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Karateke A.,Yeditepe University | Cam C.,Zeynep Kamil Maternity Hospital | Ayaz R.,Zeynep Kamil Maternity Hospital
Journal of Minimally Invasive Gynecology | Year: 2010

Synthetic mesh has become a popular treatment of pelvic floor relaxation and pelvic organ prolapse, with low complication rates. We describe the case of a woman with unilateral hydroureteronephrosis after a mesh procedure (Gynecare Prolift; Ethicon Women's Health & Urology, Ethicon, Inc., Somerville, New Jersey) successfully treated by neoureterocystostomy. A 39-year-old woman with pelvic organ prolapse underwent the mesh procedure. Two months later, she had left flank pain, and hydroureteronephrosis was diagnosed on the same side despite cystoscopic confirmation of ureteral passage at the first operation. The arm of the mesh was removed surgically, and neoureterocystostomy was performed successfully. Mesh surgery is not without serious complications, and surgeons should bear in mind the possible complications associated with this surgical procedure. © 2010 AAGL.

Cam C.,Zeynep Kamil Maternity Hospital | Karateke A.,Yeditepe University | Ozdemir A.,Zeynep Kamil Maternity Hospital | Gunes C.,Zeynep Kamil Maternity Hospital | And 3 more authors.
Taiwanese Journal of Obstetrics and Gynecology | Year: 2010

Objective: Evaluation of the problems encountered during a voluntarily fistula campaign in a regional hospital of Niger (Africa). Materials and Methods: Women underwent basic gynecological examination, methylene blue testing, and/or direct cystoscopy as necessary. According to their clinical condition, women were informed and surgical options offered as appropriate. Operations were performed under spinal or epidural anesthesia. Immediate postoperative outcomes were followed during the stay of the surgical team in the country. Results: A total of 62 women were examined and 11 had causes of incontinence other than obstetric fistula. In 9.8% of the women, severe local infection precluding any surgical intervention was evident. In 58.8% of patients, the trigonal region and/or urethra were irreversibly damaged. A proportion of patients (9.8%) with large lesions and intact urethra that were offered vaginal layered closure refused the intervention. Of the women that were operated on (21.6%), six underwent vaginal layered closure with Martius fat flap and five women underwent a combined abdomino-vaginal approach. Conclusion: It is extremely difficult to meet the needs of this global problem with short term programs and volunteers. Directing these efforts to specialist fistula centers and creating reliable scientific evidence should be the main goal. © 2010 Taiwan Association of Obstetric & Gynecology.

Karateke A.,Zeynep Kamil Maternity Hospital | Cam C.,Zeynep Kamil Maternity Hospital | Ozdemir A.,Zeynep Kamil Maternity Hospital | Guney B.,Zeynep Kamil Maternity Hospital | And 2 more authors.
Archives of Medical Science | Year: 2010

Introduction: To evaluate the need for a prognostic classification system for obstetric fistula (OF) with the data obtained by a voluntarily action for OF repair in a regional hospital and Niger, Africa. Material and methods: Obstetric fistula (OF) characteristics of 51 women with vesicovaginal fistula in a fistula campaign in Maradi Regional Hospital, Niger were evaluated. Initial basic gynecological examination, methylene blue (MBT) test and direct cystoscopy were used to describe the characteristics of the lesions. Demographic and clinical data were compared with the existing literature. Results: In 31 (60 %) cases were the sizes of the fistula greater than 4 cm. The urethra was circumferentially lost in 8 (15.7%) women. In 18 (35.3%) women the trigone was involved. Extensive fibrosis was present in 10 (19.6%) patients. Only in 11 (21.6%) patients without any obliterating scarring, neither the trigone nor urethra were damaged. Five (9.8%) patients had severe infection. Five (9.8%) had multiple lesions. Thirty-four (66.6%) had a history of at least one previous attempt for fistula repair. A significant proportion of women were divorced or abandoned from their husband, and socially isolated. Conclusions: A simple, reproducible and universally accepted scientific classification or staging system for OF dealing with outcomes rather than anatomic landmarks should replace the present proposed classification systems for prognostic and ethical purposes. Copyright © 2010 Termedia & Banach.

Citak N.,Marmara University | Cam C.,Zeynep Kamil Maternity Hospital | Arslan H.,Maltepe University | Karateke A.,Yeditepe University | And 4 more authors.
Acta Obstetricia et Gynecologica Scandinavica | Year: 2010

Objective. To evaluate the effects of early pelvic floor muscle training after vaginal delivery on sexual function. Design. Prospective randomized study. Settings. Urogynecology clinic of a tertiary medical center in Istanbul, Turkey. Population. Total of 75 primiparous women. Methods. Pelvic floor-muscle strength was assessed during rest and straining in primiparous women in their 4th postpartum month, after which the women were randomized into training (n=37) and control (n=38) groups. Patients were re-evaluated in the 7th postpartum month. Main outcome measures. Female sexual function and pelvic muscle strength scores. Results. Desire, pain and total female sexual index scores were significantly higher in the 7th month compared to 4th month in both groups (p < 0.05). However, sexual arousal, lubrication, orgasm, and satisfaction scores were improved in the 7th month in the training group (paired t-test, p < 0.001), but not significantly in the control group (p > 0.05). All domains except satisfaction were significantly higher in the training group compared with the controls. Pelvic floor-muscle strength was found to be increased in the 7th month in the training group (Wilcoxon rank test, Z=4.123, p < 0.001), whereas there was no significant difference between the 4th and 7th month measurements in the controls (p > 0.05). Conclusion. Pelvic floor-muscle training improves pelvic floor-muscle function, and starting after the puerperal period, exercise appears to have positive effects on female sexual function. © 2010 Informa UK Ltd.

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