Journal of the Turkish German Gynecological Association最新文献

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.

Multiple sclerosis (MS) is an autoimmune disease that involves the central nervous system. MS is prevalent among young adults and progressively destroys axons and myelin. Individuals with MS often experience complications, such as lower urinary tract dysfunction, urinary tract infections (UTIs) and sexual dysfunction. In young adults MS may cause sexual dysfunction and infertility, which worsens as the disease progresses. The available evidence from different studies (microbiological and clinical studies, retrieved from PubMed and Scopus databases) on possible microbial pathogens causing MS was reviewed. Lower urinary tract dysfunction, UTIs and sexual dysfunction were investigated in people with MS. Over the past two decades advances in MS treatment have significantly slowed disease progression and altered its natural history. However, UTI and sexual dysfunction continue to pose substantial challenges for affected patients. As there is a causal relationship between UTIs and corticosteroid use during outbreaks, awareness of essential complications of MS, such as UTIs and infertility, is crucial for prevention, early diagnosis, and adequate management.