A novel suturing technique for natural tissue repair in cystocele treatment.

BACKGROUND: Recently, natural tissue repair has become popular in the treatment of pelvic organ prolapsed. In this study, we compared patients who underwent cystocele repair with the rug-weaving plication technique, a natural tissue repair method implemented since 2022 for anterior prolapse, with those treated using conventional colporrhaphy. METHODS: We retrospectively reviewed the data of 65 patients who underwent anterior vaginal wall repair with the rug-weaving plication technique (n = 33, Group 1) or conventional colporrhaphy (n = 32, Group 2). We recorded the patients' clinicodemographic and surgical data. At the 6-month postoperative follow-up, we assessed patients' complaints, degree of prolapse (using the simplified Pelvic Organ Prolapse Quantification system), and pelvic floor muscle strength (using the Modified Oxford Score). Anterior vaginal wall thickness was measured using transvaginal ultrasonography. We compared clinicodemographic and surgical data and postoperative outcomes between the two groups. RESULTS: The two groups were comparable in terms of age (p = 0.326), number of pregnancies (p = 0.307), number of parities (p = 0.555), preoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p = 0.380), preoperative apical prolapse simplified Pelvic Organ Prolapse Quantification grade (p = 0.518), postoperative Modified Oxford Score (p = 0.857), operation time (p = 0.809), postoperative haemoglobin (p = 0.674), and amount of bleeding (p = 0.951). Compared with Group 2, Group 1 had significantly higher postoperative anterior vaginal wall thickness (p < 0.001) and significantly lower postoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p < 0.001). CONCLUSIONS: The rug-weaving plication technique may offer a viable alternative for cystocele repair without mesh, using natural tissue and potentially reducing mesh-related complications and recurrence rates. CLINICAL TRIAL NUMBER: NCT06410469 (03/05/2024).

The role of trimetazidine in ischemia/reperfusion damage treatment in an ovary torsion model experimentally induced in rats.

The aim of this experimental animal study was to investigate the histopathological and biochemical efficacy of trimetazidine (TMZ) in decreasing ovary damage in an ovary ischaemia/reperfusion (I/R) model in the rat. A total of 35 Wistar albino female rats were randomly separated into five groups, n = 7 per group: Group 1: Sham (S) was only given a laparotomy procedure. Group 2: Ischaemia (I) group with 2-hour ischaemia using a vascular sutur. Group 3: Ischaemia/Reperfusion (I/R) group with 2 hour ischaemia and 2-hour reperfusion. Group 4: Sham + 10 mg/kg orally TMZ (S + TMZ). Group 5: I/R + 10 mg/kg oral TMZ (I/R + TMZ) group with 2 hours ischaemia and 2 hours reperfusion after the administration orally 10 mg/kg oral TMZ. Two daily doses of TMZ were orally administered to Group 4 (S + TMZ) and Group 5 (I/R + TMZ) for three days. TMZ significantly decreased vascular congestion, haemorrhage, and polymorphonuclear leukocyte infiltration in group 5 compared to group 3 (p < .05). Despite TMZ decreased the malondialdehyde, total oxidant status, and oxidative stress index values, these decreases were not statistically significant (p > .05). TMZ which is an antioxidant agent can efficiently prevent in I/R damage in rat ovaries but further studies are necessary in order to implement it in the clinical settings.IMPACT STATEMENTWhat is already known on this subject? Adnexial torsion is the most common gynecological emergency and there are no specific clinical, laboratories, or radiological findings for adnexal torsion. Unfortunatelly, the currently accepted treatment is adnexal detorsion. Cytoprotective effects of Trimetazidine (TMZ), an antianginal drug, are well-defined and it has been demonstrated to improve oxidative stress markers and limits membrane damage induced by reactive oxygen species and protects tissues from free radicals with its antioxidant effects. The aim of this study is to investigate the effects of TMZ in experimentally induced adnexal torsion in rats and to investigate possible effects in maintaining ovarian reserve to prevent I/R damage or reperfusion damage.What do the results of this study add? Our study showed that TMZ significantly decreased vascular congestion, haemorrhage, and PMNL infiltration. TMZ decreased the malondialdehyde, total oxidant status, and the oxidative stress index values, but these decreases were not statistically significant.What are the implications of these findings for clinical practice and/or further research? Although various antioxidant drugs and chemicals have been used to protect the ovaries against I/R damage, they have not been demostrated to prevent it completely. TMZ, an antioxidant efficacy agent, has been shown to prevent ovarian I/R damage by suppressing inflammation in terms of histopathological parameters. Further studies involving a greater number of experimental animals are required before using TMZ for the treatment of humans with I/R damage in the clinical setting.

