.

Hydronephrosis as a symptom of clinically silent ureteral endometriosis.

OBJECTIVE: We present two case reports of asymptomatic ureteral endometriosis leading to hydronephrosis. We demonstrate the significance of routine ultrasound scanning of the upper urinary tract in patients with dia gnosed deep infiltrating endometriosis. CASE REPORTS: The first case report describes a symptomatic patient after a surgery for deep endometriosis. After the surgery, she was completely without symptoms, but during regular check-ups she developed progressive hydronephrosis on the right side and it did not respond to conservative treatment. Surgery deliberation of the ureter was indicated. The second case report describes a patient with already developed severe hydronephrosis on the left side. The functional kidney examination proved complete renal loss of the left kidney. Because of recurrent pyelonephritis in the nonfunctional kidney, nephrectomy was indicated. CONCLUSION: Ureteral endometriosis presents a rare, but insidious form of endometriosis, which is very often asymptomatic and diagnosed at a later stage. It can cause a complete silent loss of renal function. Routine ultrasound scanning examination of the upper urinary tract in all patients with diagnosed endometriosis could prevent this severe complication.

Fertility sparing approach in young women with endometrial cancer.

The incidence of endometrial cancer in young women is increasing, especially in developed countries. Although it is predominantly a disease of peri- and postmenopausal women, there is an absolute increase in younger women of childbearing age who, with today's lifestyle and pushing back maternal needs, do not have fulfilled reproductive plans. About 67% of cancers are diagnosed in the early stages. For these women, fertility-preserving procedures can be considered until reproductive plans are fulfilled. Subsequently, however, definitive management is appropriate even in the absence of carcinoma. This article discusses the most common gynecologic pelvic cancer, endometrial adenocarcinoma, and the possibility of fertility-preserving procedures.

Balloon vaginoplasty as a minimally invasive method in the management of vaginal aplasia.

OBJECTIVE: The aim of this article is to describe the management of vaginal aplasia and to introduce minimally invasive surgical procedures for neovagina formation. METHODOLOGY: Literature review obtained from studies and papers dealing with the management of congenital vaginal aplasia. CONCLUSION: Vaginal aplasia is a rare congenital anomaly, often in coincidence with congenital defects of the uropoietic system. Management nowadays favors non-surgical or minimally invasive surgical methods for neovagina formation. Saman et al introduced a new method of neovagina formation, namely balloon vaginoplasty. The advantage of the surgical procedure is traction using a soft Foley balloon, determining both the length and width of the neovagina. The method uses the expansion of the natural vaginal mucosa without the need for dissection of the vesicorectal space. The soft Foley balloon does not cause erosion of the vaginal mucosa.

Prospective comparison of cervical ripening with double balloon Cook catheter, misoprostol or dinoprostone in term singleton pregnancies.

OBJECTIVES: Induction of labor is indicated if the risk of continuing pregnancy is higher (either for fetus or mother) than the risk associated with the induction itself. The purpose of the present study was to compare the effectiveness of the double balloon Cook catheter and pharmacological preparations - prostaglandins (PGE), in our case it was misoprostol (PGE1) or dinoprostone (PGE2) for cervical ripening in pregnant women with gestational age at term. MATERIAL AND METHODS: The prospective observational study was conducted from March 2017 to December 2018. We used mechanical and pharmacological methods for cervical ripening. We compared the efficiency of methods and time to delivery from start of cervical ripening. We also evaluated the neonatal complications by Apgar score and neonatal intensive care unit admission in three different groups. RESULTS: Two hundred and nine women were chosen for cervical ripening. Double balloon Cook catheter and misoprostol were equally efficient in achieving vaginal delivery (76%). The shortest time for cervical ripening and successful vaginal delivery was shown in misoprostol (PGE1) group. In conclusion, no significant differences were found between groups in all neonatal outcomes. CONCLUSIONS: Currently, many methods of delivery preinduction exist and the prevalence of their usage varies considerably between countries. As yet, there is no literature comparing these three methods for the preparation of cervix.

Assisted reproduction in patients with Klinefelter syndrome.

OBJECTIVE: The goal of this article is to present the current knowledge of Klinefelter syndrome and its impact on male reproductive function as well as the current treatment options. METHODS: PubMed/Medline, WoS and Scopus were searched for articles indexed until November 2021. TEXT: Klinefelter syndrome is a chromosomal aberration with an additional X chromosome in males. This may adversely affect testicular growth and spermatogenesis, thus resulting in male infertility. Recently, new knowledge has appeared about the treatment of male infertility. CONCLUSION: Interdisciplinary approach enables early dia-gnosis and treatment of patients with Klinefelter syndrome. Assisted reproductive technology is essential for infertility treatment in patients with Klinefelter syndrome.