Randomized Trial of Single-Incision Midurethral Sling And Laparoscopic Burch Colposuspension: Postoperative Surgical Outcomes and Complications.

STUDY OBJECTIVE: Various retropubic and midurethral sling techniques have shown high cure rates in the treatment of stress urinary incontinence (SUI). The aim of this study was to compare single-incision midurethral sling (SIMS), and laparoscopic Burch colposuspension (LBC) procedures in patients with SUI in terms of the effectiveness, patient satisfaction, surgical complications and results. DESIGN: This is a prospective randomised study. SETTING: A university tertiary hospital PATIENTS: Forty patients with clinically and/or urodynamically proven SUI who agreed to surgical treatment were randomized to the SIMS and LBC groups and included in the study. INTERVENTIONS: Patients were treated with SIMS and LBC operations. MEASUREMENTS AND MAIN RESULTS: Demographic characteristics of patients, physical and pelvic examination, preoperative and postoperative clinical findings, Kings Health Questionnaire (KHQ) form, Female Sexual Function Index (FSFI) and Prolapse Quality of Life Questionnaire (P-QoL) form, postoperative Day 1 Visual Analogue Scale (VAS) score, and postoperative complications were recorded. Objective and subjective success rates were recorded by re-evaluating the patients in the first and sixth months of the operation. Objective success was defined as having a negative stress test and subjective success was defined as the absence of stress-induced urine leakage after surgery in a validated questionnaire. The primary result of our study was considered to be objective success, while the secondary result was subjective success and life quality tests. Twenty patients each in the SIMS group and the LBC group were included in the study. No significant difference was found in objective success (90% vs. 85%, p=0.633) or subjective success (85% vs. 75%, p=0.695) between the two groups at 6-month follow-up. A significant improvement in life quality was observed in the postoperative period for both groups; however, the difference between the groups was not significant. There was an improvement in sexual function in both groups. Nonetheless, while this improvement was significant in the SIMS group, it was not significant in the LBC group. Additionally, surgery time, catheterization time and hospitalization time were shorter in the SIMS group than in the LBC group. The VAS score on postoperative day 1 was lower in the SIMS group. Groups were not different in terms of peroperative and postoperative complications. CONCLUSION: This preliminary study is the first randomized study which compares the LBC and SIMS procedures in the literature. It shows that SIMS and LBC procedures have not different objective and subjective success rates in the short term. It was also observed that they increase both sexual and life quality results in a positive and similar way.

A Randomised Trial on the Effects of the Addition of Uterosacral Ligament Plication to Pectopexy Operation on Anatomical Restoration and Female Sexual Functions.

INTRODUCTION AND HYPOTHESIS: The objective was to determine whether the addition of uterosacral ligament plication to pectopexy for pelvic organ prolapse increases anatomical improvement and female sexual functioning. METHODS: This is a prospective randomised study. Forty patients who underwent laparoscopic pectopexy (LP) and laparoscopic pectopexy with uterosacral ligament plication (LPUSL) were included in the study. A total of 38 patients were evaluated in the study. Patients were assessed by the Pelvic Organ Prolapse Quantification (POP-Q) system and the patients who had symptomatic apical prolapse POP-Q ≥ II were included in the study. Patients were evaluated preoperatively and postoperatively at the 3rd, 6th and 12th month, with respect to anatomical changes as well as sexual function. RESULTS: A statistically significant difference was found when the preoperative C points was compared with the C points postoperatively, at 3rd, 6th and 12th months in both the LP and LPUSL groups (p < 0.001). Additionally, there were statistically significant difference between the LP and LPUSL groups in terms of C and Aa points at the 6th and 12th postoperative months in favour of the LPUSL group (p = 0.007, p = 0.005 respectively). There was also a statistically significant difference when Ba points were compared between the two groups at the 12th postoperative month, in favour of the LPUSL group (p = 0.002). There were no statistically significant differences between the groups with respect to the variables of the Female Sexual Function Index. Additionally, all parameters were significantly better in both groups at the 3rd and 12th months than the preoperative values in post hoc analysis; only desire also had a significant improvement between the 3rd and 12th months in the LPUSL group in post hoc analysis. CONCLUSION: Pectopexy operation seems to be a successful surgical approach as an alternative to sacrocolpopexy. The addition of uterosacral ligament plication to pectopexy operation improves the anatomical restoration more drastically than with LP on its own. Moreover, either LP or LPUSL has improved the majority of sexual function indices.

