Piotr Szkodziak

Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three‐dimensional ultrasound: prospective observational study

To compare the effects of two alternative treatment options for uterine fibroids, ulipristal acetate (UPA) and uterine artery embolization (UAE), on fibroid volume and vascularity at 3‐month follow‐up.

Infertility in the light of new scientific reports – focus on male factor

Epidemiological data indicate that infertility is a problem of global proportions, affecting one- fifth of couples trying to conceive worldwide (60-80 mln). According to the trends observed, the problem is predicted to increase by another two million cases annually. In Poland, infertility-related issues are found in about 19% of couples, including 4% with infertility and 15% with limited fertility. Inability to conceive occurs equally in men and women (50%), irrespective of the direct cause. Although it is generally thought that reproductive issues concern women, infertility affects men and women equally. This study is an attempted to systematize knowledge about the role of the male factor in infertility, particularly current knowledge concerning the environmental factors of infertility. For this purpose, the Medline and CINAHL databases and the Cochrane Library was searched for articles published in English during the last 10 years, using the following keywords: infertility, male factor, semen examination and environmental factor of infertility.

Delayed Diagnosis of Herlyn-Werner-Wunderlich Syndrome due to Microperforation and Pyocolpos in Obstructed Vaginal Canal

BACKGROUND To present a rare anomaly consisting of uterus didelphys, longitudinal vaginal septum, obstructed hemivagina with pyocolpos, fistula to the open vaginal canal, and ipsilateral renal agenesis, referred as Herlyn-Werner-Wunderlich syndrome (HWWS). CASE A 14-year-old girl with recurring purulent vaginal discharge lasting for a few months. Preoperative examination revealed one vaginal canal with one cervical opening on the right side. There was a fistula leading from the obstructed vaginal canal to the left vagina. Intravaginal ultrasound examination demonstrated a longitudinal vaginal septum and a closed pyocolpos on the right side. The longitudinal vaginal septum was excised by way of electrocauterization under direct vision. CONCLUSION HWWS should be considered in the differential diagnosis in patients with uterus didelphys and unusual symptoms such as pyocolpos and vaginal discharge.

Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease

Introduction and objective Uterine artery embolization (UAE) is a minimally invasive treatment option for symptomatic fibroids. Long-term follow-up studies have shown that at five-year follow-up after UAE, up to 30% of patients required a hysterectomy. Therefore, it seems of utmost importance to identify patients, who are unlikely to benefit from UAE. It has been postulated that the percentage volume reduction of fibroids may predict long-term UAE outcome. The results of available studies are equivocal, therefore it seemed of interest to investigate the correlation between the preinterventional intramural fibroid volume and imaging outcome of UAE in premenopausal patients. Material and methods Uterine artery embolization was performed in 65 premenopausal patients with symptomatic, intramural fibroids. Dominant fibroid volume was assessed using an integrated VOCAL (Virtual Organ Computer-aided AnaLysis) imaging program at baseline and 3 months after UAE. The percentage reduction of fibroid volume was calculated. The association between preinterventional fibroid volumes and percentage volume reductions was determined with the Spearman rank correlation test. Results Before UAE, the median dominant fibroid volume was 101 cm3 (range 23.6-610). At three-month follow-up the median dominant leiomyoma volume decreased to 50.4 cm3 (range 6.9-193.9). Median percentage reduction of fibroid volume three months after UAE was calculated at 50.1% (range 2.7-93.5). The Spearman correlation test between the preinterventional dominant fibroid volume and percentage volume reduction showed a statistically significant, positive correlation (R = 0.33; p = 0.006). Conclusions The percentage volume reduction of intramural leiomyomas after UAE seems to be more pronounced in the case of larger tumors.

P31.01: Ascites index—a new method of ultrasound evaluation of ascites volume in patients with ovarian cancer

Objectives: Ascites is often observed in malignant diseases, and is then associated with a poor prognosis. In 30–54% cases of ascites ovarian cancer is the primary tumor. Effective palliation of symptoms caused by the pressure of ascites is difficult to achieve. Assessment of the volume of ascites is necessary in monitoring the progress of the disease and in selecting appropriate methods of treatment. The aim of this study was to introduce Ascites Index (AsI), a simple to use ultrasound method of evaluating the volume of ascites. Methods: Six patients with ovarian cancer and ascites were included in the study. All patients were admitted to the hospital because of respiratory dysfunction (dyspnea) due to increasing ascites. Ultrasound measurements of the volume of ascites were performed in the external quadrants of the abdomen – in the vicinity of the liver, spleen and bilaterally above the inguinal ligament. Pockets of free fluid were measured in millimeters, perpendicularly to the tangents of each quadrant of the abdomen. The obtained values were totalled, creating the Ascites Index (AsI), similary to the amniotic fluid index. Abdominal puncture was performed in 4 cases, and exploratory laparotomy in 2 cases. AsI values acquired before and after these procedures were subsequently compared. Results: Initial AsI values ranged from 196 to 316 mm (mean 233 mm, SD 47.0). To avoid complications a maximum of 2000 ml of ascitic fluid was collected. After abdominal puncture AsI values were decreased to 89–183 mm (mean 129 mm; SD 42.5). During exploratory laparotomy 4500–5000 ml of fluid was obtained, and after the procedure the index was decreased to 6–19 mm (mean 12.5 mm; SD 9.2). Conclusions: The proposed Ascites Index seems to by a promising tool in estimating ascites volume. It is simple to implement and may be estimated using basic ultrasound equipment even in outpatient clinic. AsI may be useful in monitoring ascites, predicting dyspnea and assessing the effect of abdominal puncture.

