Vaginal axis on MRI after laparoscopic lateral mesh suspension surgery: a controlled study.

INTRODUCTION AND HYPOTHESIS: Laparoscopic lateral mesh suspension (LLMS) has emerged as a practical, safe, and feasible alternative to sacrocolpopexy (SCP) for treating female genital apical prolapse. Although several prior studies have reported changes in the vaginal axis in women who have undergone SCP or sacrospinous ligament fixation (SSLF) surgery for prolapse, there is a lack of data on changes in the vaginal axis after LLMS. This study was aimed at investigating the level of anatomical correction following LLMS and comparing the vaginal axis on magnetic resonance imaging (MRI) in patients with apical genital prolapse. METHODS: Patients who underwent LLMS and a nulliparous control group were included in this observational prospective case-control study. MRI was performed on the control group and the study group pre- and postoperatively. The angle between the pubococcygeal line and the lower vaginal segment, the angle between the levator plate and the pubococcygeal line, and the angle between the lower and upper vaginal segments were measured and compared. RESULTS: The angles measured between the pubococcygeal line and the lower vaginal segment and between the levator plate and the pubococcygeal line were significantly lower in the preoperative than in the postoperative measurements (p < 0.001). All angles were found to be similar in the nulliparous women and in the patients following LLMS surgery. The Pelvic Organ Prolapse Symptom Score (POP-SS) score decreased significantly after the operation (p < 0.001). CONCLUSION: The vaginal axis was found to be near-normal in patients who underwent LLMS.

Analysis of Clinical-Radiological-Pathological Factors in FN/SFN Bethesda Category Thyroid Nodules, Contribution of FNAB Repeat, Single Center Experience.

OBJECTIVES: Follicular neoplasm/suspected follicular neoplasm (FN/FNS) Bethesda Category (BC)-4 group cases are known as the gray zone. Nodules diagnosed in cytology are excised. However, very few of these nodules are malignant. Our aim is to investigate the usability of clinical-radiological-pathological parameters to reduce unnecessary surgery. In addition, we questioned the benefit of repeating fine-needle aspiration biopsy (rFNAB) in these nodules, which is not recommended, but performed for clinical or patient-related reasons. METHODS: The files of all thyroid FNAB patients conducted in our institution between January 2014 and September 2020 were scanned in the database. In our study, 185 (5.1%) nodules with cytology results of which were classified as FN/FNS were identified among 3624 nodules that were applied FNAB during this period. Twenty-eight patients were excluded from the study group. 157 nodules belonging to 157 patients between the ages of 21 and 82 years who were operated and met the study criteria were identified from patients with these nodules. The files of all patients were scanned and the results of age, gender, ultrasonographic nodule characteristics, FNAB repeat, type of surgery, and postoperative pathology were recorded. All data were analyzed by comparing them with nodule features. SPSS 15.0 for Windows program was used for statistical analysis. RESULTS: A significant correlation was found between the incidence of malignancy and male gender and hypervascularization (p=0.017 and p=0.002, respectively). Malignancy was less in nodules larger than 2 cm (p=0.014). There was no relationship between other clinical and radiological features and malignancy. In 29 nodules with rFNAB, a significant correlation was found between malignancy and advanced age (52.9-years-old), presence of nodules smaller than 2 cm and hypervascularization (p=0.047, p=0.047, and p=0.030, respectively). CONCLUSION: We recommend careful review of patients with hypervascular, hypoechogenic, and microcalcific BC-4 nodules (male gender and older patients at greater risk). Because of the serious risk of malignancy, patients with these features should be prepared for patient management with total thyroidectomy after examination with frozen section applied to the nodule during the operation.