Comparison of Sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa graft and laparoscopic peritoneal vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser syndrome.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to compare the perioperative, anatomical and functional outcomes of patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), undergoing Sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa (SIS) graft or laparoscopic peritoneal (Davydov) vaginoplasty. METHODS: In this retrospective study, a total of 117 patients with MRKHS undergoing creation of a neovagina from 2017 to 2020 were retrospectively investigated. Comparisons between continuous variables were performed using Student's t-test and between qualitative variables using chi-squared tests. RESULTS: The operative time, return of bowel activity and return to work were the longest in the laparoscopic Davydov group (P < 0.001). The total cost was the highest in the SIS graft group (P < 0.001). The length of the neovagina was 7.9 ± 1.2 cm in the Sheares group, 7.1 ± 0.8 cm in the SIS graft group and 8.1 ± 1.1 cm in the laparoscopic Davydov group. The difference in the length of the neovagina was significant (P < 0.001). There was significant difference in the duration of continuous mould wearing (P < 0.001). There were no significant differences in the total female sexual function index (FSFI) scores or in the satisfaction scores of the male partner among the three groups. CONCLUSION: Sheares vaginoplasty and the vaginoplasty using SIS graft caused less trauma and provided similar functional results to laparoscopic peritoneal vaginoplasty. However, the patients in the Sheares group and SIS graft group needed to wear the mould for a longer duration post-surgery. Sheares vaginoplasty can provide a valuable and economic alternative method for the creation of a neovagina in patients with MRKHS.

Comparison of two different methods for cervicovaginal reconstruction: a long-term follow-up.

INTRODUCTION AND HYPOTHESIS: As a consequence of the evolution of surgery in reconstructive techniques, cervicovaginal reconstruction has become an option for patients diagnosed with congenital cervical and vaginal atresia. This study was aimed at comparing long-term clinical and anatomical results in patients who had cervicovaginal reconstruction with either a small intestinal submucosa (SIS) graft or a split-thickness skin (STS) graft. METHODS: This was a retrospective study of 34 patients who underwent cervicovaginal reconstruction using SIS or STS grafts between January 2012 and August 2017. The patients' postoperative resumption of menstruation, vaginal length, body image satisfaction, and sexual satisfaction were assessed. Quantitative and categorical variables were compared using Student's t test and Chi-squared test respectively. RESULTS: The mean follow-up time was 81.29 ± 20.69 months. The SIS group had a shorter surgery time, an earlier return to work, and a higher cost (p < 0.05). All patients resumed menstruation, but 4 patients were diagnosed with cervical stricture. There was no significant difference in the length of the neovagina, and the satisfaction score of the sexual life of patients and their sexual partners was similar in both groups. Patients in the SIS group showed greater satisfaction with their bodies (p < 0.001). One patient in the SIS group got pregnant via assisted-reproduction techniques. CONCLUSIONS: Cervicovaginal reconstruction using SIS or STS grafts is an effective treatment for patients diagnosed with congenital cervical and vaginal atresia. The method of SIS graft is simpler, with less surgical injury and greater body satisfaction, but it is more expensive.

Association of preoperative conization with recurrences after laparoscopic radical hysterectomy for FIGO 2018 stage IB1 cervical cancer.

OBJECTIVE: To evaluate association of preoperative conization with recurrences after laparoscopic radical hysterectomy (LRH) for FIGO 2018 stage IB1 cervical cancer. METHODS: This is a retrospective single-center study. Patients who underwent LRH for cervical cancer with squamous, adenosquamous and adenocarcinoma subtype from January 2014 to December 2018 were reviewed. All patients were restaged according to the 2018 FIGO staging system. Those who were in FIGO 2018 stage IB1 met the inclusion criteria. General characteristics and oncologic outcomes including recurrence-free survival (RFS) were analyzed. RESULTS: A total of 1273 patients were included in the analysis. 616 (48.4%) patients underwent preoperative biopsy, and 657 (51.6%) patients underwent conization. Residual disease was observed in 822 (64.6%) patients. During a median follow-up of 50.30 months, 30 (2.4%) patients experienced recurrence. The univariate analysis showed that patients who had larger tumor diameter, the presence of residual tumor at final pathology, and underwent adjuvant treatment had a significant higher risk of recurrence (P < 0.01). Conversely, patients who underwent conization were significantly less likely to experience recurrence (P = 0.001). In the multivariate analysis, the independent risk factor associated with an increased risk of recurrence was resident macroscopic tumor (HR: 38.4, 95% CI 4.20-351.64, P = 0.001). On the contrary, preoperative conization was associated with a significantly lower risk of recurrence (HR: 0.26; 95% CI 0.10-0.63, P = 0.003). The Kaplan-Meier curves showed patients who underwent conization had improved survival over those who underwent biopsy (5 year RFS: 98.6 vs 95.1%, P = 0.001). The 5 year RFS of patients with residual tumor was significantly different (R0: 99.2%, R1: 97.4%, R2: 93.6%, P < 0.001), especially the patients with residual macroscopic tumor after conization (R0: 99.5%, R1: 99.0%, R2:92.4%, P = 0.006). CONCLUSION: Preoperative conization and the absence of residual tumor at the time of surgery might play a protective role in patients with FIGO 2018 IB1 cervical cancer following LRH, which support the theory of the influence of intraoperative tumor spread during radical hysterectomy. Further prospective evidence is needed.

