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Objective: Gonadotropin releasing hormone agonists (GnRHa) decrease the expression of growth factors involved in the development of human endometriotic tissue. As endometriosis has been found to be associated with a mild increase in prolactin (PRL) serum levels, we aimed to evaluate changes in PRL serum levels as well as other hormones relevant to endometriosis and infertility during long-term administration of GnRHas in women with endometriosis., Study Design: In this prospective pilot study we obtained blood samples on the first day of leuporeline administration and then subsequently after 4, 8 and 12 weeks in 22 patients., Results: Median PRL levels were unchanged after 4 weeks, but significantly decreased 8 and 12 weeks after the first leuporeline administration (p1=0.085, p2=0.020, p3=0.001). There was no significant decrease in serum anti-Mullerian hormone (AMH) levels over the whole period of down regulation with leuporeline (p1-3>0.05)., Conclusion: Our data support the hypothesis that the decrease of PRL levels might contribute to the known effect of GnRH treatment in patients with endometriosis via suppression of VEGF expression in endometriotic lesions. Moreover this study lends support to the thesis that AMH remains stable under GnRHa therapy and therefore can be also used as a marker of ovarian function prior to IVF-stimulation during down regulation., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: Pelvic organ prolapse (POP) is of growing importance to gynecologists, as the estimated lifetime risk of surgical interventions due to prolapse or incontinence amounts to 11-19%. Conflicting data exist regarding the effectiveness of POP surgery with and without uterine preservation. We aimed to compare anatomic outcomes in patients with and without hysterectomy at the time of POP-surgery and identify independent risk factors for symptomatic recurrent prolapses., Study Design: In this single-centre retrospective analysis we analyzed 96 patients after primary surgical treatment for POP. These patients were followed up with clinical and vaginal examination six months postoperatively. For comparison of the groups, the chi-squares test were used for categorical data and the u-test for metric data. A logistic regression model was calculated to identify independent risk factors for recurrent prolapse., Results: Of 96 patients, 21 underwent uterus preserving surgery (UP), 75 vaginal hysterectomy (HE). Median operating time was significantly shorter in the UP group (55 vs. 90min; p=0.000). There was no significant difference concerning postoperative urinary incontinence or asymptomatic relapse (p>0.05), whereas symptomatic recurrent prolapses were significantly more common in the UP group (23.8% vs. 6.7%; p=0.023). However, in multivariate analysis, only vaginal parity and sacrospinous ligament fixation were identified as independent risk factors for recurrent prolapse after POP surgery., Conclusion: Uterus-preservation at time of POP-surgery is a safe and effective alternative for women who wish to preserve their uterus but is associated with more recurrent symptomatic prolapses., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: Lactobacilli have been found in the neovagina of very low numbers of transsexual women. We undertook this study to determine whether an orally administered preparation of four lactobacilli strains exerts some measurable effect on the neovaginal microflora of female transsexuals., Study Design: 60 male to female transsexual women with penile linked neovagina were randomised into two groups. Women in the intervention group (n=33) received oral probiotic capsules and women in the control group (n=27) placebo in for 7 days. Swabs of the neovagina were taken before and after the therapy., Results: Comparing the first and second swabs, we observed a significant improvement of the Nugent score in the intervention group 16 (48.5%) vs. low improvement in control group 4 (14.8%) (p<0.006). The neovaginal microflora was significantly enriched with lactobacilli after oral supplementation compared to placebo. In the intervention group, an increase by 10,000±600 colony forming units (CFU) of presumptive lactobacilli was observed, compared with an increase by 1600±100CFU in the control group (p<0.0001). When measured by real-time PCR (c/ml), lactobacilli increased by 1400±100c/ml in the intervention group and 300±100c/ml in the control group (p<0.0001)., Conclusion: There was an improvement of vaginal lactobacilli microflora after of oral supplementation with lactobacilli strains in transsexual women., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)