Journal of the Turkish German Gynecological Association最新文献

Objective: To compare history-indicated cervical cerclage (HICC), ultrasound-indicated CC (UICC) and physical examination-indicated CC (PEICC) in terms of obstetric outcomes and to compare the outcomes related to braided and non-braided suture materials (Prolene suture vs. Mersilene tape).

Material and methods: We retrospectively evaluated 173 transvaginal CC procedures performed in a single center. Cases were classified based on procedure indications and the type of suture material used.

Results: Of the 173 cases reviewed, 103 (59.5%), 45 (26.0%) and 25 (14.4%) cases were in the HICC, UICC and PEICC groups, respectively. Patients in the PEICC group underwent cerclage at significantly later gestational weeks, had higher hospitalization rates, longer hospital stays following the procedure, a shorter interval between cerclage and delivery, and a higher rate of procedure-related pregnancy loss compared to the other groups (p<0.05 for all). Both the gestational age at delivery and the take-home baby rate were lower in this group compared to the other groups (p<0.05 for both). There were no significant differences identified in terms of suture materials used. Subgroup analyses revealed similar obstetric outcomes between different suture materials.

Conclusion: PEICC had worse perinatal outcomes compared to HICC and UICC procedures. CC indication was the major determinant of perinatal outcome in this cohort while suture material had no significant effect on perinatal outcomes.

Objective: The aim of this study was to investigate the timing of recurrence in patients with early-stage endometrial cancer and to determine the optimal postoperative follow-up protocol for the detection of recurrence.

Material and methods: Patients with stage 1 and 2, grade 1-3 endometrioid type endometrial cancer who underwent follow-up for at least two years were included. The diagnostic method for recurrence was analyzed for each patient. Analysis of risk factors for recurrence were done using SPSS. Sensitivity analyzes were performed comparing the diagnostic methods.

Results: A total of 303 patients were included and recurrence was diagnosed in 17 (5.61%). Cumulative risk of recurrence was 3.06% in the first 23 months, rising to 7.52% in the first 33 months. Sensitivity of physical examination (PE) was 50.00%, specificity 99.52%, positive predictive value 88.89%, negative predictive value 96.30% and accuracy rate 96.00% respectively. It was found that each step increase of grade increased recurrence odds by 2.549 times [95% confidence interval (CI): 1.078-6.027; p=0.033] while each step increase of stage increased recurrence odds by 2.943 times (95% CI: 1.270-6.820; p=0.012).

Conclusion: It is notable that recurrence rate increased after 25 months and the risk of recurrence increased as the tumor stage and grade worsened. Symptoms in patients with high-grade and deep myometrial invasion, especially after the first two years, should be considered risky and patients should be informed about seeking medical care when symptoms occur. PE and symptoms of patients are key factors in detecting reccurence while other diagnostic methods can be used according to clinical findings.

Objective: Current evidence concerning the possible clinical effects of coronavirus disease-2019 (COVID-19) vaccines on vulvar lesions is limited. The aim was to describe the effect of vaccines against COVID-19 on the progression of vulvar condylomas.

Material and methods: The data of patients diagnosed with condylomata acuminate and treated with trichloroacetic acid (TCA) between January 2021 and January 2023 in the gynecological oncology surgery clinic were evaluated. The patients were divided into groups based on their vaccination status; vaccinated or unvaccinated. The number/area of condylomas and symptom degrees of the patients before and after TCA treatment were compared.

Results: A total of 202 patients, 102 vaccinated and 100 unvaccinated, were included. There was no significant difference between the groups in terms of age, parity, smoking, oral contraceptive use, amount of condyloma and symptom degree (all p>0.05). There was no significant difference in the amount of condyloma between the groups after six months [p=0.589, 95% confidence interval (CI)=0.238-1.566]. Moreover, there was no difference in the degree of symptoms after six months between the groups (p=0.467, 95% CI=1.113-1.799).

Conclusion: The systemic effects caused by COVID-19 vaccines are still not fully understood. Considering that this vaccine, like many vaccines, elicits a strong immunogenic reaction, the possible clinical impact of this non-specific systemic inflammatory response on vulvar condyloma is a matter of curiosity. This study showed there was no difference in the amount of condyloma and the degree of symptoms six months after TCA treatment in the unvaccinated and vaccinated group. The low number of patients is the biggest limitation of this study. Larger studies may provide more robust information.

Objective: To evaluate the rate, cytology and histopathological findings of multiple-type human papillomavirus (HPV) positive women referred to a tertiary colposcopy center. To compare the role of multiple- and single-type HPV infections in women with high-grade squamous intra epithelial lesion and cervical cancer (HSIL+).

