Lateral suspension with V-NOTES for the treatment of pelvic organ prolapse with the Salman-Ketenci Gencer technique.

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is a common morbidity and 10-20% of the patients need surgical correction. Sacrocolpopexy or sacrohysteropexy procedures are satisfactory but still difficult. Lateral suspension (LS) as a safe and simple technique has become an alternative technique recently. Vaginal natural orifice transluminal endoscopic surgery (V-NOTES) is also a new modality and LS using V-NOTES has not been performed previously and should be promising. METHODS: This prospective observational pilot study was conducted with a total of 38 women with stage 3 and 4 POP according to the Pelvic Organ Prolapse Quantification grading system (POP-Q). Lateral suspension via V-NOTES was performed with the Salman-Ketenci Gencer technique using a mesh for POP. The preoperative and postoperative 6-month POP-Q stages together with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores were recorded and compared. RESULTS: Comparison of the preoperative and postoperative 6-month POP-Q stages of the patients were statistically significant except for the total vaginal length (p<0.01). Compared with the preoperative total and subscale scores of PISQ-12, the postoperative values were considerably improved (p<0.001). CONCLUSIONS: With the Salman-Ketenci Gencer technique not only good anatomical but also good functional results were obtained with V-NOTES. Surgeons may focus on uterine sparing while using the Salman-Ketenci Gencer technique for apical prolapse owing to the higher rate of complications related to the colposuspension and better sexual results after the cervicosuspension.

Is maternal serum endocan level a novel marker in gestational diabetes mellitus?

AIM: To determine whether there was a significant difference between serum endocan levels of pregnant women with and without gestational diabetes mellitus (GDM). METHODS: A total of 90 pregnant women, 45 with gestational diabetes and 45 healthy pregnant women, between 24 and 28 gestational weeks, were included in this prospective case-control study. The pregnant women were screened for gestational diabetes using a two-step protocol. Serum endocan levels were measured using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. A p-value of <0.05 was considered statistically significant. RESULTS: Serum endocan level was significantly higher in the GDM group than in healthy controls (168.46 ± 160.6 vs. 105.66 ± 26.52 pg/mL, respectively; p < 0.001). Serum endocan concentrations were positively correlated with the results of 50 g oral glucose challenge test (GCT) (p < 0.001). Receiver operating characteristic curve analysis showed that endocan with a cut-off point of 133.9 ng/dL indicated women with GDM with a sensitivity of 55.6% and specificity of 88.9% (area under the curve [AUC]: 0.737, 95% CI: 0.634-0.824). The overall differential performance of endocan according to the GDM groups was determined as 73.7% (p < 0.001). Maternal serum endocan level was positively correlated with fasting glucose, postprandial glucose, and glycated hemoglobin (HbA1c) (p < 0.001). CONCLUSIONS: Elevated endocan levels in gestational diabetes were correlated with fasting glucose, postprandial glucose, HbA1c, and oral glucose tolerance test (OGTT) results. Despite the low sensitivity of 55.6% and the high specificity of 88.9%, we found a high differential performance rate indicating that serum endocan levels were important for the pathophysiology of GDM and should be investigated for the possibility of being a novel marker in larger populations.

Serum kisspeptin, to discriminate between ectopic pregnancy, miscarriage and first trimester pregnancy.

The present study aimed to determine serum kisspeptin levels which is an emergent marker regarding trophoblastic invasion, in patients with different types of early pregnancy. We also aimed to investigate whether kisspeptin can be used for differential diagnosis of ectopic pregnancy or miscarriage from early pregnancy. This was a prospective case-control study that was conducted at a tertiary centre of obstetrics and gynaecology. Four groups of women (81 patients) enrolled in the study: group 1, women with ectopic pregnancy (n = 17); group 2, women with miscarriage (n = 23); group 3, women with healthy pregnancy at first trimester (n = 21); and group 4, healthy non-pregnant women (n = 18). Serum kisspeptin levels were found as 0.30 (0.22-0.40), 0.11 (0.08-0.16), 1.48 (1.29-1.80), and 0.03 (0.01-0.04) ng/mL in ectopic, miscarriage, healthy pregnancy and non-pregnant groups, respectively (p< .001). A moderate correlation was seen between serum kisspeptin levels and human chorionic gonadotropin (ß-hCG) (r= 0.51, p< .001). Our data showed that for the first time that a single serum kisspeptin level may be used to discriminate ectopic pregnancy or miscarriage from healthy pregnancy at early weeks' gestation. In addition, serum kisspeptin levels of the patients with ectopic pregnancy were found higher significantly than the patients with miscarriage.Impact StatementWhat is already known on this subject? Definite diagnosis of abnormal or abnormal pregnancies at first trimester is based on hCG levels and ultrasonography. Kisspeptin, a neuropeptide was investigated in normal pregnancies and found to be increased in trophoblastic invasion.What do the results of this study add? Serum kisspeptin levels in patients with normal pregnancy were found more higher than patients with ectopic or miscarriage at early weeks of gestation (p < .001). The women with ectopic pregnancy have higher kisspeptin levels than the women with miscarriage (p < .001).What are the implications of these findings for clinical practice and/or further research? These findings can be used to make differential diagnosis between abnormal and normal early pregnancies. In future studies with more sample size, serum or plasma kisspeptin levels in early weeks of gestation can be investigated.

