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Öğe A comparison of emergency and therapeutic modified Shirodkar cerclage: an analysis of 38 consecutive cases(Galenos Yayincilik, 2019) Başbuğ, Alper; Doğan, OzanObjective: To compare the maternal and neonatal outcomes of patients with emergency versus therapeutic cerclage. Materials and Methods: The study included 38 female patients who underwent cervical cerclage using the modified Shirodkar method in the Obstetrics and Gynecology Clinics of Duzce University Medical Faculty Hospital and Duzce Ataturk State Hospital. Results: The operating time for the emergency cerclage group was significantly longer than that of the therapeutic group (30.40 minutes vs 19.85 minutes, p=0.001). Following the cerclage procedure, the cervical length was longer in the therapeutic cerclage group [29.90 millimeters (mm) vs. 22.45 mm, p=0.001]. The cerclage to birth interval was also longer in the therapeutic group (91 vs. 138 days). Conclusion: In comparison with therapeutic cerclage, the total duration of pregnancy after emergency cerclage is shorter, and newborns have a greater need for intensive care. Both methods, however, protect against advanced prematurity, which causes neonatal loss.Öğe Discriminating Performance of Early Uterine and Cervical Artery Pulsatility and Resistivity In Pre-Invasive Cervical Lesions(Yerkure Tanitim Yayincilik Hizmetleri As, 2018) Doğan, Ozan; Pulatoğlu, Çiğdem; Başbuğ, Alper; Kaya, Aşkı Ellibeş; Yassa, MuratObjectives: The aim of the present study was to investigate the diagnostic effectiveness of uterine and cervical vascularity alone or in combination with human papillomavirus (HPV) DNA testing and with cytology. Methods: Data were prospectively collected from 129 patients in an outpatient clinic of a secondary setting. Routine liquid-based cervical cytology and HPV-DNA testing were obtained. An abnormal result of any of these high-risk types was viewed as positive. Pulsatility (PI) and resistance (RI) indices of uterine (UA) and cervical (CA) arteries were assessed by Doppler sonography. Pathological diagnosis was considered as the gold standard for assessment. Diagnostic efficiency of alone and joint screening of the three indices for discriminating cervical intraepithelial neoplasia (CIN-I) or above from below was assessed. Results: UA-RI and CA-RI were significantly lower in the HPV (+) group than in the controls (p=0.02 and p=0.03, respectively). In subsequent sub-analysis among patients with positive HPV-DNA, UA-PI was significantly higher in the HPV-16 (+) group than in the HPV-18 (+) group (p=0.04). High-risk HPV (Hr-HPV) testing had the highest sensitivity compared with Doppler and cytology (76.5%, 64.7%, and 58.5%, respectively). Combining CA-RI with cytology or Hr-HPV significantly reduced the sensitivity (23.5% and 29.4, respectively) but improved the specificity from 54.4% to 69.8% and 40.9% to 70.7%, respectively. Combining UA-PI with Hr-HPV slightly increased the positive predictivity when compared with testing Hr-HPV alone (36.1% vs. 33.3%). Conclusion: The potential of the Doppler indices of UA and CA was doubtful in discriminating CIN-I or above lesions in the early period. In addition, RI of UA and CA differed with regard to the presence of HPV infection, whereas CA-RI differed in high-risk HPV cases.Öğe Do external female genital measurements affect genital perception and sexual function and orgasm?(2020) Kaya, Aşkı Ellibeş; Doğan, Ozan; Yassa, Murat; Başbuğ, Alper; Özcan, Canan; Çalışkan, ErayObjective: To provide baseline data for the anatomy of the external female genitalia and to investigate the correlation between those measurements and sexual function and genital perception.Materials and Methods: This prospective cohort study consisted of 208 healthy premenopausal women. The Female Sexual Function index (FSFI) and the Female Genital Self-image scale (FGSIS) questionnaires were administered. Participants were divided into two groups according to their female sexual dysfunction (FSD) status. External genital measurements and anterior and posterior vaginal length were measured.Results: The external female genital measurements were (cm, mean ± standard deviation): clitoral prepuce length 2.05±0.48; clitoral glans length 0.87±0.21; clitoral glans width 0.60±0.15; clitoris to urethra 2.24±0.55; anterior fornix depth 7.75±0.92; posterior fornix depth 9.25±0.75; labia minora width, right 2.12±0.86, left 2.20±0.96. A weak negative correlation was found between total FGSIS scores and clitoral prepuce length (p=0.01, r=-0.17), whereas a weak positive correlation was seen between total FGSIS scores and anterior-posterior vaginal lengths (p=0.04, r=0.13; p=0.02, r=0.15, respectively). No statistically significant difference was found between the genital measurements of participants with FSD (n=82, 39.4%) and those without FSD (n=126, 60.6%), and the total FSFI scores and orgasm subdomain scores.Conclusion: The female genital measurements were found to be distributed over a wide range. Although the relationship between genital measurements and genital perception varied, no significant relationship was found between genital measurements and sexual functions or orgasm. These findings suggest that a more cautious approach should be taken towards genital surgeries for cosmetic purposes.