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

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

Should sacrouterine plication be added to lateral suspension surgery? A prospective study.

AIM: Laparoscopic lateral suspension is a novel approach for repairing anterior and apical pelvic organ prolapse (POP). According to integral theory, urinary symptoms and pelvic pain are believed to originate from suspensory ligaments. We aimed to investigate the objective and subjective outcomes of adding sacroterine plication to apical prolapse surgery. METHODS: Sixty patients with Grade 2 or higher symptomatic apical POP were included in the study. The study sample was categorized into two groups: Group 1 underwent lateral suspension and Group 2 underwent lateral suspension and sacroterine plication. Anatomical cure was defined separately for the apical and anterior compartments as POP-Q scores for sites C and Ba of less than -1 cm for each compartment. A subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia, and constipation were assessed. RESULTS: In Group 1, anatomical cure rates for apical and anterior prolapse were 100% and 70%, respectively (p <0.001). In Group 2, these rates were 100% for apical prolapse and 73.3% for anterior prolapse (p <0.001). The subjective cure was 96.6% in both groups. Furthermore, improvement in sexual and urinary symptoms was more significant in the group that underwent sacroterine plication (p <0.001). CONCLUSIONS: The additional sacroterine plication (shortening) procedure with lateral suspension proved to be an effective and successful surgical approach for apical prolapse. Its routine addition to existing lateral suspension surgery can contribute significantly to the improvement of urinary and prolapse symptoms.

A randomized prospective comparison of the needleless mini-sling "hammock" and "U-shape" configurations for management of stress urinary incontinence: 60-month follow-up results.

OBJECTIVE: To compare needleless mini-slings placed in a retropubic (U-shape) or trans-obturator (hammock-shape) configuration for treating stress urinary incontinence at 60th month. METHODS: All surgeries, conducted by a senior surgeon, involved objective and subjective assessments preoperatively and at 6, 12, 18, and 60 months postoperatively using cough-stress tests, ICIQ-SF, PGI-I, and a Likert scale. RESULTS: After 60 months, no significant differences were found in cure rates, mesh complications, or reinterventions between U-shaped and hammock-shaped groups. However, a significant decrease in cure rates was observed at 18 and 60 months in both groups. Notable differences in ICIQ-SF, Likert scale, and PGI-I scores were seen in the hammock-shaped group, while the U-shaped group showed differences in ICIQ-SF and PGI-I scores, but not in the Likert scale. CONCLUSION: Given the lack of significant differences, asserting the superiority of either retropubic (U-shape) or transobturatorly (hammock-shape) needleless mini-slings for treating stress urinary incontinence is challenging.

Does the Surgical Margin Affect Sexual Function Following Linear Labiaplasty Technique?

BACKGROUND: How much labial tissue should be left after labiaplasty is a controversial issue. OBJECTIVES: The objective was to investigate the effect of residual labial tissue following labiaplasty operations on sexual function. METHODS: A total of 150 females who underwent labiaplasty between 2019 and 2021 and their partners were included in the study. In this retrospective study, linear labiaplasty technique was applied according to the patient's request. Patients were either below 1 cm or above 1 cm according to the remaining labial width at follow-up. The remaining labial tissues were classified according to the Motakef classification. Patients with a labial width above 1 cm were included in Group 1, and patients with a labial width below 1 cm were included in Group 2. Sexual function, sexual experience, body image, and erectile function of their partners were compared preoperatively and 2 years postoperatively with appropriate questionnaires. RESULTS: Sexual function, sexual experience, and body image of females improved in all patients. However, the improvement was more apparent with with remaining labial tissue of greater than 1 cm. The increase in the survey results of the partners was found to be similar. CONCLUSIONS: The sexual function of the patients was better when the width of the labium was longer than 1 cm. This may be due to better protection of the neurovascular structures. This favorable effect was also seen in the subjective evaluation of the partners.

Partner Satisfaction in Labiaplasty Patients.

