A survey of female sexual dysfunction in gynaecological cancer survivors: A case–control study / Una encuesta sobre la disfunción sexual femenina en sobrevivientes de cáncer ginecológico: un estudio de control de casos

Background: With diagnostic and treatment advancements in cancer management, the need for improvement of survivors’ quality of life has been increasing. One of the issues affecting the quality of life in gynecologic cancer survivors is a decline in their sexual function, which is affected in many ways. In order to assess sexual dysfunction in gynecologic cancer survivors. Objective: This study is designed to assess different areas of sexual function including desire, arousal, vaginal lubrication, orgasm, satisfaction, and pain. Materials and methods: Patients who had completed treatment since 6 months to 6 years ago included in the case–control study starting from January 2019 to January 2020. Twenty-nine sexually active gynecologic cancer survivors with sexual dysfunction were enrolled as cases and 91 sexually active ones without sexual problems were assigned to the control group. The Female Sexual Function Index (FSFI) questionnaire consisting of 19-items and six areas was completed for each participant. Results: Average sexual dysfunction score of the case group was 16.78 with cut-off point of 28 for dysfunction. The most common domain of sexual dysfunction was pain (96.55%), followed by sexual arousal (86.21%), vaginal lubrication (72.41%), orgasm (72.41%), satisfaction (65.52%) and sexual desire (55.17%). Conclusion: In gynecologic cancer survivors, sexual dysfunction was directly related to employment, brachytherapy and co-existing DM and inversely related to the time elapsed since cancer diagnosis and menopause. Asking about sexual problems and referral to a specialist should be included in the patient treatment process.(AU)

Antecedentes: Con los avances en el diagnóstico y tratamiento del cáncer, la necesidad de mejorar la calidad de vida de los sobrevivientes ha ido en aumento. Uno de los problemas que afectan la calidad de vida de las sobrevivientes de cáncer ginecológico es la disminución de su función sexual, que se ve afectada de muchas maneras. Objetivo: Con el fin de evaluar la disfunción sexual en sobrevivientes de cáncer ginecológico, este estudio está diseñado para evaluar diferentes áreas de la función sexual, incluido el deseo, la excitación, la lubricación vaginal, el orgasmo, la satisfacción y el dolor. Materiales y métodos: Pacientes que habían completado el tratamiento desde hacía seis meses a seis años, incluidas en el estudio de casos y controles a partir de enero de 2019 a enero de 2020. Veintinueve sobrevivientes de cáncer ginecológico sexualmente activas con disfunción sexual se inscribieron como casos y 91 sobrevivientes sexualmente activas sin problemas sexuales fueron asignados al grupo de control. El cuestionario del Índice de Función Sexual Femenina (FSFI) que consta de 19 ítems y seis áreas se completó para cada participante. Resultados: La puntuación media de disfunción sexual del grupo de casos fue de 16,78 con un punto de corte de 28 para disfunción. El dominio más común de disfunción sexual fue el dolor (96,55%), seguido de excitación sexual (86,21%), lubricación vaginal (72,41%), orgasmo (72,41%), satisfacción (65,52%) y deseo sexual (55,17%). Conclusión: En las sobrevivientes de cáncer ginecológico, la disfunción sexual estuvo directamente relacionada con el empleo, la braquiterapia y la DM coexistente e inversamente relacionada con el tiempo transcurrido desde el diagnóstico del cáncer y la menopausia. La consulta sobre problemas sexuales y la derivación a un especialista deben incluirse en el proceso de tratamiento del paciente.(AU)

Cost and regression analysis of preeclampsia from the perspective of the reimbursement agency / Análisis de costes y regresión de la preeclampsia desde la perspectiva de la agencia de reembolso

Objective: The aim of this study is to determine the financial burden of preeclampsia (PE) from a single institution's perspective and then determine the cost of the illness from the reimbursement institution perspective and finally draw a regression model that predicts the annual cost of a patient. Materials and methods: The research is a descriptive and cross-sectional type of research and a retrospective cost analysis. Patients diagnosed with PE in 2021 were included in the study. For the regression analysis of the study, a dataset with 29 parameters belonging to 65 patients was created. Regression models were built on top of it. Results: In our study, per-patient expenses of PE patients from the perspective of the reimbursement institution were calculated and presented as average costs; severe PE patient with cesarean section 7598.5 Ł ($769.8), severe PE patient with normal vaginal delivery 8487.48 Ł (1050.43 $), mild PE patient with cesarean section 5331.67 Ł ($659.86) and mild PE patient with normal vaginal delivery was calculated as 6220.65 Ł (769.88 $). In the study, different regression formulas were created for the two groups of PE. The created regression model had an R2 score of 91.85%. Conclusion: The actors involved in the management of the disease should determine the cost-effectiveness of the disease by using the financial data of the patients and choose the right approach. Health costs in Turkey differ from the parameters in the European Union economy. Therefore, there are lower health costs. The financial findings of the disease are a guide for health policy makers, health managers and researchers.(AU)

