Ospemifene plus fractional CO2 laser: a powerful strategy to treat postmenopausal vulvar pain

Abstract

This study is a single-center, retrospective analysis of postmenopausal women presenting with dyspareunia and vulvar pain, aiming to evaluate relative effectiveness of vestibular CO₂ laser therapy as a treatment. Three monthly sessions of laser were performed to each patient and thereafter a three-months follow-up was stablished. A total number of 72 patients undergoing vestibular laser treatment were recruited from patient files in the period between 2016 and 2018. Among these, 39 women also received a concomitant treatment with ospemifene (60?mg/day) during the study period. There was a statistically significant reduction of all the symptoms in both groups up to the three month follow-up. Regarding dryness and dyspareunia, the relief tent to be more prominent in the ospemifene?+?laser group at all follow-ups and remained statistically significant at three-month follow-up. Specifically, vestibular dryness was significantly lower in the ospemifene?+?laser group compared with the laser treatment group (?87% vs???34%, respectively), and the vestibular health score started declining faster in the ospemifene?+?laser group. Although, additional research is needed to understand the mechanism of action, our data shows that a combination regimen of laser and ospemifene may improve clinical effectiveness for long-term treatment of symptoms associated with the under-recognized genitourinary syndrome of menopause.     

Diagnostic sonography of the fetal genitourinary tract

Fetal diagnosis has vastly improved over the last decade. Ultrasound has become the imaging modality of choice. As real-time equipment has improved technologically, the ability to deduce subtle abnormalities has greatly increased. The fetal genitourinary tract may be evaluated for renal dysplasias, anomalies, or obstruction. Points of obstruction and, at times, the exact cause of obstruction may be deduced. Abnormalities of the ureter, bladder, urethra, scrotum, or reproductive system can be detected.     

A narrative review of individualized treatments of genitourinary tumors: is the future brighter with molecular evaluations?

Few molecular prognostic and predictive biomarkers have been identified so far in genitourinary tumors. We started from a literature search to explore the status of the art of molecular pathology tests as diagnostic, prognostic, predictive biomarkers in genitourinary cancers. Next generation sequencing approaches now provide mind-changing information in the fields of kidney cancer diagnosis, predictive oncology of urothelial cancer, understanding the causes of testicular and penile cancer, and the comprehension of the drivers of prostate cancer progression beyond androgen regulation. The classification of kidney cancer will be based soon on molecular changes. The causes of non-HPV related penile cancer are largely unknown. The emerging high incidence of testicular cancer could be explained only on the basis of molecular changes. The response to novel therapeutic agents in prostatic and urothelial cancer will require thorough molecular tumor characterization. The hereditary risk of patients with early onset prostate cancer and their potential treatment with targeted therapy requires germline and somatic genetic assays. The implementation of effective biomarkers for the response to immune check-point inhibitors in genitourinary cancer is based on the assessment of inflammatory expression profiles and the tumor mutational burden. This review deals with the current tests and provides a tentative foresee of the future molecular biomarkers of genitourinary cancer.     

Auditory toxicity effects of long-term cis-dichlorodiammineplatinum II therapy in genitourinary cancer patients

To determine the auditory toxicity effects of long-term cis-dichlorodiammineplatinum II therapy, pure tone hearing thresholds were measured prior to therapy and repeated before each subsequent treatment. CDDP was given by a slow intravenous drip method at a low dose of 1 mg/kg body weight, with 37.5 gm mannitol, once a week for six treatments and every 3 weeks thereafter. From a group of 173 genitourinary cancer patients treated, 50 male patients were selected who received at least 12 months of CDDP with no active conductive ear pathology, and whose audiograms obtained at baseline, 6th weeks, 26th weeks, and 52nd weeks of treatment were all available for comparison. Pure tone threshold levels deteriorated across time particularly by the 52nd week and at the higher frequencies. Threshold differences across time were statistically significant and within a linear trend. Of the 50 cases, 30% showed suspect or no ototoxicity, 26% mild, 32% moderate, 2% marked, and 4% showed severe ototoxic changes. Of the two cases who developed severe ototoxicity, one showed complete recovery. There was partial recovery in 26% and no recovery in 54%. Individual variability in susceptibility to and recovery from ototoxicity necessitates systematic audiometric monitoring throughout the therapy.     

STD门诊患者泌尿生殖道支原体感染状况及其药敏试验

目的 了解STD门诊支原体感染情况及耐药情况。方法 从265例患者的尿道和宫颈留取标本，进行支原体培养，阳性者再行10种抗生素药物试验。结果 265位惠者中有93位感染支原体，其感染率为35．1％；UU、MH以及UU MH混合感染率分别为：25．7％、3．0％及6．4％。对UU药敏试验较为敏感的抗生素有：强力霉素、美满霉素及交沙霉素，耐药率分别为61．8％、63．0％及58．8％。耐药性最高者为左旋氧氟沙星及氧氟沙星，耐药率分别为52．9％及50．0％。结论 泌尿生殖道中支原体普遍存在耐药性。强力霉素和美满霉素及交沙霉素是治疗生殖道支原体感染的首选药物。     

2001年～2003年广东省泌尿生殖系统用药分析

目的:研究广东省2001年～2003年泌尿生殖系统用药金额,以了解广东省泌尿生殖系统药物的应用状况及其变化趋势.方法:本文采集"广东省药学会医院用药信息网"收集的购药统计数据,对广东省部分医院2001年～2003年泌尿生殖系统药物用药金额进行统计、排序,并加以分析.结果与结论:泌尿生殖系统药物在销售总金额中比例基本保持不变,各亚类药物的用药结构相对固定,促排卵药的比例相当高.外资、合资药厂产品所占比例较高.     

