Ceska Gynekol [JOURNAL]
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200 papers
Significance of positive excision margins in therapy of high-grade vulvar precancerosis - analysis of own data and literary review.
Driák D, Pluta M, Hricko M … +1 more , Hurt K
Ceska Gynekol · 2026 · PMID 41841535 · Publisher ↗
OBJECTIVE: In many countries, the incidence of vulvar intraepithelial neoplasia as a precursor of vulvar squamous cell carcinoma has highly increased over the last 3 decades, while the incidence of cancer remained relati...
OBJECTIVE: In many countries, the incidence of vulvar intraepithelial neoplasia as a precursor of vulvar squamous cell carcinoma has highly increased over the last 3 decades, while the incidence of cancer remained relatively unchanged. Among risk factors for recurrence, resp. progression, usually involve positive excision margins. The aim of the paper is to evaluate the risk of recurrence and progression of high-grade vulvar precancerosis in patients with histological margins "non in sano" - analysis of our own data. MATERIALS AND METHODS: The retrospective study included 62 women after surgical resection of high-grade vulvar precancerosis with histological results of positive excision margins. Using the PubMed database, the results were compared with literary data. RESULTS: Total of 35 (56.5%) patients underwent repeated surgery on the vulva. Inhalf of them (18-51.4%), histological results showed recurrence at the same stage, and in the second half of the women, no dysplastic changes were detected. There was no progression to invasive cancer in any of the patients. CONCLUSION: Beyond positive excision margins, the other predictive factors seem to be even more important for recurrence or progression of vulvar precancerosis including age, smoking, immunosuppression, radiotherapy, concomitant lesions in the vagina or cervix, and bioactivity of the human papilloma-virus. Instead of repeated resection to reach histological negative margins, we prefer the long-time, resp. long-life dispensarisation.
Cytological versus histological results in ASCUS cervical dysplasia - a retrospective study.
Rokos T, Kudela E, Pribulova T … +4 more , Holubekova V, Kozubik E, Kalman M, Biringer K
Ceska Gynekol · 2026 · PMID 41841534 · Publisher ↗
UNLABELLED: The cytological category of atypical squamous cells of undetermined significance describes cellular abnormalities that are more severe than inflammatory changes, but are quantitatively or qualitatively insuff...
UNLABELLED: The cytological category of atypical squamous cells of undetermined significance describes cellular abnormalities that are more severe than inflammatory changes, but are quantitatively or qualitatively insufficient to be included in the squamous intraepithelial lesion category. This study aims to determine the risk level for the presence of high-grade dysplasia in patients with this cytological abnormality. METHODS: We retrospectively searched our database for women with cytologically proven atypical squamous cells of undetermined significance lesions between January 2020 and June 2024. A total of 104 patients who had undergone colposcopy-directed biopsies were included in the study. RESULTS: Among the 104 women with confirmed atypical squamous cells of undetermined significance cytological lesions who had undergone biopsies, 56 cases (53.8%) were negative, while 48 cases (46.2%) demonstrated cervical intraepithelial neoplasia. Cervical intraepithelial neoplasia 2+ was present in 23.1% (N = 24) of the cases. Furthermore, among 77 human papillomavirus positive women, the precancerous condition was not histologically confirmed in almost half of the cases (N = 36), while in 16 of the 23 human papillomavirus negative biopsies, the precancerous condition was not confirmed. Human papillomavirus status was unknown in 4 cases. CONCLUSION: We identified a 23.1% presence of cervical intraepithelial neoplasia 2+ lesions in patients with atypical squamous cells of undetermined significance cytological findings. Our study also suggests a lower specificity, but a better negative predictive value of the human papillomavirus test in detecting cervical intraepithelial neoplasia in these patients.
Pelvic floor muscles High-Intensity Tesla Stimulation.
Huser M
Ceska Gynekol · 2026 · PMID 41841533 · Publisher ↗
INTRODUCTION: Stress urinary incontinence (SUI) represents a significant health problem for women, which fundamentally reduces the quality of life. Conservative treatment mainly includes pelvic floor muscle training, whe...
