Marco Aurelio Pinho Oliveira

Objective: This study evaluates the association between obesity and the presence of bowel endometriosis in patients undergoing surgery. Methods: A retrospective cross‐sectional observational study was conducted with patients treated between September 2023 and December 2024, at a specialized endometriosis outpatient clinic of a tertiary hospital in Rio de Janeiro, Brazil. Women who underwent surgery for histopathological confirmation of deep endometriosis were included. The outcome was bowel endometriosis, defined as a lesion >1 cm located in the rectosigmoid region. Preoperative weight and height were measured, and obesity was defined according to World Health Organization body mass index (BMI) criteria. The association between obesity and the outcome was assessed using multivariable logistic regression, adjusting for potential confounders. A P ‐value P = 0.031). The number of cesarean deliveries was also inversely associated with the outcome (OR: 0.39; 95% CI: 0.21–0.71; P = 0.002). Conclusion: Although higher body weight was associated with a lower chance of bowel involvement, these results should be interpreted cautiously given the cross‐sectional nature of the study and the limitations of BMI and body weight as measures of adiposity. Future studies incorporating more precise anthropometric assessments (e.g., bioimpedance, body fat percentage, or abdominal circumference) are warranted.

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Key points •Chronic pelvic pain is a common and complex condition that significantly affects women’s quality of life. •Neuropathic pain and nociplastic pain are important components in the pain picture of these patients and should be considered in clinical treatment. •Oral neuromodulators, antidepressants and anticonvulsants for the control of neuropathic and nociplastic pain should be […] Key points •Chronic pelvic pain is a common and complex condition that significantly affects women’s quality of life. •Neuropathic pain and nociplastic pain are important components in the pain picture of these patients and should be considered in clinical treatment. •Oral neuromodulators, antidepressants and anticonvulsants for the control of neuropathic and nociplastic pain should be […]

Surgical duration for endometriosis treatment varies based on the anatomical complexity of the disease and the surgical technique applied. However, the independent effects of each of these factors remain poorly understood. We hypothesized that intestinal involvement and the presence of endometrioma, whether isolated or combined, significantly increase operative time, regardless of the surgical technique. This study aimed to assess how endometriosis phenotype and surgical approach influence operative time. This retrospective observational study included 263 patients who underwent either conventional laparoscopy (n = 113) or robotic-assisted surgery (n = 150) between January 2020 and December 2024. Patients were stratified into four groups: (1) isolated deep infiltrating endometriosis, (2) endometrioma without intestinal involvement, (3) intestinal endometriosis without endometrioma, and (4) combined presentation (endometrioma with intestinal involvement). Univariate analyses and multiple linear regression models were used to examine the effects of disease phenotype and surgical approach on operative time. A p value < 0.05 was considered statistically significant. The presence of endometrioma and intestinal involvement were both significant predictors of increased operative time, with a cumulative effect in combined cases. Compared to isolated DIE, there was an average increase of 63.4 min for isolated endometrioma cases (p < 0.001), 40.9 min for isolated intestinal endometriosis (p = 0.004), and 103.8 min for combined presentation (p < 0.001). The robotic approach added an average of 34.0 min to operative time (p < 0.001), with the effect most pronounced in patients with endometrioma. Age was also a significant factor, contributing an additional 1.5 min per year (p = 0.035). The estimated mean docking time for robotic cases was approximately 12 min. When stratified by disease subtype, only the isolated endometrioma group showed a statistically significant difference between surgical techniques, with robotic-assisted surgery adding 55 min (p = 0.007). In the other groups, including those with intestinal involvement, no significant differences were observed between approaches, although there was a numerical trend towards longer operative times with the robotic technique. Operative time is primarily influenced by the clinical presentation of endometriosis, with endometrioma, especially when combined with intestinal involvement, having the greatest impact. Although robotic-assisted surgery was associated with longer operative times overall, it was more frequently used in complex cases, suggesting a positive selection bias. The additional time likely reflects both the technical intricacy of robotic procedures and the docking process. Nevertheless, this technology may offer advantages for complex dissections. These findings underscore the importance of individualized surgical planning based on the anatomical characteristics of the disease rather than solely on the choice of surgical platform.

