Effect of pregnancy and delivery on urinary incontinence after the midurethral sling procedure.

INTRODUCTION AND HYPOTHESIS: To evaluate the continence status and to reveal the optimal delivery mode of women who had an infant after application of a midurethral sling to treat stress urinary incontinence. METHODS: Between January 2007 and January 2013, 12 women who delivered an infant after application of a midurethral sling were detected and demographic data, type of MUS, interval between MUS and delivery, mode of delivery, birth weight of the newborn, complications during pregnancy, and continence status after delivery were collected. Between 2000 and 2014, in 14 articles listed in Pubmed, the data of 54 patients who had delivered after successful midurethral sling application were included. Postpartum recurrence of urinary incontinence was evaluated according to delivery type in 54 patients. RESULTS: Mean age of 12 patients at the time of MUS was 33.1 ± 4.3 years old and the interval between MUS procedure and pregnancy was 30.2 ± 14.2 months. Four patients had a transvaginal tape (TVT; 33.3%) and 8 had transobturator tape (TOT) procedure (66.7%) and mean follow-up after MUS surgery was 52 ± 12.3 months. Seven women had cesarean section (CS; 58.3%) and 5 women delivered vaginally (41.7%). Nine women were continent during pregnancy (75%) and 10 were continent after delivery (83.3%). Among 54 women who were included in the review, 28 underwent CS (51.9%), 26 women delivered vaginally (48.1%), and 11 women had postpartum incontinence (20.3%). In the case of postpartum urinary incontinence, there was no statistically significant difference between the CS and vaginal delivery groups (14.3 vs 26.9% respectively, p = 0.32). In logistic regression, incontinence during pregnancy was a risk factor for postpartum incontinence (OR:5.5; 95% CI: 1.1-27.6, p = 0.036). CONCLUSION: Risk of postpartum SUI recurrence in women who underwent application of midurethral slings seems to be similar independent of delivery mode and incontinence during pregnancy may be a risk factor for postpartum incontinence.

Associations between adipocyte fatty acid-binding protein and clinical parameters in polycystic ovary syndrome.

PURPOSE: We evaluated a possible association between serum adipocyte fatty acid-binding protein (A-FABP) levels and clinical parameters in women with polycystic ovary syndrome (PCOS). METHODS: Our study included 86 women: 49 with PCOS (study group), 37 with non-PCOS (control group). We recorded and analyzed age, body mass index [BMI = weight (kg)/height (m)(2)], waist circumference, and blood pressure and follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, free testosterone (fT), dehydroepiandrosterone sulfate, 17-OH progesterone, insulin, glucose, triglyceride, high-density lipoprotein, low-density lipoprotein, very low density lipoprotein, HOMA-IR, and A-FABP levels. RESULTS: The mean BMI, waist circumference, and levels of serum LH, fT, LH/FSH, fasting insulin, and HOMA-IR were significantly higher in PCOS patients (p < 0.05). Pearson correlation analysis showed positive correlations of A-FABP levels with BMI and HOMA-IR levels and a negative correlation between A-FABP and fT levels. A ROC curve analysis found that BMI, waist circumference, and levels of fT, A-FABP, and HOMA-IR were discriminative parameters. CONCLUSION: Serum A-FABP levels may be a good prognostic marker in predicting metabolic syndrome and cardiovascular diseases in PCOS patients.

Pain experienced during and after office hysteroscopy with and without intracervical anesthesia.

We designed this study to evaluate if intracervical anesthesia reduces pain experienced during and after office hysteroscopy (OH). Two hundred women undergoing OH were randomized into two groups. Group I received intracervical anesthesia (10 ml %2 prilocaine), group II did not receive any anesthesia before procedure. The intensity of pain during procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed. Groups were similar in age, parity, previous number of vaginal delivery, or presence of menopausal status. The mean of pain scores during OH was less in group I (0.82 ± 0.11) than in group II (0.86 ± 0.09) and the difference was statistically significant (p = 0.04). But, the difference of mean pain scores 30 and 60 minutes after procedure between the groups were not statistially significant. In conclusion, intracervical anesthesia reduces pain experienced during OH, but this effect does not last longer.