Pure large cell neuroendocrine carcinoma of ovary: A rare clinical entity.

OBJECTIVE: Large cell neuroendocrine carcinoma (LCNEC) of the ovary is a rare tumour. Its pure form without any associated surface epithelial stromal or germ cell component is more rarely seen. Its prognosis is generally very poor even when the diagnosis is made at an early stage. We report a case of pure large cell neuroendocrine tumour of ovary. The patient was a 73-year-old woman with symptom of pelvic pain. Ultrasonography detected an abdominal tumour larger than 10 cm. She underwent an exploratory laparotomy with resection of the pelvic mass. After the surgery six cycles of chemotherapy (Etoposide and Cisplatin) were administered to the woman. She is still healthy after the last chemotherapy. Due to the rarity of the disease, few number of reported cases and the lack of systematic population based studies or registry data, we reported this case.

The impact of concurrent pelvic organ prolapse reconstructive surgery on midurethral sling procedure outcome.

OBJECTIVES: To evaluate the effect of concurrent pelvic organ prolapse (POP) reconstructive surgery on midurethral sling (MUS) procedure outcome. MATERIAL AND METHODS: The present retrospective study included 300 women with urodynamically diagnosed stress urinary incontinence that underwent MUS procedures with or without concurrent POP reconstructive surgery. Patients were divided into four groups according to the performed surgery; 1) transobturator tape (TOT), 2) TOT with POP surgery (anterior colporrhaphy, posterior colporrhaphy and vaginal hysterectomy), 3) tension free vaginal tape (TVT), 4) TVT with POP surgery. Outcomes of surgeries for each group were evaluated postoperatively at the end of the first and sixth month by performing a cough stress test and also using the Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory (UDI-6) questionnaires. Presence of a negative cough stress test was defined as "Cure". Multivariate regression was used to identify the parameters for surgical failure. RESULTS: Forty-two, 70, 49 and 139 women underwent isolated TOT, concurrent TOT and POP, isolated TVT and concurrent TVT and POP surgery, respectively. Postoperative UDI-6 score and postoperative cure rate were significantly higher in the only TOT group as compared to the TOT + POP group. However, in multiple regression analysis, women's age, parity, body mass index, menopausal status, preoperative urodynamic parameters, MUS types and presence of any concomitant POP reconstructive surgery were found to have no significant effect on surgical outcome. CONCLUSIONS: Concurrent POP reconstructive surgery including anterior colporrhaphy, posterior colporrhaphy and vaginal hysterectomy have no affect MUS procedure outcomes.

Correlation of bladder wall thickness and treatment success in types of urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to investigate the correlation between mean bladder wall thickness (BWT) and treatment success in patients diagnosed with urinary incontinence, based on urodynamic test results. METHODS: In this prospective study, patient urinary incontinence type was identified using urodynamic tests. Patients (N = 125) were categorized into three groups: urodynamic stress incontinence (SUI), detrusor over-activity (DO) and mixed urinary incontinence. Measurements from the bladder dome, anterior wall and trigone were averaged to calculate BWT. Student's t test and Mann-Whitney U test were used to compare pre-treatment BWT. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for BWT to predict treatment success. RESULTS: Mean pre-treatment BWT significantly differed between success and non-success groups for each urinary incontinence type (p value for the SUI, DO and MUI groups was 0.043, 0.001 and 0.002 respectively). Using ROC curves to anticipate the treatment success, a threshold was calculated for mean pre-treatment BWT; 5.05 mm for SUI (sensitivity 74 %, specificity 66 %, positive predictive value [PPV] 85 %, negative predictive value [NPV] 50 %), 4.98 mm for DO (sensitivity 73 %, specificity 92 %, PPV 95 %, NPV 63 %) and 5.31 mm for mixed type (sensitivity 88 %, specificity 73 %, PPV 79 %, NPV 85 %). CONCLUSIONS: The study results suggest a significant relationship between the pre-treatment BWT and the success of urinary incontinence treatment. The mean BWT may be used as a benchmark in assessing the responsiveness to treatment of urinary incontinence types.