Objetivo: El objetivo de este estudio es determinar la carga financiera de la preeclampsia (PE) desde la perspectiva de una única institución, para luego determinar los costes de la enfermedad desde la perspectiva de la institución de reembolso, y así elaborar un modelo de regresión que prediga el coste anual de un paciente. Materiales y métodos: Se trata de una investigación de tipo descriptivo, transversal y de un análisis retrospectivo de costes. Se incluyeron en el estudio los pacientes diagnosticados de PE en 2021. Para el análisis de regresión del estudio se creó un conjunto de datos con 29 parámetros que pertenecían a 65 pacientes diferentes. Los modelos de regresión se construyeron en base a este. Resultados: En nuestro estudio, los gastos por paciente de las pacientes con PE desde la perspectiva de la institución de reembolso se calcularon y presentaron como costos promedio; paciente con PE grave con cesárea 7598.5 (769.8 $), paciente con PE grave con parto vaginal normal 8487.48 (1050.43 $), paciente con PE leve con cesárea 5331.67 (659.86 $) y paciente con PE leve con parto vaginal normal se calculó como 6220.65 (769.88 $). En el estudio se crearon diferentes fórmulas de regresión para los dos grupos de PE. El modelo de regresión creado tuvo una puntuación R2 de 91,85%. Conclusión: Los agentes implicados en la gestión de la enfermedad tendrán que determinar su rentabilidad utilizando los datos económicos de los pacientes y elegir el enfoque adecuado. Los costes sanitarios en Turquía difieren de los parámetros de la economía de la Unión Europea. Por tanto, los costes sanitarios se reducen. Los hallazgos financieros de la enfermedad servirán de guía para los responsables de las políticas de salud, los gerentes de salud y los investigadores.(AU)

Concept of opportunistic bilateral salpingectomy in a sample of Mexican gynecologists. What should residents be trained on? / Concepto de salpingectomía bilateral oportunista en una muestra de ginecólogos mexicanos. ¿En qué se debe capacitar a los residentes?

Background: Ovarian cancer is the fifth deadliest cancer among women. There is no effective screening method. It has been suggested that ovarian cancer originates from precursor lesions in the fimbriae of the fallopian tubes. Objective: The aim of this study was to determine the level of knowledge of opportunistic bilateral salpingectomy by gynecologists. Methods: A cross-sectional study was carried out and a survey was sent electronically to gynecologists and gynecology residents. Demographic characteristics as well as questions of interest related to clinical practice and indication for surgery were included. Results: 52 subjects were included, 21 women and 31 men, with a mean age of 40.7 years. Thirty-five board certified gynecologists, as well as 17 gynecology residents, were included as part of the total survey group. Thirty-six individuals (69.2%) reported performing elective salpingectomy. The motivation they had to perform salpingectomy as a method of sterilization was: “reduction in the risk of ovarian cancer in the future” (55.6%). The indication for elective salpingectomy while performing other procedures was: “to prevent ovarian cancer” (61.1%). Certified gynecologists (42.9%) as well as residents (41.1%) considered “transvaginal ultrasound screening” as the best primary prevention method for ovarian cancer in low-risk women. Conclusions: Opportunistic bilateral salpingectomy is safe and cost-effective. However, when gynecologists are interviewed to find out their level of knowledge, there is poor acceptance of opportunistic bilateral salpingectomy in Mexico. A training strategy should be designed in the gynecology residency in order to motivate ovarian cancer prevention.(AU)

Antecedentes: El cáncer de ovario es el quinto cáncer más mortal entre las mujeres. No existe un método de detección eficaz. Se ha sugerido que el cáncer de ovario se origina a partir de lesiones precursoras en las fimbrias de las trompas de Falopio. Objetivo: Determinar el nivel de conocimiento de los ginecólogos sobre la salpingectomía bilateral oportunista. Métodos: Se envió una encuesta por vía electrónica a médicos ginecólogos y residentes de Ginecología. Se incluyeron características demográficas, así como preguntas de interés relacionadas con la práctica clínica y la indicación de cirugía. Resultados: Se incluyeron 52 sujetos, 21 mujeres y 31 hombres, con una edad media de 40,7 años. Treinta y cinco ginecólogos certificados, así como 17 residentes de ginecología, se incluyeron como parte del grupo total. Treinta y seis individuos (69,2%) informaron haber realizado salpingectomía electiva. La motivación que tuvieron para realizar la salpingectomía como método de esterilización fue: «reducción del riesgo de cáncer de ovario en el futuro» (55,6%). La indicación de salpingectomía electiva mientras se realizaban otros procedimientos fue: «para prevenir el cáncer de ovario» (61,1%). Los ginecólogos certificados (42,9%) y los residentes (41,1%) consideraron la «detección con ultrasonido transvaginal» como el mejor método de prevención primaria para el cáncer de ovario en mujeres de bajo riesgo. Conclusiones: Cuando entrevistamos a los ginecólogos detectamos poca aceptación de la salpingectomía bilateral oportunista en México. Se debe diseñar una estrategia de formación en la residencia de Ginecología para motivar la prevención del cáncer de ovario.(AU)

