Ahmet Onoglu

Role of Endometrial Suppression on the Frequency of Intrauterine Adhesions after Resectoscopic Surgery

STUDY OBJECTIVES To evaluate long-term effects of operative hysteroscopy on the development of intrauterine adhesions (IUA), and to determine whether hypoestrogenism has a modulatory role in preventing IUA. DESIGN Prospective, randomized study (Canadian Task Force classification I). SETTING Tertiary-care teaching hospital. PATIENTS Ninety-five women requiring resectoscopic surgery. Intervention. Hysteroscopic surgery using the resectoscope and 1.5% glycine for uterine distention. MEASUREMENTS AND MAIN RESULTS Indications for hysteroscopy were polyps (28 patients), solitary myoma (32), multiple myomata (20), and uterine septa (15). Patients in each group were randomized to endometrial suppression with danazol or placebo. Second-look office hysteroscopy with CO2 for uterine distention was performed after the first menses after surgery to assess the frequency, extent, and severity of IUA. The likelihood and severity of IUA depended on the pathology treated at initial surgery. Of women treated for polyps and uterine septa, in only one with septa (placebo group) developed IUA. Mild IUA formation was present in 10 patients (31.3%) with solitary fibroids and 9 (45.5%) with multiple myomata. The frequency was similar in placebo- and danazol-treated groups with both solitary and multiple myomas (50% and 44.4% vs 50% and 55.6%). All IUA were lysed during second-look surgery, except in one woman with multiple myomata who required repeat resectoscopy. CONCLUSION Intrauterine adhesions are the major long-term complication of operative hysteroscopy, with frequency dependent on the pathology initially treated. Second-look office hysteroscopy is a cost-effective method of diagnosing and lysing IUA after resectoscopy.

Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease

STUDY OBJECTIVE To compare the effects of microlaparoscopy and decreased CO2 exposure on peritoneal microcirculation and potential adhesion formation after ovarian surgery with those of conventional operative laparoscopy. DESIGN Prospective, randomized study (Canadian Task Force classification I). SETTING Teaching hospital. PATIENTS Eighteen women with polycystic ovary disease. INTERVENTIONS Microlaparoscopic or laparoscopic ovarian coagulation of the ovaries. MEASUREMENTS AND MAIN RESULTS Approximately 10 to 12 coagulation points were applied to each ovary. Two to 3 weeks after the initial surgery second-look microlaparoscopy was performed to determine the extent of adhesions in both groups. The frequency of adhesion formation and changes in glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels were studied in homogenized peritoneal tissues obtained during surgery in each group. RESULTS Clinical profiles were similar between groups. Mean exposure, amount, and pressure of CO2 were significantly less in the microlaparoscopy group (p <0.05). The laparoscopy group had significantly more adhesions than the microlaproscopy group (24% vs 48%, p <0.05). The GSH-Px, SOD, CAT, and GSH levels were significantly lower in the laparoscopy group (0. 425 micromol, 1.2 ng, 37.55 micromol, and 0.9 nmol vs 0.755 micromol, 2.l ng, 625 micromol, and 2.6 nmol, respectively). CONCLUSION Reduced exposure to and amount of CO2 during microlaparoscopy may result in decreased adhesion formation compared with conventional laparoscopy. This effect may possibly be due to lack of or minimal adverse effects on peritoneal microcirculation and cell-protective systems, which are proposed mechanisms for adhesion formation and closely related to peritoneal injury. In addition, microlaparoscopy may be a cost-effective alternative to conventional laparoscopy. (J Am Assoc Gynecol Laparosc 6(2):159-163, 1999)

Long-Term Histopathologic and Morphologic Changes after Thermal Endometrial Ablation

STUDY OBJECTIVE To outline long-term histologic features of endometrial ablation. DESIGN Prospective longitudinal study (Canadian Task Force classification II-3). SETTING Tertiary-care teaching hospital. PATIENTS Twenty-six patients. INTERVENTION Thermal ablation followed by second-look office hysteroscopy with endometrial biopsy. MEASUREMENTS AND MAIN RESULTS Mean follow-up time to second-look hysteroscopy after ablation was 33.4 +/- 2,1 months. Complete atrophy, partial adhesions or obliteration of the cavity, and fibrosis were observed at second-look hysteroscopy. Whereas all random biopsies were normal before ablation, biopsies after ablation revealed diminished endometrial glands with necrosis and scarring. The number of endometrial glands was not correlated with amount of bleeding or menstrual pattern. No premalignant or malignant lesions were found after ablation. CONCLUSION Although efficacy of endometrial ablation is related to initial thermal destruction and correlated with postablation hysteroscopic and histologic findings, endometrial regrowth is an expected development, not a failure of ablation.

