Vol 24, No 3 (2022)

Endometriosis is a hormone-dependent condition occurring in women of predominantly reproductive age. It has an extremely diverse localization, clinical course and outcomes. The need for organ-sparing treatment to preserve and/or restore fertility, the negative effects of radical surgery for endometriosis on ovarian reserve and the effectiveness of assisted reproductive technologies, and the benign nature of the disease, which tends to self-limitation after menopause, lead to the search for effective methods of non-surgical treatment and the need for noninvasive diagnosis of endometriosis. The article presents the current principles of non-surgical management of patients with endometriosis.

Introduction. A clinical and economic study was carried out to assess the effectiveness of infertility treatment using assisted reproductive technology programs with preimplantation genetic testing (PGT) in patients with various reproductive disorders.

Materials and methods. Twenty models representing discrete-time Markov processes are developed. A total of 10 possible paired scenarios for couples undergoing infertility treatment using assisted reproductive technology, depending on reproductive disorders and the use of PGT, were considered in the study.

Results. The most cost-effective scenarios from the simulation results should be the use of PGT in the group of females aged 37–42 years and in the group of females under 35 years with missed abortion. These scenarios are not only resource-efficient in terms of the willingness-to-pay threshold, but they also preserve compulsory health insurance funds still with meaningful clinical efficiency. The remaining scenarios are characterized by significant clinical efficacy and low cost per added live birth, except for the PGT use in the group of males with teratozoospermia, which is characterized by a minimum of added live births and a maximum cost per added live birth.

Conclusion. The study results indicate the most optimal and economically feasible scenarios of PGT in patients depending on the infertility factor for implementation in the practical healthcare system of the Russian Federation.

Background. Premature delivery remains one of the most pressing issues in obstetrics.

Aim. To assess the reproductive health of 16-year-old adolescent girls born prematurely to develop an algorithm to optimize its state.

Materials and methods. A total of 180 adolescent girls aged 16 years were evaluated. The study group consisted of 120 adolescents born at a gestational age of 27–36 weeks. Subgroup 1 consisted of 18 girls born at a gestational age of 27–33 weeks, and subgroup 2 consisted of 102 adolescent girls born at 34–36 weeks of gestation. The comparison group consisted of 60 girls born at term. The study material was peripheral venous blood. Hormonal and ultrasonic examination of the internal genital organs were performed.

Results. In the main group vs. comparison group, an increase in serum leptin levels was observed: 9.4 (6.1; 15.5) and 6.9 (4.2; 9.2) ng/ml (p<0.01). The leptin blood concentration in subgroup 2 showed a positive correlation with the body mass index (p=0.001). A more frequent increase in the number of antral follicles (>10 in each ovary) was recorded in adolescents born prematurely. When assessing the results of correlation analysis, a positive direct correlation between the number of antral follicles and serum leptin concentration in adolescent girls born prematurely (p<0.001) was observed. It was found that with a leptin level >15.8 ng/ml, there is an increase in the number of antral follicles, which may be the cause of reproductive disorders.

Conclusion. Premature delivery and its long-term consequences (obesity and metabolic syndrome) contribute to hyperleptinemia, leading to ovarian function suppression in adolescents. Therefore, it is necessary to include leptin level measurement in the algorithm of examining adolescent girls for timely diagnosis and subsequent treatment of possible reproductive disorders.

Abnormal uterine bleeding is a common problem in gynecology. It is a general term to describe menstrual disorders, including frequency, regularity, duration, and bleeding volume in non-pregnant women. Up to 1/3 of women experience this condition during their lifetime. Heavy menstrual bleeding not related to structural abnormality can be a serious health problem for many young women. It has a profound adverse impact on many aspects of their lives and increases the risk of iron deficiency anemia. However, up to half of these women consider the volume of menstrual blood loss normal, and physicians do not ask the relevant questions during counseling. The Russian Clinical Guidelines "Abnormal Uterine Bleeding" provide physicians guide to the assessment, management, and choice of treatment for women with heavy menstrual bleeding.

Scleroatrophic lichen (SL) is a chronic inflammatory skin disease of unknown etiology characterized by scar formation. The most frequent localization of SL is the anogenital area. In females, the most common anogenital symptoms are pain, itching, dysuria and dyspareunia. Male patients often present with complaints of a white rash on the penile skin, itching, painful erections and urination, and bleeding or ulceration during intercourse. Although clinical descriptions of SL date back to the mid-20th century, the pathophysiological mechanism remains unclear to this day. The main hypotheses of the pathophysiology of SL are infectious, autoimmune, and chronic irritation theories (occlusive exposure to various irritants, such as urine, leads to chronic skin injury that causes the disease). It is assumed that SL quite often goes undiagnosed for a long time. However, sometimes dermatoses such as eczema in the anogenital area are misdiagnosed by specialists as SL. In this article, the authors discuss in detail the existing hypotheses of SL development, its clinical manifestations, and current methods of diagnostics and therapy.

Pelvic floor insufficiency (PFI) is one of the most common and understudied gynecological diseases. PFI is a major public health problem that will steadily increase due to population aging. The issues of early diagnosis remain unresolved. Physical examination remains the primary method of evaluating PFI, but manual examination alone is not enough to diagnose hidden pelvic floor (PF) defects. Topical verification of muscular and fascial PF defects is necessary to route patients for non-surgical or surgical treatment. 2D/3D transperineal sonography is a non-invasive, simple, and the most common method of imaging PF structures.

The absence of rigid fixation point, tissue atrophy and multi-compartment defects make post-hysterectomy vaginal vault prolapse a real challenge for the surgeon. The gold standard for treatment of post-hysterectomy vaginal vault prolapse is sacrocolpopexy. Unfortunately, this approach does not allow to perform reliable long-term meshless reconstruction in the anterior and posterior compartments. Moreover, the use of a mesh is associated with the risk of erosion. Aim – to show the possibility of replacing a standard mesh with a vaginal flap during laparoscopic sacrocolpopexy. A 60-year-old patient with post-hysterectomy prolapse stage III underwent meshless laparoscopic vaginal-assisted sacrocolpopexy. The duration of the surgery was 105 min (35 min vaginal part and 70 min LS part). Intraoperative blood loss was 55 ml. No intraoperative and early postoperative complications were recorded. According to the ultrasound postvoiding residual was 35 ml, hematomas in the operation area were not visualized. During the exam in 12 months after the surgery, no signs of POP (Aa -2 Ba -3 C -8 Ap -3 Bp -3 tvl 9 gh 4 pb 3), erosion and any pain were detected. The results of the questionnaires were as follows: PFDI-20 – 22,92, PISQ-12 – 31 and ICIQ-SF – 1. According to ultrasound the volume of residual urine was 0 ml. This approach allows to eliminate completely the risk of erosion and create a unified plastic natural construction from the vaginal cuff and tailored flap.