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Finding the proportion of levator and fascial trauma of the pelvic floor in the development of symptoms pelvic organ prolapse - the effect of vaginal birth
Horčička, Lukáš ; Krofta, Ladislav (advisor) ; Halaška, Michael (referee) ; Chmel, Roman (referee)
Determination of the proportion of levator and fascial trauma of the pelvic floor in the development of symptoms of the descent of pelvic organs - the influence of vaginal birth Abstract Injury of levator ani muscle (LAM) is a significant pelvic organ prolapse (POP) risk factor. The puborectalis (PRM) and pubvisceral (PVM) subdivisions are at Level III vaginal support structures. Null hypothesis - there were no significant differences in muscle injuries patterns among LAM subdivisions. This retrospective magnetic resonance imaging (MRI) study included: 64 nulligravidae controls without pelvic floor dysfunction (PFD) and 526 POP symptomatic women of different parity. Primary outcome was PVM and PRM morphology on axial planes 1/ the place of the attachment to the pubic bone, 2/ visible separation/border between PVM and PRM. The attachment was scored as "normal" or "abnormal". The "abnormal" was divided in two types: a) "Type I" - loss of the muscle substance, but maintenance of the overall muscle architecture, b) "Type II" - muscle detachment from the pubic bone. The puboanalis (PAM) subdivision was evaluated as representative part of PVM. PAM and PRM attachments and separation were distinguished in all control cases. PAM and PRM attachments did not significantly differ. POP group characteristics were:...
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The influence of reduced radicality of oncosurgical treatment on urogenital tract morbidity
Chmel, Roman ; Rob, Lukáš (advisor) ; Halaška, Michael (referee) ; Mlynček, Miloš (referee) ; Roztočil, Aleš (referee)
Cervical cancer is the fourth most common gynecological malignancy in Czech Republic. The incidence of cervical cancer in 2008 was 19.2/100000 (1021 women) and mortality reached 6/100000. Both radiotherapy and surgery have comparable results in the treatment of cervical cancer but surgical treatment is still the favoured modality especially in young female. Very succesful curability of early stages of this disease (88-97 %) based on individualized therapy currently leads to emphasize the quality of life increasing of treated women. Morbidity related to the treatment is connected with radicality of surgery. The dominant objective of the submitted study was prospective detection of preoperative and postoperative control over the micturition and urinary continence in 142 evaluated women who underwent nerve-sparing radical abdominal hysterectomy type C1, less radical surgery - laparoscopic pelvic lymphadenectomy and laparoscopic assisted vaginal hysterectomy type A or less radical fertility sparing surgery - laparoscopic pelvic lymphadenectomy and simple trachelectomy. Postoperative morbidity is connected with both pelvic lymphadenectomy and resection of the paracervix and proximal part of vagina with hypogastric nerve and inferior hypogastric plexus injury. The lower urinary tract function before and after the...
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The Significance of Ultrasound Examination in the Management of Experimental Uterine transplantation
Matěcha, Jan ; Chmel, Roman (advisor) ; Zikán, Michal (referee) ; Roztočil, Aleš (referee)
The significance of ultrasound examination in the management of experimental uterine transplantation Abstract Uterine transplantation (UTx) represents a new experimental method of treatment of absolute uterine factor infertility (AUFI), which includes inability to conceive and deliver as a result of absence of the uterus. This can be congenital (Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS)) or acquired (after hysterectomy, severe congenital uterine malformations). For a woman affected this way is the uterine transplantation the only way to give birth to a child by herself. This is a very sophisticated and invasive procedure for the treatment of sterility with promising results, but the woman - recipient of the uterus - is burdened by at least three abdominal surgeries (transplantation, Caesarean section, explantation), in vitro fertilization and by the need to use immunosuppressive therapy. The dissertation summarizes current knowledge on this issue from the perspective of a gynecologist-obstetrician, who regularly examined by ultrasound or gynecologically participants in the Czech uterine transplant study in 2016-2019, which was carried out on the basis of a cooperation agreement between two Prague hospitals - IKEM and FN Motol. The set contains data on ten patients with a transplanted uterus, five from...
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The influence of reduced radicality of oncosurgical treatment on urogenital tract morbidity
Chmel, Roman ; Rob, Lukáš (advisor) ; Halaška, Michael (referee) ; Mlynček, Miloš (referee) ; Roztočil, Aleš (referee)
Cervical cancer is the fourth most common gynecological malignancy in Czech Republic. The incidence of cervical cancer in 2008 was 19.2/100000 (1021 women) and mortality reached 6/100000. Both radiotherapy and surgery have comparable results in the treatment of cervical cancer but surgical treatment is still the favoured modality especially in young female. Very succesful curability of early stages of this disease (88-97 %) based on individualized therapy currently leads to emphasize the quality of life increasing of treated women. Morbidity related to the treatment is connected with radicality of surgery. The dominant objective of the submitted study was prospective detection of preoperative and postoperative control over the micturition and urinary continence in 142 evaluated women who underwent nerve-sparing radical abdominal hysterectomy type C1, less radical surgery - laparoscopic pelvic lymphadenectomy and laparoscopic assisted vaginal hysterectomy type A or less radical fertility sparing surgery - laparoscopic pelvic lymphadenectomy and simple trachelectomy. Postoperative morbidity is connected with both pelvic lymphadenectomy and resection of the paracervix and proximal part of vagina with hypogastric nerve and inferior hypogastric plexus injury. The lower urinary tract function before and after the...
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