Berna Haliloglu

Comparison of TVT and TVT‐O in patients with stress urinary incontinence: Short‐term cure rates and factors influencing the outcome. A prospective randomised study

Background: Recently, mid‐urethral slings have been commonly used in treatment of patients with stress urinary incontinence (SUI).

Intestinal vaginoplasty: seven years' experience of a tertiary center

OBJECTIVE To investigate the long-term effects of intestinal vaginoplasty in cases with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. DESIGN Prospective study. SETTING Division of Pelvic Reconstructive Surgery, Department of Gynecology and Obstetrics, at a womens and children disease education and research hospital. PATIENT(S) Between 2003 and 2009, 29 patients with MRKH syndrome underwent intestinal vaginoplasty. INTERVENTION(S) Two of the patients were treated with ileal and 27 with sigmoid vaginoplasty. MAIN OUTCOME MEASURE(S) The age, marital status, associated anomalies, method used for bowel transposition (isoperistaltic/antiperistaltic), type of abdominal incision, and intra- and postoperative complications were evaluated. RESULT(S) One of the patients for whom ileal vaginoplasty was performed had 40 cm ileal necrosis requiring bilateral ileostomy for 2 months. Introital stenosis was detected in 15 cases (79%) who were unmarried, while none of the married cases had introital stenosis. However, all patients responded to finger-dilatation. All married patients were sexually satisfied after operation. An intraluminal abscess developed in the proximal segment of the neovagina owing to stricture occurring above abdominoperineal tunnel 2 years after operation. In another patient who had a rudimentary uterine horn, hematometra developed 3 years after operation and treated with resection. CONCLUSION(S) In our experience, sigmoid vaginoplasty seems to be a favorable procedure which provides excellent long-term results for the patients with vaginal agenesis.

Erratum to: Relationship between bone mineral density, bone turnover markers and homocysteine, folate and vitamin B12 levels in postmenopausal women

Purpose We aimed to investigate whether levels of homocysteine (Hcy), folate, and vitamin B12 are related to bone turnover markers and bone mineral density (BMD) in postmenopausal women.

Effects of estradiol–drospirenone on ocular and nasal functions in postmenopausal women

Background Hormones may have an impact on the incidence and course of dry-eye syndrome, and also nasal obstruction, especially in postmenopausal women. The aim of this study was to investigate the effects of drospirenone 2 mg + estradiol 1 mg (Angeliq®, Bayer AG, Berlin, Germany) on ocular functions and nasal airflow in postmenopausal women. Methods Thirty-four postmenopausal women were recruited for the study. A questionnaire on ocular surface disease index (OSDI) was administered; after routine ophthalmologic examination, tear film break-up time (TBUT) and Schirmer tests were performed. Intraocular pressure was measured with a Goldmann applanation tonometer. Nasal airflow resistance values were measured using rhinomanometry. Participants were submitted to oral daily treatment with drospirenone 2 mg + estradiol 1 mg. The duration of the study was 6 months and the participants were studied in the basal condition and after 6 months of therapy. Results The OSDI score and intraocular pressure were significantly higher before treatment than after treatment (p < 0.001); however, the results of the TBUT and Schimer test were significantly lower (p < 0.05). Rhinomanometric values were better during drospirenone 2 mg + estradiol 1 mg therapy than those observed at baseline (p < 0.001). Conclusions Oral daily treatment with drospirenone 2 mg + estradiol 1 mg reduces the risks for ocular diseases and nasal obstruction in postmenopausal women.

Comparison of uterine artery blood flow with levonorgestrel intrauterine system and copper intrauterine device

BACKGROUND As a contraceptive method, we investigated whether the levonorgestrel-releasing intrauterine system (LNG-IUS) has any effect on uterine artery blood flow when compared with copper intrauterine device (IUD). STUDY DESIGN Sixty women with copper IUD and 60 women with LNG-IUS were included in the study. The age, gravidity, parity, body mass index (BMI) and menstrual flow pattern using a pictorial chart were recorded. All women were assessed by ultrasonography at the preinsertion period and 1 year after insertion. The pulsatility and resistance indices (PI and RI, respectively) of the uterine artery and endometrial thickness were evaluated in the preinsertion and postinsertion periods. RESULTS In copper IUD users, preinsertion and postinsertion ultrasonographic assessments were not significantly different. However, postinsertion RI was significantly higher compared with preinsertion RI in LNG-IUS users (p=.001). The PI was also increased 1 year after insertion, but it did not reach statistically significant levels (p=.08). Endometrial thickness was also significantly decreased in the postinsertion period in women with LNG-IUS (p=.04). CONCLUSION The significant increase in uterine artery RI in LNG-IUS users 1 year after insertion might be due to its local progestational effects. It might also indicate the mechanism of the LNG-IUS in reducing menstrual blood flow.