Material and methods: The cytological and histopathological results of 2070 HPV positive women were evaluated. Infection with more than one type was defined as multiple-type HPV infection. Patients were divided into single or multiple HPV groups and subgroups in terms of HPV types; and also examined in three age groups. Age-stratified HSIL and cervical cancer rates of the study groups were compared.

Results: The women with multiple HPV subtypes accounted for 24.9% of the study population. Multiple-type HPV infection rates in normal cytology, atypical glandular cells, low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells, cannot exclude HSIL and HSIL were 28.2%, 26.8%, 19.3%, 22.6%, and 21.8%, respectively. Age stratified multiple-type HPV infection rates in under 30 years, 30-49 years and ≥50 years were 27.8%, 24.1%, and 27.3%, respectively. The multiple-type HPV infection rates in LSIL, HSIL, and cancer patients were 31.4%, 19%, and 12.5%, respectively.

Conclusion: Multiple-type HPV infections were statistically less common in HSIL and cancer patients than single type HPV infection. However, multiple type infection rates were remarkable in older HSIL and cervical cancer patients.

Objective: To investigate patient characteristics and outcomes of assisted reproductive technology (ART) cycles conducted in Türkiye during the coronavirus disease-2019 (COVID-19) pandemic (2020-2021).

Material and methods: ART centers in Türkiye were invited to participate in this survey. The questionnaire focused on patient demographics and performance outcomes and was sent to center directors via anonymous Qualtrics™ links.

Results: The survey was sent to 167 centers and data were collected from 15 centers in 2020 and 24 centers in 2021. The clinical pregnancy rate from intrauterine insemination (IUI) procedures remained similar, with 15.1% in 2020 (1,245 IUI cycles) and 14.5% in 2021 (2,023 IUI cycles), while successful delivery rates were 12.5% and 11.5%, respectively. For ART treatments, the clinical pregnancy rate from fresh embryo transfers increased from 45.1% in 2020 (3,119 transfers) to 50.4% in 2021 (8832 transfers), with similar live birth rates, 34.2% vs. 34.4%. Frozen embryo transfers resulted in clinical pregnancy rates of 47.8% in 2020 (2,498 transfers) and 51.9% in 2021 (12,015 transfers), with live birth rates rising from 39.8% to 42.7%. Preimplantation genetic testing cycles resulted in clinical pregnancy rates of 64.2% in 2020 (271 transfers) and 60.8% in 2021 (2,102 transfers), with live birth rates of 53.5% and 48.2%, respectively. Regarding techniques for fertility preservation in females, 11 prepubertal and 61 postpubertal ovarian tissue cryopreservation procedures were reported, alongside 1,346 cycles performed within the same period. In males, 144 post-pubertal testicular tissue, 871 epididymal and 2,480 ejaculated sperm cryopreservations were reported. During the two years, six ovarian tissue transplantations followed by ART were performed, with 96 women using cryopreserved oocytes. In addition, 40 testicular tissue, 298 epididymal, and 238 ejaculated sperm samples were used for ART purposes.

Conclusion: This survey provides a comprehensive overview of ART practices in Türkiye for 2020 and 2021, establishing a long-term, nationallevel analysis while highlighting the challenges posed by the COVID-19 pandemic. The longitudinal analysis established a foundation for future annual reports and offers critical insights into emerging trends over these two years.

Objective: Single-incision slings, such as Contasure-Needleless® (C-NDL), were developed to improve surgical treatment success in stress urinary incontinence (SUI). However, more evidence is needed to describe the outcomes of mini-sling procedures as an alternative to classical mid-urethral slings. The aim was to evaluate the short-term outcomes of the mini-sling procedure using C-NDL in the surgical treatment of SUI patients.

Material and methods: This was a single-center, prospective study including 24 patients with SUI who underwent C-NDL. Michigan Incontinence Severity Index (M-ISI) questionnaire, the Female Sexual Function Index, and the Patient Global Impression of Improvement (PGI-I) questionnaire were applied, as well as trans-perineal ultrasound evaluations at baseline, one month and six months postoperatively.

Results: The PGI-I index showed that 54.17% of participants described their post-operative recovery as "very much better" and 29.17% as "much better". Significant improvements were observed in all SUI and M-ISI-related results. No significant differences were detected in terms of FSFI. Complications were reported as de novo urgency in 4 (16.67%) patients, mesh erosion in 2 (8.33%) patients, and pelvic pain and infection in 1 patient each (4.17%). The mean distance of the mini-sling mesh to the urethra was found to be 5.51±2.3 mm at one month and 4.69±1.85 mm at six months after surgery (p=0.006). The mean urethral rotation angle was decreased following surgery (p<0.001). No significant differences were observed between patients with and without cure regarding any of the examined variables.