Morphologic assessment of hypertonic citrate adenine, histidine-tryptophan-ketoglutarate, and university of Wisconsin solutions for hypothermic uterus preservation in rats.

AIM: Optimizing perfusate for static cold storage is one of the key ways of reducing organ dysfunction and rejection in organ transplantation. Here, we tested the effectiveness of the three different solutions for hypothermic uterus preservation. METHODS: Twenty rats were divided into four groups, five in each group. Uterine grafts were retrieved and perfused in situ. The uteri were preserved at 4°C in normal saline as control group (group NS), hypertonic citrate adenine (group HCA), histidine-tryptophan-ketoglutarate (group HTK), or university of Wisconsin solutions (group UW) for 0, 12, 24, and 48 h, respectively. HE, electron microscopy, TUNEL staining, and Cleaved Caspase3 immunohistochemical staining were assessed at each time point. RESULTS: There was no significant difference in the uterine retrieval time, perfusion time, and the amount of perfusion solution in NS, HCA, HTK, and UW groups (p > 0.05). HCA and HTK can well preserve the pathological morphology of rat uterine tissues for up to 24 h, and the apoptosis rates of the two groups are 7.2% and 7.1%, respectively, with no statistical difference (p > 0.05). Still, the protective effect of HTK on the ultrastructure of cells was much better than HCA. There was a significant difference in the apoptosis rate of UW (6.5%), HTK (8.8%), and HCA (9.4%) at 48 h, with mitochondrial and endoplasmic reticulum structure well preserved only in UW. CONCLUSION: At 4°C, normal saline is not suitable to preserve rat uterus for more than 12 h. The morphologic results would favor the use of HTK rather than HCA for short-term hypothermic uterus preservation (≤24 h). UW is better than HTK and HCA for 48 h hypothermic uterus preservation.

Long noncoding RNA TC0101441 induces epithelial-mesenchymal transition in epithelial ovarian cancer metastasis by downregulating KiSS1.

Peritoneal metastasis is a critical feature and clinical challenge in epithelial ovarian cancer (EOC). We previously identified a novel long noncoding RNA (lncRNA, TC0101441) in epithelial ovarian cancer (EOC) using microarrays. However, the impact of TC0101441 on EOC metastasis and prognosis remains unclear. TC0101441 expression in EOC tissues and its correlation with clinicopathological factors and prognosis were examined. A series of in vitro and in vivo assays were performed to elucidate the roles and mechanism of TC0101441 in EOC metastasis. We found that TC0101441 levels were elevated in EOC tissues compared with those in normal controls and significantly correlated with an advanced clinical stage and lymph node metastasis. TC0101441 was determined to be an independent prognostic predictor of overall survival (OS) and disease-free survival (DFS). Furthermore, loss-of-function assays showed that TC0101441 promoted the invasive and metastatic capacities of EOC cells both in vitro and in vivo. Mechanistically, the prometastatic effects of TC0101441 were linked to the induction of epithelial-mesenchymal transition (EMT). Importantly, KiSS1 was identified as a downstream target gene of TC0101441 and was downregulated by TC0101441 in EOC cells. After TC0101441 was silenced, the corresponding phenotypes of EOC cell invasion and EMT were reversed by the overexpression of KiSS1. Taken together, our data suggest that TC0101441 functions as a potential promigratory/invasive oncogene by promoting EMT and metastasis in EOC through downregulation of KiSS1, which may represent a novel prognostic marker and therapeutic target in EOC.

