Can the suburethral mesh angle be used to predict trans-obturator tape results?

ABSRACT: PURPOSE: The primary aim of our study was to evaluate mesh movement on ultrasonography and to compare the relationship between suburethral mesh angle and incontinence recurrence. METHODS: This study was carried out at the University of Selcuk, Konya, Turkey, Beyhekim State Hospital, Konya, Turkey and the Mus State Hospital between September 2012 and January 2015. In total, the results from 109 patients were evaluated in the statistical analysis. The suburethral mesh angle (SMA) is the angle between the two arms of the trans-obturator tape (TOT) mesh under the urethra. This angle was measured at 10 days, 6 months and 1 year after surgery. Potential risk factors for incontinence recurrence and SMA were compared in logistic regression models. The best cut-off value for SMA was calculated to predict incontinence recurrence. RESULTS: The mean resting SMA did not change with time during follow-up (p = 0.373). However, when comparing coughing SMA values, the first day measurement was significantly different from the other measurements. Another comparison was performed according to the cSMA value at each visit. The difference was significant from the first day. Lung disease and the change in the SMA (cSMA) on day 10 were significant predictors of treatment failure. The cSMA on day 10 to predict first-year treatment failure was 10°, with 61% sensitivity and 96% specificity. CONCLUSIONS: Measurement of the SMA can be used as a prognostic factor in TOT surgery. Further research is required to determine the importance of SMA as a prognostic factor.

Sleep quality of endometrial cancer survivors and the effect of treatments.

OBJECTIVE: Sleep disorders affect 54.9% of gynaecologic cancer survivors. The effect of treatment methods on sleep quality is not clear. This study evaluated the sleep quality of survivors of endometrial cancer and compared the effects of different treatments on sleep quality. MATERIALS AND METHODS: Patients were categorised as surgery (group 1), surgery + brachytherapy (BRT) (group 2), surgery + external beam radiation therapy (EBRT) (group 3), and surgery + EBRT + BRT + chemotherapy (group 4). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The PSQI was completed by the participants before surgery, 1, 3, and 6 months after each treatment was completed. The PSQI scores were compared between the different measurement times and different study groups. RESULTS: This study enrolled 114 patients with a mean age of 58.1±11 years. The number of participants in each group was 53 (46.5%), 14 (12.3%), 12 (10.5%), and 35 (30.7%), respectively. At baseline, 28 (24.6%) patients reported poor sleep quality. The mean PSQI score reached the maximum level at the second measurement and decreased slightly during follow-up and the change in the PSQI score was significant (p=0.001). Group 3 and group 4 had significantly higher scores from baseline (p<0.008). At time point 3, the differences between the groups were significant. At time point 4, the most prominent effect of treatment on sleep quality was observed in patients with combined chemo-radiotherapy when compared with the other study groups. CONCLUSION: Most survivors of endometrial cancer are affected by poor sleep quality during their treatment. To improve these patients' quality of life, this disorder must be considered at each visit and tailored care plans should be developed to meet the women's needs. Further studies are needed to evaluate the long-term results of sleep quality on patients with endometrial cancer.

Comparison of the Efficiency of Posterior Intravaginal Sling (PIVS) Procedure in Older and Younger Groups.

INTRODUCTION: Vaginal vault prolapsus is a challenging problem for the patients and physicians. There may be differences between young and elderly patients in terms of efficiency and safety of surgical procedures. AIM: The aim of our study was to compare the efficiency of the Posterior Intravaginal Sling (PIVS) procedure in older versus younger patient groups. MATERIALS AND METHODS: A total of 40 patients who underwent the PIVS procedure were chosen. Twenty of these patients were younger than 60 years of age (Group I) while the other 20 patients were 60 years of age or older (Group II). Preoperative Pelvic Organ Prolapsed Quantification (POP-Q) reference points were compared with postoperative data at the first year following surgery. Student's t-test was used to analyse continuous variables and the χ(2) test was used to analyse categorical data. The Mann-Whitney test was used for data that were not normally distributed. RESULTS: Anatomical cure rates were 90 percent in both groups (p=1.00). There were significantly greater improvements in POP-Q points in group I than group II. CONCLUSION: It could be concluded that PIVS as minimally invasive procedure for vaginal vault prolapsed and is effective in all age groups.

Relations of Serum Visfatin and Resistin Levels with Endometrial Cancer and Factors Associated with its Prognosis.

BACKGROUND: The aims of this study were compare the serum visfatin and resistin levels between endometrial cancer (EC) patients and controls and evaluate their power to predict prognosis. MATERIALS AND METHODS: This prospective study was conducted between March 2013 to June 2014 on the Gynecologic Oncology Department of the University of Selcuk, Konya, Turkey. A total of 42 EC patients and 42 controls were included and assessed for differences in serum visfatin and resistin levels, along with prognostic factors. RESULTS: Endometrial cancer patients had significantly higher visfatin levels than control s (p: 0.011), associated with deep myometrial invasion (p: 0.019). In contrast the serum level of resistin did not significantly differ between EC patients and controls (p: 0.362). However, high resistin level in EC patients was associated with increase lymph node metastasis (p: 0.009). On logistic regression analysis, we found that serum visfatin elevation was associated with risk of myometrial invasion (OR: 1,091; 95%CI: 1.021- 1.166; p: 0.010) and serum resistin with risk of lymph node metastasis (OR: 1.018; 95%CI: 1.000- 1.035; p: 0.046). For myometrial invasion prediction, a serum visfatin level greater than 26.8 ng/mL demonstrated a sensitivity and specificity of 66.6 % and 96.4%, respectively. For lymph node metastasis prediction, the best cut-off for serum resistin level was 599ng/mL. A serum resistin level greater than this demonstrated a sensitivity and specificity of 87.5% and 77.1%, respectively. CONCLUSIONS: Our data suggest that serum visfatin is elevated in patients with EC and serum visfatin and resistin levels could be used to predict the risk of advance stage lesions.