BACKGROUND: Labiaplasty operation, which has become increasingly popular in recent years, is frequently preferred by women for cosmetic and functional reasons. It creates significant changes on female sexuality with high satsfaction rates. But there is limited data on its effects on male sexual response. OBJECTIVES: To investigate the effects of labiaplasty on partners. METHODS: Partners of 49 patients who underwent labiaplasty between January 2020 and May 2023 were included in the study. Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD), Golombok Rust Sexual Satisfaction Scale and New Sexual Satisfaction Scale (NSSS) questionnaires were administered to the partners preoperatively and 6 months postoperatively. RESULTS: There was no significant difference between preoperative and postoperative results in the MSHQ-EjD questionnaire applied to the partners included in the study. The postoperative increase in the new sexual satisfaction scale compared to the preoperative sexual satisfaction score was statistically significant. In the Golombok Rust sexual satisfaction scale, statistically significant, positive changes were observed in the categories of frequency of intercourse, communication, satisfaction, and nature of sexual intercourse in postoperative results. CONCLUSIONS: Labiaplasty operation had positive effects onmale sexual response, but had no effect on ejaculation function and difficulty.

Patient Satisfaction and Bleeding Rates in Introital Fascial Approach for Temporary and Permanent Hymenoplasty Techniques: A Comparative Study.

BACKGROUND: Bleeding during the first sexual intercourse represents a significant sociocultural concern with potential implications for some couples. OBJECTIVES: This study aims to introduce a novel modification to temporary and permanent hymenoplasty and evaluate both the objective and subjective success of defined techniques by assessing surgical outcomes and patient satisfaction either temporary or permanent hymenoplasty procedures. METHODS: A retrospective study was conducted between 2015 and 2023; comprising 246 patients. Various parameters including age, sexual history, pregnancies, body mass index (BMI), and bleeding satisfaction were assessed. Pain at first intercourse was rated on a Visual Analog Scale (VAS). RESULTS: The age at the time of operation was significantly lower in patients undergoing permanent hymenoplasty compared to those undergoing temporary hymenoplasty [24,0 (22,0-26,0) vs. 27,0 (26,0-29,0); p < 0.001].Patients undergoing permanent hymenoplasty reported significantly lower VAS scores at first sexual intercourse compared to those undergoing temporary hymenoplasty [4,0 (2,0-5,0) vs.7,0 (6,0-7,0); p < 0.001]. Satisfaction rates were high in both groups, with all temporary hymenoplasty patients satisfied with duration of bleeding compared to %78.6 (110/140) of permanent hymenoplasty patients (p < 0.001). CONCLUSIONS: In conclusion, this study introduces a novel modified temporary and permanent hymenoplasty technique to the literature and provide the first video documentation for both temporary and permanent hymenoplasty procedures. The findings of the study present both hymenoplasty techniques as effective and reliable. However, it suggests that temporary hymenoplasty is associated with a higher bleeding rate compared to permanent hymenoplasty, despite resulting in higher VAS scores.

Comparison of the effect of general anesthesia and spinal anesthesia technique combined with general anesthesia on intraabdominal volume during gynecological laparoscopy.

PURPOSE: We aimed to investigate the effect of spinal anesthesia which will be performed simultaneously with general anesthesia on the site of operation with the same pressure. MATERIAL AND METHOD: This study was conducted as a randomized, prospective clinical study on 40 patients who were randomly divided into two groups. Twenty women underwent general anesthesia (Group GA) and 20 women underwent spinal anesthesia with general anesthesia (Group SGA). For all cases, preoperative height, weight, waist circumference, body mass index (kg/m2 ), the distance between both spina iliaca anterior superior, the distance of the intersection of both ribs with an imaginary line drawn over the anterior axillary line, suprapubic bone-umbilical, umbilical-xiphoid, and suprapubic bone-xiphoid distance from the midline of the abdomen were measured. Moreover, while the patient was lying in the neutral position on the operating table, the height of the highest point of the abdomen to the operating table was also measured. These measurements were repeated at intra-abdominal pressure (IAP) 14 and 25 mmHg. The amount of intra-abdominal insufflated CO2 was also recorded at IAP 14 and 25 mmHg. RESULTS: When the intra-abdominal insufflation volumes of both groups were compared at 14 and 25 mmHg, respectively, there was no statistical difference (p: 0.54, p: 0.40). When 14 and 25 mmHg were compared in all cases, a statistically significant difference was observed in other measurements except in xiphoid-umbilical distance (p < 0.05). CONCLUSION: We found that spinal anesthesia combined with GA had no effect on the abdominal volume and anthropometric measurements in laparoscopic procedures.