Clinical applications of uterus transplantation in China: Issues to take into consideration.

Uterus transplantation (UTx) is an emerging surgical treatment for patients with absolute uterine factor infertility. However, the initial low surgical success of human UTx from the teams worldwide has revealed the difficulty of the surgery and called for preparatory team training in large animals. Also, the team who carried out the human UTx without previous systematic research in large animals or deceased donors encountered transplant failures, which was controversial and even deprived them of further trials. Various UTx studies in large animals, including dogs, pigs, sheep and macaques have been performed in China from different teams, compared to other countries around the world. However, among over 70 UTx that have been carried out worldwide, only three were carried out in China, with one live baby achieved. In this paper, we explore the possible challenges for human UTx in China. We conclude that it is critical to learn the lessons from the international team and adopt the international ethic views regarding UTx on humans. Also, it would be positive for the Chinese groups to establishing an academic society for UTx with regular meetings, which will raise public awareness of UTx, and guide the proper development of human UTx in China.

Successful orthotopic uterine allotransplantation in a rabbit model using aorta and cava anastomoses: a short-term viability study.

PURPOSES: We aim to develop a rabbit model system for studies on uterus transplantation. METHODS: Six sexually mature female New Zealand white rabbits of proven fertility were used for harvesting the uterine allograft with an aortic-caval macrovascular patch (including the aorta, inferior vena cava, common and internal iliacs, and uterine arterial and venous tree). The patches were transplanted in the six recipients orthotopically using aorta and cava anastomoses. Tacrolimus (0.5 mg twice daily, p.o.) was administered postoperatively for immunosuppression. RESULTS: Surgical survival was 100% (n = 6), and the graft survival rate was 83.3% (n = 5). No rabbits died intraoperatively, but only one achieved short-term survival (for 8 days). Four rabbits (#1, #2, #3 and #4) died within the first 24 h as a result of veno-vena anastomosis breakdown, bradycardia, intestinal necrosis, and respiratory failure, respectively. Rabbits #5 (30 h) and #6 (8 days) died from intestinal obstruction and pneumonia, respectively. Uterine morphology was normal in rabbit #6, and rejection was not observed in the grafted uterus, which was further verified by H&E and immunohistochemistry. CONCLUSIONS: Aorta and cava anastomoses can be used to ensure a viable transplanted uterus by reconstructing an adequate blood supply to the transplanted uterine graft in a rabbit model. We have demonstrated the feasibility of tacrolimus monotherapy in suppressing the rejection of an allotransplanted uterus in a rabbit model. However, UTx in a rabbit model seems difficult to achieve long-term survival.

Management of partial vaginal agenesis according to the Wharton-Sheares-George technique - a long-term follow-up.

The purpose of this study was to explore the long-term follow-up of treatment of congenital partial vaginal agenesis using the Wharton-Sheares-George technique. The technique was performed on 52 patients with congenital partial vaginal atresia from January 2009 to December 2017. As a result, the mean operating time of the Wharton-Sheares-George technique procedure was 25.6 ± 2.2 min. The mean estimated blood loss was 16.7 ± 4.7 mL. The average length of stay in hospital for the patients was 2.3 ± 0.2 days. There were no intraoperative and postoperative complications. The median duration of follow-up was 58 months. All of the patients experienced a resumption of menses. The mean vaginal length at 3 months was 7.3 ± 0.8 cm. Vaginal stenosis and adhesion did not occur in any cases during the follow-up. Twenty patients had sexual activities and the mean value of the FSFI questionnaire was 31.2 ± 4.0. Six cases became pregnant. There were four cases who each delivered one child and two cases who both delivered two children.IMPACT STATEMENTWhat is already known on this subject? It has been reported that the Wharton-Sheares-George technique provides, functionally and anatomically, very satisfactory results for the patients with Mayer-Rokitansky-Küster-Hauser syndrome. However, a study of the Wharton-Sheares-George technique in patients with congenital partial vaginal agenesis has not been reported previously in the medical literature.What the results of this study add? Our results have indicated that the Wharton-Sheares-George technique provides short operation time and length of stay, little blood loss intraoperatively, a satisfactory vaginal length and sexual activity in patients with congenital partial vaginal agenesis.What the implications are of these findings for clinical practice and/or further research? The study suggests that the Wharton-Sheares-George technique provides very satisfactory results in function and anatomy for congenital partial vaginal agenesis.