Does ovulation induction and intrauterine insemination affect perinatal outcomes in singletons?

AIM: To evaluate the effect of solely intrauterine insemination on perinatal outcomes. METHODS: A total of 3830 OI/IUI cycles between January 2007 and December 2012 were included in the study. Three hundred and fifty-eight pregnancies following intrauterine insemination were encountered during the study period. Data from 246 pregnancies conceived through OI/IUI treatment were available. A total of 438 singletons with no maternal risk constituted the control group. The two groups were compared according to perinatal outcomes. RESULTS: There was a statistically significant difference between the groups in first trimester abortion and intrauterine demise. At least one or more perinatal adverse outcomes occurred in study and control groups with the rates of 38.4% and 18.5%, respectively. There were significant differences in preterm delivery rate and oligohydramnios between the groups. There were also significant differences in the rate of neonates with a birth weight < 2500 g and NICU. CONCLUSION: In general, women's health perspective, to have a pregnancy is the main target in infertility work-ups, but physicians should be aware of the risks and couples should be counseled that pregnancies after OI/IUI treatment even if singleton carries a risk of adverse perinatal outcome for both the mother and baby.

Risk factors for postoperative urinary tract infection following midurethral sling procedures.

OBJECTIVE: To identify the potential risk factors for urinary tract infections following midurethral sling procedures. STUDY DESIGN: 556 women who underwent midurethral sling procedure due to stress urinary incontinence over a four-year period were reviewed in this retrospective study. Of the study population, 280 women underwent TVT procedures and 276 women underwent TOT procedures. Patients were evaluated at 4-8 weeks postoperatively and were investigated for the occurrence of a urinary tract infection. Patients who experienced urinary tract infection were defined as cases, and patients who didn't were defined as controls. All data were collected from medical records. Multivariate logistic regression model was used to identify the risk factors for urinary tract infection. RESULTS: Of 556 women, 58 (10.4%) were defined as cases while 498 (89.6%) were controls. The mean age of women in cases (57.8±12.9years) was significantly greater than in controls (51.8±11.2years) (p<0.001). The presence of menopausal status, previous abdominal surgery, preoperative antibiotic treatment due to urinary tract infection, concomitant vaginal hysterectomy and cystocele repair, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml were more common in cases than in controls. However, in multivariate regression analysis model presence of preoperative urinary tract infection [OR (95% CI)=0.1 (0.1-0.7); p=0.013], TVT procedure [OR (95% CI)=8.4 (3.1-22.3); p=0.000] and postoperative postvoiding residual bladder volume ≥100ml [OR (95% CI)=4.6 (1.1-19.2); p=0.036] were significant independent risk factors for urinary tract infection following midurethral slings CONCLUSION: Urinary tract infection after midurethral sling procedures is a relatively common complication. The presence of preoperative urinary tract infection, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml may increase the risk of this complication. Identification of these factors could help surgeons to minimize this complicationby developing effective strategies.

A prospective case control questionnaire study for restless leg syndrome on 600 pregnant women.

AIM: To evaluate the clinical characteristics of pregnant women with restless leg syndrome (RLS). MATERIALS AND METHODS: A total of 600 pregnant women were asked to complete a questionnaire of RLS and medications. RESULTS: The educational and socio-economical status was significantly lower in study group. The number of patients living in joint family in the study group was statistically higher compared to control group. Hypothyroidism was more frequent in the study group. Calcium and magnesium intake were significantly higher in patients with RLS inversely iron intake was higher in patients without RLS. Lower hemoglobin levels were found to increase the risk of restless leg in pregnancy. Living in a joint family and low educational status were also independent risk factors for restless leg in pregnancy. Iron intake was found to decrease the risk of restless leg. Lower hemoglobin levels were found to be discriminative factor for the presence of RLS. Severity of RLS decreased by iron intake and increased by magnesium intake. CONCLUSION: Hemoglobin levels, iron intake, living in joint family, educational status are the independent risk factors for restless leg in pregnancy. Lower hemoglobin levels and supplementation of iron are the independent predictors for severity of RLS in pregnant women.

