Hallazgos genitourinarios en mujeres con tumores ováricos / Genito-urinary findings in women with ovarian tumors

Los tumores de ovario son los trastornos ginecológicos más comunes. Los tumores de ovario son el tercer tumor más común en las mujeres. Los tumores de ovario a veces son asintomáticos y tienen síntomas no específicos, lo que hace que la mayoría de los casos sean difíciles de detectar temprano. El objetivo de este estudio fue investigar las características genitourinarias del tumor ovárico en un estudio hospitalario. Se realizó un estudio observacional en Bagdad, Iraq, entre septiembre de 2018 y febrero de 2021. Las mujeres diagnosticadas con tumores ovarios a los 18 años de edad o más. Un total de cincuenta mujeres que se inscribieron en nuestro hospital. Datos clínicos y patológicos recopilados y analizados. Los datos sobre comorbilidades y resultados fueron aprobados y diagnosticados por un equipo completo de médicos ginecológicos y urológicos multidisciplinarios. La incidencia general de tumores ováricos fue 70% maligna y 30% benigna. El estudio mostró que la mayor parte del grupo de edad de tumores ováricos era superior a 55 años (62%). La mitad de los pacientes eran nuliparidades. El nivel educativo era principalmente de bajo nivel en analfabeto (20%), primario (24%), secundario (36%) en comparación con el alto nivel. Las mujeres usaron anticoncepción en 52%. La historia familiar informó en el 18% de las mujeres. El tipo histopatológico más común era el carcinoma seroso ovárico 15 (30%). Las etapas regionales eran comunes en el 50% de los pacientes. Tumores de bajo grado en 32%, intermedio en 36%y alto en 32%. Casi, el 80% de las mujeres se sometieron a TAH. Alrededor del 60% de los pacientes recibieron quimioterapia. Los resultados de salud genitourinaria adversos a largo plazo incluyeron nefritis (6%), insuficiencia renal aguda (16%), enfermedad renal crónica (18%), infección urinaria (38%), cálculo (16%), hidronefrosis (20%), Obstrucción de la vejiga (2%), estenosis ureteral (12%), retención de orina (8%), incontinencia de orina (12%), hematuria (22%), PID (14%), adhesión de órganos (8%), cervicitis (2 %), Endometriosis (2%), quiste (6%), trastornos menstruales (24%), infertilidad (2%) y dolor menopáusica (32%). En conclusión, el cáncer de ovario representa el tercer tipo de cáncer ginecológico más común. Era más común en mujeres mayores de cinco décadas. El tipo histopatológico más común es el carcinoma seroso ovárico. Observamos que los sobrevivientes de cáncer de ovario experimentaron mayores riesgos de varias enfermedades genitourinarias. Comprender los escenarios de la morbilidad múltiple para los tumores ováricos es de vital importancia para mejorar la atención clínica después del diagnóstico.

Ovarian tumors are the most common gynecological disorders. Ovarian tumors are the third most common tumor in women. Ovarian tumors are sometimes asymptomatic and have non-specific symptoms, making most cases difficult to detect early. The aim of this study was to investigate genitourinary features of ovarian tumor in a hospital-based study. An observational study was conducted in Baghdad, Iraq, between September 2018 and February 2021. Women diagnosed with ovarian tumors at 18 years of age or older. A total of Fifty women who enrolled in our hospital. Clinical and pathological data collected and analyzed. Data about comorbidities and outcomes were approved and diagnosed by full team of multidisciplinary gynecological and urological doctors were recorded. Overall incidence of ovarian tumors was 70% malignant and 30% benign. The study showed that the most age group of ovarian tumors was above 55 years (62%). Half of patients were nulliparities. Educational level was mostly of low level in illiterate (20%), primary (24%), secondary (36%) compared to high level. Women used contraception in 52%. The family history reported in 18% of women. The most common histopathological type was ovarian serous carcinoma 15(30%). Regional stages were common in 50% of patients. Low grade tumors in 32%, intermediate in 36% and high in 32%. Almost, 80% of women underwent TAH. About 60% of patients received chemotherapy. The long-term adverse genitourinary health outcomes correlated included Nephritis (6%), Acute renal failure (16%), Chronic kidney disease (18%), UTI (38%), Calculus (16%), Hydronephrosis (20%), Bladder obstruction (2%), Ureteric stenosis (12%), Urine retention (8%), Urine incontinence (12%), Hematuria (22%), PID (14%), Organ adhesion (8%), Cervicitis (2%), Endometriosis (2%), Cyst (6%), Menstrual disorders (24%), Infertility (2%), and Menopausal pain (32%). In conclusion, ovarian cancer represents the third most common gynecologic cancer type. It was more common in women aged above five decades. The most common histopathological type is ovarian serous carcinoma. We observed that ovarian cancer survivors experienced increased risks of various genitourinary diseases. Understanding the multi-morbidity scenarios for ovarian tumors is of vital importance to improve clinical care after diagnosis.

