Uterovesical fistula and its treatment in Sub-Saharan Africa

AIM

 Aim of the study to summarize the current information on diagnostic and treatment options for uterovesical fistula as a consequence of iatrogenic complication. Methods: Literature review of available information on surgical treatment options for uterovesical fistula resulting from previous caesarean section and comparison with our own experience in the developing world. Conclusion: Uterovesical fistula is an abnormal communication between the bladder and uterus. The cause of this pathology in most cases is an iatrogenic complication, most commonly arising after a caesarean section. The incidence of this pathology varies significantly geographically. In developed countries, these fistulas are rather rare. On the other hand, in developing countries, uterovesical fistulas are more common with a significant impact on the subsequent life of the patient due to generally inaccessible health care.

Risk Factors for the Anal and Oral Human Papillomavirus (HPV) Infections among Women with Severe Cervical Lesions: A Prospective Case-Control Study

The carcinogenicity of HPV infection in the anogenital and oropharyngeal regions is broadly accepted. The aim of the study was to define risk factors for anal and oral HPV infections in high-risk patients with biopsy-proven severe cervical lesions (CIN2+). Altogether immunocompetent 473 females with CIN2+ were categorized into the study group and another 245 women into the control group. The strongest risk factor for anal HPV infection was the presence of cervical HPV infection (p < 0.001). Furthermore, ten or more lifetime sexual partners (p = 0.013), a sexual non-coital contact with the anal area (p < 0.001), and actively practicing anal-penetrative intercourse (p < 0.001) were significantly associated with anal HPV. A history of genital warts in the woman (p = 0.010) and the presence of genital warts in the male partner (p = 0.029) were found statistically significant for the risk of oral HPV infection. Our data suggest that the presence of HPV infection, especially high-risk genotypes, in one anatomical site poses the greatest risk for HPV infection in another anatomical site. The cervix is the main reservoir of infection, but the risk factors for anal and oral HPV infections are dissimilar according to different anatomical distances and more complex routes of transmission.

Anti-Müllerian hormone - clinical use and future possibilities

Anti-Müllerian hormone (AMH) is a protein produced already in human fetus. It has an essential role in the differentiation of the reproductive tract, regulation of the ovaries and testes. The determination of serum AMH levels is used in clinical practice. Today, especially in reproductive medicine in the assessment of ovarian reserve and in the prediction of the response to ovarian stimulation. However, in young cancer patients, it can also predict the risk of ovarian failure after anticancer treatment. It finds further use in pediatric endocrinology in the dia-gnosis of sexual differentiation disorders. In oncology, it is used as a tumor marker for monitoring patients with granulosa tumors. In the future, however, it is also promising to use the knowledge of AMH function for the treatment of gynecological as well as other solid malignancies expressing a tissue-specific receptor for AMH.

Chemoradiotherapy in the treatment of cervical cancer - a single institution retrospective review

BACKGROUND

The aim of this study is a retrospective analysis of treatment outcomes and toxicity in a group of patients with cervical cancer who underwent (chemo) radiotherapy at the Institute of Radiation Oncology in Bulovka University Hospital in Prague in the period 2014-2017.

PATIENTS AND METHODS

During this period, 141 patients were treated, 105 (74.5%) of them underwent combined (chemo) radiotherapy with radical intent and palliative radiotherapy was performed in 36 (25.5%) cases. According to the International Federation of Gynecology and Obstetrics (FIGO) 2009 classification, the most numerous stages were IIB in 39 (27.7%) and IIIB in 64 (45.4%) cases; according to FIGO 2018, a significant number of newly established stages is evident: IIIC1 in 55 (39.0%) patients and IIIC2 in 22 (15.6%) cases.

RESULTS

The median progression-free survival (PFS) and overall survival (OS) reached 31.3, resp. 40.1 months in the whole group. In the subgroup of patients treated with radical intent, the median PFS was 44.0 months and OS 48.8 months; in the palliative subgroup, the median PFS was 9.4 months and OS 14.8 months. In a radically treated subgroup, 7 (6.7%) patients had gastrointestinal or genitourinary manifestations of G3-4 toxicity, and overall acute toxicity (including skin and haematological reactions) of G3-4 occurred in 18 (17.1%) patients. Late toxicity of G3-4 was reported in 13 (12.4%) cases. Patients who underwent complete brachytherapy (BRT) showed significantly better survival compared to patients with a lower number of BRT fractions. The prognostic potential of PS (performance status) and anemia was confirmed; significantly longer overall survival was observed in patients in good general condition or in those without anemia.

CONCLUSION

Our results confirmed the key role of BRT for the delivery of the curative dose to the target volume. The prognostic role of PS and anemia is evident. The side effects were in acceptable limits but we expect improvements because of the use of modern radiotherapy technologies.

A case report of acute apendicitis in puerperium

OBJECTIVE

This article stresses an impact of appropriate management work up in the diagnosis of acute apendicitis in puerperium. Atypical clinical symptoms may cause doubts in diagnosis and may delay necessary surgical intervention.

DESIGN

Case report.

SETTINGS

Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, and Hospital Na Bulovce, Prague.

METHODS

We present a case report describing an atypical presentation of acute apendicitis in early puerperium. Due to atypical course of the disease and atypical imaging locality and morphology, there were doubts about the diagnosis of acute apendicitis, patient was treated conservativelly and the disease later resulted in extensive surgical intervention.

CONCLUSION

Acute appendicitis is the most common cause of non-urogenital morbidity in puerperium. Management of work up and timing of surgical intervention have key impact on maternal mortality and morbidity.

The changes in FIGO staging for carcinoma of the cervix uteri

INTRODUCTION

The carcinoma of the cervix uteri is the fourth most common cancer in women worldwide and more than 85% of these cases occur in developing countries. Altogether 822 new cases were found in the Czech Republic during 2016 which means the incidence 15,3 new diseases/100,000 women.

OBJECTIVE

To provide an overview of changes in FIGO (International Federation of Gynecology and Obstetrics) staging for carcinoma of the cervix uteri with an incorporation of possible imaging methods and/or pathological findings, and clinical assessment of tumor size and extent.

SETTINGS

Gynecologic Oncology Center, Department of Gynecology and Obstetrics, Hospital Na Bulovce and 1st Medical School of Charles University, Prague; Gynecologic Oncology Center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague; Institute of Radiation Oncology, Hospital Na Bulovce, Prague.

METHODS

For this review, we have used the results of studies, review articles, and guidelines of oncogynecologic organisations on the cervical cancer published in English. They were identified through a search of literature using PubMed, MEDLINE-Ovid, Scopus and Cochrane Library with the keywords. We summarize the new classification, main changes compared to the former one and their clinical impact.

CONCLUSION

Lateral extension measurement is removed in the stage IA, the only criterion is the measured deepest invasion.