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001-es BibID:	BIBFORM084850
Első szerző:	Kozma Bence (szülész-nőgyógyász)
Cím:	Association between pelvic organ prolapse types and levator-urethra gap as measured by 3D transperineal ultrasound / Kozma Bence, Larson Kindra, Scott Lauren, Cunningham Tina, Abuhamad Alfred, Póka Róbert, Takacs Péter
Dátum:	2018
ISSN:	0937-3462
Megjegyzések:	Introduction: Pelvic organ prolapse (POP) is a common condition affecting many women. During delivery, the components of the levator ani muscle undergo significant distention and stretching leading to muscle damage 10-25% of the time. Injury to the pelvic floor muscles can result in floor dysfunction like POP or stress urinary incontinence. Levator ani defects can be diagnosed clinically by vaginal palpation or using transperineal ultrasound. Previously the standard sonographic diagnosis of levator avulsion required observation of an abnormal insertion of the muscle on tomographic ultrasound imaging (TUI). But most recently the measurement of the levator?urethra gap (LUG) has been described as a quantitative tool in this regard. LUG is the distance between the center of the urethral lumen and insertion of the levator on the inferior pubic ramus, determined bilaterally, in axial slices on transperineal 3D ultrasound. The measurement of LUG is reproducible and an abnormal LUG (?25mm) has been strongly associated with avulsion diagnosed by vaginal palpation. Objectives: To evaluate the association between POP types and LUG as measured by 3D transperineal tomographic ultrasound (TPUS). Methods: A retrospective study was carried out on ninety-eight women with symptomatic POP. 3D TPUS images and Pelvic Organ Prolapse Quantification coordinates were reviewed. Each vaginal compartment was staged for the degree of prolapse, and total number of involved compartments identified. LUG was measured on 3D tomographic ultrasound images as the distance between the center of the urethra and the levator insertion bilaterally. Based upon prior studies, an abnormal LUG?25mm indicated levator avulsion. LUG and presence or absence of unilateral/bilateral avulsions was analyzed with reference to the clinical diagnosis of prolapse [single vs. multi compartment, and mild (stage II) vs. severe (stage III-IV)]. Generalized logit models were used to evaluate the association between avulsion and prolapse type and stage. Results: The LUG was significantly larger in women with multi compartment compared to single compartment POP (28.9?4.1mm vs. 22.7 ?4.1mm, P<0.01). Similarly, LUG was significantly larger in women with severe (stage III-IV) compared to mild POP (stage II) (28.8 ?4.7mm vs. 23.3?4.5mm, P<0.01). Women with severe prolapse were 32 times more likely than women with mild prolapse to have bilateral levator avulsion. Those with POP involving all three vaginal compartments were 76 times more likely than single compartment POP to have bilateral levator avulsions. Conclusions: Bilateral levator ani avulsion as diagnosed by LUG measurements of ?25mm at rest is associated with multi compartment, sever prolapse.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idézhető absztrakt folyóiratcikk
Megjelenés:	International Urogynecology Journal. - 29 : S1 (2018), p. 174. -
További szerzők:	Larson, Kindra Scott, Lauren Cunningham, Tina D. Abuhamad, Alfred Póka Róbert (1960-) (szülész-nőgyógyász, klinikai onkológus) Takács Péter (1968-) (szülész-nőgyógyász)
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001-es BibID:	BIBFORM084851
Első szerző:	Kozma Bence (szülész-nőgyógyász)
Cím:	Fractional CO2 laser treatment significantly increases vaginal fluid zinc and copper level / Kozma Bence, Takács Péter, Póka Róbert
Dátum:	2018
ISSN:	0937-3462
Megjegyzések:	Introduction: Fractional CO2 laser treatment became a popular treatment option for postmenopausal vaginal atrophy. The laser therapy creates microinjuries of the vagina and subsequent remodeling leads to the reorganization of the extracellular matrix of the vagina. Zinc and copper are essential trace elements and both play a vital role in tissue remodeling. Both zinc and copper functions as a cofactor for many enzymes participating in the composition of the extracellular matrix. Objectives: To evaluate the effect of the Mona Lisa Touch CO2 laser treatment on postmenopausal women vaginal fluid trace element content: zinc and copper. Both zinc and copper play a pivotal role as a cofactor for several enzymes responsible for tissue remodeling. Our hypothesis was that increased tissue remodeling secondary to vaginal laser treatment will result in altered vaginal fluid zinc and copper content. Materials and Methods: Twenty-seven postmenopausal women with genitourinary symptoms of menopause were enrolled and underwent vaginal laser treatment. Mona Lisa Touch is a functional vaginal rejuvenation treatment based on a special fractional CO2 laser, specifically created for the vaginal mucosa. Patients received three vaginal laser treatments with the 360 degree probe 4-6 weeks apart. Vaginal fluid was collected in a standardized fashion. Extreme care was exercised to avoid any possible contamination. Only single use plastic speculums free of trace elements were used. Atomic absorption spectroscopy was used to determine the vaginal fluid zinc and copper content. Paired t-test was used to compare the before and after treatment results. Results: All patients were in menopause. The average age was 58 ? 