Prevalencia e impacto del sangrado menstrual abundante en España: resultados de una encuesta nacional / Prevalence and impact of heavy menstrual bleeding in Spain: Results of a national survey

Antecedentes: El sangrado menstrual abundante (SMA) es un problema ginecológico frecuente. Los datos sobre su prevalencia en España y su impacto son limitados. Material y métodos: Encuesta realizada en España en mujeres de 23-49 años incluidas en un panel en línea voluntario. La encuesta abordó varios aspectos, incluidos las características y el impacto de la menstruación. La información se recogió mediante un cuestionario semiestructurado enviado por correo electrónico. Los resultados se ponderaron por edad y distribución geográfica. Resultados: Se obtuvieron datos de 1.206 mujeres de las 4.478 invitadas (26,9%), de las que 1.169 (96,9%) tenían la menstruación. El 32,7% (n=373) expresó tener «sangrado menstrual excesivo» (SME), lo que se asoció con una mayor frecuencia e intensidad de síntomas menstruales. También con un porcentaje superior de mujeres a las que la menstruación limita «bastante o mucho» (29,1% frente a 15,7% con sangrado normal/leve). Las relaciones sexuales fueron el ámbito más afectado (al 59% les limitaba «bastante o mucho»). El porcentaje de mujeres con afectación de los ámbitos analizados fue significativamente superior entre aquellas con SME, excepto para la vida familiar. El 67,5% de las mujeres con SME había acudido al médico por este motivo; el 19,8% seguía algún tratamiento específico. Conclusiones: En nuestra muestra de 1.206 mujeres de edad fértil, el 6,2% presentaba SMA (SME+limitación «bastante o mucho» de la vida diaria). El SME tiene un impacto importante en la vida diaria de la mujer. Dos de cada 3consultan al médico por este motivo.(AU)

Background: Heavy menstrual bleeding (HMB) is a common gynecological complaint. Data on its prevalence and impact in Spain are limited. Material and methods: A voluntary web-based survey was conducted in Spain among women aged 23–49. The survey covered several aspects of menstruation, including the characteristics and impact. The information was gathered using a semi-structured questionnaire sent by email. Results were weighted by age and geographic distribution. Results: Of the 4478 women invited to participate, 1206 (26.9%) responded, of whom 1169 (96.9%) were menstruating. 32.7% (n=373) said they experienced “excessive menstrual bleeding” (EMB), which was associated with increased frequency and intensity of menstrual symptoms as well as a higher percentage of women whose menstruation limited them “a lot or quite a lot” (29.1% vs. 15.7% with normal/light bleeding). Sexual intercourse was the domain most affected (59% were limited “a lot or quite a lot”). Except for family life, the impact on the domains analyzed was significantly higher among women with EMB. 67.5% of women with EMB had seen a doctor for this reason; 19.8% were receiving some type of treatment. Conclusions: In our sample of 1206 women of childbearing age, 6.2% had HMB (EMB+“a lot or quite a lot” of limitations of daily activities). Excessive menstrual bleeding has a major impact on the daily lives of women. Two out of 3see a doctor for this reason.(AU)

Manejo conservador con radioterapia e inmunoquimioterapia en el linfoma difuso de células B grandes primario de cuello uterino: Diagnóstico y tratamiento de una entidad rara / Conservative management with radiotherapy and immunochemotherapy in primary diffuse large B-cell lymphoma of the cervix: Diagnosis and treatment of a rare entity

Introducción: El linfoma maligno primario de cuello uterino es una enfermedad muy rara, que representa solo el 0,008% de todos los tumores de cérvix y el 2% de todos los linfomas extraganglionares femeninos.Principales síntomas o hallazgos clínicos: Se presenta el caso de una mujer de 66 años, de los Andes peruanos, con tiempo de enfermedad de 4 meses caracterizado por ginecorragia, con evidencia de cérvix tumoral de 5cm. Se realizó inmunohistoquímica a la biopsia de cérvix para diferencia linfoma del carcinoma epidermoide.Diagnóstico principal: Linfoma difuso de células B grandes primario de cuello uterino con estadificación Ann Arbor IE IPI de bajo riesgo.Intervenciones terapéuticas y resultados: Fue manejada con inmunoquimioterapia (rituximab, ciclofosfamida, adriamicina, vincristina y prednisona), seguida de radioterapia externa consolidativa a dosis de 3.000 cGy en 15 sesiones con técnica especial IMRT. El control de la enfermedad resultó satisfactorio y no presentó complicaciones por la irradiación.Conclusión: El linfoma difuso de células B grandes primario de cuello uterino es muy raro, por lo que, en un caso de lesión primaria del estroma del cérvix, debe tenerse en cuenta la sospecha de linfoma.(AU)

