Cetin Cam

Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data

OBJECTIVE To determine whether the use of vaginal progesterone in asymptomatic women with a sonographic short cervix (≤ 25 mm) in the midtrimester reduces the risk of preterm birth and improves neonatal morbidity and mortality. STUDY DESIGN Individual patient data metaanalysis of randomized controlled trials. RESULTS Five trials of high quality were included with a total of 775 women and 827 infants. Treatment with vaginal progesterone was associated with a significant reduction in the rate of preterm birth <33 weeks (relative risk [RR], 0.58; 95% confidence interval [CI], 0.42-0.80), <35 weeks (RR, 0.69; 95% CI, 0.55-0.88), and <28 weeks (RR, 0.50; 95% CI, 0.30-0.81); respiratory distress syndrome (RR, 0.48; 95% CI, 0.30-0.76); composite neonatal morbidity and mortality (RR, 0.57; 95% CI, 0.40-0.81); birthweight <1500 g (RR, 0.55; 95% CI, 0.38-0.80); admission to neonatal intensive care unit (RR, 0.75; 95% CI, 0.59-0.94); and requirement for mechanical ventilation (RR, 0.66; 95% CI, 0.44-0.98). There were no significant differences between the vaginal progesterone and placebo groups in the rate of adverse maternal events or congenital anomalies. CONCLUSION Vaginal progesterone administration to asymptomatic women with a sonographic short cervix reduces the risk of preterm birth and neonatal morbidity and mortality.

Vaginal progesterone vs cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix, previous preterm birth, and singleton gestation: a systematic review and indirect comparison metaanalysis

OBJECTIVE No randomized controlled trial has compared vaginal progesterone and cervical cerclage directly for the prevention of preterm birth in women with a sonographic short cervix in the mid trimester, singleton gestation, and previous spontaneous preterm birth. We performed an indirect comparison of vaginal progesterone vs cerclage using placebo/no cerclage as the common comparator. STUDY DESIGN Adjusted indirect metaanalysis of randomized controlled trials. RESULTS Four studies that evaluated vaginal progesterone vs placebo (158 patients) and 5 studies that evaluated cerclage vs no cerclage (504 patients) were included. Both interventions were associated with a statistically significant reduction in the risk of preterm birth at <32 weeks of gestation and composite perinatal morbidity and mortality compared with placebo/no cerclage. Adjusted indirect metaanalyses did not show statistically significant differences between vaginal progesterone and cerclage in the reduction of preterm birth or adverse perinatal outcomes. CONCLUSION Based on state-of-the-art methods for indirect comparisons, either vaginal progesterone or cerclage are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the mid trimester, singleton gestation, and previous preterm birth. Selection of the optimal treatment needs to consider adverse events, cost and patient/clinician preferences.

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.

Postpartum sexual function of women and the effects of early pelvic floor muscle exercises

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.

Validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in a Turkish population

OBJECTIVE To validate the Turkish translated version of short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). STUDY DESIGN After the test-retest reliability and internal consistency were established in a pilot study, 270 patients were enrolled and general and subscale scores of the questionnaire were calculated. All participants underwent the International Continence Society (ICS) prolapse score (POP-Q) and urodynamic assessment. Main scores and scores of Prolapse Quality of Life questionnaire (PQoL) and Incontinence Impact Questionnaire (IIQ-7) were compared between patients with incontinence+/-prolapse and asymptomatic women. RESULTS 62.24% of the participants showed urodynamic abnormality and/or leakage with or without prolapse. 28.91% had prolapse stage 3 or higher diagnosed by the POP-Q system. PISQ-12 showed a high internal consistency (Cronbachs alpha was 0.89). For test-retest reliability Spearmans rho was 0.72-0.79 for all domains. The mean scores of PISQ-12 were significantly better in asymptomatic women compared with the incontinence+/-prolapse group. Sexual function was negatively affected by prolapse and/or incontinence as assessed with PQoL and IIQ-7 questionnaires. CONCLUSION The Turkish translated version of the PISQ-12 is a reliable, consistent and valid instrument to evaluate sexual functioning in women with urinary incontinence and/or pelvic organ prolapse. It is easy to understand that it may be easily administered and self-completed by the women.

Effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state.

OBJECTIVE Our aim was to investigate the effects of urinary incontinence subtypes on womens quality of life (including sexual life) and psychosocial state. STUDY DESIGN The patients, who applied to our clinic from March 2011 to August 2011, were identified and stratified into three groups: those with stress incontinence proved urodynamically (USI), those with urge incontinence (UI), and those with mixed incontinence urge incontinence (UI) proved by urodynamic and clinic evaluation. Scores on the Beck anxiety inventory (BAI), pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), urogenital distress inventory (UDI-6), and incontinence impact questionnaire (IIQ-7) were compared between the urinary incontinence subtypes. RESULTS According to urodynamic and clinical examination of 111 women with urinary incontinence, 59 (53%) had USI, 35 (32%) had UI, and 17 (15%) had MI. BAI-scores significantly differed between the USI and UI groups (p=0.030) and between the USI and MI groups (p=0.011) not between the UI and MI groups (p=0.597). UDI-6 scores did not significantly differ between the three groups (p=0.845). IIQ-7 scores significantly differed between the USI and MI groups (p=0.003) and between the UI and MI groups (p=0.006) but not between the USI and UI groups. Patients with USI had significantly lower PISQ-12 scores than those with UI (p=0.015). CONCLUSIONS These differences in the effects of incontinence subtypes should be kept in mind in the evaluation of patients with urinary incontinence. Psychiatric assessment may improve the management of incontinence in women, especially UI and MI.

Inguinal herniorrhaphy in childhood may result in tubal damage and future infertility.

IntroductionInguinal hernias commonly occur during infancy. They are approximately six times more common in males than in females. They are one of the most common surgical conditions in childhood. About 5–20% of inguinal hernias have the ovary or fallopian tube in the hernia sac. Surgical interventions during childhood may cause damage. Unawareness of this damage can cause infertility in future.Case reportPresentation of a case diagnosed as having tubal damage during laparoscopic operation because of primary infertility with a history of inguinal hernia during her childhood. Inguinal hernia repair caused tubal damage and bilateral tubal occlusion as a cause of primary infertility.ConclusionMedical history is of great importance during infertility investigation and may reveal some unexpected conditions.

Acute pancreatitis associated with hypertriglyceridemia: a life-threatening complication

Acute pancreatitis is rare cause in pregnancy and gallstones are clearly the most common cause of pancreatitis during pregnancy. Only a small percentage of women with acute pancreatitis are associated with hypertriglyceridemia and it is most often noted during the last two trimesters of pregnancy. Hypertriglyceridemia is a rare cause of pancreatitis in pregnant women and complication such as pancreatitis carries a higher risk of mortality for both the mother and the fetus. Our purpose was to report our experience with acute pancreatitis as a lethal complication of hypertriglyceridemia during the third trimester of pregnancy.

Fistula campaigns--are they of any benefit?

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.