A comperative study for short-term surgical outcomes of midurethral sling procedures in obese and non-obese women with stress urinary incontinence.

There is little data comparing the surgical outcomes of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures in obese women. Therefore, we aimed to compare the surgical outcomes of TOT and TVT procedures among obese women with a diagnosis of stress urinary incontinence (SUI). One hundred and eighty-nine women who underwent TVT or TOT procedures due to pure SUI were included. Women in whom the body mass index (BMI) was ≥30 kg/m2 were considered as obese, while <30 kg/m2 were non-obese. And women with BMI ≥35 kg/m2 was defined as morbidly obese. At sixth month postoperative follow-up, neither the comparison of TVT and TOT results in obese women nor the comparison of TVT or TOT results between obese and non-obese women showed any significant differences in terms of objective and subjective cure rates, quality of life improvements, or intra/postoperative complications. TVT and TOT procedures also have similar effectiveness among morbidly obese women. We have concluded that TVT and TOT operations seem to be equally effective and safe surgical treatment procedures for female SUI regardless of BMI.

Krukenberg carcinoma metastasized from stomach resembling mucinous cystadenocarcinoma of the ovary.

The ovaries are common site of metastasis in a variety of primary neoplasms. Multiple tumors such as breast, lung, and pancreas have been reported to metastasize to the ovary, however; the colon and stomach are the most common primary cancer sites that of ovarian metastasis. An ovarian mass mostly originates from its self-tissue, but sometimes it can be a metastasis of a gastrointestinal system tumor. Such cases are often misdiagnosed as primary ovarian cancers. A 42-year-old woman was admitted to our hospital with pelvic pain. She had a history of her complaints for two months. Bilateral large ovarian mass was detected in transvaginal ultrasound. Laparotomy was performed, the pathologist suggested inspection of the stomach after the frozen section analysis; therefore, an irregular mass on the stomach was detected. The general surgeon was attended to the operation, and an inoperative stomach tumor was reported by the general surgeon. After that due to the partial obstruction of jejunum, a gastrojejunostomy was performed. It is in fact difficult to distinguish between metastatic mucinous carcinomas and primary mucinous carcinomas of the ovary, due to the similar appearance of as cystic tumors on gross examination. The clinicians should be aware of the likely concomitant gastrointestinal system tumor when a large and bilaterally mass was detected on physical examination. This case also reminds that a systemic examination is necessary even if the large ovarian tumors suspicious of primary malignancy were noticed.

Effect of pregnancy and delivery on urinary incontinence after the midurethral sling procedure.

INTRODUCTION AND HYPOTHESIS: To evaluate the continence status and to reveal the optimal delivery mode of women who had an infant after application of a midurethral sling to treat stress urinary incontinence. METHODS: Between January 2007 and January 2013, 12 women who delivered an infant after application of a midurethral sling were detected and demographic data, type of MUS, interval between MUS and delivery, mode of delivery, birth weight of the newborn, complications during pregnancy, and continence status after delivery were collected. Between 2000 and 2014, in 14 articles listed in Pubmed, the data of 54 patients who had delivered after successful midurethral sling application were included. Postpartum recurrence of urinary incontinence was evaluated according to delivery type in 54 patients. RESULTS: Mean age of 12 patients at the time of MUS was 33.1 ± 4.3 years old and the interval between MUS procedure and pregnancy was 30.2 ± 14.2 months. Four patients had a transvaginal tape (TVT; 33.3%) and 8 had transobturator tape (TOT) procedure (66.7%) and mean follow-up after MUS surgery was 52 ± 12.3 months. Seven women had cesarean section (CS; 58.3%) and 5 women delivered vaginally (41.7%). Nine women were continent during pregnancy (75%) and 10 were continent after delivery (83.3%). Among 54 women who were included in the review, 28 underwent CS (51.9%), 26 women delivered vaginally (48.1%), and 11 women had postpartum incontinence (20.3%). In the case of postpartum urinary incontinence, there was no statistically significant difference between the CS and vaginal delivery groups (14.3 vs 26.9% respectively, p = 0.32). In logistic regression, incontinence during pregnancy was a risk factor for postpartum incontinence (OR:5.5; 95% CI: 1.1-27.6, p = 0.036). CONCLUSION: Risk of postpartum SUI recurrence in women who underwent application of midurethral slings seems to be similar independent of delivery mode and incontinence during pregnancy may be a risk factor for postpartum incontinence.

