Urinary incontinence more than 15 years after premenopausal risk-reducing salpingo-oophorectomy: a multicentre cross-sectional study

OBJECTIVE

To study the impact of premenopausal risk-reducing salpingo-oophorectomy (RRSO), compared with postmenopausal RRSO, on urinary incontinence (UI) ≥10 years later.

DESIGN

Cross-sectional study, nested in a nationwide cohort.

SETTING

Multicentre in the Netherlands.

POPULATION

750 women (68% BRCA1/2 pathogenic variant carriers) who underwent either premenopausal RRSO (≤45 years, n = 496) or postmenopausal RRSO (≥54 years, n = 254). All participants were ≥55 years at the time of the study.

METHODS

Urinary incontinence was assessed by the urinary distress inventory-6 (UDI-6); a score ≥33.3 indicated symptomatic UI. The incontinence impact questionnaire short form (IIQ-SF) was used to assess the impact on women's health-related quality of life (HR-QoL). Differences between groups were analysed using regression analyses adjusting for current age and other confounders.

MAIN OUTCOME MEASURES

Differences in UDI-6 scores and IIQ-SF scores between women with a premenopausal and a postmenopausal RRSO.

RESULTS

Women in the premenopausal RRSO group had slightly higher UDI-6 scores compared with women in the postmenopausal RRSO group (P = 0.053), and their risk of symptomatic UI was non-significantly increased (odds ratio [OR] 2.1, 95% confidence interval [95% CI] 0.93-4.78). A premenopausal RRSO was associated with a higher risk of stress UI (OR 3.5, 95% CI 1.2-10.0) but not with urge UI. The proportions of women with a significant impact of UI on HR-QoL were similar in the premenopausal and postmenopausal RRSO groups (10.4% and 13.0%, respectively; P = 0.46).

CONCLUSIONS

More than 15 years after premenopausal RRSO, there were no significant differences in overall symptomatic UI between women with a premenopausal and those with a postmenopausal RRSO.

Long-term effects of premenopausal risk-reducing salpingo-oophorectomy on cognition in women with high familial risk of ovarian cancer: A cross-sectional study

OBJECTIVE

To examine the effect of a premenopausal risk-reducing salpingo-oophorectomy (RRSO) in women at increased risk of ovarian cancer on objective and subjective cognition at least 10 years after RRSO.

DESIGN

A cross-sectional study with prospective follow-up, nested in a nationwide cohort.

SETTING

Multicentre in the Netherlands.

POPULATION OR SAMPLE

641 women (66% BRCA1/2 pathogenic variant carriers) who underwent either a premenopausal RRSO ≤ age 45 (n = 436) or a postmenopausal RRSO ≥ age 54 (n = 205). All participants were older than 55 years at recruitment.

METHODS

Participants completed an online cognitive test battery and a questionnaire on subjective cognition. We used multivariable regression analyses, adjusting for age, education, breast cancer, hormone replacement therapy, cardiovascular risk factors and depression.

MAIN OUTCOME MEASURES

The influence of RRSO on objective and subjective cognition of women with a premenopausal RRSO compared with women with a postmenopausal RRSO.

RESULTS

After adjustment, women with a premenopausal RRSO (mean time since RRSO 18.2 years) performed similarly on objective cognitive tests compared with women with a postmenopausal RRSO (mean time since RRSO 11.9 years). However, they more frequently reported problems with reasoning (odds ratio [OR] 1.8, 95% confidence interval [95% CI] 1.1-3.1) and multitasking (OR 1.9, 95% CI 1.1-3.4) than women with a postmenopausal RRSO. This difference between groups disappeared in an analysis restricted to women of comparable ages (60-70 years).

CONCLUSIONS

Reassuringly, approximately 18 years after RRSO, we found no association between premenopausal RRSO and objective cognition.

