Comparison of vNOTES technique with conventional laparoscopy in gynecological emergency cases.

BACKGROUND: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has emerged as a minimally invasive approach. This study aimed to evaluate the feasibility and surgical outcomes of the vNOTES method and compare it with conventional laparoscopy (CL) in gynecological emergency cases. MATERIAL AND METHODS: A retrospective study was conducted to compare vNOTES with CL regarding pre-/intra-/postoperative outcomes. The women who were operated on for emergency indications such as ectopic pregnancy, ovarian torsion, ovarian cyst rupture and acute abdominal pain were evaluated. Patients' age, gravidity, parity, medical/surgical history, height, weight, blood pressure, heart rate, pre-/postoperative hemoglobin and hematocrit levels, the quantity of aspirated hemoperitoneum, visual analog scale (VAS) pain scores six and 12 h postoperatively, duration of surgery and hospital stay were recorded. RESULTS: The study was conducted with 90 women. Sixty of them underwent CL, while 30 women had vNOTES. The vNOTES group had a significantly shorter duration of surgery -28.5 min (15-48 min) vs. 77 min (29-155 min), respectively, p < .001), shorter hospital stay - 32 h (11-125 h) vs. 38 h (12-201 h), respectively, p = .007), lower VAS scores after 6 h - 5 (4-7) vs. 6 (2-8), respectively, p < .001), and after 12 h - 2 (1-3) vs. 2 (1-5), respectively, p < .001) and a lower dose of postoperative analgesic administration - 2 (2-3) vs. 3 (1-5), respectively, p < .001) than the CL group. CONCLUSION: vNOTES surgeries can be considered an alternative technique to CL by providing shorter surgery duration, lower postoperative pain scores, shorter hospital stays and better cosmetic outcomes.

Comparison of Surgical Outcomes of Total Laparoscopic Hysterectomy and vNOTES Hysterectomy for Undescended-Enlarged Uteri.

AIM: This study aimed to compare the surgical outcomes of laparoscopic hysterectomy (LH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in women with undescended-enlarged uteri. MATERIALS AND METHODS: This cross-sectional study was conducted with 78 women who underwent LH (48 patients) or vNOTES hysterectomy (30 patients) for benign gynecological pathologies. The dimension of the uterus, operation time, intraoperative blood loss, the presence of peri-, postoperative complications, conversion to laparotomy, pre-, postoperative hemoglobin (Hb), and hematocrit (Hct) levels, postoperative hospital stay, total dose of postoperative analgesics, VAS scores at the postoperative 6th and 24th hours, and the final pathology reports were recorded. RESULTS: There was no significant difference between LH and vNOTES hysterectomy groups regarding age (47 vs. 47.5 years, p = 0.92), parity (2 vs. 2, p = 0.74), and BMI (30.8 vs. 28.2 kg/m2, p = 0.31). The patients in the vNOTES hysterectomy group had significantly shorter durations of surgery (45 vs. 160 min) and hospitalization (48 vs. 72 h) than the LH group (p < 0.001, p < 0.001, respectively). The 24th hour VAS score was lower (VAS score 2 vs. 3, p = 0.003) in favor of the vNOTES hysterectomy group. In matched group analysis, the 24th hour VAS score (2 vs. 3, p = 0.008), operation time (45 vs. 157, p < 0.001), and hospitalization (48 vs. 72, p < 0.001) were lower in the vNOTES hysterectomy group than the LH group. CONCLUSION: vNOTES hysterectomy provides favorable outcomes compared to conventional LH considering the shorter operation time, hospitalization, and lower 24th h VAS score.

The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients.

