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We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged. © 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Colorectal cancer in pregnancy is a rare but life-threatening disease. The authors present a case of early-stage sigmoid colon cancer in pregnancy, discussing the issue in the light of the current literature.

The efficacy of antimuscarinic drug therapy in patients who have more severe symptoms of overactive bladder (OAB) at baseline has not been evaluated thoroughly.This analysis determined the effects of solifenacin in patients with severe OAB symptoms at baseline.All randomized, placebo-controlled phase III studies of solifenacin were pooled to determine the effects in patients with severe OAB symptoms at baseline. In these studies, patients were randomized to treatment with placebo or solifenacin 5 or 10 mg once daily. Baseline severity was defined according to the number of incontinence episodes/24 h, number of urgency episodes/24 h, and micturition frequency/24 h. The proportion of patients with restoration of continence, resolution of urgency, and normalization of micturition frequency at endpoint was determined. Mean change from baseline to endpoint in the number of episodes/24 h for incontinence, urgency, and micturition, and in the volume voided/micturition were assessed. Comparisons of change from baseline to endpoint were done with analysis of covariance (ANCOVA), and comparisons of percentage change from baseline to endpoint were based on van Elteren's test.Results from four multinational phase III studies of solifenacin with 2848 patients were pooled. The proportion of patients with restoration of continence, resolution of urgency, and normalization of micturition frequency at endpoint was significantly greater with solifenacin than with placebo among patients with severe OAB at baseline. Solifenacin 5 and 10 mg were significantly (p0.05) more effective than placebo for reductions in the number of episodes of incontinence, urgency, and micturition, and for the increase in volume voided/micturition among most subgroups of patients who were highly symptomatic at baseline (incontinence, urgency, or micturitions).Solifenacin was significantly more effective than placebo for patients with severe symptoms of OAB. The significant and consistent response was observed for all endpoints with solifenacin 10 mg and for most endpoints with solifenacin 5 mg using different definitions of baseline disease severity, and supports the overall effectiveness of solifenacin in highly symptomatic patients.

Our objectives were to ascertain the tolerability and efficacy of trospium chloride in doses of 20 mg twice daily for long-term therapy (52 weeks) in patients with urge syndrome. The trial comprised a total of 358 patients with urge syndrome or urge incontinence. After randomisation in the ratio of 3:1, participants were treated continuously for 52 weeks with either trospium chloride (20 mg twice daily) or oxybutynin (5 mg twice daily). At intervals of 4-8 weeks, patients were physically examined with measurements of blood pressure and pulse rate, were questioned about any adverse events, checked for compliance and underwent relevant laboratory tests. As an additional safety measure, an ECG was made at 26 and 52 weeks. Urodynamic measurements were performed at the beginning, and at 26 and 52 weeks to determine the maximal cystometric bladder capacity. Among others things, the frequencies of micturition, incontinence and number of urgency events were recorded in patient diary protocols in weeks 0, 2, 26 and 52. The evaluation of vital parameters, laboratory results and ECGs did not show any relevant changes attributable to the action of the anticholinergics. Analysis of the micturition diary clearly indicated a reduction of the micturition frequency, incontinence frequency, and a reduction of the number of urgencies in both treatment groups. Mean maximum cystometric bladder capacity increased during treatment with trospium chloride by 92 ml after 26 weeks and 115 ml after 52 weeks (P=0.001). Further comparison with oxybutynin did not reveal any statistically significant differences in urodynamic variables between the drugs. Adverse events occurred in 64.8% of the patients treated with trospium chloride and 76.7% of those treated with oxybutynin. The main symptom encountered in both treatment group was dryness of the mouth. For patients on trospium chloride, the estimated risk of an unexpected adverse event was 0.027 per patient per week for all adverse events and 0.009 for dryness of the mouth, resulting in a considerably lower risk during treatment given with trospium chloride than with oxybutynin (0.045 and 0.021, respectively). An overall assessment for each of the drugs reveals a comparable efficacy level and a better benefit-risk ratio for trospium chloride than for oxybutynin due to better tolerability.

PURPOSE The efficacy of propiverine in elderly patients suffering from urge incontinence or urge-stress incontinence was intended to be investigated. Especially in elderly patients a cardiac influence of propiverine is possible due to its dual mode of action. That is why besides the efficacy especially the cardiac safety was intended to be investigated. MATERIAL AND METHODS Ninety-eight patients (21 male, 77 female; 67.7 +/- 6.3 years of age) suffering from urgency, urge incontinence or mixed urge-stress incontinence were included in the double-blind, multicentre, placebo-controlled, randomized study. After a two-week placebo run-in period, the patients received propiverine (15 mg t. i. d.) or placebo (t. i. d.) for four weeks. Before (U 1, U 2) and during the treatment period (U 3, U 4), standard ECG's and 24 h long-term ECG's were recorded. RESULTS Propiverine caused a significant reduction in the micturition frequency (U 2 : 8.7 +/- 4.2, U 4 : 6.5 +/- 3.2 ml; p < 0.01) reflected in a significant increase in the average micturition volume (U 2 : 163.5 +/- 65.9, U 4 : 216.3 +/- 101.5 ml; p < 0.01) and a significant reduction in the episodes of incontinence (- 54 %; p < or = 0.05). These findings were confirmed by the overall assessment after four weeks in which approximately 90 % of patients under propiverine were either free from urge incontinence and urge symptoms or improved. The efficacy parameters demonstrated a better efficacy for urge incontinence than for mixed urge-stress incontinence. Resting and ambulatory electrocardiograms evidenced no significant changes. Neither QTc interval nor other cardiac parameters were relevantly altered. The frequency of cardiac events (Lown classes IV a/b) was fortuitous, revealing no difference between placebo and propiverine. The incidence of adverse events was very low (2 % dryness of the mouth under propiverine) and confirmed by the findings from the quality of life questionnaires. CONCLUSIONS A favourable benefit-risk ratio in the treatment of elderly patients suffering from urgency, urge incontinence or combined urge-stress incontinence is therefore proven for propiverine. Cardiac arrhythmia were not induced.

