E Dreher

Inselspital, Universitätsspital Bern, Berna, Bern, Switzerland

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Publications (74)139.45 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To compare clinical outcomes and sexual function between transvaginal and transabdominal repairs of vesicovaginal fistulae (VVF). Study Design Participants, 99 women with VVF presenting to a tertiary referral centre, were treated with urinary catheterization for 12 weeks, and if unsuccessful, underwent repair using either the transvaginal (Latzko) or transabdominal technique. Objective clinical parameters were analyzed. Subjective outcomes were recorded prospectively and at the six month follow-up using the FSFI (Female sexual function index) to evaluate sexual function and the VAS (visual analogue scale) to measure general disturbance by the fistula. Results After bladder drainage for 12 weeks, eight patients had spontanous fistula closure. Demographic variables were similar in the transvaginal (n=60) and transabdominal (n=31) repair groups. The transvaginal procedure showed significantly shorter operation times, less blood loss and shorter hospital stay. Continence rates six months after surgery were 82% (transvaginal) and 90% (transabdominal). Sexual function in the 64 sexually active patients was significantly improved and overall disturbance by the fistula was reduced with both operative techniques. Neither surgical intervention was superior to the other regarding any domain of sexual function or VAS. Conclusion Fistula repair improves sexual function and quality of life with no difference attributable to surgical route. Given this, and that operating time, blood loss and length of stay are less with the transvaginal approach, the transvaginal approach is preferred in VVF repair if fistula and patient characteristics are suitable.
    American journal of obstetrics and gynecology 07/2014; 211(1). DOI:10.1016/j.ajog.2014.02.011 · 3.97 Impact Factor
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    ABSTRACT: INTRODUCTION AND HYPOTHESIS: To investigate sexual and anatomical outcome after Shears neovagina in patients with Mayer-von Rokitansky-Kuster-Hauser syndrome (MRKH). METHODS: Forty-three consecutive patients with MRKH syndrome underwent surgery creating a neovagina according to Shears. Follow-up was 8 years. Sexual function was assessed using the Female Sexual Function Index (FSFI) as patient reported outcome; anatomical results were assessed measuring anterior, posterior and apical prolapse using the ICS Pelvic Organ Prolapse Score (ICS-POP Score). Pelvic floor contraction was measured applying the Oxford grading system. RESULTS: Thirty-seven of the patients were regularly sexually active and filled in the FSFI; mean total FSFI was 27.2 (range 24-28). No significant prolapse of the neovagina was noted, 11 patients had a grade I cystocele, rectocele or apical descent that was asymptomatic. Oxford grading of the pelvic floor contraction was 4 in median (range 2-5). CONCLUSION: The neovagina according to Shears is a valuable surgical option with good sexual and anatomical outcome 8 years after therapy.