Introduction: Primary malignant cervical lymphoma is a very rare disease, which represents only 0.008% of all cervical tumors and 2% of all female extranodal lymphomas. Main symptoms and/or clinical findings: The case of a 66-year-old woman from the Peruvian Andes is presented, with a disease period of 4 months characterized by gynaecorrhagia, with evidence of a 5cm tumor cervix. Immunohistochemistry was performed on the biopsy of cervix to differentiate lymphoma from squamous cell carcinoma. Primary diagnosis: Primary diffuse large B-cell lymphoma of the cervix with Ann Arbor IE IPI low-risk staging. Therapeutic interventions and results: She being managed with immunochemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone), followed by consolidative external radiotherapy at a dose of 3,000cGy in 15 sessions with a special IMRT technique. Resulting in satisfactory disease control and no complications from irradiation.Conclusion: Primary diffuse large B-cell lymphoma of the cervix is very rare, therefore, in a case of primary stromal lesion of the cervix, suspicion of lymphoma should be taken into account.(AU)

Sclerosing stromal tumor of the ovary: Two case reports and literature review / Tumor estromal esclerosante de ovario: reporte de 2 casos clínicos y revisión de la literatura

Introduction: Sclerosing stromal tumors (SSTs) are rare benign ovarian tumors. They represent 6% of sex cord stromal tumors. Its preoperative diagnosis is often a challenge due to its similarity to malignant tumors on ultrasound imaging. We present two cases of SSTs to emphasize the consideration of this type of tumors in the differential diagnosis of solid adnexal masses in young women. A review of the literature on the typical ultrasound features, clinical presentation, and management of SSTs was performed. Main symptoms and/or clinical findings: Pelvic pain was the main symptom in both cases. In the first case, transvaginal ultrasound revealed an unilocular solid adnexal mass of 59mm×44mm×45mm with cystic areas and marked peripheral and central vascularization. MRI (magnetic resonance imaging) revealed a 50mm×50mm heterogeneous adnexal mass with a solid peripheral component and a cystic-necrotic center. In the second case, pelvic ultrasound showed a solid cystic adnexal mass of 103mm×77mm with marked peripheral vascularity. Main diagnoses: Postoperative anatomopathological diagnosis in both cases was an ovarian SST.Therapeutic interventions and results. Unilateral laparoscopic salpingo-oophorectomy and oophorectomy, respectively, was performed without incidents. There has been no recurrence during follow-up.Conclusion: It is important to consider SSTs in the differential diagnosis of young women with a unilateral solid-cystic adnexal mass with a high degree of peripheral and central vascularization. Laparoscopic approach together with fertility-sparing techniques should be considered the treatment of choice.(AU)

Introducción: Los tumores esclerosantes del estroma (SST) son tumores benignos raros del ovario. Representan un 6% de los tumores del estroma de los cordones sexuales. Su diagnóstico preoperatorio suele ser un desafío por su similitud ecográfica con los tumores malignos. Presentamos 2 casos de SST para enfatizar la consideración de este tipo de tumores en el diagnóstico diferencial de masas anexiales sólidas en mujeres jóvenes. Se realizó una revisión de la literatura sobre las características ecográficas típicas, la presentación clínica y el manejo de los SST. Principales síntomas y/o hallazgos clínicos: El dolor pélvico fue el síntoma principal en ambos casos. En el primer caso, la ecografía transvaginal reveló una masa anexial unilocular sólida de 59×44×45mm con áreas quísticas y marcada vascularización periférica y central. La resonancia magnética nuclear reveló una masa anexial heterogénea de 50×50mm con componente sólido periférico y un centro quístico-necrótico. En el segundo caso, la ecografía pélvica mostró una masa anexial sólido quística de 103×77mm con marcada vascularización periférica. Diagnósticos principales: El diagnóstico anatomopatológico postoperatorio en ambos casos fue de un SST de ovario.Intervenciones terapéuticas y resultados: Se realizó ooforectomía y salpingooforectomía unilateral laparoscópica, respectivamente, sin incidencias. No se ha producido recidiva durante el seguimiento. Conclusión: Es importante considerar los SST en el diagnóstico diferencial ante mujeres jóvenes con una masa anexial sólido-quística unilateral con un alto grado de vascularización periférica y central. El abordaje laparoscópico junto con técnicas preservadoras de fertilidad deben ser consideradas el tratamiento de elección.(AU)

Fallo ovárico, una problemática para las mujeres en edad reproductiva y su relación genética / Ovarian failure, a problem for women in reproductive age and its genetic relationship

La insuficiencia ovárica primaria es una condición en la que las mujeres menores de 40años experimentan oligomenorrea o amenorrea durante 4meses o más; esta pérdida temprana de la función ovárica puede estar relacionada con una serie de etiologías, incluidos trastornos genéticos, autoinmunes, infecciones o causas iatrogénicas; no obstante, del 74 al 90% son idiopáticas. A pesar de ser una alteración poco prevalente, es de gran importancia clínica, ya que afecta en múltiples aspectos de la vida a todas las mujeres. En la actualidad se están desarrollando diferentes estudios con el fin de encontrar nuevos blancos moleculares para establecer nuevas terapias para el tratamiento de esta patología.(AU)