Objective To assess the tolerability and efficacy of propiverine and oxybutynin in patients with urgency and urge incontinence in a randomized, double-blind placebo-controlled clinical trial. Patients and methods In all, 366 patients (149 on propiverine, 145 oxybutynin and 72 placebo, ratio 2:2:1) with urgency and urge incontinence were recruited in 32 study centres. Propiverine (group 1, 15 mg three times daily), oxybutynin (group 2, 5 mg twice daily) or placebo (group 3) were administered for 4 weeks, using the double-dummy technique. The dosages were selected specifically to compare the tolerability profile of propiverine with the commonly used therapeutic dosage of oxybutynin. Tolerability was assessed by directly questioning the patients about adverse events at four visits (V-1 before and V0 after a 1-week ‘washout’ period, V1 after 1 week and V4 after 4 weeks of treatment) during a 5-week surveillance period, and by tolerability ratings of the physicians. Efficacy was assessed using urodynamics at V0 and V4, evaluating the cystometric bladder capacity at maximal and first desire to void, and postvoid residual urine, according to the criteria of the International Continence Society. Additionally, a voiding protocol, overall assessment of clinical symptomatology and efficacy ratings by the physicians were documented. Results A remarkably high percentage of adverse events was reported in the washout period (VO: 13%, 16% and 18% in groups 1–3, respectively). At V4, the clinically most relevant symptom (dry mouth) occurred in 53% of patients in group 1, in 67% of group 2 and in 28% of group 3. Furthermore, dry mouth was less severe in group 1 than group 2. In contrast to groups 2 and 3, only patients in group 1 showed increasing tolerability during the treatment (from V1 to V4). These tolerability results were further supported by the overall tolerability assessment (‘very good’ or ‘good’ tolerability in 67% of group 1, in 59% of group 2 and in 83% of group 3). The urodynamic assessment of efficacy (comparing V0 and V4) showed a statistically significant increase in the mean (sd) maximal cystometric bladder capacity in group 1, being 222 (77) mL at V0 and 311 (125) mL at V4, an increase of 89 (108) mL, and in group 2, at 226 (75) mL and 322 (123) mL, an increase of 96 (106) mL, compared with group 3, at 211 (77) mL and 263 (93) mL, an increase of only 52 (92) mL. The cystometric bladder capacity at first desire to void also increased in group 1 (93 to 160 mL) and group 2 (89 to 160 mL), whereas in group 3 there were only minor changes (93 to 120 mL). Changes in the residual urine volume within and between the treatment groups were minimal and clinically irrelevant. The overall assessment of efficacy showed significant differences between the drugs when compared with placebo. Conclusion Propiverine is a safe and effective drug in the treatment of urgency and urge incontinence; it is as effective as oxybutynin, but the incidence of dry mouth and its severity is less with propiverine than with oxybutynin. The availability of alternative pharmacotherapeutics such as propiverine should reduce the therapeutic failure rate and improves the success rate in the treatment of patients suffering from urgency and urge incontinence.

Objective: The aim of this study was to assess the impact of a 12–month treatment period with alfuzosin, 2.5 mg t.i.d, on symptomatic patients with BPH (n = 355) by means of the Int

The study investigated the efficacy and cardiac safety of propiverine in the elderly, because the induction of life-threatening ventricular arrhythmia has been reported for some drugs prescribed in the therapy of urinary incontinence. Ninety-eight patients (21 male, 77 female; 67.7+/-6.3 years of age) suffering from urgency, urge incontinence or mixed urge-stress incontinence were included in the double-blind, multicentre, placebo-controlled, randomized study. After a 2-week placebo run-in period, the patients received propiverine (15 mg t.i.d.) or placebo (t.i.d.) for 4 weeks. Before (V1, V2) and during the treatment period (V3, V4), standard ECGs and 24-hour long-term ECGs were recorded. Propiverine caused a significant reduction of the micturition frequency (V2: 8.7+/-4.2, V4: 6.5+/-3.2 ml; p< or =0.01), reflected in a significant increase in the average micturition volume (V2: 163.5+/-65.9, V4: 216.3+/-101.5 ml; p< or =0.01) and a significant decrease in episodes of incontinence (-54%; p = 0.048). These findings were confirmed by the overall assessment at V4, in which approximately 90% of patients under propiverine either had no urge incontinence or urge symptoms, or showed improvement. Resting and ambulatory electrocardiograms indicated no significant changes. Neither the frequency-corrected Q-T interval nor other cardiac parameters were relevantly altered. The frequency of cardiac events (Lown classes IVa/b) was random, revealing no difference between placebo and propiverine. The incidence of adverse events was very low (2% dryness of the mouth under propiverine) and confirmed by the findings from the quality of life questionnaires. A favourable benefit-risk ratio without the induction of any cardiac arrhythmia in the treatment of elderly patients suffering from urgency, urge incontinence or combined urge-stress incontinence is therefore proven for propiverine.

Find out the features of descending posterior vaginal wall using ultrasonography and set the objective diagnostic criteria.Prospective comparative study.Department of Obstetrics and Gynaecology, Teaching Hospital Bulovka, First Medical Faculty, Charles University in Prague.We included 39 attendants, 19 with clinicaly proven descent of posterior vaginal wall; 20 as a negative control group. We observed the ultrasonographical features of descending posterior vaginal wall according to the horisontal line crossing the inferior margin of pubic bone (PM) and central anorectal angle (PARA) at rest and during Valsalva manoevre with and without intrarectal application of sonographic yelly. Student's t-Test was used for statistical evaluation.We proved the statisticaly significant increase in the distances PM and PM' in the group of females suffering from the descent compared to the group of healthy women. Values of PARA were also signifinatly hightened in the group of patients with the descent compared to healthy females.The ultrasonographical evaluation of descending posterior vaginal wall appears to be promising chance in diagnostics of female's pelvic floor pathology.

Review of new staging systems for gynaecological cancers and their impact on prognosis and planning treatment.Review article.Department of Gynaecology and Obstetrics, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Radiotherapeutic Oncology, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Pathology, University Hospital Na Bulovce, Prague.Every staging system should have 3 basic characteristics: it must be valid, reliable, and practical. Over the years, these staging classifications--with the exception of cervical cancer and gestational trophoblastic neoplasia--have shifted from a clinical to a surgical-pathological basis. Changes based on new findings were proposed in 2008 by the FIGO Committee on Gynecologic Oncology, approved in September 2008 by the FIGO Executive Board, and published in 2009. The greatest changes were made in the new staging system for carcinoma of the vulva and others in the new staging systems for carcinoma of the cervix and carcinoma of the endometrium. A new stanging system was also created for uterina sarcomas, based on the criteria used in other soft tissue sarcomas. A clinical staging system for carcinoma of cervix continues because surgical staging cannot be employed worldwide (especially in third world countries). Stage 0 has been deleted from the staging of all tumours, since it is pre-invasive lesion and it is not an invasive tumour. In the revised staging system for carcinoma of the endometrium, four fundamental changes have occurred, which will be discussed. Carcinosarcoma is still staged identically to carcinoma of the endometrium. A completely new staging system was created for adenosarcomas, along with an almost identical staging system for leiomyosarcoma and endometrial stromal sarcoma. The staging system for carcinoma of ovary and Fallopian tube remains without changes.Since medical research and practice in the field of oncology have shown explosive growth, the staging of some of the gynaecological cancers did not give a good spread of prognostic groupings. Therefore, revised FIGO and TNM staging system has been structured to represent major prognostic factors in predicting patients' outcomes and lending order to the complex dynamic behavior of gynaecological cancers. The purpose of good staging system is to offer a classification of the extent of gynaecological cancer in order to provide a method of conveying one's clinical experience to others for the comparison of treatment methods.

