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Introduction: The early detection of cervical cancer requires the implementation of molecular screening programmes for human papillomavirus (HPV). However, there are discrepancies in the optimization of screening protocols. The performance of 10 primary screening strategies based on molecular, cytological or combined techniques is now evaluated., Material and Methods: A blind, prospective, and interventional study was designed in 1.977 35-year-old women. The molecular determination was carried out by the Cobas 4800 HPV platform. Cytological analysis were performed on the same samples without knowledge of the result of the molecular assay. All women in whom HPV-16/HPV-18 was detected or presented cytological alteration together with detection of other high-risk genotypes (HPVhr) were referred to colposcopy., Results: The molecular assay detected the presence of HPVhr genotypes in 12.5% of the women, while only 8.1% of the cytologies were pathological. Among the patients referred to colposcopy, in 19.5% high-grade lesions were observed, being HPV-16 present in 65.3% of them. In six of these high-grade lesions (associated with HPV-16 in all cases), cytology was reported as normal. The follow-up one year later, of women with normal cytology and HPVhr detection a HSIL/CIN2+ lesion was detected (associated to HPV-33). In the comparative study with other strategies, the protocol called CRYGEN 16/18 yielded the best balance of sensitivity and specificity with the least referral to colposcopy., Conclusions: Performing molecular detection of HPVhr with partial first-line genotyping of at least HPV-16, with direct referral to colposcopy, increases the detection rate of HSIL/CIN2+ lesions., (Copyright © 2021 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Several viral infections cause changes in the placenta. Cytomegalovirus, herpes viruses, and HIV cause increased placental thickness; Zika virus induces focal regions of necrosis; parvovirus B19 causes a structural injury. Umbilical flow can be considered a direct measurement of vascular placental function., Objective: This study aimed to compare placental ultrasound and umbilical Doppler findings in pregnant women who tested positive or negative for SARS-CoV-2. Our work aimed to confirm the suspicion of placental infection and the consequence in fetal physiopathology., Study Design: Fifty-seven pregnant women who tested positive for SARS-CoV-2 at the time of or 1 month before the ultrasound scan were evaluated. Cases included 9 first trimester, 16 second trimester, and 32 third trimester ultrasound scans. For comparison, 110 pregnant women (controls) were evaluated. They included 19 women in their first trimester, 43 in their second trimester, and 48 in the third trimester. Controls were asymptomatic and tested negative for SARS-CoV-2 infection in the last 72 hours before the ultrasound scan. Fetal biometry, placental thickness, placental lakes and Doppler umbilical vein parameters, including venous cross-sectional area (mean transverse diameter and radius of umbilical vein, mean velocity of umbilical vein), and umbilical vein blood flow were evaluated., Results: Placental thickness (in millimeter) was significantly higher in the group of pregnant women with SARS-CoV-2 infection (53.82 [10-115]) than in the control group (33.82 [12-66]; P <.001) in their second and third trimesters. The frequency of >4 placental lakes was significantly higher in the group of pregnant women with SARS-CoV-2 infection (28/57 [50.91%]) than in the control (7/110 [6.36]; P <.001) in all 3 trimesters. The mean velocity of umbilical vein was significantly higher in the group of pregnant women with SARS-CoV-2 infection (12.45 [5.73-21]) than in the control group (10.81 [6.31-18.80]; P =.001) in all 3 trimesters. Umbilical vein blood flow (in milliliter per minute) was significantly higher in the group of pregnant women with SARS-CoV-2 infection (389.9 [6.52-1496.1]) than in the control group (305.05 [3.11-1441]; P =.05) in all 3 trimesters., Conclusion: Significant differences in placental and venous Doppler ultrasound were documented. Placental thickness, placental venous lakes, mean velocity of umbilical vein, and umbilical vein flow were significantly higher in the group of pregnant women with SARS-CoV-2 infection in all 3 trimesters., (© 2023 The Authors.)