INTRODUCTION: Stress urinary incontinence (SUI) represents a significant health problem for women, which fundamentally reduces the quality of life. Conservative treatment mainly includes pelvic floor muscle training, where the effectiveness is limited by the patient's ability to actively engage the muscles and long-term compliance. An alternative is electrical stimulation of the pelvic floor, which, however, is sometimes painful and requires invasive application of probes to the pelvic floor. A new option is high-frequency electromagnetic stimulation using High-Intensity Tesla Stimulation (HITS) technology, which induces intense muscle contractions without the need for insertion of probes or electrodes and with higher patient tolerance. The aim of the study was to evaluate the effectiveness of six HITS sessions in women with SUI - based on subjective assessment by patients and objective assessment of muscle strength according to the modified Oxford scale (MOS) and electromyographic activity of the pelvic floor using the Multiple Array Probe Leiden (MAPLe) probe). METHODS: A prospective study was conducted at the urogynecological center Gyn-Line in Brno from February to September 2025. Twenty women with urodynamically proven SUI who did not wish to undergo surgical treatment of the disease were included. Patients underwent six sessions of high-frequency electromagnetic stimulation HITS on the MagRex Pelvic Seat device over 4-5 weeks. The protocol included contractions at frequencies of 25 Hz, 35 Hz, and 35-75 Hz according to tolerance. Evaluation of effectiveness included MOS, electromyographic activity of the pelvic floor muscles measured by the MAPLe probe, and a subjective Patient Global Impression of Improvement (PGI-I) questionnaire. Statistical analysis was performed using a Student's t-test at a significance level of P < 0.05. RESULTS: All patients (N = 20; age 62.5 ± 9.4 years; parity 2.4 ± 2.7; BMI 29.2 ± 6.4 kg/m²; 90% postmenopausal) completed the series of six sessions without adverse effects. The procedure was evaluated as painless and well tolerated. Muscle strength according to MOS increased from 2.4 to 3.8 (increase of 58.3%). Electromyographic activity of the pelvic floor muscles measured by MAPLe increased from 7.0 to 9.9 μV/s (increase of 41.4%). Subjective assessment according to PGI-I improved from 4.0 to 5.9 (increase of 47.5%). All differences were statistically significant (P < 0.05). CONCLUSION: The results demonstrated that high-frequency electromagnetic stimulation HITS of the pelvic floor is a safe and effective method of conservative treatment of stress urinary incontinence in women. This therapy led to statistically significant improvement in muscle strength assessed by the Oxford scale, electromyographic activity of the pelvic floor according to MAPLe, and also subjective perception of difficulties by patients. HITS may thus represent as an alternative or adjunct therapy to traditional pelvic floor muscle training. To confirm long-term efficacy, larger randomized clinical studies are recommended.
Negative pressure wound therapy in gynecologic oncology - current knowledge and clinical applications.
Balcárová K, Bretová P, Ndukwe MI … +3 more , Leško D, Štěpán M, Špaček J
Ceska Gynekol · 2025 · PMID 41577464 · Publisher ↗
Negative pressure wound therapy is a modern and effective method for the prevention and treatment of postoperative wound healing complications, with growing applications in gynecology, especially in gynecologic oncology....
Negative pressure wound therapy is a modern and effective method for the prevention and treatment of postoperative wound healing complications, with growing applications in gynecology, especially in gynecologic oncology. Its mechanism of action includes enhanced drainage, reduction of edema, promotion of angiogenesis, and stimulation of granulation tissue formation, ultimately contributing to faster healing and a lower risk of infection, seroma, and wound dehiscence. Negative pressure wound therapy has been shown to be effective in the therapeutic management of complex, infected, or dehiscent wounds following gynecologic-oncologic surgery. Recent studies also suggest that its prophylactic application to primarily closed incisions after laparotomy or vulvectomy may significantly reduce surgical complications, shorten hospitalization, and accelerate recovery, which is particularly important in patients scheduled for adjuvant therapy. However, because most available evidence is based on retrospective studies, further prospective randomized trials are needed to confirm the role of this method in both therapeutic and prophylactic use and to guide its integration into standard perioperative care in gynecologic oncology.
Sperm navigation mechanisms.
Ješeta M, Lošťáková K, Mekiňová L … +3 more , Lousová E, Remundová K, Hudeček R
Ceska Gynekol · 2025 · PMID 41577463 · Publisher ↗
OBJECTIVE: Mechanisms of sperm navigation are important for understanding the principles of sperm selection prior to fertilization. The aim of this work is to provide an overview of current knowledge about the physiologi...