Vaginal axis on MRI after laparoscopic lateral mesh suspension surgery: a controlled study.

INTRODUCTION AND HYPOTHESIS: Laparoscopic lateral mesh suspension (LLMS) has emerged as a practical, safe, and feasible alternative to sacrocolpopexy (SCP) for treating female genital apical prolapse. Although several prior studies have reported changes in the vaginal axis in women who have undergone SCP or sacrospinous ligament fixation (SSLF) surgery for prolapse, there is a lack of data on changes in the vaginal axis after LLMS. This study was aimed at investigating the level of anatomical correction following LLMS and comparing the vaginal axis on magnetic resonance imaging (MRI) in patients with apical genital prolapse. METHODS: Patients who underwent LLMS and a nulliparous control group were included in this observational prospective case-control study. MRI was performed on the control group and the study group pre- and postoperatively. The angle between the pubococcygeal line and the lower vaginal segment, the angle between the levator plate and the pubococcygeal line, and the angle between the lower and upper vaginal segments were measured and compared. RESULTS: The angles measured between the pubococcygeal line and the lower vaginal segment and between the levator plate and the pubococcygeal line were significantly lower in the preoperative than in the postoperative measurements (p < 0.001). All angles were found to be similar in the nulliparous women and in the patients following LLMS surgery. The Pelvic Organ Prolapse Symptom Score (POP-SS) score decreased significantly after the operation (p < 0.001). CONCLUSION: The vaginal axis was found to be near-normal in patients who underwent LLMS.

The Female Genital Self-Image Scale (FGSIS): cross-cultural adaptation and validation of psychometric properties within a Turkish population.

INTRODUCTION AND HYPOTHESIS: Women's perceived satisfaction from their own genital appearance is linked to genital image and sexual esteem. A comprehensive and easy to use scale to measure self-image was scarce in the literature. It was aimed in the present study to complement cross-culturally adapted and validated into Turkish version of the Female Genital Self-Image Scale (FGSIS) and to assess its psychometric properties. METHODS: After cross-cultural adaptation, the Turkish version of the FGSI, Female Sexual Distress Scale-Revised (FSDS-R), and Female Sexual Function Index (FSFI) were administered to 461 female participants. Content/face validity, exploratory, and confirmatory factor analysis, internal consistency, and reliability were appropriately assessed. Predefined and specific hypotheses were formulated for construct validity. RESULTS: Our findings indicated excellent content/face validity, sufficient internal consistency (Cronbach's alpha 0.818), and test-retest reliability [intraclass correlation coefficient (ICC) 0.951]. Construct validity was demonstrated by proving the hypothesis that participants who have performed at least one vaginal/clitoral masturbation for the last month reported significantly higher FGSIS scores compared with those who abstained (Z -6.37, p < 0.001). Factor analyses formed one factor structure. In the proposed two-factor construct, all seven items demonstrated good to high correlations with their subdomains and lower correlations with the other domain, indicating sufficient convergent validity. CONCLUSIONS: The FGSIS was successfully validated for use in the Turkish population. The scale exhibited strong psychometric properties to assess perceived female genital image. It might be reliably used in genital cosmetic surgeries and in a variety of gynecologic conditions.

Major Motivators and Sociodemographic Features of Women Undergoing Labiaplasty.

