Introduction: Due to its low recurrence rate and the advantages of minimally invasive surgery, laparoscopic sacrocolpopexy has become one of the most commonly performed procedures for the treatment of apical uterovaginal prolapse. Several variations of the surgical technique exist, with the choice often reflecting the surgeon’s individual experience. However, the benefits of standardized surgical steps are indisputable in ensuring proper adaptation and safe execution of the procedure. Objective:This study aims to present the main surgical steps of laparoscopic sacrocolpopexy as applied in our clinical practice, based on the available literature and current evidence, and to analyze our clinical data. Method: Following the relevant literature, international guidelines, and our experience, the procedure was standardized into the following steps: (1) exposure of the surgical field, (2) dissection of the promontory, (3) pararectal dissection, (4) rectovaginal dissection, (5) vesicovaginal dissection, (6) supracervical hysterectomy (when indicated and the uterine corpus is present, and removal of the cervix is not justified), (7) mesh fixation to the vagina, (8) mesh fixation to the promontory, (9) peritoneal closure, (10) removal of the uterine corpus from the abdominal cavity. Results: We analyzed data from 30 laparoscopic sacrocolpopexy procedures performed at the Department of Obstetrics and Gynecology, University of Debrecen, between September 2022 and April 2023. No major intraoperative or postoperative complications occurred; deviation from the planned surgical type was required in three cases. After 6 weeks, the majority of patients reported a marked improvement in subjective prolapse symptoms. Two cases of symptomatic recurrence were identified: one managed conservatively, and one required surgical correction. No cases of de novo stress urinary incontinence were observed. Conclusion: Laparoscopic sacrocolpopexy may represent an effective surgical option for the treatment of apical uterovaginal prolapse. The application of standardized surgical steps may improve procedural safety, facilitate surgical training, and contribute to reduced operative time. Orv Hetil. 2025; 166(31): 1217–1223.

Bevezetés: Alacsony recidívaarányának és a minimálinvazív sebészet előnyeinek köszönhetően a laparoszkópos sacrocolpopexia mára az egyik leggyakrabban alkalmazott beavatkozássá vált az apicalis uterovaginalis prolapsus kezelésében. A műtét számos módozata ismert, amelyek megválasztása általában az operatőr egyéni tapasztalatát tükrözi. A beavatkozás megfelelő adaptálásához és biztonságos kivitelezéséhez a standardizált műtéti lépések előnyei vitathatatlanok. Célkitűzés: A közlemény célja, hogy bemutassuk a laparoszkópos sacrocolpopexiának az irodalomban fellelhető evidenciák alapján általunk is alkalmazott fő lépéseit, valamint elemezzük a műtéttel kapcsolatos klinikai adatokat. Módszer: A vonatkozó szakirodalomnak és a nemzetközi irányelveknek, valamint saját tapasztalatainknak megfelelően a műtétet a következő standardizált lépésekből állítottuk össze: 1. a műtéti terület feltárása, 2. a promontorium dissectiója, 3. pararectalis dissectio, 4. rectovaginalis dissectio, 5. vesicovaginalis dissectio, 6. supracervicalis hysterectomia (amennyiben indikáció vagy igény fennáll, a méhtest jelen van, és a cervix eltávolítása nem indokolt), 7. a háló rögzítése a hüvelyhez, 8. a háló rögzítése a promontoriumhoz, 9. peritonizálás, 10. a méhtest eltávolítása a hasüregből. Eredmények: A Debreceni Egyetem Klinikai Központjának Szülészeti és Nőgyógyászati Klinikáján 2022 szeptembere és 2023 áprilisa között végzett 30 laparoszkópos sacrocolpopexia adatait gyűjtöttük össze. Major intraoperatív és posztoperatív komplikáció nem történt, a tervezett műtéti típustól három esetben volt szükséges eltérni. A műtétet követő 6. heti kontroll során a betegek többségénél a szubjektív prolapsustünetek jelentős javulást mutattak. Két esetben panaszokat okozó recidíva fordult elő, amelyek közül az egyik konzervatív kezelést, a másik műtéti korrekciót igényelt. De novo stresszincontinentia nem jelentkezett. Következtetés: A laparoszkópos sacrocolpopexia az apicalis uterovaginalis prolapsus hatékony műtéti megoldása lehet. A standardizált lépések követése a műtét elvégzését biztonságosabbá, könnyebben elsajátíthatóvá teheti, valamint alkalmazásával a műtéti idő is csökkenthető. Orv Hetil. 2025; 166(31): 1217–1223.