Sexual functioning more than 15 years after premenopausal risk-reducing salpingo-oophorectomy

BACKGROUND

Women with a BRCA1/2 pathogenic variant are advised to undergo premenopausal risk-reducing salpingo-oophorectomy after completion of childbearing, to reduce their risk of ovarian cancer. Several studies reported less sexual pleasure 1 to 3 years after a premenopausal oophorectomy. However, the long-term effects of premenopausal oophorectomy on sexual functioning are unknown.

OBJECTIVE

This study aimed to study long-term sexual functioning in women at increased familial risk of breast or ovarian cancer who underwent a risk-reducing salpingo-oophorectomy either before the age of 46 years (premenopausal group) or after the age of 54 years (postmenopausal group). Subgroup analyses were performed in the premenopausal group, comparing early (before the age of 41 years) and later (at ages 41-45 years) premenopausal risk-reducing salpingo-oophorectomy.

STUDY DESIGN

Between 2018 and 2021, 817 women with a high familial risk of breast or ovarian cancer from an ongoing cohort study were invited to participate in our study. Because of a large difference in age in the study between the premenopausal and postmenopausal salpingo-oophorectomy groups, we restricted the comparison of sexual functioning between the groups to 368 women who were 60 to 70 years old at completion of the questionnaire (226 in the premenopausal group and 142 in the postmenopausal group). In 496 women with a premenopausal risk-reducing salpingo-oophorectomy, we compared the sexual functioning between women in the early premenopausal group (n=151) and women in the later premenopausal group (n=345). Differences between groups were analyzed using multiple regression analyses, adjusting for current age, breast cancer history, use of hormone replacement therapy, body mass index, chronic medication use (yes or no), and body image.

RESULTS

Mean times since risk-reducing salpingo-oophorectomy were 20.6 years in the premenopausal group and 10.6 years in the postmenopausal group (P<.001). The mean age at questionnaire completion was 62.7 years in the premenopausal group, compared with 67.0 years in the postmenopausal group (P<.001). Compared with 48.9% of women in the postmenopausal group, 47.4% of women in the premenopausal group were still sexually active (P=.80). Current sexual pleasure scores were the same for women in the premenopausal group and women in the postmenopausal group (mean pleasure score, 8.6; P=.99). However, women in the premenopausal group more often reported substantial discomfort than women in the postmenopausal group (35.6% vs 20.9%; P=.04). After adjusting for confounders, premenopausal risk-reducing salpingo-oophorectomy was associated with substantially more discomfort during sexual intercourse than postmenopausal risk-reducing salpingo-oophorectomy (odds ratio, 3.1; 95% confidence interval, 1.04-9.4). Moreover, after premenopausal risk-reducing salpingo-oophorectomy, more severe complaints of vaginal dryness were observed (odds ratio, 2.6; 95% confidence interval, 1.4-4.7). Women with a risk-reducing salpingo-oophorectomy before the age of 41 years reported similar pleasure and discomfort scores as women with a risk-reducing salpingo-oophorectomy between ages 41 and 45 years.

CONCLUSION

More than 15 years after premenopausal risk-reducing salpingo-oophorectomy, the proportion of sexually active women was comparable with the proportion of sexually active women with a postmenopausal risk-reducing salpingo-oophorectomy. However, after a premenopausal risk-reducing salpingo-oophorectomy, women experienced more vaginal dryness and more often had substantial sexual discomfort during sexual intercourse. This did not lead to less pleasure with sexual activity.

Long-Term Morbidity and Health After Early Menopause Due to Oophorectomy in Women at Increased Risk of Ovarian Cancer: Protocol for a Nationwide Cross-Sectional Study With Prospective Follow-Up (HARMOny Study)

Background

BRCA1/2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) at 35 to 45 years of age. RRSO substantially decreases ovarian cancer risk, but at the cost of immediate menopause. Knowledge about the potential adverse effects of premenopausal RRSO, such as increased risk of cardiovascular disease, osteoporosis, cognitive dysfunction, and reduced health-related quality of life (HRQoL), is limited.