The aim of our study is to present initial experiences, with regard to safety and short-term efficacy, of mini-sling MiniArc and AJUST operations for stress urinary incontinence (SUI).Cross-sectional clinical study.Gynecological and Obstetric Clinic 1. LF UK and VFN Prague; Gynecological and Obstetric Clinic FN Bulovka and 1. LF UK Praha; Urological dpt. FTN Prague; GONA spol. s r.o.; Urological dpt. FN Ostrava Poruba.We present briefly the technique employed in the operations, the urodynamic examination procedure before and after the operation, and the subjective and objective outcomes of these procedures from the 5 above-mentioned hospitals which participated on the study. Objectively the leakage of urine was assessed during urodynamic examination and by cough test. Subjectively leakage of urine was assessed by ICIQ-SF questionnaire (The International Consultation on Incontinence, short form). This study evaluated the cure effect and complications accompanying the MiniArc and AJUST procedures, and compared these results. The clinical study included 66 women with previously untreated stress urinary incontinence. These women were randomly divided by envelop method into two groups; the first group of patients underwent operations using the MiniArc (n=33) technique and the second group the AJUST (n=33) technique. Mean age was 57.9 years in the AJUST group and 57.7 years in the MiniArc group. Mean body mass index (BMI) was 29.2/28.7 in the AJUST/MiniArc groups respectively, and mean parity was 2.09/2.24. We did not find statistically significant differences between these two groups.The curative rate of the MiniArc and AJUST procedure was evaluated 3 months after the operation (+/- 1 week). We can conclude from the outcomes of the cough test that this test was negative in 61 (92%) of patients overall; in the AJUST group it was 31 (94%) of patients and in the MiniArc group 30 (91%) of patients. In the subjective evaluation of the leakage of urine before operation (ICIQ-SF) the mean score in the group of patients who subsequently underwent the AJUST operation was 15.4 (SD-3.39; median-16, range 8-21) and in women who underwent the MiniArc operation it was 15.5 (SD-3.3; median-16, range 8-21). The AJUST/MiniArc procedure caused a statistical significant decrease in the total score to -14.09(SD-5.18)/-14.45 (SD-3.73). The difference in the decrease of the score between the AJUST/MiniArc groups was not statistically significant. In the AJUST group of patients, according to the ICIQ-SF, 30 (91%) women were without problem or improved [27 (81.7%) of women were without problem], while in the MiniArc group 32 (96.9%) were without problem or improved [24 (72.7%) of women were without problem]. The urodynamic examination before and after operation indicated that there were no differences between the groups of patients either before and or after the operation. Changes in the parameters MUCP, Qmax and others caused by the operation were not significant, and there were no statistical significant differences in the values of these parameters between the groups of patients. Complications of the MiniArc and AJUST procedures were not recorded.Our first experiences with MiniArc and AJUST procedures, including possible complications and curative rate, are positive. From the preliminary results the cure effect of MiniArc and AJUST 3 months after the operation (+/- 1 week) is similar. It will be important to evaluate the efficacy of these procedures one year after the operation for a definitive evaluation of the cure effect.

The set of pregnant females suffering from bronchial asthma-retrospective analysis.Retrospective analysis.Department of Obstetrics and Gynecology, University Hospital Na Bulovce, First Medical Faculty, Charles University in Prague, Czech Republic.Our set consists of pregnant women suffering from bronchial asthma and attending our Antenatal Clinicdelivering at our Maternity Hospital from January 2008 through December 2009. Retrospective analysis of the set based on the medical records was performed.80 females suffering from bronchial asthma gave birth at our Hospital during the studied time span, i.e., 1.7% of all deliveries at our Maternity Hospital. In 4 females (i.e. 5%) the asthma attack was observed during the pregnancy. 33% of all females suffering from bronchial asthma did not require any bronchodilator medication, 22% were just on betamimetics, 23% required inhalational betamimetics with intermittent inhalational corticosteroid and 21% use both regularly. Perorally corticosteroids or leukotrien inhibitors were not used at all. There was no negative influence on subjective felling of the female during her pregnancy and labor in 71% of cases. 24% of all females suffering from bronchial asthma delivered by Caesarean Section but just in two of them it was indicated due to the bronchial asthma itself. We observed no case of IUGR or congenital defect. No change in the length of the hospital stay in comparison to the other females was shown.The nowadays standard treatment of bronchial asthma during pregnancy is based on local inhalative bronchodilator and anti-inflammatory medication. Pregnant females are usually well compensated, and thus their perinatal outcome shows no difference compared to the healthy population.

HELLP syndrome is a serious obstetrical complication that tends to occur in the second half of pregnancy that complicates six promiles of pregnancies. The term HELLP syndrome is derived from the beginning letters of the English words indicating laboratory changes, which is occurs as a specific illness in pregnancy. There is hemolysis, elevated liver enzymes and a decreased platelet count. It can present itself with preeclampsia or without it. The most serious complications are disseminated intravascular coagulation, liver rupture or various organ failures. The pathogenesis at the moment is not completely known. The basic approach to care is delivery at the earliest possible term. HELLP syndrome generally arises in the second or third trimester of pregnancy, but can also occur after delivery. It has typical signs, which can also arise due to other liver diseases, but more frequently in diseases of the gall bladder, which in pregnancy given the physiological changes in the body of the pregnant women is also predisposed. In this context, woman with this problem can seek out other physicians than obstetricians. In our case, we wanted to refer to the needs of early diagnosis of this frequently diagnosed illness, since in the case of late diagnosis and a woman not sent to the obstetrical department can lead to a serious life threatening state for the mother and child.

Retrospective analysis of the population of women examined for suspicion of sexual assault to compare the situation in the Czech Republic with the world's published works.Retrospective analysis.Department of Obstetrics and Gynecology, 1st Medical Faculty of Charles University and the Faculty Hospital Na Bulovce Prague.Retrospective analysis of medical reports for all women examined for suspicion of sexual violence during the period from January 2007 to December 2008.During observed period 37 women were examined, average age of examined women was 26.2 years, range 15-51 years, 76% of females younger than 29 years, 16% of examined women were from abroad. We have found no differences in occurrence throughout the year. In 3 cases there were more aggressors, in 30% of cases the alleged perpetrator was a known person or relative. In 54% of cases completed vaginal intercourse with ejaculation allegedly took place. We detected one case of forced oral sex and one case of forced anal sex. In 19% touching was involved. 22% of women did not know whether coitus really occurred--in 14% the alleged victim was under the influence of alcohol, in 3 cases under the influence of drugs, including one case of drinking an unknown substance in a beverage. Obvious signs of violence were found in 27% of cases, of which mostly in the face (14%), the extremities (8%) and only in two cases on the genitals (5%). No woman did require medical treatment of injuries.Our experience is similar to the published world data. In our group there were more strangers among the perpetrators. We did not record any use of a weapon in the enforcement of sexual contact. It is necessary to examine the alleged victims whole body thoroughly, signs of violence were more frequent in extragenital localization.