OBJECTIVE: Mechanisms of sperm navigation are important for understanding the principles of sperm selection prior to fertilization. The aim of this work is to provide an overview of current knowledge about the physiological process of sperm navigation from ejaculation to fertilization of the ovulated oocyte. METHODS: Literature search of the PubMed database published up to June 2025 with terms focusing on "sperm navigation," "fertilization," and "chemoattractants". RESULTS: The principles of sperm navigation in the in vivo environment are still unclear in humans. Currently, there are simple in vivo studies performed on model animals, as well as a number of in vitro studies on human sperm. Based on these results, three main navigation systems are described: rheotaxis, thermotaxis, and chemotaxis. Rheotaxis acts over the longest distances and stimulates sperm movement against the flow of fluid. Thermotaxis acts over a shorter distance and guides sperm to places with higher temperatures. Chemotaxis acts over the shortest distance, attracting capacitated sperm to places where the ovulated oocyte is located. CONCLUSION: Given how massively the sperm microinjection technique is used in the treatment of human infertility, it is important to carefully select sperm prior to fertilization. Knowledge of the principles of human sperm selection in in vivo conditions is crucial for effective sperm selection in the laboratory.
Atypical placental site nodule detected via hysteroscopy - first case report from Brazil.
Braga A, Paiva G, Padron L … +9 more , Nobre A, Pereira JS, Callado GY, Amim Junior J, Sun SY, Araujo Júnior E, Rezende-Filho J, Horowitz N, Berkowitz R
Ceska Gynekol · 2025 · PMID 41577462 · Publisher ↗
Atypical placental site nodule (APSN) is a rare form of gestational trophoblastic disease (GTD) originating from the proliferation of intermediate trophoblasts, with uncertain clinical behavior. It is considered a potent...
Atypical placental site nodule (APSN) is a rare form of gestational trophoblastic disease (GTD) originating from the proliferation of intermediate trophoblasts, with uncertain clinical behavior. It is considered a potential precursor to rare forms of gestational trophoblastic neoplasia (GTN), such as placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). This report describes the first Brazilian case of APSN diagnosed via hysteroscopy in a 43-year-old woman following miscarriage. Histopathological analysis revealed a circumscribed, hyalinized aggregate of intermediate trophoblasts with nuclear atypia, positive immunostaining for PLAP and p63, and a Ki-67 index > 5%. The patient declined hysterectomy, opting for conservative management with close monitoring. After 12 months of follow-up, no progression was observed. This case emphasizes the diagnostic challenges of APSN, given its subtle presentation and overlap with benign placental site nodules or even PSTT/ETT. Hysteroscopy proved valuable for both diagnosis and fertility-preserving management. Although hysterectomy remains the definitive treatment in many cases, individualized approaches balancing oncologic safety and reproductive goals are increasingly considered. Long-term clinical vigilance is essential, as APSN may precede aggressive GTN forms. Multicenter studies and registries are urgently needed to establish evidence-based guidelines for the diagnosis, treatment, and follow-up of this rare lesion, improving patient outcomes in these uncommon forms of GTD.
Not every seizure is eclampsia - a rare case of a brain abscess in a pregnant woman caused by Streptococcus pneumoniae from a dental source.
Moamar DM, Mustafa MT, Ismaeel R … +4 more , Alshamasneh F, Abusidreh NS, Jamous OM, Abu Lehyah NAA
Ceska Gynekol · 2025 · PMID 41577461 · Publisher ↗
We present a rare case of a brain abscess in a pregnant woman due to an untreated dental abscess, initially presenting as a new-onset seizure. This article highlights the need for a broad differential diagnosis for seizu...
We present a rare case of a brain abscess in a pregnant woman due to an untreated dental abscess, initially presenting as a new-onset seizure. This article highlights the need for a broad differential diagnosis for seizures in pregnancy, extending beyond the common assumption of eclampsia, and further emphasizing the importance of thorough history-taking and physical examination. We suggest integrating routine dental care into prenatal healthcare to reduce the risk of such serious events. Informed consent was obtained, and all identifiable information has been de-identified to protect patient confidentiality.
Arteriovenous malformation developing in a cesarean scar after termination of pregnancy - a case report and review of the literature.