Risk factors for adenomyosis, leiomyoma and concurrent adenomyosis and leiomyoma.

AIM: To evaluate the risk factors for adenomyosis, leiomyoma and concomitant adenomyosis and leiomyoma in patients with treatment-resistant menometrorrhagia. METHODS: A retrospective study was conducted on 129 women who underwent abdominal hysterectomy for treatment-resistant menometrorrhagia. The patients were divided into four groups according to the postoperative histopathology: concomitant adenomyosis and leiomyoma (n = 33), adenomyosis only (n = 26), leiomyoma only (n = 48) and controls (n = 22). Patients without any organic uterine pathology constituted the control group. RESULTS: Age at menarche was higher in the concomitant adenomyosis and leiomyoma group compared to the adenomyosis only group (P = 0.006). The mean age (P = 0.007), age at menarche (P = 0.001) and gravidity (P = 0.001) were higher in the concomitant adenomyosis and leiomyoma group compared to the leiomyoma only group. Preoperative hemoglobin was lower in the concomitant adenomyosis and leiomyoma, adenomyosis only, and leiomyoma only groups than the control group (P < 0.008). On receiver operating characteristic analysis, hemoglobin <10.9 mg/dL had a sensitivity and specificity of 77% and 70%, respectively, in discrimination of any uterine organic pathology, including adenomyosis only, leiomyoma only, and concomitant adenomyosis and leiomyoma, from the control group. Patients in the adenomyosis group were older (OR, 1.20; 95%CI: 1.05-1.50) and had a lower age at menarche (OR, 0.42; 95%CI: 0.19-0.89) than the other groups. CONCLUSIONS: Preoperative anemia may be a useful predictor of adenomyosis. Older patients, and patients who had a lower age at menarche, were also more likely to have adenomyosis.

Associations between adipocyte fatty acid-binding protein and clinical parameters in polycystic ovary syndrome.

PURPOSE: We evaluated a possible association between serum adipocyte fatty acid-binding protein (A-FABP) levels and clinical parameters in women with polycystic ovary syndrome (PCOS). METHODS: Our study included 86 women: 49 with PCOS (study group), 37 with non-PCOS (control group). We recorded and analyzed age, body mass index [BMI = weight (kg)/height (m)(2)], waist circumference, and blood pressure and follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, free testosterone (fT), dehydroepiandrosterone sulfate, 17-OH progesterone, insulin, glucose, triglyceride, high-density lipoprotein, low-density lipoprotein, very low density lipoprotein, HOMA-IR, and A-FABP levels. RESULTS: The mean BMI, waist circumference, and levels of serum LH, fT, LH/FSH, fasting insulin, and HOMA-IR were significantly higher in PCOS patients (p < 0.05). Pearson correlation analysis showed positive correlations of A-FABP levels with BMI and HOMA-IR levels and a negative correlation between A-FABP and fT levels. A ROC curve analysis found that BMI, waist circumference, and levels of fT, A-FABP, and HOMA-IR were discriminative parameters. CONCLUSION: Serum A-FABP levels may be a good prognostic marker in predicting metabolic syndrome and cardiovascular diseases in PCOS patients.

Preliminary Outcomes of a New, Safe, Tension-free Vaginal Tape Trocar.