Elastography Improves the Diagnostic Accuracy of Sonography in Differentiating Endometrial Polyps and Submucosal Fibroids

To assess whether strain elastography may be used to visualize the different stiffness of endometrial polyps and submucosal fibroids.

Usefulness of elastography in predicting the outcome of Foley catheter labour induction

Incorrect selection of women for labour induction may increase the risk of caesarean section and other postpartum and neonatal complications. It has been recently shown that elastography of the uterine cervix holds the potential to predict the outcome of pharmacological labour induction. There are no data on the usefulness of elastography in predicting the outcome of mechanical induction of labour.

Primary ovarian Burkitt’s lymphoma: a rare oncological problem in gynaecology: a review of literature

PurposeThis review presents the information about epidemiology, clinical manifestation, diagnosis and treatment of primary ovarian Burkitt’s lymphoma (BL), including a literature search of available BL cases. The purpose of this review is to draw clinicians’ attention to the possibility of ovarian BL occurrence, which may be important in the differential diagnosis of ovarian tumours.MethodsPubMed and Web of Science databases were searched using the keywords ‘‘Burkitt’s’’, ‘‘Lymphoma’’, ‘‘Ovarian’’, ‘‘Primary’’, ‘‘Burkitt’s lymphoma’’. Only cases with histopathologically confirmed diagnosis of primary ovarian BL were included in this review.ResultsFifty articles, reporting cases with an ovarian manifestation of primary non-Hodgkin’s lymphoma, were found. Twenty-one cases with a histopathologically confirmed BL were evaluated to compare various manifestations, treatment and prognosis in ovarian BL.ConclusionsPrimary ovarian BL is a rare condition, included in the entity of non-Hodgkin lymphoma. The tumour can occur uni- or bilaterally in the ovaries with major symptoms such as abdominal pain or a large abdominal mass. Differential diagnosis, based on imaging features and pathological examination of the specimens, is essential for further treatment due to various aetiology of ovarian tumours. Although most of the patients suffering from ovarian BL underwent surgery after the ovarian tumour had been detected, surgical treatment is not the treatment of choice in patients with ovarian lymphoma. The mainstay of therapy is chemotherapy without further surgery. The prognosis is better if the chemotherapy protocol is more aggressive and followed by prophylactic central nervous system chemotherapy. Nowadays, multiagent protocols are administered, which improves the survival rate.

The effect of ulipristal acetate treatment on symptomatic uterine fibroids within 12-months follow-up

Aim of the study The purpose of the study was to monitor the effect of ulipristal acetate treatment on symptomatic uterine fibroids within 12-months follow-up. Material and methods Fifty six patients with symptomatic uterine fibroids qualified for surgical treatment were included in the prospective observational study. All patients received preoperative oral UPA treatment for 3 months (1 × 5 mg). Patients that refused surgical treatment after UPA therapy were followed-up for the next 9 months. The volume of the intramural fibroid was estimated by TV-US using and integrated VOCAL 3D imaging program at baseline, after 3 months of UPA treatment and further at 3-months intervals. Results Before UPA mean dominant fibroid volume was estimated to be 216.0 cm3 (38.4-768.2 cm3) and decreased to 117.6 cm3 (12.6-668.0 cm3) after 3 months of UPA therapy. Mean percentage volume reduction was 45.6%. Mean hemoglobin level increased from an initial 10.1 g/dL (6.8-12.9 g/dL) to 12.6 g/dL (10.1-14.8) after 3 months of UPA therapy. At 12 months after initiating UPA treatment mean dominant fibroid volume decreased by 43.9%. In one third of followed-up patients the effect of 3 month UPA therapy persisted for the next 9 months. Conclusions Three month UPA therapy decreases fibroid volume and improves hemoglobin level before planned surgical treatment. In one third of followed-up patients the effect of 3 month UPA therapy persisted for the next 9 months.

EP15.24: Ultrasound image of the uterus after myomectomy of large fibroids with intraoperative application of absorptive materials with fibrinogen: Electronic Poster Abstracts

Objectives: Uterine fibroids are benign tumors occurring in about 25% of women during their reproductive age. In cases of fertility preservation myomectomy is recommended. Myomectomy of large fibroids is associated with massive blood loss and increased risk of hysterectomy, what leads to irreversible infertility. The aim of the study was to evaluate the ultrasound image of the uterus after myomectomy of large fibroids with intraoperative application of absorptive materials with fibrinogen. Methods: The study included 12 patients hospitalized due to symptomatic, single intramural fibroids larger than 6 cm in diameter, so distorting uterus cavity. In order to preserve fertility patients were qualified for myomectomy. In 5 patients, after enucleation of fibroids in addition to hemostatic sutures, in order to reduce bleeding absorbent material with fibrinogen has been applied to the lodge after fibroids (study group, SG). In 7 patients, intraoperative absorptive materials with fibrinogen was not applied, thus the lodge after fibroids was provided only by sutures (control group, CG). In all patients’ ultrasound examination has been done 1, 3, 6 and 12 months after myomectomy to assess the healing of the myomectomy wound. Results: In CG, in the ultrasound examination, an avascular hypoechogenic area, less than 3 cm in diameter, was observed. In SG, 1 month after myomectomy an avascular hyperechogenic area (AHA) (Fig. 1) corresponding to the absorbent material was observed in the place of enucleation of the fibroid. Median (Me) AHA volume (calculated from 3 dimensions) 1 month after surgery was 30% of the volume of enucleated fibroids. Me AHA volume 3 and 6 months after myomectomy was respectively 12,5% and 3,7%. 12 months after surgery, in all patients, AHA was not observed (an ultrasound image similar to CG) (Fig. 2). Conclusions: we conclude that uterus image after myomectomy of large fibroids with intraoperative application of absorptive materials with fibrinogen is similar to that after classic myomectomy, after 12 months of observation.