Objective: Our study aimed to improve the understanding of the biomechanical changes occurring in the pelvic floor due to pelvic floor muscle training (PFMT), which is responsible for improving stress urinary incontinence (SUI) symptoms. Study design: In this prospective cohort study, we examined the impact of a six-week PFMT program in women with stress or stress-predominant urinary incontinence on the biomechanical parameters of the pelvic floor. Fifty-two biomechanical parameters were measured by Vaginal Tactile Imager (VTI) at baseline and at a six-week follow-up. In addition, we have assessed the Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Patient's Global Impression of Severity (PGI-S) scores at enrolment and at six-week follow-up. We have divided our cohort into two groups, Improved Group (IG) and Not-improved Group (NIG), based on the change in UDI-6 score after six weeks and compared the biomechanical changes within and between the two groups. Results: The overall cohort included twenty women with stress or stress-predominant SUI based on MESA questionnaire [MESA SUI index (mean +/- SD) 63.3 % +/- 24.0 %, MESA UUI index (mean +/- SD) 13.3 % +/- 15.3 %, p < 0.01]. Nine of the 52 VTI parameters have changed significantly after six weeks of PFMT in the entire cohort. Eleven women (IG) achieved the minimum 11-point change in the UDI-6 scaled score. In IG, we found that three VTI parameters differed significantly: Parameter 1: the maximum value of force measured during the VTI probe insertion [(N, mean +/- SD) 0.55 +/- 0.18 vs. 0.78 +/- 0.31, p < 0.049], parameter 18: the maximum gradient at the upper third of the vagina (posterior) [(kPa/mm, mean +/- SD) 0.16 +/- 0.05 vs. 0.36 +/- 0.28, p < 0.048], and parameter 47: integral force change in the anterior compartment at reflex pelvic muscle contraction (cough) [(N, mean +/- SD) 1.61 +/- 0.85 vs. 1.97 +/- 0.71, p < 0.045]. Conclusion: Our study revealed a significant association between the improvement of strength in targeted muscle groups and a reduction in urinary incontinence symptoms. Identifying specific muscles changing PFMT provides valuable insights for specific interventions. Our findings may help to create personalized and targeted interventions to improve the quality of life of women affected by SUI.

Genitourinary syndrome of menopause (GSM) affects a significant percentage of postmenopausal women and manifests as vaginal dryness, irritation, and urinary discomfort, typically treated with vaginal estrogens. Hydrogels are preferred over creams due to their superior comfort and mucoadhesive properties. This study introduces a novel vaginal gel formulation containing hydroxyethyl cellulose (HEC) and estriol-hydroxypropyl-β-cyclodextrin complex (E3-HPBCD) for the treatment of GSM. The estriol (E3) release profile of the gel was evaluated using a Franz diffusion cell system, and its permeability was tested on reconstructed human vaginal epithelium. Biocompatibility was assessed using (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) (MTT), lactate dehydrogenase (LDH) assays, and real-time cell analysis (RTCA) on human skin keratinocyte (HaCaT) cells, which showed increased cell viability and no obvious cytotoxicity. The results indicated that efficient E3 release and satisfactory epithelial permeability with HPBCD provide the bioavailability of E3. These results suggest the potential of the gel as a biocompatible and effective alternative for the treatment of GSM. Further studies are required to assess the long-term safety and clinical efficacy.

Background Stress urinary incontinence (SUI) is a common condition that requires proper evaluation to select a personalized therapy. Vaginal Tactile Imaging (VTI) is a novel method to assess the biomechanical parameters of the pelvic floor. Methods Women with SUI were enrolled in this cross-sectional study. Participants completed the Medical, Epidemiologic, and Social Aspects of Aging (MESA) questionnaire and the Patient Global Impression of Severity Question (PGI-S) and underwent a VTI examination. Based on the MESA and PGI-S questionnaires, participants were divided into mild, moderate, and severe SUI groups. Fifty-two biomechanical parameters of the pelvic floor were measured by VTI and compared between the groups (mild vs. moderate and severe). SUI Score and Index were calculated from the MESA questionnaire. Pearson correlation was used to determine the strength of association between selected VTI parameters and the MESA SUI Index and MESA SUI Score. Results Thirty-one women were enrolled into the study. Significant differences were observed in the VTI parameters 16, 22–24, 38, 39 when the difference between mild and severe subgroups of SUI based on the PGI-S score was examined. Parameter 16 refers to the maximum gradient at the perineal body, parameter 22–24 refers to the pressure response of the tissues behind the vaginal walls, and parameter 38, 39 refers the maximum pressure change and value on the right side at voluntary muscle contraction. VTI parameter 49, describing the displacement of the maximum pressure peak in the anterior compartment, showed a significant difference between the mild SUI and the moderate-severe SUI according to the MESA SUI score (mean ± SD 14.06 ± 5.16 vs. 7.54 ± 7.46, P = 0.04). The MESA SUI Index and SUI Score displayed a positive correlation concerning VTI parameters 4 (the maximum value of the posterior gradient) and 27 (the displacement of the maximum pressure peak in the anterior compartment) (VTI4 vs. MESA SUI Index r = 0.373, P = 0.039; VTI4 vs. MESA SUI Score r = 0.376, P = 0.037; VTI27 vs. MESA SUI Index r = 0.366, P = 0.043; VTI27 vs. MESA SUI Score r = 0.363, P = 0.044). Conclusions Female pelvic floor biomechanical parameters, as measured by VTI, correlate significantly with the severity of SUI and may help guide therapeutic decisions.