The aim of this study is to introduce a new, safe, tension-free vaginal tape (TVT) trocar. Twenty-eight women with stress urinary incontinence who underwent a TVT procedure with a new trocar during a 6-month period were prospectively enrolled in this study. All the operations were performed by the same surgeon who developed the trocar. The trocar has two buttons, which make the tip of the device sharp or blunt. Median age of the study population was 52 years (range, 30-76 years), median number of vaginal deliveries was 3 (range, 1-10). And 57.1% of women were at menopause. Median body mass index was 30.0 kg/m² (range, 23.8-35.2 kg/m²). Preoperative median Valsalva leak point pressure was 78 cmH2O (range, 50-94 cmH2O), while the median maximum urethral closure pressure was 50 cmH2O (range, 14-74 cmH2O). Concomitant prolapse surgery was present in 23 women (82.1%). At the 6-month postoperative visit, objective and subjective cure rates were 89.3% for each. No serious intraopeartive or postoperative complication such as bladder, intestine, or major vessel injury occured. Only 3 women (10.7%) needed blood transfusion, and 2 women (7.1%) had postoperative voiding difficulty. Due to the modifiable tip, this new sling trocar seems safer than the conventional trocars. But large studies are necessary to prove this assumption. Due to the modifiable tip, this new sling trocar seems safer than the conventional trocars. But large studies are necessary to prove this assumption.

Incidentally detected ectopic right kidney following total abdominal hysterectomy and bilateral salpingoophorectomy.

Congenital organ anomalies in surgical patients can be incidentally detected during operation. A pelvis located right kidney was found incidentally in 54 year-old women after total abdominal histerectomy and bilateral salpingoophorectomy. The clinical importance of pelvic kidney detected during the surgery was discussed in this case report.

Pain experienced during and after office hysteroscopy with and without intracervical anesthesia.

We designed this study to evaluate if intracervical anesthesia reduces pain experienced during and after office hysteroscopy (OH). Two hundred women undergoing OH were randomized into two groups. Group I received intracervical anesthesia (10 ml %2 prilocaine), group II did not receive any anesthesia before procedure. The intensity of pain during procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed. Groups were similar in age, parity, previous number of vaginal delivery, or presence of menopausal status. The mean of pain scores during OH was less in group I (0.82 ± 0.11) than in group II (0.86 ± 0.09) and the difference was statistically significant (p = 0.04). But, the difference of mean pain scores 30 and 60 minutes after procedure between the groups were not statistially significant. In conclusion, intracervical anesthesia reduces pain experienced during OH, but this effect does not last longer.

Retention of fetal bones 8 years following termination of pregnancy.

Foreign bodies; in particular, fetal bones may present with a variety of clinical symptoms and signs including infertility, vaginal discharge, disparonia, pelvic pain, abnormal uterine bleeding. Many case reports were described post- abortal removal of retained fetal bone at varying time intervals from the previous (D&E), ranging from weeks to years. In our case, a 34-year-old woman presented with abnormal uterine bleeding and secondary infertility, her only pregnancy being a termination 8 years previously at 15 weeks' gestation. A transvaginal ultrasound revealed a normal-sized, normal-shaped uterus with an echogenic scarred endometrium. After then office hysterescopy revealed fragments of the immature bone. All the immature bones were removed by operative hysterescopy. Significant numbers of patients may have endometrial pathology; the differential diagnosis of such unusual findings on ultrasound examination includes intrauterine contraceptive devices, foreign bodies, calcified submucous fibroids and Asherman's syndrome, as well as rarities such as heterotopic bone. The presence of this pathology may be a causal or contributory factor to subfertilty, and will remain undetected if the endometrium is not routinely evaluated. Indeed, these cases highlight the advantage of performing a hysteroscopy at the same time as the more invasive laparoscopy and dye insufflation, in selected cases.

Effects of horizontal vs vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy: a prospective randomized study.