Laparoscopic management of selected adnexal masses.

STUDY OBJECTIVE To investigate the significance, safety, and intraoperative and immediate postoperative outcomes of laparoscopic management of adnexal masses thought to be at low risk for malignancy. DESIGN Prospective cohort study (Canadian Task Force classification II-2). SETTING Tertiary-care teaching hospital. PATIENTS Two hundred twenty women undergoing laparoscopic surgery for adnexal masses. INTERVENTIONS Laparoscopic treatment including cystectomy, oophorectomy, adnexectomy, and peritoneal cytology, and, if necessary, frozen sections. A histologic diagnosis was obtained in every patient. MEASUREMENTS AND MAIN RESULTS Only one ovarian cancer and one borderline ovarian tumor were diagnosed by histologic examination, and both were managed by laparotomy. The remaining 218 patients had laparoscopy for benign adnexal masses. CONCLUSION Operative laparoscopy with the finding of incidental ovarian malignancy is rare, as shown by pathologic examination. With appropriate preoperative evaluation, laparoscopic surgery is technically feasible, safe, and advantageous, with minimal morbidity, and should replace laparotomy in the management of most adnexal masses. (J Am Assoc Gynecol Laparosc 6(3):313-316, 1999)

Comparison of the Clinical Efficacy and Safety of Flutamide versus Flutamide plus an Oral Contraceptive in the Treatment of Hirsutism

Objective: To compare the clinical, hormonal, biochemical and hemotological effects of flutamide versus flutamide plus an oral contraceptive (OC) in the treatment of hirsutism. Patients: Eighty-four women with hirsutism were equally randomized to receive either flutamide or flutamide plus OC. Design: Eighty-four women with hirsutism were recruited from patients presenting to our hospital. Each patient underwent a complete medical and gynecological examination as well as blood cell counts, biochemical and endocrine profiles. Hirsutism scores and laboratory tests were done during the 1st, 3rd and 6th months of therapy. Thirty-seven women in the flutamide group (taking 250 mg flutamide per day) and 32 women in the flutamide plus OC group (taking 250 mg flutamide plus 35 µg ethinyl estradiol and 2 mg cyproterone acetate per day) regularly followed the therapy regimens. Results: There were no significant differences in Ferriman-Gallway scores at the beginning and at the end of the therapies between the two groups (p > 0.05). At the 6th month, the decreases in Ferriman-Gallway scores were significant in both flutamide (from 18.95 ± 4.44 to 14.46 ± 5.02; p < 0.05) and flutamide plus OC groups (from 19.94 ± 4.31 to 15.58 ± 4.28; p < 0.05). In the first group, 2 of 6 oligomenorrheic women had regular cycles at the end of the therapy. Oligomenorrhea in 8 women was all changed to regular cycles in the flutamide plus OC group. Regarding the hormonal profile, only in the second group were prolactin, free testosterone and dehydroepiandrosterone sulfate levels significantly decreased (p < 0.05). Hepatic function tests were significantly increased in both groups, but they were all within normal ranges. Conclusion: These data suggest that both therapies were similarly effective and safe in the treatment of hirsutism. In women with oligomenorrhea and/or needing contraception, adding an OC shows better results than flutamide treatment alone in providing regular cycles.

The Effect of the Ovarian Endometrioma Surgery on Ovarian Reserve and Ovarian Blood Flow

1 Manolya Yılmaz1, Ahmet Uysal1,2, Ahmet Seçkin Önoğlu1, Fatma Uysal3, Cüneyt Eftal Taner1 1SB Ege Doğumevi ve Kadın Hastalıkları Eğitim Hastanesi, Kadın Hastalıkları ve Doğum, İzmir, 2Çanakkale Onsekiz Mart Üniversitesi, Kadın Hastalıkları ve Doğum ABD, Çanakkale, 3SB Ege Doğumevi ve Kadın Hastalıkları Eğitim Hastanesi, Radyoloji, İzmir, Türkiye Endometrioma Cerrahisinin Over Rezervi Üzerine Etkisi / Ovarian Reserve After Endometrioma Surgery The Effect of the Ovarian Endometrioma Surgery on Ovarian Reserve and Ovarian Blood Flow