Primary ovarian failure is a condition in which women under 40 experience oligomenorrhea or amenorrhea for 4months or longer; this early ovarian function loss may be related to a series of etiologies, including genetic disorders, autoimmune diseases, infections or iatrogenic causes; however 74%-90% are idiopathic. Despite being a less prevalent disorder, it is of great clinical importance since it affects all women in multiple aspects of life. At present, different studies are being developed in order to find new molecular targets to establish new therapies for the treatment of this pathology.(AU)

El tratamiento hormonal es imperativo para todas las pacientes: lo antes posible y siempre / Hormone treatment is imperative for all patients: As soon as possible and always

La endometriosis se considera una enfermedad inflamatoria crónica sistémica benigna y hormonodependiente que afecta aproximadamente a un 10% de las mujeres en edad fértil. Parece que cambios innatos o adquiridos de la capacidad del endometrio para implantar, invadir y crecer en un ambiente inflamatorio con dependencia estrogénica, así como la resistencia a la progesterona son características fundamentales para la aparición y desarrollo de la endometriosis. No existe, por el momento, ningún tratamiento óptimo que consiga alcanzar los cuatro objetivos básicos del tratamiento de la endometriosis: suprimir los síntomas, restaurar la fertilidad, eliminar la endometriosis visible, y evitar la progresión de la enfermedad. Puesto que la enfermedad se considera crónica, el tratamiento médico administrado, hasta la llegada de la menopausia o de una gestación, debe ser de larga duración, efectivo y seguro. Así pues, sus objetivos reales serán la reducción o eliminación de los síntomas y/o mejoría de la fertilidad. Dadas las limitaciones y riesgos de las cirugías, el tratamiento de primera elección en la actualidad es el hormonal. Este debe individualizarse en función de la edad, paridad, deseo genésico, síntomas asociados, antecedentes patológicos y preferencias de la paciente. De forma global, existen dos tipos de tratamientos de primera elección: los estroprogestágenos en regímenes extendidos o continuos y algunos progestágenos en diferentes vías de administración (dienogest, acetato de noretisterona o desogestrel por vía oral, así como el dispositivo intrauterino de levonorgestrel de alta dosis). Los diferentes tratamientos y sus pros y contras se exponen en el artículo.(AU)

Endometriosis is nowadays considered an inflammatory chronic benign disease that responds to hormone manipulation and affects up to 10% of women in fertile age. It seems that innate or acquired changes in the endometrium ability to implant, invade and grow in an inflammatory milieu with estrogenic dependence and progesterone resistance are the responsible for new endometriosis implants and contribute to perpetuate the illness. There is, at the moment, no optimal known treatment that achieves the four basic objectives for the treatment of endometriosis: treat the symptoms, improve fertility, eliminate endometrial implants, and avoid illness progression. As is now considered a chronic condition, the prescribed medical treatment, until the patient arrives to the physiological menopause status or gets pregnant, must be considered in the long term, and must be effective and safe. Therefore, the realistic objectives of the treatment are the reduction or abolishment of symptoms and/or improve fertility. As a consequence of the limitations and risks of endometriosis surgeries, the first-line treatment is hormonal. This must be individualized according to age, parity, pregnancy desire, associated symptoms, other illnesses and patients preferences. Globally, there are two main types of first-line hormonal treatments: estroprogestins in extended or continuous regimens and some progestins in different routes of administration (dienogest, norethisterone acetate or desogestrel orally, and levonorgestrel high-dose intrauterine device). The different hormonal treatments and their pros and cons are explained in the manuscript.(AU)

Nuevo paradigma en la cirugía del mioma: reparación uterina / New paradigm in fibroid surgery: Uterine repair

Los miomas uterinos son una patología frecuente que afecta fundamentalmente a mujeres en su tercera y cuarta década de su vida. La mayoría son asintomáticos. Sin embargo, algunos pueden tener una importante repercusión clínica o en la fertilidad de la paciente. Recientemente se han producido cambios relevantes en el diagnóstico y manejo de esta entidad. En este manuscrito se pretende resumir dichos cambios abordados en el 1er Congreso Nacional de la Sociedad Española para el estudio de las Miomas y Endometriosis.(AU)

Uterine fibroids are a frequent pathology that mainly affects women in their third and fourth decade of life. Most are asymptomatic. However, some may have a significant clinical impact or on the fertility of the patient. Recently there have been relevant changes in the diagnosis and management of this entity. This paper aims to summarize these changes discussed at the 1 st National Congress of the Spanish Society for the Study of Fibroids and Endometriosis.(AU)

Controversias en el tratamiento de los miomas / Controversy in the treatment of uterine fibroids