Objective

The aim of this study is to assess the long-term health effects of premenopausal RRSO on cardiovascular disease, bone health, cognitive functioning, urological complaints, sexual functioning, and HRQoL in women with high familial risk of breast or ovarian cancer.

Methods

We will conduct a multicenter cross-sectional study with prospective follow-up, nested in a nationwide cohort of women at high familial risk of breast or ovarian cancer. A total of 500 women who have undergone RRSO before 45 years of age, with a follow-up period of at least 10 years, will be compared with 250 women (frequency matched on current age) who have not undergone RRSO or who have undergone RRSO at over 55 years of age. Participants will complete an online questionnaire on lifestyle, medical history, cardiovascular risk factors, osteoporosis, cognitive function, urological complaints, and HRQoL. A full cardiovascular assessment and assessment of bone mineral density will be performed. Blood samples will be obtained for marker analysis. Cognitive functioning will be assessed objectively with an online neuropsychological test battery.

Results

This study was approved by the institutional review board in July 2018. In February 2019, we included our first participant. As of November 2020, we had enrolled 364 participants in our study.

Conclusions

Knowledge from this study will contribute to counseling women with a high familial risk of breast/ovarian cancer about the long-term health effects of premenopausal RRSO. The results can also be used to offer health recommendations after RRSO.

Trial Registration

ClinicalTrials.gov NCT03835793; https://clinicaltrials.gov/ct2/show/NCT03835793.

International Registered Report Identifier (IRRID)

DERR1-10.2196/24414

[Two case reports of cerebral autosomal dominant arteriophaty with subcortical infarctions and leukoencephalopathy (CADASIL)]

Cerebral autosomal dominant arteriopathy with subcortical infarctions and leukoencephalopathy (CADASIL) was first reported in European families and since 1993 it has been observed in America, Africa and Asia, suggesting that today the disease probably still remains largely underdiagnosed. CADASIL appears to be essentially a disorder of the arteries linked to single missense mutations in the Notch3 gene locus on chromosome 19; the aberrant dimerisation of Notch3, due to abnormal disulphide bridging with another Notch3 molecule or with another protein, may be involved in the pathogenesis of the disorder. It is characterized by recurrent stroke episodes and focal neurologic deficits progressing to pseudobulbar palsy and dementia, caused by multiple lacunar infarctions with ischemic and diffuse white matter abnormalities on neuroimaging. Migraine with aura, epileptic seizures and affective disorders are frequent additional symptoms of CADASIL. It is usually observed in the 3rd decade, but some individuals remain asymptomatic close to the age of 60. MRI displays a marked leukoencephalopathy in affected individuals as early as in the age of 20. The authors emphasize the role of a direct DNA test for gene mutation to make a differential diagnosis between CADASIL and other forms of vascular leukoencephalopathy as Alzheimer's dementia, multiple sclerosis and Binswanger's subcortical arteriopathic encephalopathy where CADASIL's arteriopathy is characterized by major alterations of vascular smooth muscle cells and the presence of specific granular osmiophilic deposits.

[Splenic artery aneurysm and portal hypertension. Report of a case]

Visceral arteries aneurysms are an uncommon pathology. Lienal artery (60%), hepatic (20%), superior mesenteric (5.9%) and tripod celiac (4%) are the most involved. Female predominance, portal hypertension, arteriosclerosis, pregnancy, traumatic and infective factors are the most remarkable etiopathogenetic factors. Portal hypertension with splenomegaly might be an important factor in the pathogenesis of intra- and extraparenchimal splenic artery aneurysms. Stress is laid on the importance of arteriography during portal hypertension in pregnancy as a preventive measure because the rupture of aneurysm of the splenic artery, despite laparotomy in emergency is often fatal, and of coeliac angiography prior to liver transplantation; if splenic artery aneurysm is found, ligation of the splenic artery should be performed at the time of transplantation to prevent possible rupture. The different roles of the imaging techniques used are examined.