In the PALOMA trial, Papilocare ® demonstrated efficacy in repairing low-grade cervical lesions related to human papillomavirus (HPV). This sub-analysis aimed to evaluate its efficacy in repairing these cervical lesions and clearing HPV in women aged older than 40 years. This was a multicenter, randomized, open-label, parallel-group, controlled clinical trial. Patients with low-degree HPV-dependent cervical lesions receiving 6-month treatment with the vaginal gel were compared to those with a watchful waiting approach. Among the 41 women analyzed (aged 47.7 years), 31 presented high-risk (HR) oncogenic HPV subtypes, and 14 had 16-18-31 HPV genotypes. After 6 months, normalized cytology and concordant colposcopy were achieved by a greater percentage of treated women. The difference was significant in the total population (92.3% vs. 50.0%, p = 0.007), and HR-HPV subpopulation (90.5% vs. 33.3%, p = 0.003). In the HR HPVs-16-18-31 subpopulation, the values were 75.0% and 40.0% ( p = 0.293). In the total population, 61.5% of treated patients obtained HPV clearance, compared to 50.0% in the control group. Regarding the HR-HPV subpopulation, these values were 66.7% and 44.4%, respectively. Papilocare ® demonstrated significant efficacy in repairing low-degree HPV-related cervical lesions and a positive trend to clear HPV in women older than 40 years old in comparison to the watchful waiting approach.

A fully government-funded human papillomavirus (HPV) vaccination program started in 2007 in Spain (only 11-14-year-old girls). The first of those vaccinated cohorts, with the quadrivalent vaccine (Gardasil), turned 25 years old in 2018, the age at which cervical cancer screening begins in Spain. The current study could provide the first evidence about the effectiveness of the quadrivalent vaccine against HPV in Spain and the influence of age of vaccination. The present ambispective cohort study, which was conducted on 790 women aged 25 and 26 years old, compares the rate of HPV prevalence and cytologic anomaly according to the vaccination status. The overall infection rate was 40.09% (vaccinated group) vs. 40.6% (non-vaccinated group). There was a significant reduction in the prevalence of HPV 6 (0% vs. 1.3%) and 16 (2.4% vs. 6.1%), and in the prevalence of cytological abnormalities linked to HPV16: Atypical Squamous Cells of Undetermined Significance (ASCUS) (2.04% vs. 14%), Low-grade Squamous Intraepithelial Lesions (LSIL) (2.94% vs. 18.7%) and High-grade Squamous Intraepithelial Lesion (HSIL) (0% vs. 40%), in the vaccinated group vs. the non-vaccinated group. Only one case of HPV11 and two cases of HPV18 were detected. The vaccine effectively reduces the prevalence of vaccine genotypes and cytological anomalies linked to these genotypes.

Background: Recent data have shown that the human papillomavirus (HPV) vaccine could impact on a decrease in high-grade cervical intraepithelial lesions (HSIL) in women who have undergone surgical treatment. This study aimed to evaluate the efficacy of human papilloma virus (HPV) vaccination against persistent/recurrent disease in patients undergoing conization for high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia-grade 2-3 (HSIL/CIN 2-3). Methods: From January 2009 to March 2019, 563 patients with HSIL/CIN 2-3 underwent conization. The population was divided into two groups according to vaccination status: vaccinated-group (V-Group) and non-vaccinated-group (NV-Group). Bivalent or quadrivalent vaccines were administered indiscriminately. A follow-up was scheduled every 6-12 months according to clinical guidelines. The mean follow-up was 29.6 vs. 36.5 months in the V-group and NV-group, respectively. Results: 277 (49.2%) women were vaccinated, while 286 (50.8%) were not. Overall, persistent/recurrent HSIL/CIN 2-3 was presented by 12/277 (4.3%) women in the V-Group and 28/286 (9.8%) in the NV-Group (HR: 0.43, 95% Confidence interval 0.22-0.84, p = 0.014). Vaccination was associated with a 57% reduction in HSIL persistence/recurrence after treatment. When no disease was present in the first 6-month follow-up visit, persistence/recurrence rates were very low in both groups: 1.1% in the V-Group vs. 1.5% in the NV-Group ( p > 0.05). The factor associated with a high-risk of HSIL persistence/recurrence was the presentation of a positive co-test in the first control after treatment ( p < 0.001). Conclusions: Our results corroborate the benefit of HPV vaccination in woman treated for HSIL/CIN 2-3, showing a reduction of persistent/recurrent HSIL/CIN 2-3.