Genitourinary syndrome of menopause: the unmet need.

ABSTRACT: Genitourinary syndrome of menopause (GSM) is a highly prevalent and progressive condition of postmenopausal women that has significant negative effects on vulvovaginal health, sexual health, and overall quality of life. Despite many available safe and effective therapies, GSM often goes undiagnosed and untreated. This Practice Pearl addresses the pathophysiology of GSM and reviews available treatment options.

Nerve-sparing in Gynecologic Surgery: A Perspective.

OBJECTIVE: To provide a perspective on nerve-sparing (NS) surgery in gynecology. DATA SOURCES: Literature review, English language. METHODS OF STUDY SELECTION: Systematic reviews and meta-analyses studies were selected for review for oncology; comparative studies were selected for endometriosis, and 1 comparative and 1 prospective study were chosen for sacrocolpopexy. TABULATION, INTEGRATION, AND RESULTS: Two tables summarize the results of systematic reviews and meta-analyses in oncology. Oncology, endometriosis, and urogynecology sections. Primary benefit of NS technique is decreased bladder dysfunction, and, to a lesser degree, vaginal and rectal dysfunc. CONCLUSION: NS is preferable to conventional surgery for benign and malignant conditions to reduce postoperative bladder, rectal, and vaginal dysfunction.

Urogenital myiasis - An atypical presentation

The infestation of the human body by maggots has been reported worldwide and occurs most commonly in people of lower socioeconomic status and poor personal hygiene. Urogenital is the rarest site of myiasis presentations. Here we report the case of a 20-year-old, sexually inactive female student who presented with a necrotic growth in the paraurethral region infested with numerous maggots. The lesion involved the urethra and the bladder base. She was treated with debridement and bladder irrigation. The cystoscopy and local examination performed 2 weeks after admission, confirmed the complete healing of the urogenital lesion. Managing this patient's unique challenge was to assess the extent of the involvement and removal of all maggots from the deepest wound portion. The female internal and external urogenital myiasis is a very occasional and under-reported health hazard. Reporting such cases increases the public and physician awareness about the mode of presentation, right diagnosis, and available treatment options.

The effect of pathophysiological changes in the vaginal milieu on the signs and symptoms of genitourinary syndrome of menopause (GSM).

IMPORTANCE AND OBJECTIVE: The aim of this study was to provide an overview of the most recent literature on genitourinary syndrome of menopause (GSM), to explore the key elements of GSM diagnosis, and the potential impact of pathophysiological changes in the vaginal milieu on vulvovaginal symptoms. METHODS: The MEDLINE database was searched, and only articles written in English were considered. Additional references were identified by hand searching the bibliographies of the included articles. DISCUSSIONS AND CONCLUSION: The vaginal milieu plays important roles in producing bothersome symptoms in the host. In women with GSM, low hormone states can result in pathophysiological changes in the vaginal milieu, including the vaginal microbiome and the mucosal immunity. Hormone-associated disruption of the balance of the indigenous microbiota and the dysregulation of these immune responses are the pathophysiological basis of GSM symptoms. However, whether the microbiome and mucosal immunity are markers of vulvovaginal disorder or agents actively promoting a healthy vagina are still not fully understood. It is an important area of focus.

Viewing symptoms associated with Vulvovaginal Atrophy (VVA)/Genitourinary syndrome of menopause (GSM) through the estro-androgenic lens - Cluster analysis of a web-based Italian survey among women over 40.

