An in vitro pilot study investigating placenta-derived mesenchymal stem cell coating on polypropylene mesh materials.

INTRODUCTION AND HYPOTHESIS: Polypropylene meshes (PM) used in pelvic organ prolapse surgery are being withdrawn from the market. Although concerns about the usage of PMs in stress incontinence surgery have been raised, it is still one of the best methods of curing stress urinary incontinence. With advancements in stem cell-based therapies, especially mesenchymal stem cells (MSCs), it is believed that coating the synthetic meshes with MSCs may minimize excessive tissue reactions ultimately leading to clinical problems such as pain, erosion or extrusion of the implanted material. In our study we tried to show the possibility of coating the PM with placenta-derived MSCs. METHODS: Mesenchymal stem cells obtained from six placentas were isolated, cultured, and identified. MSCs were then soaked in either fibronectin or collagen prior to co-culturing with strips of PMs. One group is used as a control, and hence was not pretreated before co-culturing. Specimens were fixed and stained with both Gram and hematoxylin and eosin and marked with Vybran Dil and DAPI. All preparations were examined under a light microscope. The IMAGEJ program was utilized to determine the surface area of meshes coated with MSCs. RESULTS: We clearly showed that PMs can be coated successfully with placenta-derived MSCs. The percentage of the coated area is significantly increased when meshes were pretreated with fibronectin or collagen (p<0.0001). CONCLUSIONS: Placenta-derived MSCs can successfully coat PMs. The immunomodulatory properties of MSCs, which may be of great advantage in preventing the side effects of meshes, should be tested by in vivo and hopefully human studies before clinical applications.

Labiaplasty Outcomes and Complications in Turkish Women: A Multicentric Study.

INTRODUCTION AND HYPOTHESIS: We aimed to evaluate the outcomes, complication rates, and complication types of different labiaplasty techniques. METHODS: In this cross-sectional retrospective study, a total of 2,594 patients who underwent surgery owing to hypertrophy or asymmetry of the labium minus were retrospectively analyzed. Data were collected by individual interviews with 43 experts from different centers. The patients were between 18 and 50 years of age. During the interview information about the presence and nature of complications, and about concomitant or revision surgeries, were gathered. The surgeons who performed these surgeries were also questioned about their training and surgical experience. RESULTS: The most frequently observed complication was complete dehiscence, accounting for 29% of all complications. Complete dehiscence was most commonly seen after wedge resection (16 cases). The second most common complication was labium majus hematoma, accounting for 12.5% of all cases. Among the labiaplasty techniques, wedge resection had the highest complication rate at 3% (26 cases out of 753 patients). This was followed by composite labiaplasty at 1.2% (5 cases out of 395 patients), Z-plasty at 0.8% (1 case out of 123 patients), and trimming labiaplasty at 0.5% (7 cases out of 1,323 patients). CONCLUSION: Considering the heterogeneity and low quality of the existing studies on this subject, this study provides valuable information for surgeons practicing in this field. However, further research is clearly warranted as female genital aesthetic procedures are being performed with a steadily increasing trend.

Comparison of Fat Transfer Combined with Plasma Energy and Only Fat Transfer Methods for Genital Rejuvenation.

BACKGROUND: To compare the fat transfer combined with plasma energy and only fat transfer methods for genital rejuvenation and to investigate the efficacy enhancing properties of plasma energy. METHODS: Forty-six patients were equally divided into two groups according to the surgical method as the group A (n = 23) and the group B (n = 23). The patients in the group A received only fat transfer, while the patients in the group B received fat transfer combined with plasma energy. Both groups were scheduled for postoperative follow-up at 1, 3, 6, and 12 months. The lifting effect on the labia majora after the procedure was evaluated with photographs and patient satisfaction questionnaires including the female genital self-image scale (FGSIS). RESULTS: The mean age of all participants was 32.8 ± 5.1 years, and the mean body mass index (BMI) was 24.7 ± 3.4 kg/m2. The mean preoperative FGSIS scores were similar between the groups (p = 0.542). The mean total FGSIS score was 18.8 ± 1.4 in the group A and 18.3 ± 1.5 in the group B in the preoperative period. However, the mean FGSIS scores at 1, 3, and 6 months were significantly higher in the group B than the group A (p = 0.032, p = 0.012, and p = 0.009, respectively). At 6 months of follow-up, the mean total FGSIS score was 20.7 ± 1.4 in the group A and 22.3 ± 1.5 in the group B, indicating a statistically significant difference (p = 0.028). CONCLUSION: This novel technique is a more minimally invasive technique compared to other energy modalities with lower lateral and vertical energy dissipation than other conventional methods, and labia majora fat filling augmentation application can be performed with more permanent and longer-lasting outcomes than fat transfer only. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