Öğe Does educational level affect vulvar perception?(OrtadogŸu Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S., 2018) Kaya, Aşkı Ellibeş; Doğan, OzanObjective: The purpose of this study was to reveal whether educational status level affects vulvar perception. Material and Methods: The participants were separated into three groups according to their educational status, with the first Group consisting of participants who were primary school graduates, the second Group those who were middle school/high school graduates, and the third Group included those who had studied at the post-graduate or doctoral level. A total of 17 questions about genital perception were posed using a questionnaire. Results: Among the groups, no differences were observed in terms of satisfaction with the genital area (p= 0.293). The satisfaction rates and aesthetic desires of the individuals who had the highest level and the lowest level of education were similar; however, it was observed that the middle group found the image of their genital area less normal (p=0.026), and it was determined that more of the participants in this group planned to have aesthetic surgery than those in the other groups (p?0.001). In Group 2, of the participants, 23.6% stated that they would like to undergo aesthetic surgery if they could financially afford it, while this rate was 6.6% and 8.9% in Groups 1 and 3, respectively (p=0.007). Conclusion: Vulvar perception is higher in both low and high levels of awareness. The participants having a middle-level education might have been using the media in a wrong way and thus had difficulties in obtaining accurate and reliable information. Copyright © 2018 by Türkiye Klinikleri.Öğe Does Suture Material Affect Uterine Scar Healing After Cesarean Section? Results from a Randomized Controlled Trial(Taylor & Francis Inc, 2019) Başbuğ, Alper; Doğan, Ozan; Kaya, Aşkı Ellibeş; Pulatoğlu, Çiğdem; Çağlar, MeteBackground: Impaired healing of the uterine scar after cesarean has been associated with adverse gynecological and obstetric outcomes. Although a large number of studies have been conducted on the events leading to this, information obtained from prospective randomized studies examining the role of suture material in the formation of cesarean scar defect (CSD) is lacking. Objective: To evaluate the effects of synthetic suture materials on CSD formation. Study design: We performed a two-arm 1:1 randomized study in women with singleton pregnancies undergoing elective primary cesarean delivery after the 38th week of gestation. Uterine scar closure was performed using synthetic absorbable monofilament and multifilament sutures. The primary outcome was residual myometrial thickness (RMT) in the area of the scar, measured by transvaginal ultrasound 6-9 months after birth. Secondary outcomes included differences in mean operative time, mean estimated blood loss at the time of surgery, and the rates of postoperative gynecological sequelae. Results: Complete follow-up was obtained from 94 (88%) of 107 participants. RMT was thicker in the monofilament compared to the multifilament suture group (5.5 +/- 2.24 vs. 4.18 +/- 1.76, p = 0.01). Hemoglobin delta was higher in the monofilament suture group (1.59 +/- 0.96 vs. 1.25 +/- 0.60, p = 0.04). There was no statistically significant difference between the monofilament suture and multifilament suture groups in terms of gynecological sequelae. Conclusion: Closure of the uterine scar with monofilament suture has a positive effect on scar healing and increases RMT thickness.Öğe An Evaluation of the Association of Reproductive History and Multiple Births during Adolescence with Postmenopausal Osteoporosis(Georg Thieme Verlag Kg, 2019) Kaya, Aşkı Ellibeş; Doğan, Ozan; Başbuğ, Alper; Sönmez, Cemil Işık; Sungur, Mehmet Ali; Ataoğlu, SafinazIntroduction Osteoporosis is the most common metabolic bone disease characterized by low bone mass. Reproductive factors are known to affect bone mineral density (BMD). Calcium loss from maternal bone and decreased BMD have been observed especially during pregnancy and lactation, although this loss has been reported to recover within 6-12 months. There is no consensus on whether the effect of reproductive factors on the bone is positive or negative. The adolescent period is important for total bone mass, and total bone mass is significant in osteoporosis. The aim of this study was to investigate the effect of first gestational age, multiple births during adolescence, interpregnancy interval and reproductive history such as duration of breastfeeding on bone mineral density in postmenopausal women. Materials and Methods BMD was measured in a total