AIM: This study aimed to compare the surgical outcomes of total laparoscopic hysterectomy (TLH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in obese patients. MATERIALS AND METHODS: This cross-sectional study was conducted with 83 obese women (BMI > 30 kg/m2) who underwent TLH (35 patients) or vNOTES hysterectomy (48 patients) for benign gynecological indications. The duration of surgery, intra/postoperative complications, intra- and postoperative hemoglobin (Hb) and hematocrit (Hct) levels, hospital stay, Visual analogue scale (VAS) scores at the postoperative 6th and 24th hours of the patients were compared. RESULTS: There was no significant difference between TLH and vNOTES groups regarding age (49 vs. 52 years, p = 0.35), parity (2 vs. 3, p = 0.17), and uterine weight (290 vs. 230 g., p = 0.13) The median BMI was 31.6 kg/m2 (30-42.2 kg/m2) in the TLH group and 31.9 kg/m2 (30-54.6 kg/m2) in the vNOTES group (p = 0.31). The vNOTES hysterectomy group had significantly shorter durations of surgery (67.5 vs. 136 min) and postoperative hospitalization than the TLH group (p < 0.05 for all comparisons). Besides, the 6th-hour (6 vs. 7, p = 0.02) and 24th-hour (4 vs. 3, p < 0.001) VAS scores were significantly lower in the vNOTES hysterectomy group. The propensity-matched group analysis showed significantly lower 6th-hour and 24th-hour VAS scores and shorter duration of surgery (80 vs. 135 min, p < 0.001) in the vNOTES hysterectomy group than the TLH group. CONCLUSION: vNOTES is a feasible technique in obese women who require a hysterectomy and provides favorable outcomes considering the shorter duration of surgery and postoperative hospitalization and lower pain scores.

Evaluation of genital self-image and sexual dysfunction in women with vulvar lichen planus or lichen sclerosus.

INTRODUCTION: Vulvar lichen planus (LP) and vulvar lichen sclerosus (LS) are chronic inflammatory diseases that affect women's sexual health. In this study, our aim was to investigate sexual function, anxiety level and genital self-image in vulvar LP and vulvar LS patients. METHODS: This study was conducted on a total of 178 women who presented to the gynecology clinic between February 2019 and January 2020. The patients were divided into the following groups: group 1, vulvar LP (n = 21); group 2, vulvar LS (n = 59); group 3, fungal vulvitis controls (n = 48); and group 4, healthy controls (n = 50). The validated Female Sexual Function Index (FSFI), Beck Anxiety Index (BAI), and Female Genital Self-Image Scale (FGSIS) questionnaires were assessed in all women. RESULTS: There were no significant differences among the groups with respect to age, parity, menopausal status, body mass index (BMI), vaginal intercourse past 1 month, marital status or educational status (p > .05). There were statistically significant differences between the vulvar LP and vulvar LS groups compared to control groups in terms of FSFI total scores and subscores (p < .001). When FGSIS and BAI scores were analyzed, significant statistical differences were found among the study groups (p < .001). A positive correlation was found between the FSFI and FGSIS scores in patients with vulvar LP and LS. Additionally, a negative correlation was found between the FSFI and BAI scores in patients with vulvar LP and LS. CONCLUSIONS: Our study showed that sexual function, genital self-image and anxiety level were associated in vulvar LP and vulvar LS patients. Vulvar LP and vulvar LS patients with worse genital self-image have more sexual problems and anxious conditions.

The effects of exogenous oral micronized progesterone on first trimester aneuploidy screening markers in women with threatened miscarriage: a matched case control study.

OBJECTIVES: To evaluate the effect of using progesterone due to early vaginal bleeding on aneuploidy screening markers in the first trimester. MATERIAL AND METHODS: This case control study includes the pregnant women who applied to our clinic in order to have a screening test for Down syndrome in the weeks of 11°/7-136/7. The patients were divided into three groups. Self reported vaginal bleeding with progesterone therapy (Bl+, Prg+, n:70), Self reported vaginal bleeding without progesterone therapy (Bl+, Prg-, n:70) and as a control group pregnant women who had no vaginal bleeding. (NoBl, NoPrg, n:70). In all patients, free beta-human chorionic gonadotrophin (ß-hCG), pregnancy associated plasma protein-A (PAPP-A) levels and nuchal translucency (NT) thickness were analyzed. Mean MoMs of the markers were compared between three groups. RESULTS: In the two groups with vaginal bleeding (Bl+, Prg + and Bl+, Prg-) the free ß-Hcg MoM values were statistically higher (1.22 ± 0.72, 0.98 ± 0.45, respectively) compared to the No Bleeding/No Progesterone group (0.81 ± 0.52) (p ≤ 0.001, p ≤ .01, respectively). However, no significant difference was found between the free ß-hCG MoM value of women with Bl+, Prg + group (1.22 ± 0.72) and Bl+, Prg - group (0.98 ± 0.45). (p: .053, significance level limitation with Bonferroni correction p: .017). PAPP-A and NT thickness did not differ significantly between the groups. CONCLUSION: Our data did not find an association between the use of oral progesterone and any alternations in first trimester screening parameters. Regardless of the progesterone usage, vaginal bleeding in the first trimester pregnancies increased the free ß-hCG MoM values compared to pregnancies without vaginal bleeding during pregnancy.