To 'douche' or not to 'douche': hygiene habits may have detrimental effects on vaginal microbiota.

The importance of a healthy vaginal micro-flora is indisputable. Therefore, intravaginal practices, such as vaginal douching (VD), may inhibit or lower the colonisation of beneficial Lactobacilli strains. Although the results of disrupted vaginal microbiota have been widely reported in the literature, direct microbicidal effects of products used for VD have been rarely studied. Moreover, there are certain studies advocating the beneficial effects of VD. This in vitro study was designed to provide more evidence to help health care givers in disseminating the knowledge that VD might have detrimental effects on vaginal microbiota. Three commercially available VD products (A, B and C) were examined for their minimal inhibiting concentrations (MICs) against Lactobacilli strains. Although the MICs of product A (ranging from 0.19% to 0.09%, p < .05) were proven to be lower than the other two, all the products were potentially able to inhibit the growth of Lactobacilli strains effectively, and hence should be used with caution. Impact statement What is already known on this subject? The importance of vaginal microbiota has long been reported for the maintenance of health. The lack of a healthy vaginal ecosystem may lead to various diseases including pelvic inflammatory disease, bacterial vaginosis, sexually transmitted diseases, etc. Moreover, studies also stress that lack of beneficial bacteria may lead to miscarriages, premature delivery, ectopic pregnancy and cervical cancer. Despite a huge amount of data regarding the importance of vaginal microbiota, studies confirm that women still utilise VD for various reasons. Whilst the detrimental effect of VD have been widely reported in the literature; there are a few publications advocating the potential benefits of VD. Educational efforts are reported to lessen this practice. What do the results of this study add? In this in vitro study we aimed to substantiate the bactericidal potential of three commercially available products. There are studies about the clinical outcomes of VD, but a limited number of in vitro studies exist. Our results represent a direct measure of how potentially destructive VD is. What are the implications of these findings for clinical practice and/or further research? This information can be used for educational purposes, enhancing the efforts provided by health care givers used to lessen VD practice.

A right sliding indirect inguinal hernia containing paraovarian cyst, fallopian tube, and ovary: a case report.

Albeit very uncommon, the hernia sac may contain unusual structures such as vermiform appendix, acute appendicitis, ovary, fallopian tube and, urinary bladder. Most of the cases of hernia containing ovary and fallopian tubes were reported to be found in children and, often accompanied with other congenital anomalies of genital tract. We present the first case of sliding inguinal hernia containing right ovary and fallopian tube and a right paraovarian cyst in 80-year-old, multiparous patient without any associated genital anomaly. The hernia was repaired with plication darn, while the paraovarian cyst was excised and adnexa were preserved. It is of utmost importance to keep in mind that the hernia sac may contain almost any abdominal organ, and surgical dissection should be carried out accordingly. Pathophysiologically, the ovary might be simply pulled along with a sliding paraovarian cyst or the paraovarian cyst might be accompanying the maldescended ovary. There seems to be a need for clinical and experimental studies to further explain the mechanisms that apply to the pathogenesis of sliding inguinal hernias.

Intraoperative mapping of anal and perineal anatomy using an electrostimulator.

OBJECTIVE: To present a new technique to identify perineal and anal sphincter anatomy using an electrostimulator in order to facilitate anatomical repair. METHODS: A neglected perineal tear was repaired using the technique described. RESULTS: The patient's St Mark's incontinence score improved from 22 out of 24 to 6 out of 24. CONCLUSIONS: This technique may be practical and useful for intraoperative mapping of distorted perineal and anal anatomy to assist surgical repair.