Combined Laparoscopic and Vaginal Cervicovaginal Reconstruction Using Acellular Porcine Small Intestinal Submucosa Graft in a Patient with Mayer-Rokitansky-Küster-Hauser Syndrome (U5aC4V4).

STUDY OBJECTIVE: To introduce a creation that combines laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using a small intestinal submucosa (SIS) graft in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome who had a rudimentary cavity (U5aC4V4) [1]. DESIGN: A video article introducing a new surgical technique. SETTING: A university hospital. PATIENTS: A 24-year-old patient had primary amenorrhea and irregular lower abdominal pain for 9 years. The patient was Tanner stage 3 for pubic hair and Tanner stage 4 for breast development. The physical examination revealed no vagina. A primordial uterus and a uterus with a rudimentary cavity were detected by magnetic resonance imaging [2,3]. However, the rudimentary cavity had no hematometra. Magnetic resonance imaging also found a left solitary kidney. The diagnosis was MRKH syndrome with a rudimentary cavity (U5aC4V4) [4]. The patient desired resumption of menses and possible future fertility. INTERVENTIONS: Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft was performed. MEASUREMENTS AND MAIN RESULTS: With the Wharton-Sheares-George neovaginoplasty, a vaginal mold with a surrounding SIS graft was inserted into the newly created cavity [5]. Using laparoscopy, the lower uterine segment was incised by shape dissection. The proximal segment of the SIS graft to the lower uterine segment was sutured. A T-shaped intrauterine device with a Foley catheter was fixed in the uterine cavity by the delay of absorbed sutures to prevent cervical or vaginal stenosis. The distal segment of the SIS graft was sutured with the high vaginal or vestibular mucosa vaginally. The operation was successfully completed. The operating time was 2 hours. Hospitalization was 4 days. There were no blood transfusions or complications. The patient had resumption of menses for 2 cycles postoperatively, and she had no dysmenorrhea. The patient did not have sexual intercourse because of the mode in the vagina to prevent vagina stenosis. No cervical stenosis occurred because of the Foley catheter. CONCLUSION: In the past, a uterus with a rudimentary cavity in patients with MRKH was always excised, and patients lost the chance of menstrual onset and fertility. Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft provided a minimally invasive, safe, and effective surgical option for the young patient with MRKH syndrome with a rudimentary cavity. The technique is not complex, is easy to learn and perform, and provided a result with functional and anatomic satisfaction. No special surgical apparatus is needed with this technique.

Comparison of neovaginoplasty using acellular porcine small intestinal submucosa graft or Interceed in patients with Mayer-Rokitansky-Küster-Hauser syndrome.

OBJECTIVE: To compare using the acellular porcine small intestinal submucosa (SIS) graft or the Interceed in patients with MRKH syndrome undergoing creation of a neovagina. METHODS: In this retrospective study, patients with MRKH syndrome undergoing creation of a neovagina from 2016 to 2018 were retrospectively investigated. Wharton-Sheares-George neovaginoplasty was performed using the acellular porcine SIS graft or the Interceed. RESULTS: Overall, 67 patients were included for analysis. The operating time, the estimated blood loss and return of bowel activity were similar between the two groups. However, the total cost in the SIS group was significantly higher than that in the Interceed group due to the cost of the SIS graft. The mean length and width of the neovagina were similar between the two groups. However, the incidence of granulation in vaginal apex was higher in the SIS graft group than that in the Interceed group. There was no statistically significant difference in the total FSFI scores between the two groups who became sexually active postoperatively. CONCLUSIONS: Our results demonstrated that Wharton-Sheares-George method provided the patients to have satisfactory sexual intercourse. The Interceed played a role in the reconstruction of neovagina no less than the SIS graft.

Analysis of the reproductive outcomes and the size of the unicornuate uterus measured by magnetic resonance imaging and their relationship.