Hysteroscopic Removal of Intrauterine-retained Suture Material Causing Pelvic Inflammatory Disease.

Retained intrauterine objects are rare causes of persistent vaginal discharge and pelvic inflammatory disease. Hysteroscopy is a minimally invasive technique used for removing these materials. A 47-year-old female who had recurrent vaginal discharge was admitted to our emergency department with pelvic pain. Retained nonabsorbable suture material was observed during her vaginal examination. After treating with intravenous antibiotics, operative hysteroscopy was performed, and the material was removed from the lower segment of the uterus.

Vaginal-assisted Laparoscopic Sacrohysteropexy and Vaginal Hysterectomy with Vaginal Vault Suspension for Advanced Uterine Prolapse: 12-month Preliminary Results of a Randomized Controlled Study.

OBJECTIVE: Vaginal-assisted laparoscopic sacrohysteropexy (VALH) is a new modified form of uterine-sparing prolapse surgery using a combined vaginal and laparoscopic approach. We aimed to compare 1 year efficacy and safety of VALH and vaginal hysterectomy with vaginal vault suspension (VH + VVS) in the surgical treatment of apical pelvic organ prolapse (POP). MATERIALS AND METHODS: Women who requested surgical treatment for stage 2-4 symptomatic uterine prolapse were recommended to participate in one year-long randomized study between July 2017 and January 2019. POP Quantification (POP-Q) examination and validated questionnaires such as International Consultation on Incontinence Questionnaire Vaginal Symptoms (IVIQ-VS) survey, Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire Short Form (IIQ-7), and Patient Global Impression of Improvement (PGI-I) were recorded at baseline and 12 months after surgery. The main primary outcome measure was apical prolapse recurrence. Secondary results were duration of surgery, pain score, blood loss, postoperative hospital stay, and quality of life scores related to prolapse. RESULTS: There were 15 women in VALH and 19 women in the VH + VVS group. ICIQ-VS score, ICIQ-QOL, UDI-6, and IIQ-7 scores were improved for both groups. According to the PGI-I scores, 80% of subjects in the VALH group, and 100% in the VH + VVS group, were "very much better" or "much better" with their prolapse symptoms at their 1-year follow-up. There was no reoperation or operation-related complication in both groups. CONCLUSION: VALH and VH + VVS have similar 1-year cure rates and patient satisfaction.

Comparison of placental α microglobulin-1 protein assay (Amnisure) with speculum examination for the diagnosis of premature preterm rupture of membranes (PPROM): a clinical evaluation.

