Alicja Zietek

Use of uroflow parameters in diagnosing an overactive bladder—Back to the drawing board

The aim of our study was to analyze whether uroflowmetry parameters are helpful in diagnosing overactive bladder (OAB). The working hypothesis was that the flow curves of patients with OAB symptoms would appear as a sharp peak flow rate with a short duration and high amplitude, lasting only for a short period during urgency sensation, followed by reduced urine flow. We introduced a new parameter called flow index (FI) defined as an average divided by maximal urine flow rates as a potential marker for diagnosing OAB.

Power morcellation for women undergoing laparoscopic supracervical hysterectomy — safety of procedure and clinical experience from 426 cases

OBJECTIVES Minimally invasive gynaecological surgeries are performed for several malignant and nonmalignant indications. The aim of our study was to evaluate the rate of unexpected malignancies among women who underwent laparoscopical supracervical hysterectomy (LASH) with power morcellation. MATERIAL AND METHODS The retrospective analysis included clinical data of 426 consecutive female patients who underwent LASH with power morcellation due to presumed benign disorders (78.4% - symptomatic uterine fibromas, 12.7% - abnormal uterine bleeding, 8.9% - suspicion of uterine adenomyosis) between January 2011 and December 2015. Pre-malignant or malignant preoperative abnormalities in the cervix and the uterine corpus were contraindications for LASH. RESULTS The unexpected malignancies were found in four patients from study group: one ovarian cancer located on the inner part of simple ovarian cyst and 3 endometrial carcinomas (0.9%) were documented. All these patients underwent abdominal reoperations and no histological abnormalities were detected in the extirpated cervix and adnexa. CONCLUSIONS The incidence of unintended endometrial carcinoma in morcellated uterus after LASH was relatively small. However, careful pre-operative counseling should be undertaken in order to exclude the possibility of any malignant disease in uteri among women scheduled to power morcellation.

Use of free uroflowmetry vs pressure-flow studies in the diagnosis of overactive bladder syndrome in females

OBJECTIVES To determine if pressure-flow study (PFS) parameters, including flow index (FI) calculated by dividing average urethral flow by maximal urethral flow, increase the accuracy of urodynamic studies in the diagnosis of overactive bladder (OAB). STUDY DESIGN Retrospective study to evaluate the medical history and urodynamic examination results of female patients diagnosed with lower urinary tract symptoms (LUTS) between January 2014 and December 2015. Patients were stratified into four groups depending on the type of LUTS: OAB; stress urinary incontinence (SUI); mixed urinary incontinence with predominant SUI symptoms (MUI-SUI); and mixed urinary incontinence with predominant OAB symptoms (MUI-OAB). RESULTS OAB was diagnosed in 26 (15%) patients, SUI was diagnosed in 93 (52%) patients, MUI-OAB was diagnosed in 43 (24%) patients, and MUI-SUI was diagnosed in 17 (9%) patients. FI calculated using free uroflowmetry (FI-free) was significantly lower in the OAB group compared with the other groups (p<0.01). Analysis revealed no difference in FI-free between the SUI, MUI-SUI and MUI-OAB groups. Significant differences were found between the study groups for most free uroflowmetric parameters, including maximal urethral flow, average urethral flow and micturition volume (p<0.05). Similar differences were not found in PFS parameters. CONCLUSIONS The decrease in the urethral lumen due to the presence of a transurethral catheter in patients with OAB, in contrast to women with SUI and MUI, was not found to influence FI calculated using free uroflowmetry or PFS. FI may serve as an important objective diagnostic tool for OAB, but only when calculated from free uroflowmetry parameters when assessing patients with LUTS.

Opportunistic salpingectomy for prevention of sporadic ovarian cancer — a jump from basic science to clinical practice?

Ovarian cancer is the most malignant and aggressive gynecological cancer. Due to nonspecific symptoms in the early stage and a lack of effective screening methods, it is typically diagnosed at an advanced stage. The high-grade serous cancer (HGSC) represents 75% of all ovarian cancers and accounts for the majority of deaths. Contemporary thought suggests that precursor lesions of HGSC originate in the fallopian tube. The presumed precursor tubal lesion, localized at the fimbrial end of the fallopian tubes, is termed the serous tubal intraepithelial carcinoma (STIC). Thus, removal of the fallopian tubes at the time of pelvic or abdominal surgery for a benign condition (i.e. opportunistic salpingectomy) appears as an attractive option for primary prevention of HGSC. This paper presents the scientific background of opportunistic salpingectomy and discusses controversies regarding the benefits and safety of the procedure.

Prevalence of common comorbidities among urogynaecological patients

OBJECTIVES Due to prolonged life expectancy, regardless of the fact that elderly women are more likely to suffer from comorbidities, urogynaecologists worldwide should expect a growing demand for counseling and effective treatment for patients with pelvic floor defects. The aim of the study was to investigate the incidence of popular comorbidities among urogynaecological patients. MATERIAL AND METHODS The retrospective analysis included clinical data of 4,065 consecutive female patients who under-went surgical treatment in the 2nd Department of Gynaecology at the Medical University of Lublin due to urogynaecological disorders between January 2005 and December 2014. Patients were divided into two groups (< 65 years and ≥ 65 years). The vast majority of patients affected by stress urinary incontinence were treated with mid-urethral slings. Most of patients affected by pelvic organ prolapse underwent reconstructive vaginal surgery with reinforcement using anterior and/or pos-terior meshes. Statistical analysis was performed using STATISTICA 10.0 PL (unpaired Student t-test, U Mann Whitney, χ2 test). RESULTS In both study groups, overweight and obesity were the most common disorders affecting urogynaecological patients (72.6% overall). Furthermore, the elderly patients suffered more often from the most common comorbidities, such as hypertension (p < 0.01), coronary artery disease (p < 0.001) and diabetes mellitus (p < 0.005). CONCLUSIONS Common comorbidities such as overweight and obesity, followed by hypertension and coronary heart diseases, are usual among urogynaecological patients. Changes in lifestyle leading to a decrease in obesity should be considered as an important line treatment when counselling urogynaecological patients.