Transobturator Tape Operation for the Treatment of Stress Urinary Incontinence in Postmenopausal Women Aged Over 65 Years.

OBJECTIVE: We compared success rates and complication rates in women aged less then and equal to or more than 65 years who had undergone transobturator tape (TOT) surgery for stress urinary incontinence (SUI). METHODS: This was a retrospective cohort study that included patients who underwent surgery to treat SUI. We separated patients into two groups according to age: younger than 65 years and equal to or older than 65 years. Exclusion criteria were patients with history of incontinence surgery, history of radical pelvic surgery, concomitant pelvic organ prolapse repair, detrusor overactivity, and less than 1 year of postoperative follow-up. The surgical procedures and pre- and postoperative evaluations including urodynamics were performed in a tertiary center. The primary objective was to assess the success rate, patient-reported satisfaction after surgery, and improvement in quality of life (QOL). The secondary outcome the assessment of complications. RESULTS: A total of 123 women, including 53 (43.1%) women aged less than 65 years, and 70 (56.9%) women aged 65 years and over with SUI who underwent TOT surgery between January 2004, and March 2013. After a median follow-up of 52 (IQR 31) months for the older patients and 54 (IQR 42) months for younger patients, cure rates and patients satisfaction rates were similar in both group (82.9 vs. 81.1%, P = 0.81 and 87.2 vs. 88.6%, P = 0.79, respectively). The improvement in QOL, which was confirmed with changes in Kings Health Questionnaire (KHQ) scores, was similar in both the older and younger women -209.6 (IQR 420.9) vs. -191.1 (IQR 379.4), P = 0.62, respectively). Postoperative complications were similar in both age groups. CONCLUSIONS: Transobturator tape surgery in the management of SUI is safe and efficient in improving QOL, has high success and patient satisfaction, and low postoperative morbidity rates even in women aged ≥65 years.

Spectroscopic analysis of embryo culture media for predicting reproductive potential in patients undergoing in vitro fertilization.

OBJECTIVE: To predict the reproductive potential of embryos via Raman spectroscopy evaluation of the spent culture media as well as with a conventional morphologic evaluation. MATERIALS AND METHODS: Women of reproductive age (n=31) who were treated for unexplained infertility and scheduled for single embryo transfer were invited to participate in this prospective study. After the embryos were removed from the culture, the spent culture media were stored at -80 °C after snap-freezing in liquid nitrogen. RESULTS: Fifteen patients were clinically pregnant, and 16 patients were clinically non-pregnant. Clinical pregnancy was predicted using Raman spectroscopy in 93% (14/15) of clinically pregnant patients, and in 62.5% (10 out of 16) of clinically non-pregnant patients. The sensitivity of the Raman spectroscopic analysis was 93% and the specificity was 62.5%. CONCLUSION: Metabolomic evaluation of spent embryo culture media is an emerging technique with promising objective results. However, there is clearly room for improvement.

Bipolar cord coagulation in the management of complicated monochorionic twin pregnancies.

AIM: To report our experience in selective termination of monochorionic twin pregnancies with bipolar cord coagulation and to analyze the pregnancy outcomes and complications based on the indication of the procedure. METHODS: This is a retrospective study of 71 complicated monochorionic pregnancies treated with bipolar cord coagulation between August 2006 and March 2013. RESULTS: The rates of live birth and survival up to 28 days after birth were 73.2% (52/71) and 63.4% (45/71), respectively. The highest rates of survival up to 28 days after birth were in the procedures with an indication of selective intrauterine growth restriction, while the lowest rates of survival were recorded with the indication of twin reversed arterial perfusion sequence and discordant anomaly. However, there were no statistically significant differences in the live birth and perinatal survival rates among the four different groups of indications. CONCLUSION: The survival rate of bipolar cord coagulation in complicated monochorionic pregnancies such as twin-to-twin transfusion syndrome, twin reversed arterial perfusion sequence, selective intrauterine growth restriction and discordant anomaly was 63% in our series.

Stage-related outcome after fetoscopic laser ablation in twin-to-twin transfusion syndrome.

AIM: To review the perinatal outcome of twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser coagulation in a developing country with detailed analysis according to the stage of the syndrome. METHODS: This was a retrospective study of 85 TTTS cases treated with fetoscopic laser coagulation at the Fetal Diagnosis and Treatment Unit of Istanbul Faculty of Medicine between January 2006 and March 2013. RESULTS: The surgical failure rate was 5.8% (5/85). Among all the cases of the total cohort, only 1 fetus survived in 27 pregnancies (31.8%), and both fetuses survived in 22 pregnancies (25.9%). In 49 pregnancies (57.6%) at least one fetus survived at the end of the neonatal period. The overall survival and live birth rates were 41.8% (71/170) and 56.4% (96/170), respectively, and they significantly decreased as the stage of disease increased. Delivery occurred before 32 weeks of gestation in 54 (63.5%) pregnancies. Logistic regression analysis showed that gestational age at delivery was the only independent factor, and the risk of nonsurvival significantly decreased with increasing age. CONCLUSION: Based on our experience, the outcome of fetoscopic laser coagulation of the placental anastomoses for TTTS became worse as the Quintero stage of the disease advanced.