OBJECTIVE: we aimed to explore the use of an estro-androgenic symptom questionnaire in women (EASQ-W), including items typically associated with menopausal hypoestrogenism and some others possibly related to androgen insufficiency that may be relevant to further characterize women reporting VVA/GSM at midlife. METHODS: web-based survey involving a representative sample of 1505 Italian women (age range: 40-65 years). The responders completed a structured, online questionnaire, reporting symptoms (yes/no option) and rating them (from 1 to 10), if present during the past 4 weeks. A factor analysis methodology (principal component analysis and K-MEANS clustering algorithm) was used to segment women. Statistically significant differences between groups were determined at the 95 % level of confidence. RESULTS: more than half of our study sample were aged 50-65 years (n = 901; 59.9 %) and 55 % were postmenopausal women (PMW). We obtained 8 principal domains of the EASQ-W with PMW reporting significantly more severe symptoms in the majority of domains related to well-being at mid-life. The K-MEANS clustering algorithm identified 4 clusters of women characterized by different symptoms: vasomotor (VMS; n = 341), sexual (SEX; n = 301), poorly symptomatic (LOWSYMPT; n = 766), sexual and anatomic, mainly at genital level (SEX + ANAT; n = 97), independently from the menopausal status. The cluster SEX + ANAT was the one reporting overall more symptoms in each of the other principal domains. Some symptoms (impression of being diminished in height, deterioration in work performance, more memory lapses/confusion than before, more wrinkles/signs of aging in the mirror, put on more tummy than usual) and the entire urological (UROL) cluster were significantly more reported by women in the cluster SEX + ANAT. Even when only severe symptoms were analysed, women in the SEX + ANAT cluster were the ones more symptomatic. The SEX only cluster identified younger women, with significantly less day and night hot flushes and sweats and less vaginal dryness and low lubrication associated with sexual pain as compared to SEX + ANAT. CONCLUSION: our results provide insight into the constellation of symptoms associated with VVA/GSM by identifying women with distinct clusters of complaints that may require a tailored diagnostic and therapeutic approach across age and menopause.

A new treatment of genito-urinary post-menopausal atrophy with autologous micro-fragmented fat tissue: a thirty-six months follow up case series.

OBJECTIVE: Genitourinary atrophy is a menopausal pathological change determined by the definitive drop of ovarian hormones' production that can impact heavily on the health status of women, with important direct and indirect social costs. Unfortunately, available treatments are only symptomatic, and they are not able to reverse the atrophy and other related symptoms. Regenerative medicine, with single local injection of autologous micro-fractured fat tissue, could represent a viable new solution for these patients as it not only helps to relieve symptoms, but it also counteracts the mechanisms that lead to the menopausal genitourinary atrophy. The objective of this paper is to evaluate the long-term effectiveness of micro-fractured fat vulvar injection for genito-urinary atrophy in patients, affected by severe genitourinary atrophy (at least 4 symptoms lasting for at least 4 years). PATIENTS AND METHODS: We present a case series of 35 patients followed for 36 months to evaluate the effectiveness and safety of a single subcutaneous vulvar injection of autologous micro-fragmented fat tissue (MFAT). RESULTS: We have not observed any adverse effects in any patients. All symptoms, and especially pelvic pain and dyspareunia, improved in almost half of patients within 3 months. Ninety-nine percent of patients recovered completely from all symptoms after 9-12 months, reporting no relapse of the symptoms up to the third year of follow up. CONCLUSIONS: Our case series is the first case series, evaluating the long-term (3 years) safety and effectiveness of micro-fragmented adipose tissue graft for urogenital atrophy.

Rigorous characterization of urinary extracellular vesicles (uEVs) in the low centrifugation pellet - a neglected source for uEVs.

Urinary extracellular vesicles (uEVs) provide bio-markers for kidney and urogenital diseases. Centrifugation is the most common method used to enrich uEVs. However, a majority of studies to date have focused on the ultracentrifugation pellet, potentially losing a novel source of important biomarkers that could be obtained at lower centrifugation. Thus, the aim of this study is to rigorously characterize for the first time uEVs in the low speed pellet and determine the minimal volume of urine required for proteomic analysis (≥9.0 mL urine) and gene ontology classification identified 75% of the protein as extracellular exosomes. Cryo-Transmission Electron Microscopy (≥3.0 mL urine) provided evidence of a heterogeneous population of EVs for size and morphology independent of uromodulin filaments. Western blot detected several specific uEV kidney and EV markers (≥4.5 mL urine per lane). microRNAs quantification by qPCR was possible with urine volume as low as 0.5 mL. Particle enumeration with tunable resistive pulse sensing, nano particles tracking analysis and single EV high throughput imaging flow cytometry are possible starting from 0.5 and 3.0 mL of urine respectively. This work characterizes a neglected source of uEVs and provides guidance with regard to volume of urine necessary to carry out multi-omic studies and reveals novel aspects of uEV analysis such as autofluorescence of podocyte origin.