Background The basic principle of vaginal laser therapy is the rejuvenation of the affected tissue. Zinc and copper are essential nutritional trace elements and have a key role in connective tissue homeostasis. We aimed to investigate the effect of vaginal, fractional CO 2 laser treatment on cervicovaginal lavage (CVL) zinc and copper levels. Methods Twenty-nine postmenopausal women with symptoms of vaginal dryness were enrolled in our prospective cohort study. Three treatments with MonaLisa Touch CO 2 laser system were performed four weeks apart. At each treatment CVL was collected, Vaginal Health Index (VHI) was obtained, and Visual Analog Scale (VAS) for vaginal dryness was assigned by patients. Zinc and copper concentrations were measured with optical emission spectrometry before each treatment and six weeks after the 3rd treatment. Results The VHI scores significantly improved after each laser treatment (mean ± SD VHI score, 13.03 ± 4.49 before vs. 15.55 ± 4.35 after the 1st, 17.79 ± 4.57 after the 2nd and 19.38 ± 4.39 after the 3rd treatment, P < 0.01). Similarly, VAS scores reflected improvement (mean ± SD VAS score 6.59 ± 2.86 before vs. 4.17 ± 2.86 after the 1st, 2.45 ± 2.43 after the 2nd and 1.41 ± 1.94 after the 3rd treatment, P < 0.01). CVL zinc levels were significantly higher compared to copper levels (0.06 ± 0.04 vs. 0.006 ± 0.006 mg/L, P < 0.01) at baseline. While copper levels remained the same through treatments, the CVL zinc level was significantly higher after the second laser treatment compared to the baseline. Conclusions Fractional CO 2 laser treatment of the vagina impacts CVL zinc and copper levels differently. While CVL copper levels were not different after each laser treatment, zinc levels were significantly higher after the second treatment before returning to baseline values.

OBJECTIVES:To investigate the effect of oral zinc supplementation on cervicovaginal lavage fluid (CVL) zinc level in pre and postmenopausal women. STUDY DESIGN:A prospective interventional cohort study was carried out by the enrollment of twelve premenopausal and ten postmenopausal women without significant gynecological conditions. Women received daily oral supplementation with 30 mg of zinc for two weeks. Clinical and demographic variables were stored in a dedicated database. Vaginal Health Index was calculated, and vaginal cytology was obtained. CVL and serum samples were collected in a standardized fashion before and after completion of the oral supplementation. Zinc and copper levels were measured by inductively coupled plasma optical emission spectrometry. Paired t-test was used to compare the before and after treatment results. RESULTS:Serum zinc levels increased significantly both in the pre and postmenopausal women (0.88 ± 0.17 vs. 1.06 ± 0.23, p < 0.01 and 0.83 ± 0.24 vs. 0.96 ± 0.33, p < 0.01) after two weeks of daily oral zinc supplementation. CVL zinc level was significantly higher in the premenopausal group compared to the postmenopausal group before and after supplementation (0.13 ± 0.05 vs. 0.06 ± 0.04, p < 0.01 and 0.10 ± 0.03 vs. 0.05 ± 0.01, p < 0.01). Zinc supplementation had no significant impact on the CVL zinc level in either group. Neither serum nor CVL copper levels were affected by the zinc supplementation. There was no significant correlation between serum and CVL zinc or copper levels. CONCLUSION:Daily oral supplementation with 30 mg of zinc had no significant impact on CVL zinc level despite a significant rise in serum zinc level.