El mioma uterino representa el tumor más frecuente en la mujer de edad reproductiva, aunque solo un 25% de mujeres precisarán tratamiento debido a la presencia de síntomas. Disponemos de pocos estudios aleatorizados que hayan comparado las distintas opciones de tratamiento para el mioma uterino entre ellas; por ahora, la cirugía sigue siendo la opción que ha ofrecido mejores tasas de resolución sintomática, mejoría en calidad de vida y menor tasa de recurrencia. A pesar de la amplia difusión de la cirugía, sí que parece razonable pensar que, disminuyendo los tratamientos quirúrgicos, ya sea con terapias menos invasivas o con nuevos tratamientos médicos, se podría disminuir por un lado la morbilidad asociada a la cirugía y, por otro lado, los costes asociados. En este sentido, las técnicas ablativas para el tratamiento del mioma, la EAU, el HIFU y la radiofrecuencia, han demostrado resultados en cuanto a control sintomático y calidad de vida equiparables a la cirugía, con una baja tasa de complicaciones graves. El mayor problema sería las tasas de recurrencia y el impacto que pueden tener sobre la fertilidad futura de las pacientes. Será necesario disponer de mayor evidencia y estudios comparativos a largo plazo respecto a nuevas técnicas ablativas alternativas a los abordajes quirúrgicos.(AU)

Uterine fibroids are the most common tumours in women of reproductive age, but only 25% of women will require treatment due to the presence of symptoms. There are few randomised studies that have compared the different treatment options for uterine myoma; for the moment, surgery remains the option that offers the best rates of symptomatic resolution, improved quality of life, and a lower recurrence rate. Despite the widespread use of myoma surgery, it seems reasonable to believe that by reducing surgical treatments, either with less invasive therapies or with new medical treatments, both associated morbidity and costs would be reduced. In this sense, ablative techniques for myoma treatment, UAE, HIFU, and radiofrequency, have demonstrated results in terms of symptomatic control and quality of life comparable to surgery, with a low rate of major complications. Recurrence rates and the impact on patients’ future fertility would be the main concern. Future long-term comparative studies of ablative techniques and surgical approaches are needed.(AU)

Conceptos actuales en cirugía histeroscópica: superando barreras y ampliando límites / Current concepts in hysteroscopic surgery: Overcoming barriers by extending limits

Dentro de la patología intracavitaria estructural, los miomas submucosos plantean una mayor dificultad de manejo frente a los pólipos. Dentro de los miomas submucosos los miomas tipo0 y1 son más fáciles de tratar, dado que su separación del miometrio subyacente es técnicamente más fácil. Así, las cirugías histeroscópicas más complicadas son actualmente las miomectomías de miomas submucosos tipo2.Se ha empezado a describir también el manejo histeroscópico de miomas tipo3 por histeroscopia.Con este artículo planteamos hacer una revisión de los puntos más relevantes para llevar a cabo un tratamiento adecuado de este tipo de miomas, revisando su diagnóstico, las técnicas quirúrgicas, la preparación de la paciente y la forma de evitar complicaciones quirúrgicas.(AU)

Within structural intracavitary pathology, submucosal myomas are more difficult to manage than polyps. Of the submucosal myomas, type0 and type1 are easier to treat because their separation from the underlying myometrium is technically easier. Therefore, the most complicated hysteroscopic surgeries are currently type2 submucosal myomectomies.We have also begun to describe the hysteroscopic management of type3 myomas.With this article we propose to make a review of the most relevant points for the correct treatment of this type of myoma, reviewing its diagnosis, surgical techniques, patient preparation, and how to avoid surgical complications.(AU)

Endometriosis: papel del láser de CO2 en el abordaje quirúrgico / Endometriosis: CO2 laser in surgical treatment

El tratamiento quirúrgico de elección del endometrioma es la quistectomía clásica o decapsulación. No obstante, hay suficiente evidencia científica donde se demuestra que esta técnica se asocia a una reducción de la reserva ovárica, ya sea por la exéresis de tejido ovárico sano durante el procedimiento o por el daño térmico realizado durante el control de la hemostasia. Por este motivo, se han descrito nuevas aproximaciones quirúrgicas para paliar este efecto negativo sobre la reserva ovárica. El uso del láser CO2 en ginecología se conoce desde la década de los 80, y la vaporización de la cápsula del endometrioma mediante este láser es una técnica simple, sencilla de usar, fácilmente reproducible y técnicamente accesible. Aunque inicialmente se pensó que la tasa de recurrencia con esta técnica era superior, varios estudios demuestran lo contrario. Asimismo, el daño sobre la reserva ovárica es menor comparado con la decapsulación, en términos de mejor recuento folicular y nivel de hormona antimülleriana. Aunque las tasas de gestación espontánea y por técnicas de reproducción asistida son similares, en los casos de reproducción asistida las pacientes tratadas con vaporización láser CO2 presentan un mayor recuento folicular y nivel de hormona antimülleriana comparadas con las pacientes tratadas con decapsulación. A día de hoy, el tratamiento del endometrioma sigue siendo motivo de discusión. No obstante, los estudios revisados a continuación favorecen las técnicas ablativas en términos de preservar mejor la reserva ovárica sin mayor riesgo de recurrencia.(AU)