Analysis of two cases uterine rupture following caesarian section.Two case studies.Gynecological obstetrics clinic, First Medical Faculty and Faculty Hospital Bulovka, Prague.The authors in their article describe two cases of rupture of the uterus in pregnancy prior to delivery. In both cases there was a history of cervicocorporal caesarian section.In the first case the patient was admitted from her home with bleeding, and signed a nonconsent form. The second case concerned a hospitalized patient, in which the first signs of uterine rupture were indicated by fetal heart rate. Both women underwent hysterectomy, paradoxically, in the first case the child was saved and discharged home in good health.

The aim of the study is to show the possible variations of early symptoms of haematological malignity during pregnancy and to summarize data about treatment modalities and possible management of gravidity in case of the disease.Case report.Department of Obstetrics and gynaecology, Charles University, 2nd Medical Faculty; 1st internal clinic - department of hematology, Charles University, 1st Medical Faculty, Prague.Pubmed database was searched between years 1989 and 2009. The data we used focused on non- Hodgkin's lymphomas diagnosed during pregnancy, especially on Burkitt lymphoma. The treatment modalities, neonate outcomes and prognosis of the mothers were emphasised.The diagnostics of haematological malignities in pregnancy is difficult. The most frequent symptoms are subfebris, fever of unknown etiology, lymphadenopathy, night sweats, infirmity and the weight lost. According to the literature the Burkitt lymphoma is potencialy currable disease during pregnancy. The close cooperation of the gynecologists and hematooncologists and the individualization of treatment based on the stage of pregnancy, localization of the tumorous mass and the agresivity of disease is needed.

Herpes simplex virus (HSV) is considered to be one of the most frequent viral infectious agents in humans. Transmission of HSV from mother to foetus during pregnancy is uncommon with about 85% of transmission occurring perinatally, when neonates acquire HSV during vaginal birth from infected genital tract secretions. For women, who present with an episode of recurrent genital herpes several weeks before the expected delivery date, suppressive therapy with acyclovir or valacyclovir is recommended during the last 4 weeks of pregnancy. The study group consists of 21 women with recurrent genital tract herpes, who delivered between the years 2007-2009 at the Department of Obstetrics and Gynaecology, University Hospital Na Bulovce. Women in the last month of pregnancy were administered prophylactic viralstatic treatment with acyclovir 3 x 400 mg per day orally until delivery. In this study, no patient showed signs of acute lesions and viral DNA was not detectable on PCR in vaginal secretions. One woman delivered by acute caesarean section following signs of foetal hypoxia during the first stage of labour, two women were delivered by forceps. No newborns showed signs of HSV neonatal infection. Antiviral prophylaxis in the last month of pregnancy in women with recurrent genital herpes infection is considered to be safe and effective in the prevention of vulvar lesions and in decreasing the incidence of caesarean sections in this group of women.

Endometrial cancer is the second most common malignancy of the female genital tract. Its incidence in the Czech Republic is 32/100 000 women and year with a permanent increasing tendency. In comparison with incidence, its mortality remains relatively low, with mortality ratio of 6.7 per 100,000 women and year. The decrease in mortality might be explained predominantly by early diagnostics. The most controversial issue is the potential risk of microscopic extrauterine dissemination of cancerous cells within the peritoneal cavity and circulation during hysteroscopy, and the question if the relatively high pressure of distension medium used during hysteroscopies may or may not multiply the risk.Retrospective study.Totally, 400 endometrial biopsies were collected during years 2007-2009 at our clinic. In 56 patients, endometrial cancer was diagnosed. Afterwards, 44 women underwent surgery, during which peritoneal washing (lavage) and cytological examination were done.Fifty-six patients with histologically verified endometrial carcinoma were studied. The samples examined in the study were classified by grading as follows: G1 n=34, G1-2 n=10, G2 n=10, G3-4 n=2. In 44 cases that underwent radical surgery, no cancerous cells in peritoneal washings were found. Only in 1 case, the cytology obtained from peritoneal washing was considered to be suspicious. In 9 cases, carcinoma on the base of the polyp was detected, and in 2 cases, no residuum of cancer was observed after hysterectomy.In accordance with contemporary literature and based on our study, we suggest that hystero-resectoscopy does not increase the risk of dissemination of malignant cells within the peritoneal cavity and does not worsen the prognosis of the disease. On the contrary, the samples taken under visual control provide more precise and earlier diagnostics of endometrial cancer.

The aim of this paper is to introduce the new Single-Incision Sling System MiniArc in treatment of the female stress urinary incontinence.Prospective follow up.Department of Obstetrics and Gynaecology, The First Faculty of Medicine, Charles University in Prague.Prospective follow up of the first set of 38 patients treated with the new method MiniArc.We performed initial 38 cases of MiniArc under the local anesthesia. There was neither the complication during procedure, nor during the early postoperative period. No patient required urine derivation. Late postoperative period showed neither obstruction, nor ,,de novo urgency". One asymptomatic sub-urethral tape protrusion into the vagina was found. No late postoperative pain occurred. Subjective cure rate was investigated in 33 ladies with follow up from 6 weeks through 19 months. 23 females declared full dryness (i.e., 76.7%), 6 patients were very satisfied and declared improvement of more than 70% (i. e. 20.0%); thus we obtained efficacy in 29 cases of 30 (i. e. 96.7%). We have not seen any vanishing of the sling effect. Based on our initial experience we judge the new single incision tape as very promising.

Polypropylene mesh in the treatment of genital prolapse in women was introduced at the turn of the millennium with the rationale of decreasing surgical invasiveness, reinforcing weak tissues and to possibly complement insufficient surgical techniques. Prospective randomized studies comparing traditional and modern operations are lacking.Prospective multicentre randomized study.Department of Obstetrics and Gynaecology, The First Faculty of Medicine, Charles University in Prague.A prospective multicentre trial was approved by the Ministry of Health of the Czech Republic and registered with the FDA planning to recruit 500 patients with vaginal prolapse, 18 years of age and over, undergoing surgery at 5 major urogynaecologic centres. The patients were divided into three groups according to prolapse predominance. The surgical techniques used were: anterior and posterior prolift, and randomly allocated total prolift or sacrospinous fixation. The examination setup included lower urinary tract ultrasound, MRI, POP-Q assessment and QoL questionnaires before surgery and six and 24 month after the surgery.Preliminary analysis of partial data of 225 women showed an acceptable rate of complications and a better success rate in the mesh groups, whereas operation time and blood loss was lower in the classical operation group. Quality of life questionnaires documented that all the methods used have comparably good results. The surgical techniques used are acceptable methods for pelvic organ prolapse repair with low complication rates and excellent impact on the subjective perception of the patient's quality of life.

