Carbon dioxide laser treatment for vulvovaginal atrophy in women treated for breast cancer: Preliminary results of the feasibility EPIONE trial.

BACKGROUND AND OBJECTIVE: Quality of life preservation after anti-cancer therapy is a major challenge for breast cancer survivors. Approximately 42-70% of patients who receive systemic therapy for breast cancer, including endocrine therapy, will develop vulvovaginal atrophy (VVA). For these patients, the commonly proposed gel-based treatments for topical applications are restrictive. Recently, innovative, non-hormonal therapeutic approaches, such as laser therapy, have emerged. The purpose of this feasibility study is to investigate the safety and efficacy of CO2 laser therapy in women with a history of breast cancer. MATERIAL AND METHODS: This prospective monocentric study included 20 patients with vulvovaginal atrophy who were treated at Henri Mondor University Hospital between 2017 and 2018. We included patients with a vaginal health index (VHI) score<15 and a contraindication for hormone administration due to a history of breast cancer. Two carbon dioxide laser sessions were used. The treatment was delivered using the following settings: vaginal tightening, FinePulse (pulse width 0.9ms), and energy density of 11.5J/cm2 that allows coverage of 70% of the targeted vaginal area to be treated. All patients had their follow-up visit at one (M1), three (M3), and six (M6) months after the first treatment to evaluate efficacy of the treatment on vulvovaginal atrophy. Vaginal health index score and female sexual distress (FSD) score were used to assess treatment efficacy and its impact on sexual quality of life. A score≥11 was associated with sexual dysfunction. The vaginal health index and female sexual distress scores were evaluated at baseline, M1, M3, and M6 of follow-up. RESULTS: The mean age of the patients was 56.1±8.8 years (range, 27-69 years). Seventeen of the 20 patients had experienced menopause (mean menopausal age, 51.25±1.5 years). At inclusion, the mean vaginal health index and the female sexual distress scores were 10.58±1.71 and 21.36±15.10, respectively. Fourteen out of 20 patients (70%) had FSD scores≥11 at the baseline. At M1, the mean vaginal health index score increased significantly to 13.42±2.3 (P=0.03), which represented an improvement of 21% from the baseline. A persistent and significant improvement in the vaginal health index score was observed at M6, with the score increasing to 16.75±4.23 post-treatment (P<0.0001), representing a 34% improvement from the mean baseline score. The mean female sexual distress at M1 was 19.83±13.57, representing a 7% decrease compared to the baseline scores (P<0.01). At M3, the female sexual distress significantly decreased to 13.88±15.58, representing an improvement of 35% (P=0.006). It increased to 10.35±14.7 at M6, representing an improvement of 52% (P=0.001). At M3, 35% of the patients had a female sexual distress score>11, and at M6, only 15% had a female sexual distress score>11. No side effects were reported during follow-up. CONCLUSION: This pilot feasibility study showed that carbon dioxide laser treatment appears to be an effective and safe method to improve the trophicity and decrease vaginal mucosal dryness in women with vulvovaginal atrophy that developed after systemic breast cancer therapy.

Immediate vaginal reconstruction following pelvic exenteration using the pedicled vertical Deep Inferior Epigastric Perforator (DIEP) flap: A technical note.

Immediate vaginal reconstruction is usually offered following pelvic exenteration for recurrent cervical cancer in women previously treated with radiotherapy or with severe radiation-induced fistulae. Introduction of muscle-sparing flaps, such as the pedicled vertical deep inferior epigastric perforator (DIEP) flap, provides viable tissues for vaginal reconstruction and is associated with reduced donor-site morbidity. This report describes the surgical technique, which is one of the procedures of choice for vaginal reconstruction. It is safe and beneficial, especially for women with gynecologic cancer who have undergone pelvic exenteration after failed radiation therapy.

Efficacy and satisfaction of surgical treatment for hidradenitis suppurativa.