The surgical treatment of choice for endometrioma is cystectomy or endometrioma decapsulation. However, there is sufficient scientific evidence showing that this technique is associated with a decrease in ovarian reserve, either due to the removal of healthy ovarian tissue during the procedure or due to thermal damage performed during the control of haemostasis. For this reason, new surgical approaches have been described to alleviate this negative effect on ovarian reserve. The use of the CO2 laser in gynecology has been known since the 1980s, and vaporization of the endometrioma capsule using this laser is a simple, easy-to-use, easily reproducible, and technically accessible technique. Although it was initially thought that the recurrence rate with this technique was higher, several studies show the opposite. Likewise, the damage to the ovarian reserve is less compared to decapsulation, in terms of better follicular count and antimullerian hormone level. Although the rates of spontaneous pregnancy and assisted reproductive techniques are similar, in assisted reproductive techniques patients treated with CO2 laser vaporization have a higher follicular count and antimullerian hormone level compared to patients treated with decapsulation. To this day, the treatment of endometrioma continues to be a matter of discussion. However, the studies reviewed below favor ablative techniques in terms of better preserving ovarian reserve without increased risk of recurrence.(AU)

MicroRNAs as the critical regulators of Forkhead box protein family during gynecological and breast tumor progression and metastasis.

Gynecological and breast tumors are one of the main causes of cancer-related mortalities among women. Despite recent advances in diagnostic and therapeutic methods, tumor relapse is observed in a high percentage of these patients due to the treatment failure. Late diagnosis in advanced tumor stages is one of the main reasons for the treatment failure and recurrence in these tumors. Therefore, it is necessary to assess the molecular mechanisms involved in progression of these tumors to introduce the efficient early diagnostic markers. Fokhead Box (FOX) is a family of transcription factors with a key role in regulation of a wide variety of cellular mechanisms. Deregulation of FOX proteins has been observed in different cancers. MicroRNAs (miRNAs) as a group of non-coding RNAs have important roles in post-transcriptional regulation of the genes involved in cellular mechanisms. They are also the non-invasive diagnostic markers due to their high stability in body fluids. Considering the importance of FOX proteins in the progression of breast and gynecological tumors, we investigated the role of miRNAs in regulation of the FOX proteins in these tumors. MicroRNAs were mainly involved in progression of these tumors through FOXM, FOXP, and FOXO. The present review paves the way to suggest a non-invasive diagnostic panel marker based on the miRNAs/FOX axis in breast and gynecological cancers.

Matching of advanced undergraduate medical students' competence profiles with the required competence profiles of their specialty of choice for postgraduate training.

BACKGROUND: Matching between undergraduate students and their chosen specialty has implications for their personal job satisfaction and performance as well as societies' needs regarding health care quality. Knowledge regarding student-specialty fit can help improve students' decisions and detect potential deficiencies in specific competences. In this study, we compare self-assessed competence profiles of medical students close to graduation with the competence profiles of their specialty of choice for postgraduate training. METHODS: Self-assessed competence profiles were collected with the modified requirement-tracking (R-Track) questionnaire from 197 final-year medical students close to graduation in 2022. To determine student-specialty fit, difference scores between students' self-assessed competences and physicians' requirements for specific specialties were calculated across the R-Track's six competence areas "Motivation", "Personality traits", "Social interactive competences", "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities", which were assessed on a 5-point Likert scale (1: "very low" to 5: "very high"). Mean difference scores across competence areas were calculated and compared between specialties with multivariate analysis of variance. Student-specialty fit was also calculated independent of students' choices. RESULTS: The competence area "Motivation" scored highest for both students and physicians across specialties. However, students' scores were lower than physicians' requirements for "Motivation" as well as "Personality traits" across all specialties. Difference scores for "Social interactive competences" were either close to zero or showed higher scores for students. A similar competence pattern for internal medicine, general medicine, paediatrics, and gynaecology was identified with higher than required student scores for "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities". All other specialties showed higher physicians' requirements for at least one of these competence areas. Independent of students' specialty choice, we found the highest difference score in favour of student scores for general medicine (0.31) and the lowest difference score for internal medicine (-0.02). CONCLUSIONS: Students' competence profiles overall show better fit with person-oriented specialties. "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities" show higher requirement scores for more technique-oriented specialties. Students interested in such specialties could focus more on basic skill development in undergraduate training or will develop specific skills during residency.

[ICG technologies in surgical treatment of benign diseases in gynecology]. / ICG-tekhnologii v khirurgicheskom lechenii dobrokachestvennykh zabolevanii v ginekologii.

ICG (indocyanine green) angiography is a method of visualizing blood flow and tissue perfusion based on intravenous administration of ICG and assessment of vascular distribution through an infrared fluorescence camera. Since the advent of ICG as a near-infrared fluorophore, fluorescence imaging has become an important tool in many areas of surgery. Several options for ICG angiography have been recently proposed in surgical gynecology. The authors describe application of ICG including assessment of myometrial and endometrial perfusion in myomectomy or resection of adenomyosis, tissue perfusion in surgical treatment of endometriosis, blood flow in hard-to-reach places in laparoscopic procedures and reconstructive surgery. ICG was useful in laparoscopic management of some benign gynecological diseases. In particular, this technology can improve treatment of endometriosis, especially deep infiltrative endometriosis, benign neoplasms.