The aim of this paper is to report the outcomes of the registry of the urogynaecologic procedures involving implant in the Czech Republic during the year 2007.Retrospective registry analysis.Czech Urogynaecological Association, Prague.We performed a retrospective analysis of all urogynaecologic procedures involving implant registered in the Czech Registry during the year 2007.We report the results of 2557 urogynaecologic procedures involving implant from the 33 referring centres from the Czech Republic. 2232 (87%) implants were intended to treat the stress urinary incontinence and 325 (13%) were used to treat the pelvic organ prolapse. Intraoperative complications were reported in 36 (1.41%) cases, early postoperative complications intervened in 117 cases (4.58%) and the late complications were found in 121 females (4.73%).

Caesarean section is the most frequent abdominal operation carried out in obstetric practice. Parturients undergoing this operation are still exposed to a substantial rate of short- and long-term complications. The incidence of re-laparotomy after caesarean section is 0.12-0.70%. The most common indication for re-laparotomy is intra-abdominal bleeding, uterine atony, eventration, haematoma in the muscle and intra-abdominal abscesses. We present the case report of an unusual life-threatening complication of caesarean section that led to re-laparotomy. Caesarean section rate has been continually increasing globally in the last few decades, thus we also have to take into account unusual complications e.g. intestinal complication.

The cause of ‘female urethral instability’ is still controversial. With the help of this retrospective analysis of 1168 continuous long-term recordings of the intraurethral pressure at the maximum point of urethral pressure, the correlation between pressure variations (UPV) and simultaneous bladder instability was investigated. It could be stated that clinically important UPV (more than 15 cmH2O) are found more often in women who suffer from signs of bladder instability (defined as low bladder compliance combined with uninhibited detrusor contractions and/or urinary leakage) than in patients without signs of unstable bladder.

The authors present a case report of unrecognized herpes genitalis, which was caused by primary HSV-1 infection. The 28-year old female was examined by three board certified gynaecologist and initially treated as mycotic vulvitis. The authors point out the atypical course in the patient without anti-HSV-1 and HSV-2 antibodies. This infection is rather very painful, extensive and with complications. Thus, it is necessary to consider the diagnosis and to begin antiviral therapy as soon as possible.

The aim of the study was to establish a new method of the multiple-frequency bioimpedance analysis (MFBIA) for patients with controlled ovarian hyperstimulation (COH) and to determine the significance of this method in prediction and early diagnosis of severe forms of ovarian hyperstimulation syndrome (OHSS).Prospective case control study.Department of Obstetrics and Gynecology, 2nd Medical Faculty, Charles University and University Hospital Motol, Prague.53 patients were recruited into the case control study. The surface body impedances for the frequencies of the current 1, 5, 50 and 100 kHz were measured. Study group included 13 patients with developed OHSS grade III.-V. according Golans classification. The control group included 40 women undergoing COH without developed OHSS. Measurements of impedances were performed by MFBIA device.The decrease of the values of impedance between the day of oocyte retrieval and the day of embryotransfer significantly increases relative risk of OHSS grade III.-V. development. The best correlation was found for the frequency of 5 kHz (9.08 p0.0001). The study suggests, the predictive value of MFBIA in OHSS development might be higher than the number of retrieved oocytes (20 oocytes-RR 5,71).Patients in risk of OHSS development are those with decreasing impedances. The highest predictive value of OHSS development is for the impedances at frequency of 5 kHz. Greater multicenter studies should be done to confirm our preliminary results.

Analysis of the set of women that underwent the termination of pregnancy in IInd trimester at the OBGYN clinic, Teaching Hospital Na Bulovce at interval of years 2006-2007. We appreciated the effect of method and compared with references in the literature. TYPE STUDY: Retrospective descriptive study. SEATTING: OBGYN clinic of the 1st faculty of Charles University, teaching hospital Na Bulovce, Prague.Retrospective analysis of the set of women that underwent termination of pregnancy in the IInd trimester. Data are obtained from medical documentation and statistically processed. The analysis treats with 50 cases, in all of them, cervix was prepared with hydrophile dilators. In 37 cases were subsequently handed up prostaglandins intraamnially, in two cases generally intravenously, in two cases vaginally and 9 pregnancies were finished directly by dilatation and curettage without endeavour about expulsion.From 37 women after intraamnial administration of prostaglandins, 35 (94.6%) aborted successfully. Average time from amniocentesis to expulsion was 13 hours 45 minutes, 23 women aborted to 24 hours (62.2%). Undesirable effects were present in 12 cases (32.4%).Our record of local intraamnial administration of prostaglandins appears to be effective method. On the other hand, other methods are described in recent literature, which appear to be more efficient and have smaller occurrence of adverse effects.

Lymphoedema is a severe postoperative complication after treatment of many malignancies. It is a pathological accumulation of extracellular water (ECW). Early diagnostic tool is needed. Multifrequency bioimpedance analysis (MFBIA) is a method for detection of changes in ECW.Prospective study.Dept. of Obstetrics and Gynaecology of the 2nd Medical Faculty, Charles University, Prague.We measured a control group of 72 women and a group of 74 patients undergoing a breast cancer surgery during 18 month after the surgery by MFBIA and circumferency. Characteristics of the patients were recorded. The detection of lymphoedema was done using MFBIA, circumferency measurement and upon the symptoms of the patients.The average age in the controll and tested group was 40,1 and 58,9 years. The average size of the tumour, grade and positivity if oestrogen receptors was 15,1 mm, 2,04 and 43%. In 23 patients (21%) complete lymphadenectomy was performed, in 51 patients (79%) a detection of sentinel lymph node was performed. Lymphoedema was detected in 8 women (11%). In these patients MFBIA detected lymphoedema 9 month earlier in total than other methods.MFBIA is a low-cost and precise method for the detection od early stage postoperative lymphoedema. We recommend to incorporate MFBIA into standard dispensatory plan of every patient combined with circumferency measurement.