PURPOSE: To evaluate the relationship between the uterine size measured by pelvic magnetic resonance and reproductive outcome in women with a unicornuate uterus. METHODS: This was a retrospective study including 140 patients affiliated with unicornuate uterus diagnosed by the pelvic MR prior to their first pregnancy in the Obstetrics and Gynecology Hospital of Fudan University from April 2010 to December 2017. All the length of the unicornuate uterus were re-measured and recorded by skilled radiologists during the study period. We divided all the 140 participants with complete pelvic MR imaging into four groups by the best reproductive outcomes, which refers to Group 1 (primary infertility, n = 21), Group 2 ( < 24 weeks' gestation, n = 34), Group 3 (preterm delivery, 24-35 weeks' gestation, n = 13), Group 4 ( ≥ 35 weeks' gestation, n = 72), followed them up and then analyzed the data. RESULTS: Measurements of 140 patients with hemi-uteri were retrieved for analysis. The mean length of the uterine was 4.90  ± 0.56 cm. There were no significant differences in the uterine cavity length, cervical length, endometrial thickness and uterine wall thickness between the four groups while the uterine length (P = 0.001) was statistically significant. Women with uterine lengths ≥  4.5 cm were more likely to experience full-term delivery compared with the other group (P = 0.001). Ordinal multiple logistic regression analysis showed that the uterine length [OR = 9.03 (95% CI: 2.90-28.13)] and uterine cavity length [OR = 0.32 (95% CI: 0.06-2.04)] were independent protective factors for better obstetric outcomes CONCLUSION: The uterine length is a reliable prognostic factor for the gestational week of delivery and an appropriate antenatal surveillance factor of women with unicornuate uterus.

The role of oral oil administration in displaying the chylous tubes and preventing chylous leakage in laparoscopic para-aortic lymphadenectomy.

BACKGROUND AND OBJECTIVES: This study is aimed to investigate the possibility of preoperative oral oil administration in displaying the chylous tubes and preventing chylous leakage in laparoscopic para-aortic lymphadenectomy. MATERIALS AND METHODS: In this retrospective nonrandomized study, of the 30 patients with gynecological malignancies who had indications for laparoscopic para-aortic lymphadenectomy up to renal vessels, 15 were administered preoperative oral oil (oil a administration) (control group) at our hospital between September 2017 and June 2018. The chylous tube displaying rates, incidences of chylous leakage, and other perioperative data of the two groups were compared. RESULTS: Successful display of chylous tubes was observed in 93.3% (14/15) patients in the oil administration group. The chylous leakage was zero in the oil administration group, and 33.3% (5/15) in the control group. The postoperative drainage duration (4.1 ± 1.0 days vs 7.6 ± 1.4 days, P = 0.000), somatostatin application time (0 day vs 5.9 ± 0.8 days), and postoperative hospital stay (6.0 ± 2.3 days vs 9.1 ± 2.1 days, P = 0.001) were significantly shorter in the oil administration group. The total cost is lower in the oil administration group (4972.52 ± 80.54 dollars vs 6260.80 ± 484.47 dollars, P = 0.000). CONCLUSIONS: Preoperative oil administration is a feasible and effective method to display the chylous tubes and to prevent the chylous leakage in para-aortic lymphadenectomy.

Genetic defect of a combined 17 α-hydroxylase/17,20-lyase deficiency patient with adrenal crisis.

Combined 17 α-hydroxylase/17,20-lyase deficiency (17OHD) is a rare autosomal recessive disease that is a type of congenital adrenal hyperplasia, which results in hypertension, hypokalemia, sexual infantilism, primary amenorrhea in females (46,XX), or pseudohermaphroditism in males (46,XY). It is mainly caused by mutation in the CYP17A1 gene, which encodes a key enzyme in the steroidogenic pathway. However, these patients rarely experience adrenal crisis, due to abnormally high corticosterone levels. Here, we report a 17OHD patient who experienced clinical adrenal crisis on day 1 after gonadectomy. Her (46,XY) genetic defect was c0.715 C > T p.Arg239-stop in exon 4 of CYP17A1, which was confirmed by targeted sequence capture/high-throughput sequencing and Sanger sequencing technology. To the best of our knowledge, 17OHD with adrenal crisis has not been reported previously, and the reason why it arose in this patient might have been inappropriate glucocorticoid administration during the perioperative period.

Evaluation of Tubal Pregnancy After Treatment With Methotrexate by Ultrasound Elastography.