Kizildemir YZ, Karsli SE, Okuyan II … +2 more , Emral ÇK, Civelek M
Ceska Gynekol · 2025 · PMID 41577460 · Publisher ↗
Uterine arteriovenous malformations (AVMs) are a rare cause of severe uterine bleeding. Uterine traumas, such as cesarean section or abortion, are known risk factors. In this article, we present a rare case of an AVM tha...
Uterine arteriovenous malformations (AVMs) are a rare cause of severe uterine bleeding. Uterine traumas, such as cesarean section or abortion, are known risk factors. In this article, we present a rare case of an AVM that developed in a patient with a history of a previous cesarean section and recent abortion. In this case, we review the pathogenesis, diagnosis, and treatment strategies of AVMs that develop in cesarean scars in light of the current literature. The patient presented with 2 months of vaginal bleeding that led to life-threatening anemia. Doppler ultrasound identified an AVM in the cesarean scar. Given the hemodynamic status of the patient, an emergency surgical intervention was performed and the AVM was successfully treated. This case highlights that AVM should be primarily considered in the differential diagnosis of severe bleeding in patients with a "double-hit" risk, such as a cesarean section followed by subsequent uterine trauma, and that emergency surgical intervention can be life-saving.
Twin pregnancy in a caesarean scar - a case study and literature review of therapeutic approaches.
Vaněk L, Zapletal J, Sehnal B … +2 more , Rob L, Halaška MJ
Ceska Gynekol · 2025 · PMID 41577459 · Publisher ↗
Caesarean scar pregnancy is a rare form of ectopic pregnancy. It can be reliably diagnosed through transvaginal ultrasonography, typically during the 1st or early 2nd trimester. While one-third of patients remain asympto...
Caesarean scar pregnancy is a rare form of ectopic pregnancy. It can be reliably diagnosed through transvaginal ultrasonography, typically during the 1st or early 2nd trimester. While one-third of patients remain asymptomatic, others may develop severe complications. The most common symptoms are vaginal bleeding and abdominal pain, with rare cases involving uterine rupture or the development of placenta accreta spectrum. Caesarean scar pregnancy is associated with a risk of various complications and poses a risk factor for future pregnancies. In many cases, surgical intervention cannot be avoided. Treatment options include surgical management or medical therapy. In some cases, an expectant management approach may be chosen. No single treatment method has yet been definitively established as sufficiently rapid, safe, and effective. This case report presents a patient with twin pregnancy in a caesarean scar, in whom a conservative approach was chosen due to the low gestational age. Additionally, we provide a literature review of the current therapeutic options for managing this challenging condition.
Status of a lipid accumulation product, triglycerides/ glucose index and visceral adiposity index on cardiometabolic risk factors in young polycystic ovary syndrome patients.
Arslan G, Karakelleoğlu G, Karadağ C
Ceska Gynekol · 2025 · PMID 41577458 · Publisher ↗
OBJECTIVE: To determine whether the triglycerides/glucose index (TyG-index), lipid accumulation product (LAP), and visceral adiposity index (VAI) would differ in young polycystic ovary syndrome (PCOS) patients when compa...
OBJECTIVE: To determine whether the triglycerides/glucose index (TyG-index), lipid accumulation product (LAP), and visceral adiposity index (VAI) would differ in young polycystic ovary syndrome (PCOS) patients when compared to the non-PCOS group, and to investigate the relationship between these markers and cardiovascular disease (CVD) risk in PCOS patients. MATERIALS AND METHODS: One hundred and ninety two women with PCOS, and 148 age and body mass index (BMI) matched healthy women without PCOS were enrolled. Levels of serum androgens, sex hormones, lipids, fasting glucose, fasting insulin, and N-terminal pro-brain natriuretic peptide (Nt-probnp) were determined. The 75 g oral glucose tolerance test was performed. The Homeostatic Model Assessment-Insulin Resistance Index (HOMA-IR) and Matsuda insulin sensitivity index were calculated. Levels of TyG-index, LAP, and VAI were determined. RESULTS: TyG, LAP, and VAI were significantly higher in PCOS patients than in the control group (P = 0.001 vs. P = 0.001 vs. P = 0.001, resp.). HOMA-IR was significantly higher in PCOS patients and Matsuda ISI was significantly lower in PCOS patients (P = 0.001 vs. P = 0.001, resp.). Levels of Nt-probnp were significantly higher in PCOS patients (P = 0.001). Serum total testosterone and androstenedione levels had significant correlations with TyG, LAP, and VAI. Nt-probnp was significantly correlated with TyG, LAP, and VAI. LDL was positively correlated and HDL was negatively correlated with TyG-index, LAP, and VAI. CONCLUSION: PCOS patients have increased values of TyG-index, LAP, and VAI. TyG index, LAP, and VAI may indicate an increased risk of CVD and hyperandrogenism in PCOS patients.