An analysis of HIV positive women who gave birth between 1st January 1985 to 31st December 2006 in the Czech Republic.A retrospective descriptive analysis.Teaching Hospital Bulovka, 1st Faculty of Medicine, Charles University, Prague.The study included HIV positive women that gave birth between 1st January 1985 to 31st December 2006 at Bulovka hospital. The group of 62 HIV positive women (including 7 secundiparae) gave birth to 71 new-borns (twice twins). The deliveries were performed by C-section. We interrupted breast-feeding by all these women.All new-borns were born alive, no one had Apgar score less than 7 at five minutes. No congenital disorders were found. Three new-borns were transfered to Intensive care unit for new-born babies, two due to dysmaturity and one due to abstinence syndrome. 3 new-borns out of total 71 new-borns were HIV positive (4.2%).Routine prenatal screening for HIV and high-quality cooperation between obstetricians and infection control doctors are the basic condition of low rate of vertical trasmission HIV infection in the Czech Republic.

OBJECTIVE AND DESIGN OF STUDY: Determination of TGF-beta 1 levels in plasma of patients with operable breast cancer. The correlation of TGF levels with the stage of disease and other prognostic markers. Prospective study.There were 36 patients fulfilling the entrance criteria included in the study. The blood samples were taken to set the plasma levels of TGF-beta before the operation, with no adjuvant therapy. 27 age matched healthy volunteers served as controls. The study was approved by ethical board and patients signed informed consent regarding blood sampling and results presentation. Differences between groups were determined using the Mann-Whitney U-test.We proved that TGF-beta 1 levels are elevated in patients with operable breast cancer. Moreover, TGF-beta in plasma of patients with positive sentinel lymph node was significantly higher as compared to patients with negative sentinel node. Most important is the fact that patients involved in our study were in very early stages of disease.TGF-beta 1 is marker correlating with breast cancer disease risk factors, especially with positive sentinel lymph node. We conclude that TGF is one of the early markers which may help define the risk of disease progression already before the operation.

The aim of this study is to discuss incidence and treatment of synechia vulvae at our Institute in the five years period.Retrospective analysis.Department of Obstetrics/Gynaecology, Teaching Hospital Na Bulovce, the First Medical Faculty of Charles University in Prague.We performed a retrospective analysis of our set of patients treated at our Institute from 2001 through 2005. We assessed age, type of synechia, symptoms and treatment.We treated 108 cases of synechia vulvae in 83 patients, 16 cases were relapsing. Most patients were in the group of less than 3 years of age. Almost 64% of all cases were incidental findings of paediatrician. Our set comprised of posterior fusion (79% of patients), subtotal posterior fusion (14%) and the rest was anterior or middle fusion. 87% of all labial fusions were disintegrated without any need of anaesthesia.Our results confirmed high prevalence of posterior labial fusion; most of our cases were treated without any need of anaesthesia.

The aim of our study is to follow patients diagnosed with breast cancer associated with pregnancy.Prospective follow-up study.Department of Obstetrics and Gynecology of the 2nd Medical Faculty of the Charles University and Faculty Hospital Motol, Prague.Between the year 2002 and 2006 12 women were reffered to our department, seven with the diagnosis of breast cancer during pregnancy, three within one year after the delivery, two pregnant after the therapy for breast cancer. A managment was sellected individually with respect to the age of pregnancy, the stage of the disease and to the decision of the women. The average age of the diagnosis, managment, way of delivery, fetal and maternal outcome were recorded.The average age was 31.7 years. Two patients underwent a termination of the pregnancy, other delivered a healthy newborn. Two of our patients are dead, three have a metastatic disease, one was lost for follow-up, the rest are further followed.Breast cancer diagnosed during pregnancy is a special and rare situation, which needs to be managed individually as there is a lack of information about such patients. These patients should be concentrated in specialized centers.

To present an overview of current procedures used in female pelvic floor reconstructive surgery.Review article.Teaching Hospital Bulovka, 1st Faculty of Medicine, Charles University, Prague.Pelvic organ prolapse (POP) in women including associated disorders belong to the top problems in current urogynecology. During the last decade a substantial progress in elucidation of detail morphology and function of each pelvic floor compartments had been made. These new findings could be rapidly implemented into clinical medicine, mainly as application of new mesh implants. The results of reconstructive operations are variable, one of the reason is the existence of many operation techniques. This review article represents a short overview of those methods.Wide range of current operation procedures must be re-evaluated respecting the existence of new techniques based on recent anatomical studies.

The objective of the study was to evaluate the feasibility of radio guided occult lesion localization (ROLL) in the cases of nonpalpable breast cancers with sentinel lymph node biopsy.Prospective clinical studyDepartment of Gynecology and Obstetrics, 2nd Medical Faculty and Teaching Hospital, PrahaThirty-eight patients with nonpalpable breast cancer diagnosed by core cut biopsy underwent an injection of the radiopharmaceutical 18-20 hours before surgery. The dose of the radiopharmaceutical was 45 MBg into tumor and 15 MBg subdermaly. Surgical excision of radioactive breast tissue with nonpalpable tumor was carried out using the hand held gamma probe and the same technique was performed for biopsy of sentinel lymph node. Standard localization technique with hook-wire was performed in the control group of fifty-one patients.Radioguided surgery of nonpalpable tumor was successful in all cases. Surgical margins were clear in all cases, in four cases (10.5%) the margins were only 2 mm. The sentinel node was identified in all cases, in 3 patients (7.9%) the sentinel node was involved by tumor and axillary lymphadenectomy was performed. Infiltrating carcinomas were diagnosed in the "hook-wire" group in 21 cases (41.2%), all with clear margins over 3mm. Proportion of margins status between ROLL and hook-wire was the same. It seems that the health tissue loss around the tumor is in hook-wire technique bigger but it requires next study.Simultaneous performance of ROLL and sentinel node biopsy is useful and practicable methods in the management of nonpalpable breast cancer. In comparison to hook-wire, radioguided removal allows reduced excision volume and better lesion centering within the specimen.

This review summarizes the data from published studies that dealt with observation of various bioparameters changes in cancer population dependant on used therapy. Critically evaluating these studies and looking for relations among separate results we are trying to estimate prognostic value of these parameters (likelihood of recurrence, overall survival, ...) and also their value for prediction of tumor response to cytostatic, hormonal or other treatment. The aim is selection of such tumor population characteristics the testing of them would enable better patient stratification in postoperative adjuvant systemic therapy.

Analysis of reasons and risks of planned and unplanned deliveries out of medical facilities.Review of literature and casuistry. NAME AND SITE OF DEPARTMENT: Department of Obstetrics and Gynaecology, Teaching Hospital Na Bulovce, 1st Faculty of Medicine, Charles University in Prague.Authors of this paper are discussing published evidences concerning the reasons and the risks of planned and unplanned deliveries out of the medical facilities. They are pointing out at the activities of some independently practising midwives, who systematically encourage females against medically conducted deliveries during their prenatal courses, thus obtaining clients for home deliveries. At the end of the paper the authors present three casuistries from their own practice to document the outcomes of disinformation and prenatal courses guided in a wrong way.According to the results of foreign studies and own experience home deliveries are accompanied by senseless risks for mother and child. Dubitable benefits of the home surroundings cannot counterbalance these risks. Prenatally purposely misinformed woman and her partner often threaten themselves and their arriving child during labour with senseless risks.