Association of clinical outcomes and complications with obesity in patients who have undergone abdominal myomectomy.

BACKGROUND: This study aimed to evaluate the association between complications and clinical parameters with obesity in 273 women who have undergone abdominal myomectomy during the study period. METHODS: The patients were classified into two groups according to body mass index (BMI) (≤30 kg/m(2) and >30 kg/m(2)). Demographic, preoperative and postoperative clinical parameters were evaluated. RESULTS: Demographic, preoperative and postoperative clinical parameters were evaluated. The results showed statistically significant differences between the obese and non-obese groups in terms of age, gravidity, diameter of fibroid (DOF), postoperative hemoglobin, duration of hospital stay, and complications. Patients in the obese group had greater DOF and complications such as hemorrhage, postoperative fever, wound infection and ileus (p < 0.05). CONCLUSION: Based on our results, we conclude that obesity adversely affects the clinical outcomes of patients who undergo abdominal myomectomy.

Diagnostic value of screening tests in subgroups of women with recurrent pregnancy loss.

OBJECTIVE: To evaluate the diagnostic value of screening laboratory tests in women who had recurrent pregnancy loss (RPL). METHODS: A total of 252 women with RPL managed in our tertiary referral research and education hospital were included in the study. Risk factors recorded involved age, gravidity, parity, number of prior live births, number of pregnancy losses, and thrombophlia tests. The cases were divided into three different groups and each group was analyzed separately. RESULTS: There was no statistically significant difference between the first and second groups in terms of clinical and laboratory parameters (p > 0.05). In the third group, there was a statistically significant difference among cases in terms of parity, gravidity, number of pregnancy losses, serum AT III levels, APCR, and age of the women. According to the logistic regression model, odds ratios (95% CI) were 6.116 (3.797-9.852), 5.665 (2.657-12.079), 4.763 (3.099-7.321), 4.729 (3.080-7.260), 2.820 (1.836-4.333), and 1.911 (1.232-2.965), respectively. CONCLUSIONS: We do not recommend the screening of all women with RPL, but in women with high parity and those who had prior live birth pregnancies, increased AT III, and APCR may be diagnostic markers for subsequent pregnancy loss.

Decreased placental thickness and impaired Doppler indices in idiopathic polyhydramnios: a prospective case-control study.

OBJECTIVE: To evaluate placental thickness, Doppler velocimetry, biophysical profile and perinatal outcomes in pregnancies complicated by idiopathic polyhydramnios. MATERIALS AND METHODS: This prospective case-control study was conducted on 139 pregnant women, of these 70 patients with idiopathic polyhydramnios comprised the study group and 60 pregnant women comprised the control group. Risk factors recorded were; age, parity, body mass index (BMI), gestational weeks, amniotic fluid index (AFI), biophysical profiles (BPP), placental thickness, middle cerebral artery pulsatility index (MCA PI), umbilical artery Doppler velocimetry (Umb A S/D) values and perinatal outcomes. RESULTS: Sixty-nine of the cases had mild-moderate (AFI: 250-450 mm) polyhydramnios (%98.5) and one of the cases had severe polyhydramnios (>450 mm) in study group. There was no statistically significant difference between the groups in terms of age, parity, BMI, gestational weeks, fetal birth weights and BPP (p > 0.05). Placental thickness, MCA PI and UA S/D values showed statistically significant difference between the groups (p < 0.05). The fetuses with lower placental thickness had lower scores of biophysical profile. There were negative correlations between placental thickness and AFI (r = -0.265), umbilical artery S/D and placental thickness (r = -0.212), MCA PI and AFI (r = -171, p = 0.44). However there was a positive correlation between AFI and umbilical artery Doppler values (r = 0.450). CONCLUSION: Idiopathic polyhydramnios is associated with decreased placental thickness, impaired uterine, umbilical and middle cerebral artery flow.

Comparison of TVT and TOT on urethral mobility and surgical outcomes in stress urinary incontinence with hypermobile urethra.