    International Urogynecology Journal 11/2012; 24(6). DOI:10.1007/s00192-012-1980-z · 2.16 Impact Factor
  • Annette Kuhn, Peter Kuhn, Ekkehard Dreher
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    ABSTRACT: Aim of the study was to correlate urethral retro resistance pressure with the maximum urethral closure pressure (MUCP) and functional urethral length (FUL) in patients with urinary incontinence and healthy individuals. Two hundred and twenty patients with the complaint of urinary incontinence had a urodynamic examination including urethral pressure profiles and URP. Additionally, 15 healthy individuals without the complaint of any incontinence had their URP and urethral pressure profiles measured. The correlation of MUCP, FUL and URP were calculated using Graph Pad Instat 4.0 for windows. URP correlates well with the diagnosis of urodynamic stress incontinence. Correlation coefficient between URP and MUCP is 0.9262. Healthy individuals have significantly higher values for URP and MUCP. URP is a valuable less invasive test than conventional urethral function tests for the diagnosis of urodynamic incontinence with an excellent correlation of MUCP and URP.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 02/2008; 136(1):116-20. DOI:10.1016/j.ejogrb.2007.04.002 · 1.63 Impact Factor
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    ABSTRACT: To evaluate whether intra- and post-operative morbidity varies according to the method used for female sterilization. The database of the Swiss obstetric study group was analyzed for a period of 9 years. After the exclusion of cases with extraneous factors that may have influenced the operative outcome, three groups of patients were identified: (1) interval laparoscopic sterilization unrelated to pregnancy (n=20,325); (2) postpartum laparoscopic sterilization (n=2233); (3) postpartum sterilization by minilaparotomy (n=5095). Intra-operative and post-operative complications were compared according to the surgical approach. A total of 27,653 patients were included in the study. The proportion of major complications was higher in group 3 than in group 1 (0.39% versus 0.10%, odds ratio 4.0, 95% CI 2.15-7.44, p<0.001) but not statistically different between groups 1 (0.10%) and 2 (0.18%). Minor complications were statistically significantly more frequent in group 3 (0.82%) than in group 1 (0.26%) or group 2 (0.27%). There was no case of intra-operative or post-operative death in the study population. When available, a laparoscopic approach should be chosen for female sterilization. After uneventful pregnancy course and delivery, it does not seem justified to delay the endoscopic sterilization to a later time.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 09/2007; 134(1):105-9. DOI:10.1016/j.ejogrb.2006.06.016 · 1.63 Impact Factor
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    ABSTRACT: Aim of the study was to determine if gynaecological operations have an effect on sexual function using the current medlined literature. We performed a Medline search using the terms "sexual life/function after operative gynaecological treatment", "sexual life/function after operations for gynaecological problems", "sexual life/function after hysterectomy", "sexual life/function, incontinence" and "sexual life/function, pelvic organ prolapse". Reviews were excluded. We divided the operations into four groups of (1) combined prolapse and incontinence operations, (2) prolapse operations only, (3) incontinence operations only and (4) hysterectomy and compared pre-to postoperative sexual outcome. Thirty-six articles including 4534 patients were identified. Only 13 studies used a validated questionnaire. The other authors used self-designed and non-validated questionnaires or orally posed questions by the examiner to determine sexual function. Prolapse operations particularly posterior repair using levator plication seem to deteriorate sexual function, incontinence procedure have some worsening effect on sexual function and hysterectomy seems to improve sexual function with no differences between subtotal or total hysterectomy. Gynaecological operations do influence sexual function. However, little validated data are available to come to this conclusion.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 01/2007; 129(2):104-10. DOI:10.1016/j.ejogrb.2006.05.026 · 1.63 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate whether pregnancy-associated plasma protein A, glycodelin, osteoprotegerin, and soluble CD163 are possible peritoneal fluid markers for endometriosis and to compare them with the established chemokine markers interleukin-8 and regulated on activation, normal T-cell expressed and secreted. Determination of the concentrations of interleukin-8, regulated on activation, normal T-cell expressed and secreted, pregnancy-associated plasma protein A, glycodelin, CD163, osteoprotegerin, and progesterone in the peritoneal fluid collected from women undergoing laparoscopy. From a total of 132 women, 77 women were diagnosed with endometriosis, and 55 women were free of the disease and served as control subjects. Pregnancy-associated plasma protein A and osteoprotegerin showed significantly (P < 0.05) elevated peritoneal fluid concentrations as a function of the severity of the disease, together with interleukin-8 and regulated on activation, normal T-cell expressed and secreted (P < .001). Glycodelin and CD163 did not differ between cases and control subjects. Many of these marker concentrations were intercorrelated strongly. Pregnancy-associated plasma protein A and osteoprotegerin may play a role in the inflammation process of endometriosis, but interleukin-8 and regulated on activation, normal T-cell expressed and secreted are superior peritoneal fluid markers.