How best is to discontinue postmenopausal hormone therapy: immediate or tapered?

BACKGROUND: To evaluate the differences between the immediate and tapered cessation protocols of hormone therapy in terms of recurrence of menopausal symptoms. MATERIALS AND METHODS: In this prospective, randomized clinical study 70 consecutive patients in whom hormone therapy was no longer preferred were recruited from the menopause clinic of a university hospital and rank randomized into two groups. In group 1 (n=35) hormone therapy was immediately discontinued and in group 2 (n=35) the medication was tapered. Every patient was questioned about vasomotor symptoms before the initiation of hormone therapy at the first visit, and then revisited at the end of 2 and 4 weeks. RESULTS: We did not find any statistically significant difference between two protocols in terms of symptom severity and frequency at the end of 2 and 4 weeks of discontinuation. Although statistically insignificant, the symptoms tended to recur in fewer patients and in a less severe form in both groups when compared with their pretreatment status. CONCLUSIONS: Tapering or immediate discontinuing of hormone therapy did not affect the recurrence rate and severity of menopausal symptoms at the end of 4 weeks.

Spinal segmental myoclonus related to pregnancy.

A 33-year-old pregnant woman (gestational age, 39 weeks and 2 days) presented with a one-day history of abdominal rhythmic myoclonus. Gynecological examination revealed that the cervix was unfavorable with irregular contractions that were ineffective. Electroencephalography, MRI of the dorsal spine and blood biochemical, examinations were normal. Electrophysiological recordings from the rectus abdominis muscles with surface electrodes showed 2 Hz rhythmic myoclonic activity bursts. On the same day, the delivery was induced and the frequency and severity of involuntary contractions decreased and disappeared in two days. This is the first case of abdominal myoclonus developed as a complication of pregnancy or delivery.

Sjögren's syndrome diagnosed in pregnancy: a case report.

BACKGROUND: As in most other autoimmune diseases, Sjögren's syndrome is seen predominantly in women. Since the peak age is around the late reproductive and early postmenopausal period, the obstetric aspect has not been well studied. CASE: A 28-years-old woman, pregnant for 22 weeks and 5 days, was admitted with worsening general status, skin lesions, arthralgias, and oral and ocular symptoms typical of Sjögren's syndrome. She underwent hemodialysis for renal insufficiency. To prevent autoantibody formation, progression of the disease, therapy with methyl prednisolone, 100 mg/d intravenously; cyclophosphamide, 500 mg/month in a single intravenous application; hemodialysis 3 times a week; and plasmapheresis 7 times was instituted. An 1,100-g, male infant at 27 weeks and 5 days was delivered by cesarean section because of premature preterm rupture of membranes and severe late decelerations on cardiotocography. The infant was discharged from the neonatal intensive care unit after 30 days, weighing 1,800 g. Postnatal echocardiographic examination of the infant revealed neither cardiac malformations nor arrhythmias. CONCLUSION: Since the presence of autoantibodies against SS-A and SS-B are reported to accompany congenital heart block, the primary goal of therapy should be preventing this untoward effect of the disease. Close monitoring during pregnancy is mandatory to detect preeclampsia, intrauterine growth retardation and preterm labor.

Intima-media thickness of the carotid arteries is related to serum osteoprotegerin levels in healthy postmenopausal women.

Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and also plays a role in vascular calcification. The objective of this study was to evaluate the relationship between serum OPG levels, and carotid artery intima-media thickness (IMT) and carotid plaque formation in healthy postmenopausal women. We recruited 68 healthy postmenopausal women for the study. Carotid plaque presence and IMT were evaluated by high resolution B-mode ultrasound. IMT was positively correlated with presence of plaque, age, menopause age and OPG, and inversely correlated with Apolipoprotein A1 (Apo A1). Serum OPG level was positively correlated with IMT (r = 0.366; p < 0.003) and age (r = 0.324; p < 0.008), and negatively correlated with Apo A1 (r = -0.481; p < 0.0001). We did not observe any significant relation between plaque occurrence and levels of serum OPG. In regression analysis OPG (p < 0.02) and menopause age (p < 0.05) were independent risk factors for IMT, and age (p < 0.05) and IMT (p < 0.05) were independent risk factors for plaque formation. Although the role of OPG in the vascular biology is poorly understood, our results suggest that elevated levels of serum OPG is associated with IMT and may play a role in the pathogenesis of atherosclerotic disease.

