Lucia Anna Otten

Background/Objectives: Women with breast cancer (BC) and gynaecological cancer (GC) often undergo extensive oncological treatment, which can lead to pelvic floor disorders (PFD). However, there is still limited evidence regarding their real-world treatment practices, patient counselling, and prevalence. This study aims to systematically evaluate the prevalence of PFD and current treatment approaches, identify unmet needs, and improve future care. Methods: This observational multicentre survey was conducted at four university hospitals and one gynaecological oncology outpatient clinic in Germany. Women with BC and GC, who had undergone at least one oncological treatment, completed anonymously a study-specific questionnaire and the validated German Pelvic Floor Questionnaire. Recruitment was undertaken over a period of nine months, reflecting real-world daily care. Results: A total of 246 patients were included (median age 57 years, range 30–88); 74% were postmenopausal, and 52% had at least one vaginal delivery. BC was the most common diagnosis (63.8%). The most common symptoms were urinary incontinence (22.3% in BC, 38.1% in GC) and urgency (32.5% in BC, 35.7% in GC). Pelvic radiotherapy was significantly associated with increased urgency symptoms (p = 0.017), pelvic surgery with urgency symptoms (p = 0.048) and dyspareunia (p = 0.045), and antihormonal therapy with vaginal dryness (p = 0.028). The combination of chemotherapy and antihormonal therapy was associated with significantly higher rates of vaginal dryness in women with GC, whereas no such association was observed in women with BC (p = 0.036). Among the 108 patients classified as having new-onset symptoms, 51 (47.2%) reported symptom onset within one year of the cancer diagnosis. Overall, 34.1% of patients reported impairment in more than one patient-reported domain, including daily life, social life, sexual well-being, and psychological well-being. The median study-specific impact rating for the most bothersome pelvic floor symptom was 5/10. Only 28.0% of patients received prior counselling on PFD, and 19.9% were actively asked about symptoms. In total, 26.0% received urogynaecological treatment, whereas 15.4% reported unmet treatment needs. Conclusions: PFD is highly prevalent in women with BC and GC. Symptoms are clinically relevant but underestimated in routine care. Despite the availability of effective treatment options, significant gaps exist in patient counselling, early detection, and access to specialised care.

Background/Objectives: Stress urinary incontinence (SUI) can be masked by pelvic organ prolapse (POP), resulting in so-called latent SUI, and can also worsen postoperatively after POP surgery. Preoperative urodynamic (UD) testing can help identify such hidden dysfunctions, though its routine use and predictive value remain unclear. Material and Methods: This retrospective cohort study included women who underwent POP surgery between January 2019 and October 2025 and who underwent selective preoperative UD and postoperative follow-up (FU). The primary endpoint was to identify urodynamically latent SUI in women undergoing POP surgery, defined as clinical loss of urine during UD with prolapse reposition in patients without preoperatively diagnosed SUI. Secondary endpoints included evaluating de novo SUI rates, incontinence outcomes in women with preoperative UI, and the predictive value of UD for postoperative SUI in asymptomatic patients. SUI outcomes were assessed using validated questionnaires (International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form, German pelvic floor questionnaire), clinical stress testing, and anamnesis. Results: A total of 261 patients were included. Of those, 70 patients (26.8%) reported SUI, 16 (6.1%) urgency urinary incontinence, and 101 (38.7%) mixed urinary incontinence. Ninety-four patients (36%) received incontinence surgery. Latent SUI was identified in 13 patients (5%): of these, one underwent Burch colposuspension, and two underwent tension-free vaginal tape implantation, while the remaining 10 patients (76.9%) did not undergo incontinence surgery. At FU, 12 of 13 patients (92.3%) were continent; data were missing for one patient (7.7%). De novo SUI occurred in 6 patients (2.3%); these patients did not undergo incontinence surgery and did not show signs of latent SUI in UD. Preoperative UD demonstrated low sensitivity (0–44.4%) but moderate specificity (73.8–77.3%) for predicting postoperative SUI, with high negative predictive values (up to 98%), although these findings should be interpreted in light of the low event rates. Conclusions: In this selected cohort of women undergoing POP surgery, preoperative UD showed limited predictive value for postoperative SUI.