In this study, we aimed to compare the clinical outcomes of Premature Preterm Rupture of Membranes (PPROM) cases diagnosed by classical speculum examination and by placental alpha microglobulin-1 protein (PAMG-1) assay. The medical records of all patients with singleton pregnancies that were diagnosed with PPROM were retrospectively reviewed. Singleton pregnancies with PPROM diagnosis that was confirmed either by direct visualisation of amniotic fluid leaking through the cervix or by placental alpha microglobulin-1 protein (PAMG-1) assay if no amniotic fluid leakage was documented were included in the study. Demographics, prenatal and postnatal characteristics were reviewed from the medical charts and were recorded. The study included 138 pregnancies with PPROM; 111 patients in clinical speculum examination group and 27 in PAMG-1 assay group. There were no significant differences in maternal and pregnancy characteristics between the clinical speculum examination and PAMG-1 assay groups. Foetal outcomes were comparable between clinical speculum examination and PAMG-1 assay groups. In the clinical speculum examination group, there were nine (8.1%) chorioamnionitis cases, however, there were no chorioamnionitis cases in the PAMG-1 assay group during the latency period (p = .21).Impact statementWhat is already known on this subject? Placental alpha microglobulin-1 protein assay uses immunochromatography method to detect trace amount of placental alpha microglobulin-1 protein in vaginal fluids and has high sensitivity and specificity for ROM diagnosis. However, to the best of our knowledge, the clinical outcome of ROM cases detected by classical speculum examination and by placental alpha microglobulin-1 protein assay has not been compared in the literature previously.What do the results of this study add? Although statistically insignificant, cases diagnosed by PAMG-1 assay had lower risk of chorioamnionitis during latency period.What are the implications of these findings for clinical practice and/or further research? Whether cases diagnosed by PAMG-1 assay represent a milder form of rupture of membranes than cases diagnosed by classical speculum examination group warrants further research.

The impact of cryotherapy for symptomatic cervical ectropion on female sexual function and quality of life.

In rare cases, cervical ectropion causes symptoms such as abundant leucorrhoea, postcoital bleeding, recurrent cervicitis, pelvic pain, and dyspareunia. Cryotherapy is a commonly used treatment for symptomatic cervical ectropion. We assessed the impact of cryotherapy on sexual function and quality of life among patients with symptomatic cervical ectropion. In this prospective observational study, 73 patients were assessed before and six months after cryotherapy treatment using the Female Sexual Function Index (FSFI) and Short Form-12 Health Survey questionnaires. The double-freeze cryotherapy procedure was performed using a cryotherapy unit, and liquid nitrogen was used as a refrigerant. The mean physical and mental quality of life scores were significantly improved after treatment. With the exception of the pain domain, the overall and domain FSFI scores exhibited no significant differences before and after cryotherapy. The sexual pain domain scores were significantly increased after treatment. There was a statistically significant improvement in vaginal discharge, pelvic pain, and postcoital bleeding symptoms after the cryotherapy. We concluded that cryotherapy is an effective and feasible treatment for symptomatic cervical ectropion. Although cryotherapy results in improved quality of life scores, it has no significant impact on female sexual function.Impact statementWhat is already known on this subject? Cryotherapy is the most preferred treatment option for symptomatic cervical ectropion. Its feasibility and effectiveness with respect to symptom relief have been observed in previous studies. No study has evaluated quality of life and sexual function after cryotherapy among patients with symptomatic cervical ectropion.What do the results of this study add? Although the patients' quality of life scores were significantly improved after treatment, no significant improvement was observed in overall and domain sexual function scores, with the exception of the pain domain. The sexual pain domain scores were significantly improved after cryotherapy.What are the implications of these findings for clinical practice and/or further research? Patients should not expect better sexual function after cryotherapy. Comparative studies should seek to identify the ideal treatment option, which would result in both symptom relief and better sexual function.

Comparison of hysterectomy cases performed via conventional laparoscopy or vaginally assisted natural orifice transluminal endoscopic surgery: a paired sample cross-sectional study.

