Fuat Demirci

Long-Term Results of Burch Colposuspension

The study included 220 women who had undergone Burch colposuspension. Group I (65 women) was studied prospectively and the mean follow-up was 1.5 years. Group II (155 women) was studied retrospectively and the mean follow-up was 4.5 years. The cure rate was 87.7% in group I and 77.4% in group II. The cure rate was significantly higher following the primary procedure than the secondary procedure. At follow-up, late complications in 220 women were: cystocele in 18; rectocele in 32; enterocele in 35; dyspareunia in 6, and groin or suprapubic pain in 15. In group I, of the 11 women with detrusor instability preoperatively, 10 were cured and in 1 detrusor instability persisted postoperatively. Two women had de novo detrusor instability. In conclusion, the cure rate of Burch colposuspension is satisfactory, although it declines a little with time. Women who had previous anti-incontinence surgery have a greater probability of recurrence. The procedure elevates the bladder neck into the abdominal cavity and stabilizes it. Surgical failure is related to inadequate elevation and stabilization of the bladder neck.

Comparison of pubovaginal sling and burch colposuspension procedures in type I/II genuine stress incontinence.

Abstract We compared morbidity and success rate of pubovaginal sling with Burch colposuspension operations in Type I/type II genuine stress urinary incontinence (GSI). The study included patients who had no preoperative detrusor instability (DI), no recurrent GSI, no severe pelvic prolapsus and whose Valsalva leak point pressure (VLPP) values were higher than 90 cm water. Twenty three of free-rectus fascial sling and 23 of Burch colposuspension operations were performed randomly on the patients by a single surgeon. There was no statistical difference between patients in terms of age, BMI, parity, number of daily pads used and preoperative bladder neck mobility. Operation time, change in hematocrit, spontaneous voiding time, length of hospitalization and urinary infection were not different in 2 procedures. 17 patients from both groups could be compared after one year. The bladder neck mobility of both groups were similar. One surgical failure, 1 DI, 1 severe cystocele and 1 enterocele were found in the Burch group while only 1 DI was found in the pubovaginal sling group. When pubovaginal sling operation was performed as the primary surgery on the patients with type I/II GSI, the morbidity, complications and 1 year success rate are the same as Burch procedure.

Primary Omental Pregnancy Presenting with Hemorrhagic Shock

Abdominal pregnancy is a very rare and serious type of extrauterine gestation that accounts for approximately 0.003% of all ectopic pregnancies. Omental pregnancy, an extremely rare form of abdominal pregnancy, can be primary or secondary to a tubal pregnancy that aborts out of the fimbria and reimplants in the peritoneal cavity. We present an additional case of primary omental pregnancy at 12 gestational weeks presenting with symptoms of hemoperitoneum and acute abdomen.

A Retrospective Review of Perioperative Complications in 360 Patients who had Burch Colposuspension

EDITORIAL COMMENT: We accepted this paper for publication because it reports a large experience with the Burch colposuspension operation and presents the complications encountered. It also provides a detailed review of the complications reported by others. In this series of 360 patients, 75.8% had an abdominal hysterectomy performed at the time of the Burch colposuspension. Our urogynaecologist reviewer tells us that this is a very high proportion of hysterectomies although there is a body of opinion that believes that a hysterectomy improves the results when the Burch operation is done in the treatment of women with genuine stress incontinence of urine. The incidence of hysterectomy has to be factored in to the data presented in this paper with regard to the complications that followed the operation. N.B.

Comparison of colour Doppler indices of pelvic arteries in women with bilateral hypogastric artery ligation and controls.

The aim of this study is to compare the blood flows of bilateral uterine, ovarian and arcuate arteries in patients who underwent bilateral hypogastric ligation (BHL), with the controls having similar characteristics. The S/D, the RI and the PI were measured on uterine, arcuate and ovarian arteries in 7 women with BHL and compared with 10 controls. There were not significant differences between the Doppler indices of the two groups. In conclusion, our study suggests that BHL preserves pelvic function and fertility.

The Effects of Abdominal Hysterectomy on Bladder Neck and Urinary Incontinence

We assessed the bladder neck (BN) by perineal ultrasonography of 39 patients before and 1 year after hysterectomy, and we compared them with 30 control cases in terms of stress urinary incontinence. We evaluated the BN position and mobility in the downwards and backwards directions. The bladder neck was found to be significantly lower at rest, in the downwards direction, in the postoperative period. The stress position of the BN was not significantly different. Its downwards mobility decreased, but not significantly. There was no significant difference in the location of the BN with respect to the pubis, at rest and during stress, in the backwards direction, between the preoperative and postoperative periods. Backwards mobility of the BN decreased significantly following hysterectomy. Stress incontinence was not significantly different between the study group and the control group after one year. We concluded that hysterectomy did not weaken urethral support and did not increase the rate of stress incontinence.

Transperineal versus transvaginal ultrasonographic evaluation of the cervix at each trimester in normal pregnant women

Aims: To compare transvaginal and transperineal ultrasonography in the assessment of cervical length and cervical changes in normal gravid patients at each trimester.

Effects of tibolone on blood flow resistance and intima-media thickness of the carotid arteries: effect of time since menopause.

Objective The aim of this prospective study was to evaluate the effects of tibolone on carotid atherosclerosis in healthy postmenopausal women. Methods Twenty-five healthy postmenopausal women were included in the study. Patients received tibolone 2.5 mg daily for 6 months. Resistance indices of the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA) and vertebral arteries, and intima-media thickness of the CCA were measured both at baseline and at the end of the study with ultrasonography. Results No significant differences were observed in the resistance indices of the CCA, ICA, ECA and vertebral arteries, as well as intima-media thickness of CCA at 6 months in comparison with baseline. Tibolone significantly improved the intima-media thickness of the CCA of women who were less than 18 months since menopause. Conclusion Overall, these results demonstrate no significant effects of tibolone on either intima-media thickness or blood flow resistance in the carotid arteries in postmenopausal women. However, the results suggest that tibolone may have a positive effect on the vascular system if commenced within 18 months since menopause; this warrants further investigation.

Perioperative Complications in Abdominal Sacrocolpopexy, Sacrospinous Ligament Fixation and Prolift Procedures

BACKGROUND Pelvic organ prolapse is an important problem for women. To overcome this issue, different operational technics are in use, such as abdominal sacrocolpopexy, sacrospinous fixation, and the total Prolift procedure. AIMS This study assessed perioperative complications in abdominal sacrocolpopexy, sacrospinous fixation, and the total Prolift procedure. STUDY DESIGN Retrospective comparative study. METHODS Perioperative complications were defined as any complication occurring during surgery or the first 6 weeks postoperatively. Forty-five patients underwent abdominal procedures, 60 patients underwent sacrospinous fixation, and 43 patients underwent the total Prolift procedure. RESULTS In the abdominal group, one bladder injury, four hemorrhages, and three wound dehiscences occurred. In the sacrospinous group, one rectal injury and one postoperative vault infection occurred. In the Prolift group, one bladder injury and one hemorrhage occurred. Minor complications were more frequent in the abdominal group than the others. The operating time and hospital stay of the abdominal group were significantly longer than the others. The Pro-lift procedure had less operating time and hospital stay than other procedures. CONCLUSION The total Prolift may be a novel alternative for apical prolapse with low perioperative morbidities and complications.

Does postoperative misoprostol use induce intestinal motility? A prospective randomised double-blind trial.

Background:  Misoprostol has been shown to increase colonic activity and decrease colonic transit time in chronic constipation patients.