OBJECTIVES: The purpose of this study was to evaluate the application of ultrasound elastography in the assessment of methotrexate (MTX) treatment for tubal pregnancy and the association with the elasticity score and human chorionic gonadotropin (hCG) concentration. METHODS: A total of 73 cases of unruptured tubal pregnancy were diagnosed and treated systemically with MTX. The sonographic characters of conventional transvaginal sonography and elastography and serum hCG concentrations before and after MTX therapy were retrospectively reviewed and analyzed. RESULTS: The mean elasticity score was statistically significantly lower for the ectopic tubal masses of the success group (mean ± SD, 2.58 ± 0.68) than for the failure group (3.33 ± 0.47) on day 7 (P < .001) and similar on day 0. The median elasticity score for the success group on day 7 was 3, and for the failure group, it was 4. When elasticity scores of 3 and 2 were used for the criterion of successful MTX treatment, the elastography had 94.5% sensitivity, 61.1% specificity, 88.1% positive predictive value, and 78.6% negative predictive value. Elastography of the ectopic masses and subsequent hCG concentration at 1 week after the MTX injection in the success group had a strong relationship. CONCLUSIONS: Our results suggest that transvaginal elastography was a useful tool in the evaluation of tubal pregnancy after pharmacologic management.

Evaluation of the Cervix After Cervical Conization by Transvaginal Elastography.

OBJECTIVES: The purpose of this study was to investigate the stiffness of the cervix after the loop electrosurgical excision procedure (LEEP) by transvaginal elastography and its potential ability to predict future pregnancy. METHODS: A retrospective study included patients of reproductive age who underwent LEEP for cervical high-grade squamous intraepithelial lesions on the basis of colposcopic findings and who desired fertility. The characteristics on conventional transvaginal ultrasonography and elastography before and 6 months after LEEP were reviewed and analyzed. Each case had a 12-month follow-up, and the information on pregnancy and a cervical cytologic examination was recorded. RESULTS: Fifty-three patients who completed the 12-month follow-up were included in the analysis. Thirty-two cases (group 1) were pregnant during the follow-up, and the other 21 (group 2) had pregnancy failure. The cervical lengths of group 1 and 2 as measured by traditional transvaginal ultrasonography were similar before and 6 months after LEEP. The resistive index of group 1 was significantly higher 6 months after LEEP than before LEEP (mean ± SD, 0.88 ± 0.36 versus 0.42 ± 0.22; P = .007). The mean elasticity score for the cervix was statistically significantly lower after LEEP (2.21 ± 0.53) than before (3.46 ± 0.78; P = .001) in group 1. However, in group 2, the mean elasticity scores were similar after LEEP (3.19 ± 0.58) and before (3.25 ± 0.66; P = .75). CONCLUSIONS: Our results suggest that elastography was a useful technique for evaluating the stiffness of the cervix after LEEP. Elastography could provide a potential means to predict future pregnancy after LEEP.

Ovarian conservation is associated with better survival in young patients with T1N0M0 cervical adenocarcinoma: a population-based study.

PURPOSE: Ovarian conservation is controversial in patients with cervical adenocarcinoma due to the risk of ovarian metastasis. The aim of this study is to evaluate the association of ovarian conservation with survival outcomes in young patients with T1N0M0 cervical adenocarcinoma. METHODS: Women who were 45 years of age or younger with T1N0M0 cervical adenocarcinoma from 1988 to 2013 recorded in the Surveillance, Epidemiology, and End Results (SEER) database were included. Propensity score weighting was used to balance the intragroup differences. Cause-specific survival (CSS) and overall survival (OS) were compared using Kaplan-Meier estimates. A multivariate Cox model was used to adjust for covariates including propensity score. A stratified analysis was then conducted. RESULTS: Totally, 1090 (79.7%) patients underwent oophorectomy and 278 (20.3%) patients whose ovaries were preserved were identified. Patients with preserved ovaries were younger, with a lower T classification and less likely to undergo pelvic lymphadenectomy (all p < 0.05). After propensity weighting, ovarian conservation group had better cause-specific survival (CSS) (5-year 98.8 versus 97.1%, 10-year 98.0 versus 95.2%, p = 0.0370) and overall survival (OS) (5-year 98.8 versus 97.1%, 10-year 96.5 versus 93.5%, p = 0.0025). After adjustment, the CSS benefit of ovarian conservation was marginally significant (p = 0.051) and OS benefit was still significant (p = 0.006). Stratified analysis showed that the CSS benefit was found in T1b classification (HR, 0.23; 95% CI 0.06-0.89, p = 0.033) and histological grade > 1 (HR 0.12; 95% CI 0.02-0.87; p = 0.035). CONCLUSION: Among young women with T1N0M0 cervical adenocarcinoma, ovarian conservation is associated with better survival.

