Neuroendocrine tumors of the gynecological tract: A narrative literature review.

Neuroendocrine neoplasms (NENs) of the gynecological tract are a rare, heterogenous and aggressive group of neoplasms, with high recurrence rates and poor prognosis. In this review we focus on NENs of the gynecological system emphasizing the classification, epidemiological and clinical characteristics of NENs across the gynecological tract (cervix, endometrium, ovary, vagina, and vulva), risk/prognostic factors, pathology and molecular biology (including actionable genomic mutations), imaging, staging and the most effective treatment modalities in the "standard of care" approach as well as the pipeline products. We also focused on metastatic spreading patterns of gynecological NENs.

Episiotomy and innervation zones of the external anal Sphincter: A case series investigating the impact on neurological patterns.

Objective: To investigate the impact of mediolateral episiotomy on the innervation zones of the External Anal Sphincter (EAS) in the absence and presence of direct muscular injury.

Methods: This case series examined four primiparous women, including three who underwent vaginal deliveries with mediolateral episiotomy and one cesarean section case for reference. Pre- and post-delivery assessments utilized surface electromyography (sEMG) and endoanal ultrasound to evaluate changes in the EAS's innervation zones and obstetrical EAS injuries, alongside the Wexner score for fecal incontinence.

A Deeper Look at Office Hysteroscopy in Asymptomatic Postmenopausal Patients: Indications and Outcomes of 822 Cases.

Study Objective: This study aims to assess the prevalence of malignancy and other endometrial pathologies in asymptomatic postmenopausal women referred for office hysteroscopy (OH), identify main referral indications, and assess their relationship with the risk of malignancy. Secondary objectives included evaluating the association between ultrasound variables and malignancy risk and assessing procedure validity, which encompasses duration, feasibility, and patient comfort during OH.

Design: Retrospective analysis.

Delayed surgical management of rectovaginal fistula: a case report highlighting challenges and lessons learned.

Background: Rectovaginal fistulas following an obstetric anal sphincter injury's repair are rare in developed country and their management could be challenging, particularly in cases of delayed repair. This study emphasizes the importance of accurately diagnosing and promptly repairing such fistulas for optimal patient well-being.

Case: A 30-year-old patient presented with gas incontinence and a greenish discharge from the vagina, 6 months after delivering her baby.

Sigmoid neovagina prolapse treated with Altemeier procedure: case report and systematic review of the literature.

Background: Bowel vaginoplasty is a surgical method for neovagina construction that, despite its advantages over other techniques, is still burdened by complications such as prolapse. The incidence of sigmoid neovagina prolapse (SNP) is difficult to determine, and there are no evidence-based recommendations for treatment. We present a case of SNP and a systematic review of previous cases.

The influence of the fundal pressure manoeuvre at delivery on the anal sphincter injury diagnosed with endoanal ultrasonography.

Objectives: The fundal pressure manoeuvre (FPM) is a procedure where the fundus of the uterus is pushed through the abdominal wall by the midwifes and doctors to shorten the terminal phase of the second stage vaginal delivery. Nowadays its use is controversial and associated with many adverse effects. The aim of the study was to evaluate benefits and adverse maternal outcomes after FPM.

Office hysteroscopy in removing retained products of conception - a highly successful approach with minimal complications.

Data of 101 patients with retained products of conception (RPOC), treated with office hysteroscopy (OH) from 2012 to 2015 at the University Medical Centre Ljubljana were analysed. Patients with >30 mm RPOC thickness or strong vascularisation on ultrasound (US) were excluded. Procedures were successfully completed in 94/101 (93%).

Obstetric risk factors for early-onset anal incontinence.

Purpose: The aim of the study was to identify primiparous pregnant women with a higher risk for early anal incontinence (AI) after labour.

Methods: In the retrospective case control study, 133 primiparous women were questioned using the Wexner scoring system, and possible obstetric anal sphincter injuries (OASIS) were assessed using endoanal ultrasonography (EUS) 6-12 weeks after the labour. Obstetric characteristics (possible risk factors) for AI were collected from the maternal medical records.

Ultrasound-guided embryo transfer: summary of the evidence and new perspectives. A systematic review and meta-analysis.

Despite the purported advantages of ultrasound guidance during embryo transfer, and the large number of clinical trials published on this topic, recommendations for the use of this technique in daily clinical practice are still under debate. We designed a meta-analysis based exclusively on evidence from published randomized controlled trials, with the aim of analysing the effect of trans-abdominal ultrasound guidance during embryo transfer versus clinical touch and of transvaginal ultrasound guidance (TV-US) versus the trans-abdominal approach on IVF outcomes. On the basis of 14 randomized trials, we found a moderate quality of evidence supporting the beneficial effects of transabdominal guidance during embryo transfer compared with conventional clinical touch in clinical pregnancy and ongoing or live birth rates.

Could the correct side of mediolateral episiotomy be determined according to anal sphincter EMG?

Introduction And Hypothesis: Mediolateral episiotomy is one of the most frequent surgical interventions performed in obstetrics. There is conflicting evidence as to whether mediolateral episiotomy reduces the risk of obstetric anal sphincter injuries (OASI). Recent studies suggest that functional asymmetry of pelvic floor innervation exists in healthy women and is strongly associated with postpartum incontinence when the trauma occurs on the dominant side of innervation.

Impact of mediolateral episiotomy on incidence of obstetrical anal sphincter injury diagnosed by endoanal ultrasound.

Objective: to examine potential association between mediolateral episiotomy and reduced incidence of obstetrical anal sphincter injuries (OASIS) diagnosed by endoanal ultrasound.

Design: prospective cohort study.

Setting: tertiary referral university hospital.

Can we predict obstetric anal sphincter injury?

Objective: The aim of the study was to identify primiparous pregnant women with a higher risk for obstetric anal sphincter injuries (OASIS) based on obstetric characteristics (risk factors).

Study Design: In the retrospective case control study primiparous women were examined using endoanal ultrasonography (EUS) for OASIS identification 6-12 weeks after delivery. Obstetric characteristics for OASIS were collected from the mothers' medical records.

Effect of vaginal delivery on the external anal sphincter muscle innervation pattern evaluated by multichannel surface EMG: results of the multicentre study TASI-2.

Introduction And Hypothesis: A correlation exists between external anal sphincter (EAS) damage during birth and the subsequent development of fecal incontinence. This study evaluated the effect of delivery-related trauma on EAS innervation by means of intra-anal EMG performed with a rectal probe with 16 silver electrodes equally spaced along the circumference, before and after delivery.

Methods: Pre-partum EMG measurements were performed on 511 women, by nine clinical partners from five European countries at the 28th to 34th gestational weeks and the 6th to 8th post-delivery weeks; 331 women returned, after delivery, for the second test.

Characterization of the motor units of the external anal sphincter in pregnant women with multichannel surface EMG.

Introduction And Hypothesis: Locating the innervation zones (IZs) of the external anal sphincter (EAS) is helpful to obstetricians to identify areas particularly vulnerable to episiotomy in pregnant women. The aim was to investigate the motor unit (MU) properties of the EAS during voluntary contractions.

Methods: Electromyographic signals were detected, from 478 pregnant women, by means of an intra-anal cylindrical probe carrying a circumferential array of 16 electrodes.