Conclusion: For SUI treatment, the C-NDL procedure is a safe and effective method with few complications and high subjective cure rates on short-term follow-up (6 months).

To assess the efficacy of anti-hypertensive medications during pregnancy according to race, ethnicity and geographical location as current evidence is not clear in this regard. A subgroup meta-analysis of randomized controlled trials was performed. The efficacy of oral medications for chronic hypertension in pregnancy by geographical location [United States of America (USA) vs. rest of the World] was investigated. The location was used as a surrogate of racial identification and differences in health care systems and availability of medications that might affect the efficacy of the treatment. The number of patients in each group experiencing the following outcomes: small for gestational age (SGA), preeclampsia, severe hypertension were compared. Seven studies were identified. Subgroup analysis revealed that medications did not affect the occurrence of SGA. In six studies, therapies were protective for preeclampsia in the rest of the world but not in USA (p=0.02). Therapies were protective for severe hypertension. Our findings suggest that location does not affect the efficacy of medication in treating chronic hypertension during pregnancy. Geographical location may serve as a surrogate for genetic characteristics of a population of interest. However, it can also be influenced by other factors such as the heterogeneity of populations such as the USA.

Objective: Our aim was to reduce blood loss during C-section through the intraoperative temporary occlusion of the bilateral uterine vascular bundles.

Material and methods: This randomized controlled study included 99 singleton pregnant patients at 37 weeks of gestation or later, with normal fetal development and no obstetric complications, attending a university hospital. In the intervention group (n=45), bilateral occlusion of the uterine vascular bundles at their entry point to the uterus was performed using atraumatic Darmklemmen clamps after the delivery of the baby. In the control group (n=54), routine C-section was performed. Our primary outcome was the amount of blood loss, measured using the suction canister, gauze and abdominal mops and underpads after the operation, along with the comparison of preoperative and postoperative hemoglobin and hematocrit values. Our secondary outcomes were operative time, transfusion rate, maternal outcomes (including postoperative complications during follow-up), and neonatal outcomes.

Results: In the intervention group, blood loss measured in gauze, abdominal compress pads, underpads and total blood loss were significantly lower than in the control group (p=0.031, p=0.001, p=0.003, and p=0.010, respectively). The mean decrease in hematocrit value was 5.3±2.67% in the intervention group and 4.85±2.53% in the control group (p>0.05). Operative time and neonatal outcomes were similar between the two groups. No perioperative or postoperative complications were observed during follow-up.

Conclusion: Bilateral temporary occlusion of the uterine vascular bundles using atraumatic clamps was a feasible and safe technique for reducing blood loss during cesarean section without adverse maternal and neonatal outcomes. Trial registration number and date of registration: NCT05948436- July 10, 2023.

Objective: The association between skeletal muscle mass and postoperative morbidity in cancer patients has been demonstrated, but the results are not conclusive. The study aims to determine the predictive efficacy of rectus abdominis muscle (RAM) and psoas major muscle (PMM) thickness and other factors such as age, American Society of Anesthesiologists (ASA) score, operation duration, obesity, preoperative inflammatory markers, and pathological findings for postoperative morbidity.

Material and methods: One hundred forty-one patients who underwent total abdominal hysterectomy + bilateral salpingo-oophorectomy + retroperitoneal lymphadenectomy + omentectomy for endometrial cancer were assessed retrospectively. Standard procedures (antibiotic prophylaxis and thromboembolism prophylaxis) were applied pre- and postoperatively, and the thicknesses of the RAM and PMM were measured by computed tomography. Postoperative morbidity was defined in the 3-month postoperative period as patients treated with a diagnosis of postoperative infection, those who developed pulmonary complications, thromboembolic complications, lymphatic drainage disorders, intracranial hemorrhage, and mortality.

Results: The mean thickness of the right-left RAM in the morbidity group was 7.4±2.1 mm, and 8.2±2.1 mm in the group without morbidity (p=0.038). On the other hand, the thickness of the right-left PMM was similar in both groups. When the predictive cut-off value for RAM thickness was 7.52 mm, the sensitivity, specificity, and negative and positive predictive values were 54.2%, 65.6%, 73.5%, and 44.8%, respectively. Advanced age, high ASA score, and extended operation duration were associated with an increased risk of morbidity in univariate analysis. However, multivariate analysis revealed that only age and operation duration were independent risk factors for postoperative morbidity [respectively, odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01-1.12, p=0.033 and OR: 1.003, 95% CI: 1.0003-1.007, p=0.039].

Conclusion: Age and operation duration were identified as independent risk factors for predicting postoperative morbidity. However, it has been shown that a more comprehensive evaluation, including RAM thickness and ASA score alongside these two factors, could provide more definitive results.