Effectiveness of CO2 laser on urogenital syndrome in women with a previous gynecological neoplasia: a multicentric study.

BACKGROUND: Many women diagnosed with gynecological cancers undergo adjuvant therapy, which may lead to transient or permanent menopause that ultimately leads to urogenital syndrome and vulvovaginal atrophy. Studies advise against the use of estrogen in women with a history of hormone-dependent cancer. One alternative is vaginal microablative fractional CO2 laser, which promotes tissue regeneration through the production of collagen and elastic fibers. OBJECTIVE: To evaluate the effectiveness of CO2 laser in the treatment of urogenital syndrome-in particular, symptomatic vulvovaginal atrophy in women who have survived gynecological cancers. METHODS: A retrospective study was carried out, including all patients with a history of gynecological cancers and vulvovaginal atrophy who underwent CO2 laser treatment between November 2012 and February 2018 in four Italian centers. The study was approved by the local ethics committee of each participating institution. The inclusion criteria were women aged between 18 and 75; Eastern Cooperative Oncology Group performance status <2; and history of breast, ovarian, cervical, or uterus cancer. Patients had to have vulvovaginal atrophy and at least one of the following symptoms of urogenital syndrome: vaginal dryness, dyspareunia, vaginal introitus pain, burning, or itching. Three applications were administered at baseline, 30 days, and 60 days. All patients were evaluated before the first laser session, at each session, and 4 weeks after the last session. In particular, patients were asked to indicate the intensity of symptoms before the first session and 4 weeks after the last session, using Visual Analog Scale (VAS) scoring from 0 ('no discomfort') to 10 ('maximum discomfort'). RESULTS: A total of 1213 patients underwent CO2 laser treatment and of these, 1048 were excluded because they did not meet the inclusion criteria in the analysis. Finally, a total of 165 patients were included in the study. The mean age at the time of treatment was 53 years (range 31-73). Dryness improved by 66%, dyspareunia improved by 59%, burning improved by 66%, pain at introitus improved by 54%, and itching improved by 54%. The side effects were evaluated as pain greater than VAS score 6 during and after the treatment period. No side effects were seen in any sessions. CONCLUSIONS: Fractional microablative CO2 laser therapy offers an effective strategy in the management of the symptoms of genitourinary syndrome in post-menopausal women and in survivors of gynecological cancer.

Role of Interventional Procedures in Obstetrics and Gynecology.

Radiological guided intervention techniques are discussed in obstetric and gynecologic patients. Fallopian tube recanalization, postpartum hemorrhage control, techniques of treating uterine leiomyomas, pelvic congestion treatment, and the use of percutaneous and transvaginal ultrasonography-guided aspirations and biopsy are covered. These techniques use basic radiological interventional skills and show how they are adapted for use in the female pelvis.

Total Exenteration En Bloc with a Nephrectomy for Locally Advanced Cervical Cancer Invading a Pelvic Kidney-a Case Report and Literature Review.

Introduction: Extended pelvic resection might be the option of choice in patients presenting locally advanced cervical cancer. However, the possibility of a co-existence of an ectopic, pelvic kidney that is invaded by such a tumor is extremely rare. Case Presentation: A 54-year-old female patient, diagnosed with locally advanced cervical cancer in the presence of a pelvic kidney, was submitted to surgery with curative intent. A large, abscessed cervical tumor invading the urinary bladder and the rectum was found, so a total exenteration was planned. Intraoperatively, tumor invasion of the left kidney, which was found in an ectopic, pelvic position was also encountered; therefore, total pelvic exenteration in association with a left nephrectomy was successfully performed. Conclusions: The presence of an ectopic, pelvic disposition of the kidney makes it susceptible to be invaded by locally advanced pelvic tumors; in such cases, a nephrectomy might also be needed.

Vulvar Tuberculosis-A Rare Manifestation of the Disease.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. According to data from the World Health Organization, this disease remains one of the leading causes of death worldwide. Although it most commonly affects the lungs, tuberculosis can compromise any organ. The present study reports a rare case of vulvar tuberculosis in a postmenopausal woman with a history of asymptomatic pulmonary and pleural tuberculosis, with no prior documented contact with the bacillus. Diagnosis was based on vulvar lesion biopsies, with histological findings suggestive of infection and isolation of M. tuberculosis by microbiological culture and polymerase chain reaction (PCR) essays. The lesions reverted to normal after tuberculostatic therapy.