    American journal of obstetrics and gynecology 07/2006; 195(1):103-8. DOI:10.1016/j.ajog.2005.12.010 · 3.97 Impact Factor
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    ABSTRACT: Glycodelin (GdA) is an immunosuppressive endometrial glycoprotein critical for embryonic implantation and pregnancy establishment. The aim of the present study was to examine the effect of dioxin [2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)] on GdA production in human endometrial cells. Controlled endometrial explant (EE) and cell cultures were used in this study. Work was conducted at university hospital research laboratories in Bern, Switzerland, and in San Francisco, California. Ovulatory women provided endometrial biopsies in the proliferative or secretory phase. EEs and cells were cultured without and with TCDD. GdA protein and gene expression were quantified. A 2.5-fold increase in GdA production was demonstrated in EEs treated with 10 nm TCDD for 9 d. Fluorography revealed a 3- to 4-fold increase in new GdA biosynthesis and secretion in TCDD-treated endometrial epithelial cells. Because the action of dioxin is mediated by the aryl hydrocarbon receptor (AhR), we ascertained that primary epithelial and Ishikawa cells express AhR. Dose responses to TCDD and expressed AhR were established in transiently transfected Ishikawa cells using luciferase fusion vectors containing 1.0 kb of 5' flanking DNA relative to the GdA transcriptional start site but not when shorter promoter constructs were used. A dioxin response element was mapped to nucleotides -539 to -533 of the gene promoter and verified by site-directed mutagenesis. We demonstrated a direct AhR-mediated effect of dioxin on GdA gene transcription and protein secretion that might influence human female fertility.
    Journal of Clinical Endocrinology &amp Metabolism 09/2005; 90(8):4809-15. DOI:10.1210/jc.2004-2064 · 6.31 Impact Factor
  • Fertility and Sterility 09/2005; 84. DOI:10.1016/j.fertnstert.2005.07.481 · 4.59 Impact Factor
  • A Kuhn, E Dreher
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    ABSTRACT: Emergency consultations happen frequently in gynaecology and may be due to abdominal pain, itching, utero-vaginal bleeding, rape, emergency contraception, insertion of foreign bodies, prolapse and urinary tract infection. Considering pregnancy in patients with child bearing potential is essential. Vaginal bleeding may be due to atrophy, infection, carcinoma or pregnancy. In the latter it is crucial to differentiate between ectopic, pathologic or physiologic pregnancy. In postmenopausal women further investigations by the gynaecologist are mandatory to exclude malignancy. Patients who have been raped need psychological, forensic and gynaecological support. Sexually transmitted disease including HIV must be considered and prophylactic drugs should be administered. If unprotected intercourse has occurred the "morning after pill" can be considered within 72 hours after intercourse or an IUD up to five days. Prolapse occurs rarely as an acute problem but may induce urinary retention. Urinary tract infection is a common complaint and should be treated with antibiotics.
    Therapeutische Umschau 07/2005; 62(6):359-62.
  • A. Kuhn, E. Dreher
    Therapeutische Umschau 06/2005; 62(06):0359-0362. DOI:10.1024/0040-5930.62.6.359
  • Geburtshilfe und Frauenheilkunde 09/2004; 64(9):912-916. DOI:10.1055/s-2004-820930 · 0.96 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 08/2004; 24(3):232 - 232. DOI:10.1002/uog.1178 · 3.14 Impact Factor
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    ABSTRACT: To evaluate whether the serum concentrations of novel placental markers and nonplacental markers differ in ectopic pregnancy when compared with normal intrauterine pregnancy. Prospective clinical study. University hospital. Patients with confirmed ectopic pregnancy (EP) and control population with normal intrauterine pregnancy (IUP). Laparoscopy. Serum concentrations of placental markers: pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific beta(1)-glycoprotein (SP1), human placental lactogen (HPL), and HCG; and nonplacental markers: glycodelin, vascular endothelial growth factor (VEGF), and P. The multiples of median of all markers (except VEGF) were decreased in EP when compared with the control group. Conversely, the serum values of VEGF were significantly increased in EP. VEGF showed a negative correlation with HCG and SP1, but not with PAPP-A, P, or the nonplacental markers. HCG, PAPP-A, SP1, and HPL strongly correlated with each other. But, in contrast to the above, P only correlated with HCG and, in contrast to the controls, with glycodelin. The combination of three independent markers in the formula VEGF/(PAPP-A x P) was found to be largely superior to the measure of any single marker. The "triple marker analysis" [VEGF/(PAPP-A x P] allows a clear discrimination between normal IUP and EP.
