Background: The second major cause of death is cancer. In fact, the effectiveness of anticancer treatments and positive long-term prognosis for young women has increased. However, the problem of post-cancer infertility plays a significant role, because chemotherapy can be gonadotoxic and lead to the functional death of ovaries. There is potential key solution to this problem: cryopreservation of ovarian tissue before cancer therapy with re-implantation after convalescence. Data regarding cryopreservation and re-transplantation of ovarian tissue from patients with ovarian insufficiency is limited. The aim of this treatment was the re-transplantation of cryopreserved ovarian tissue after anticancer therapy of patient with ovarian insufficiency (56 IU/l FSH, 8 ng/l β-estradiol, < 1.1 ng/ml anti-Mullerian hormone, 1 primary follicle per 10mm³). Case presentation: After the operation, four tissue fragments (10–16 × 8–13 × 1.0–1.2 mm) were cooled to 5 °C in the freezing medium (culture medium+ 6% ethylene glycol+ 6% dimethyl sulfoxide+ 0.15 M sucrose) for 24 h, frozen and thawed. Freezing was performed in four standard 5 ml cryo-vials with ice formation at − 9 °C, cooling from − 9 to − 34 °C at a rate of − 0.3 °C/min and plunging at − 34 °C into liquid nitrogen. After thawing in a 100 °C (boiling) water bath, the removal of cryoprotectants was performed in 0.5 M sucrose with 20 min. exposure in sucrose and 30 min. stepping rehydration. After thawing of one cryo-vial, part (5 mm³) of experimental ovarian tissue after 7 day in vitro culture was histological evaluated and two ovarian fragments (8 × 7 × 1.0 mm and 7 × 6 × 1.0 mm) were re-transplanted. The quantity of follicles after cryopreservation and in vitro culture was not increased (P > 0.1): it was found 1 primordial follicle in 5 mm³ of tissue. Thirty seven days after the re-transplantation of ovarian tissue, the restoration of the menstrual cycle of Patient W. was noted. Three months after the transplantation, the patient became spontaneously pregnant and delivered a healthy baby girl at term. Conclusions: Described protocol of conventional cryopreservation of ovarian tissue can be used for treatment of patients with ovarian insufficiency.

Introduction: Vulvar carcinoma is a rare malignancy with approximately 3090 cases annually in Germany. Squamous cell carcinoma of the vulva (SCC) can be HPV-associated or non-HPV-associated. Surgical excision is the primary treatment, but the optimal tumor-free resection margin remains debated. This study evaluates the impact of resection margin distance on disease prognosis in SCC patients. Methods: A retrospective analysis was conducted on patients diagnosed with SCC of the vulva at the University Hospital of Cologne between 2007 and 2022. Patients with TNM stage pT1a or higher who underwent primary surgical treatment with a tumor-free resection margin status were included. The cohort of 73 patients was divided into three groups based on resection margin distance: >0.01–<0.3 cm (Group 1), ≥0.3–<0.8 cm (Group 2), and ≥0.8 cm (Group 3). Statistical analyses including logrank tests were performed to assess correlations between resection margin distance and recurrence, disease-free survival (DFS), and overall survival (OS). Results: A total of 37.0% of patients were categorized into Group 1, 48.0% into Group 2, and 15.1% into Group 3. Disease recurrence occurred in 26% of patients, with rates of 31.6% in Group 1 (minimum resection margin distance), 42.1% in Group 2, and 26.3% in Group 3. The prevalence of recurrence was not dependent on resection margin distance (p = 0.28). Similarly, the prevalence of deaths was not dependent on resection margin distance (p = 0.43). Disease-free survival (DFS) and overall survival (OS) did not show significant differences between the groups (p = 0.25 and p = 0.87, respectively). Conclusions: This study found no significant impact of pathological tumor-free resection margin distance on DFS or OS in patients with SCC of the vulva. Given the heterogeneity in international guidelines and existing literature, further studies with larger patient cohorts are needed to establish definitive surgical recommendations.

Background: Uterine rupture is a rare but severe obstetric complication with significant maternal and neonatal consequences. While partial uterine ruptures (PURs) are generally associated with less severe outcomes, complete uterine ruptures (CURs) carry a higher risk of serious impact on both mother and child. The present study aimed to evaluate outcomes and identify risk factors for each type of rupture, and also to define high- and low-risk uterine ruptures based on clinical outcomes. Methods: A retrospective analysis of 112 uterine rupture cases, including 29 CURs and 83 PURs, was conducted at the Women’s Hospital of the University of Cologne from October 2010 to January 2021. Results: Maternal outcomes revealed that CUR was associated with higher risks of prolonged hospitalization (p = 0.003), postpartum hemorrhage (p < 0.001), maternal transfusion (p = 0.003), and ICU transfer (p = 0.004) compared to PUR. Neonatal outcomes showed a significantly higher risk of severe acidosis (p < 0.001), low APGAR scores (p < 0.001), NICU transfers (p = 0.004), and resuscitation needs (p = 0.016) in CUR cases. Factors increasing the risk of CUR included pathological CTG (OR = 1.9, 95% CI: 0.99–7.14, p = 0.05), abdominal pain (OR = 2.63, 95% CI: 1.10–6.25, p = 0.03), previous vaginal birth (OR = 7.14, 95% CI: 0.025–20, p < 0.001), and no uterine contractions (OR = 7, 95% CI: 1.21–40.56, p = 0.03). A previous cesarean section significantly increased the risk of CUR (OR = 4.94, 95% CI: 1.38–17.67, p = 0.014), whereas more than two cesarean sections reduced the risk (OR = 0.66, 95% CI: 0.13–3.22, p = 0.61). A comparison of CUR with maternal and neonatal high-risk rupture groups revealed that low gestational age and a history of previous cesarean sections were significant risk factors for neonatal high-risk rupture. Conclusion: Vaginal birth and abdominal pain were identified as key risk factors for CUR, which lead to severe maternal and neonatal outcomes. Recognizing these risk factors can help clinicians optimize risk stratification and decision-making, and enhance monitoring strategies to prevent adverse outcomes.