A tuberculose é uma doença infeciosa causada pelo Mycobacterium tuberculosis. De acordo com dados da Organização Mundial de Saúde, esta doença mantém-se entre as principais causas de morte no mundo. Embora afete mais frequentemente os pulmões, a tuberculose pode comprometer qualquer órgão. O presente artigo relata um caso raro de tuberculose vulvar numa mulher na pós-menopausa, com antecedentes de tuberculose pleural e pulmonar assintomática, sem contato documentado com o bacilo. O diagnóstico foi feito com base na biópsia da lesão vulvar, com achados histológicos sugestivos da infeção e isolamento do M. tuberculosis por meios de cultura e pela técnica da reação em cadeia da polimerase (PCR). Após terapêutica tuberculostática, as lesões reverteram.

Vulvar tuberculosis-A rare manifestation of the disease / Tuberculose vulvar - Uma manifestação rara da doença

Abstract Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. According to data from the World Health Organization, this disease remains one of the leading causes of death worldwide. Although it most commonly affects the lungs, tuberculosis can compromise any organ. The present study reports a rare case of vulvar tuberculosis in a postmenopausal woman with a history of asymptomatic pulmonary and pleural tuberculosis, with no prior documented contact with the bacillus. Diagnosis was based on vulvar lesion biopsies, with histological findings suggestive of infection and isolation of M. tuberculosis by microbiological culture and polymerase chain reaction (PCR) essays. The lesions reverted to normal after tuberculostatic therapy.

Resumo A tuberculose é uma doença infeciosa causada pelo Mycobacterium tuberculosis. De acordo com dados da Organização Mundial de Saúde, esta doença mantém-se entre as principais causas demorte nomundo. Embora afetemais frequentemente os pulmões, a tuberculose pode comprometer qualquer órgão. O presente artigo relata um caso raro de tuberculose vulvar numa mulher na pós-menopausa, com antecedentes de tuberculose pleural e pulmonar assintomática, sem contato documentado com o bacilo. O diagnóstico foi feito com base na biópsia da lesão vulvar, com achados histológicos sugestivos da infeção e isolamento do M. tuberculosis pormeios de cultura e pela técnica da reação em cadeia da polimerase (PCR). Após terapêutica tuberculostática, as lesões reverteram.

The Impact of Vaginal Laser Treatment for Genitourinary Syndrome of Menopause in Breast Cancer Survivors: A Systematic Review and Meta-analysis.

INTRODUCTION: Genitourinary syndrome of menopause (GSM) is caused by hypo-estrogenism, resulting in vaginal dryness, pain, dyspareunia, and urinary tract infection. It is more severe and common in breast cancer (BC) survivors owing to the severity of induced menopause following treatment (ie, chemotherapy, GnRH agonists/anti-estrogen therapy). It has a detrimental effect on quality of life. The gold standard therapy is topical estrogen, which is highly effective; however, it is contraindicated in patients with BC owing to concerns with recurrence. Recently, vaginal laser therapy has been used to restore vaginal mucosal thickness, lubrication, and elasticity with good effect in menopausal women with GSM. The aim of this study is to assess the impact of vaginal laser therapy on BC-associated GSM. MATERIALS AND METHODS: This study is a systematic review and meta-analysis. RESULTS: A total of 48 papers were identified, revealing 10 observational studies of GSM symptoms before and after vaginal laser therapy with no randomized trials. Vaginal laser was effective in treating GSM in BC survivors with improvement in the Vaginal Health Index and the Visual Analogue Scale score for dyspareunia and vaginal dryness, sexual function, and overall satisfaction in the short term with minimal adverse events. CONCLUSION: Vaginal laser may be effective in treating GSM in BC survivors in the short term, but there are no long-term data on safety and efficacy. More research is needed looking at longer term follow-up, health economic costs, and sub-group analysis as well as the complex interplay between GSM and the other negative impacts of BC therapy on intimate relationships.

Laser Therapy for Genitourinary Syndrome of Menopause.