广东梅州地区性病门诊3824例支原体检测及药敏分析

目的 了解梅州地区性病门诊就诊患者支原体引起泌尿生殖道感染的状况及支原体感染的药敏情况.方法 2008年8月至2011年3月对性病门诊拟诊为尿道炎、阴道炎或宫颈炎的3 824例就诊者,采用珠海迪尔生物工程公司支原体培养、药敏一体化试剂盒进行支原体培养,并对阳性患者进行12种抗生素的药敏试验.结果 共培养出1 103例支原体感染者(阳性率28.24%),解脲支原体(Uu)743株(67.36%),人型支原体(Mh)24株(2.18%),两种支原体混合感染336株(30.46%).对Uu药敏感率最高的药物为交沙霉素,其次为多西环素和美满霉素;对Mh及Uu/Mh两种支原体混合感染药物敏感也呈同样趋势.对Uu耐药最高的是环丙沙星,其次是红霉素和氧氟沙星;对Mh耐药最高的红霉素,其次是阿奇霉素和克拉霉素,对Uu/Mh两种支原体混合感染耐药最高的是红霉素,其次是氧氟沙星和罗红霉素.结论 临床用药应该考虑该地区耐药株的流行情况,最好按照药敏试验结果合理用药.     

Yttrium-90 Radioembolization to the Prostate Gland: Proof of Concept in a Canine Model and Clinical Translation

PurposeTo investigate the feasibility, safety, and absorbed-dose distribution of prostatic artery radioembolization (RE) in a canine model.Materials and MethodsFourteen male castrated beagles received dihydroandrosterone/estradiol to induce prostatic hyperplasia for the duration of the study. Each dog underwent fluoroscopic prostatic artery catheterization. Yttrium-90 (⁹⁰Y) microspheres (TheraSphere; Boston Scientific, Marlborough, Massachusetts) were delivered to 1 prostatic hemigland (dose escalation from 60 to 200 Gy), with the contralateral side serving as a control. Assessments for adverse events were performed throughout the follow-up (Common Terminology Criteria for Adverse Events v5.0). Positron emission tomography/magnetic resonance (MR) imaging provided a confirmation after the delivery of absorbed-dose distribution. MR imaging was performed before and 3, 20, and 40 days after RE. Tissue harvest of the prostate, rectum, bladder, urethra, penis, and neurovascular bundles was performed 60 days after RE.ResultsAll the animals successfully underwent RE. Positron emission tomography/MR imaging demonstrated localization to and good coverage of only the treated hemigland. No adverse events occurred. The MR imaging showed a significant dose-dependent decrease in the treated hemigland size at 40 days (25%–60%, P < .001). No extraprostatic radiographic changes were observed. Necropsy demonstrated no gross rectal, urethral, penile, or bladder changes. Histology revealed RE-induced changes in the treated prostatic tissues of the highest dose group, with gland atrophy and focal necrosis. No extraprostatic RE-related histologic findings were observed.ConclusionsProstate ⁹⁰Y RE is safe and feasible in a canine model and leads to focal dose-dependent changes in the gland without inducing unwanted extraprostatic effects. These results suggest that an investigation of nonoperative prostate cancer is warranted.     

Eleven Patients With Testicular Leydig Cell Tumors

We present the sonographic and magnetic resonance imaging findings of Leydig cell tumors in a series of patients, along with a brief review of the literature. We evaluated the sonographic features of 11 cases of Leydig cell tumors, including echogenicity, size, margins, and patterns of vascularity. The magnetic resonance imaging characteristics of 9 patients were also assessed, with special attention to the appearance of the tumors on T2-weighted imaging and postcontrast T1-weighted imaging. Seven tumors were hypoechoic, and 4 were almost isoechoic. Ten patients showed various patterns of hypervascularity in the tumors, combined in some cases with feeding vessels. One case presented with a single feeding vessel. The tumors showed homogeneous or heterogeneous low signal intensity on T2-weighted imaging and marked enhancement on postcontrast T1-weighted imaging. The small size of these tumors, the various patterns of vascularity on color and power Doppler sonography, and the marked enhancement on postcontrast T1-weighted imaging are considered valuable but generally nonspecific for identification of these tumors.     

Genitourinary Complaints in Young Adults: A Sheep in Wolf’s Clothing

With adolescents and young adults constituting a large percentage of sexually transmitted infection cases in the United States, providers serving this population are often required to manage suspected and confirmed cases. Unique presentations may prove challenging when considering empiric treatment, possible diagnostic culprits, and management of patients at risk for loss to follow-up. Additionally, concerns regarding the appropriateness of human immunodeficiency virus pre-exposure or postexposure prophylaxis can confound care strategies. This case describes an atypical encounter involving a college student. It highlights the importance of prompt and effective care of genitourinary complaints in college health settings.