Postoperative analgesia in breast cancer surgeries - anesthetic techniques and the role of cytokines.
Perfeito Abud PB, Barra Bizinoto FM, Nunes Santos N … +7 more , Dornelas de Melo LT, Barcelos Andrade R, Gomes Parizzi BH, Prata Jammal M, Côbo Micheli D, Candido Murta EF, Simões Nomelini R
Ceska Gynekol · 2025 · PMID 41577457 · Publisher ↗
OBJECTIVES: To examine the relationships between postoperative pain and anesthetic technique and analgesic use, to compare preoperative and postoperative serum cytokine levels, and to determine the influence of the anest...
OBJECTIVES: To examine the relationships between postoperative pain and anesthetic technique and analgesic use, to compare preoperative and postoperative serum cytokine levels, and to determine the influence of the anesthetic technique on these levels in patients undergoing breast cancer surgery. MATERIALS AND METHODS: Thirty-six patients undergoing oncological breast surgery were allocated to general anesthesia only (G; N = 20) and general anesthesia with erector spinae plane block (ESPB, E; N = 16) groups. Postoperative pain intensity was evaluated using a visual analogue scale at three periods (M): 2, 24, and 48 hours after the end of surgery (M2, M24, and M48, resp.). Blood was collected preoperatively, before the induction of general anesthesia (M0), and at M24 and M48. Plasma interleukin (IL) -1, IL-8, and tumor necrosis factor-α (TNF-α) levels were determined by enzyme-linked immunosorbent assay. Associations between categorical variables were evaluated using the Fisher's exact test. Pain scores and cytokine levels were compared between groups G and E and between patients undergoing mastectomy and quadrantectomy using repeated-measures analysis of variance. The significance level adopted for all tests was 5.0%. RESULTS: Moderate to severe pain was more frequent in group G than in group E at M24 (P = 0.016). The IL-8 level was lower in group E than in group G (P = 0.029). In the whole cohort, TNF-α level was reduced at M48 (P = 0.010), IL-8 level was reduced at M24 (P < 0.001), and IL-1 level was increased at M48 (P < 0.001). CONCLUSIONS: ESPB is an effective alternative in cases with contraindications or technical difficulties with other anesthetic techniques, such as epidurals. Its use could improve women's quality of life and health after breast cancer surgery.
Which causes less pain? A comparison of misoprostol and dinoprostone in labor induction.
Canan S, Kalkan SC, Özden S … +2 more , Uslu Yuvaci H, Bostanci MS
Ceska Gynekol · 2025 · PMID 41577456 · Publisher ↗
OBJECTIVE: Effective labor pain management is essential in prenatal care. Identifying factors that contribute to increased pain in patients undergoing labor induction is essential for optimizing pain control. This study...
OBJECTIVE: Effective labor pain management is essential in prenatal care. Identifying factors that contribute to increased pain in patients undergoing labor induction is essential for optimizing pain control. This study assesses pain levels in labor induction patients receiving vaginal misoprostol or dinoprostone for cervical ripening using a visual analogue scale (VAS). MATERIALS AND METHODS: This prospective study includes 60 volunteer women who received either vaginal dinoprostone (50%) or vaginal misoprostol (50%) as cervical ripening agents. Group 1 consists of patients who received misoprostol, while Group 2 includes those who were administered dinoprostone. VAS scores were recorded during both active labor and crowning. In addition to these pain assessments, birth outcomes and patient characteristics were documented, and comparative analyses were conducted between the groups. RESULTS: According to VAS scores, pain intensity was significantly lower in Group 1 compared to Group 2 at both stages of labor (during active labor: 6.67 ± 2.68 vs. 7.77 ± 1.59, P < 0.05; during crowning: 8.9 ± 1.32 vs. 9.8 ± 0.55, P < 0.05). All participants’ pain scores recorded during crowning were significantly higher than those recorded during active labor (P < 0.05). No statistically significant difference was observed between the two agents in terms of oxytocin administration or the interval from drug administration to delivery (P > 0.05). CONCLUSIONS: Pain scores should be considered when selecting a cervical ripening agent. Misoprostol may be associated with lower pain levels.