Background: Cervical cancer is a leading cause of morbidity and mortality among women globally. Currently, treatment is primarily based on tumor staging; however, discrepancies between preoperative and postoperative tumor staging remain a significant challenge and may impact treatment decisions and outcomes. This study aims to investigate the disparity between preoperative and postoperative risk factors in early-stage cervical cancer, with a particular focus on the histopathological parameters and the correlation with preclinical risk factors. Methods: Patients who underwent surgical treatment for an initial diagnosis of primary cervical carcinoma at the University Hospital Cologne in the Department of Gynecology and Obstetrics between 2015 and 2021 were included. A retrospective analysis was conducted to examine variations in histological parameters and their relationships with preclinical risk factors, such as age, BMI, smoking status, and HPV status, along with pretherapeutic diagnostic results. Results: In 85.7% of cases, preoperative grading showed concordance with postoperative grading. Postoperative upgrading was observed in 14.3% of cases with no instances of downgrading. Inconsistent findings were noted for venous invasion (3.6% of cases) and lymphovascular space invasion (6.7% of cases). No significant correlations were found between pre- and postoperative discrepancies and preclinical risk factors or pretherapeutic diagnostics. Kaplan–Meier analyses revealed no impact of discordance in grading (p = 0.559) or lymphatic vessel invasion (p = 0.752) on recurrence-free survival. Conclusions: The analyzed discrepancies were not influenced by preclinical risk factors or pretherapeutic interventions and showed no significant prognostic relevance for the patients’ recurrence-free survival. More robust conclusions would require further studies with larger sample sizes.

Background/Aim: This study investigated the clinical impact of resection of pelvic sentinel lymph nodes (PSLNs) in squamous cell vulvar cancer (SCVC). Patients and Methods: Sixty-two groins of 33 patients with SCVC who underwent sentinel lymph node (SLN) resection between 2010 and 2021 at the University Hospital of Cologne, Germany, were analyzed in this retrospective cohort study. The frequency of additionally resectable PSLNs, histological findings, and count rates were analyzed and compared to the findings for inguinal sentinel lymph nodes (ISLNs). Results: In all patients and in 61 (98%) of the 62 radiolabeled groins, at least one SLN could be resected. Five (8%) of the 62 groins had histologically confirmed lymph node metastases (4/33 patients, 12%). Twenty (33%) of the 62 groins underwent additional PSLN resection. Resection of these PSLNs was feasible without causing an additional burden for the patients. None of the PSLNs showed signs of tumor infiltration. Information on the extent of radioactivity for ISLNs and simultaneously for PSLNs, expressed as count rate of intraoperative measurement with the gamma probe, was available for 20 (32%) groins. In three (15%) of these cases, the highest count rate in a SLN was found in a PSLN and not in an ISLN. Conclusion: Resection of PSLNs is feasible and can be performed without short-term complications. In patients with early SCVC, resection of PSLNs is not necessary, even in those with early infiltration of inguinal lymph nodes. The intraoperative count rate of SLN is not relevant for the decision to perform resection.

Background: Pelvic organ prolapse significantly affects women’s health, often requiring surgery. Unilateral sacrocolpopexy (SCP) is the gold standard for apical prolapse repair. However, varied SCP techniques can lead to inconsistencies in clinical outcomes, with differences in synthetic materials, mesh dimensions, placement, and apical tensioning. This variability may impact the comparability of clinical outcomes. Bilateral apical fixation has gained attention for its potential to provide effective apical support and restore anatomical integrity. Objective: To date there are not many studies on bilateral apical cervicosacropexy between the vaginal apex and the sacrum at the level of S1/promontory with one-year follow-up. Methods: This study presents a one-year follow-up comparing the clinical outcomes of open abdominal (CESA) and laparoscopic cervicosacropexy (laCESA) for bilateral apical suspension in women with pelvic floor disorders. A total of 145 women underwent either CESA (n = 75) or laCESA (n = 70) using a surgical technique with a designed polyvinylidene-fluoride (PVDF) mesh of defined shape replacing both uterosacral ligaments. Outcomes were efficacy, safety, and success rates of both surgical approaches in restoring apical vaginal support and pelvic floor functioning. Results: Both techniques demonstrated high efficacy of apical prolapse repair and a high level of safety. While comparable rates of urinary continence restoration were achieved, laCESA showed significant advantages in terms of operative time, hospital stay, and recovery time. Conclusions: These findings demonstrate the reproducibility of a surgical technique including clinical outcomes in the treatment of pelvic floor dysfunction. The standardization of mesh design and surgical methodology enhances reproducibility and may mitigate some of the variability associated with clinical outcomes in apical mesh fixation techniques.