Serkan Bodur

Safety, Efficiency, and Outcomes of Perineoplasty: Treatment of the Sensation of a Wide Vagina

Background. The sensation of a wide vagina is a common problem for women after childbirth. As its etiology is unknown, there is no uniform management strategy. We hypothesized that, rather than vaginal laxity, the cause was level 3 pelvic support deficiency. Methods. This retrospective study compared preoperative and postoperative genital hiatus length, perineal length, and total vaginal length in patients treated with perineoplasty for the sensation of a wide vagina. A telephone survey was used to determine postoperative patient and male partner satisfaction rates. Results. Mean age of patients was 48 (26–68) years; mean body mass index (BMI) was 25.3 (17.6–33.2); and mean parity was 2.5 (2–5). Preoperative and postoperative genital hiatus, perineal length, and total vaginal length were 4.62 and 3.18 (p < 0.01), 3.06 and 4.04 (p < 0.01), and 9.43 and 9.43 (p = 0.882), respectively. At the 6-month follow-up, the success rate of the perineoplasty procedure was 87.9%; according to a visual analog scale, partner satisfaction rate was 92.6%. Ten percent (n = 4) of patients said they experienced dyspareunia during sexual intercourse at the introitus of the vagina. Conclusion. With low dyspareunia rates, low complication rates, high patient satisfaction, and satisfactory anatomical success, perineoplasty can be considered successful for treatment of the sensation of a wide vagina.

Value of vaginal cervical position in estimating uterine anatomy

The anatomy of the uterus is defined with the angles of the vagina, cervix and uterine corpus. Hereunder there are angles of version and flexion. The cervical position observed during the vaginal speculum examination, may give information about the uterine anatomy. In this study, we investigated the place of the cervical position in the estimation of the uterine anatomy observed during the cervical examination. We enrolled 240 patients in our study, who applied to our routine gynecology outpatient clinic with various complaints. We divided these patients into two groups according to the cervical position (anterior cervical position and posterior cervical position) observed during the speculum examination. We recorded the uterine anatomy also with the transvaginal ultrasonography. During the speculum examination, we determined that 90% of the cases with posterior fornix position were anteverted and 10% retroverted; 64.2% of the cases with anterior fornix position were anteverted and 35.8% retroverted. According to these findings, cervical position observed during the speculum examination might be useful in the estimation of the uterine anatomy regarding the angles of the version. However, the ultrasonographic examination is essential for a definitive determination of the uterine anatomy. Clin. Anat. 30:404–408, 2017.

Association of oxidative stress marker ischemia modified albumin and polycystic ovary syndrome in adolescent and young girls

Abstract Objective The pathophysiologic features of polycystic ovary syndrome (PCOS) seem to be a combination of genetic predisposition and environmental factors. However, data regarding the exact effect of oxidative stress on PCOS is conflicting. This cross sectional and case-control study was designed to compare the serum ischemia modified albumin (IMA) levels in adolescent and young girls with and without PCOS. Methods A total of 41 non-obese adolescents and young girls (15–21 years) diagnosed as PCOS and 41 age and body mass index (BMI) matched controls were enrolled to study. The main features of PCOS and markers of chronic inflammation were determined together with serum IMA levels at the time of study enrollment. Results The C-reactive protein and neutrophil-to-lymphocyte ratio were within the normal ranges and also there were no significant difference between the two groups (p>0.05). Serum levels of IMA were significantly increased in adolescents with PCOS respect to healthy controls (0.44±0.12 versus 0.35±0.10 absorbance units, p<0.001). And also there was a significant positive correlation between serum IMA and BMI in all groups (r=0.274, p=0.013). Conclusion Serum IMA levels were higher in PCOS patients than in the healthy controls. This elevation may contribute to the increased cardiovascular diseases risk in PCOS patients.

Serum betatrophin/angiopoietin-like protein 8 (ANGPTL8) levels in pregnancies affected by hyperemesis gravidarum

OBJECTIVEnThe association between serum betatrophin levels and hyperemesis gravidarum (HEG) remains unknown. The aim of this study was to determine and understand the alterations in serum betatrophin levels in pregnancies complicated by HEG compared with unaffected normal pregnancies.nnnSTUDY DESIGNnA cohort study was carried out to evaluate serum betatrophin levels in patients with HEG. Serum betatrophin concentrations were measured with other metabolic markers for lipids and glucose metabolism in 40 singleton pregnancies affected by HEG and 40 gestational age- and body mass index-matched controls.nnnRESULTSnThe serum betatrophin concentrations were significantly higher in pregnant women with HEG than in the controls (1000 [600-1100] vs. 900 [500-1000] pg/ml, pu202f=u202f0.003). The serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels were significantly higher in patients with HEG than in the healthy counterparts at the first trimester of pregnancy (158.5u202f±u202f29.4 vs. 143.8u202f±u202f29.7u202fmg/dl and 47.3u202f±u202f14.2 vs. 40.1u202f±u202f8.6u202fmg/dl, pu202f=u202f0.031 and pu202f=u202f0.007, respectively). Receiver operating characteristic (ROC) analyses demonstrated that the area under the curve (AUC) indicative of the betatrophin value for discriminating HEG patients was 0.690 (95% CI: 0.574-0.806, pu202f=u202f0.003). The optimal cutoff value was 976u202fpg/ml with a sensitivity of 50% (95% CI: 33.80-66.20%) and a specificity of 82.5% (95% CI: 67.22-92.66%). We also found a positive correlation between betatrophin levels and HDL-C (ru202f=u202f0.311; pu202f=u202f0.005). Logistic regression analyses demonstrated that increased levels of betatrophin and HDL-C were risk factors for HEG with odds ratios (95% confidence interval) of 4.884 (1.589-15.009) and 5.346 (1.044-27.366), respectively.nnnCONCLUSIONnWe conclude that serum betatrophin concentrations were increased in pregnancies affected by HEG. Furthermore, HDL-C levels seem to be associated with alterations in serum betatrophin levels.

