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Hemostasis Techniques in Myomectomies
AbstractPurpose of ReviewMyomectomy can be associated with significant blood loss, particularly when large and numerous fibroids are removed. Surgeons have incorporated a large number of methods to reduce blood loss, including pre-operative optimization, the use of minimally invasive surgery, and intraoperative techniques. The purpose of this review is to summarize these methods and evaluate the literature supporting those with clinical value.Recent FindingsThe use of minimally invasive surgery has clear benefit in reducing blood loss in myomectomy for appropriately selected patients. Preoperative hormonal treatments reduc...
Source: Current Obstetrics and Gynecology Reports - June 1, 2018 Category: OBGYN Source Type: research

Management of Fibroids in Resource-Limited Settings
This article reveals that limited data are available regarding the prevalence, treatment, and extent of the management of uterine fibroids in such settings. Myomectomy is the most common procedure used for fibroids ’ treatment and it can be done during cesarean sections under certain circumstances. Medical treatment and new technologies of fibroids treatment are rarely available for use.SummaryManagement and treatment of fibroids needs continuous efforts in research and innovation into finding cost-effective solutions. Media should play a major rule in increasing the awareness of the problem among women. On the other han...
Source: Current Obstetrics and Gynecology Reports - June 1, 2018 Category: OBGYN Source Type: research

New Horizons in Fibroid Management
AbstractPurpose of ReviewReview of the latest advances in the treatment of uterine fibroids. Addressing conservative management, medical therapy, interventional radiological procedures (non-surgical alternatives or non-excisional procedures) and conservative or radical endoscopic or open surgery (myomectomy, hysterectomy).Recent FindingsNewer medical therapy relied on the use of selective progesterone receptor modulators (SPRMs) (Esmya/UPA) for management of heavy menstrual bleeding (HMB) associated with fibroids. However, the drug is currently under investigation for a link with hepatic damage associated with its use. Oth...
Source: Current Obstetrics and Gynecology Reports - May 16, 2018 Category: OBGYN Source Type: research

Natural History of Uterine Fibroids: A Radiological Perspective
AbstractPurpose of ReviewThis review aims to update our understanding of the radiological life cycle of fibroids, so that we may better counsel patients making difficult treatment decisions. Evidence for both pregnant and non-pregnant women have been considered separately.Recent FindingsRecent findings have shown that fibroids can undergo both growth and regression in non-gravid uterus. In pregnant women, fibroid growth is non-linear fashion, with the greatest growth occurring in the first 7  weeks of pregnancy. Growth in the later trimesters was significantly slower.SummaryFibroid growth, both in the intra- and inter-gra...
Source: Current Obstetrics and Gynecology Reports - May 8, 2018 Category: OBGYN Source Type: research

The Loss of Vaginal Hysterectomy
AbstractPurpose of ReviewThe purpose of this review is to provide an update on evidence to support primary use of the minimally invasive approach provided by vaginal hysterectomy in benign conditions that meet criteria for removal of the uterus. This paper will also serve to discuss why the vaginal approach to hysterectomy has decreased over the last decade and to provide observations and solutions to this problem.Recent FindingsRecent findings continue to support vaginal hysterectomy as the preferred route for hysterectomy as endorsed by position statements by the American College of Obstetrics and Gynecology, the America...
Source: Current Obstetrics and Gynecology Reports - May 1, 2018 Category: OBGYN Source Type: research

The Life Cycle of the Uterine Fibroid Myocyte
AbstractPurpose of ReviewUterine fibroids are common benign tumors of women in the USA and worldwide, yet the biological nature and pathogenesis of these tumors remain largely unknown. This review presents our view of the stages in the life cycle of a subset of uterine fibroid myocytes, introduces hypothetical concepts and morphological data to explain these changes, and relates these changes in individual myocytes to the phases of fibroid tumor development.Recent FindingsThe observations gained from light and electron microscopic, immunohistochemical, and morphometric studies in our laboratory have led to the hypothesis t...
Source: Current Obstetrics and Gynecology Reports - April 28, 2018 Category: OBGYN Source Type: research

Endometrial Ablation —Current Evidence for Patient Optimization and Long-Term Outcomes
AbstractPurpose of ReviewEndometrial ablation is a minimally invasive surgical option to treat abnormal uterine bleeding. Here, we summarize the evidence regarding patient optimization prior to endometrial ablation and the long-term outcomes of this procedure. Patient optimization includes preoperative planning, patient selection, and preoperative predictors of postoperative failure. Long-term outcomes include postoperative bleeding patterns, frequency of additional procedures for treatment failure, patient satisfaction, risk of endometrial cancer, and pregnancy outcomes.Recent FindingsEndometrial ablation is a safe proced...
Source: Current Obstetrics and Gynecology Reports - April 25, 2018 Category: OBGYN Source Type: research

An Overview of Surgical Treatment for Female Stress Urinary Incontinence
AbstractPurpose of ReviewWe aimed to present an overview of recent data on the proven surgical techniques for female stress urinary incontinence (SUI) including their efficacy, safety, and adverse events.Recent FindingsSurgical treatment of female SUI is the mainstay of urogynecological surgery, with two accepted gold standard techniques: Burch colposuspension and synthetic midurethral slings (MUS). Thorough understanding of the historical evolution of the surgical techniques before and after the introduction of integral theory is important. This theory enhances our comprehension for the continence mechanism of MUS, which ...
Source: Current Obstetrics and Gynecology Reports - April 23, 2018 Category: OBGYN Source Type: research

