A comparison of pelvic organ prolapse and sexual function after abdominal and laparoscopic hysterectomy

Objectives: Hysterectomy is one of the risk factors of pelvic organ prolapse (POP). There is no consensus on whether the route of hysterectomy affects the subsequent development of POP. The aim of the study was to assess POP and sexual function 1 year after a hysterectomy when comparing total abdominal hysterectomy (TAH) with total laparoscopic hysterectomy (TLH). The study applied the pelvic organ prolapse quantification (POP-Q) as the measure of POP and a short-form of the POP/Urinary Incontinence Sexual Function Questionnaire (PISQ-12).Material and methods: All patients that underwent either TAH or TLH due to benign causes between March 2016 and March 2017 at the tertiary hospital used for the study were included in our prospective cohort study. POP-Q measurements and PISQ-12 scores were assessed 1 year postoperatively.Results: We included 182 patients in the clinical examinations. There were no statistically significant differences in demographic characteristics between the TAH and TLH groups. Also, there we no differences observed in the objective POP measurements between the two study groups. Results of the two groups’ PISQ-12 scores were also similar. However, postoperative vaginal lengths were found to be significantly shorter in the patients who had undergone TAH compared with those who had undergone TLH.Conclusions: TAH and TLH are comparable regarding short-term objective pelvic organ prolapse. Although we foundstatistically a significant difference in vaginal lengths between the two groups, no clinical significance was found in terms of sexual function

The effect of anesthetic agents used in oocyte collection on intracytoplasmic sperm injection results in patients treated for infertility due to male factor

Aim: Different anesthetic methods and agents are used for transvaginal oocyte retrieval procedures (TORP) in assisted reproductive techniques (ART). In our study, we evaluated prospectively the effect of propofol and thiopental sodium during TORP on intracytoplasmic sperm injection (ICSI) results in the spouses of patients with male factor indication.Material and Methods: The study was approved by the ethics committee with Protocol No. 2019-21-07 on dated October 28, 2019. Sixty female patients who underwent TORP for intracytoplasmic sperm injection were included in the study. Anesthesia was randomized into two groups according to propofol (GP) or thiopental sodium (GT) used for induction and maintenance anesthesia. Patients' demographic data, effects of the anesthetic drug used on hemodynamics and nausea and vomiting, laboratory parameters including fertilization rate, cleavage rate, optimal embryo rate and implantation rate, and pregnancy outcomes were recorded.Results: Sixty patients, including the propofol group (n:30) and the thiopental sodium group (n:30), were evaluated. Mean age, body mass index and motile sperm count were similar in both groups. Mean arterial pressures and nausea and vomiting rates were lower in GP (p<0.05). Although intracytoplasmic sperm injection, pronucleus, MII oocyte values were statistically significantly higher in GP, B-HCG and clinical pregnancy outcomes were similar in both groups.Discussion: Our findings revealed that propofol and thiopental sodium, the anesthetic agents used in transvaginal oocyte collection procedure before ICSI treatment, had similar effects on clinical pregnancy. The results of our study are similar to many studies in the literature

A novel biochemical marker-OKL38- with its apoptotic and antioxidant properties for the development of PCOS and its related clinical implications

Aim: To investigate the role of serum OKL38 levels in the development of polycystic ovary syndrome (PCOS) and clinical implications related to PCOS. Method: PCOS (n = 33) and ovulatory controls (n = 48) were recruited for the study. Anthropometric measurements were recorded, and blood samples for hormonal and biochemical parameters including serum OKL38 levels were obtained. The potential role of OKL38 on the development of PCOS, metabolic syndrome and cardiovascular disease (CVD) were investigated. Framingham risk score (FRS) was used for the determination of CVD risk. Results: Mean Ferriman-Gallway (FG) score, insulin, low-density lipoprotein (LDL), total cholesterol (TC) levels, and the homeostasis model assessment of insulin resistance index (HOMA-IR) were significantly increased (p < .05) in women with PCOS compared to controls. PCOS group had lower mean OKL38 level compared to controls (p < .0001) and OKL38 was negatively predictive for the diagnosis of PCOS after adjustment of variables that were significantly different between two groups. A negative association between OKL38 and metabolic syndrome in PCOS women was evident after adjustment for age, obesity, and abdominal obesity. OKL38 level was also negatively correlated with body mass index, waist-to-hip-ratio, fat composition, serum TC, LDL, free testosterone levels, FRS, and FG scores. Conclusion: OKL38 may have a partial role in the etiopathogenesis of PCOS and may protect development of metabolic syndrome and CVD in women with PCOS

What is new in peripartum hysterectomy? A seventeen year experience in a tertiary hospital