BACKGROUND: Influencing factors involved in the decision to undergo labiaplasty are evolving and show diversity among different settings and countries. Updated underlying motivators may assist in clinical decision-making and assessing outcomes from the patients' perspective. OBJECTIVES: Herein, the main motivators of women undergoing labiaplasty and sociodemographic features are discussed. METHODS: Seventy-one patients who were scheduled for labiaplasty were assessed via an open-ended, well-detailed questionnaire to determine the main motivational factors from the patients' perspective. Validated questionnaires to measure genital self-image, self-esteem, body appreciation, attitude toward having cosmetic surgery, sexual dysfunction, and body-dysmorphic disorder were performed. RESULTS: Half of the patients reported that they had an idea about the appearance of other women's genitalia (50.7%) and were influenced through the media (47.9%). The majority of those (71.8%) stated that they did not have normal genitalia and considered labiaplasty more than 6 months ago (88.7%). The pornography consumption rate in the last month was 19.7% and was significantly related with lower genital self-image and self-esteem. The main motivation was improvement in appearance (43.7%) and a better sexual life (26.8%). Patients reported aesthetic (52.1%), sexual (46.5%), and psychological (39.4%) reasons leading to their decision. Patient-reported 8-items of 11-item motivators for having labiaplasty were statistically consistent with validated questionnaires. The self-esteem and body appreciation of the patients were comparable to the literature. Genital self-image and sexual function were found to be impaired. CONCLUSIONS: The women's main motivator for labiaplasty was improvement in genital appearance integrated with their aesthetic and sexual demands. Eleven-item motivators derived from the statements of women seeking labiaplasty were determined in this study. Sociodemographic features and main motivators can conveniently be used as normative data for this population.

A randomized comparison of a single-incision needleless (Contasure-needleless®) mini-sling versus an inside-out transobturator (Contasure-KIM®) mid-urethral sling in women with stress urinary incontinence: 24-month follow-up results.

INTRODUCTION AND HYPOTHESIS: There is a shortage of reliable data on the efficiency of the under-investigated mini-slings to treat stress urinary incontinence (SUI). We aimed to compare the effectiveness of the single-incision needleless mini-sling (SIMS) with the transobturator inside-out mid-urethral sling (TOT). MATERIALS AND METHODS: Two hundred one women with clinically proven SUI were included in this single-center prospective randomized trial. The patients were randomly allocated to the groups. All surgeries were done by the same single surgeon. Examinations were done by one other blinded surgeon. The patients were followed up for 24 months. Objective cure was defined as the absence of SUI and negative cough-stress test. Subjective cure was defined as no stress leakage of urine after surgery in a validated questionnaire. Failure of the surgery was defined as the need for reoperation. Every complaint was categorized by the IUGA/ICS Classification of Prosthesis-related Complications. RESULTS: The objective (85.4% versus 89.9%, p = 0.362) and subjective (87.6% versus 89.9%, p = 0.636) cure rates were similar with the TOT and SIMS at the postoperative month 24, respectively. The mesh exposure ≤ 1 cm rate was 3.4% for both groups, and the mesh exposure > 1 cm rate was 2.2% for both groups. Overall failure rates were 3.4% and 2.2% for the TOT and SIMS group, respectively. No viscus organ perforation was noted. Complications with the SIMS procedure were less painful compared with TOT (p = 0.024). CONCLUSIONS: Single-incision needleless mini-slings exhibited similar cure rates as the trans-obturator mid-urethral slings from both the patient and clinician points of view in 24 months of follow-up. Mini-slings resulted in significantly less postoperative pain than trans-obturator mid-urethral slings.

A randomized prospective comparison of the needleless mini-sling "hammock" and "U-shape" configurations for management of stress urinary incontinence: 18 month follow-up results.

