Niyazi Tug

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.

Concomitant surgical correction of occult stress urinary incontinence by TOT in patients with pelvic organ prolapse.

OBJECTIVES To assess the post-operative urinary incontinence states of pelvic organ prolapse cases operated on with concomitant trans-obturator tape (TOT) procedure. STUDY DESIGN Urodynamic evaluation of 79 patients with pelvic organ prolapse, before and after operation, while reducing the prolapsed organs by ring forceps placed bilaterally on the anterolateral sulcuses avoiding urethral compression. According to urodynamic tests, 25 patients were diagnosed as having occult stress urinary incontinence. RESULTS Post-operative overactive bladder, stress urinary incontinence and mixed incontinence were found in three (12%), two (8%) and one (4%) patients of the occult stress urinary incontinence group, respectively. The corresponding numbers were six (11%), five (9%) and three (6%) in the continent group. No significant difference was found between the groups in terms of post-operative overactive bladder symptoms, stress urinary incontinence and mixed incontinence (Kruskal-Wallis test, X(2) = 0.52, p = 0.820). CONCLUSIONS This retrospective study suggests that a complete pre-operative urodynamic evaluation, including urodynamic tests at the time of POP reduction by placing ring forceps on the anterolateral sulcuses, is an efficient method for the diagnosis of occult symptomatic stress urinary incontinence (SUI). Prospective randomized studies are needed to establish the benefits and the risks of concomitant prophylactic surgery in patients with pelvic organ prolapse.

Validation of the Wexner scale in women with fecal incontinence in a Turkish population

Introduction and hypothesisThe main aim of this study was to validate the Turkish translated version of the Wexner scale.MethodsAfter establishing the test–retest reliability and internal consistency of the Turkish version of Wexner scale on 31 patients, total and subscale scores and anal manometric measurements of 60 participants were performed. Correlation between Wexner scale scores and manometric measurement values were analyzed and those values of patients with or without anal incontinence symptoms were compared.ResultsOf the 60 participants, 47 (78%) showed no signs or symptoms of anal incontinence. Wexner scale showed a high internal consistency (Cronbach’s alpha = 0.816). Total and each subscale score of Wexner scale showed strong correlation with resting and maximal squeeze pressures and between each other (p < 0.005). The pressure values were significantly less in asymptomatic patients compared to patients with any degree of symptoms (p < 0.05).ConclusionThe Turkish translated version of the Wexner scale is a reliable, consistent, and valid instrument to evaluate anal functions in women with anal incontinence for Turkish speaking women. Total and subscale scores of the Wexner scale and anal manometric measurements showed significant correlation.

Correlation of spermiogram profiles with DNA damage in sperm cells of infertile men: a comet assay study.

We have investigated a relationship between DNA damage in sperm and spermiogram profiles in the infertile men. Twenty-one non-smoking infertile men <40 years of age with no systemic or genetic disease were randomly selected from the pool of infertile couples applied to our clinic. Sperm samples were collected and evaluated according to WHO guidelines. DNA damage of sperm cells was assessed using neutral comet assay. Fifty cells per slide and two slides per sample were scored to evaluate DNA damage. The cells were visually classified into four categories based on DNA migration such as undamaged (UD), little damage (LD), moderate damage (MD) and significant damage (SD). Total comet scores (TCS) were calculated as: 1×UD + 2×LD + 3×MD + 4×SD. There was a negative correlation between the percentage of slow- and in situ-motion sperm cells in spermiograms and TCS (p < 0.001 and p < 0.05, respectively). The relationship between the percentage of non-motile sperm cells and TCS was negative (p < 0.001). This study provides new evidence that DNA damage in spermatozoa and sperm motility parameters are negatively correlated. We suggest that evaluation of sperm DNA by the neutral comet assay may be valuable to use in fertility research.