The objective of this work was to assess proper management of squamous intraepithelial lesion (SIL) and microinvasive carcinoma during and after pregnancy, to assess risks of punch biopsy and conization in pregnancy and to assess regression, persistence and risk of progression with low-grade (L) and high-grade (H) SIL.We carried out a prospective study of 167 pregnant women from our colposcopic unit who were referred to us for abnormal cytological findings between 1997 and 2002. The diagnosis of precancerosis was verified in all of the women by punch biopsy, suspect microinvasive carcinoma needle or LETZ conization up to the 20th week of pregnancy. All women were followed-up during the pregnancy and 24 months after their deliveries.In 23 women with suspect early invasion we performed conization during the pregnancy (weeks 13-23). There were six cases (26.1%) of microinvasive carcinoma and 17 cases (73.9%) of HSIL. One pregnancy aborted two days after the conization. No other obstetrical complications were recorded and there were no premature deliveries. Sixty-two women with HSIL were only followed-up during their pregnancy. We observed complete regression of HSIL during the study in 14 patients (22.6%), regression to LSIL in 17 patients (27.4%), persistence in 25 patients (40.3%) and progression to microcarcinoma in six cases (9.7%). Eighty-two patients were followed up for LSIL. Complete regression of LSIL was observed during the study in 40 cases (48.8%), persistence in 24 cases (29.2%) and progression to HSIL in 18 cases (22.0%).For LSIL and HSIL during pregnancy the above follow-up is a sufficient and safe protocol. Suspect microinvasive carcinoma should be treated by conization, which is a safe procedure until the 24th week of pregnancy.

Pregnancy in a woman with thrombosis of heart valve prosthesis at the 25th week of gestation and fetal death during reimplantation of prosthesis with the use of extracorporeal circulation.Case report.Department of Gynecology and Obstetrics, 2nd Medical Faculty of Charles University, Motol Hospital, Prague.Patient L. S., 24 years old, first pregnancy, admitted to coronary heart unit at the 25th week of gestation with a blocked heart valve prosthesis, NYHA IV, left heart failure, and pulmonary edema. There was an insufficient anticoagulation therapy during pregnancy and a thrombosis of the prosthetic heart valve was suspected from that reason. Reimplantation of a prosthetic heart valve with the use of extracorporeal circulation was indicated in spite of a possible risk for the fetus. The thrombosis was confirmed during cardio surgical operation and a change of the prosthesis was successfully performed. After the patient was converted to extracorporeal circulation, bradycardia and intrauterine fetal death occurred. With regard to the patient's coagulation and circulatory instability, further management was necessary because of fetal death--termination of pregnancy by minor caesarean section was the only alternative. Six hours later an 850 g weight dead fetus was delivered. There were no serious complications during the postoperative period.Reimplantation of a prosthetic heart valve from vital indication was performed at the 25th week of gestation. After conversion of mother to extracorporeal circulation, fetal death occurred. The patients was released with satisfactory cardiopulmonal compensation.

This paper reviewed the feasibility and accuracy of sentinel lymph node status in women with breast cancer.Clinical retrospective study.Dept. of Obstetrics and Gynecology, 2nd Medical School, Teaching Hospital Motol, Praha.Our trial involved 169 patients with breast cancer in the T1 and T2 stage without suspicion for axillary lymph node involvement. Lymphatic mapping was performed by sub dermal or subareolar injection of 99mTc labeled collodial human albumin (Senti-Scint) in the dose of 15 MBg one day before surgery. During the operation lymphatic mapping with vital blue dye (patent blau) was performed. Then the hand-held gamma-ray detector probe was used to locate the sentinel node. From a small axillary incision the blue-stained sentinel node was removed. Both methods of detection were compared, the sentinel lymph node has to be hot-radioactive and blue-stained. Complete axillary lymphadenectomy was then done. All removed lymph nodes were prepared for histopathological examination.Failures of sentinel lymph node detection were in 9 cases (5.3%) of the 169 patients. There was one case of false negative sentinel lymph node biopsy (0.6%). Most failures occurred during the learning phase of lymphatic mapping and were associated with excessive tumor involvement of axillary lymph nodes. Success of sentinel lymph node detection was in 160 cases (94.7%) and in our trial both methods of lymphatic mapping were equally effective. Tumor involvement of sentinel lymph nodes were in 43 patients (26.9%), in 19 (11.9%) of them, the sentinel nodes were the only metastasis nodes, whereas in the remaining 24 (15%) patients other axillary nodes were positive. The concordance between negative sentinel node and axillary lymph node status was in 117 (73.1%) cases.The introduction of sentinel lymph node biopsy allows directed and accurate assessment of axillary involvement with minimal morbidity. Sentinel node accurately predicts the status of all axillary nodes in more than 94.7% of cases.

The aim of our study was to find correlation between Valsalva leak-point pressure (VLPP) and cough leak-point pressure (CLPP) and to determine whether water perfusion maximum urethral closure pressure (MUCP) correlates with Valsalva leak-point pressure (VLPP).Cross-sectional clinical study.Gynecological and Obstetric Clinic, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague.Thirty women with previously untreated GSI were recruited to participate in a clinical study. Their mean age was 56.9, mean body mass index (BMI) 27.6, and mean parity 1.8. As part of the urethral pressure profile we determined MUCP and functional length (FUL) of the urethra. VLPP and CLPP were assessed during US examination using an ultrasound contrast medium and the color Doppler velocity (CDV). Funneling was described as the increase in distance between the inner edges of proximal urethra during Valsalva maneuver.We did not find statistically significant differences in the mean value of VLPP and CLPP. The mean value of VLPP was 51.6 cm H2O (SD=26.5) and CLPP 53.1 cm H2O (SD=25.5). The mean values of MUCP were 39.7 cm H2O (SD=22.1) with 500 ml and 41.5 cm H2O (SD=22.7) with 300 ml of sterile saline; the difference between them is not statistically significant. In the study group (n=30), 22 patients had low VLPP (or = 60 cm H2O). Only 8 patients had simultaneously MUCPor = 30 cm H2O and of these patients only 2 had simultaneously MUCPor = 20 cm H2O (the bladder volume 300 ml). Similar results were obtained with the bladder volume 500 ml. We did not find statistically significant differences in the funneling of proximal urethra between the groups of patients with low MUCP (or = 30 cm H2O) and with higher MUCP (30 cm H2O) and between the groups of patients with low VLPP (or = 60 cm H2O) and with higher VLPP (60 cm H2O).This study mainly compares two parameters--the MUCP and the VLPP. Based on our results we support the theory that ISD has a multifactorial basis, and a low MUCP or a low VLPP derives from two different pathogenic mechanisms. We support the Pajoncini hypothesis that low VLPP correlates with a deficiency in mucosal sealing and compromise of the intrinsic proximal component at the level of the bladder neck, and low MUCP correlates with a deficiency at the level of the rhabdosphincter in the middle urethra. In the future we must establish the prognostic value of the VLPP and the MUCP in the postoperative follow-up.