9 years. The mean zinc level was 0.08 ? 0.08 mg/L before the initiation of the first treatment. After the first treatment the vaginal zinc level did not change significantly (0.08 ? 0.05 mg/L) But after the second laser treatment vaginal fluid zinc level was significantly higher 0.11 ? 0.07 mg/L (P< 0.01) and the third treatment increased vagina zinc levels even further to 0.16 ? 0.08 mg/L (P<0.01). The mean copper level was 0.008 ? 0.009 mg/L before the initiation of the first treatment. After the first and second treatment the vaginal copper level did not change significantly (0.010 ? 0.011 mg/L and 0.009 ? 0.008) But after the third laser treatment vaginal fluid copper level was significantly higher 0.016 ? 0.014 mg/L (P=0.04). Zinc content of the vaginal fluid was ten folds higher than copper levels. Conclusion: Microablative fractional CO2 vaginal laser treatment significantly increases vaginal fluid zinc content. Zinc and copper levels increased by two folds after the third laser treatment. Elevated zinc and copper levels in the vaginal fluid is most likely occurs secondary to the increased vaginal remodeling.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idézhető absztrakt folyóiratcikk
Megjelenés:	International Urogynecology Journal. - 29 : S1 (2018), p. 174-175. -
További szerzők:	Takács Péter (1968-) (szülész-nőgyógyász) Póka Róbert (1960-) (szülész-nőgyógyász, klinikai onkológus)
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001-es BibID:	BIBFORM084853
Első szerző:	Kozma Bence (szülész-nőgyógyász)
Cím:	The effects of fractional CO2 laser treatment on the symptoms of pelvic floor dysfunctions and vulvovaginal atrophy / Kozma Bence, Takács Péter, Sipos Attila Gergely, Póka Róbert
Dátum:	2018
ISSN:	0937-3462
Megjegyzések:	Introduction: Vaginal laser treatment became a popular treatment modality for genitourinary syndrome of menopause. However scientific data is limited regarding the effects of laser treatment on different pelvic floor dysfunctions. Objectives: To evaluate the effect of the Mona Lisa Touch CO2 laser treatment on postmenopausal women vulvovaginal and pelvic floor dysfunction symptoms. Methods: Forty-three postmenopausal women were enrolled and underwent vaginal laser treatment with. Mona Lisa Touch. Patients received three vaginal laser treatments with the 360 degree probe 4-6 weeks apart. Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), Colorectal?Anal Distress Inventory 8 (CRADI-8) and Urinary Distress Inventory 6 (UDI-6) validated questionnaires were filled out by each patient before each session and 4 weeks after the final treatment. Vaginal Health Index (Elasticity, Fluid Secretion, pH, Epithelial mucosa, Moisture) was calculated before each session and 4 weeks after the final treatment. In addition, patients were asked to fill out a Visual Analog Scale (1-10, lower scores indicates less bother) on vaginal pain, dryness, burning, itching, dyspareunia and dysuria. Paired ttest was used to compare the before and after treatment results. Results: All patients were in menopause. The average age was 57?10 years. POPD-6 standardized scores were not significantly different after the first treatment (20 ?19 vs. 14?11 after the first treatment). But after the second treatment there was a significant improvement in the standardized score to 11?12 ( P=0.02). After the third treatment the score was even lower 10?13 (P=0.01). CRADI-8 standardized scores did not change significantly after three laser treatment (16 ?18 vs. 13?17 after the 1st treatment/13?16 after the 2nd treatment/ 12?18 after the 3rd treatment). UDI-6 standardized scores were not significantly different after the first laser treatment (32?23 vs. 26?23 after the first treatment). But after the second treatment there was a significant improvement in the standardized score to 25 ? 20 ( P=0.03). The Vaginal Health Index was 15?5 before and 17?4 after the first treatment, 19?5 after the second and 21?4 after the third treatment. VHI was significantly improved after each treatment (P<0.01). The largest incremental change occurred in vaginal moisture, followed by vaginal fluid and elasticity. The patient reported combined Visual Analog Score (VAS) was 16?16 before and 9?12 after the first treatment, 6 ? 9 after the second and 3 ? 8 after the third treatment. VAS was significantly lower (P<0.01) after each laser treatment. The largest improvement occurred after the first laser treatment, but each additional treatment added additional symptoms relief. Conclusion: CO2 vaginal laser treatment significantly improves patient reported urinary and pelvic organ prolapse bother. The minimum of two laser treatments were needed to achieve a significant benefit. In addition, CO2 vaginal laser treatment significantly improves both the patient reported subjective symptoms and the Vaginal Health Index in postmenopausal women even after a single laser treatment.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idézhető absztrakt folyóiratcikk