Hysterectomy is one of the most frequent gynaecological procedures performed for various uterine pathologies. There are several approaches for conducting hysterectomies, including abdominal, vaginal, laparoscopic and robotic. Recently, natural orifices transluminal endoscopic surgery (NOTES) has emerged as an alternative approach for conducting hysterectomies. In this study, we aimed to compare the results of total laparoscopic hysterectomy (TLH) and vaginally assisted-NOTES (vNOTES) hysterectomy procedures for the treatment of benign gynaecological diseases. Ninety-nine patients, who underwent conventional TLH or vNOTES hysterectomies, were included in this study. The operation time, presence of per/postoperative complications, visual analogue scale (VAS) scores at postoperative sixth and 24th hours, and the duration of hospital stays were all analysed. The duration of surgery was significantly shorter in the vNOTES hysterectomy group (79.56 ± 32.54 min) compared to the TLH group (120.67 ± 38.35 min) (p: < .001). Also, postoperative hospital stays were significantly shorter in favour of the vNOTES hysterectomy group (44 ± 16.47 h) compared to the TLH group (57.86 ± 21.31 h) (p: .002). These results indicate that vNOTES hysterectomy can be a promising approach for treating a variety of different uterine pathologies and, furthermore, that it can be an alternative to TLH.Impact statementWhat is already known on this subject? A hysterectomy can be done in a variety of different ways, such as abdominal, laparoscopic, vaginal, and robotic. Even though the standard practice guidelines recommend that a vaginal hysterectomy (VH) should be the first choice of treatment, it can be challenging in cases of non-descendent and large uteruses. In such cases, NOTES hysterectomy can be an alternative option.What do the results of this study add? The study has shown that vNOTES is associated with a shorter operation and briefer postoperative hospitalisation time, in comparison to TLH.What are the implications of these findings for clinical practice and/or further research? This study speculates that vNOTES is an approach which may offer better outcomes than a conventional laparoscopy. Further randomised controlled trials with larger sample sizes, however, should be conducted in order to establish the place of vNOTES in hysterectomy surgeries.

Conventional Laparoscopy or Vaginally Assisted Natural Orifice Transluminal Endoscopic Surgery for Adnexal Pathologies: A Paired Sample Cross-Sectional Study.

AIM: To compare the results of conventional laparoscopic (CL) and vaginal natural orifice transluminal endoscopic surgery (vNOTES) techniques for the treatment of benign adnexal pathologies. MATERIALS AND METHODS: The study consisted of 114 patients who underwent CL or vNOTES for oophorectomy, ovarian cystectomy, or ectopic pregnancies. The medical and surgical data of the study population in terms of age, gravidity, parity, body mass index (BMI), duration of surgery, size of the mass, decrease in hemoglobin/hematocrit levels, the presence of complications, and visual analogue scale (VAS) pain scores at the 6th and 24th hours were analyzed. RESULTS: Both groups of patients (CL and vNOTES) had a similar mean age (42.22 ± 12.05 vs. 42.38 ± 13.06), mean BMI (27.51 ± 4.96 kg/m2 vs. 29.63 ± 7.86 kg/m2), and mean mass size (53.17 ± 24.41 vs. 48.93 ± 32.33) (the p-value was nonsignificant for all comparisons). According to the logistic regression propensity score match model, the duration of surgery was significantly shorter in the vNOTES group (48.33 ± 33.12 min) compared to the CL group (72.23 ± 43.63 min) (p = .04). Postoperative hospital stay was significantly shorter in the vNOTES group (38.4 ± 14.91 hours) compared to the CL group (48 ± 17.82 hours) (p = .03). Postoperative 6th- and 24th-hour VAS pain scores were significantly lower in the vNOTES group (p = .003 and .03, respectively). CONCLUSION: As an alternative to CL, vNOTES seems to be a promising approach for the treatment of a variety of adnexal pathologies.

Association between overactive bladder and serum nerve growth factor concentrations in women with high-grade uterine prolapse.

INTRODUCTION AND HYPOTHESIS: The association between overactive bladder (OAB) and uterine prolapse remains unclear. The extent of the role of serum nerve growth factor (NGF) levels in this relationship is also not known. Therefore, our study evaluated the association among OAB, high-grade uterine prolapse and serum NGF levels. METHODS: A total of 90 patients participated in our study and were grouped as follows. Group I included patients with high-grade uterine prolapse and OAB, group II included patients with only high-grade uterine prolapse, and group III included healthy women without uterine prolapse or OAB. Serum NGF level analysis was performed in all groups. RESULTS: Serum NGF levels varied greatly among the three groups, with significantly higher levels in group 1 than in groups 2 and 3 (p < 0.001). Serum NGF levels with a cutoff point of 120.49 pg/ml identified women with significant OAB symptoms to discriminate among groups with a sensitivity of 80%, specificity of 86.7%, positive predictive value of 75.0%, negative predictive value of 89.7% and positive likelihood ratio of 6.01 (p < 0.001). CONCLUSIONS: Our study showed that NGF-related pathways may play an active role in the pathophysiology of OAB with high-grade uterine prolapse patients based on obstruction hypothesis.

