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Han A.,Kanuni Sultan Suleyman Research and Teaching Hospital
Gynecologic and Obstetric Investigation | Year: 2015

Aims: To determine and compare the effectiveness, peri- and postoperative outcomes of mid-urethral sling (MUS) operations for urinary incontinence, using 2 different patient positions during surgery. Methods: In this study, 146 patients underwent MUS surgery in a urogynecology clinic. Of them, 72 patients underwent the intraoperative surgical procedure of reverse trendelenburg patient positioning for tape adjustment (group 1) and the remaining 74 patients had the routine surgical procedure of MUS surgery (group 2). The primary outcome was the evaluation of postoperative urine leaks, using the stress test, and secondary outcomes were quality of life, using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF, Turkish version) and complication rates. Results: There were no significant differences in demographic variables between the 2 groups. The overall cure rates for incontinence in the lithotomy position was 97.22 and 85.13% for groups 1 and 2, respectively, in which group 1 had a statistically significant decrease in urine leak postoperatively (p < 0.05; OR 3.08, 95% CI 2.78-22.14). The postoperative ICQ-SF scores showed no significant difference between the 2 groups (p = 0.19). Conclusion: Applying a 45-degree reverse trendelenburg position for tape adjusting during MUS operation results in a greater objective cure rate compared with the typical dorsolithotomy position; however, there was no difference in the subjective outcome. © 2015 S. Karger AG, Basel Copyright © 2015, S. Karger AG. All rights reserved. Source

Corbacioglu Esmer A.,Istanbul University | Goksedef B.P.C.,Haseki Research and Teaching Hospital | Gunduz N.,Kanuni Sultan Suleyman Research and Teaching Hospital
Gynecologic and Obstetric Investigation | Year: 2014

Aim: To determine a cutoff age for endometrial evaluation in premenopausal abnormal uterine bleeding (AUB). Methods: Histopathology reports of endometrial sampling performed due to AUB in women aged 50 years or less were reviewed retrospectively. Histopathological findings were categorized into three groups as follows: group 1: hyperplasia without atypia + hyperplasia with atypia + malignancy, group 2: hyperplasia with atypia + malignancy, and group 3: malignancy. Results: Data from 2,516 patients were analyzed for this study. Overall, 13.5% of patients had endometrial hyperplasia without atypia, 1% of patients had hyperplasia with atypia and 0.6% of patients had malignant disease. Logistic regression revealed a significant difference in the odds ratios of group 1 in the age ranges of 40-45 and 45-50 years compared with <40 years (p = 0.001 and p = 0.01, respectively). There were no significant differences between the age groups for the odds ratio of group 2 and group 3. Conclusion: There is no cutoff age for sampling the endometrium in order to detect hyperplasia with atypia and cancer in premenopausal women with AUB. Therefore, the management of AUB should be tailored to each patient regardless of age, incorporating all risk factors for malignant disease. Copyright © 2013 S. Karger AG, Basel. Source

Alkis I.,Yuzuncu Yil University | Karaman E.,Ercis State Hospital | Han A.,Kanuni Sultan Suleyman Research and Teaching Hospital | Gulac B.,Kanuni Sultan Suleyman Research and Teaching Hospital | Ark H.C.,Kanuni Sultan Suleyman Research and Teaching Hospital
Archives of Gynecology and Obstetrics | Year: 2014

Purpose: The aim of this study was to evaluate the clinical characteristics, peri- and post-operative outcomes, and clinical effectiveness of the Manchester-Fothergill (MF) procedure for uterine descensus as a uterine-sparing surgery. Methods: In this study, 49 patients underwent the MF procedure as a uterine-sparing surgery for uterine descensus during 2008-2012 in the Department of Urogynecology at Kanuni Sultan Süleyman Research and Teaching Hospital, Istanbul, Turkey. Results: Medical records and follow-up data were collected from 24 of the 49 patients (48.9 %). The mean age was 49.3 ± 9.1 years, and parity 3.6 ± 1.5; 41.6 % were post-menopausal; 6 patients (25 %) had grade II, and 18 (75 %) had grade III uterine prolapse; 95.8 % had associated cystoceles, and 79.1 % had associated rectoceles; 66.6 % complained of urinary incontinence. On follow-up examination, the cervical stumps were satisfactorily situated in 23 of 24 patients, and recurrent prolapse was seen in 1 patient (4.1 %). Bladder perforation was repaired at the time of the operation in 1 patient, and one complained of post-operative urinary retention. Conclusion: The MF procedure is a viable option to surgically correct uterine descent while preserving the uterus to treat recurrent prolapse with a low complication rate and low morbidity. © 2014 Springer-Verlag. Source