Female Voiding Dysfunction: a Practical Approach to Diagnosis and Treatment
AbstractPurpose of ReviewIn this review, we examined a practical approach to diagnosis and treatment of voiding dysfunction in female patients.Recent FindingsThis field of urogynaecology has been the subject in many studies over the last few decades, but despite that, there is no universally accepted algorithm for diagnosis and treatment of this condition. This is primarily related to a lack of standardised definition of different types of voiding dysfunction. The International continence society (ICS) and International Urogynecology Association (IUGA) have created a joint document on terminology of female pelvic floor dys...
Source: Current Obstetrics and Gynecology Reports - April 21, 2018 Category: OBGYN Source Type: research

Hemostasis Techniques in Myomectomies
AbstractPurpose of ReviewMyomectomy can be associated with significant blood loss, particularly when large and numerous fibroids are removed. Surgeons have incorporated a large number of methods to reduce blood loss, including pre-operative optimization, the use of minimally invasive surgery, and intraoperative techniques. The purpose of this review is to summarize these methods and evaluate the literature supporting those with clinical value.Recent FindingsThe use of minimally invasive surgery has clear benefit in reducing blood loss in myomectomy for appropriately selected patients. Preoperative hormonal treatments reduc...
Source: Current Obstetrics and Gynecology Reports - April 21, 2018 Category: OBGYN Source Type: research

Management of Fibroids in Resource-Limited Settings
This article reveals that limited data are available regarding the prevalence, treatment, and extent of the management of uterine fibroids in such settings. Myomectomy is the most common procedure used for fibroids ’ treatment and it can be done during cesarean sections under certain circumstances. Medical treatment and new technologies of fibroids treatment are rarely available for use.SummaryManagement and treatment of fibroids needs continuous efforts in research and innovation into finding cost-effective solutions. Media should play a major rule in increasing the awareness of the problem among women. On the other han...
Source: Current Obstetrics and Gynecology Reports - April 17, 2018 Category: OBGYN Source Type: research

The Current Landscape of PARP Inhibitors in Ovarian Cancer
AbstractPurpose of ReviewThe aim of this study is to discuss the background of PARP inhibitors and to provide an overview of the utility of these drugs for treatment of epithelial ovarian cancer.Recent FindingsNumerous phase I –III trials are presented within the manuscript that outline the safety and efficacy of several PARP inhibitors in women with primary and recurrent ovarian cancer. There are now three FDA-approved PARP inhibitors for use in ovarian cancer patients in the USA: olaparib, niraparib, and rucaparib. Th ese drugs have activity both alone and in combination with other agents, including chemotherapy and ta...
Source: Current Obstetrics and Gynecology Reports - March 3, 2018 Category: OBGYN Source Type: research

Enhanced Recovery After Minimally Invasive Surgery (ERA mi S) for Gynecology
AbstractPurpose of ReviewEnhanced Recovery After Surgery (ERAS) programs are mechanisms for achieving multimodal, evidence-based reductions in surgical stress and value-based improvements in perioperative care. Implementation of these programs has been shown to significantly decrease narcotics utilization, perioperative morbidity, length of stay (LOS), and cost of care. This review summarizes the origins and penetrance of ERAS programs into the field of gynecology to date. It presents the rationale and basic construct for an ERAS program customized for gynecologic minimally invasive surgery (MIS), with special focus on pat...
Source: Current Obstetrics and Gynecology Reports - March 1, 2018 Category: OBGYN Source Type: research

Updates in Sentinel Lymph Node Mapping in Gynecologic Cancer
AbstractPurpose of ReviewThe aim of this study is to review the indications, techniques, and outcomes of sentinel lymph node (SLN) mapping in endometrial, cervical, and vulvar cancers.Recent FindingsIn endometrial cancer, the prospective FIRES trial showed that the negative predictive value of SLN mapping was 99.6%. Furthermore, multi-institutional retrospective studies comparing SLN mapping to traditional lymphadenectomy have found comparable survival between the two techniques, in both type 1 and type 2 endometrial cancer. In cervical cancer, randomized data from the SENTICOL-2 study has demonstrated significant reductio...
Source: Current Obstetrics and Gynecology Reports - March 1, 2018 Category: OBGYN Source Type: research

Immune Checkpoint Inhibition in the Treatment of Gynecologic Cancer
AbstractPurpose of ReviewThe purpose of this review is to update readers on recent advancements in the use of immune checkpoint inhibitors for the treatment of ovarian, uterine, and cervical cancers.Recent FindingsImmunotherapy has emerged as a novel therapeutic paradigm in the treatment of gynecologic malignancies. Currently, immune checkpoint inhibitors are approved for use across five solid malignancies, with recent approval of pembrolizumab in patients with MMR-deficient, recurrent, solid tumors in a disease site agnostic fashion. Phase 3 clinical trials are being conducted in the gynecologic cancer arena to determine ...
Source: Current Obstetrics and Gynecology Reports - March 1, 2018 Category: OBGYN Source Type: research