    Fertility and Sterility 05/2004; 81(4):1106-11. DOI:10.1016/j.fertnstert.2003.08.049 · 4.59 Impact Factor
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    ABSTRACT: We report two women who presented with a recurrent, mildly painful, bluish nodule in the umbilicus. Both patients complained of local tenderness and occasional bleeding that increased during menstruation. Neither patient had had previous pelvic surgery. Excision of the lesions revealed a primary umbilical endometriosis; in one case, a simultaneous laparoscopy showed a pelvic endometriosis. We review the current literature and discuss the possible etiopathogenesis and when a laparoscopy is indicated to diagnose a concomitant pelvic endometriosis. Umbilical endometriosis is a very rare disease but should be considered in the differential diagnosis of umbilical lesions.
    Surgical Endoscopy 03/2004; 18(2):347. DOI:10.1007/s00464-003-4245-6 · 3.31 Impact Factor
  • Geburtshilfe und Frauenheilkunde 12/2003; 63(12). DOI:10.1055/s-2003-815268 · 0.96 Impact Factor
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    ABSTRACT: To investigate the presence of epithelial neutrophil-activating peptide 78 (ENA-78) in peritoneal fluid of women with and without endometriosis and to identify the cells that produce this inflammatory protein. Case-control study. University hospital. Eighteen women with and 9 women without endometriosis. ENA-78 protein and mRNA levels were compared among women with and without endometriosis in samples of peritoneal fluid, samples of endometriotic lesions obtained by biopsy during laparoscopy, and peritoneal macrophages. Enzyme-linked immunosorbent assay, reverse transcription polymerase chain reaction, and in situ hybridization methods were used. Secretion of ENA-78 protein by interleukin-1beta-stimulated endometriotic stromal cells and in the media of lipopolysaccharide-stimulated peritoneal macrophages were compared to that in unstimulated cell cultures. Peritoneal fluid concentrations of ENA-78 were significantly higher in affected women than in controls. Ectopic epithelial and stromal cells and peritoneal macrophages express ENA-78 messenger RNA. Interleukin-1beta stimulation of stromal cell cultures resulted in a 23-fold increase in ENA-78 concentration, and lipopolysaccharide stimulation of peritoneal macrophages increased concentrations by 8-fold. Levels of ENA-78 are elevated in the peritoneal fluid of women with endometriosis. Ectopic glandular cells, ectopic stromal cells, and peritoneal macrophages express this inflammatory chemokine. Epithelial neutrophil-activating peptide 78 may play an important role in the pathogenesis of endometriosis.
    Fertility and Sterility 04/2003; 79 Suppl 1:815-20. DOI:10.1016/S0015-0282(02)04828-8 · 4.59 Impact Factor
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    ABSTRACT: To determine whether progestins activate vascular endothelial growth factor (VEGF) gene transcription in endometrial adenocarcinoma cells. In vitro study. University reproductive biology laboratories. None. Ishikawa cells were transfected with VEGF promoter-luciferase reporter constructs and expression vectors encoding human progesterone receptors (hPR) A or B. The cells were treated with different progestins and antiprogestins, and luciferase activity was compared with controls. Three functional progesterone response elements (PREs) in the VEGF promoter were identified by electrophoretic mobility-shift assay, and different constructs were created to assess each PRE. In cells expressing hPRA or B, treatment with 10 nM R5020 or 100 nM medroxyprogesterone acetate statistically significantly increased luciferase activity (3.3- to 4.8-fold). Pretreatment with 100 nM RU486 blunted the effect of 10 nM R5020, resulting only in a slight, statistically nonsignificant increase in luciferase activity (1.3- to 1.7-fold). Although three different functional PREs could be identified, no single PRE accounted for the preponderance of the luciferase activity. Full VEGF promoter activation required all three PREs. Progestins have a direct effect on VEGF gene transcription. However, hPR-mediated transcriptional regulation of the VEGF promoter is complex and cannot be localized to confined PRE sequences. Other response element motifs are likely to play a contributory role.