Introduction: The early detection of cervical cancer requires the implementation of molecular screening programs for human papillomavirus (HPV). However, there are discrepancies in the optimization of screening protocols. The performance of 10 primary screening strategies based on molecular, cytological or combined techniques is now evaluated., Material and Methods: A blind, prospective, and interventional study was designed in 1977 35-year-old women. The molecular determination was carried out by the Cobas 4800 HPV platform. Cytological analysis was performed on the same samples without knowledge of the result of the molecular assay. All women in whom HPV-16/HPV-18 was detected or presented cytological alteration together with detection of other high-risk genotypes (HPVhr) were referred to colposcopy., Results: The molecular assay detected the presence of HPVhr genotypes in 12.5% of the women, while only 8.1% of the cytologies were pathological. Among the patients referred to colposcopy, in 19.5% high-grade lesions were observed, being HPV-16 present in 65.3% of them. In six of these high-grade lesions (associated with HPV-16 in all cases), cytology was reported as normal. The follow-up one year later, of women with normal cytology and HPVhr detection a HSIL/CIN2+ lesion was detected (associated to HPV-33). In the comparative study with other strategies, the protocol called CRYGEN 16/18 yielded the best balance of sensitivity and specificity with the least referral to colposcopy., Conclusions: Performing molecular detection of HPVhr with partial first-line genotyping of at least HPV-16, with direct referral to colposcopy, increases the detection rate of HSIL/CIN2+ lesions., (Copyright © 2021 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Obstetric fistulas in developed countries are infrequent and have been associated with instrumental vaginal delivery, manual removal of placenta and surgical complications during caesarean section. We present the diagnosis and treatment of an obstetric fistula of patient without clear risk factors in a developed country., Case Report: The case presented is of a 37 weeks pregnant with history of previous cesarean section. A male of 2,600 g was born after a not prolonged vaginal delivery. In the immediate postpartum period, appeared evident hematuria and in the exploration a defect was detected in the vaginal anterior face at 3 cm from the urethral meatus. Cystoscopy showed a torn in bladder of 8 cm at the bottom. Reparation of vesicovaginal fistula was carried out with omentoplasty. Postoperative course was uneventful., Conclusion: A vesicovaginal fistula must be considered in any patient with hematuria. Early repair is essential for a favorable outcome.

Exaggerated placental site, a trophoblastic benign lesion, is characterized by an extensive infiltration of the endometrium, myometrium and arterial walls by intermediate trophoblast cells. Trophoblastic benign lesions are often an incidental finding in the anatomopathological study, but may be associated with severe bleeding especially in relation to trauma. Case report: Multigravida 39 years old with excessive uterine bleeding after medical treatment of abortion. Once expelled gestational vesicle is seen sonographically a uterine cavity occupied by a heterogeneous endometrium with maximum anteroposterior diameter of 21 mm, plenty of color map, reaching myometrium. B-HCG serum is 164 mlU/ml. During hysteroscopy a massive bleeding happens and its necesary to use an intrauterine catheter to stop it. Computed tomography angiography shows suggestive findings of uterine vascular malformation. A hysterectomy as a diagnostic and definitive treatment is made and pathology reports an exaggerated placental site.

Objectives: To analyse the outcomes of patients undergoing Essure sterilization in a single institution, interns of complications and technique failure., Patients and Methods: Retrospective descriptive study of 517 patients underwent definitive contraception with Essure device in outpatient hysteroscopy office without anesthesia and controlled at 3 months with abdominal radiography, ultrasonography and hysterosalpingography in selected cases., Results: The success rates of the insertion of Essure was 96.8%, similar to data reported in the literature with 3.7% of vagal reactions, as most prevalent complication. 7 (1.35%) unintended pregnancies were observed., Conclusions: Essure is a permanent birth control device, with high rate of successful insertion and a low rate of complications. Unintended pregnancies in our study are high and we must change the protocols of placement and monitoring, considering hysterosalpingography as a routine control test.

