An Optimal Uterine Closure Technique for Better Scar Healing and Avoiding Isthmocele in Cesarean Section: A Randomized Controlled Study.

Objective: The aim of this study is to compare the effects of two different uterine closure techniques, used during cesarean section (CS) operations on isthmocele formation. Material and Methods: This prospective, randomized, controlled study was performed on 138 patients in a university hospital between the dates December 2016 and August 2017. Uterine closures were performed using the double-layer, far-far-near-near (FFNN) unlocked technique, in the study group (n = 70) and using a single-layer continuous locked (SLL) technique in the control group (n = 68). The presence of isthmocele, residual myometrial thickness (RMT), postmenstrual spotting, dysmenorrhea, chronic pelvic pain and uterus position were evaluated in postoperative sixth month. Results: Isthmocele formation was less frequent and RMT was greater in the study group when compared to the control group (p < 0.001 and p < 0.001, respectively). Duration of operation, amount of blood loss and additional hemostatic suture requirement were not significantly different between the two groups (p = 0.221, p = 0.520 and p = 0.930, respectively). Postmenstrual spotting was less common in FFNN group, while the rates of chronic pelvic pain and dysmenorrhea were not significantly different between the groups (p = 0.002, p = 0.205 and p = 0.490, respectively). Conclusion: The findings of the present study demonstrate that uterine closure using the FFNN technique is beneficial in terms of providing protection from isthmocele formation and ensuring sufficient RMT. This method has the potential to become the optimal uterine closure technique, but the findings of the present study should be supported by large-scale studies in the future.

Maternal nutrition and reproductive functions of female and male offspring

This study aimed to investigate the effects of maternal unhealthy nutrition on the reproductive functions of female and male adult offspring. This was an animal study carried out with 24 virgin female Wistar rats (dams) and their male and female offspring. Rats were divided standard diet (SD) or cafeteria diet (CD) groups, after 10 weeks of feeding, all rats were paired with a Wistar stud male, and each group was again divided into CD and SD groups during the pregnancy and lactation periods. After birth, six female and six male pups in each group, were subjected to study. Following 3 weeks of lactation, the pups were fed with SD for 8 weeks and killed when they were considered adult at 11th week for analysis. Primordial and antral follicle counts, serum anti-Mullerian hormone (AMH) and phosphatase and tensin homolog (PTEN) in the oocyte cytoplasm were examined to evaluate ovarian function, and E-cadherin and integrin-ß1 levels were examined in endometrial tissues for the evaluation of endometrial receptivity in female offspring. Sperm analysis was performed in male offspring. In groups in which the dams were fed CD, primordial follicular pool, PTEN, and endometrial receptivity were reduced. In contrast, AMH and the number of antral follicles were not changed. In male offspring, the testicles were smaller, testosterone production decreased, AMH increased and the number and function of sperm were not changed. Sperm analysis results were not changed. All negative effects on reproductive functions were more apparent in groups fed with the CD during the pregestational period.

The Effect of Stress Incontinence Operations on Sexual Functions: Laparoscopic Burch versus Transvaginal Tape-O.

AIM: Stress urinary incontinence (SUI) has some negative emotional and physical effects on sexual functions. In this study, we aimed to question the effects of surgical treatment of stress incontinence on sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) form. MATERIALS AND METHODS: A total of 77 sexually active women who were surgically treated for SUI between 2014 and 2015 at a university hospital. Tension-free transvaginal tape (TVT-O) operation and the laparoscopic Burch procedure were performed on 42 and 35 patients, respectively. Patients with isolated stress incontinence were included in this study. All patients enrolled were invited to fill out the PISQ-12 questionnaire before surgery and 6 months after surgery. RESULTS: The mean total postoperative PISQ-12 score in both TVT-O and Burch groups was significantly increased compared to the preoperative period (P < 0.001 and P < 0.001, respectively). When the PISQ-12 scores were evaluated according to the subgroups, physical and partner-dependent scores significantly increased in the postoperative period compared to the preoperative period in the TVT-O group (P < 0.001 and P = 0.004, respectively). CONCLUSIONS: Rate of the surgery success for SUI is positively correlated with the improvement of sexual functions. Minimally invasive methods in SUI surgery has been progressively increasing day-by-day. The lesser invasive approaches seem to replace the more invasive approaches in the near future.