The effect of intrauterine insemination preceding frozen-thawed elective single embryo transfer in couples with unexplained subfertility.

Introduction: This prospective randomized controlled trial aimed to evaluate the effect of intrauterine insemination (IUI) before frozen-thawed elective single embryo transfer (FT-eSET). Material and methods: A total of 200 couples with unexplained subfertility underwent in-vitro fertilization (IVF) treatment. Patients were randomly assigned to either FT-eSET or IUI preceding FT-eSET. Both groups were composed of 100 women. IUI was timed 6 days before FT-eSET in the IUI preceding FT-eSET group. Implantation rates (IR), biochemical and clinical abortion rates (AR), clinical pregnancy rates (PR), ongoing pregnancy rates (PRs), and live birth rates were measured in this study. Results: The IUI preceding FT-eSET group was associated with higher rates of clinical pregnancy, 54% vs. 42%, but not significantly. Similarly, IR, PR and live birth rate were higher in the IUI preceding FT-eSET group but not significantly. In the IUI preceding FT-eSET group, the biochemical and clinical abortion rates were lower than in the control group (9.5% vs. 14.2% and 5.5% vs. 5.2%, respectively). However, no statistically significant difference was found between the two groups, either. Conclusions: This is the first study showing that IUI may precede FT-eSET to improve PR in couples with unexplained subfertility. Also, performing IUI before FT-eSET may decrease biochemical and clinical abortion rates.

May endocan be a new biomarker in the diagnosis of endometriosis?

AIM: As known, inflammatory substances are considered to have a role in the onset and progression of endometriosis. In this study, we aimed to find a biomarker that can be used in the diagnosis of endometriosis by investigating the serum levels of endocan, which is a substance that we know to have an important role in angiogenesis and inflammation, in patients with endometriosis. STUDY DESIGN: 45 patients between the ages of 18-40 with the diagnosis of stage 3-4 endometriosis and whose postoperative histopathological tissue diagnoses were endometriosis were included in the study as study group. As the control group, a total of 45 healthy women between the ages of 18-40 were included in the study. The two groups were statistically compared. RESULTS: There was no statistically significant difference between the two groups in terms of age, BMI, LH, E2, and mean Hb values. It was observed in the examination of the endocan levels that the mean values in the study (endometriosis, patient group) group were statistically and significantly higher compared to the control (healthy) group (p:0.000). Also, mean FSH and Ca125 levels were determined to be statistically and significantly higher in the endometriosis group (p:0.042 and p:0.000). CONCLUSION: In this study, we found a statistically significant correlation between the levels of serum endocan and endometriosis. As the results, endocan can be used as a new biomarker to diagnose patients with endometriosis or in their follow up period. Much more comprehensive future studies are needed on this subject.

Management of patients with urinary tract endometriosis by gynecologists

Objective: The aim was to report the postoperative outcomes of urinary tract endometriosis (UTE), which is a form of deep, infiltrative endometriosis, and to contribute to the literature by presenting our experience. Material and Methods: In the present study, patients who underwent surgery for endometriosis at our clinic between 2005 and 2019 and had a final pathological diagnosis of UTE were examined in detail. Patient information was retrospectively retrieved from the medical records. Data obtained pre-, peri-, and postoperatively were analyzed. Results: Mean age of the 70 patients included, according to the study criteria, was 32.73±7.09 years. Ureteral involvement alone was observed in 49% (n=34) of the patients, bladder involvement alone was observed in 24% (n=17) of the patients, and both bladder and ureteral involvement were observed in 27% (n=19) of the patients. Microscopic hematuria was detected in 16% (n=11) of the patients, whereas preoperative urinary tract findings, such as recurrent urinary tract infections, were detected in 19% patients (n=13). Of the patients, 56% (n=39) were identified with dyspareunia, 56% (n=39) with dysmenorrhea, and 30% (n=21) with pelvic pain. Visual analog scale score was significantly lower after the procedure (p<0.0001). Conclusion: Although postoperative results were typically considered positive, surgical method performed in deep infiltrative endometriosis should aim to preserve fertility, improve quality of life, and reduce the complication rate to a minimum.

