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CENNI DI ANATOMIA FUNZIONALE DEL PAVIMENTO PELVICO Lil pavimento pelvico è costituito da un insieme di strutture muscolari e fasciali che chiudono inferiormente lo scavo pelvico femminile, sostengono gli organi pelvici (vescica, vagina, utero, retto) e intervengono nei meccanismi della continenza urinaria e fecale, nell'attività sessuale e nel parto. La statica e la dinamica degli organi pelvici sono condizionate da due sistemi. - un sistema di sospensione costituito davanti dai legamenti pubo-vesci-co-uterini e dai legamenti rotondi, posteriormente dai legamenti ute-ro-sacrali, lateralmente dal legamento cardinale di Mackenrodt. Tale sistema collega i visceri pelvici alla parete della pelvi stessa e alla fascia endopelvica. - un sistema di sostegno, formato da un complesso di muscolatura striata e da tessuto connettivale (fascia endopelvica). Procedendo dall'interno verso l'esterno tale sistema è rappresentato: 1) dal diaframma pelvico, costituito dal muscolo elevatore dell'ano (con le sue componenti pubo-rettale, ileococcigea, pubococcigea e ischiococcigea) e dalla fascia endo-pelvica che lo riveste superiormente ed inferiormente; 2) dal diaframma urogenitale, situato inferiormente al diaframma pelvico, rappresentato da una lamina muscoloaponeurotica comprendente i legamenti pubo-uretra-li, uteropelvico e il muscolo traverso profondo del perineo; 3) dal piano dei muscoli superficiali del perineo (piano degli sfinteri) costituito dal muscolo bulbo-cavernoso, dall'ischio-cavernoso e dal trasverso superficiale dell'ano.

L'incontinenza urinaria femminile rappresenta un problema socio assistenziale sottostimato e, per molti aspetti, irrisolto. Numerosi studi hanno messo in evidenza il notevole impatto negativo che essa ha su molti aspetti della vita della donna, tanto da condizionarne le attività quotidiane, le relazioni sociali e la vita privata, fino ad un intenso disagio psicologico ed a una profonda ripercussione sulla qualità di vita

Objective: Surgery represents the mainstay of treatment of stage I adult type granulosa cell tumors of the ovary (AGCTs). Because of the rarity and indolent course of the disease, no prospective trials are available. Open surgery has long been considered the traditional approach; oncological safety of laparoscopy is only supported by small series or case reports. The aim of this study was to compare the oncological outcomes between laparoscopic and open surgery in stage I AGCTs treated within the MITO (Multicenter Italian Trials in Ovarian cancer) Group. Methods: Data from patients with stage I AGCTs were retrospectively collected. Clinicopathological features were evaluated for association with relapse and death. Survival curves were calculated using the Kaplan-Meier method and compared with the log-rank test. The role of clinicopathological variables as prognostic factors for survival was evaluated using Cox's regression model. Results: 223 patients were identified. Stage 1A, 1B and 1C were 61.5%, 1.3% and 29.6% respectively. 7.6% were apparently stage I. Surgical approach was laparoscopic for 93 patients (41.7%) and open for 130 (58.3%). 5-years DFS was 84% and 82%, 10-years DFS was 68% and 64% for the laparoscopic and open-group (p = 0.6).5-years OS was 100% and 99%, 10 years OS was 98% and 97% for the laparoscopic and open-surgery group (p = 0.8). At multivariate analyses stage IC, incomplete staging, site of primary surgery retained significant prognostic value. Conclusion: The present study suggests that surgical route does not affect the oncological safety of patients with stage I AGCTs, with comparable outcomes between laparoscopic and open approach.

Objective The purpose of this study was to explore in greater depth the outcomes of the Italian randomized trial investigating the role of pelvic lymphadenectomy in clinical early stage endometrial cancer. In the attempt to identify the patients with poorer prognosis, the impact of age and body mass index were also thoroughly investigated by cancer-specific survival (CSS) analyses. Study Design Survival outcomes of trial patients were analyzed in relation to age (>65 years and >65 years) in the 2 arms (lymphadenectomy and no lymphadenectomy) and in the whole population of the trial. Results Univariate and multivariable analyses of CSS and overall survival (OS) of patients showed that age >65 years is a strong independent poor prognostic factor (5-y OS 92.1% and 78.4% in >65 years and >65 years patients, respectively, P <.0001; 5-y CSS 93.8% and 83.5% in >65 years and >65 years patients, respectively, P =.003). Among women >65 years, node negative patients had 94.4% 5-y OS and 96.3% 5-y CSS vs 74.3% 5-y OS and 74.3% 5-y CSS for node positive patients (P =.009 and P =.002, respectively), while among women >65 y, node negative patients had 75.7% 5-y OS and 83.6% 5-y CSS vs 74.1% 5-y OS and 83.3% 5-y CSS for node positive patients (P =.55 and P =.58, respectively). Univariate and multivariable survival analyses in the whole trial population showed that older age, and higher tumor grade and stage were significantly associated to a worse prognosis. Conclusion Older women faced an intrinsic poorer survival whether or not they underwent lymphadenectomy, and, unexpectedly, irrespective of the presence of nodal metastasis. Only in older patients was obesity (body mass index >30) significantly associated with scarce prognosis. © 2014 Mosby, Inc. All rights reserved.