Akbayir O.,Kanuni Sultan Suleyman Research and Teaching Hospital | Corbacioglu Esmer A.,Istanbul University | Cilesiz Goksedef P.,Haseki Research and Teaching Hospital | Ekiz A.,Kanuni Sultan Suleyman Research and Teaching Hospital | And 3 more authors.
Archives of Gynecology and Obstetrics | Year: 2013

Objective: The objective of this study is to describe a novel technique for the treatment of postpartum hemorrhage and evaluate its effectiveness and safety. Methods: Single square hemostatic suture was performed for uterine atony when postpartum hemorrhage did not respond to medical therapy and bilateral uterine artery ligation. We retrospectively reviewed the data of 11 women and evaluated their endometrial cavity with hydrosonography after a follow-up period of 8-34 months. Results: The single square hemostatic suture successfully stopped bleeding in all of the cases. Of the 11 women, 2 could not be traced. Menstruation started without delay in nine women. One of the women achieved pregnancy 25 months after surgery. The six women who underwent hydrosonography had an intact endometrial cavity. Conclusions: For women who desire future fertility, and when bilateral uterine artery ligation is not sufficient to control PPH, single square suturing may be used as an effective and safe procedure. © 2012 Springer-Verlag. Source

Turkgeldi E.,Koc University | Turkgeldi L.,Kanuni Sultan Suleyman Research and Teaching Hospital | Seyhan A.,Assisted Reproduction Unit | Ata B.,Koc University
Turk Jinekoloji ve Obstetrik Dernegi Dergisi | Year: 2015

Gonadotropin-releasing hormone agonists (GnRHa) have gained increasing attention in the last decade as an alternative trigger for oocyte maturation inpatients at high risk for ovarian hyperstimulation syndrome (OHSS). They provide a short luteinizing hormone (LH) peak that limits the production ofvascular endothelial growth factor, which is the key mediator leading to increased vascular permeability, the hallmark of OHSS. Initial studies showedsimilar oocyte yield and embryo quality compared with conventional human chorionic gonadotropin (hCG) triggering; however, lower pregnancy rates andhigher miscarriage rates were alarming in GnRHa triggered groups. Therefore, two approaches have been implemented to rescue the luteal phase in freshtransfers. Intensive luteal phase support (iLPS) involves administiration of high doses of progesterone and estrogen and active patient monitoring. iLPS hasbeen shown to provide satisfactory fertilization and clinical pregnancy rates, and to be especially useful in patients with high endogenous LH levels, suchas in polycystic ovary syndrome. The other method for luteal phase rescue is low-dose hCG administiration 35 hours after GnRHa trigger. Likewise, thismethod results in statistically similar ongoing pregnancy rates (although slightly lower than) to those of hCG triggered cycles. GnRHa triggering decreasedOHSS rates dramatically, however, none of the rescue methods prevent OHSS totally. Cases were reported even in patients who underwent cryopreservationand did not receive hCG. GnRH triggering induces a follicle stimulating hormone (FSH) surge, similar to natural cycles. Its possible benefits have beeninvestigated and dual triggering, GnRHa trigger accompanied by a simultaneous low-dose hCG injection, has produced promising results that urgefurther exploration. Last of all, GnRHa triggering is useful in fertility preservation cycles in patients with hormone sensitive tumors. In conclusion, GnRHatriggering accompanied by appropriate luteal phase rescue protocols is a relatively safe option for patients at high risk for OHSS. © 2015, Turkish Society of Obstetrics and Gynecology. All rights reserved. Source

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