A Comparative Study of Video Endoscopic Inguinal Lymphadenectomy and Conventional Open Inguinal Lymphadenectomy for Treating Vulvar Cancer.

OBJECTIVE: This study aims to compare the complications, oncological outcomes, cosmetic satisfaction, and quality of life experienced by women with vulvar cancer undergoing video endoscopic inguinal lymphadenectomy (VEIL) versus conventional open inguinal lymphadenectomy (COIL). PATIENTS AND METHODS: Forty-eight consecutive patients with vulvar cancer who underwent COIL (n = 27) or VEIL (n = 21) at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China between 2003 and 2016 were included in this retrospective cohort study. The perioperative data, postoperative complications, oncological outcomes, cosmetic satisfaction, and quality of life of the COIL and VEIL groups were compared. RESULTS: Twenty patients (74.1%) in the COIL group and 19 patients (90.5%) in the VEIL group returned for follow-up after the operation. The median follow-up time was 73 months (8-162 months) for the COIL group and 28 months (8-58 months) for the VEIL group. The inguinal lymph node yield in the VEIL group was comparable with that in the COIL group (15 ± 5 vs 18 ± 6, P = 0.058). The VEIL and COIL groups had a similar 2-year recurrence rate (10.5% vs 10%, P = 0.957) and 2-year disease-specific survival rate (95.5% vs 93.3%, P = 0.724). The wound complication rate was significantly lower in the VEIL group than the COIL group (4.8% vs 55.6%, P = 0.000). The VEIL group had higher body image scores (16.27 ± 1.20 vs 13.16 ± 0.87, P < 0.0001) and cosmetic scores (20.13 ± 0.98 vs 16.92 ± 0.72, P < 0.0001) than the COIL group. The patients in the VEIL group had higher life quality scores on the Functional Assessment of Cancer Therapy-Vulvar questionnaire than those in the COIL group (165.9 ± 6.3 vs 160.5 ± 6.0, P = 0.026). CONCLUSIONS: Compared with COIL, VEIL can effectively reduce postoperative wound complications and improve patients' cosmetic satisfaction and life quality without compromising therapeutic efficacy. Hence, we believe that VEIL is a good alternative to COIL for vulvar cancer patients when surgical expertise is available.

Intraoperative nerve staining in nerve-sparing radical hysterectomy: a pilot study.

OBJECTIVE: To evaluate the feasibility and effectiveness of intraoperative nerve staining by modified leucomethylene blue (MLB). METHODS: Animal experiment was performed to assure whether the tissues dyed blue by MLB were nerves with microscopic examination. Ten patients with cervical cancer were performed by nerve-sparing radical hysterectomy (NSRH) and nerve staining intraoperatively by MLB. The status of staining was recorded. The post-void residual urine volume after removing was measured by ultrasound. The time to post-void residual urine volume of less than 100 ml and the first defecation were recorded. RESULTS: In animal experiment, the tissues dyed blue obviously showed abundant nerve fibers by microscopic examination. The minor nerves were dyed blue clearly in NSRH. The time to post-void residual urine volume of less than 100 ml after removal of the urethral catheter was 10.3 (7-13) days by records. The time to the first defecation was 67.7 (60-82) h. CONCLUSION: Intraoperative nerve staining by MLB provided a new method for nerve location in NSRH. It was safe, effective and convenient.

Efficacy of caesarean scar defect repair in improving postmenstrual bleeding and factors associated with poor effect.