OBJECTIVES:This study aimed to investigate the correlation between cervicovaginal fluid zinc levels and participants' menopausal status and the presence of vulvovaginal symptoms of genitourinary syndrome of menopause.METHODS:Women included in the study underwent a pelvic examination, collection of vaginal cytology, and cervicovaginal lavage was performed in a standardized fashion. The cervicovaginal lavage zinc content was determined. The vaginal health index was calculated, and the visual analog scale was obtained based on the participant's burning, itching, vaginal pain, dyspareunia, dryness, and dysuria.RESULTS:One hundred twenty women participated in the study. Eighty-two participants were menopausal. The mean vaginal health index was 15 ± 6, while the total visual analog scale score was 14 ± 14. We found significant differences between cervicovaginal lavage zinc level and age group, menopausal status, presence of vaginal dryness, and vaginal atrophy. We also found a moderate positive correlation between Vaginal Maturation Value and cervicovaginal lavage zinc levels (r = 0.495, P value < 0.01) in the correlation analysis. However, in the multivariate regression model, including all significant factors, only vaginal atrophy remained significant.CONCLUSIONS:We found a significant association between vaginal atrophy (vaginal maturation value < 50) and cervicovaginal lavage zinc levels. Zinc levels of cervicovaginal lavage could be used as a new marker of vaginal atrophy. : Video Summary:http://links.lww.com/MENO/A575.

Objective: Our laboratory previously published that long-term administration of estradiol (E-2) was detrimental to the kidneys of midlife ovariectomized Long Evans rats, contrasting clinical studies in showing that menopausal hormone therapy is associated with decreased albuminuria. However, it is unknown whether this renal benefit was due to estrogen and/or the combination with progestogen. Therefore, the objective of the current study was to determine the impact of medroxyprogesterone (MPA) on E-2-mediated renal damage using a rodent model. Methods: Female Long Evans retired breeders underwent ovariectomy at 11 months of age and were treated for 40 days with subcutaneous E-2, E-2+MPA or vehicle at doses mimicking that of menopausal hormone therapy (N = 5-7 per group). Systolic blood pressure was measured along with indices of renal damage and function to investigate the impact of MPA on E-2-mediated renal outcomes. Renal estrogen receptor alpha and G protein-coupled estrogen receptor transcript copy numbers were measured in all treatment groups through droplet digital PCR. Results: Middle-aged female Long Evans rats displayed spontaneous hypertension with similar systolic blood pressures and heart weights between groups. Even though blood pressure was comparable, E-2 reduced glomerular filtration rate and increased proteinuria indicating pressure-independent renal damage. Coadministration with MPA prevented E-2-induced glomerular filtration rate impairment and proteinuria by promoting renal hypertrophy and preventing renal interstitial fibrosis. Both E-2 and E-2+MPA reduced renal estrogen receptor alpha (ER alpha) and increased renal G protein-coupled estrogen receptor mRNA, but neither ER alpha nor ERss protein was different between groups. Conclusion: MPA was protective against E-2-induced renal damage and dysfunction in middle-aged female Long Evans rats. Assessing the impact of hormone therapy on renal outcomes may be an important clinical factor when considering treatment options for postmenopausal women.

Background and Objectives Most recently vaginal laser treatment was introduced as a new option for women with genitourinary syndrome of menopause, vaginal dryness. Our objective was to assess the effects of intravaginal CO2 laser treatment on vaginal cytology. Study Design/Materials and Methods Fifty-two women with symptoms of vaginal dryness were enrolled and underwent vaginal laser treatment using a fractional CO2 laser. Patients received three vaginal laser treatments 4 weeks apart. Vaginal cytology was obtained before the first treatment and 4 weeks after each additional treatment. Vaginal dryness was assessed by using a Visual Analog Scale (VAS). Results Out of the 52 women enrolled, 34 were in menopause. Postmenopausal women had significantly lower vaginal maturation values (VMV) compared with premenopausal women at the baseline visit (mean +/- standard deviation [SD], 42 +/- 23 vs. 68 +/- 13, P < 0.01). The vaginal dryness VAS was higher (worse) in postmenopausal women compared with premenopausal cases (mean +/- SD, 5.7 +/- 4 vs. 2.4 +/- 3, P < 0.01). The VMV did not change significantly over time after vaginal laser treatment. However vaginal dryness VAS improved significantly after each treatment. Both in the premenopausal and postmenopausal groups, vaginal dryness scores improved significantly from baseline after the three treatments (postmenopausal 5.7 +/- 4 vs. 1.6 +/- 2.5, P < 0.01 and premenopausal 2.4 +/- 3 vs. 0.2 +/- 0.5, P < 0.01). Those patients who had improvement in VMV had significantly better (lower) dryness VAS compared with those women without an improvement in VMV after the three treatments (mean +/- SD, 0.3 +/- 0.8 vs. 1.6 +/- 2.6, P = 0.04). Conclusions Vaginal dryness VAS improved significantly in a cohort of premenopausal and postmenopausal women undergoing vaginal CO2 laser treatment despite no significant change in vaginal cytology. Lasers Surg. Med. (c) 2020 Wiley Periodicals, Inc.

