Nurettin Demir

Balloon occlusion of the descending aorta in the treatment of severe post‐partum haemorrhage

The current case report presents a patient with life-threatening post-partum haemorrhage who was treated successfully with arterial balloon occlusion of the descending aorta, using an intra-aortic balloon pump without counterpulsation. This appears to be the first report of the use of this procedure in the treatment of post-partum haemorrhage. The literature is reviewed and the usefulness of the procedure discussed.

Hemostatic cervical suturing technique for management of uncontrollable postpartum haemorrhage originating from the cervical canal.

OBJECTIVE To evaluate the efficacy and safety of a novel cervical suturing technique for management of uncontrollable postpartum haemorrhage originating from the cervical canal. STUDY DESIGN Cervical suturing was performed on three women to control intractable postpartum haemorrhage originating from the cervical canal and not responding to classic management. Haemostatic cervical suturing by using no. 1 chromic catgut is a new surgical technique which approximates anterior and posterior cervical lips. It controls cervical haemorrhage by attachment and compression of the haemorrhage site of the cervical lips and lower uterine segment. RESULTS The procedure was effective in all cases and hysterectomy was not needed in any case. No complication occurred and the survival rate was 100%. The procedure required no special expertise or extraordinary equipment. CONCLUSION Cervical suturing technique for management of postpartum haemorrhage originating from the cervical canal is an easy, safe and highly effective conservative surgical technique that may be alternative to hysterectomy.

A new tension-adjustment technique for sling operation: an animal model.

Objective: To investigate the effectiveness of a new tension-adjustment technique for postoperative voiding difficulties encountered after sling operations. Method: To test our new method, urethral obstruction was developed in 5 female dogs by modifying the sling operation by exerting more tension on a specially prepared polypropylene strip in which a gap had been developed. After filling the bladder with isotonic solution, detrusor contractions were induced by pelvic nerve stimulations, and urodynamic studies were performed to document the urethral obstruction. In each case Foley catheters were inserted into the bladder and left in place until the time of tension adjustment. Tension adjustment was performed in the 1st, 2nd, 3rd, 4th and 5th weeks postoperatively for dogs 1, 2, 3, 4, and 5, respectively. Results: On the day of tension adjustment, after filling the bladder with isotonic solution and removing the Foley catheter, none of the dogs, except dog 3, was able to produce a free flow of urine either spontaneously or provoked by detrusor contractions. The release of the prolene sutures was readily achieved in all cases except dog 5. In this case, sling takedown was achieved after surgical exploration in which the sling location was confirmed by following the prolene sutures and Hegar’s dilator. After identifying the sling, the gap was opened by cutting the prolene sutures, instead of a sling incision. Release of the prolene sutures resulted in a distinct drop in the urethra with decreased resistance of Hegar’s dilator. The improvement in voiding was confirmed by postoperative urodynamic studies and was immediate in all cases. Conclusion: Our new technique for postoperative voiding difficulties encountered after sling operation is simple, effective and avoids re-operation in the early postoperative period.

Expeditious Method of Urethrovesical Junction Determination in Retropubic Colposuspension with Intraballoon Illumination of Foley Catheter

Objective: To investigate the efficiency and safety of Foley catheter intraballoon illumination in determining the urethrovesical junction (UVJ) in retropubic colposuspension. Method: Our accessory set for UVJ determination is composed of a 24-french Foley catheter and a 5-mm 0° telescope. The telescope is inserted into the catheter from the urinary luminal side until the tip has reached the level of the catheter balloon. After dissection of the bladder, urethra, and paraurethral tissues to reveal the submucosal endopelvic fascia, the accessory set is inserted into the bladder and the balloon is inflated with 5 ml air and illuminated by a switch on the cold light source. To determine the right side of UVJ, the catheter is pulled slightly downward and to the right of the patient. The contralateral side of the UVJ is determined by pulling the catheter slightly downward and to the left of the patient. Result: Intraballoon illumination of the Foley catheter helps to ensure accurate placement of paraurethral sutures at UVJ. Conclusion: Intraballoon illumination for determination of UVJ is simple, safe, effective and precludes an invasive approach such as cystoscopy and cystotomy.