Asynchronous Bilateral Ovarian Torsion: A Case Report and Review of Literature.

Ovarian/adnexal torsion is a rare gynaecological emergency presenting with nonspecific signs and symptoms mimicking other causes of acute abdomen. Asynchronous bilateral ovarian torsion is even rarer but has serious implications as it may potentially lead to castration. Traditionally, ovarian torsion has been treated by surgical resection; however, there is growing evidence that the ovary regains its function when detorsed and left in situ. We report a case of a bilateral asynchronous ovarian torsion in a young female that occurred after an interval of 8 years, which was managed by untwisting the pedicle and preserving the ovary. Key Words: Ovarian torsion, Castration, Bilateral, Gynaecological emergency.

Prevalence and Bother of Postvoid Dribbling and Urine Spraying or Splitting: Survey of a General Gynecology Population.

IMPORTANCE: Postvoid dribbling is described well for men in urologic literature but is poorly defined for women, especially in those not presenting for urogynecologic care. OBJECTIVE: The objective was to assess prevalence and bother of postvoid dribbling, urine spraying (ie, deviation of the urine stream), and other bothersome voiding/storage symptoms in a general gynecology population. STUDY DESIGN: This was an anonymous cross-sectional survey study of women presenting to academic general gynecology practices for benign gynecologic care or well-woman visits; patients were not presenting for urinary incontinence or voiding dysfunction. A questionnaire was used to assess the presence and perceptions of voiding behavior and urinary symptoms with an emphasis on postvoid dribbling and urine spraying. The questionnaire included both the validated Questionnaire for Urinary Incontinence Diagnosis and nonvalidated questions. RESULTS: Nonpregnant adult women (N = 355) were surveyed. The median age was 43 years (interquartile range, 33-51 years). The sample was 45% White, 23% Black, 3% Asian, and 13% other. Furthermore, 39% were Latina; 68%, parous; and 28%, postmenopausal. The prevalence (95% confidence interval) of immediate postvoid dribbling was 186 of 327 or 57% (51-62%), and of these, it was at least somewhat bothersome in 37% but moderately-to-quite-a-bit bothersome in 8%. Urine spraying occurred in 222 of 333 or 67% (61-72%), and of these, it was at least somewhat bothersome in 53% but moderately-to-quite-a-bit bothersome in 17%. Approximately 20% reported stress and/or urgency urinary incontinence; both postvoid dribbling and urine spraying were highly associated with these symptoms. CONCLUSIONS: This study of women seeking benign gynecologic care shows a high prevalence of postvoid dribbling and urine spraying symptoms. However, moderate-or-greater bother was relatively uncommon.

Geographic Disparities in Potential Accessibility to Gynecologic Oncologists in the United States From 2001 to 2020.

OBJECTIVE: To use a spatial modeling approach to capture potential disparities of gynecologic oncologist accessibility in the United States at the county level between 2001 and 2020. METHODS: Physician registries identified the 2001-2020 gynecologic oncology workforce and were aggregated to each county. The at-risk cohort (women aged 18 years or older) was stratified by race and ethnicity and rurality demographics. We computed the distance from at-risk women to physicians. Relative access scores were computed by a spatial model for each contiguous county. Access scores were compared across urban or rural status and racial and ethnic groups. RESULTS: Between 2001 and 2020, the gynecologic oncologist workforce increased. By 2020, there were 1,178 active physicians and 98.3% practiced in urban areas (37.3% of all counties). Geographic disparities were identified, with 1.09 physicians per 100,000 women in urban areas compared with 0.1 physicians per 100,000 women in rural areas. In total, 2,862 counties (57.4 million at-risk women) lacked an active physician. Additionally, there was no increase in rural physicians, with only 1.7% practicing in rural areas in 2016-2020 relative to 2.2% in 2001-2005 ( P =.35). Women in racial and ethnic minority populations, such as American Indian or Alaska Native and Hispanic women, exhibited the lowest level of access to physicians across all time periods. For example, 23.7% of American Indian or Alaska Native women did not have access to a physician within 100 miles between 2016 and 2020, which did not improve over time. Non-Hispanic Black women experienced an increase in relative accessibility, with a 26.2% increase by 2016-2020. However, Asian or Pacific Islander women exhibited significantly better access than non-Hispanic White, non-Hispanic Black, Hispanic, and American Indian or Alaska Native women across all time periods. CONCLUSION: Although the U.S. gynecologic oncologist workforce increased steadily over 20 years, this has not translated into evidence of improved access for many women from rural and underrepresented areas. However, health care utilization and cancer outcomes may not be influenced only by distance and availability. Policies and pipeline programs are needed to address these inequities in gynecologic cancer care.