Although it is advised to use vaginal dilators following radiotherapy to prevent vaginal stenosis, compliance is frequently low. This study aimed to assess adherence to the use of vaginal dilators after brachytherapy and its effects in women who received phone call or texting apps guidance. A total of 30 women who previously underwent brachytherapy for cervical cancer were randomized into two groups using the R program: monitoring via phone calls and monitoring via text messages. They underwent gynecological examination with measurement of vaginal volume and answered the Functional Assessment of Cancer Therapy-Cervix Cancer (FACT-CX) questionnaire at the initial consultation and at the sixth month. No association was found between adherence and the types of follow-up (p=0.79). In the first month, 43.3% adhered to dilators, 36.6% did so in the third month, and 23% in the sixth month. The highest adherence group had higher difference in vaginal volume scores (16.81±10.45 cm3) compared to the nonadherence group (10.45±9.55 cm3) with a strong effect size (d=1.68). The difference between the initial and final vaginal volume was not associated with the FACT-CX scores (rho=−0.369; p=0.08. Although no differences were observed in adherence to dilators and type of follow-up, high adherence demonstrated a direct effect on increasing vaginal volume, showing the need to promote educational forms that encourage adherence.

RESUMO Embora seja aconselhado o uso de dilatadores vaginais após a radioterapia para prevenir a estenose vaginal, a adesão frequentemente é baixa. O objetivo deste estudo foi avaliar a adesão ao uso de dilatadores vaginais após a braquiterapia e seus efeitos em mulheres que receberam orientações por telefone ou aplicativos de mensagens de texto. Trinta mulheres previamente submetidas à braquiterapia para câncer cervical foram randomizadas por meio do programa R, em dois grupos: acompanhamento por telefone; e monitoramento via mensagens de texto. Todas realizaram exame ginecológico com aferição do volume vaginal e responderam ao questionário Functional Assessment of Cancer Therapy-Cervix Cancer (FACT-CX) na consulta inicial e no sexto mês. Não foi encontrada associação entre adesão e tipos de acompanhamento (p=0,79). No primeiro mês, 43,3% aderiram aos dilatadores, 36,6% no terceiro mês e 23% no sexto mês. O grupo de maior adesão teve maior diferença nos escores de volume vaginal (16,81±10,45 cm3) em comparação com o grupo de não adesão (10,45±9,55 cm3) com um tamanho de efeito forte (d=1,68). A diferença entre o volume vaginal inicial e final não apresentou relação com os escores do FACT-CX (rho=−0,369; p=0,08). Embora não tenham sido observadas diferenças na adesão aos dilatadores e no tipo de acompanhamento, a alta adesão demonstrou efeito direto no aumento do volume vaginal, mostrando a necessidade de promover formas educativas que estimulem a adesão.

Chemoradiotherapy combined with brachytherapy is the standard treatment for locally advanced cervical cancer. Guidelines recommend initiating treatment within 8 weeks of diagnosis and completing it within 8 weeks of initiation. This study aimed to analyze the duration between diagnosis and the completion of treatment for women attending a gynecological oncology clinic. We retrospectively evaluated the waiting times and treatment durations for 57 women diagnosed with cervical cancer attended at a tertiary hospital in Rio de Janeiro, Brazil, who received radiotherapy between January 2016 and December 2023. Out of 57 medical records, 23 were excluded due to incomplete data, leaving 34 records for analysis. Radiotherapy treatment initiation was delayed beyond 8 weeks in 73.5% of women, with 47% experiencing delays exceeding 16 weeks. Throughout the study period, no significant temporal trends were observed in the time to initiate treatment (z = −0.99741, p = 0.31), the interval between radiotherapy and brachytherapy (z = 0, p = 1), the treatment duration (z = 0, p = 1), or the total treatment time (z = −0.24935, p = 0.8). The waiting time to initiate treatment and the interval between radiotherapy and brachytherapy exceeded the recommended duration. The main delay was attributed to the waiting period for brachytherapy. Expanding service availability and integrating the scheduling of radiotherapy and brachytherapy could help reduce delays and improve treatment efficiency.