HLA-C and KIR interactions as a possible cause of reproductive failures.
Šťastná E, Višňová H
Ceska Gynekol · 2025 · PMID 41577455 · Publisher ↗
OBJECTIVE: Despite advancements in assisted reproduction, the cause of up to 50% of cases of idiopathic fertility disorders remains unclear. The immune system, particularly the interaction between human leukocyte antigen...
OBJECTIVE: Despite advancements in assisted reproduction, the cause of up to 50% of cases of idiopathic fertility disorders remains unclear. The immune system, particularly the interaction between human leukocyte antigen-C (HLA-C) molecules on the trophoblast and killer-cell immunoglobulin-like receptors (KIR) on uterine natural killer (NK) cells, plays a crucial role in implantation and placental development. The aim of this analysis was to evaluate our experience with testing KIR/HLA-C compatibility and its potential role in personalizing infertility treatment. METHODS: This is an interventional study examining the success of therapy in 23 couples who underwent infertility treatment with donated gametes between 1/2023 and 12/2024, with additional consideration of KIR/HLA-C compatibility between the recipient and the donor. For better homogeneity of the sample, patients in the intervention group were divided into two subgroups. The first subgroup consisted of 14 couples undergoing their first therapy with donated gametes. The second subgroup consisted of 9 couples with a history of repeated unsuccessful embryo transfers from donated gametes. A control group of 320 single embryo transfers with donated gametes from couples treated using standard methods between 1/2023 and 12/2024 was used for comparison. RESULTS: In both intervention subgroups, success rates were comparable. Clinical pregnancy was achieved in 62.5% and 63.6%, resp., which exceeded the average success rate of 55.2% in the control group. CONCLUSION: The high number of achieved clinical pregnancies in a prognostically unfavorable group, burdened by repeated unsuccessful embryo transfers, appears to be a therapeutic success. It is important to bear in mind the low number of evaluated transfers; however, this result suggests that testing KIR/HLA-C compatibility between the recipient and the donor and taking it into account when selecting a donor may significantly increase the success of therapy in indicated cases.
The influence of selected immunohistochemical and clinical-pathological markers on the prognosis of patients with malignant uterine tumors.
Herboltová P, Ovesná P, Dvořáková K … +6 more , Focko T, Kaštan R, Stráník P, Smoligová V, Kosťun J, Presl J
Ceska Gynekol · 2025 · PMID 41577454 · Publisher ↗
INTRODUCTION: Endometrial carcinoma is the most common gynecological malignancy in developed countries, and its incidence has been increasing in recent decades. The prognosis of patients depends on a combination of clini...
INTRODUCTION: Endometrial carcinoma is the most common gynecological malignancy in developed countries, and its incidence has been increasing in recent decades. The prognosis of patients depends on a combination of clinical-pathological characteristics, and more recently, molecular indicators. The aim of this study was to analyze the influence of the selected prognostic markers - immunohistochemical (L1CAM, ER, PR) and classical (FIGO stage, grade, myometrial invasion, lymph node involvement, distant metastases) - on the survival of patients with endometrial carcinoma. MATERIALS AND METHODS: A retrospective evaluation was performed on 143 women with histologically confirmed endometrial cancer treated between 2014 and 2018. All patients underwent primary surgical treatment. Resected specimens were subjected to immunohistochemical analysis of L1CAM, ER, and PR. Data were statistically processed using a Kaplan-Meier analysis and the Cox proportional hazards model, adjusted to age. RESULTS: L1CAM expression was detected in 14% of patients and was associated with shortened survival (HR ≈ 3.9). ER and PR positivity (89% and 85%, resp.) correlated with a more favorable prognosis (HR for ER positivity 0.21; PR 0.23). Classical factors such as higher grade, advanced FIGO stage, cervical and lymphovascular invasion, or presence in nodes were statistically associated with worse survival. An interesting finding was a significantly better prognosis in asymptomatic patients - the presence of symptoms increased the risk of death up to fourfold. CONCLUSION: L1CAM positivity and loss of hormone receptors are significant adverse prognostic factors. Their inclusion in routine immunohistochemical panel testing improves risk stratification and treatment personalization, which at the time of publication of this paper is already included in the updated ESGO-ESTRO-ESP 2025 guidelines. At the same time, it has been shown that the absence of symptoms at diagnosis is a favorable survival indicator. The results support further research into prognostic markers and their integration into clinical decision-making algorithms.