OBJECTIVE: To compare the efficacy of needleless mini-sling placed either retropubic (U-shape) or trans-obturator (hammock-shape) to treat stress urinary incontinence. SETTING: One hundred and twenty six women were randomized in a 2:1 ratio to receive hammock-shaped or U-shaped of Contasure-NDL. METHODS: All surgical procedures were performed by one senior surgeon experienced in anti-incontinence surgery with mesh. Cough-stress test was considered for objective outcome. Subjective outcomes consisted of International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Patient Global Impression of Improvement (PGI-I) and three-item Likert scale to measure satisfaction. Assessments were performed preoperatively and at postoperative 6th, 12th and 18th month. RESULTS: The objective cure rates at postoperative 6th and 12th month were significantly lower in U-shape group compared to hammock-shape group (85.4 vs. 96.4%; p = 0.034) and was comparable with hammock-shape group at 18th month postoperative (90.2 vs. 96.4%, respectively; p = 0.216). The subjective cure rates at postoperative 6th, 12th and 18th month were similar between groups (90.2/90.2/100% vs. 96.4/96.4/96.4%, respectively; p > 0.05). Median of total ICIQ-SF scores was significantly lower in hammock-shaped group (1.62 ± 2.92) compared to U-shape (3.80 ± 2.64) at 18th month (p < 0.001). The rate of patients reported as very satisfied or satisfied to the Likert scale was 90.2% in U-shape group and 96.4% in hammock group. Patients' responses to PGI-I were majorly distributed to "much better" and "very much better" with a mean score of 1.93 ± 2 in U-shape and 1.33 ± 1 in hammock group at 18th month of follow-up (p < 0.001). CONCLUSION: U-shape placement of needleless single-incision mini-sling mimicking the retropubic route did not satisfy in achieving the patient's goal when compared to hammock-shape placement.

Proteinuria in preeclampsia: is it important?

OBJECTIVES: Our aim is to evaluate the laboratory results and proteinuria levels of preeclamptic women and their relation-ships to maternal and fetal outcomes. MATERIAL AND METHODS: One hundred preeclamptic pregnant women who gave birth in our clinic between 2013 and 2015 were included in our study retrospectively. The data collected from the patients included gestational week, age, gravidity, parity, abortus history, blood pressure, biochemical parameters, delivery method, maternal hospitalization time, cesarean indication, complications, blood products required, plasmapheresis use and dialysis need. The details about the newborns were recorded retrospectively. The relationships between preeclampsia signs and maternal and neonatal out-comes were analyzed. The protein amounts were analyzed via 24-hour collected urine analyses and spot urine analyses. RESULTS: A statistically significant positive correlation was observed between neonatal intensive care unit needs and pro-teinuria levels. Fetal growth restriction, respiratory distress syndrome and sepsis were observed as the level of proteinuria increased, but the result was not statistically significant. Eclampsia was observed only in patients with massive proteinuria, and it was statistically significant. An increase in cesarean sections, placental abruptions, antihypertensive drug needs and blood product replacement rates was observed as the amount of proteinuria increased in preeclamptic women, but the results were not statistically significant. CONCLUSIONS: The severity of preeclampsia cannot be determined by the level of proteinuria. However, when massive proteinuria is detected, the clinician should be more cautious about maternal and fetal complications.

Comparison of uterine, endometrial and ovarian blood flow by transvaginal color Doppler ultrasound in ovulatory and anovulatory cycles.

OBJECTIVES: Blood flow to uterus and ovaries is demonstrated to be altered during mensturation. Studies has been published stating that blood flow differs also in ovulatory and anovulatory cycles. In this study, using color Doppler ultrasound, we aim to compare uterine, endometrial and ovarian blood flow during ovulatory and anovulatory cycles. MATERIAL AND METHODS: Women volunteers who are aged between 18-40 had no endocrinological problem and not recieving exogenous hormone therapy were included to study. Blood levels of FSH, LH, E2, prolactine, DHEAS, free T4 were collected in early follicular phase. Uterina, subendometrial and intraovarian artery blood flow pulsatility and resistance indexes were analysed using Doppler USG technique. Patients were called out to control on 21st of cycle and progesterone levels were analysed. Patients who has ovulation signs in USG and progesterone level above 5 ng/mL were included to ovulatory cycle group. Patient who has no signs of ovulation in ultrasound and has not enough progesterone level were included to anovulatory cycle group. RESULTS: LH and E2 levels were significantly higher in anovulatory patients. No correlation was found between endometrial blood flow resistance and basal E2, prolactine, testosterone levels. However, DHEAS levels were related to endometrial blood flow resistance in anovulatory cycles. No correlation was found between ovarian blood flow resistance/uterine blood flow resistance and basal E2, prolactine, testosterone, DHEAS levels. CONCLUSIONS: There is statistically significant difference between endometrial, ovarian, uterine artery blood flow resistance in ovulatory and anovulatory cycles. Blood flow resistance was found to be increased in anovulatory patients. Increased E2 levels in anovulatory cycles were related to endometrial linethickness and endometrial volume.