Comparison of two natural tissue repair-based surgical techniques; sacrospinous fixation and uterosacral ligament suspension for pelvic organ prolapse treatment.

INTRODUCTION AND PURPOSE: The present study aims to compare the effectiveness and perioperative results of the natural tissue repair-based treatments sacrospinous fixation (SSF) and uterosacral ligament suspension (USLS) based on the preoperative Pelvic Organ Prolapse Quantification system (POP-Q). MATERIALS AND METHODS: Medical records of patients with stage ≥2 uterine prolapse between January 2011 and December 2016 were retrospectively examined. Preoperative POP-Q stages, demographic characteristics, perioperative results, and recurrence ratios in mid-term follow-up for patients were compared. RESULTS: Overall, 235 patients were determined according to our study's inclusion criteria. A total of 155 patients underwent vaginal hysterectomy and USLS (VH/USLS), whereas 80 patients underwent vaginal hysterectomy and SSF (VH/SSF). There were no significant differences between groups in terms of body mass index (BMI), age, and parity as well as cardiovascular disease and diabetes mellitus. There was no significant difference in terms of anatomical success and clinical success rates in the postoperative follow-up period between both groups. (p = 0.588 and 0.692, respectively). However, the assessment of results based on preoperative stages of patients revealed that recurrence and anatomical failure were higher in the stage 4 group (p < 0.001). CONCLUSION: Our findings indicate that the main determinant factor in evaluating recurrence rates is preoperative POP-Q staging of the patient. Recurrence rates significantly increase with disease stage. Consistent with studies that do not report a clear superiority for USLS or SSF, we observed no significant differences between both procedures in terms of recurrence. The effectiveness of these procedures is similar. We believe that prospective, long-term follow-up studies with larger populations are required to accurately identify preoperative risk factors and compare them with mesh techniques.

A Novel Multimodal Treatment Method and Pilot Feasibility Study for Vaginismus: Initial Experience With the Combination of Sacral Erector Spinae Plane Block and Progressive Dilatation.

Background Genito-pelvic pain/penetration disorder, commonly referred to as vaginismus, is a relatively common condition in women of childbearing age and has physical and psychological aspects. Various cognitive and behavioral therapies, dilatators, botulinum injections, and so on have been tried in the treatment. We hypothesize that the combination of sacral erector spinae plane (ESP) block and progressive dilatation treatment increases treatment quality. Methods We performed the sacral ESP block and progressive dilatation, which we added to multimodal treatment for resistant vaginismus cases. After the procedure, all patients were followed up during one menstrual cycle. They were recommended to have sexual intercourse on the day of the procedure. Results In 15 of our treatment-resistant cases, when we added the sacral ESP block, successful penetration after the first block was 73%. Pregnancy occurred in eight patients after the initial one-month follow-up. Four of the 15 patients needed a second block. Conclusions The sacral ESP block added to the multimodal treatment protocol significantly improves treatment quality.

The relationship between C-reactive protein, carbohydrate antigen 125, and hematological parameters to endometriotic nodule localization in pelvis.