Ginger (zingiber officinale) might improve female fertility: A rat model.

BACKGROUND: Ginger (Zingiber officinale) is a well known and extensively used antioxidant in traditional remedies. In this study, we aimed to investigate the effects of ginger powder on ovarian folliculogenesis and implantation in rats. METHODS: There were two study groups. In the 5-day treatment group (one estrous cycle), 100 mg ginger powder, 200 mg ginger powder or distilled water was given for 5 days to the three subgroups each containing seven rats. In the 10-day treatment group, same doses were given for 10 days (two estrous cycle) to the three subgroups each containing seven rats. At the end of the 5th and 10th days, ovarian volumes, ovarian weights, primordial follicles, antral follicles, atretic follicles, and corpus luteum counts were assessed. To evaluate the angiogenic effects of ginger, vascular endothelial growth factor (VEGF) and for the antioxidant effects of ginger endothelial nitric oxide synthase (eNOS) were examined in the ovaries and in the endometrium immunohistochemically. RESULTS: In the 5-day treatment group, antral follicle count and ovarian stromal VEGF were significantly high in the 100 mg ginger subgroup in comparison to the control group (p < 0.05). In the 10-day treatment group, endometrial VEGF and ovarian stromal eNOS were significantly high in the 100 mg ginger subgroup in comparison to the control group (p < 0.05). There was no statistically significant difference at 200 mg ginger dose both in 5-day and 10-day treatment groups. CONCLUSION: The increases in the antral follicle count and ovarian stromal VEGF in the 100 mg/5-day treatment subgroup indicate that ginger have positive effects on folliculogenesis in short term with low dose. Additionally, ginger may enhance implantation in rats in long term with low dose.

The relationship between postmenopausal women's sclerostin levels and their bone density, age, body mass index, hormonal status, and smoking and consumption of coffee and dairy products.

PURPOSE: To investigate the relationship between postmenopausal women's sclerostin levels and bone density and the factors that may affect this relationship. MATERIALS AND METHODS: 135 postmenopausal patients' ages, BMIs, hormonal statuses, BMD values, and smoking, and consumption of coffee and dairy products were compared with their sclerostin levels. RESULTS: No statistical relationship was found between sclerostin level and age in the group with osteoporosis (p = 0.204, r = -0.305). There was a positive, high-level relationship between sclerostin levels and BMI in the osteoporosis group and it was found to be statistically significant (p < 0.001, r = 0.786). No statistical relationship was found between sclerostin level and age in the non-osteoporosis group with (p = 0.496, r = -0.88). There was a positive, moderate relationship between sclerostin levels and BMI in the non-osteoporosis group and it was found to be statistically significant (p < 0.001, r = 0.505). No statistically significant relationship could be found between sclerostin levels and vitamin D (p = 0.723), PTH (p = 0.112), FSH (p = 0.795), E2 (p = 0.627), TSH (p = 0.517), T3 (p = 0.788), and T4 (p = 0.664) blood levels. No significant difference was found among the groups formed by smoking, consumption of coffee and milk, and dairy products, either (p = 0.405; p = 0.626; p = 0.234, respectively). It was monitored that sclerostin's negative effect observed on BMD scores was independent from age; however, it had a positive correlation with BMI. CONCLUSION: As blood sclerostin levels increase, bone mineral density decreases. This negative effect of sclerostin on bone density increases as BMI increases, too. Effects of sclerostin levels on bone density are independent from age, and they are not affect by levels of vitamin D: PTH, FSH, E2 and thyroid hormones, and daily activities, such as smoking and consumption of coffee and milk and dairy products, either.