The effect of the distance between mesh and the urethra on sexuality in patients who underwent transobturator tape.

Objective: We aimed to evaluate the effect of mesh-urethra distance on sexual functions in continent patients who underwent transobturator tape (TOT) surgery due to isolated stress urinary incontinence. Material and Methods: Eighty-two continent patients who had undergone TOT surgery for stress urinary incontinence were included in the study. Objective treatment for stress urinary incontinence was defined as the absence of urine leakage during a stress test. Translabial perineal ultrasound was performed 6 months after the surgery. The successful surgical group was split into two subgroups based on the distance from the posterior of the urethra at the bladder neck to the nearest proximal edge of the tape: < 5 mm and > 5 mm. In addition to these, band percentile, the descent of bladder neck and urethra length measured by perineal ultrasound, pubo-urethral distance, urethral thickness, detrusor thickness, cystocele descent, rectal descent, and uterine descent were evaluated. Preoperative and postoperative results of the standardized and internationally valid incontinence questionnaires Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Female Sexual Function Index (FSFI) were compared between groups. Results: The postoperative FSFI scores for the > 5-mm group were statistically significantly lower than those of the < 5-mm group, including the postoperative FSFI average, all subscales except lubrication, and average change scores due to the operation (p < .001). There was no statistically significant relationship between the percentile it occupied and postoperative FSFI level (p = .553), and FSFI preoperative-postoperative difference was not significant (p = .905). Conclusion: Sexual functions are more affected in patients with a mesh-urethra distance > 5 mm as observed via perineal ultrasound.

A randomized, prospective, controlled study comparing uterine preserving laparoscopic lateral suspension with mesh versus laparoscopic sacrohysteropexy in the treatment of uterine prolapse.

OBJECTIVES: Pelvic organ prolapse (POP) significantly affects women's quality of life, occurring in 20-30% of females aged over 20 globally. With aging populations, demand for pelvic reconstructive surgery is rising. Patients seek anatomical restoration while preserving uterus and sexual function. Sacrohysteropexy is the gold standard for apical prolapse, but carries risks. Lateral suspension, offers safer apical and anterior correction especially for obese, sexually active women. Our prospective study compares laparoscopic sacrohysteropexy and lateral suspension objectively and subjectively. STUDY DESIGN: The study included patients who had laparoscopic lateral suspension (n = 22) or laparoscopic sacrohysteropexy (n = 22) for symptomatic stage 2 apical prolapse. Groups randomized with using block design. Anatomical cure was based on measurements taken by the same physician, unaware of intervention, before and at 12 months using POP-Q score. Pelvic floor ultrasound also used for objective rates. Subjective comparison used Prolapse Quality of Life (P-QoL), Pelvic Organ Prolapse-Symptom Score (POP-SS), Female Sexual Function Index (FSFI), Visual Analog Score (VAS), and Michigan Incontinence Severity Index (M-ISI). RESULTS: Age, BMI, parity, menopause, sexual activity, complications, showed no significant difference between groups (p > 0.05). Surgical procedure duration significantly varied between groups lateral suspension group was shorter. There was no significant difference in post operative complications. No significant differences in posterior/enterocele stages.) Anterior staging showed no significant difference in sacrouteropexy (p = 0.130), but significant difference in lateral suspension group (p < 0.001). No significant differences in pre-op and post-op PQOL, POP-SS, FSFI, and M-ISI scores between the two groups. CONCLUSION: Both methods effectively managed apical prolapse with similar outcomes. Objective measurements showed lateral suspension's superiority in reducing bladder descent.

Development and benchmarking of a dose rate engine for raster-scanned FLASH helium ions.

