Erhan Aktürk

Introduction and Hypothesis The objective was to compare anatomical and safety outcomes of laparoscopic lateral suspension (LS), pectopexy (PP), and sacrocolpopexy (SCP) for apical pelvic organ prolapse (POP) in a retrospective comparative cohort using propensity score weighting. The cohort consisted of consecutive women undergoing LS, PP or SCP at a tertiary referral centre between 2017 and 2023. Methods Confounding by indication was addressed using a multinomial propensity score with inverse probability of treatment weighting; covariate balance was assessed by standardised mean differences. Weighted regression models with robust standard errors were used; primary-outcome pairwise comparisons were Holm corrected. Sensitivity analyses included overlap weighting, entropy balancing and doubly-robust estimation. The main outcome measures were 12-month apical anatomical success; perioperative outcomes; Clavien–Dindo complications; mesh-related events; reoperation; time to recurrence. Results Of 188 women (58 with SCP, 63 with PP, 67 with LS), 12-month apical success was 74.1%, 73.0%, 80.6%, with no significant pairwise differences (PP vs SCP: aOR 0.80, 95% CI 0.33–1.93; LS vs SCP: aOR 1.42, 95% CI 0.56–3.60; global p = 0.437). Post hoc analysis indicated 80% power only for large effects (≈18 percentage points). LS required longer operative time (+44.2 min, p < 0.001); PP had modestly higher blood loss (+23.6 ml, p = 0.038). Complications, mesh exposure, reoperation and time-to-recurrence did not differ. Findings were robust across sensitivity analyses. Conclusions No significant differences in 12-month apical success or safety were detected among women undergoing SCP, PP or LS after adjustment; LS required a longer operative time. Wide confidence intervals and absence of a prespecified non-inferiority margin preclude any equivalence claim; short-term findings cannot be extrapolated to long-term durability. Graphical Abstract

Aims: To investigate whether there is a difference between serum tumor markers panel (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well-staged patients with borderline ovarian tumors (BOTs). Methods: Over the past 20 years (January 2001 to January 2021), the results of four tumor markers (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) have been clinically analyzed for for this retrospective cohort study of 156 patients who underwent surgery and were diagnosed with histopathology consistent with a borderline ovarian tumor. Results: The average age of patients with borderline ovarian tumors was determined to be 51.67 (4.726) years. Before the first surgery, high CA 125 levels (>35 U/l) were found in 53 patients (34%), high CEA levels (>4 ng/ml) were found in 24 patients (15.4%), high CA 19-9 levels (>37 U/ml) were found in 29 patients (18.6%), and high CA 15-3 (>30 ng/ml) levels were found in 12 patients (7.7%). The average CA 125 levels in tumors with serous histopathology [372.8 (1805.2)] were higher than those in tumors with mucinous histopathology (p=0.006). There was no statistically significant difference in tumor markers between tumors smaller than 8 cm and larger than 8 cm [(CA 125 p=0,257), (CEA p=0.9), (CA 19-9 p=0.295), (CA 15-3 p=0.404)]. Conclusion: Our primary outcome of the study is an increase in CA 125 levels, which indicates serous histopathology. Our secondary outcome is the higher levels of tumor markers, but it does not suggest larger tumors.

Cervical fibroids are rare neoplasms of uterine origin whose management has not been standardized. Cervical fibroids, which can be challenging in surgical management, can become a difficult problem for the surgeon when neglected or asymptomatic and reach gigantic dimensions. Suspending the aorta abdominalis or arteria illiaca communis with vascular tapes and balloting the uterus with the help of vaginal taping while searching for the correct cleavage may reduce the risk of intraoperative hemorrhage and adjacent organ injury, as well as may be guide for the steps of the operation. Management of neglected giant cervical fibroids may not be suitable for testing alternative treatment methods to surgery used in the treatment of uterine neoplasms. However, surgical management will also be challenging. For this reason, the technique we describe can help the surgeon with clues that should be considered in the surgical management of these patients.

Background/Aim: Urogynecological symptoms, including pelvic pain, lower backache, feeling of bearing down, frequency, nocturia, urgency, stress incontinence, and urge incontinence, are common during pregnancy. But little has been reported regarding possible changes in lower urogenital tract anatomy and its effects in pregnancy. Therefore, the subject of this study is whether the incidence of urogynecological symptoms is higher when the uterus is retroverted in pregnancy. Methods: We enrolled 1432 pregnant women examined before the 20th week of pregnancy between January 2018 and March 2022. Patients were allocated into two groups according to whether the uterus was retroverted (n=226 (15.7%)) or anteverted (n=1206 (84.3%)). These two groups were compared regarding pelvic pain, lower backache, the feeling of bearing down, frequency, nocturia, urgency, stress incontinence, and urge incontinence. Results: Retroverted gravid uterus was noted in 11.8% (n=41) of nulliparae and 17% (n=185) of multiparae (P=0.021), with an overall prevalence of 15.7%. Of 1432 patients, the overall prevalence for frequency, urgency, nocturia, urge incontinence, stress incontinence, lower backache, pelvic pain, and feeling of bearing down were 31%, 26.7%, 18.2%, 5.4%, 7.5%, 6.9%, 56.4% and 7.5%, respectively. Between both groups, there were differences in frequency, urgency, nocturia and lower back pain. There were two patients with incarcerated gravid uterus with urinary retention. Conclusion: Patients with a retroverted uterus are more likely to experience the symptoms of lower back pain, frequency, nocturia, and urgency in the first half of pregnancy. '+st+' Sweigart AN, Matteucci MJ. Fever, sacral pain, and pregnancy: an incarcerated uterus. West J Emerg Med. 2008;9:232–4. Silva PD, Berberich W. 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DOI: https://doi.org/10.1111/j.1471-0528.2002.01124.x Copyright (c) 2023 Erhan Akturk, Cagdas Nurettin Emeklioglu, Hale Ozer Caltek, Necirvan Cagdas Caltek, Fatih Sahin, Veli Mihmanli This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Aim: Abruptio placenta is one of the most important causes of antepartum bleeding and is linked to the major (unpleasant) obstetrics consequences leading to the increased risks of fetal and maternal morbidity and mortality. The aim of our study is to establish a prevalence in our tertiary hospital and find out the fetal and maternal outcomes, along with the patient’s demographic characteristics and risk factors of abruptio placenta. Material and Method: This trial was carried out in Profesör Doktor Cemil Taşçıoğlu State Hospital, between January 2018 and March 2022. Patient data were extracted from computer system, and files were retrospectively evaluated. We established the fetal and maternal outcomes, along with the demographic characteristics and risk factors of abruptio placenta. All analysis was performed using SPSS software (Statistical Package for the Social Sciences, version 25.0, SPSS Inc., Chicago, IL, USA). Results: Within the review period there were 7126 deliveries. And 112 cases with abruptio placenta were seen out of the total deliveries. In our population, prevalence of the abruptio placenta was calculated as 1.5%. Because of the incomplete data in certain files, only a total of 102 cases (91%) were eligible for the study. Conclusion: In conclusion, since the abruptio placenta is highly associated with maternal and fetal morbidity and mortality, timely diagnosis is crucial to prevent devastating consequenuces.

Aktürk E, et al. J Gynecol Oncol. 2011 Sep;22(3):177-182. http://dx.doi.org/10.3802/jgo.2011.22.3.177