Robotic-assisted cesarean scar defect repair.
Dosedla E, Ballová Z
Ceska Gynekol · 2025 · PMID 41182877 · Publisher ↗
The rising global incidence of cesarean deliveries has led to a marked increase in associated obstetric and gynecological complications, notably the cesarean scar defect. Clinical management decisions are predominantly g...
The rising global incidence of cesarean deliveries has led to a marked increase in associated obstetric and gynecological complications, notably the cesarean scar defect. Clinical management decisions are predominantly guided by patient-reported symptoms, reproductive goals, and individual anatomical considerations. The literature currently lacks definitive guidelines recommending a singular optimal approach. The recent advent and incremental adoption of robotic surgery has introduced a promising new technique, characterized by enhanced surgical precision, improved visualization, reduced morbidity, and rapid patient recovery. Ultimately, embracing robotic-assisted surgery for cesarean scar defect repair represents a critical advancement in gynecological surgery.
Early detection of recurrent ovarian cancer, current use of oncomarkers, imaging methods, and future perspectives.
Smoligová V, Kosťun J, Stráník P … +1 more , Presl J
Ceska Gynekol · 2025 · PMID 41182876 · Publisher ↗
Ovarian carcinoma is one of the most serious types of gynecological tumors. It is usually diagnosed in advanced stages, mainly due to an asymptomatic course or non-specific symptoms in the early stages. It is also charac...
Ovarian carcinoma is one of the most serious types of gynecological tumors. It is usually diagnosed in advanced stages, mainly due to an asymptomatic course or non-specific symptoms in the early stages. It is also characterized by a tendency to recur frequently, thus reducing the overall survival of patients. This article focuses on the possibility of detecting recurrence of the disease during follow-up of patients after complete remission. According to the analyzed literature, the monitoring of CA-125 and HE4 oncomarker levels in combination with imaging methods such as expert ultrasonography, CT, and positron emission techniques offers the potential for early detection of recurrence. The most advanced type of computed tomography, photon-counting CT, with high detection capability and lower radiation burden, also holds promise. The question of further management of early-detected asymptomatic recurrence is open for further discussion.
Role of tru-cut bio psy in the management of myometrial lesions.
Richtárová A, Hlinecká K, Lisá Z … +3 more , Lukavec V, Vaisová V, Mára M
Ceska Gynekol · 2025 · PMID 41182875 · Publisher ↗
The aim of this article was to summarize current knowledge regarding ultrasound-guided tru-cut biopsy, with a focus on its applicability in preoperative diagnosis of myometrial lesions. Tru-cut biopsy is used in gynecolo...
The aim of this article was to summarize current knowledge regarding ultrasound-guided tru-cut biopsy, with a focus on its applicability in preoperative diagnosis of myometrial lesions. Tru-cut biopsy is used in gynecologic oncology for the management of pelvic and abdominal tumors; however, its application in the diagnostic algorithm for uterine tumors has been validated by only a limited number of studies. Nevertheless, this literature review highlights that tru-cut biopsy of uterine smooth muscle lesions demonstrates high sample adequacy for histological examination, diagnostic accuracy, and a low complication rate. Leiomyomas are among the most common benign uterine tumors, whereas uterine sarcomas are rare and aggressive malignancies. Symptoms of these conditions do not differ significantly. Their differentiation relies on imaging methods such as ultrasonography and magnetic resonance imaging. However, distinguishing between benign and malignant tumors remains challenging, as criteria for differentiating benign and malignant lesions using these imaging methods have not yet been sufficiently validated. Incorporating tru-cut biopsy into the standard diagnostic algorithm for uterine tumors could provide valuable insights into the oncological nature of atypical tumors on ultrasonography or magnetic resonance imaging, leading to optimized and personalized treatment strategies for each patient.