Effects of the gonadotropin-releasing hormone antagonist cetrorelix in the early postimplantation period on rat pregnancy

OBJECTIVE The effect of cetrorelix given in the early implantation period on rat pregnancy was investigated. STUDY DESIGN Forty-nine virgin Sprague-Dawley rats were randomized into six groups. At the 4th or 8th days of sperm plug, groups received 15, 75, 150 μg/kg cetrorelix or saline. Three subjects were randomly selected from each group and sacrificed at 11th gestational day for histomorphometric analysis. The remaining subjects were allowed to complete their pregnancy period. Volumes of total conceptus, labyrinth zone, transitional zone, giant cell zone, and exocoelomic cavity were calculated according to Cavalieris principle. RESULTS Subjects receiving cetrorelix at 15 or 150 μg doses at the 4th day (D4) and those receiving cetrorelix at 150 μg dose at the 8th day (D8) of pregnancy delivered later than the controls. On necropsy examination at the 11th day, mean embryo weights of the cetrorelix 15 D4, 150 D4, 15 D8 and 75 D8 groups were found to be significantly lower than that of the controls (p<0.05). On histomorphometric evaluation, volumes of the fetuses and the amniotic sacs were decreased by cetrorelix at all doses studied dose dependently. Gross congenital anomalies were observed in the pups of three rats of the cetrorelix 150 D4 and D8 groups. CONCLUSION The results of this study suggest that cetrorelix in the early post-implantation period may lead to serious side effects in the rat.

Effects of short-term maternal fasting in the third trimester of pregnancy on fetal biophysical profile and Doppler indices scores

IntroductionIt was aimed to investigate the effects of short-term maternal fasting on fetal biophysical profile (BPP) scores and obstetric doppler indices.Materials and methods Thirty healthy uncomplicated singleton pregnancy cases were enrolled into the study.Results and conclusionFasting decreased BPP reversibly, but not to a level below 8/10. AFI, umbilical and MCA impedances were unchanged while pulsatility, resistance and systolic/diastolic values of uterine arteries were increased.

Effects of Single Vaginal Incision Technique on Quality of Life in Women with Stress Urinary Incontinence

STUDY OBJECTIVE To estimate the short-term effects of a minimally invasive single vaginal incision technique without passing through the abdomen or groin (ContaSure Needleless System) on the quality of life in women with incontinence. DESIGN Prospective cohort study (Canadian Task Force classification II-2). SETTING Tertiary referral urogynecology clinic. PATIENTS 50 consecutive patients with urodynamically proved stress urinary incontinence from October 2008 to March 2009. INTERVENTIONS Preoperative and postoperative scores on the short forms of the IIQ-7 (Incontinence Impact Questionnaire, UDI-6 (Urinary Distress Inventory) PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function), and long form of the P-QOL (Prolapse Quality of Life) were evaluated in 50 patients with urodynamically proved stress urinary incontinence. Scores were compared with postoperative urodynamic findings. MEASUREMENTS AND MAIN RESULTS Mean (SD) follow-up was 433.5 (44.1) days (95% CI, 420.1-445.1). Patients showed statistically significant improvement insofar as preoperative and postoperative scores on the IIQ-7, P-QOL, and PISQ-12 and the irritative and stress subgroups of UDI-6. Obstructive score of UDI-6 worsened, consistent with the findings of pressure-flow studies. Postoperatively, 40 patients (80%) were urodynamically continent. Eight patients (16%) were still incontinent; however, their quality of life scores (IIQ-7 and UDI-6 stress) improved. Two patients (4%) continued to experience leakage, with equal or worsened quality-of-life scores. CONCLUSION Early clinical results of the present trial demonstrate that the ContaSure Needleless System seems to be capable of improving significantly all aspects of quality of life in women with incontinence. To improve the willingness for treatment of women with stress incontinence, this minimally invasive technique should be encouraged after confirming its efficacy in larger prospective, randomized, comparative trials.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: are they useful for predicting gestational diabetes mellitus during pregnancy?

