Mülazım Yildirim

Transvaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse

Objective: The transvaginal sacrospinous ligament fixation technique was used as part of the vaginal repair procedure for marked uterovaginal prolapse, and in the treatment of vault prolapse. Method: Out of the 26 women treated with sacrospinous ligament suspension of the vaginal vault, 23 had marked uterovaginal prolapse and three had vault prolapse following hysterectomy. Patients with vault prolapse underwent posterior vaginal repair, obliteration of the enterocele sac and sacrospinous colpopexy. Patients with marked uterovaginal prolapse underwent vaginal hysterectomy with high ligation of the enterocele sac, anterior and posterior vaginal repair, and sacrospinous colpopexy. Bilateral salpingoopherectomy was added to the procedure in five patients. All patients were examined 6 weeks after the operation and, subsequently, on an annual basis. The mean follow‐up period was 2.6 years (1–5 years). Results: Out of the three patients with previous vault prolapse, none had recurrences. Out of the 23 patients with previous marked uterovaginal prolapse, only two had small cystocele, and one had small enterocele at 36 months following the operation. These patients were asymptomatic and did not need an operation. Vaginal vault prolapse was not observed in any of these patients. Two women had post‐operative urinary tract infection and five had buttock discomfort, which subsided after 2 months. No other intra‐ or post‐operative complications occurred. Conclusion: Transvaginal sacrospinous colpopexy can be performed together with vaginal hysterectomy, and anterior and posterior vaginal wall repair in patients with marked uterovaginal prolapse because of its high success in avoiding possible vault prolapse, and low intra‐ and post‐operative complication rates.

Serum leptin levels in patients with polycystic ovary syndrome

OBJECTIVE To determine whether polycystic ovary syndrome (PCOS) is related to leptin dysregulation. DESIGN Prospective study. SETTING Department of Obstetrics and Gynecology in a university hospital. PATIENT(S) Fifty patients with PCOS (33 nonobese and 17 obese) and 32 control women (19 nonobese and 13 obese) were included in the study. INTERVENTION(S) Serum leptin levels were measured in patients with PCOS and the controls. Correlations between leptin levels and serum hormone levels (FSH, LH, free testosterone, androstenedione, DHEA-S and fasting insulin) were studied. MAIN OUTCOME MEASURE(S) Serum leptin levels and correlations between leptin levels and the hormonal parameters. RESULT(S) Mean serum leptin levels were not significantly higher in patients with PCOS compared to the control group. Leptin levels were found to be significantly higher in the obese subgroups both in patients with PCOS and in the control women. Leptin levels were found to be higher in obese patients with PCOS compared to obese controls; however, when the levels were evaluated again with covariance analysis excluding body mass index, there was no statistically significant difference. Leptin levels had a positive correlation with body mass index, both in patients with PCOS and the controls. CONCLUSION(S) Leptin levels were not higher in patients with PCOS compared to the control group; the leptin level was correlated with the amount of fat tissue not only in patients with PCOS but also in healthy women.

The changes in ovarian hormone levels and ovarian artery blood flow rate after laparoscopic tubal sterilization

OBJECTIVE To investigate the changes in serum ovarian hormone levels and ovarian artery blood flow rate by Doppler ultrasonography following laparoscopic tubal sterilization. METHODS Laparoscopic tubal sterilization have been performed on 13 voluntary subjects between the sixth and eighth days of the menstrual cycle. Serum ovarian hormone levels and ovarian artery blood flow rate, by Doppler ultrasonography, were determined 3 days before the operation, on the post-operative third day and on the post-operative third month. The results of 10 participants who finished the follow-up period were analyzed. RESULTS There were no statistically significant changes in serum levels of ovarian hormones after laparoscopic tubal ligation. The end-diastolic blood flow in ovarian artery was found to be decreased following tubal sterilization (8.7+/-2.8 and 7.4+/-1.8m/sec, respectively, P>0.05), while resistivity index (RI) increased after the operation (0.7+/-0.1 and 0.8+/-0.03, respectively, P>0.05). CONCLUSION There was no change in ovarian hormone levels after laparoscopic tubal sterilization. There is slight but statistically non-significant decrease in ovarian artery blood flow rate following tubal sterilization, signifying a local increase in vascular resistance.

Surgical Treatment of Urinary Stress Incontinence by a Suburethral Sling Procedure Using a Mersilene Mesh Graft

A suburethral sling procedure using a Mersilene mesh has been performed in 24 patients. Six patients had recurrent incontinence after an unsuccessful past operation. A postoperative follow-up was done for an average of 24 months. Twenty-three patients were free of symptoms, while only 1 patient had recurrent incontinence. The suburethral sling procedure can be applied to all patients, particularly for recurrent stress urinary incontinence, with reasonable cure rates when performed with a proper technique.

Comparison of microlaparoscopy and conventional laparoscopy for tubal sterilization under local anesthesia with mild sedation.

STUDY OBJECTIVE To compare tubal sterilization performed by microlaparoscopy and conventional laparoscopy. DESIGN Prospective, randomized trial (Canadian Task Force classification I). SETTING Gazi University School of Medicine. PATIENTS Twenty women undergoing surgical sterilization. INTERVENTION Ten sterilizations by conventional laparoscopy and 10 by microlaparoscopy. MEASUREMENTS AND MAIN RESULTS The techniques were comparable in quality of visualization, operating time, amount of drugs used for sedation and local anesthesia, and intraoperative pain scores. However, the postoperative analgesic requirement was significantly less in women treated by by microlaparoscopy. CONCLUSION Tubal sterilization by microlaparoscopy does not differ greatly from conventional laparoscopic sterilization.