To investigate levels of antiovarian autoantibodies in girls and young women with disturbances of menstrual cycle before and during treatment with hormonal therapy. To explain morphological changes in ovarian structure in these patients.Studied group included 39 patients. 18 patients were treated for primary amenorrhoea, 21 for menstrual cycle disorders. Patients included in the study were repeatedly examined at the beginning of the study and after six months during which they were treated by estrogen and gestagen. In all patients we have tested FSH, LH and FSH/LH ratio, presence of antiovarian antibodies. Results were compared with those obtained in control women. 21 antiovarian antibodies positive patients were indicated for laparoscopic biopsy. Bioptic sample was examined using light and electron microscopy.Our treatment with hormonal therapy lead to the reduction of ovarian antigens. In 85% of the cases marked decrease of antiovarian autoantibodies levels was observed, while in 28% of the cases the levels were undetectable. From morphological changes of the bioptic sample enhanced atresia of follicules at different developmental stages was frequently observed. It evoked marked reduction of follicular apparatus up to its complete disappearing.The results of our study and mapping of the antiovarian antibodies positivity support our hypothesis that the antiovarian antibodies positivity corresponds with the clinical symptoms. Appropriate treatment with hormonal replacement therapy minimizes ovarian destruction, preserves ovarian hormonal functions and saves healthy ovarian tissue necessary for future fertility.

Numerous anatomical studies over the last years resulted in a principal shift in the view of the area of female pelvic floor. These studies also deal with the area of posterior compartment, i.e. a region which used to be of little interest to urogynecologists. This article presents a brief outline of anatomical and physiological knowledge as well as a brief survey of most important methods of examination and basic clinical symptoms associated with disorders of posterior part of hiatus urogenitalis. The presently accepted concept of a complex approach to disorders of female pelvic floor will probably require increased interest in this area among urogynecologists. The article is aimed at summarizing elementary knowledge necessary for adequate clinical care of patients suffering from disorder in posterior compartment function.Review article.Department of Gynecology and Obstetric, Faculty Hospital Na Bulovce, 1st Medical Faculty, Prague, Czech Republic.

In a placebo-controlled, randomized, double-blind study the efficacy of a Vitex agnus castus extract-containing solution (VACS) was investigated in patients suffering from cyclical mastalgia. Patients had mastalgia on at least 5 days in the pre-treatment cycle. During this cycle and during treatment (3 cycles; 2 x 30 drops/day), the intensity of mastalgia was recorded once per cycle using a visual analogue scale (VAS). After one/two treatment cycles, the mean decrease in pain intensity (mm, VAS) was 21.4 mm /33.7 mm in women taking VACS (n=48) and 10.6 mm/20.3 mm with placebo (n=49). The differences of the VAS-values for VACS were significantly greater than those with placebo (p=0.018; p=0.006). After three cycles, the mean VAS-score reduction for women taking VACS was 34.3 mm, a reduction of 'borderline significance' (p=0.064) on statistical testing compared with placebo (25.7 mm). There was no difference in the frequency of adverse events between both groups (VACS: n=5; placebo : n=4). VACS appears effective and was well tolerated and further evaluation of this agent in the treatment of cyclical mastalgia is warranted.

The efficacy of propiverine in elderly patients suffering from urge incontinence or urge-stress incontinence was intended to be investigated. Especially in elderly patients a cardiac influence of propiverine is possible due to its dual mode of action. That is why besides the efficacy especially the cardiac safety was intended to be investigated.Ninety-eight patients (21 male, 77 female; 67.7 +/- 6.3 years of age) suffering from urgency, urge incontinence or mixed urge-stress incontinence were included in the double-blind, multicentre, placebo-controlled, randomized study. After a two-week placebo run-in period, the patients received propiverine (15 mg t. i. d.) or placebo (t. i. d.) for four weeks. Before (U 1, U 2) and during the treatment period (U 3, U 4), standard ECG's and 24 h long-term ECG's were recorded.Propiverine caused a significant reduction in the micturition frequency (U 2 : 8.7 +/- 4.2, U 4 : 6.5 +/- 3.2 ml; p0.01) reflected in a significant increase in the average micturition volume (U 2 : 163.5 +/- 65.9, U 4 : 216.3 +/- 101.5 ml; p0.01) and a significant reduction in the episodes of incontinence (- 54 %; por = 0.05). These findings were confirmed by the overall assessment after four weeks in which approximately 90 % of patients under propiverine were either free from urge incontinence and urge symptoms or improved. The efficacy parameters demonstrated a better efficacy for urge incontinence than for mixed urge-stress incontinence. Resting and ambulatory electrocardiograms evidenced no significant changes. Neither QTc interval nor other cardiac parameters were relevantly altered. The frequency of cardiac events (Lown classes IV a/b) was fortuitous, revealing no difference between placebo and propiverine. The incidence of adverse events was very low (2 % dryness of the mouth under propiverine) and confirmed by the findings from the quality of life questionnaires.A favourable benefit-risk ratio in the treatment of elderly patients suffering from urgency, urge incontinence or combined urge-stress incontinence is therefore proven for propiverine. Cardiac arrhythmia were not induced.

The objective of the study was to investigate the changes of histopathological and immunohistochemical parameters of breast tissue among the HRT users.Prospective, pilot study.Departments of Gynecology and Obstetrics, Pathology and Radiology of the 2nd Medical School, Charles University and the Teaching Hospital Motol, Praha 5, Czech Republic.The samples of breast issue were obtained by core cut biopsy and during the breast surgery procedures in the study group of HRT users (no = 48) and in the control group of women without HRT (n = 22). Proliferation index (Ki-67), expression of ERB2 oncoprotein and hormonal receptors (ER, PR) were examined in the breast tissue in addition to routine histopathological examinations.We did not record increasing frequency of proliferative and precancerous lesions in the group of HRT users. Ki-67 expression was very low both in HRT users and in the control group of women. The values of estrogen receptors expression in breast tissue samples of women with HRT were similar to the findings in the normal breast. The values of progesterone receptor expression were higher among the HRT users then non-users, but it can be considered as a normal response of breast tissue to hormonal influence. Expression of ERB protein in HRT users was similar to that found in non-users.The findings indicate that HRT has not increased the proliferation rate of the breast tissue in our study group, so this mechanism certainly does not increase the risk of breast cancer.