PURPOSE OF REVIEW: The purpose of this article is to review the available data regarding the application and therapeutic outcomes of laser therapy for the treatment of genitourinary syndrome of menopause (GSM). RECENT FINDINGS: There have been several studies regarding the use of laser therapy for the treatment of GSM. Most of these studies show a trend toward safe and effective treatment in the short term (less than or equal to 12 weeks). However, these studies are lacking in randomization, blinding, placebo, and comparison groups. Although laser therapy for the treatment of the symptoms of GSM appears promising, there is currently a lack of high-level and long-term evidence regarding its safety and efficacy. There is also a lack of professional guidelines in the USA regarding this modality of treatment, specifically for GSM. Opportunities exist for future research in this area, specifically to determine safety and long-term outcomes of therapy.

Vaginal estrogen and mammogram results: case series and review of literature on treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors.

OBJECTIVE: To examine mammographic density before and after at least 1 year of vaginal estrogen use in a small cohort of healthy postmenopausal women and women with a personal history of breast cancer. METHODS: We extracted data via chart review of patients from a single practitioner's menopause specialty clinic in Baltimore, MD. Mammographic change was primarily determined via the Bi-RADS scoring system, including the Bi-RADS density score. In addition, we conduct a narrative review of the current literature on the usage of local estrogen therapy, and systemic and local alternatives in the treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors. RESULTS: Twenty healthy postmenopausal women and three breast cancer survivors fit our inclusion criteria. Amongst these two groups, we did not find an increase in mammographic density after at least 1 year and up to 18 years of local vaginal estrogen. Ospemifene use in one patient did not appear to be associated with any change in Bi-RADS score. Our narrative review found little data on the effects of vaginal estrogen therapy or newer alternative systemic therapies such as ospemifene on mammographic density. CONCLUSIONS: Low-dose vaginal estrogen use for 1 or more years in a small cohort of women with GSM did not appear to be associated with any changes in breast density or Bi-RADS breast cancer risk scores in the majority of study participants, including three breast cancer survivors. Larger long-term controlled clinical trials should be conducted to examine the effects of low-dose vaginal estrogen on mammographic density in women with and without a personal history of breast cancer. Furthermore, relative efficacy and risk of vaginal estrogen compared with other forms of treatment for GSM should also be studied in long-term trials.

Variation in the microbiome of the urogenital tract of Chlamydia-free female koalas (Phascolarctos cinereus) with and without 'wet bottom'.

Koalas (Phascolarctos cinereus) are iconic Australian marsupials currently threatened by several processes, including infectious diseases and ecological disruption. Infection with Chlamydia pecorum, is considered a key driver of population decline. The clinical sign of 'wet bottom', a staining of the rump associated with urinary incontinence, is often caused by chlamydial urinary tract infections. However, wet bottom has been recorded in koalas free of C. pecorum, suggesting other causative agents in those individuals. We used 16S rRNA diversity profiling to investigate the microbiome of the urogenital tract of ten female koalas in order to identify potential causative agents of wet bottom, other than C. pecorum. Five urogenital samples were processed from koalas presenting with wet bottom and five were clinically normal. All koalas were negative for C. pecorum infection. We detected thirteen phyla across the ten samples, with Firmicutes occurring at the highest relative abundance (77.6%). The order Lactobacillales, within the Firmicutes, comprised 70.3% of the reads from all samples. After normalising reads using DESeq2 and testing for significant differences (P < 0.05), there were 25 operational taxonomic units (OTUs) more commonly found in one group over the other. The families Aerococcaceae and Tissierellaceae both had four significantly differentially abundant OTUs. These four Tissierellaceae OTUs were all significantly more abundant in koalas with wet bottom. This study provides the foundation for future investigations of causes of koala wet bottom, other than C. pecorum infection. This is of clinical relevance as wet bottom is often assumed to be caused by C. pecorum and treated accordingly. Our research highlights that other organisms may be causing wet bottom, and these potential aetiological agents need to be further investigated to fully address the problems this species faces.

Post-menopausal vulvovaginal atrophy - an overview of the current treatment options.

Sex hormone deficiency in post-menopausal women causes changes in the lower urinary tract. Vulvovaginal atrophy is a pathology resulting from those changes. VVA has a negative effect on the quality of life therefore prompting a search for new therapeutic options. The aim of this article is to summarize the current treatment modalities, both hormonal and non-hormonal for post-menopausal vaginal atrophy. Topical oestrogen therapy remains the "golden standard". Alternatives, although promising, require well-designed control studies.