Objective: To measure the vascularization and ovarian volume with three-dimensional sonography in patients diagnosed of polycystic ovary syndrome with stimulated ovulation treatment, and to analyse the differences between the patients treated with clomiphen citrate versus clomiphen citrate and metformin., Material and Method: Therty patients were studied. Twenty ovulation cycles were obtained with clomiphen citrate and 17 with clomiphen citrate plus merformin (added in case of obesity or hyperglucemy/hyperinsulinemia). Ovarian volumes and vascular indexes were studied with 3D-sonography and results were analysed by treatment., Results: There were no statistical differences of ovarian volume by treatment along the cycles, although bigger volume were found in ovulatory cycles compared to non-ovulatory ones (20,36 versus 13,89 ml, p = 0,026). No statistical differences were also found concerning vascular indexes, neither by treatment nor by the obtention of ovulation in the cycle., Conclusions: Ovarian volume and vascular indexes measured with three-dimensional sonography in patients diagnosed of polycystic ovary syndrome do not show differents values in patients treated with clomiphen citrate alone versus clomiphen citrate plus metformin.

Objective: To evaluate the efficacy and security of polypropylene meshes in the repair of urogenital prolapse., Material and Method: Retrospective and non-randomized study in 106 patients which had different kinds of urogenital prolapse repaired using polypropylene meshes between April 2005 and January 2007. The follow-up was carried out by two visits to the hospital, 2 and 6 months after surgery. The variables analyzed were age, parity, menopause presence, kind of surgical technique, surgical time, time at hospital and complications. Afterwards, the information was analyzed descriptively., Results: Average age was 64.4 years. The rate of multiparity and menopause women was 91.51% and 92.45% respectively. The most used surgical technique was the anterior mesh with tension-free band (34.90%), to repair the associated urinary incontinence. The rate of intraoperatory complications was 2.83%, immediate complications was 37.73% and late complications was 21.69%. The success rate after 6 months was 80-100% depending on the technique., Conclusions: There is a low rate of intraoperatory and 6 months after the repair in the reconstructive surgery of pelvic floor for the urogenital prolapses using polypropylene meshes, which makes this technique a secure and effective option for the treatment of this problem.

Background: Urogenital prolapse is a condition that affects 1 to 43% of post-hysterectomized patients. Since several years some synthetic meshes have been used to repair pelvic floor, and apparently they have advantages over them predecessors., Objective: To evaluate the efficacy and security of polypropylene meshes in the repair of urogenital prolapse., Material and Method: Retrospective and non-randomized study in 106 patients that had different kinds of urogenital prolapse repaired using polypropylene meshes. The follow-up was carried out by two visits to the hospital, 2 and 6 months after surgery. The variables analyzed were age, parity, menopause presence, kind of surgical technique, surgical time, time at hospital and complications. Afterwards, the information was analyzed descriptively., Results: Average age was 64.4 years. The rate of multiparity and menopause women was 91.51% and 92.45% respectively. The most used surgical technique was the anterior mesh with tension-free band (34,90%) to repair the associated urinary incontinence. The rate of intraoperatory complications was 2.8%, immediate complications was 37.7% and late complications was 21.6%. The success rate after 6 months was 80 to 100%, depending on the technique., Conclusions: There is a low rate of intraoperatory and medium-term complications in the reconstructive surgery of pelvic floor for the urogenital prolapses using polypropylene meshes, which makes this technique a secure and effective option for the treatment of this problem.

Introduction: Urinary incontinence is an extended problem between middle-aged women. There are several options for its correction with different effectiveness and complication rates. Our objective is to evaluate the effectiveness of tension-free vaginal transobturator tapes (TOT) in the repair of this incontinence. Also to evaluate the patients satisfaction rate with this kind of surgery., Material and Methods: Retrospective study in 241 women with a surgical repair of their urinary incontinence with TOT. We analyzed the rates of effectiveness and satisfaction of the patients with the surgical repair after 2 and 6 months. The complication rate was also analyzed., Results: Urinary continence rate 2 months after surgery was around 70% and the satisfaction one around 65%. After 6 months the rates were 70% and 70% respectively with a minimal variation depending on the associated surgery. The complication rate during surgery was 3.31% and the one after surgery was 26.55%, although most of them were minor complications., Comment: The use of TOT for the repair of urinary incontinence is an effective and safe option with a low complication rate. Moreover the rate of patients satisfaction is high.