Apical pelvic organ prolapse repair via vaginal-assisted natural orifice transluminal endoscopic surgery: Initial experience from a tertiary care hospital.

INTRODUCTION: Natural orifice transluminal endoscopic surgery has been used for gynecologic operations in recent years. The aim of the study is to describe our initial experience using vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) for apical pelvic organ prolapse repair. METHODS: After patients underwent vaginal hysterectomy, vNOTES sacrocolpopexy (n = 4) or vNOTES high uterosacral ligament suspension (n = 7) were performed to treat symptomatic apical pelvic organ prolapse. Sociodemographic and clinical characteristics, Pelvic Organ Prolapse Quantification results, and recorded surgical data (eg, duration of surgery, intraoperative complications, additional prolapse and incontinence surgeries) were obtained from patient files and the hospital's database. Information from postoperative follow-up visits, including complications and anatomical results, were also recorded. RESULTS: The mean age of the patients was 60.7 ± 9.1 years. The mean total operative time was 121.3 ± 22.7 minutes. The mean operative time for vaginal hysterectomy, vNOTES sacrocolpopexy, and vNOTES uterosacral ligament suspension was 46 ± 11.9, 65 ± 38, 25 ± 8.2 minutes, respectively. There were no intraoperative and postoperative complications observed. The mean postoperative 24-hour visual analog scale score was 3.5 ± 1.9 for vNOTES sacrocolpopexy patients and 3.2 ± 0.9 for vNOTES uterosacral ligament suspension patients. Only one patient in the vNOTES sacrocolpopexy group had a recurrence; she experienced stage 2 anterior compartment prolapse 8 months after surgery. CONCLUSION: As a treatment for apical pelvic organ prolapse, vNOTES is a feasible approach in both sacrocolpopexy and uterosacral ligament suspension.

The clinical findings and outcomes of symptomatic pregnant women diagnosed with or suspected of having coronavirus disease 2019 in a tertiary pandemic hospital in Istanbul, Turkey.

AIM: To observe the clinical course of symptomatic pregnant women diagnosed with or suspected of having COVID-19. METHODS: This study analyzed the clinical and laboratory results of 27 patients with real-time polymerase chain reaction (RT-PCR)-confirmed COVID-19 and 25 patients with a suspected COVID-19 diagnosis based on their symptoms and chest computed tomography (CT) findings. The patients' coagulation parameters and acute-phase reactants were evaluated both before and after treatment. The maternal and neonatal outcomes were also reviewed. RESULTS: The mean duration of hospitalization was 6.1 ± 3 days. The gestational age of the patients ranged from 6w2d to 40w2d. Thirty-five patients' CT scan findings suggested viral pneumonia. Four patients delivered vaginally, and 10 patients underwent a cesarean section during the study period. Four of the cesarean deliveries were indicated due to COVID-19 hypoxemia-related fetal distress. Four patients were admitted to the intensive care unit (ICU) after the cesarean section. CONCLUSION: Early hospitalization and medical treatment can alleviate symptoms, improve the clinical course and reduce the need for ICU in symptomatic pregnant patients with suspected or confirmed COVID-19. Chest CT scans are a suitable option for suspected but unconfirmed COVID-19 infection.

The pain symptoms and mass recurrence rates after ovarian cystectomy or uni/bilateral oophorectomy procedures in patients over 40 years old with endometriosis.