    Fertility and Sterility 03/2003; 79(2):386-92. DOI:10.1016/S0015-0282(02)04577-6 · 4.59 Impact Factor
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    ABSTRACT: Members of the Eph family of tyrosine kinases have been implicated in embryonic pattern formation and vascular development; however, little is known about their role in the adult organism. We have observed estrogen-dependent EphB4 expression in the normal breast suggesting its implication in the hormone-controlled homeostasis of this organ. Since the endometrium is a similarly hormone dependent organ and endometrial carcinoma is thought to result from estrogenic stimulation, we have investigated EphB4 expression in normal human endometrium and during its carcinogenesis. EphB4 expression was analyzed immunohistochemically in 26 normal endometrium specimens, 15 hyperplasias and 102 endometrioid adenocarcinomas and correlated with clinical and prognostic tumor characteristics. In normal endometrial tissue no EphB4 protein was detected. Strikingly, we observed a drastic increase (P <0.0001) in the number of EphB4 protein-expressing glandular epithelial cells in the majority of hyperplasias and carcinomas. Moreover, we found a statistically highly significant positive correlation between EphB4 expression and post-menopausal stage of the patient (P = 0.007). These findings indicate that in the endometrium, EphB4 is an early indicator of malignant development and, thus, EphB4 may represent a potent tool for diagnosis and therapeutic intervention.
    Annals of Oncology 02/2003; 14(2):220-6. DOI:10.1093/annonc/mdg072 · 6.58 Impact Factor
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    ABSTRACT: To evaluate the effects of tamoxifen on human endometrial vascular endothelial growth factor (VEGF) gene expression in vitro and in vivo. Ishikawa cells were transiently co-transfected with plasmids expressing human estrogen receptor (ER)-alpha or -beta and a 2.3-kb human VEGF promoter-luciferase construct. Transfected cells were treated with tamoxifen and the increase in luciferase activity was compared to controls. In addition, immunohistochemical analysis of VEGF expression in endometrial biopsies from 11 postmenopausal women receiving tamoxifen was compared to 24 postmenopausal women on no hormone replacement. In transfected cells expressing ERalpha, tamoxifen induced a significant VEGF promoter activation (3.2-fold, p < 0.01), whereas cells expressing ERbeta showed a 1.6-fold stimulation (p = NS). No significant differences in VEGF immunostaining were observed in tamoxifen-exposed women. Although tamoxifen exposure increases VEGF expression in vitro, a significant increase in VEGF expression is not apparent in endometrial biopsies of postmenopausal women treated with this drug.
    Gynecologic and Obstetric Investigation 01/2003; 55(2):119-24. DOI:10.1159/000070190 · 1.25 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 01/2003; 22(S1):173 - 173. DOI:10.1002/uog.851 · 3.14 Impact Factor

Publication Stats

744 Citations
139.45 Total Impact Points


  • 1993–2014
    • Inselspital, Universitätsspital Bern
      • Department of Obstetrics and Gynaecology
      Berna, Bern, Switzerland
  • 1992–2012
    • Universität Bern
      • • Department of Clinical Research
      • • Institute of Applied Physics
      Berna, Bern, Switzerland
  • 2005
    • University of California, San Francisco
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      San Francisco, California, United States