Objective The purpose of this study was to explore in greater depth the outcomes of the Italian randomized trial investigating the role of pelvic lymphadenectomy in clinical early stage endometrial cancer. In the attempt to identify the patients with poorer prognosis, the impact of age and body mass index were also thoroughly investigated by cancer-specific survival (CSS) analyses. Study Design Survival outcomes of trial patients were analyzed in relation to age (>65 years and >65 years) in the 2 arms (lymphadenectomy and no lymphadenectomy) and in the whole population of the trial. Results Univariate and multivariable analyses of CSS and overall survival (OS) of patients showed that age >65 years is a strong independent poor prognostic factor (5-y OS 92.1% and 78.4% in >65 years and >65 years patients, respectively, P <.0001; 5-y CSS 93.8% and 83.5% in >65 years and >65 years patients, respectively, P =.003). Among women >65 years, node negative patients had 94.4% 5-y OS and 96.3% 5-y CSS vs 74.3% 5-y OS and 74.3% 5-y CSS for node positive patients (P =.009 and P =.002, respectively), while among women >65 y, node negative patients had 75.7% 5-y OS and 83.6% 5-y CSS vs 74.1% 5-y OS and 83.3% 5-y CSS for node positive patients (P =.55 and P =.58, respectively). Univariate and multivariable survival analyses in the whole trial population showed that older age, and higher tumor grade and stage were significantly associated to a worse prognosis. Conclusion Older women faced an intrinsic poorer survival whether or not they underwent lymphadenectomy, and, unexpectedly, irrespective of the presence of nodal metastasis. Only in older patients was obesity (body mass index >30) significantly associated with scarce prognosis

Study Objective: To evaluate continuous (CON) compared with cyclic (CYC) administration of combined oral estroprogestins for 6 months after laparoscopic excision of ovarian endometriomas associated with pain. Design: Multicenter, prospective, randomized trial (Canadian Task Force classification I). Setting: Tertiary care university hospitals. Patients: Fifty-seven women aged 18 to 40 years with ovarian endometriomas associated with moderate to severe pelvic pain who underwent laparoscopic excision of the disease. Interventions: Patients were randomized to receive postoperative estroprogestins for 6 months, administered as either a CON or CYC regimen. Measurements and Main Results: At 3, 6, 12, and 24 months postoperatively, patients were evaluated for recurrence of endometriomas (defined as cysts >3 cm in greatest diameter) using ultrasonography, for recurrence of pain using a visual analog scale, and for patient satisfaction. After a minimum follow-up of 12 months (mean, 22 months), at intent-to-treat analysis, no endometrioma recurrence was observed in the CON group, whereas there was recurrence in 1 patient (4%) in the CYC group. Pain recurred in 5 and 9 patients, respectively (17% vs 32%; p = .23). Compared with pretreatment values, pain scores improved in both groups, with no significant difference between the 2 groups. Most patients in both groups were either satisfied or very satisfied, with no significant difference between treatment groups. However, compared with the CYC group, significantly more patients in the CON group experienced moderate to severe adverse effects, and therapy was discontinued (41% vs 14%; p = .03). Conclusions: Although both regimens were equally effective insofar as postoperative pain and recurrence of endometrioma, when compared with the CYC regimen, the CON regimen seems to be associated with significantly more adverse effects and discontinuation rates. © 2011 AAGL.

Pelvic lymph nodes are the most common site of extrauterine tumor spread in early-stage endometrial cancer, but the clinical impact of lymphadenectomy has not been addressed in randomized studies. We conducted a randomized clinical trial to determine whether the addition of pelvic systematic lymphadenectomy to standard hysterectomy with bilateral salpingo-oophorectomy improves overall and disease-free survival.