Effect of antiepileptic drugs on serum biochemical marker levels of first and second trimester screening tests.

OBJECTIVES: Our aim in this study was to evaluate the effect of antiepileptic drugs on biochemical components of screening tests. MATERIALS AND METHODS: This longitudinal case-control study was performed at Ankara City Hospital, Ankara, Turkey, from June 2020 to January 2021. The case group included epileptic singleton pregnant women which were using antiepileptic drugs, between 18 and 44 years of age. The control group included healthy pregnant women between 18 and 44 years old who did not use any drugs. Maternal medical, obstetric, and gynecological history were recorded. The antiepileptic agents that are used in our study were; lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, valproic acid, and clonazepam. For the aneuploidy screening program conducted in our laboratory, the biochemical markers that are analyzed include; free b-hCG and PAPP-A in the first trimester, as well as AFP, HCG, and unconjugated estriol (uE3) in the second trimester. MoM values of these markers were compared between the case and control groups. RESULTS: Fifty-three pregnant women with epilepsy using antiepileptic drugs were compared with 106 healthy pregnant women. The levels of serum-free b-hCG, and PAPP-A were similar between the case and control groups (p = 0.653, p = 0.351). For the second-trimester screening biochemical markers, the maternal serum uE3 and AFP levels expressed as MoM were significantly higher in the epileptic group than in the control patients (p = 0.015 and p = 0.001). CONCLUSION: Serum marker levels of second-trimester screening tests may be affected by antiepileptic drugs, which may lead to misinterpretation of the risk level. Antiepileptic drug usage should be considered when evaluating screening test results.

Comparison of Unilateral and Bilateral Sacrospinous Ligament Fixation Using Minimally Invasive Anchorage.

Objective The aim of this study was to determine the effectiveness of a newly developed anchoring system for unilateral sacrospinous ligament fixation (USSLF) and bilateral sacrospinous ligament fixation (BSSLF) procedures. Material and Methods Ninety-three patients with pelvic prolapse who were treated surgically with the Anchorsure System ® between 2013 and 2018 were included in the study. USSLF was performed in 52 patients (group 1), and BSSLF was performed in 41 patients (group 2). Pelvic organ prolapse was assessed preoperatively and 6 months postoperatively. Results There were no significant differences between groups 1 and 2 with regard to age, parity, and demographic characteristics. Anatomical improvement rates were similar, irrespective of the type of SSLF used. No bleeding requiring blood transfusion or organ injuries occurred in any patient. Three patients in the group that received BSSLF developed small asymptomatic cystoceles (grade 1 to 2); there was no recurrence of rectoceles or enteroceles. Mild cystocele was found in 1 patient from the USSLF group. There was no significant difference between the groups with respect to the recurrence of cystocele. Recurrence of vaginal vault prolapse was found in 2 patients from the USSLF group (3.84%). There was no significant difference between the groups with regard to recurrence. Febrile morbidity, clinical outcomes, blood loss, duration of operation, intraoperative complications, and length of hospital stay were similar for the two groups. Conclusions Unilateral and bilateral SSLF techniques produce similar clinical outcomes. USSLF and BSSLF performed using the new anchoring system are safe and effective methods to treat pelvic organ prolapse.

Borderline ovarian tumors: clinical characteristics, management, and outcomes - a multicenter study.

BACKGROUND: The optimal surgical management and staging of borderline ovarian tumors (BOTs) are controversial. Institutions have different surgical approaches for the treatment of BOTs. Here, we performed a retrospective review of clinical characteristics, surgical management and surgical outcomes, and sought to identify variables affecting disease-free survival (DFS) and overall survival (OS) in patients with BOTs. METHODS: A retrospective review of ten gynecological oncology department databases in Turkey was conducted to identify patients diagnosed with BOTs. The effects of type of surgery, age, stage, surgical staging, complete versus incomplete staging, and adjuvant chemotherapy were examined on DFS and OS. RESULTS: In total, 733 patients with BOTs were included in the analysis. Most of the staged cases were in stage IA (70.4 %). In total, 345 patients underwent conservative surgeries. Recurrence rates were similar between the conservative and radical surgery groups (10.5 % vs. 8.7 %). Furthermore we did not find any difference between DFS (HR = 0.96; 95 % confidence interval, CI = 0.7-1.2; p = 0.576) or OS (HR = 0.9; 95 % CI = 0.8-1.1; p = 0.328) between patients who underwent conservative versus radical surgeries. There was also no difference in DFS (HR = 0.74; 95 % CI = 0.8-1.1; p = 0.080) or OS (HR = 0.8; 95 % CI = 0.7-1.0; p = 0.091) between complete, incomplete, and unstaged patients. Furthermore, receiving adjuvant chemotherapy (CT) for tumor stage ≥ IC was not an independent prognostic factor for DFS or OS. CONCLUSIONS: Patients undergoing conservative surgery did not show higher recurrence rates; furthermore, survival time was not shortened. Detailed surgical staging, including lymph node sampling or dissection, appendectomy, and hysterectomy, were not beneficial in the surgical management oF BOTs.

A 5-year follow-up study comparing Burch colposuspension and transobturator tape for the surgical treatment of stress urinary incontinence.

OBJECTIVE: To compare the effectiveness of transobturator tape (TOT) and Burch colposuspension in the treatment of stress urinary incontinence (SUI). METHODS: The present retrospective study included 770 patients who underwent SUI surgery with Burch colposuspension (n=498) or TOT (n=272). Clinical follow-up occurred at 2 weeks, 3, 6, and 12 months, and annually thereafter. Objective and subjective cure rates and intra- and postoperative complications were assessed. RESULTS: Among patients who had SUI surgery without another concomitant procedure, the Burch group had a significantly longer mean operation time (41.48 ± 10.61 minutes versus 23.77 ± 10.49 minutes; P<0.001) and a significantly longer length of hospital stay (3.11 ± 0.49 days versus 1.98 ± 0.40 days; P<0.001), compared with the TOT group. The rates of unintended functional outcomes were lower among women undergoing TOT than among those undergoing the Burch procedure (long-term voiding dysfunction 0.7% versus 4.2%, P=0.007; urinary retention 10.7% versus 26.9%, P<0.001). The 5-year cure rates were similar in the 2 groups (objective cure rate, 73.9% versus 77.5%, P=0.574; subjective cure rate, 76.8% versus 81.7%, P=0.416). CONCLUSION: In terms of efficacy, TOT appears equal to Burch colposuspension; however, TOT has fewer unintended functional outcomes than Burch colposuspension.