BACKGROUND: Endometriosis is a pelvic inflammatory process, and hormonal, environmental, and genetic factors play a role in its etiopathogenesis; especially, deep pelvic endometriosis exhibits an extensive anatomical distribution. In the present study, we evaluated the contribution of routinely measured hematological parameters to the diagnosis as the number of endometriotic nodule localization increases, when evaluated with C-reactive protein (CRP) and carbohydrate antigen (CA) 125. METHODS: The present study included patients with histopathologically confirmed diagnosis of endometriosis who underwent surgery at our hospital between January 2007 and December 2018. Their medical records were examined retrospectively. RESULTS: In total, 205 patients were included in the study, of which 129 patients (62.9%) with ovarian endometrioma and 76 patients (37.1%) with deep infiltrative endometriosis were assigned to Group 1 and Group 2, respectively, and the two groups were compared. Endometriotic nodules were observed in several localizations in 71 patients (34.6%) of the 205 patients with endometriosis. Pelvic nodules were grouped as per their four different localizations: uterosacral, recto-vaginal, bladder, and ureteral. Because the anatomical localization of endometriotic nodules increased in the pelvis, the variability in the levels of CA 125 and CRP as well as hematological parameters was examined. There were significant differences in hemoglobin (p < 0.036), CA 125 (p < 0.000), and CRP (p < 0.007) levels between patients with nodules in ≤2 localizations and those with nodules in ≥3 localizations. CONCLUSION: Our study included a total of 205 patients. There was a significant difference in the CRP, CA 125, and hemoglobin levels between Group 1 and Group 2, but it was concluded that coexistence of the endometriotic nodule had no effect on the other hematological parameters. For this purpose, prospective studies with a larger number of patients are needed.

Bilateral iliac artery aneurysm: A rare cause of postpartum recurrent hemorrhage.

Postpartum hemorrhage (PPH) is a critical health problem that may result in maternal death. In cases of impaired maternal hemodynamics, several surgical therapies such as hypogastric artery ligation or postpartum hysterectomy may be employed to control the bleeding. A 30-year-old multiparous patient who had given birth via spontaneous vaginal delivery had undergone hysterectomy and then hypogastric artery ligation due to postpartum hemorrhage. The patient was referred to our clinic due to uncontrolled bleeding and she experienced recurrent episodes of massive hemorrhage during her follow-up in our clinic. Pelvic angiography performed by interventional radiologists to detect the bleeding focus revealed arteriovenous fistula and aneurysm in the right internal iliac artery and incomplete ligation of the left internal iliac artery. The bleeding was controlled by selective embolization through coiling of the fistula in the right internal iliac artery and branches of the left uterine artery. PPH is still an important cause of maternal mortality and vascular structural anomalies must be borne in mind in cases with delayed onset.

Incidence of occult malignancies identified during hysterectomies performed for benign indications.

OBJECTIVE: Hysterectomy is a commonly performed gynaecological procedure worldwide. Although most hysterectomies are performed for benign indications, the possibility of an unexpected malignancy in the final pathology results should be considered. The aim of our study was to investigate the evaluation and management of patients who underwent hysterectomy for benign reasons but were diagnosed with a malignancy in the final pathology results. METHODS: We retrospectively examined the medical records of patients who underwent hysterectomy for benign indications between 2011 and 2017, and recorded the information obtained from these patient files. RESULTS: In total, 1050 patients who underwent hysterectomy for benign indications were included in the study. Among these patients, 127 underwent hysterectomy for uterine prolapse, 230 for uterine myoma, 223 for treatment-resistant menometrorrhagia, 150 for treatment-resistant menometrorrhagia and uterine myoma, 61 for endometriosis, 108 for ovarian cysts, 45 for endometrial polyps, and 106 for treatment-resistant menometrorrhagia and ovarian cysts. In 13 of these patients, malignancy was unexpectedly identified via the final pathology results. Seven of these patients had sarcoma, three had cervical cancer, two had ovarian cancer, and one had metastasis of a haematological malignancy. CONCLUSION: Malignancy was identified in 13 of the 1050 patients included in our study. The incidence of unexpected malignancy in these patients who underwent hysterectomies performed for benign indications was determined to be 1.23%. Seven of these 13 patients had sarcoma. Our results demonstrate the absence of reliable data for preoperative detection of sarcoma.

Comparison of the harmonic scalpel with scissors in women who experience obturator nerve injury during lymph node dissection for gynaecological malignancies.

