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Anogenital and oropharyngeal infections with human papilloma viruses (HPV) are common. Clinically manifest disease may significantly impact quality of life; the treatment of HPV-associated lesions is associated with a high rate of recurrence and invasive neoplasms, such as cervical, anal, vulvar, penile, and oropharyngeal cancers, which are characterized by significant morbidity and mortality. Vaccination against HPV is an effective and safe measure for the primary prevention of HPV-associated lesions, but immunization rates are still low in Germany. The present publication is an abridged version of the German evidence and consensus-based guideline "Vaccination recommendations for the prevention of HPV-associated lesions", which is available on the website of the German Association of the Scientific Medical Societies (AWMF). On the basis of a systematic review with meta-analyses, a representative panel developed and agreed upon recommendations for the vaccination of different populations against HPV. In addition, consensus-based recommendations were developed for specific issues relevant to everyday practice. Based on current evidence and a representative expert consensus, these recommendations are intended to provide guidance in a field in which there is often uncertainty and in which both patients and health care providers are sometimes confronted with controversial and emotionally charged points of view.

Till the end of the 1980s the only access to hysterectomy was the vaginal and the abdominal approach. By implementing the laparoscopic methods, it was to be expected that the rates of abdominal hysterectomies would decrease radical.

Background Hysterectomy is the second most common operation in obstetrics and gynecology after Cesarean section. Until now, there has not been any German clinical guideline with recommendations concerning the indications for hysterectomy for benign uterine conditions, in consideration of the available uterus-preserving alternative treatments. Methods We systematically searched the Medline database in 2013, in 2014, and in December 2015, focusing on aggregate evidence, and assessed the retrieved literature. The guideline recommendations were developed by a consensus process with structured independent moderation. Results 30 systematic reviews and 8 randomized controlled trials were analyzed. Among the study patients treated with either hysterectomy (by any technique) or an organ-preserving alternative, at least 75-94% were satisfied with their treatment. Vaginal hysterectomy was associated with lower complication rates, shorter procedure duration, and more rapid recovery than abdominal hysterectomy and is therefore the preferred technique. If vaginal hysterectomy is not possible, a laparoscopic approach should be considered. Abdominal hysterectomy should be reserved for special indications. In 2012, the frequency of abdominal hysterectomy in Germany, Austria, and Switzerland was lower than elsewhere in the world, at 15.7% , 28.0% , and 23.9% , respectively. Uterus-preserving techniques were associated with higher reintervention rates compared to hysterectomy (11-36% vs 4-10% ). Conclusion The main objective is to reduce the frequency of abdominal hysterectomy. Patients should be counseled and made aware of uterus-sparing alternatives to hysterectomy so that they are able to make informed decisions.

Objective To present a synopsis concerning adenomyosis uteri interna with respect to endometrial ablation. The definition of adenomyosis, different diagnostic methods and their effectiveness, as well as the influence of adenomyosis on the outcome after endometrial ablation, are discussed. Design Review. Setting Obstetrics and gynaecology clinic of an academic teaching university hospital. Results Depending on which definition is used, the incidence of adenomyosis varies between 8 and 61%. The term ‘adenomyosis’ should be restricted to those cases with a deeper ingrowth of glands, as only these show clinical symptoms. Adenomyosis can not be diagnosed or excluded with certainty by either sonography, diagnostic hysteroscopy, or dilation and curettage. Needle biopsies of the myometrium show low accuracy and are difficult to obtain. Hysteroscopic resection of myometrium detects some cases of adenomyosis, but misses the majority. In patients undergoing hysterectomy after unsuccessful endometrial ablation, incidence rates of 75–100% for adenomyosis were reported. Thus adenomyosis might be a principal reason for treatment failure. As there is no safe means of excluding adenomyotic foci, adenomyosis can be assumed in patients with an enlarged uterus and marked dysmenorrhoea. Conclusion Patients with dysmenorrhoea and uteri >10 cm show a high incidence of adenomyosis. Because of an increased risk of failure, these patients should be excluded from endometrial ablation.