OBJECTIVES: To evaluate the rates of pain and mass recurrence of the patients over 40 years old with endometriosis who underwent ovarian cystectomy or uni/bilateral oophorectomy. MATERIAL AND METHODS: A retrospective study was conducted with 98 patients undergoing laparoscopic surgery for endometriosis in a tertiary referral center between the time period July 2015 and July 2019. All the patients followed every 3 months and requested to fill the Visual Analogue Scale (VAS) for evaluation of pelvic pain and an ultrasound scan was performed. The inclusion criteria for this study were as follows, patients with ages over 40, with regular menstrual periods, and who denied hysterectomy and any postoperative hormonal medical treatments. RESULTS: When the groups were compared in terms of age, body mass index, cyst diameter, CA-125 serum concentrations, preoperative and after surgical pelvic pain scores, mean follow up periods, postoperative hospital stay. However, each of the mean numbers of gravidity and parity were significantly higher than bilateral salpingo-oophorectomy (BSO) groups compared to the other groups (p = 0.04 and p = 0.03, respectively). The laterality, the recurrence rates, and the type of recurrence did not have a significant effect in the group comparison. CONCLUSIONS: The ovarian tissue preserving procedures could be offered for the women over 40 years old suffering from endometriosis with no significant increase in pain symptom or mass recurrence rates considering beneficial effects of estrogen on cardiovascular system, vasomotor symptoms, and bone mineral density.

Diagnostic value of preoperative ultrasonography, cervical length measurement, and POP-Q examination in cervical elongation estimation.

INTRODUCTION AND HYPOTHESIS: Cervical elongation (CE) has not been clearly defined and has similar symptoms to pelvic organ prolapse. We aimed to evaluate the diagnostic value of preoperative POP-Q examinations, ultrasonographic measurements, and direct cervical length measurement with a Foley catheter in predicting CE on postoperative hysterectomy specimens. METHODS: Fifty-six patients who underwent vaginal hysterectomy for apical pelvic organ prolapse were included. The patients were divided into two groups based on the hysterectomy specimens' corpus/cervix ratio (CCR) as follows: the non-CE group, CCR > 1; the CE group, CCR < 1. The preoperative direct cervical length measurement was performed using 10-French Foley catheters. The recommended cutoff values and sensitivity/specificity analysis of the cervical measurements with Foley, ultrasound, and C-D measurements according to POP-Q were determined by the receiver-operating characteristic analysis. RESULTS: There were 13 patients (23%) in the non-CE group and 43 patients (76%) in the CE group. The mean cervical measurements with Foley catheter and ultrasound, C-D diameter, and postoperative cervix measurements were 49.4 ± 12.6 mm, 42.14 ± 9.4 mm, 41.4 ± 17.2 mm, and 49.5 ± 13 mm, respectively. Cervical measurement with a Foley catheter had 65% sensitivity and 62.5% specificity with a 47.5-mm cutoff value. Among these preoperative measurements, Foley catheter measurements were the most compatible with postoperative cervical measurements. There was no significant association between CE and age, body mass index, menopause duration, point C, and point D. CONCLUSION: Cervical length measurement with a Foley catheter may be preferred for estimation of CE.

The Feasibility of Natural Orifice Transluminal Endoscopic Surgery in Gynecology Practice: Single-Surgeon Experience.

OBJECTIVES: Natural orifice transluminal endoscopic surgery (NOTES) has been performed in gynecology practice for the surgical treatment of ovarian cysts, uterine fibroids, ectopic pregnancies, adnexal masses, and pelvic organ prolapse. The aim of this study is to evaluate the intraoperative and postoperative outcomes of patients who underwent NOTES for gynecological diseases. MATERIALS AND METHODS: This study was a retrospective clinical study. The data of 50 patients who had been treated via NOTES procedure for benign gynecological indications such as ectopic pregnancy, adnexal mass, uterine fibroid, and treatment-resistant heavy menstrual bleeding during the time period between January 2016 and 2019 were included. All procedures were performed by a single surgeon (C.K.) using a self-constructed glove port, and a sealing device in addition to conventional laparoscopic (CL) equipment. Descriptive analysis of the patients' data was performed. RESULTS: The initial two of the adnexectomy procedures were performed via hybrid NOTES technic and four of them were performed via total vaginal NOTES technic. The remaining procedures, namely hysterectomies, adnexectomies, salpingectomies, and myomectomy were performed via vaginally assisted NOTES (VaNOTES) technic. The mean operation time for the hysterectomy ± bilateral salpingo-oophorectomy (BSO) and salpingo-oophorectomy patients was 85.25 min and 53.15 min, respectively. For those patients who underwent VaNOTES procedure, the median postoperative visual analog scale pain score at the 6thh was six and at the 24thh was two. The mean length of the hospital stay was 2.07 days in the hysterectomy ± BSO patients and 1.63 days in the salpingo-oophorectomy patients. CONCLUSION: The NOTES procedure is a feasible technic in regards to the duration of surgery, postoperative pain scores, and cosmetic outcomes.

