Cenk Yasa

Objective: To evaluate the impact of bilateral salpingectomy added to hysterectomy performed via different surgical routes on ovarian reserve, ovarian stromal blood flow, and sexual function in premenopausal women. Methods: This prospective longitudinal cohort study included premenopausal women undergoing hysterectomy with bilateral salpingectomy for benign gynecologic indications. Patients were categorized according to surgical approach as laparoscopic hysterectomy (L/S) or abdominal hysterectomy (L/T). Ovarian reserve was assessed using serum anti‐Müllerian hormone (AMH) levels preoperatively and at postoperative months 1 and 3. Ovarian stromal blood flow was evaluated bilaterally using color Doppler ultrasonography. Sexual function was assessed using the Female Sexual Function Index (FSFI) preoperatively and at postoperative month 3. Results: A total of 46 patients were included (26 L/S, 20 L/T). In the L/S group, AMH levels showed no significant change at postoperative months 1 or 3. In the L/T group, a significant decline in AMH was observed at postoperative month 1 ( p = 0.043), which was not sustained at month 3. No significant between‐group differences were observed in AMH changes. Transient alterations in ovarian Doppler indices were observed, with no persistent differences. FSFI scores improved significantly in both groups, with no differences between surgical approaches. Conclusion: Opportunistic salpingectomy during hysterectomy does not adversely affect ovarian reserve, ovarian stromal blood flow, or sexual function, regardless of surgical route, supporting its safety in premenopausal women.

This study aimed to compare the efficacy of the combined intraurethral and intravaginal (UEL + VEL) non-ablative Erbium (Er): YAG laser with UEL alone in improving the symptoms of stress urinary incontinence (SUI) and/or stress-dominant mixed urinary incontinence (MUI) in women.This retrospective, multicenter cohort study included 228 women with SUI and/or MUI, with 161 women in the UEL + VEL group and 67 in the UEL group. The primary outcome was the change International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF) scores at baseline and at 3, 6, and 12 months.Demographic characteristics, including age, body mass index (BMI), and menopausal duration, were similar between the groups, with the exception of parity, which was significantly higher in the UEL group (2.49 ± 1.15 vs. 2.01 ± 1.15, p = 0.025). Baseline ICIQ-UI SF scores were significantly higher in the UEL + VEL group (12.08 ± 4.17 vs. 10.35 ± 4.95, p = 0.008). Over time, the UEL + VEL group showed a steeper and more substantial decline in symptom scores, eventually converging with the UEL group at 12 months. The UEL group, starting with lower baseline scores, showed a more moderate decline. This suggests that UEL + VEL might be more effective in reducing symptoms over time. Within-subjects test indicated that parity significantly influenced symptom improvement over time (p < 0.001, F = 13.843), and between-subjects test at 12 months showed that treatment type (p = 0.036, F = 4.479), parity (p = 0.002, F = 10.029), and their interaction (p = 0.022, F = 5.333). were significant predictors of outcome.Both UEL and combined UEL + VEL applications significantly improved UI symptoms up to 12 months. However, UEL + VEL was more effective overall. Parity was a significant factor influencing the treatment outcome, suggesting that increasing parity may be a prognostic factor in laser therapy for UI.

Objectives: A special group of stem cells with multipotent and immunomodulatory properties are mesenchymal stem cells (MSCs). Many modulatory factors are thought to mediate immunomodulatory properties of MSCs. One of these modulatory factors is thought to be HLA-G, one of human leukocyte antigens (HLA). This study aimed to compare HLA-G levels in both stimulated and unstimulated of peripheral blood mononuclear cell (PBMC) cultures with “cord blood-MSC” (CB-MSC) and “Wharton’s jelly-MSC” (WJ-MSC) at different rates and different incubation periods. Methods: WJ-MSCs were obtained by explant method, and CB-MSCs using Ficoll-paque. They were characterized by flow cytometry. MSCs and PBMCs were directly co-cultured for 24 and 72 h at 1:5 and 1:10, respectively. After incubations, the media were collected and HLA-G levels were measured by ELISA. Results: In the unstimulated group, the highest HLA-G level was found in the PBMC:WJ-MSC-72-1:5 group, while the lowest HLA-G level was found in the PBMC:CB-MSC-72-1:5. When 24-1:5 and 72-1:5 groups were examined, the HLA-G level decreased significantly in CB-MSC groups compared to WJ-MSC, while it increased significantly in the 24-1:10 and 72-1:10 groups (pin vitro approach to evaluate the immunomodulatory effect via HLA-G.

Introduction and Hypothesis The aim of this study was to evaluate the effectiveness of core stabilization exercises combined with pelvic floor muscle training (PFMT, Kegel exercises) in women with stress urinary incontinence (SUI) on pelvic floor muscle strength, incontinence parameters, and quality of life scores. Methods This prospective, randomized controlled study included 60 women diagnosed with SUI or stress-dominant mixed urinary incontinence (MUI). Participants were randomly assigned to two groups: the intervention group, which performed both core and Kegel exercises, and the control group, which engaged only in Kegel exercises. Evaluations were conducted immediately after the intervention and at the 10-week follow-up using digital palpation, perineometer, bladder diaries, pad tests, and quality of life assessments, including UDI-6, IIQ-7, ISI, and the King’s Health Questionnaire (KHQ). Results Both groups demonstrated significant reductions in the frequency and severity of incontinence, as well as improvements in quality of life scores. However, while the intervention group exhibited sustained benefits at the 10th-week follow-up, improvements in the control group regressed over time. Conclusions The addition of core stabilization exercises to Kegel exercises did not yield significant short-term differences; however, at follow-up, the core exercise group maintained significantly better outcomes compared to the control group. These findings suggest that, in women diagnosed with SUI, core stabilization exercises enhance pelvic floor muscle strength and endurance more sustainably than Kegel exercises alone.

