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To determine the indication for the use of synthetic materials in pelvic floor reconstructive surgery.
El Haddad, Rachid ; Švabík, Kamil (advisor) ; Huser, Martin (referee) ; Kališ, Vladimír (referee)
Introduction: Pelvic organ prolapse is a major health problem affecting 50% of parous women over the age of 50. The lifetime risk for pelvic floor surgery for prolapse is likely to be between 10 and 20% and a large number of patients require repeat surgery for recurrence. Cochrane review showed that mesh use at the time of anterior repair reduce the risk of recurrence. In our first study we prospectively evaluate the impact of mesh insertion during anterior repair on sexual function and quality of life. Mesh insertion may be associated with significant and in some cases serious adverse events. To justify its use, it seems necessary to identify women at high risk of prolapse recurrence. There is evidence indicating that levator ani avulsion injury is closely associated with prolapse recurrence. The aim of our second and main study was to demonstrate in a prospective randomized way that levator avulsion may be used to identify patients at high risk for failed native tissue prolapse surgery. Methods: The first study prospectively evaluated with validated questionnaires the impact of mesh insertion on quality of life and sexual function. The second study is a single-center, prospective, randomized interventional trial of two standard surgical procedures for post-hysterectomy vaginal vault prolapse in...
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The effort to minimize complications in ovulation induction with gonadotropins
Středa, Robert ; Tošner, Jindřich (advisor) ; Dostál, Jiří (referee) ; Huser, Martin (referee)
The effort to minimize risks of ovulation induction with gonadotropins The aim of this study was to evaluate three different starting doses of follitropin beta based on patients' response to clomiphene citrate treatment to assess the lowest effective dose for follicular development. In fact the determination of the appropriate gonadotropins' starting dose to achieve only mono-follicular development is the most important issue in ovulation induction. This is the main goal to minimize cycle's cancellation due to low or high ovarian response and to prevent multiple pregnancies or ovarian hyperstimulation syndrome. The objective of the trial was to determine the effect of different follitropin beta dose (50, 75 and 100 IU daily) on follicular development, thickness of the endometrium, total consumption of gonadotropins per cycle etc. We evaluated 90 cycles with ovarian stimulation for 90 patients with unexplained infertility, mild male factor or anovulatory disorder. We prospectively divided patients into 50, 75 and 100 IU groups based on patients' response to clomiphene citrate treatment. We performed 85 intrauterine inseminations. We cancelled 5 cycles (1 cycle due to high ovarian response (1.1 %), 3 cycles due to low ovarian response, 1 cycle the other reason). We achieved 15 clinical pregnancies,...
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