Liquid-based cytology (LBC) has replaced conventional cytology (CC) for cervical cancer screening in some countries. However, it remains unclear whether LBC is superior to CC. A randomized controlled trial was conducted between August 2007 and March 2009 in Germany to compare LBC, alone and in combination with computer-assisted imaging technology (CAS), to CC in the detection of histologically confirmed cervical intraepithelial neoplasia (CIN). The main outcome measures were detection rates, relative sensitivities, positive predictive values (PPVs) and relative PPVs comparing LBC without and with CAS to CC. Primary histological outcome was CIN2 or higher. Included were 20,627 women participating in opportunistic cervical cancer screening at 20 gynecologic practices. The practices were randomized weekly to use LBC (n = 11,331) or CC (n = 9,296). Patients with positive findings were invited to expert colposcopy. The relative sensitivity of LBC versus CC using the CIN2+ cut-off was 2.74 (95% confidence interval [CI] 1.66-4.53). The relative sensitivity of LBC/CAS versus CC for CIN2+ was 3.17 (95% CI 1.94-5.19). The PPV of LBC and CC for CIN2+ was 48% and 38%, respectively. The PPV ratio did not differ significantly from unity. Differences between LBC and CC were smaller in some sensitivity and subgroup analyses; however, relative sensitivity of LBC remained increased. LBC without and with CAS compared with CC under the field conditions of an opportunistic screening system had a significantly higher sensitivity for the detection of CIN without deterioration of PPVs. Additional use of CAS did not further improve sensitivity of LBC. © 2012 Wiley Periodicals, Inc.

Study Objective To evaluate the diagnostic benefit of fluid hysteroscopy before dilatation and curettage (D&C) in women with missed abortion, with respect to frequency of congenital and acquired uterine anomalies and geographic relationship of uterine anomalies to nidation site. Design Prospective case study (Canadian Task Force classification II–2). Setting Obstetric-gynecologic clinic of an academic teaching hospital. Patients One hundred five women with one or more recurrent missed abortions. Intervention Hysteroscopy before D&C. Inspection of the fetus was attempted in 62 patients. Control hysteroscopy of the nonpregnant uterus was performed in 20 patients. Measurements and Main Results The uterine cavity was visualized in 87 patients (83%). These women had an obstetric history significant for 143 spontaneous abortions in 208 pregnancies. Except for three small, finger-shaped polyps in the tubal ostia, no uterine anomalies were detected. In 20 women control hysteroscopy of the nonpregnant uterus confirmed initial findings. The fetus was successfully visualized in 30 cases (48%). We observed one case of umbilical cord torsion at 12 weeks' gestation. Conclusion Absence of uterine anomalies in patients with single as well as recurrent spontaneous abortions was unexpected since it contradicts the existing literature. However, all previous data were gathered from hysteroscopies of nonpregnant uteri. Larger comparative studies are required.

Study Objectives. To assess the frequency of clinically apparent and undetected cardiopulmonary emboli duringdiagnostic CO 2 hysteroscopy, to determine the causes of these events, and to define a risk profile. Design. Retrospective and propective case study (Canadian Task Force classification II-2). Setting. Obstetric-gynecologic clinic of an academic teaching hospital. Patients. Five thousand one hundred ninety-three women. Intervention. Diagnostic CO 2 hysteroscopy performed between September 1990 and December 1998. Measurements and Main Results. From September 1990 to December 1996, 1 (0.03%) severe but nonfatal embolism occurred in 3932 diagnostic CO 2 hysteroscopies. Undetected emboli were present in 20 patients (0.51%). Starting in January 1997 the gas supply tube (volume 40 ml) was deaerated before the procedures, and no emboli occurred in the next 1261 examinations up to December 1998. The decrease in frequency was statistically significant (p=0.009). No pathologic flow sounds were found in any of 50 hysteroscopies monitored by Doppler stethoscope. Conclusion. A manifest gas embolism is rare in diagnostic CO 2 hysteroscopy. The 10% to 50% frequency of undetected gas emboli cited by other authors could not be confirmed. If the supply tube system that holds room air is purged with CO 2 before the procedure, the already low risk drops to zero or almost zero, confirming the theory that emboli that occur during CO 2 hysteroscopy are caused by room air.