Objective To investigate the effectiveness of ischemic compression and low-level laser therapy methods combined with exercise on the myofascial trigger points in women with Chronic Pelvic Pain and to determine which method is more effective. Methods It was a parallel designed, single-blind pilot randomized clinical trial. Patients were recruited at physiotherapy laboratory of the Istanbul University from September 2017 to June 2019. Twenty-eight women patients with Chronic Pelvic Pain were included into the trial. Patients were randomized into two groups. Group 1 received ischemic compression and Group 2 received low-level laser therapy twice a week for 6 weeks. Both groups received the same standard exercise program. Pain, range of motion, pelvic floor symptom severity, quality of life, satisfaction, anxiety, and depression were assessed after 6 weeks, and 1-year follow up. Results Following the treatment, significant differences were observed within both group subjects in pain, range of motion, symptom severity, quality of life, and anxiety-depression (p<0.05). This significant improvement in pain, symptom severity, symptoms related quality of life and pain subgroup of Short Form 36, continued after 1-year follow up (p<0.05). In comparison between group, Group 1 have more significant improvement than Group 2 in terms of symptoms related quality of life (p<0.05). Conclusion Both methods have shown efficacy and can be used safely in chronic pelvic pain patients. Because it is more effective on symptoms related quality of life, the ıschemic compression method may be preferred for primary use.

Aims: De novo stress urinary incontinence (SUI) may develop after surgical correction of advanced pelvic organ prolapse (POP) in otherwise continent women. Prediction of which women with POP will develop SUI after the prolapse is corrected is difficult. We aimed to externally validate a previously described prediction model for de novo SUI after performing vaginal surgery for POP and to assess its clinical performance when used as a diagnostic test.Methods: This retrospective cohort study included all continent women with ≥ stage 2 POP according to the POP‐Quantification System who underwent reconstructive surgery for symptomatic POP. Surgical correction for prolapse of the anterior and/or apical compartment was performed using native tissue or vaginal mesh repair. Seven parameters of the prediction model including age at surgery, number of vaginal births, body mass index, preoperative stress test, previous continence procedure history, urine leakage associated with a feeling of urgency, and diagnosis of diabetes for each patient was provided from the medical records, and the predicted probability of de novo SUI after POP surgery was calculated. The primary outcome used to validate the prediction model was the presence of SUI 1 year after surgery. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive accuracy. A cut‐off point of ≥ 50% was used to evaluate its clinical performance as a diagnostic test.Results: Two hundred twenty‐five women were suitable for analysis. The rate of de novo SUI was 5.3%. The predictive accuracy of the model in our population using the area under the ROC curve was 0.56 (95% confidence interval = 0.35–0.77). Its performance as a diagnostic test was poor (positive likelihood ratio = 1.20 and negative likelihood ratio = 0.89).Conclusions: Our clinical validation of this model showed that it did not have good clinical performance. We need future prospective studies to identify and incorporate additional markers of de novo SUI to improve the prediction capacity.

Objective : The ideal controlled ovarian stimulation protocol for patients with poor ovarian response (POR) is not clear yet, and is the subject of many studies. Aromatase inhibitors have been introduced as a new treatment modality in controlled ovarian stimulation as they were found to elevate follicular sensitivity to gonadotropins(Gn). The aim of this study was to evaluate whether it is possible to reduce the required Gn dose by adding letrozole to the treatment without compromising success. Material and Methods: Patients who underwent in vitro fertilization treatment between 2014 and 2015 in our department and who were classified as poor responder patients according to Bologna criteria were recruited and randomized. In the first group, 33 patients were treated with 150 IU Gn in combination with letrozole 5 mg /day for the first five days of the stimulation. In the second group, 27 patients were treated with 300 IU Gn. Results: Amoung the groups there were no statistically significant difference in duration of ovulation stimulation, duration of antagonist use, number of retrieved oocytes, number of transferred embryos, implantation, cycle cancelation, chemical, clinical and ongoing pregnancy rates (all p>0.05). Gn use was significantly higher in 300 IU Gn alone group compared to 150 IU Gn in combination with letrozole group (1354 ± 468 IU versus 2555 ± 725 IU, p<0.05). Conclusion: The addition of letrozole yields comparable pregnancy outcomes with significantly low doses of Gn, so may be regarded as an effective adjuvant agent in POR patients.

Midurethral slings (MUSs) have been used successfully for the last 20 years in the treatment of stress urinary incontinence and accepted as the gold standard surgical procedure. High success rates and minimal invasiveness of surgery are among the most important advantages, but sometimes serious complications can occur during or after surgery. Although serious complications are rare after widely performed transobturator tape (TOT) operation, awareness, early diagnosis, and aggressive management are essential as they can progress with serious morbidity and mortality. In order to reduce the infectious complications after MUS procedures, in addition to sterility of the operating theater and the operating equipment, the type of mesh used and the preparation of the surgical site are crucial. We aimed to pre­sent the successful management of a case of necrotizing fasciitis in a TOT patient.