[Imported myiasis. Report of a case and prevention measures]

Myiasis is the invasion of tissue by larvae of flies. They parasitize living tissues (specific myiasis) or cavity of warm blood animals compulsorily, optional (hemispecific myiasis) or accidentally (accident myiasis). It is frequent in sub-saharian Africa, while in European countries only imported cases are described. A case personally observed and some measures for prevention are described.

[Laboratory diagnosis of intestinal micro-parasitosis in AIDS patients: state of the art]

BACKGROUND

The diarrhea, often associated with growing thin and weight loss, is important for nutritional state and quality of life in AIDS patients. It was demonstrated that patients with AIDS who present diarrhea have a greater degree of immunosuppression than those without diarrhea, predisposing the gastrointestinal tract to the action of protozoa, bacterial, viral, fungal pathogens which may cause morbidity and death. HIV-patients are particularly susceptible to protozoa infections. Cryptosporidium infection is among the most common causes of enteric disease but Microsporidium (Enterocytozon bieneusi) and Cyclospora are emerging as potentially important enteric pathogens in AIDS patients. In spite of frequent interest of gastrointestinal tract the knowledge of diarrhea syndromes AIDS-related are often greatly limited by diagnostic difficulties.

OBJECTIVE

A review is made of the different laboratory methods employed in intestinal microparasitosis in the light of considerable dangerousness and aggressiveness of some protozoa on HIV-patients.

METHODS

The methods for the diagnosis of intestinal microparasitosis are based particularly on direct diagnosis (macroscopic or microscopic examination at fresh or after concentration) or an immunological diagnosis.

RESULTS

The laboratory methods available at present permit to evidence different protozoa not evidenced in the past and without invasive techniques.

CONCLUSIONS

The etiological diagnosis of diarrhea in AIDS-patients is often difficult and/or disappointing. Epidemiological knowledge on protozoa pathology has been limited by diagnostic difficulties but their identification is important particularly because an increasing therapeutic regimens are now available to treat these infections.

[Aplastic anemia in acute viral hepatitis type A. Our experience]

A case of posthepatitis A aplastic anemia is described. The pathogenesis of this rare complication of viral hepatitis type A infection is underlined.

[Tropical pyomyositis. A case report]

Tropical pyomyositis is an infection of large muscle groups that can lead to sepsis and death. The most common etiologic agent is Staphylococcus aureus. It usually occurs in patients living in the tropics but is seen with increasing frequency in temperate climates, particularly in immunosuppressed patients, where it may be misdiagnosed and may cause severe morbidity and mortality. Diagnosis is based on the examination of pus from a muscle aspirate and treatment consists of surgical incision, drainage and appropriate antibiotic therapy. It is stressed to take into account pyomyositis in the differential diagnosis of immunocompromised patients with "cryptic" myalgia.

[Cytomegalovirus pneumonia in patients with AIDS treated foscarnet. Our experience]

A case of cytomegalovirus pneumonia occurring in a patient affected with AIDS is reported. The treatment of this disease is still difficult and remission of CHV-pneumonia after therapy with foscarnet is emphasized.

[Norwegian scabies in immunosuppressed patients. Report of a case]

A case of Norwegian scabies in an immuno-suppressed patient is reported. This skin ectoparasite, rarely described in healthy individuals, varies from common scabies for clinical presentation, appearance and distribution of skin lesions. Norwegian scabies should be suspected in any atypical itching, or non, rash in immunosuppressed patient. Attention is also drawn to the importance of early diagnosis to precede familiar and hospital epidemics.

[Visceral leishmaniasis in patients with HIV infection. Our experience]

The authors describe a case of visceral leishmaniasis in an intravenous drug abuser, HIV seropositive patient. Visceral leishmaniasis was the first opportunist infection and diagnosis was based on smear from bone marrow. A treatment with N-methylglucamine and allopurinol was successful. The authors stress to take into account visceral leishmaniasis in HIV-infected patient in act resident or in past lived in endemic for Leishmania areas even in presence of atypical clinical features and propose to include visceral leishmaniasis as an opportunist infection in the IVC-2 group of clinical classification of HIV infection.