Prenatal treatment of posterior urethral valves in a newborn with anorectal stenosis.
Miguel DA, Araujo Júnior E, Ruano R … +1 more , Sá RAM
Ceska Gynekol · 2025 · PMID 41182874 · Publisher ↗
Posterior urethral valves (PUV) account for most cases of lower urinary tract obstruction (LUTO) in male fetuses, with a prevalence of 1 in 5,000 live births. Prenatal ultrasound findings include bladder wall thickening,...
Posterior urethral valves (PUV) account for most cases of lower urinary tract obstruction (LUTO) in male fetuses, with a prevalence of 1 in 5,000 live births. Prenatal ultrasound findings include bladder wall thickening, keyhole sign, oligohydramnios, and ureteral dilatation. If untreated, PUV can cause pulmonary hypoplasia and renal failure, often requiring dialysis or transplantation. Treatment options include vesicoamniotic shunting and fetoscopic laser fulguration. PUV is rarely associated with anorectal malformations, posing a diagnostic and therapeutic challenge. This case report describes a neonate diagnosed prenatally with PUV who underwent intrauterine procedures, followed by preterm cesarean section at 32 weeks. Postnatally, he exhibited renal dysplasia, cryptorchidism, and developed necrotizing enterocolitis. Despite multiple laparotomies and colostomy, the infant improved and was then discharged. At 4 months, imaging confirmed rectal stenosis. We highlight the diagnostic limitations of prenatal ultrasound in differentiating PUV from other LUTO causes and the benefits of fetal magnetic resonance imaging. Anorectal malformations have diverse phenotypic presentations and are linked to environmental risk factors. The rare association of PUV with anorectal anomalies requires careful prenatal counseling due to potential complications. This case highlights the importance of early diagnosis and multidisciplinary management for improved outcomes.
Isolated fallopian tube torsion - case reports of one symptomatic and one asymptomatic patient.
Kale İ, Kırmacı C
Ceska Gynekol · 2025 · PMID 41182873 · Publisher ↗
OBJECTIVE: We present two cases of isolated tubal torsion, one was asymptomatic in the postmenopausal period and the other was symptomatic in the reproductive period. CASE REPORTS: Case 1: A 66-year-old asymptomatic post...
OBJECTIVE: We present two cases of isolated tubal torsion, one was asymptomatic in the postmenopausal period and the other was symptomatic in the reproductive period. CASE REPORTS: Case 1: A 66-year-old asymptomatic postmenopausal woman underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy for atypical endometrial hyperplasia. Intraoperatively, the left fallopian tube was found to have isolated torsion. Case 2: A 36-year-old female presented to the emergency department with acute abdominal symptoms. Diagnostic laparoscopy revealed isolated torsion of the left fallopian tube. CONCLUSION: Isolated tubal torsion, a rare condition in both reproductive and postmenopausal periods, may be asymptomatic or present with acute abdominal symptoms.
Laser therapy for type III fetal congenital cystic adenomatoid malformation.
Dantas JB, Longo C, Saito M … +1 more , Araujo Júnior E
Ceska Gynekol · 2025 · PMID 41182872 · Publisher ↗
Congenital cystic adenomatoid malformation (CCAM) is a rare developmental anomaly of the fetal lung that can lead to severe respiratory distress in the neonatal period. Type III CCAM, characterized by solid, microcystic...
Congenital cystic adenomatoid malformation (CCAM) is a rare developmental anomaly of the fetal lung that can lead to severe respiratory distress in the neonatal period. Type III CCAM, characterized by solid, microcystic lesions, often poses diagnostic and therapeutic challenges, especially in progressive cases. We report a rare case of antenatal laser therapy used to treat a fetus diagnosed with type III CCAM. Despite two cycles of corticosteroid therapy, the lesion showed no significant regression, leading to the decision to perform ultrasound-guided intrauterine laser ablation. The procedure resulted in a reduction in lesion size, normalization of the fetal cardiac axis, and a favorable perinatal outcome, with the newborn discharged 5 days after birth in stable condition. This case highlights the potential role of fetal laser therapy as a less invasive and effective alternative to surgical excision for selected cases of progressive type III CCAM. Further studies are needed to validate the safety, efficacy, and long-term outcomes of this approach.
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