Megjelenés:	International Urogynecology Journal. - 29 : S1 (2018), p. 174. -
További szerzők:	Takács Péter (1968-) (szülész-nőgyógyász) Sipos Attila Gergely (1990-) (szülész-nőgyógyász) Póka Róbert (1960-) (szülész-nőgyógyász, klinikai onkológus)
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001-es BibID:	BIBFORM084852
Első szerző:	Takács Péter (szülész-nőgyógyász)
Cím:	Novel zinc containing vaginal moisturizer gel (JUVIA) improves postmenopausal vulvovaginal symptoms / Takács Péter, Kozma Bence, Erdődi Balázs, Póka Róbert
Dátum:	2018
ISSN:	0937-3462
Megjegyzések:	Introduction: Many postmenopausal women suffer from vaginal dryness. Although vaginal estrogen is highly effective in alleviating this symptom, more and more women are reluctant to use hormonal treatment. Previous cell culture experiments revealed that zinc supplementation increases elastin and collagen synthesis. In addition, animal experiments revealed a beneficial effect of vaginal zinc treatment on the composition of the vagina in oophorectomized rats (1). Objectives: To evaluate the effect of a novel zinc containing vaginal moisturizer gel (JUVIA) on postmenopausal women vulvovaginal symptoms. Materials and Methods: Twenty postmenopausal women with genitourinary symptoms of menopause were enrolled. Patient were asked to use the JUVIA gel daily for 2 weeks. The novel gel was self-applied intra vaginally via a vaginal applicator. Two ml of gel was placed into the vagina nightly. Vaginal Health Index (Elasticity, Fluid Secretion, pH, Epithelial mucosa, Moisture) was calculated before and 1 week after the completion of treatment. Patients were asked to fill out a Visual Analog Scale (1-10, lower scores indicates less bother) on vaginal pain, dryness, burning, itching, dyspareunia and dysuria. Also validated questionnaire VSQ-21 was used to assess subjective symptoms of GSM before and one week after treatment. After completion of the treatment women were asked to complete an anonymous self-administered online 16 item questionnaire. Paired t-test was used to compare the before and after treatment results. Results: All patients were in menopause. The average age was 61?8 years. The Vaginal Health Index was 13?4 before and 19 ?4 after completion of treatment. VHI was significantly improved (P<0.01). The largest incremental change occurred in vaginal moisture out of the VHI. In sixty percent of women the vaginal pH remained normalized even a week after cessation of treatment. The patient reported VAS combined score was 17?17 before and 10?17 after treatment. VAS was significantly lower (P=0.04) after JUVIA treatment. VSQ-21 combined scores were 5?5 before and 2?4 after intervention. VSQ21 scores were significantly lower (P=0.01) indicative of symptom improvement. Seventy percent of sexually active women reported a significant improvement in the vulvar symptoms affecting sexual activity. Ninety percent of patients reported that during the treatment their vagina was well moisturized. Similarly 90% percent felt that the treatment was very comfortable. The moisturizing effect lasted for more than 1 week after cessation of treatment in 75% of women. Eighty-percent reported that the consistency of the product was adequate and 100% were satisfied with the smell of the gel. Seventy-five percent of participant felt more self-confident after using the gel and reported a significant improvement in the quality of sexual relationship. Overall ninety-percent of women were extremely satisfied or satisfied with the JUVIA treatment. Side effects were rare and minor. Conclusion: Novel zinc containing vaginal moisturizer gel (JUVIA) significantly improves postmenopausal vulvovaginal symptoms. Postmenopausal women were highly satisfied with the novel zinc containing vaginal moisturizer gel without serious side effects.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idézhető absztrakt folyóiratcikk
Megjelenés:	International Urogynecology Journal. - 29 : S1 (2018), p. 175. -
További szerzők:	Kozma Bence (1982-) (szülész-nőgyógyász) Erdődi Balázs (1984-) (szülész-nőgyógyász szakorvosjelölt) Póka Róbert (1960-) (szülész-nőgyógyász, klinikai onkológus)
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