Objective: To identify changing trends in peripartum hysterectomy (PH), both elective. cesarean hysterectomy and emergency cesarean hysterectomy, at a single training and research hospital over the last 17 years in Istanbul, Turkey. Materials and methods: A retrospective cohort study was performed between January 2001 and September 2017. The records of all patients who had PH at Kanuni Sultan S & uuml;leyman Training and Research Hospital were analyzed. Results: There were 243 cases of PH during the study period. A total of 266,386 births occurred, of which 60.1% were vaginal deliveries and 39.8% were cesarean sections. The incidence of PH increased from 0.67 per 1000 deliveries to 1.14 per 1000 deliveries during 2001-2008 and 2009-2017, respectively, with an overall incidence of 0.91 per 1000 deliveries during the 17 years. The main indication for PH changed significantly during this time from uterine atony (57.1%) to placenta accreta spectrum (85%). About 37% of women who underwent PH had at least one previous cesarean delivery during 2001-2008, whereas that percentage increased to 95.4% during 2009-2017. Conclusion: Placenta accreta spectrum was the leading cause of PH and was associated with significant maternal morbidity and mortality

Testis spectroscopy may predict sperm retrieval rate in men with non-obstructive azoospermia undergoing micro-TESE: A pilot study

Objective: To investigate whether prior testis magnetic resonance spectroscopy predicts the success or failure of micro-dissection testicularsperm extraction (micro-TESE) in patients with non-obstructive azoospermia (NOA).Material and Methods: Nine men with NOA who were scheduled for micro-TESE for the first time, 9 NOA men with a history of previousmicro-TESE and 5 fertile men were enrolled. All NOA patients and fertile controls underwent testis spectroscopy. A multi-voxel spectroscopysequence was used. Testicular signals of choline (Cho), creatine (Cr), myo-inositol (MI), lactate, and lipids were analyzed quantitatively andcompared with the results of the micro-TESEs.Results: The most prominent peaks were Cho and Cr in the fertile controls and NOA subjects with positive sperm retrieval in the micro-TESE. Ahigh Cho peak was detected in 87% of the NOA men with positive sperm retrieval. NOA men without sperm at the previous micro-TESE showeda marked decrease in Cho and Cr signals. For positive sperm retrieval in micro-TESE, the cut-off value of Cho was 1.46 ppm, the cut-off value ofCr was 1.43 ppm, and the cut-off value of MI was 0.79 ppm.Conclusion: Testis spectroscopy can be used as a non-invasive screening method to predict the success or failure of micro-TESE. (J Turk GerGynecol Assoc 2020; 21: 70-8)WOS:00054031000000

Characteristics of total laparoscopic hysterectomy among women with or without previous cesarean section: retrospective analysis

ABSTRACT BACKGROUND: The number of hysterectomized patients with previous cesarean sections (CSs) has increased due to increasing CS rates. A previous history of CS has been demonstrated to be an important risk factor for major complications in total laparoscopic hysterectomy. The aim here was to evaluate the major complications and safety of TLH in patients with previous CS. DESIGN AND SETTING: Retrospective analysis in a tertiary-level center. METHODS: The medical records of 504 total laparoscopic hysterectomy patients operated between May 2013 and May 2017 were reviewed retrospectively. Data on age, parity, surgical indications, duration of operation, length of hospital stay, histopathological diagnosis and major intra and postoperative complications were gathered. The patients were categorized into two groups according to their CS history, namely those with and those without previous CS. Major complications were defined as the presence of lower urinary tract injury (bladder or ureter injury), enterotomy/colostomy, bowel serosal injury or vascular injury. RESULTS: There was no difference between the groups in terms of parity, duration of operation, hospital stay or pre and postoperative hemoglobin levels. The conversion rates to laparotomy in the previous CS and no CS groups were 2% and 1.7%, respectively. The rates of major complications in the previous CS and no CS groups were 5% and 1.3%, respectively, and these results did not differ significantly (P > 0.05). CONCLUSION: TLH could be performed safely in the previous CS group, since the complication rate was not different from that of the patients without previous CS

Skin closure at cesarean section, polypropylene versus polyglactin 910: A randomized controlled study

Aim: To compare the rates of surgical wound infection in women who have undergone cesarean delivery with subcuticular skin closure with polyglactin 910 or polypropylene. Methods: Between April 2018 and October 2018, patients who had undergone a cesarean delivery for any reason were randomized with polyglactin 910 or polypropylene for subcuticular skin closure. Participants were evaluated for wound complications on day 7 and 30 postoperatively. The primary outcome was surgical site infection within the first 30 days following delivery. In addition, factors affecting surgical site infections were analyzed by binary regression. Results: A total of 220 women who had undergone cesarean delivery were randomized and 213 were included in the final analysis. The groups were similar in terms of demographic characteristics and perioperative features. No statistically significant difference was observed between the groups in terms of wound complications or superficial site infections (8.3% in the polypropylene group versus 10.6% in the polyglactin 910 group, p = .642). Similarly, no difference was observed between the groups in terms of other wound complications. A binary logistic regression analysis indicated that superficial wound site infection was not affected by gravidity, BMI, duration of operation, repeated or unplanned cesarean delivery. Conclusion: It was observed that surgical site infections and other wound complications in skin closures with polyglactin 910 were similar to those with polypropylene