Renal failure due to renal vein thrombosis in a fetus with growth restriction and thrombophilia.

We report a case of renal vein thrombosis diagnosed at 27 weeks of gestation in a dichorionic twin pregnancy. The left kidney of one fetus was hyperechoic and enlarged with echoic streaks following the direction of interlobular veins and the loss of corticomedullary differentiation. In the following weeks, left kidney became smaller and echoic, and Doppler examination showed no flow in both artery and vein. The right kidney had totally normal appearance in the beginning, but it became enlarged and hyperechoic, and progressed into a small echoic kidney with no flow in artery and vein. In the postnatal ultrasound examination, both kidneys appeared hyperechoic with no vascularization in the hilum region. There was thrombosis in arteries and veins of both kidneys, as well as in the inferior vena cava. The investigation for thrombophilia resulted with the combined presence of heterozygote mutation in factor V Leiden and prothrombin 20210 genes.

Treatment of vaginal agenesis using a modified McIndoe technique: Long-term follow-up of 23 patients and a literature review.

BACKGROUND: Congenital vaginal agenesis is a rare malformation with an incidence of one in 4000 to 5000 female newborns. The purpose of vaginal agenesis treatment is not only to create an adequate passageway for penetration but also to facilitate satisfactory sexual intercourse. OBJECTIVE: To present the results of a modified McIndoe technique with respect to sexual function, vaginal length and complication rates in patients with vaginal agenesis. METHODS: Between 2002 and 2010, 23 patients with vaginal agenesis were admitted to the Gynecology Clinic of Istanbul University School of Medicine (Istanbul, Turkey) for vaginal reconstruction. All patients underwent a modified McIndoe procedure. The long-term results with a follow-up period ranging from 18 to 118 months are presented. RESULTS: The postoperative mean vaginal length was 8.4 cm (range 6 cm to 11 cm) in 19 patients who used the mould regularly. Among 14 patients who used the mould regularly and had partners, only one experienced severe pain during intercourse and 13 reported that they were engaging in satisfactory sexual activity with mild or no pain, and with good mucosal sensitivity. Conversely, two of three patients who used the mould irregularly experienced severe pain during intercourse and had a mean vaginal length of 6 cm (range 4 cm to 8 cm). CONCLUSION: The findings suggest that a modified McIndoe technique is a simple, effective procedure for the treatment of vaginal agenesis; however, proper mould use after surgery remains the cornerstone of the treatment.

HISTORIQUE: L'agénésie vaginale congénitale est une malformation rare à l'incidence de un cas sur 4 000 à 5 000 nouveau-nés de sexe féminin. Le traitement de l'agénésie vaginale vise non seulement à créer un passage suffisant pour la pénétration, mais également à favoriser des relations sexuelles satisfaisantes. OBJECTIF: Présenter les résultats d'une technique de McIndoe modifiée à l'égard de la fonction sexuelle, de la profondeur du vagin et des taux de complication chez les patients ayant une agénésie vaginale. MÉTHODOLOGIE: De 2002 à 2010, 23 patientes ayant une agénésie vaginale ont été hospitalisées à la clinique de gynécologie de la faculté de médecine de l'université d'Istanbul, en Turquie, pour subir une reconstruction vaginale. Toutes les patientes ont subi une intervention de McIndoe modifiée. Les chercheurs présentent les résultats à long terme de cette intervention, après une période de suivi de 18 à 118 mois. RÉSULTATS: Le vagin avait une profondeur moyenne de 8,4 cm après l'opération, variant de 6 cm à 11 cm chez les 19 patientes qui utilisaient le moule régulièrement. Chez les 14 patientes qui utilisaient le moule régulièrement et avaient des partenaires, une seule a ressenti des douleurs marquées pendant les relations sexuelles, et 13 ont déclaré avoir des relations sexuelles satisfaisantes associées à des douleurs légères, sinon inexistantes, et à une bonne sensibilité muqueuse. Par contre, deux des trois patientes qui n'utilisaient pas le moule régulièrement ont ressenti des douleurs marquées pendant les relations sexuelles, et leur vagin avait une profondeur moyenne de 6 cm (plage de 4 cm à 8 cm). CONCLUSION: D'après les observations, la technique de McIndoe modifiée est une intervention simple et efficace pour traiter l'agénésie vaginale, mais une bonne utilisation des moules après l'opération demeure la pierre angulaire du traitement.