Caesarean scar defect (CSD) can cause postmenstrual bleeding. Defect repair is an effective technique to improve this symptom, but there are still a few patients getting little improvement. This retrospective study evaluates the efficacy of scar repair and explores the factors associated with poor effect. In total, 123 patients were involved in the final analysis. All of them complained about menstruation period >7 days due to postmenstrual bleeding. Before surgery, 87.8% of patients had a menstruation period more than 10 days and 20.3% had a period more than 15 days. After surgery, a normal menstruation period (< =7 days) was achieved in 46.3% (95%CI 37.3%-55.6%) of patients and a menstruation period lasting no more than 10 days was achieved in 74.8% (95%CI 66.2%-82.2%). Through multivariate logistic analysis, four factors were found dependently associated with poor effect (defined as menstruation period >10 days after surgery): repeated caesarean section (OR 9.75, 95%CI 2.30-41.36, 0.002) was a risk factor, while defect volume >600 mm3 (OR 0.14, 95%CI 0.03-0.56, 0.006), interval from caesarean section to symptom emerging >3 months (OR 0.25, 95%CI 0.07-0.94, 0.041) and straight or retroflexed uterus (OR 0.19, 95%CI 0.05-0.79, 0.022) were protective factors. Impact statement What is already known on this subject? Caesarean scar defect can cause postmenstrual bleeding. Defect repair can improve this symptom, but there are still a few patients getting little improvement after surgery. What do the results of this study add? Defect volume >600 mm3, interval from caesarean section to symptom emerging >3 months and straight or retroflexed uterus are protective factors of poor effect (defined as menstruation period >10 days after surgery), and repeated caesarean section is a risk factor. What are the implications of these findings for clinical practice and/or further research? These findings may help in counselling the patients and in medical decision. Further researches are needed to explore other factors associated with surgical effect and build prediction models.

Comparison of small intestinal submucosa graft with split-thickness skin graft for cervicovaginal reconstruction of congenital vaginal and cervical aplasia.

STUDY QUESTION: What is the difference in vaginal-length gain and resumption of menstruation following cervicovaginal reconstruction using split-thickness skin (STS) graft versus small intestinal submucosa (SIS) graft for patients with congenital vaginal and cervical aplasia? SUMMARY ANSWER: No difference was found in the number of patients who resumed menstruation between the two groups; however, significantly greater vaginal-length gain was found in the STS group. WHAT IS ALREADY KNOWN: Hysterectomy and vaginoplasty are typically recommended for patients without a cervix or without a sufficient cervix to avoid postoperative re-obstruction. Advances in surgical techniques have enabled the use of autologous tissues or heterologous biological grafts for reconstructive procedures, allowing patients undergoing these procedures to preserve the possibility of conception. STUDY DESIGN, SIZE, DURATION: This was a retrospective study of 26 women who were diagnosed with congenital vaginal and cervical aplasia with a functional endometrial cavity and underwent cervicovaginal reconstruction using STS or SIS grafts between January 2012 and October 2015 at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. PARTICIPANTS/MATERIALS, SETTING, METHOD: 15 women underwent cervicovaginal reconstruction using SIS graft and 11 underwent cervicovaginal reconstruction using STS graft. Clinical characteristics, perioperative data, resumption of menstruation, vaginal stenosis, length of the neovagina, vaginal-length gain, stricture of the cervix and body image were postoperatively assessed. MAIN RESULTS AND THE ROLE OF CHANCE: At a median follow-up of 21 (2-46) months, all but one of the patients experienced relief of abdominal pain and resumed menstruation. Re-obstruction of the cervix occurred in only one patient in the SIS group. The SIS group reported significantly higher body image scores and cosmetic satisfaction. Although the two groups had a similar vaginal length before surgery, the vaginal-length gain was significantly greater in the STS group (4.9 ± 1.7 cm in the SIS group versus 7.5 ± 0.7 cm in the STS group, P = 0.004) and the neovagina length at 6 months post-operation was significantly shorter in the SIS group (6.5 ± 0.7 cm in SIS the group versus 8.0 ± 0.5 cm in the STS group, P < 0.0001). LIMITATIONS, REASONS FOR CAUTION: Due to a lack of long-term follow-up, patient satisfaction with sex life, pregnancy rates and outcomes after the two approaches require further evaluation. WIDER IMPLICATIONS OF THE FINDINGS: Combined laparoscopic and vaginal cervicovaginal reconstruction using SIS or STS graft is a safe and effective treatment for preserving uterus function in women with congenital vaginal and cervical aplasia. However, SIS graft must still be improved to achieve satisfactory vaginal length. STUDY FUNDING/COMPETING INTERESTS: This study was supported by the Chinese National Nature Sciences Foundation (grant number 81471416) and the National Key Clinical Faculty Construction Program of China. No competing interests are declared. TRIAL REGISTRATION NUMBER: N/A.