The impact of concurrent HPV infections on the presentation of high grade cervical intraepithelial lesions.

OBJECTIVES: We investigate how concurrent high-risk (hr) HPV (human papillomavirus) genotypes affect CIN2-3 risk and evaluate the relationship of different genotype combinations with cervical epithelial lesions. MATERIAL AND METHODS: This study included HPV positive patients between the ages of 30 and 60 who underwent liquid-based cervical smears and HPV screening through community-based, cervical cancer screening programs between June 2015 and June 2017. The impact of the increase in hrHPV types was calculated by estimating how it changed the odds ratio of CIN2-3 risk. RESULTS: The rate of multiple concurrent HPV infections was 48.7% in the CIN2-3 group and 58.4% in the CIN1 group. Among patients in the CIN2-3 and CIN1 groups, the most common HPV coinfection was respectively HPV 16+31 and HPV 16+51. The HPV 51 ratio in CIN1 patients was 28.9% and the HPV 51 ratio in the CIN2-3 patient was 6.6%. With every increase in the number of hrHPV infection types, the frequency of CIN2-3 decreased [OR: 0.72, 95% CI: 0.54-0.95]. For all hrHPV combinations, the addition of HPV 16 was associated with a higher risk of CIN2-3. CONCLUSIONS: An increase in number of hrHPV types is associated with lower CIN2-3 risk. Further cohort studies with larger samples are needed to clarify this relationship. The available evidence suggests that HPV 16 genotype plays an important role in patients with high-grade cervical lesions and has a negative impact on the cervix in concurrent multiple HPV infections.

Endocan as a predictor of increased cardiovascular risk during the menopausal transition period.

PURPOSE: Our aim was to investigate the serum endocan levels and carotid artery intima-media thickness (CIMT) measurements of pre- and postmenopausal patients to clarify the relationship between the menopausal transition and endothelial injury. METHODS: This cross-sectional study was conducted on women who were premenopausal and postmenopausal between January 2019 and June 2019. The patients were divided into two groups according to premenopausal (n = 32) and postmenopausal (n = 32) status. Serum endocan levels were assessed by enzyme-linked immunosorbent assay (ELISA). CIMT ultrasonographic measurements were determined. Hormonal and biochemical parameters were measured. The validated Menopause Rating Scale (MRS) questionnaire was used on all women. RESULTS: Serum endocan levels were significantly higher in the postmenopausal group than in the premenopausal group (222.90 ± 121.00 ng/L and 146.62 ± 41.88 ng/L, p = 0.033, respectively). The mean CIMT was significantly higher in the postmenopausal group than in the premenopausal cohort (0.70 ± 0.14 mm and 0.58 ± 0.11 mm, p < 0.001, respectively). A positive correlation was found between body mass index (BMI), systolic blood pressure (SBP), abdominal circumference (AC), and CIMT and postmenopausal serum endocan levels. Serum endocan levels with a cutoff point of 141.14 ng/L identified women with significant CIMT levels with sensitivity of 73.8% and specificity of 77.3%. A positive correlation was found between CIMT and endocan and total MRS scores. CONCLUSION: Serum endocan levels were associated with CIMT during the menopausal transition period. Increased circulating endocan levels can be a predictor of cardiovascular risk in pre- and postmenopausal women.