STUDY OBJECTIVE: To compare the effects of horizontal and vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy. DESIGN: Prospective randomized study (Canadian Task Force classification I). SETTING: Teaching and research hospital, a tertiary center. PATIENTS: Fifty-two women with POP-Q stage 0 or 1 uterine prolapse were randomized into 2 groups using vertical (n = 26) or horizontal (n = 26) vaginal cuff closure. INTERVENTIONS: All patients underwent vaginal hysterectomy. MEASUREMENTS AND MAIN RESULTS: Vagina length in the 2 groups was compared preoperatively, immediately after surgery, and at 6 weeks postoperatively. Mean (SD) preoperative vagina length in the horizontal and vertical groups was similar (7.87 [0.92] cm vs 7.99 [0.78] cm; p = .41). Immediately postoperatively, the vagina was significantly shorter in the horizontal group than in the vertical group (6.61 [0.89] cm vs 7.51 [0.74] cm; p < .001). At 6 weeks postoperatively, the vagina was still significantly shorter in the horizontal group (6.55 [0.89] cm vs 7.42 (0.73) cm; p < .001). The mean difference in vagina length before and after surgery was also significantly higher in the horizontal group than in the vertical group (-1.26 [0.12] cm vs 0.49 [0.11] cm; p < .001). CONCLUSION: Vertical cuff closure during vaginal hysterectomy seems to preserve vagina length better than does horizontal cuff closure.

A new approach for the management of bladder injury in retropubic slings: one side transobturator/ one side retropubic sling.

The aim of this study was to establish a new management modality for bladder perforation during retropubic slings. In 2013, among 102 retropubic slings, there were five bladder injuries. All procedures were performed by one of the fourth year residents under direct supervision of experienced surgeons. Bladder perforation was detected in cystoscopic examination. In the bladder perforated side, tape was retracted and placed by transobturator approach and the Foley catheter remained in place for seven days. Demographic features, preoperative urodynamic examination, and preoperative and postoperative life quality questionnaires (IIQ-7 and UDI-6) were recorded. The mean age of the patients was 44 ± 2.5 years and body mass index was 29.4 ± 1.7 kg/ m2. Mean parity was 2.8 ± 1.8 and all the patients delivered with vaginal route. None of the patients were in menopause. Of the five bladder perforations, 40%(2) occurred on the right side, 60%(3) on the left side. All the surgeons were right handed. All patients underwent other vaginal reconstructive procedures like anterior colporraphy and posterior colporraphy. None of the patients had previous anti-incontinence surgery. Mean follow-up was 10.2 ± 2.4 months. All patients had negative stress tests and improvement in IIQ-7 and UDI-6 at postoperative sixth month. There was no postoperative voiding dysfunction in any of the patients. If bladder perforation occurs in patients who undergo retropubic sling, the tape can be placed by transobturator approach in the bladder perforated side.

Hepcidin and erythropoietin measurements in the cord blood of neonates with meconium-stained amniotic fluid.

AIM: To compare hepcidin and erythropoietin levels in the cord blood of neonates with meconium-stained amniotic fluid (MSAF) to levels obtained from age-, body mass index- and gravidity-matched neonates with clear amniotic fluid. METHODS: A cross-sectional controlled study was conducted in secondary and tertiary care centers. Cord blood samples of 40 neonates following term gestations (≥37 weeks' gestation) with MSAF and 40 maternal age-, body mass index- and gravidity-matched controls with clear amniotic fluid were analyzed in this study. Demographic data, delivery outcomes and laboratory evaluations were recorded. RESULTS: Cord blood pH levels were lower in fetuses with MSAF when compared to those with clear amniotic fluid (P=0.0001). Fetuses with MSAF had higher cord blood erythropoietin levels in comparison to those with clear amniotic fluid (P=0.0001). Delivery outcomes and hepcidin measurements were similar in both groups. CONCLUSIONS: We demonstrated a significant relationship between erythropoietin levels and meconium passage, but failed to show the existence of a relationship between hepcidin levels and meconium passage.

Minimally invasive sacrospinous ligament suspension: perioperative morbidity and review of the literature.

PURPOSE: The objective of this study is to determine the perioperative outcomes of minimal invasive sacrospinous ligament suspension (SSLS) in women with apical prolapse. METHODS: This prospective randomized study included 1,464 patients for a 10-year period. SSLS was performed by Deschamps ligature carrier at 762 patients (Group 1) and automatic suturing instrument was applied at 702 patients (Group 2). Patients' perioperative complications, blood loss, operative time, and hospital stay were recorded. RESULTS: Suturing took 46 s (range 31-63 s) in Group 2 and 775 s (range 585-965 s) in Group 1. Group 2 patients had shorter time for suturing process, less postoperative analgesic requirement, and shorter hospital stay (p < 0.0001, p < 0.01, p < 0.01, respectively). Also there were no bladder, ureteral, rectum or nerve injuries in Group 2. CONCLUSION: Minimally invasive SSLS is a reliable procedure with less procedural complications, reduced postoperative pain, less hospital stay and shorter operation times.

