The study aimed to validate the Betella algorithm, focusing on molecular analyses exclusively for endometrial cancer patients, where molecular classification alters risk assessment based on ESGO/ESTRO/ESP 2020 guidelines. Conducted between March 2021 and March 2023, the retrospective research involved endometrial cancer patients undergoing surgery and comprehensive molecular analyses. These included p53 and mismatch repair proteins immunohistochemistry, as well as DNA sequencing for POLE exonuclease domain. We applied the Betella algorithm to our population and evaluated the proportion of patients in which the molecular analysis changed the risk class attribution. Out of 102 patients, 97 % obtained complete molecular analyses. The cohort exhibited varying molecular classifications: 10.1 % as POLE ultra-mutated, 30.3 % as mismatch repair deficient, 11.1 % as p53 abnormal, and 48.5 % as non-specified molecular classification. Multiple classifiers were present in 3 % of cases. Integrating molecular classification into risk group calculation led to risk group migration in 11.1 % of patients: 7 moved to lower risk classes due to POLE mutations, while 4 shifted to higher risk due to p53 alterations. Applying the Betella algorithm, we can spare the POLE sequencing in 65 cases (65.7 %) and p53 immunochemistry in 17 cases (17.2 %). In conclusion, we externally validated the Betella algorithm in our population. The application of this new proposed algorithm enables assignment of the proper risk class and, consequently, the appropriate indication for adjuvant treatment, allowing for the rationalization of the resources that can be allocated otherwise, not only for the benefit of settings with low resources, but of all settings in general.

Iatrogenic urinary tract injury is a known complication of pelvic surgery, most commonly occurring during gynecological procedures. The bladder and ureters are particularly vulnerable due to their close anatomical proximity to the uterus. Urinary tract damage can result from various mechanisms, including laceration, ligation, and thermal injury. Incidence rates vary according to the affected organ and surgical type; bladder injuries occur in 0.24% of benign and 0.4–3.7% of oncologic surgeries, whereas ureteral injuries are reported in 0.08% of benign and 0.39–1.1% of oncologic procedures. Timely diagnosis is essential for effective management. When detected intraoperatively, the injury can often be repaired immediately. Surgical treatment options vary depending on the specific nature and location of the bladder or ureteral damage. Delayed diagnosis can significantly impact the patient’s quality of life, increasing the risk of severe complications such as genitourinary fistulas. This narrative review aims to summarize current evidence on the diagnosis, prevention, and treatment of urinary tract injuries occurring during gynecological surgery. It evaluates risk factors, incidence, management, complications, and prevention strategies for iatrogenic bladder and ureteral injuries. Additionally, it highlights the innovative role of artificial intelligence in preventing urologic damage during gynecological procedures. The relevant literature was identified through a structured search of the PubMed database using predefined keywords related to gynecological surgery and urinary tract injury.

Background: The tumor microenvironment offers a new perspective in gynecologic oncology. In ovarian cancer, numerous preclinical studies, especially organoid models, have highlighted cellular, immune, and biochemical mechanisms. Beyond these sophisticated findings, more practical aspects require attention, such as the role of vaginal microbiota, which represents an interplay between external agents and internal genitalia, and its potential profiling role in early detection beyond the promise of microbiota-targeted therapies. Objectives: This review aims to assess whether such a correlation is speculative or scientifically grounded. Methods: A focused literature search was conducted on vaginal microbiota and its correlation with ovarian cancer to define the current state of knowledge. Results: Mixed outcomes have been reported, yet there is a rational and scientific basis supporting further investigation. Clinical approaches increasingly consider vaginal microbiota as relevant. However, we have to say that most available evidence is still preliminary and largely preclinical to set realistic expectations for readers. Although additional studies are needed, emerging insights highlight its importance and practical implications. We present a diagnostic–therapeutic management flowchart summarizing current evidence). Discussion: Most links between the vaginal microbiota and ovarian cancer are correlational rather than causal. The idea that microbes ascend from the vagina to the ovaries is proposed but still definitely not demonstrated. Confounding factors like age, hormones, and BRCA status complicate interpretation, and ovarian cancer itself could secondarily alter the microbiota. Mechanistic studies and longitudinal data are still needed to clarify whether dysbiosis contributes to carcinogenesis or is merely a consequence. As gynecologists, we summarize key aspects and emphasize to colleagues the importance of incorporating these findings into daily clinical practice. Vaginal dysbiosis should be considered not only a local imbalance but also a potential strategy for primary cancer prevention. Conclusions: Future research on the tumor microenvironment and vaginal microbiota will expand scientific knowledge and guide innovative preventive and therapeutic strategies.

Ovarian cancer (OC) remains the most lethal gynecologic malignancy worldwide, largely due to late-stage diagnosis and the absence of effective screening strategies. As a result, primary prevention is a critical approach to reducing disease burden. This narrative review summarizes current evidence on modifiable lifestyle, reproductive, and environmental factors associated with OC risk, based on a comprehensive PubMed, MEDLINE, Scopus, and Web of Science search conducted through April 2026. Consistent protective associations have been reported for reproductive factors, including parity, breastfeeding, oral contraceptive use, salpingectomy, and tubal ligation. Among lifestyle factors, excess body weight is modestly associated with increased OC risk, while evidence regarding physical activity remains inconclusive. Diets rich in fiber and aligned with a Mediterranean pattern appear protective, potentially through hormonal modulation and anti-inflammatory effects. In contrast, pro-inflammatory diets high in trans fats and refined carbohydrates may increase risk, whereas omega-3 fatty acids show potential protective benefits. Chronic pelvic inflammation, particularly related to Chlamydia trachomatis infection, has been linked to elevated epithelial OC risk. Smoking demonstrates a dose–response association with mucinous tumors. Environmental exposures, including genital talc use and endocrine-disrupting chemicals such as phthalates and bisphenols, have linked to a possible, albeit modest, increase in risk, although the causal mechanisms remain uncertain. Although individual associations are generally modest, their cumulative population impact may be substantial. Integrating lifestyle-based prevention strategies into gynecologic practice and public health initiatives could represent a cost-effective approach to reducing OC incidence and improving women’s health outcomes.