Objective We aimed to investigate whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) could be utilized to screen for gestational diabetes mellitus (GDM). Subjects and methods NLR and PLR were assessed by retrospective analysis of 762 healthy and pregnant women with GDM. The patients were stratified into four groups, as follows: GDM (n=144), impaired glucose tolerance (n=76), only screen positive (n=238), and control (n=304). Results The leukocyte, neutrophil, and lymphocyte counts were significantly higher in the study groups compared with the control group (P=0.001; P<0.01). There were no statistically significant differences between the groups with respect to the NLR and PLR (P>0.05). Conclusion We do not recommend that blood NLR and PLR can be used to screen for GDM. However, increase in the leukocyte count is an important marker for GDM as it provides evidence of subclinical inflammation.

Metastatic ovarian malignant melanoma with no obvious primary

The differential diagnosis of metastatic ovarian malignant melanoma from primary ovarian tumors is a significant challenge, particularly if there is no obvious primary site. A 39-year-old patient with bilateral ovarian malignant melanoma presented as stage IV primary ovarian tumor, with metastases in the omentum and spleen. She underwent a total abdominal hysterectomy and bilateral salpingo-oopherectomy with infracolic omentectomy and splenectomy. The diagnosis on examination of frozen sections was inconclusive. The final diagnosis was made by immunohistochemistry. The sections showed positive staining with HMB-45, vimentin, S-100, and no staining for cytoceratin, inhibin, calretinin and caldesmon. After the operation, the MRI at the 14(th) postoperative day revealed metastatic lesions in the vertebrae, sacrum, bilateral humerus and femur and in the cerebral cortex, together with edema and hemorrhagic foci. The patient stayed in the intensive care unit for 12 weeks until her death due to cardio-respiratory arrest. This case highlights the clinical fact that metastatic malignant melanoma may mimic primary ovarian tumor with an occult or regressed primary. Both the standard pre-operative imaging modalities (such as CT, MRI) and the histo-pathologic examination of the frozen sections may be inconclusive in the differentiation of ovarian melanoma from epithelial ovarian malignancies. The final diagnosis could be established by immunohistochemistry. Intra-abdominal debulking surgery would not prolong the survival of metastatic ovarian melanoma because of the occult or rapid metastasis to the extra abdominal sites of the tumor.

Multidose Methotrexate Treatment of Ectopic Pregnancies with High initial β-Human Chorionic Gonadotropin: Can Success Be Predicted?

Objective: To investigate the clinical results and prognostic factors of multiple dose methotrexate (Mtx) treatment of ectopic pregnancy patients with high initial serum (human chorionic gonadotropin [hCG]). Design: Retrospective cohort study. Patients: Twenty-six ectopic pregnancy patients with serum (βhCG) > 5,000 mIU/mL who received multiple doses of Mtx (1 mg/kg) with folinic acid rescue on the alternating days. Results: Success rate was 88.5%. All failures were tubal ruptures in those who underwent surgery. Median initial hCG values of the success and the failure patients were 8,582 (5,058–31,114) and 5,280 (5,042–13,563) mIU/mL respectively (p > 0.05). Side effects were seen in 18 patients (69.2%, one bone marrow suppression and 17 minor side effects). The number of Mtx injections (7.04 ± 1.71), Mtx dose (71.35 ± 13.16 mg) and follow-up period (42.04 ± 23.77 days) did not differ between groups. Body mass index (BMI), Mtx dose, number of Mtx and change in βhCG levels between the initials and the levels measured 2 days after the 3rd, 4th, and 5th Mtx injections were found to be highly predictive for tubal rupture. Conclusions: Multiple-dose Mtx treatment of ectopic pregnancies with high initial hCG is safe and effective. BMI, Mtx dose, number of Mtx injections and the decrement of βhCG levels were found as highly predictive for the success of the treatment.