Assessment of relationship between serum vascular adhesion protein-1 (VAP-1) and gestational diabetes mellitus.

Purpose: VAP-1 plays a crucial role in inflammation, oxidative stress and endothelial dysfunction which are main pathophysiologic mechanisms for gestational diabetes. We aimed to determine serum VAP-1 levels, assess its diagnostic value and correlation with clinical parameters in gestational diabetes.Methods: A total of 60 pregnant women with gestational diabetes and 75 healthy pregnant women between 24-28th gestational weeks between January-June 2017 were included. Pregnant women were screened for gestational diabetes by two-step protocol. Demographic, clinical and laboratory parameters of patients were recorded. VAP-1 was measured using an enzyme-linked immunosorbent assay method.Results: Gestational diabetes group had higher fasting and postprandial glucose, HbA1c, neutrophil-to-lymphocyte-ratio, platelet-to-lymphocyte-ratio, plateletcrit and C-reactive protein. Furthermore, VAP-1 levels were higher in gestational diabetes (3.35 ± 1.52 vs 2.2 ± 0.74; p < 0.001). VAP-1 levels >2.315 could predict gestational diabetes with a sensitivity of 70% and specificity of 65.3%. VAP-1 was correlated with clinical follow-up parameters such as fasting glucose (r = 0.473, p < 0.001), postprandial glucose (r = 0.416, p < 0.001), HbA1c (r = 0.462, p < 0.001) and inflammatory biomarkers such as platelet-to-lymphocyte-ratio (r = 0.254, p = 0.04), neutrophil-to-lymphocyte-ratio (r = 0.375, p = 0.003) and C-reactive protein (r = 0.306, p = 0.017).Conclusions: Elevated VAP-1 levels in gestational diabetes correlated with clinical follow-up and inflammatory markers may suggest the pathogenetic role of VAP-1 in gestational diabetes. Hence, we think that VAP-1 could be a promising marker for the prediction of gestational diabetes.

TWEAK and monocyte to HDL ratio as a predictor of metabolic syndrome in patients with polycystic ovary syndrome.

We aimed at analyzing serum TWEAK levels and monocyte/HDL ratio in polycystic ovary syndrome (PCOS) and their predictivity for metabolic syndrome (MS) in PCOS. We included 71 women with PCOS and 40 healthy controls without any cardiovascular risk factors in this cross-sectional study. Patient group was classified as MS positive (n = 34) and negative (n = 37). Study group had higher monocyte/HDL ratio and TWEAK levels (9.59 ± 2.82 vs 8.2 ± 2.46, p = .007 and 1085.54 ± 780.95 vs 694.88 ± 369.67 ng/ml, p = .009). Monocyte/HDL ratio and TWEAK levels were higher in MS positive group (10.47 ± 2.81 vs 8.77 ± 2.61, p = .01 and 1417.59 ± 921.52 vs 780.41 ± 455.67, p = .009). In multivariate regression analysis, monocyte/HDL ratio (>9.9, OR 3.42, 95%CI 1.41-5.78, p = .008) and TWEAK (>846.5 ng/ml, OR 5.49, 95%CI 3.14-7.59, p = .002) were found to be independent predictors of MS in study group. Discriminative value of monocyte/HDL ratio for MS in study group was evaluated by receiver operating curve. Area under curve for monocyte/HDL ratio was 0.669 with a sensitivity of 70.3% and specifity of 67.7%, cutoff value was >9.9. Receiver operating curve for TWEAK at >846.5 pg/ml threshold to diagnose MS in study group was performed and area under the curve was 0.769 with a sensitivity of 73% and specifity of 72%. TWEAK and monocyte/HDL ratio may be promising in predicting MS at early stages in PCOS to prevent future cardiovascular diseases by modifying life-style or giving pharmacotheraphy.