Vulvar syringoma aggravated by pregnancy.

Syringoma is a benign tumors of eccrine sweat gland. They appear as multiple, tiny, firm, skin-colored papules. Vulvar involvement of syringoma is rare. Only 24 cases with vulvar syringoma have been previously reported in the literature. The majority of patients with vulvar syringomas are asymptomatic. A case of syringoma of the vulva exacerbated during pregnancy is presented. The case appears remarkable for the experienced aggravated pruritic symptoms of the patient during her pregnancy.

Moclobemide in the treatment of hot flashes in postmenopausal women.

This randomized, prospective, double-blind study evaluated the efficacy and tolerability of moclobemide, a reversible, selective inhibitor of monoamine oxidase-A, in reducing the frequency and severity of hot flashes. Thirty postmenopausal women were enrolled, and 28 were allocated to 5 weeks of treatment with moclobemide 150 mg (group 1, n = 10), moclobemide 300 mg (group 2, n = 11), or placebo (group 3, n = 9). Data on hot flashes were recorded in a daily diary. Mean reductions in the hot flash severity score were 24.4% in the placebo group, 69.8% in group 1, and 35.0% in group 2. This large difference suggests that the beneficial effects were not due to a placebo effect. Moclobemide may be a new nonhormonal option for reducing the incidence, severity, and duration of hot flashes in postmenopausal women who do not wish to take estrogen or have contraindications to its use.

Effects of lumbar disc surgery on bone mineral density in women with lumbar disc disease.

This prospective study evaluated 60 reproductive-age and postmenopausal women with lumbar disc disease to demonstrate the short-term effects of lumbar disc surgery on bone mineral density (BMD). Lumbar BMD was measured preoperatively and 3 months postoperatively by dual-energy X-ray absorptiometry (DEXA). Surgery was performed at only one level (L3-L4) and consisted of partial hemilaminectomy, discectomy, and, if necessary, partial facetectomy. Before surgery, 50% of the patients had osteopenia, and 31.7% had osteoporosis. After surgery, BMD decreased 5.5% in L3 vertebrae (P=.07), 14% in L4 vertebrae (P=.003), and 4.6% in L1-L4 (P=.039). Six of 11 patients with normal BMD before surgery became osteopenic postoperatively; 9 of 30 women with osteopenia fulfilled criteria for osteoporosis after surgery. Reproductive-age and postmenopausal women undergoing surgery for lumbar disc disease are at risk of bone loss and should be spared an extensive procedure, which can further increase the amount of bone lost. All women for whom a surgical intervention is planned should be evaluated by DEXA preoperatively and postoperatively.

Theranekron for treatment of endometriosis in a rat model compared with medroxyprogesterone acetate and leuprolide acetate.