Subjective versus objective measurement of surgical outcomes of treatment of female stress urinary incontinence: it is not just black and white

Stress urinary incontinence (SUI) is encountered in as many as 20% of women with adverse social and hygienic consequences [1]. Recently, most studies have shown that the majority of surgical procedures, particularly the minimally invasive midurethral slings, are both safe and effective treatment of female SUI. However, the success rates reported varied between studies, depending on whether objective or subjective outcomes had been measured. The postoperative objective and subjective cure rates were not also correlated in most of these studies. For example, a recent review gives a very wide range of short-term success rates of various surgical procedures for treatment of female SUI, from 32% to 100% [1]. It is extremely important that comparison of the results of surgical treatment of SUI between different surgeons and centers as well as patient counseling is based on robust scientific evidence that includes valid and accurate assessment of the treatment outcome. It seems timely, therefore, to discuss this topic further mainly by addressing three main questions: What do we mean by surgical cure of SUI? How do we measure this cure? What is the definition of success of operative intervention for SUI? There has been a lack of consensus in the urogynecologic community about which postoperative outcomemeasure to use to evaluate the efficacy of surgical procedures for SUI. Castillo et al. [2] analyzed 91 surgical series of SUI and reported that 33% of these studies used only subjective measures, 4% only objective measures, and 63% both objective and subjective measures, for the definition of “cure.” Not surprisingly, therefore, the cure rates of the same surgical procedure for SUI differed among these studies. A universal definition of cure is thus obviously needed for accurate interpretation of cure rates when surgical treatment of SUI is contemplated. Surgeons tend to define the cure of SUI as the successful anatomical repair of defective tissue support of the urethra measured by objective improvement in urinary incontinence. As a direct result, earlier studies of surgical treatment of SUI focused on objective outcomes for measurement and definition of “surgical” cure. However, these measures tend to underestimate the impact of lower urinary tract symptoms on social limitations and emotional well-being of the woman [3]. Patients may have completely different expectations of cure after surgery for SUI other than the anatomical cure, such as absence of odor, lack of disruption of routine activities, use of less pads, and/or improvement of emotional status. For patients, the improvement of these symptoms might be more important than the “objective” demonstration of leakage of urine. In fact, a number of patients who are considered as objectively cured from SUI might even feel worse following the operation due to surgery-induced negative outcomes such as de novo urge urinary incontinence or intermittent selfcatheterization because of voiding dysfunction. Conversely, some patients who are considered not to be objectively cured by surgeons are satisfied with the outcome following the B. Haliloglu Department of Obstetrics and Gynecology, Faculty of Medicine, Maltepe University, Istanbul, Turkey

Negative correlation between D-dimer and homocysteine levels during pregnancy and the postpartum period: a prospective study

OBJECTIVE There have been conflicting data about the role of increased levels of homocysteine (Hcy) on haemostatic system. We aim to investigate prospectively the relation between serum Hcy levels and changes in haemostatic system in pregnancy and postpartum period. STUDY DESIGN Sixty-eight healthy pregnant women were included in the study. Blood samples were obtained in the 11th gestational week, 25th gestational week, 32nd gestational week and postpartum 4th week. The haemoglobin levels, white blood cell count (WBC), platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen, D-dimer, Hcy, vitamin B12, and folate levels were measured. RESULTS Serum Hcy levels were negatively correlated with D-dimer levels (r = -0.57, p < 0.0001). The highest levels of D-dimer (1046.62 ± 322.01 ng/ml) were achieved in the third trimester and the lowest levels of serum Hcy (4.45 ± 1.23 mmol/l) were detected in the same trimester. In postpartum fourth week, D-dimer levels were decreased to normal levels (238.27 ± 198.59 ng/ml) while the serum Hcy levels were reached to the highest levels (7.99 ± 1.36 mmol/l). CONCLUSION The negative correlation between Hcy and D-dimer levels may be a compensatory mechanism to maintain the normal haemostatic balance in pregnancy. Hence, possible advantage of low Hcy levels in pregnancy may be to prevent undesired thrombosis.

Pure 46,XY Gonadal Dysgenesis (Swyer Syndrome) with Breast Development and Secondary Amenorrhea

55% of these patients [2, 4] . These neoplasms, especially gonadoblastomas, usually have hormonal (estrogen) secretion which can cause breast development after the normal age of puberty. Also, some ovarian follicles may persist and function at puberty in 46,XY phenotypic females who undergo spontaneous puberty and experience menarche. However, most of the patients with Swyer syndrome have neither breast development nor menarche experience.

Evaluation of carotid wall thickness and vertebro-basilar system insufficiency in patients with obese polycystic ovary syndrome

Aim:  To investigate the risk of cardiovascular disease by measuring carotid intima‐media thickness (CIMT) and to evaluate the diameters and blood flow volume of vertebral arteries using Doppler ultrasound and the possible contribution of hyperandrogenemia that exists in these patients.

Fluid intake and voiding parameters in asymptomatic Turkish women

Introduction and hypothesisFor an accurate evaluation of bladder diaries, we aim to investigate normal urinary habits and determining factors on functional bladder capacity, frequency, and 24-h volume in the bladder diaries of asymptomatic women.MethodsOne-hundred and fifteen asymptomatic women who recorded a 24-h bladder diary were included in the study. Linear regression analyses were used to explore associations between diary values and patient characteristics.ResultsTotal number of voids was related to age, body mass index, total voided volume, total fluid intake, total diuresis rate, and maximum fluid intake in one go. Maximum, average, and minimum volumes per void were found to be related to body mass index, total voided volume, total fluid intake, total diuresis rate, and maximum fluid intake. When we used multiple regression analysis, only maximum fluid intake was found to be related to the total number of voids, maximum, average, and minimum volumes per void.ConclusionsMaximum fluid intake rather than total voided volume seems to be an important determinant factor for total number of voids and functional bladder capacity.