OBJECTIVES: Lymphadenectomy is crucial for accurate staging in most gynecological malignancies. Serious complications can occur during the surgery. The present study aimed to present the early and late findings associated with obturator nerve injury, which is rarely observed during lymphadenectomy but can result in serious sequela if not noticed. MATERIAL AND METHODS: The files of the patients who underwent lymphadenectomy at our clinic between 2012 and 2018 were examined. Patients with obturator nerve incisions were identified retrospectively. RESULTS: In total, 287 women patients underwent lymphadenectomy at our clinic between 2012 and 2018. Examination of surgical notes revealed that nine patients underwent obturator nerve incisions using a scissor or a harmonic scalpel (energy- activated ultrasonic scissors). With respect to management of obturator nerve damage, no significant difference was found between the use of a harmonic scalpel and scissors (p < 1.000) and the trendelenburg and lithotomy positions (p < 0.167). In addition, no significant difference was found between laparoscopy and laparotomy in terms of surgical type (p < 0.167). At 6 months post-operatively, sensory-motor examinations and EMG findings of the patients were completely normal. CONCLUSIONS: Surgeries performed for gynaecological malignancies have high mortality and morbidity rates. Moreover, in the event of a complication such as nerve damage during laparoscopy, successful management of the complication before the patient undergoes laparotomy allows the patient to continue benefitting from the advantages of the laparoscopy. The results of our study show that these high-risk surgeries should be performed in advanced and well-equipped medical centres by teams experienced in gynaecological oncology.

Spontaneous Ovarian Hyperstimulation Syndrome with FSH Receptor Gene Mutation: Two Rare Case Reports.

Development of ovarian hyperstimulation syndrome (OHSS) is very rare in a spontaneous ovulatory cycle and it is usually seen during pregnancy. In the etiology of OHSS, higher hCG (molar pregnancies or multiple pregnancies) and thyroid-stimulating hormone (TSH) levels have been accused. In recent years, some follicle-stimulating hormone (FSH) receptor (FSHR) gene mutations have been described in patients with OHSS in the first trimester with normal hCG levels. Herein, we report two cases of FSHR gene mutation during the investigation of the etiology of spontaneous OHSS. Although OHSS is typically associated with ovulation induction, it should be kept in mind that this condition may also develop in spontaneous pregnancies.

Gynaecological robotic surgery at a state hospital - our own experience.

OBJECTIVES: In recent years, the rapid development of minimally invasive surgical methods, including robotic surgery, has resulted in a marked decline of the traditional methods in gynaecological surgery. The aim of the study was to share our experience with robotic surgery at a state hospital. MATERIAL AND METHODS: A total of 40 patients, who underwent robotic gynaecological surgery (GS) between 2015 and 2017, were included. Age, BMI, previous abdominal operations (PAO), operation indications (OI), operative time (OT), pathological evaluation, uterine weight (UW), blood loss during surgery (BL), complications, and duration of the hospitalization (DoH) were analyzed. The Da Vinci XI was used during surgery. RESULTS: A total of 40 patients were analyzed. Mean values were as follows: age - 48 years, BMI - 28, and PAO - 12%. The most common OI included uterine fibroids (52%) and abnormal uterine bleeding (45%). Mean OT, docking time and console time values were 166 min, 15 min, and 123 min, respectively. Mean BL was 93 mL. Mean UW was 256 gr, and DoH was 4 days. Perioperative and postoperative complications were observed in 10% and 20% of the cases, respectively. CONCLUSIONS: Robotic-assisted surgery is invaluable in gynaecology, especially in the case of endometriosis, extensive adhesion, and in some oncological patients, as it allows for better visualization and higher maneuverability. In order for a surgeon to prepare for such cases, the use of the robot in benign cases is necessary to complete the learning curve and gain speed.

A Rare Case Report: A Malignant Histiocytic Tumor in the Form of Ovarian Mass.

Histiocytic cell malignancies are very rare. Hence, the information about this disease in hematology is limited. In this case report, we present a case of malignant histiocytic tumor affecting the ovary of a 40-year-old virgin female. Primary ovarian malignancy was not considered for the patient who was approached as if she had ovarian malignancy, since there was an indication of a mass in the ovary. Therefore, an aggressive surgery was not performed. Since our patient was in the reproductive age, fertility-preserving surgery was performed. Our patient was then treated systemically by medical oncology. In conclusion, the rare malignancy group was investigated in the present study along with an evaluation of the current literature.