OBJECTIVES: The aim of this study was to compare the effects of theranekron, medroxyprogesterone acetate (MPA), and leuprolide acetate (LA) on surgically induced endometriosis in a rat model. STUDY DESIGN: Endometriosis was surgically induced in forty female rats during estrus. After 3 weeks, a second operation was performed and the rats were randomized using a randomization table into theranekron, MPA, LA, and control groups. These treatments were continued for 3 weeks. A third operation was performed to evaluate treatment results. Then, the experimental treatments were halted and estrogen was initiated again to maintain estrus. After three additional weeks; i.e. after 9 weeks, the recurrence rate of endometrial foci was evaluated in a fourth operation and the rats were sacrificed. The volume of endometriotic foci and histopathology scores before and after treatment were compared. RESULTS: The respective mean volumes of the endometriotic foci after 3, 6, and 9 weeks were 86.4±21.2, 16.4±8.2, and 20.1±9.6 mm(3) in the theranekron group, 78.3±20.4, 42.6±13.5, and 66.7±16.2 mm(3) in the MPA group, and 91.8±30.2, 34.4±11.4, and 72.4±21.9 mm(3) in the LA group. The respective mean histopathology scores were 2.4±0.6, 1.8±0.6, and 1.6±0.6 in the theranekron group, 2.5±0.8, 2.0±1.1, and 2.7±1.0 in the MPA group, and 2.3±0.5, 2.1±1.2, 2.4±0.8 in the LA group. After 9 weeks, the mean volume of endometriotic foci and histopathology scores were significantly lower in the theranekron group. CONCLUSIONS: Theranekron caused more evident regression of endometriotic foci than MPA or LA in a rat model. After stopping the theranekron treatment, the recurrence rate was also lower than that of the other groups.

The protective effect of erythropoietin and dimethylsulfoxide on ischemia-reperfusion injury in rat ovary.

OBJECTIVES: The aim of this study was to investigate the effects of erythropoietin and dimethylsulfoxide in the recovery from ischemia-reperfusion injury in an experimental rat adnexal torsion model. STUDY DESIGN: Thirty-six Wistar-albino rats were divided into six groups. Except for the sham operation group, all groups were subjected to left unilateral adnexal torsion for 3h. Erythropoietin and dimethylsulfoxide were intraperitoneally administered 30min before the detorsion operation. Malondialdehyde and nitric oxide levels were detected from both the plasma and the tissue samples. The sections of the tissues were evaluated histologically. The results were analyzed by a one-way analysis of the variance (ANOVA) followed by the Duncan test for multiple comparisons using computer software, SPSS Version 15.0 for Windows. RESULTS: This study demonstrated that dimethylsulfoxide and erythropoietin pretreatment attenuated ischemia-reperfusion-induced lipid peroxidation, prevented post-ischemic ovarian injury and helped to maintain the ovarian morphology. Malondialdehyde levels of plasma and ovary were higher in the torsion and detorsion groups than the sham group. This showed that ischemia-reperfusion had caused lipid peroxidation of the ovarian tissue, thus leading to oxidative damage. One of the major findings of this study is that malondialdehyde was significantly decreased in the plasma of rats who were pre-treated with dimethylsulfoxide and erythropoietin before detorsion. This suggests that dimethylsulfoxide and erythropoietin might prevent oxidative damage in ovarian ischemia-reperfusion injury. Histological examination confirmed that reperfusion caused more detrimental effects than only ischemia, which could be at least partially prevented by dimethylsulfoxide and erythropoietin administration prior to detorsion. CONCLUSION: Erythropoietin and dimethylsulfoxide may have beneficial effects in ischemia-reperfusion injury in ovarian torsion.

Transvaginal excision of a retrorectal tumor presenting as rectocele.

Tumors occupying the retrorectal (presacral) space are uncommon and heterogeneous. It is estimated that an average of two patients with retrorectal tumors will be diagnosed per year in a standard metropolitan area. They are usually asymptomatic and diagnosed during routine physical examination incidentally. Our case was admitted with complaints of a swelling in her vagina, constipation, and difficulty in emptying her bowels. The diagnosis and treatment utilizing transvaginal approach in this case is discussed in comparison with the literature. Up to our knowledge, this is the first case presenting as rectocele and second case of retrorectal tumor surgically treated using transvaginal approach.

Female sexual dysfunction.

Female sexual dysfunction is a common problem with detrimental effects on woman's quality of life. It also has an economical and societal impact. It is defined as disorders of sexual desire, arousal, orgasm, and sexual pain, which lead to personal distress. The etiology of sexual dysfunction is frequently multifactorial as it relates to general physical and mental well-being, quality of relationship, past sexual functioning, social class, education, employment, life stressors, personality factors, the presence of a sexual partner, and partner's age and health. It is very important to adopt the most efficient approach to gather information, and this may be achieved via standardized questionnaires or open-ended questions. Therapy should be tailored according to the patient's needs and may involve a multidisciplinary team approach including psychosexual counselor/sexologist/therapist and the physician. There is still more work needed to optimize the care of women with this problem. Priority should be given to international standardization and training of health care professionals.

