Reut Rotem

Clinical characteristic and risk factors for post-operative complications in women undergoing laparoscopy myomectomy

To assess clinical characteristic and risk factors for post-operative complications in women undergoing laparoscopic myomectomy using the Clavien-Dindo classification system. A retrospective cohort study was conducted at Soroka University Medical Center, Beer Sheva, Israel, between 2010 and 2020, including women who underwent laparoscopic myomectomy. Postoperative adverse events were classified using the Clavien-Dindo system. The study population was divided into two groups: those with complications (Clavien-Dindo classification ≥ 1) and those without complications (Clavien-Dindo classification = 0). Risk factors were compared between the groups and analyzed for statistical significance using univariate and multivariate logistic regression. A total of 111 women who underwent laparoscopic myomectomy were included. Of these, 26 experienced complications (study group) and 85 did not (comparison group); all complications were minor. Women in the study group had a higher incidence of pre-operative symptoms (76.9 % vs. 55.3 %). Additionally, the duration of surgery was significantly longer in the study group (137 min vs. 97 min, p  100 mL was found to be independently associated with complications (aOR 4.4, 95 % CI 1.5-12.5). Laparoscopic myomectomy is a safe and effective surgical option for women, with a low rate of minor complications. Although longer surgeries and increased blood loss were associated with complications, the overall risk remains minimal. Proper identification of risk factors such as pre-operative symptoms and intraoperative blood loss can help optimize patient outcomes. Future research should further explore the relationship between anemia and surgical outcomes, as no significant differences in anemia were observed in this study.

Quantifying the impact of bladder complications following gynecological cancer treatment: systematic review and meta-regression

Gynecological cancer treatments, including radiotherapy (RT) and chemotherapy, leads to various bladder complications. The anatomical proximity of the treatment site to the urinary bladder primarily explains the complications following RT, while chemotherapy contribute to bladder dysfunction through systemic mechanisms. This study systematically reviews the nature, extent, and prevalence of bladder complications among women treated for these malignancies, underscoring the influence of treatment modalities on bladder function. A comprehensive search of databases including Embase, Scopus, PubMed/MEDLINE, CINAHL, and the Cochrane Library was conducted, focusing on women undergoing RT, chemotherapy, or both for gynecological cancers. Meta-regression was performed to quantify the effects of treatments on bladder function, using random-effect models. From 15,081 citations, 12 studies with a total of 12,469 participants were included. Our analysis revealed a broad spectrum of bladder complications, with urinary incontinence (UI) and overactive bladder symptoms being common, alongside with radiation cystitis and anatomical defects formation. The prevalence of these complications varied, reflecting the complexity of treatment modalities, cancer types, and patient characteristics. Specifically, UI rates ranged from 2.6% to 84%, while the incidence of fistula formation and ureteral stenosis remained relatively low but clinically significant. Urodynamic findings showed reduced bladder capacity and increased detrusor overactivity in up to 44% of evaluated patients, highlighting treatment's impact on bladder function. Bladder complications are prevalent among gynecological cancer survivors, with notable occurrences associated with chemotherapy and RT treatments. Integrated care focusing on both oncological and urological health is essential for enhancing survivors' quality of life. PROSPERO Identifier: CRD42023467123.