Serum endocan levels in endometrial and ovarian cancers.

BACKGROUND: Ovarian and endometrial carcinomas are the two most common malignancies of the female reproductive system. Endocan is a proteoglycan that is specific to vascular endothelial cells. Increased serum levels have been reported in some tumors. The aim of this study was to investigate serum endocan levels in cases of endometrial and ovarian cancer. METHODS: Levels of serum endocan were assessed in 27 patients with endometrial cancer and 20 with ovarian cancer, and in 38 control subjects with benign ovarian or endometrial disorders. Thirty-five healthy subjects were also included. Serum endocan levels were measured using a specific enzyme-linked immunosorbent assay. Serum CA-125 levels were also measured in the patient and control groups. RESULTS: All patients had detectable serum endocan levels among endometrial and ovarian cancer groups except six cases. However, in the benign and healthy control groups, all endocan levels were undetectable except for two cases in the benign group and three in the healthy control group. Serum endocan levels were significantly higher in the entire patient group than in the controls (P<.0001 for both). Serum endocan levels in cases of endometrial cancer and ovarian cancer were higher than in both the control groups (P<.0001 for both). Evaluation of all groups revealed a positive correlation between serum CA-125 and endocan levels (r=.43, P<.0001). CONCLUSION: Although benign ovarian or endometrial disorders do not lead to expression of endocan, malignant cases can result in measurable endocan levels. This may be useful in differentiating benign and malign diseases of the endometrium or ovary.

Endometrial and Ovarian Cancer with MR Imaging Importance of Serum HE4 and CA 125 Levels in the Extent of Disease at Evaluation.

OBJECTIVE: Currently, no clinically useful tumor marker is available for primary diagnosis in endometrial cancer. Human epididymis protein-4 (HE-4) has high sensitivity and specificity as a tumor marker. Further, HE-4 has been shown to be elevated in early stage endometrial cancer and is more sensitive than CA 125. In our study, CA 125 and HE-4 reputation as a tumor marker for diagnosis of ovarian and endometrial cancer with the use of both the availability and affect the way we investigated the rate of diagnosis. MATERIALS AND METHODS: Here 20 patients with ovarian cancer, 26 patients with endometrial cancer, which had been histologically diagnosed, and 40 healthy volunteers were included. Peripheral blood samples were taken and serum CA 125 and HE-4 were tested. RESULTS: Serum CA 125 and HE-4 levels in patients with ovarian cancer were found to be significantly higher than those in healthy volunteers (p<0.05). Receiver-operating characteristic (ROC) analysis was performed. For patients with ovarian cancer and healthy controls, the CA 125 (0.83) and HE-4 (0.84) levels showed increased sensitivity (95%). There was no significant difference in the CA 125 levels in patients with endometrial cancer and healthy controls (p>0.05), whereas HE-4 levels were found to be higher in patients with endometrial cancer than in healthy controls (p<0.05). ROC analysis was performed. For endometrial cancer patients and healthy controls, the CA 125 (0.59) and HE-4 (0.63) levels showed increased sensitivity (88.5%). CONCLUSION: In ovarian and endometrial cancer, wherein early diagnosis is the most important factor for prognosis and survival, HE-4 is a new serum tumor marker that can be used with the aim of noninvasive diagnoses. For early diagnosis, the concomitant use of CA 125 and HE-4 is more effective and reliable than using either of them alone.

Evaluation of the effects of fulvestrant and micronized progesterone on the post-operative adhesion formation and ovarian reserve in rat model with immunohistochemical and biochemical analysis.