Role of serum renalase levels in predicting the presence of metabolic syndrome in patients with polycystic ovary syndrome.

OBJECTIVE: This study was designed to compare the serum renalase levels of polycystic ovary syndrome (PCOS) women with and without metabolic syndrome (MS) and those of healthy non-PCOS women. MATERIALS AND METHODS: Seventy-two patients diagnosed with PCOS and age-matched 72 healthy non-PCOS were included in the study. The PCOS group was divided into two groups as having metabolic syndrome or not. General gynecological and physical examination findings and laboratory results were recorded. Renalase levels in serum samples were determined using Enyzme-Linked ImmunoSorbent Assay method. RESULTS: Mean serum renalase level was significantly higher in PCOS patients with MS compared with both PCOS patients without MS and healthy controls. Additionally, serum renalase correlates positively with body mass index, systolic and diastolic blood pressure, serum triglyceride and homeostasis model assessment-insulin resistance values among PCOS women. However, systolic blood pressure was found to be the only significant independent factor that can affect the serum renalase levels. A serum renalase level of 79.86 ng/L had a sensitivity of 94.7% and specificity of 46.4% in discriminating PCOS patients with metabolic syndrome from healthy women. CONCLUSIONS: Serum renalase level increases in women with PCOS in the presence of metabolic syndrome. Therefore, monitoring the serum renalase level in women with PCOS can predict the metabolic syndrome that may develop.

Prediction of uterine dehiscence via machine learning by using lower uterine segment thickness and clinical features.

BACKGROUND: With the global increase of cesarean delivery rates, the long-term effects of cesarean delivery have started to become clearer. One of the most prominent complications of cesarean delivery in recurrent pregnancies is uterine rupture. Assessing the risk of uterine rupture by accurately predicting dehiscence is very important to prevent untimely operations and/or maternal and fetal complications. OBJECTIVE: This study aimed to assess whether machine learning can be used to predict uterine dehiscence by using patients' ultrasonographic findings, clinical findings, and demographic data as features. Hence, we investigated a potential method for preventing uterine rupture and its maternal and fetal complications. STUDY DESIGN: The study was conducted on 317 patients with term (>37 weeks' gestation) singleton pregnancies and no medical complications or medications that may affect uterine wound healing. Demographics, body mass indices, smoking and drinking habits, clinical features, past pregnancies, number and history of abortions, interdelivery period, gestational week, number of previous cesarean deliveries, fetal presentation, fetal weight, tocography data, transabdominal ultrasonographic measurement of lower uterine segment full thickness and myometrium thickness, and lower uterine segment findings during cesarean delivery were collected and analyzed using machine learning techniques. Logistic regression, multilayer perceptron, support vector machine, random forest, and naive Bayes algorithms were used for classification. The dataset was evaluated using 10-fold cross-validation. Correct classification rate, F-score, Matthews correlation coefficient, precision-recall curve area, and receiver operating characteristic area were used as performance metrics. RESULTS: Among the machine learning techniques tested in this study, the naive Bayes algorithm showed the best predictive performance. Among the various combinations of features used for prediction, the essential features of parity, gravidity, tocographic contraction, cervical dilation, dilation and curettage, and sonographic thickness of lower uterine segment myometrium yielded the best results. The second-best performance was achieved with sonographic full thickness of lower uterine segment added to the base features. The base features alone could classify patients with 90.5% accuracy, whereas adding the myometrium measurement increased the classification performance by 5.1% to 95.6%. Adding the full thickness measurement to the base features raised the classification performance by 4.8% to 95.3% in terms of correct classification rate. CONCLUSION: The naive Bayes algorithm can correctly classify uterine dehiscence with a correct classification rate of 0.953, an F-score of 0.952, and a Matthews correlation coefficient value of 0.641. This result can be interpreted as indicating that by using clinical features and lower uterine segment ultrasonography findings, machine learning can be used to accurately predict uterine dehiscence.