Effect of mRNA COVID-19 vaccine on ovarian reserve of women of reproductive age.

OBJECTIVES: To evaluate the effect of messenger ribonucleic acid (mRNA) vaccines developed for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) on the ovarian reserve of women of reproductive age. MATERIAL AND METHODS: This prospective study was conducted between July and December 2022 in a tertiary care hospital affiliated with a university. A total of 117 patients were included in the study. The patients were divided into two groups. The first group (n = 62) consisted of women of reproductive age who received two doses of Pfizer-BioNTech COVID-19 vaccine administered 21 days apart. The control group (n = 55) included women with the same demographic characteristics who did not plan to be vaccinated. Hormonal values and basal antral follicle count were compared between two groups. RESULTS: The mean age of the study group was 26.3 ± 3.6 years, and the mean age of the control group was 25.4 ± 6.2 years (p = 0.332). In the vaccinated group, mean follicular stimulating hormone (FSH) on day 2 was 5.29 ± 2.28; luteinizing hormone (LH): 5.18 ± 1.3; E2: 46.43 ± 24.51; anti-Mullerian hormone (AMH): 4.17 ± 2.1; antral follicle count: 16.23 ± 8.04; right ovarian volume: 6.4 ± 1.7; left ovarian volume: 6.2 ± 2.1. FSH measured at D2 in the control group was 5.68 ± 1.89; LH: 5.22 ± 2.2; E2: 48.41 ± 27.12; AMH: 4.30 ± 1.74; number of antral follicles: 15.64 ± 9.04; right ovarian volume: 6.1 ± 1.8; left ovarian volume: 6.3 ± 1.4. There were no statistically significant differences for FSH, LH, E2, AMH, ovarian volume, and number of antral follicles on the second day of menstruation between the groups. CONCLUSIONS: According to the results of the present study, the mRNA SARS-CoV-2 vaccine does not affect the ovarian reserve of patients.

Levonorgestrel-Releasing Intrauterine Device Use Can Be a Treatment Option in Symptomatic Patients with Isthmocele.

Levonorgestrel-releasing intrauterine devices have been used for contraception and treatment of heavy menstrual bleeding. There is only limited data about the effect of this on isthmocele. Here, we aimed to evaluate the effect of levonorgestrel-releasing intrauterine devices in a larger study population with a longer follow-up as compared to the literature on symptomatic patients with isthmocele. A total of 29 patients with symptomatic isthmocele and inserted levonorgestrel-releasing device were included in this prospective study. All patients were included at January 2020 and followed for 18 months. Sociodemographic findings, laboratory parameters, premenstrual spotting, postmenstrual spotting, menorrhagia, dysmenorrhea, and pelvic pain related to isthmocele were recorded. In sonography, width, length, area of isthmocele, and residual myometrial thickness were determined. The frequency of symptoms during follow-up was compared between visits and also compared between groups according to residual myometrial thickness. Premenstrual spotting and pelvic pain were significantly reduced at 6th months (48.3 to 10.3%, p = 0.007 and 34.5 to 10.3%, p = 0.039, respectively) and no significant change was detected until the end of follow-up period. Postmenstrual spotting reduced at 6th months (96.6 to 34.5%, p < 0.001) and also significant change was detected between 6 and 12th months (34.5% vs 13.8%, p = 0.031). Menorrhagia and dysmenorrhea disappeared at 12th months. No association was found between residual myometrial thickness and the frequency of symptoms for each follow-up. Levonorgestrel-releasing intrauterine devices are useful and reliable therapeutic tools for symptomatic isthmocele patients who do not desire fertility, regardless of residual myometrial thickness.

Evaluation of Women's Sexual Functions After COVID-19 Infection.

Objectives: Sexual health is an essential component of life quality. In this study, we aim to compare the sexual dysfunction of women who had a history of COVID-19 and those who did not have been infected by COVID-19. Methods: This study was conducted in a tertiary center between May 2020 and December 2020. Our study group included 50 women treated for COVID-19 at home, and control group included 51 women with no history of COVID-19. Female Sexual Functioning Index (FSFI) was used to assess of these patients' sexual dysfunctions. Results: Sexual dysfunction in women with a history of COVID-19 was found to be significantly higher than those with no history of COVID-19. Sexual dysfunction development risk in women with a history of COVID-19 (study group) was 3.4 times higher compared to women with no history of COVID-19 (control group) (p=0.008). In addition, high number of children and low economic status were found to be predictive for sexual dysfunction after recovery (p=0.02 and p=0.024, respectively). Arousal, orgasm, satisfaction subscale scores, and total FSFI scores in women with a history of COVID-19 were significantly lower than those with no history of COVID-19 (p=0.011, p=0.002, p=0.028, and p=0.008, respectively). Conclusion: Sexual dysfunction in the patients with a history of COVID-19 seems to be higher than in women with no history of COVID-19. Increased parity and low economic status are predictive for sexual dysfunction after treatment. There is a need for future studies relating to the effect of the COVID-19 infection in women's sexual functions.