OBJECTIVE: To evaluate the effects of fulvestrant and micronized progesterone on post-operative adhesion formation and ovarian reserve in a rat uterine horn adhesion. METHODS: In this prospective randomized controlled trial, 32 female Wistar albino rats were randomly divided into four groups including control group (Group 1), the control adhesion group (Group 2), 1 mg/kg daily intramuscular fulvestrant received group (Group 3) and 1 mg/kg daily oral micronized progesterone received group (Group 4). The extent and severity of adhesions were scored and samples were taken from adhesion areas to investigate the grades of adhesions according to the immunohistochemical scoring system. Ovarian reserves were measured with anti-Müllerian hormone (AMH) and histological ovarian follicles count. RESULTS: The extent, severity and total adhesion scores were reduced in all treatment groups compared to control adhesion group (Group 2). Similarly, immunohistochemical adhesion scores were lower in the treatment groups. AMH and follicle count were significantly found lower in adhesion groups compared with control group. However, treatment groups were found to have higher ovarian reserve compared to control adhesion group (Group 2). CONCLUSIONS: Fulvestrant and micronized progesterone were found to reduce post-operative adhesion formations and have decreased detrimental effects of adhesion formation on ovarian reserve.

High serum HTATIP2/TIP30 level in serous ovarian cancer as prognostic or diagnostic marker.

BACKGROUND: Human HIV-1 TAT interactive protein 2 (HTATIP2/TIP30) is an evolutionarily conserved gene that is expressed ubiquitously in human tissues and some tumor tissues. This protein has been found to be associated with some gynecological cancers; as such, this study aimed to investigate blood HTATIP2/TIP30 levels in patients with ovarian cancer. METHODS: Twenty-three women with ovarian cancer and 18 patients with various non-cancerous gynecological complaints (for example, dysfunctional uterine bleeding, fibroids, and urinary incontinence) were included in the study. The pathological diagnosis of ovarian cancer was adenocarcinoma. HTATIP2/TIP30 concentration in the patients' blood samples was determined using ELISA kits. RESULTS: The HTATIP2/TIP30 level was significantly higher in the cancer group than in the control group (1.84 ± 0.82 versus 0.57 ± 0.13 ng/ml, mean ± SD). CONCLUSIONS: We demonstrated the potential role of HTATIP2/TIP30 in ovarian cancer for the first time, thereby enlightening future studies targeting HTATIP2/TIP30 in ovarian cancer treatment, diagnosis, and prevention.

Pregnancy and delivery after anterior vaginal mesh replacement: a case presentation.

A 36-year-old para 2 woman with Pelvic Organ Prolapse Quantification (POP-Q) stage III anterior prolapse and stress urinary incontinence (SUI) was treated using Polypropylene monofilament anterior vaginal mesh kit. She conceived 3 months after mesh replacement. During pregnancy and after delivery, patient satisfaction was achieved in terms of symptom relief, and surgeon satisfaction was obtained in terms of anatomical results. Three years after cesarean section, she had no incontinence, and on exam, POP-Q score was Ba -2 cm. No mesh complication was noted, and no sexual dysfunction was declared. In summary, vaginal mesh kits can be used satisfactorily for patients with anterior prolapse and SUI who want to be pregnant.

Minimally invasive approach to cases of lost intra-uterine device: a 7-year experience.

OBJECTIVES: To evaluate the effectiveness of hysteroscopy and laparoscopy for diagnosis and treatment in women with lost intra-uterine devices (IUDs), and to elucidate the most common extra-uterine locations of lost IUDs. STUDY DESIGN: Retrospective clinical study at Atatürk University Hospital, Erzurum, Turkey. Women with lost IUDs presenting in the last 7 years were referred to the obstetrics and gynaecology clinics. Women whose lost IUDs were removed using a Novak curette were excluded from the study. RESULTS: Of the 55 cases studied, 29 (52.7%) lost IUDs were located inside the uterine cavity, 23 (41.8%) were located outside the uterine cavity, and three (5.5%) were embedded in the myometrium. The most common extra-uterine location of lost IUDs was around the uterosacral ligaments (n=8, 34.7%). Considerable association was found between the position of the uterus and the extra-uterine location of lost IUDs. In all eight cases where the lost IUD was located around the uterosacral ligaments, the uterine position was anteverted and perforation was found on the posterior side of the uterus. IUD removal was performed successfully in 46 women (83.6%) by either hysteroscopy or laparoscopy. CONCLUSIONS: Lost IUDs inside or outside the uterine cavity can be managed by minimally invasive approaches. If an anteverted uterus is seen on laparoscopy, the initial exploration for the lost IUD should be made around the uterosacral ligaments.