BACKGROUND: Surgery is a radical treatment for hidradenitis suppurativa (HS) and may be considered as the only one potentially curative. OBJECTIVES: To characterize HS recurrence in patients after surgery and assess the risk factors of recurrence. METHODS: We conducted a monocentric retrospective cohort study. All consecutive patients who had surgery (January 1, 2012 to March 31, 2017) were included. We estimated the rate of recurrence of HS lesions after surgery (<1 cm from the scar), and recurrence-associated factors were analysed by univariate then multivariate logistic regression, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 75 patients [median age 31.4 years (range 16-71); 36 females], corresponding to 115 interventions were included. The Hurley score at surgery was III for 70 (60%) patients. In total, 61/115 (53%) interventions involved wide excision and 50 (43%) limited local excision. The localizations were axillary folds (n = 46; 40%), buttocks (n = 15, 13%), genital area (n = 13; 11%), perineal area (n = 12; 10%) and inguinal folds (n = 18; 16%). We observed 11 (10%) complications and 40 (35%) recurrences. On multivariate analysis, probability of recurrence was associated with only one-stage surgical closure [OR 3.2 (95% CI 1.4-7.3), P = 0.005]. Overall, 44 (52%) patients were completely satisfied and 22 (26%) partially satisfied, and most (81%) considered the surgery the best treatment. CONCLUSIONS: Hidradenitis suppurativa recurrence in our study was 35% and associated with one-stage surgical closures, but two-thirds of patients were satisfied with surgical treatment and would recommend surgery.

Experience of assisted reproductive technology at King Abdulaziz University Hospital.

AIM: To present the authors' experience with assisted reproductive technology (ART) at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. MATERIALS AND METHODS: Retrospective analysis of data collected from the charts of 264 women who were undergoing their first cycle of ART between September 2013 and March 2014. All the women were treated with gonadotropin-releasing hormone (GnRH) antagonist protocol. For all patients, the documented data included age, infertility type, cause, and hormone profile. Number of follicles > 10 mm, endometrial thickness, number of oocytes retrieved, number of fertilized ova, and number of embryos produced, as well as the number transferred, day of transfer, cancellation rate, and treatment administered for luteal phase support (oral and vaginal progesterone) treatment type, and outcome were recorded. The data was analyzed using the Statistical Package for the Social Sciences. RESULTS: The authors included women aged 21 to 39 years (mean ± standard deviation, 32.28 ± 5.51). Patients suffered from primary infertility in 69.7% of the cases; approximately 30% of the women had secondary infertility. Eighty of the 264 patients (30.3%) conceived; however, only 56 women (21.2%) had a live birth. The overall cancellation rate in the patients was 12.1%. The following reasons were documented for cases of failure: no oocytes, 16 (6.1%); no sperm, eight (3.0%); and no embryo, eight (3.0%). CONCLUSION: The success rate of ART at the present institution falls within the range reported in the medical literature. However, further studies should be conducted to investigate the course and outcome of ART in patients who undergo treatment in this institution.

Failure of laparoscopic Vecchietti procedure in a woman with androgen insensitivity syndrome.

The authors describe a case with androgen insensitivity syndrome (AIS) who underwent the laparoscopic Vecchietti procedure for creation of a neovagina. Postoperatively, the patient achieved anatomic success, with a vaginal length of about eight cm, and she was advised to use vaginal dilators after discharge. The patient reported improved sexual function, but presented about six months later for shortening of her vagina and difficult vaginal intercourse. Physical examination revealed an obliterated vaginal canal about two cm long. Further examination revealed lack of vaginal epithelization. The patient was instructed to continue using vaginal dilators in combination with estrogen cream; however, the patient did not achieve a vaginal length > two cm. The authors believe that the laparoscopic Vecchietti procedure may not be appropriate for women with AIS due to lack of epithelization.

Prevalence of endometriosis at a university hospital in Jeddah, Saudi Arabia.

PURPOSE: To determine the prevalence of endometriosis in women who had gynecologic laparoscopy at a university hospital in Saudi Arabia. MATERIALS AND METHODS: The hospital records were reviewed to identify all women who had undergone gynecological laparoscopy between January 2008 and December 2013. RESULTS: A total of 190 gynecologic laparoscopies were performed. The indications for laparoscopy were infertility (n = 76; 40%), chronic pelvic pain (n = 34; 17.9%), infertility and chronic pelvic pain (n = 7; 3.7%), ectopic pregnancy (n = 30; 15.8%), pelvic mass (n = 12; 6.3%), removal of a missing intrauterine contraceptive device (n = 6; 3.2%); other indications were documented in 25 cases (13.1%). Endometriosis was diagnosed in 21 women (11.1%). The presenting complaints in women with endometriosis were pelvic pain (n = 7; 33.3%), infertility (n = 5; 23.8%), pelvic pain and infertility (n = 6; 28.6%), and pelvic mass (n = 2; 9.5%); the complaint was unknown in one patient (4.8%). CONCLUSION: Endometriosis was uncommon in women who had undergone gynecologic laparoscopy.