OBJECTIVE: To compare the change of urethral mobility after midurethral sling procedures in stress urinary incontinence with hypermobile urethra and assess these findings with surgical outcomes. STUDY DESIGN: 141 women who agreed to undergo midurethral sling operations due to stress urinary incontinence with hypermobile urethra were enrolled in this non-randomized prospective observational study. Preoperatively, urethral mobility was measured by Q tip test. All women were asked to complete Urogenital Distress Inventory Short Form (UDI-6) and Incontinence Impact Questionnaire Short Form (IIQ-7) to assess the quality of life. Six months postoperatively, Q tip test and quality of life assessment were repeated. The primary surgical outcomes were classified as cure, improvement and failure. Transient urinary obstruction, de novo urgency, voiding dysfunction were secondary surgical outcomes. RESULTS: Of 141 women, 50 (35. 5%) women underwent TOT, 91 (64.5%) underwent TVT. In both TOT and TVT groups, postoperative Q tip test values, IIQ-7 and UDI-6 scores were statistically reduced when compared with preoperative values. Postoperative Q tip test value in TVT group was significantly smaller than in TOT group [25°(15-45°) and 20° (15-45°), respectively]. When we compared the Q-tip test value, IIQ-7 and UDI-6 scores changes, there were no statistically significant changes between the groups. Postoperative urethral mobility was more frequent in TOT group than in TVT group (40% vs 23.1%, respectively). Postoperative primary and secondary outcomes were similar in both groups. CONCLUSIONS: Although midurethral slings decrease the urethtal hypermobility, postoperative mobility status of urethra does not effect surgical outcomes of midurethral slings in women with preoperative urethral hypermobility.

Are uterine and ovarian artery Doppler velocimetry values good pregnancy predictors in clomiphene citrate cycles?

BACKGROUND: We conducted this prospective study to evaluate the prognostic significance of uterine and ovarian artery Doppler velocimetry in clomiphene citrate (CC) cycles. MATERIALS AND METHODS: A total of 80 patients with unexplained infertility were given 100 mg/day of CC from day 3 to day 7 of their cycles in this current prospective study. On cycle day 3, before administration of CC, each patient underwent Doppler transvaginal ultrasonography. The Doppler velocimetries of the right and left uterine and ovarian arteries were recorded and analyzed in association with demographic and clinical parameters. RESULTS: TheThere were 6 out of 80 patients who became pregnant, the overall pregnancy rate in this population was 7.5% for the current study. The cases were divided into two groups according to whether they became pregnant or not. Demographic characteristics showed no statistically significant differences between these groups (p>0.05). However, the duration of infertility did show statistically significant differences between the groups. Doppler velocimetry was not statistically significantly different between the two groups. CONCLUSION: Doppler velocimetry of the uterine and ovarian arteries is not a factor in the prognosis for pregnancy in CC cycles.

Comparison of neutrophil/lymphocyte and platelet/ lymphocyte ratios for predicting malignant potential of suspicious ovarian masses in gynecology practice.

PURPOSE: To compare the diagnostic accuracy of the neutrophil/lymphocyte ratio (NLR) with the platelet/lymphocyte ratio (PLR) in predicting malignancy of pelvic masses which are pre-operatively malignant suspicious. MATERIALS AND METHODS: In this retrospective study we evaluated the clinical features of patients with ovarian masses which had pre-operatively been considered suspicious for malignancy. The patients whose intraoperative frozen sections were malign were classified as the study group, while those who had benign masses were the control group. Data recorded were age of the patient, diameter of the mass, pre-operative serum Ca 125 levels, platelet count, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio. RESULTS: There was statistically significantly difference between the groups in terms of age, diameter of the mass, serum Ca 125 levels, platelet number and platelet/lymphocyte ratio. Mean neutrophil/lymphocyte ratios showed no difference between the groups. ROC curve analysis showed that age, serum Ca 125 levels, platelet number and PLR were discriminative markers in predicting malignancy in adnexal masses. CONCLUSIONS: According to the current study, serum Ca 125 levels, pre-operative platelet number and PLR may be good prognostic factors, while NLR is an ineffective marker in predicting the malignant characteristics of a pelvic mass.