Do serum hepassocin levels change in women with polycystic ovary syndrome?

BACKGROUND: Insulin resistance is common in polycystic ovary syndrome (PCOS), especially in obese patients. Hepassocin is a peptid marker which increases in obesity and insulin resistance. OBJECTIVE: We aimed to investigate hepassocin levels in patients with PCOS in this study. METHODS: This prospective case-control study was conducted with a total of 60 patients with PCOS and age-matched 30 healthy women with body mass index < 30. Patients with PCOS were classified as obese PCOS and non-obese PCOS according to their BMI. Hepassocin levels were measured by using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. A multivariate linear regression analysis was used to determine independent factors related to hepassocin levels. RESULTS: Hepassocin levels of the obese-PCOS group were found significantly higher than non-obese PCOS and control group (6.95 ± 3.59, 2.69 ± 2.51, 2.66 ± 2.22, respectively, p < 0.001). There was no significant difference in hepassocin levels between control and non-obese PCOS group (p = 0.99). Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was independently associated with hepassocin concentrations after adjusting for age, low density lipoprotein C (LDL-C), high density lipoprotein C (HDL-C), triglyceride (TG), total testosterone, dehydroepiandrosterone sulfate (DHEA-S), and C reactive protein (CRP). CONCLUSION: Obese patients with PCOS exhibited high serum levels of hepassocin. HOMA-IR index was found as the independent variable associated with high levels of hepassocin. Hepassocin can be used as a simple and easy way of detecting insulin resistance in obese patients with PCOS.

P-wave and QT dispersion in hypertensive disorders of pregnancy.

Aim: To compare P-wave and QT dispersion values in hypertensive disorders of pregnancy and controls and also in preeclampsia, chronic hypertension, and gestational hypertension separately.Material and methods: We included 140 hypertensive pregnants and 110 healthy age-matched pregnants in this study. The hypertensive pregnants were divided into three subgroups: preeclampsia (n = 43), chronic hypertension (n = 51), and gestational hypertension (n = 46). P-wave and QT dispersion values were compared between groups.Results: Hypertensive pregnants had higher P-wave (41.74 ± 5.51 vs. 37.73 ± 5.62, p < .001) and QTc dispersion (45.44 ± 7.62 vs. 39.77 ± 8.34, p < .001) values. In subgroup analysis, P-wave dispersion and QTc dispersion were different between preeclamptic, chronic hypertensive, and gestational hypertensive patients. Also, they were significantly higher in chronic hypertension as compared to gestational hypertension and they were higher in preeclampsia than in gestational hypertension. No difference was found according to these parameters between preeclampsia and chronic hypertension. In correlation analysis, both P-wave dispersion and QTc dispersion were positively correlated with systolic (r = 0.409, p < .001 and r = 0.306, p < .001) and diastolic blood pressure (r = 0.390, p < .001 and r = 0.287, p < .001) which are main clinical determinants of hypertensive disorders.Conclusion: In clinical practice, chronic hypertensive pregnants are generally followed up in their future life for cardiovascular disorders. Also, we recommend that we must inform and follow preeclamptic patients for future cardiovascular diseases.

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.

Unsuspected Diagnosis of Uterine Leiomyosarcoma after Laparoscopic Myomectomy in an Isolated Bag.

Minimally invasive techniques are generally applied for patients suspected of having benign fibroids if medical treatment is insufficient. On the other hand, sometimes some occult carcinomas of uterus like leiomyosarcomas may be reported for the patients' applied morcellation. This condition is rare but outcomes are clinically significant. Fragmentation of occult sarcoma in the abdominal cavity without isolation bag results in widespread and poor survival. In this article, we report a case of 37-year-old woman suffering from pain due to unexpected leiomyosarcoma. Laparoscopic myomectomy was performed with power morcellation in an isolated bag. Although isolation bag is generally reported to be preventive, recurrence of sarcoma was seen at 5th month of follow-up. Even though morcellation within a bag seems to block wide spreading, dispersion of tumor cannot be stopped and more investigations have to be done.