Understanding the interactions between the cervico-vaginal microbiome, immune responses, and sexually transmitted infections (STIs) is crucial for developing targeted diagnostic and therapeutic strategies. Although microbiome analyses are not yet standard practice, integrating them into routine diagnostics could enhance personalized medicine and therapies. We investigated the extent to which partial 16S short-read amplicon microbiome analyses could inform on the presence of six commonly encountered STI-causing pathogens in a patient cohort referred for colposcopy, and whether relevant taxonomic or diagnostic discrepancies occur when using vaginal rather than cervical swabs. The study cohort included cervical and vaginal samples collected from women referred for colposcopy at the University Hospital Bonn between November 2021 and February 2022, due to an abnormal PAP smear or positive hrHPV results. 16S rRNA gene sequencing libraries were prepared targeting the V1–V2 and V4 regions of the 16S RNA gene and sequenced on the Illumina MiSeq. PCR diagnostics for common STI-causing pathogens were conducted using the Allplex STI Essential Assay Kit (Seegene, Seoul, Republic of Korea). Concerning the bacterial microbiome, no significant differences were found between vaginal and cervical samples in terms of prevalence of taxa present or diversity. A total of 95 patients and 171 samples tested positive for at least one among Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Chlamydophila trachomatis or Neisseria gonorrhoeae. Sequencing the V1–V2 region enabled detection of one-third to half of the PCR-positive samples, with the detection likelihood increasing at lower cycle threshold (Ct) values. In contrast, sequencing the V4 region was less effective overall, yielding fewer species-level identifications and a higher proportion of undetermined taxa. We demonstrate that the vaginal microbiome closely mirrors the cervical microbiome, a relationship that has not been explored previously, but which broadens the possibilities for microbiome analysis and pathogen detection and establishes vaginal swabs as a reliable method for detecting the investigated pathogens, with sensitivities comparable with or superior to endocervical swabs. On the other hand, the sensitivity of partial 16S amplicon sequencing appears insufficient for effective STI diagnostics, as it fails to reliably identify or even detect pathogens at higher Ct values.

Purpose: Uterine fibroids pose clinical challenges due to varied symptoms and impact on fertility. Aim of this research is to compare open and laparoscopic myomectomy, with focus on evaluating their effects on patients' quality of life and analyzing their implications for pregnancy outcomes. Methods: This retrospective study compares open and laparoscopic myomectomy outcomes in 168 patients treated October 2017 and July 2023. Preoperative characteristics and postoperative outcomes in terms of symptoms and pregnancy outcomes were examined. Results: The patient cohort comprised patients with a high symptom burden. Only 51.2% expressing a desire for future pregnancies, highlighting diverse motivations for uterus-preservation. No significant differences were observed in preoperative symptoms. Larger and multiple myomas were associated with a higher likelihood of laparotomy. Recurrence rates were lower after laparoscopy (10.2% vs. 23.8%, p = 0.02). Cesarean section recommendations were more frequent post-laparotomy group (36.6% vs. 86.6%, p = 0.000). Morbidities and satisfaction showed no significant differences between approaches, with slightly better bleeding improvement after laparotomy. Despite similar pregnancy outcomes, a high proportion of patients did not conceive postoperatively (75.4%). Among patients who became pregnant postoperatively (n = 31), most patients conceived after one year or more, with no dependence on the surgical approach (p = 0.227). Conclusion: Both open and laparoscopic myomectomy surgeries showed high patient satisfaction, symptom alleviation, and comparable pregnancy results. A preference emerged for laparoscopy in terms of cesarean section recommendations and recurrence risk. Laparoscopic procedures tended to offer higher operative satisfaction and fewer complications. The study emphasized the complexity of therapeutic decision-making.

The assessment of ovarian perfusion after detorsion is crucial in the surgical management of patients with ovarian torsion. In current routine clinical practice, the surgical decision (preservation of the ovary versus oophorectomy) is based on the subjective impression of the surgeon. Intraoperative indocyanine green (ICG) angiography has been shown to sufficiently reflect tissue perfusion with a potential impact on the surgical procedure. Currently, there are only sparse data available on the utilization of ICG in the surgical treatment of ovarian torsion. Here, we describe the successful intraoperative use of ICG in a 17-year-old female patient with ovarian torsion who underwent ovary-preserving surgery. Further, a systematic literature review was performed. Based on the data available to date, the use of ICG in the surgical treatment of ovarian torsion is feasible and safe. The extent to which this might reduce the necessity for oophorectomy has to be evaluated in further investigations.

Background: The Cancer Genome Atlas (TCGA) network (United States National Cancer Institute) identified four molecular endometrial cancer (EC) subtypes using an extensive multi-method approach. The aim of this study was to determine the four TCGA EC molecular subtypes using a single-method whole-exome sequencing (WES)-based approach provided by MH Guide (Molecular Health, Heidelberg, Germany). Methods: WES and clinical data of n = 232 EC patients were obtained from TCGA. The four TCGA EC molecular subtypes designated as (i) Mutated Polymerase ε (POLE), (ii) Microsatellite Instability (MSI), (iii) Copy Number (CN) low and, (iv) CN-high were determined using the MH Guide software. The prognostic value of the subtypes determined by MH Guide were compared with the TCGA classification. Results: Analysis of WES data using the MH Guide software led to the precise identification of the four EC molecular subtypes analogous to the TCGA classification. Both approaches displayed high concordance in terms of prognostic significance. Conclusions: The multi-method-based TCGA EC molecular subtypes can reliably be reproduced by the single-method-based MH Guide approach. The easy-to-implement single-method MH Guide approach represents a promising diagnostic tool.