Arm reduced robotic-assisted laparoscopic hysterectomy with transvaginal cuff closure

Introduction The use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost. Aim To evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy. Material and methods A sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients). Results An increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p < 0.001). The cost reduction observed in the study group was primarily derived from one robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between

Unicornuate Uterus with a Rudimentary Horn Diagnosed at Scheduled Third Cesarean Section

399.5 and

Anemia prevalence at the time of pregnancy detection

421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy. Conclusions Two-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.

The value of prostatic specific antigen in diagnosis of polycystic ovarian syndrome in adolescent girls

A unicornuate uterus with a rudimentary horn is an anomaly caused by defective fusion of the Müllerian duct, estimated to occur in one in 76,000 pregnancies. Life threateningly heavy bleeding is a highly expected clinical consequence of such pregnancies. According to the known literature, only two living twins and few living singleton pregnancies have been reported up to now. Here we report on an incidentally diagnosed unicornuate uterus with a communicating rudimentary horn, found during a cesarean section of a gravida 3, parity 2 (G3 P2) patient. This case is rather unique since the patient has had three full term pregnancies and three cesarean sections without significant fetal compromise. This delivery and the existing literature showed us that extensive uterine correction surgeries need not be automatically proposed when a unicornuate uterus is diagnosed in the preconception period. Such deliveries indicate that women with this uterine anomaly may have the potential to carry pregnancies to full term.

The effect of anatomical placental location on the third stage of labor

Objective: Anemia in the first trimester of pregnancy is the situation as described by the World Health Organization when the level of hemoglobin (Hb) is less than 11 g in 100 cc of blood. The prevalence of this problem is 18% in developed countries, whereas it is between 35-75% in developing countries. In this study, we aimed to determine the prevalence of anemia at the time of pregnancy detection. Materials and Methods: A retrospective cross-sectional study was designed to determine the prevalence of anemia. A total of 5228 first trimester pregnant women were admitted to the study between 2012 and 2014. Hb levels of 11 to 9.5 g/dL, 9.5 to 8 g/dL, and less than 8 g/dL were considered as mild, moderate, and severe anemia, respectively. Results: We detected mild, modarate, and severe anemia at rates of 16.64%, 3.07%, and 0.28%, respectively, in our population. The overall prevalence of anemia at the time of detection of pregnancy was 20.0%. Conclusion: Anemia is a significant risk factor for maternal mortality in developing countries. The prevalence of anemia at the time of pregnancy detection was 20% and this rate is close to those indicated in developed countries.

Hereditary leiomyomatosis and renal cell carcinoma syndrome: a case report and implications of early onset

STUDY OBJECTIVEnThis study was designed to evaluate and compare the serum total prostate-specific antigen (PSA) levels in adolescent girls in with and without polycystic ovarian syndrome (PCOS) to show whether evaluation of PSA levels have a diagnostic benefit over existing diagnostic criteria.nnnDESIGNnCase-control study.nnnSETTINGnA territory referral center.nnnPARTICIPANTSnA total of 89 (15-19xa0years) nonobese (body mass index, 18-24.9) adolescents with PCOS (nxa0=xa042) and controls without PCOS (nxa0=xa047) were enrolled in the study.nnnINTERVENTIONSnPathophysiological features of PCOS and serum total PSA levels were determined at the time of study enrollment.nnnMAIN OUTCOME MEASURESnDetermination, comparison, and diagnostic performance of serum total PSA levels in diagnosis of PCOS in adolescent girls were the main outcome measures of the study.nnnRESULTSnThe serum total PSA levels of adolescents with PCOS were detected to be higher than for control participants (0.63xa0±xa01.38xa0ng/mL vs 0.48xa0±xa00.95xa0ng/mL) without meeting statistical significance (Pxa0=xa0.923). There was a correlation between total PSA levels and indices of insulin resistance like the homeostasis insulin resistance model (rxa0=xa00.414; Pxa0=xa0.010). The serum total PSA level was not a discriminative parameter for diagnosis of PCOS in adolescent girls (area under the curve, 0.559; Pxa0=xa0.476).nnnCONCLUSIONnThe serum total PSA level was not a predictor of PCOS in adolescent girls. This finding might be related to the extemporal nature of tissues capable of PSA production and lack of sufficient exposure interval to hyperandrogenemia, rather than lack of stimulatory relationship between serum androgens.