BACKGROUND: Radiotherapy with charged particles at high dose and ultra-high dose rate (uHDR) is a promising technique to further increase the therapeutic index of patient treatments. Dose rate is a key quantity to predict the so-called FLASH effect at uHDR settings. However, recent works introduced varying calculation models to report dose rate, which is susceptible to the delivery method, scanning path (in active beam delivery) and beam intensity. PURPOSE: This work introduces an analytical dose rate calculation engine for raster scanned charged particle beams that is able to predict dose rate from the irradiation plan and recorded beam intensity. The importance of standardized dose rate calculation methods is explored here. METHODS: Dose is obtained with an analytical pencil beam algorithm, using pre-calculated databases for integrated depth dose distributions and lateral penumbra. Dose rate is then calculated by combining dose information with the respective particle fluence (i.e., time information) using three dose-rate-calculation models (mean, instantaneous, and threshold-based). Dose rate predictions for all three models are compared to uHDR helium ion beam (145.7 MeV/u, range in water of approximatively 14.6 cm) measurements performed at the Heidelberg Ion Beam Therapy Center (HIT) with a diamond-detector prototype. Three scanning patterns (scanned or snake-like) and four field sizes are used to investigate the dose rate differences. RESULTS: Dose rate measurements were in good agreement with in-silico generated distributions using the here introduced engine. Relative differences in dose rate were below 10% for varying depths in water, from 2.3 to 14.8 cm, as well as laterally in a near Bragg peak area. In the entrance channel of the helium ion beam, dose rates were predicted within 7% on average for varying irradiated field sizes and scanning patterns. Large differences in absolute dose rate values were observed for varying calculation methods. For raster-scanned irradiations, the deviation between mean and threshold-based dose rate at the investigated point was found to increase with the field size up to 63% for a 10 mm × 10 mm field, while no significant differences were observed for snake-like scanning paths. CONCLUSIONS: This work introduces the first dose rate calculation engine benchmarked to instantaneous dose rate, enabling dose rate predictions for physical and biophysical experiments. Dose rate is greatly affected by varying particle fluence, scanning path, and calculation method, highlighting the need for a consensus among the FLASH community on how to calculate and report dose rate in the future. The here introduced engine could help provide the necessary details for the analysis of the sparing effect and uHDR conditions.

Intrapartum ultrasound for fetal head asynclitism: Is it possible to establish a degree of asynclitism to correlate to delivery outcome?

OBJECTIVE: To investigate the role of intrapartum ultrasound (IU) in the diagnosis of asynclitism and the importance of asynclitism degree in labor outcomes. METHOD: This prospective cohort study included 41 low-risk pregnant women with fetus in singleton-vertex. The IU assessment to diagnose asynclitism was performed during labor at two specific steps, including the suspicion and/or diagnosis of labor arrest. The "four-chamber view" and "squint sign without nose" were classified as marked/severe asynclitism. The "midline deviation" and "squint sign with nose" findings were classified as moderate asynclitism. Obstetric outcomes and maternal-fetal complications were compared with the degree of asynclitism. RESULTS: Severe and moderate asynclitism was seen in 17 (41.7%), 10 (58.8%) and seven (41.2%) women, respectively. All pregnant women diagnosed with asynclitism delivered by vacuum extraction (VE) or cesarean section (CS). CS was performed in nine patients with asynclitism (52.9%). The difference between asynclitism type and VE/CS ratios was statistically significant (P = 0.039). Four fetuses with squint sign without nose delivered by VE. A significant correlation was seen between the presence of squint without nose sign and second-/third-degree perineal injury. CONCLUSION: Severe asynclitism is associated with increasing operative birth and maternal-fetal complications. Detection of asynclitism degree by IU could be useful, alerting the obstetrics team to possible perinatal problems during delivery.

Radical vulvectomy with right gluteal and left medial thigh V-Y advancement flap reconstruction

Vulvar cancer is rare. The vulva constitutes the external female genitalia and it is associated with the perineum with the intersection of urinary, sexual and anal systems. The deep anatomy of the perineum in the urogenital and anogenital triangle should be well-known to gynecological oncologists. Radical vulvectomy is the surgical treatment of choice in gross tumors expanding over the vulvar skin. After this type of excision, reconstruction is critically important because it is not always feasible to suture the vulvar defect in a primary manner. Thus, the reconstruction options should also be known to gynecological oncologists. Here, we present a video of radical vulvar cancer surgery, which was performed on a cadaver with gluteal and medial thigh V-Y advancement flap reconstruction.