Adenomatoid tumor of the uterus in a patient with chronic renal failure

A case of adenomatoid tumor of the uterus in a 34-year-old patient, who had received a renal transplant and was undergoing immunosuppresive therapy is presented. At surgery, there were a total of eight nodular intramural and subserous masses thought to be leiomyoma nodules, and tumor excision was unusually, hardly performed because the nodules were strictly adherent to the myometrium. All the specimens yielded the same pathological diagnosis - adenomatoid tumor. This case is unusual because of the multiple nodular pattern and its association with the immunocompromised status of the patient. Although adenomatoid tumors have not been shown to recur, we are in doubt in our case, because the uterus is still intact and the immunocompromised status of the patient might have a role in the extensive growth and also in the possibility of recurrence.

Cardiovascular risk assessment with oxidised LDL measurement in postmenopausal women receiving intranasal estrogen replacement therapy

Objective. To investigate the effect of intranasal estrogen replacement therapy administered to postmenopausal women alone or in combination with progesterone on markers of cardiovascular risk. Methods. The study was conducted with 44 voluntary postmenopausal women. In group I (n = 15), the patients were treated with only intranasal estradiol (300 μg/day estradiol hemihydrate). In group II (n = 11), the patients received cyclic progesterone (200 mg/day micronized progesterone) for 12 days in each cycle in addition to continuous intranasal estradiol. Group III (n = 18) was the controls. Serum lipid profiles, oxidised low-density lipoprotein (LDL) and other markers of cardiovascular risk were assessed at baseline and at the 3rd month of the treatment. Results. Lipid profile, LDL apolipoprotein B, lipoprotein a, homocysteine, oxidised LDL values and oxidised LDL/LDL cholesterol ratio were not observed to change after 3 months compared to baseline values within each group (p > 0.016). In comparison to changes between the groups after the treatment, only oxidised LDL levels and oxidised LDL/LDL cholesterol ratios of group II were increased compared to control group (p < 0.05). Conclusions. Intranasal estradiol alone did not appear to have an effect on markers of cardiovascular risk in healthy postmenopausal women. However, the addition of cyclic oral micronized progesterone to intranasal estradiol influenced the markers of cardiovascular risk negatively in comparison to non-users in healthy postmenopausal women.

Ovarian wedge resection by minilaparatomy in infertile patients with polycystic ovarian syndrome: a new technique

OBJECTIVE To determine the effects of ovarian wedge resection by minilaparotomy in infertile patients with polycystic ovarian syndrome (PCOS). STUDY DESIGN One hundred and thirty-four anovulatory patients with PCOS, who were previously treated with clomiphene citrate and gonadotropins and did not conceive were operated via minilaparotomy with microsurgical principles and ovarian wedge resection was performed on each subject. Pregnancy rates and adhesion formation were investigated retrospectively. RESULTS A total of 121 pregnancies were achieved in 2 years (90%). One hundred and four patients conceived within the first 6 months (78%) and the remaining 17 patients conceived within 2 years (13%) following the operation. Sixty-eight patients had a second pregnancy later. In the post-operative period, 24 patients had cesarean delivery and 20 had diagnostic laparoscopy. Out of these 44 patients, only 5 of them were found to have minimal adhesions. CONCLUSION This technique offers high pregnancy rates and minimal adhesion formation. Ovarian wedge resection by minilaparotomy might be an alternative treatment approach in patients with PCOS who did not conceive with standard ovulation induction protocols.

Effects of a monthly injectable steroidal contraceptive, Mesigyna, on menstrual pattern, lipoproteins, and coagulation parameters.

The objective of this study was to determine the effects of a once-monthly injectable contraceptive (Mesigyna) on menstrual pattern, lipoproteins, and coagulation parameters. Thirty-six women aged 18-35 years requesting monthly injectable contraception were included. Before injecting estradiol valerate 5 mg and norethisterone enanthate 50 mg, coagulation, lipoprotein, and liver function parameters were determined. After the 3- and 6-month injections, the same coagulation and serum lipid measurements and liver function tests were repeated, and women were questioned about their menstrual patterns and side effects. Thirty women who completed 6 months were evaluated. At the end of 3 months, two-thirds of the 30 women had normal menstrual patterns; at the end of 6 months, 80% of the women had normal menses. Serum LDL, total cholesterol, and triglyceride levels did not change significantly, while HDL and VLDL decreased significantly (p = 0.032 and p = 0.039, respectively) at 6 months. PT and aPTT measures did not change at the end of 6 months, while fibrinogen levels were significantly lower (p = 0.013). Serum total bilirubin levels increased (p = 0.022) and albumin levels decreased (p = 0.022) at the end of 6 months. Mesigyna was well tolerated and side effects and menstrual abnormalities were acceptable. There were no clinically significant changes in lipoprotein, coagulation, or hepatic parameters.

Estrogen–progestagen pre-treatment before HMG induction in hypogonadotropic patients

Hypogonadotropic patients are candidates for ovulation induction when they desire fertility. This study aims to evaluate the effect of estrogen-progestagen combination pretreatment before ovulation induction by human menopausal gonadotropins. 30 infertile hypogonadotropic patients with no other pathological findings that might cause infertility except for anovulation participated in the study. After 3 months of pretreatment patients were given hMG monthly for at least four cycles unless pregnancy was achieved. 8 patients were lost to follow-up during the study period; the remaining 22 subjects who were pretreated with the estrogen-progestagen combination underwent a total of 63 cycles of hMG-hCG induction and all achieved pregnancy by the fourth cycle. It was observed that estrogen-progestagen pretreatment before hMG induction may result in higher ovulatory and pregnancy rates in hypogonadotropic patients probably due to a high estrogenic environment and new steroid receptor formation.