Symphysial pelvic dysfunction.

PURPOSE OF REVIEW: Symphysial pelvic dysfunction is a condition which develops during pregnancy and may lead to significant morbidity affecting quality of life. While postpartum resolution is common, symptoms may persist for many years. The consequences, specifically disabling pain, are even more detrimental on mothers with a young family. This review summarizes current understanding of the condition, including pathogenesis, risk factors and management. RECENT FINDINGS: There is no current international consensus on definition, diagnostic criteria, and treatment protocols for symphysial pelvic dysfunction. Discrepancy between the reported rates of prevalence stems from ambiguity in definition and inclusion criteria in reported studies. The pathogenesis of the condition is still unclear although numerous theories have been proposed. It is likely to be multifactorial in origin with multiple factors both biomechanical and genetic factors playing an important role. There is also a paucity of information in the literature about the best management strategy. SUMMARY: There is an urgent need to standardize terminology and define diagnostic criteria for symphysial pelvic dysfunction in order to improve the management and better understand the pathophysiology of this condition.

A case of unicornuate uterus with ipsilateral ovarian and renal agenesis.

OBJECTIVE: To present a case of a unicornuate uterus with ipsilateral ovarian and renal agenesis. DESIGN: Case report. SETTING: Baskent University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey. PATIENT(S): A 48-year-old gravida 3 (para 3 with term deliveries) woman with a 6-month history of menometrorrhagia was admitted to our clinic. Our diagnosis was a pedunculated submucous leiomyoma that protruded into the vagina. INTERVENTION(S): The patient chose to have a total abdominal hysterectomy and unilateral salpingoopherectomy. MAIN OUTCOME MEASURE(S): During laparotomy, a unicornuate uterus with a noncommunicating horn, together with ipsilateral ovarian agenesis, was observed. A total abdominal hysterectomy and unilateral salpingoopherectomy were performed successfully. Because we could not detect the left ovary and left ureter during the operation, we planned an abdominal ultrasonography and intravenous pyelography (IVP) postoperatively to demonstrate possible urinary tract abnormalities. RESULT(S): We detected left renal agenesis by IVP. CONCLUSION(S): We presented a very rare clinical condition that demonstrates a unicornuate uterus with a noncommunicating horn, and ipsilateral ovarian and renal agenesis concomitantly. The absence of one ovary and one kidney in our case may be explained by the abnormal development of organs derived from a unilateral urogenital ridge.

Administration of B-group vitamins reduces circulating homocysteine in polycystic ovarian syndrome patients treated with metformin: a randomized trial.

BACKGROUND: The aim of the current study was to assess the effects of B-group vitamins and folic acid administration on serum levels of homocysteine (Hcy) in patients with polycystic ovarian syndrome (PCOS) on short-term metformin treatment. METHODS: Patients were randomly assigned to one of three treatment groups. Group 1 patients (n = 20) received metformin (850 mg twice daily); group 2 patients (n = 20) received metformin (850 mg twice daily) and B-group vitamins (vitamin B1, 250 mg; vitamin B6, 250 mg; vitamin B12, 1000 microg twice daily); and group 3 patients (n = 20) received metformin (850 mg twice daily) and folic acid (174 microg twice daily). In all groups, lipid profiles and plasma total Hcy, vitamin B12, folic acid and glucose levels were recorded at baseline and at 3 months. RESULTS: A 26.5% increase in Hcy levels was seen after 12 weeks of metformin therapy, while 21.17 and 8.33% decreases in Hcy levels were detected when B-group vitamins or folic acid plus metformin were given respectively. There were no statistically significant differences recorded in insulin sensitivity using homeostasis model assessment in the three groups. CONCLUSION: These findings suggest that B-group vitamins and folic acid administration counteract the Hcy-increasing effect seen with metformin therapy.