Background and Objectives To assess the improvement on pelvic floor distress (PFD)-related urogenital symptoms using validated questionnaires after intravaginal CO2 laser treatment. Study Design/Materials and Methods Forty postmenopausal women with genitourinary symptoms of menopause (GSM) were enrolled into this prospective cohort study and underwent vaginal laser treatment using MonaLisa Touch (R) fractional CO (2) laser system. Patients received three vaginal laser treatments with 360 degrees probe 4 weeks apart. A three-component Pelvic Floor Distress Inventory (PFDI-20) validated questionnaire was filled out by each patient before each session and 4 weeks after the final treatment. Wilcoxon rank sum test was used to compare the before and after treatment scores. Results Pelvic Organ Prolapse Distress Inventory (POPDI-6) scores were not significantly different after the first treatment compared with baseline (mean +/- standard deviation [SD], 21 +/- 18 vs. 17 +/- 15, P = 0.44). However, each subsequent treatment resulted in further, statistically significant improvement in symptom scores (14 +/- 15, P = 0.03 and 13 +/- 13, P = 0.01, after the second and third treatments, respectively). Similarly, Urinary Distress Inventory (UDI-6) scores were not significantly different after the first laser treatment (mean +/- SD, 36 +/- 25 vs. 29 +/- 23, P = 0.36). After the second and third treatments there were significant improvement in the standardized scores (24 +/- 20, P = 0.03 and 22 +/- 21, P = 0.01). Colorectal-Anal Distress Inventory (CRADI-8) scores did not change significantly after three laser treatments. Conclusions Three sessions of microablative fractional CO2 vaginal laser treatment significantly improves patient reported urinary and pelvic organ prolapse symptoms. Lasers Surg. Med. (c) 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Attila Gergely Sipos, MD, 1* Bence Kozma, MD, Robert Poka, MD, Kindra Larson, MD, and Peter Takacs, MD Department of Obstetrics and Gynecology, University of Debrecen Faculty of Medicine, 98 Nagyerdei krt, 4032, Debrecen, Hungary Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 526, Norfolk, Virginia, 23507‐2007

Introduction: We report about organization and management Simulated Mars Rover Competition www.magyarokamarson.hu [1] (Hungarians on Mars). This is a competition of applied engineering sciences. We report also about collected experience and results at place of tournament Kiskunhalas, II. Rákóczi Fer-enc High School, Hungary. Organizers of the competition are independent persons and organizations work together with High School and enthusiast sponsors. Founder of the competition is Mr. SIPOS, Attila electrical engineer. Discussion: Ideas: We do not get the knowledge together with life. To start young people to get more experience is one of the most important things nowadays. Mission: The actual goal of the competition can be achieved by building a device, a rover. The track is an 8x8 square meter sized field of sand or special material. 2006.: Competitors have to build a rover which starts from either corner of the field to reach the target crater at the opposite other corner and to collect debris or soil of the crater.

The PET technique is widely used in human clinical studies and recent developments of image resolution has made it suitable for small animal research. The second generation of our PET scanner consists of 12 detector modules and has a field of view large enough to image mice and rats. Parameters of the incoming data are extracted by Digital Signal Processing in the detector modules and a System-on-Module is used to transmit the data through an Ethernet network for storage and reconstruction.The experimental scanner setup described in this paper was constructed in order to investigate the applicability of the developed detector modules in a full ring small animal PET camera. The preliminary results of the system are also presented.

We report on a distributed online coincidence detection implementation that we have recently added to the miniPET-II small animal PET scanner. The implementation uses standard Ethernet and IP multicasting techniques, therefore no architectural changes were necessary to the existing system. For 2D reconstruction the implementation scales with the number of detectors in the system, so it can be used for larger ring configurations, too. The online coincidence detection makes the system suitable for real time imaging applications.