of 196 postmenopausal patients and in accordance with the results, analysis was made of three groups as normal, osteopenia and osteoporosis. Dual Energy X-Ray Absorptiometry (DEXA) was used to take the lumbar, femoral and total bone BMD measurements. Results No statistically significant difference was determined between the groups in respect of total breastfeeding time (p = 0.596). It was detected that an increased interpregnancy interval decreased the risk of osteoporosis. In patients with osteoporosis, the mean interpregnancy interval was 1.4 +/- 0.73 years, while it was longer in patients with osteopenia (1.92 +/- 1.20) and normal BMD (2.45 +/- 1.77) (p = 0.005). While no effect was determined of the first gestational age on BMD, in the univariate logistic regression analysis, multiple births in the adolescent period were seen to increase the risk of osteoporosis 6.833-fold (p = 0.001, OR = 6.833, 95% CI = 2.131-21.908; p = 0.001). The increase in the age of menopause was determined to decrease the risk of osteoporosis (OR = 0.911, 95% CI = 0.843-0.985; p = 0.019). Conclusion Having frequent births throughout the whole reproductive age and having more than one child in adolescence has an adverse effect on postmenopausal bone mineral densities.Öğe Feasibility of basket technique compared to the office hysteroscopy to treat endometrial polyps in patients undergoing in vitro fertilization(OrtadogŸu Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S., 2018) Zeteroğlu, Şahin; Kaya, Aşkı Ellibeş; Başbuğ, Alper; Çakıroğlu, Yiğit; Doğan, Ozan; Çalışkan, ErayObjective: The authors aim to compare the results of office hysteroscopic basket polypectomy with operative hysteroscopy in endometrial polyps detected prior to in vitro fertilization (IVF). Material and Methods: Infertile patients, who underwent polypectomy before treatment, were analyzed retrospectively. Patients who underwent basket polypectomy as office hysteroscopy (Group 1, n=55) and hysteroscopic polypectomy (Group 2, n=49) were included in the study. Demographic data, operation time, success rates, and pregnancy rates after operation were compared between the two groups. Results: The mean operating time for Group 1 was 14.98 ±3.67 min, while that for Group 2 was 18.84±3.30 min (p=0.001). The success rates between the groups were similar (96.3% vs. 100%; p=0.652), without any major complications. Further, the biochemical (52.7% vs. 48.9%, OR 1.19; 95% CI: 0.55-2.59; p=0.696), clinical (43.6% vs. 40.8%, OR 1.16; 95% CI: 0.52-2.59; p=0.712), ongoing pregnancy (38.1% vs. 34.6%, OR 1.21; 95% CI: 0.52- 2.81; p=0.647), live births (34.5% vs. 28.6%, OR 1.3116; 95% CI:0.57-3.03; p=0.514), early spontaneous miscarriage (5.5% vs. 6.1, OR 0.88; 95% CI: 0.17-4.60; p=0.884) and spontaneous pregnancy (5.5 vs. 4.1, OR 0.745;%95 CI: 0.21-8.4; p=0.745) rates after polypectomy were observed to be similar in both the groups. Conclusion: Hysteroscopic basket polypectomy was not inferior to operative hysteroscopy regarding success rates and was found to be superior in terms of operating time in patients planning in vitro fertilization. Copyright © 2018 by Türkiye Klinikleri.Öğe The Female Genital Self-Image Scale (FGSIS): cross-cultural adaptation and validation of psychometric properties within a Turkish population(Springer London Ltd, 2019) Kaya, Aşkı Ellibeş; Yassa, Murat; Doğan, Ozan; Başbuğ, Alper; Pulatoğlu, Çiğdem; Çalışkan, ErayIntroduction and hypothesisWomen's perceived satisfaction from their own genital appearance is linked to genital image and sexual esteem. A comprehensive and easy to use scale to measure self-image was scarce in the literature. It was aimed in the present study to complement cross-culturally adapted and validated into Turkish version of the Female Genital Self-Image Scale (FGSIS) and to assess its psychometric properties.MethodsAfter cross-cultural adaptation, the Turkish version of the FGSI, Female Sexual Distress Scale-Revised (FSDS-R), and Female Sexual Function Index (FSFI) were administered to 461 female participants. Content/face validity, exploratory, and confirmatory factor analysis, internal consistency, and reliability were appropriately assessed. Predefined and specific hypotheses were formulated for construct validity.ResultsOur findings indicated excellent content/face validity, sufficient internal consistency (Cronbach's alpha 0.818), and test-retest reliability [intraclass correlation coefficient (ICC) 0.951]. Construct validity was demonstrated by proving the hypothesis that participants who have performed at least one vaginal/clitoral masturbation for the last month reported significantly higher FGSIS scores compared with those who abstained (Z -6.37, p<0.001). Factor analyses formed one factor structure. In the proposed two-factor construct, all seven items demonstrated good to high correlations with their subdomains and lower correlations with the other domain, indicating sufficient convergent validity.ConclusionsThe FGSIS was successfully validated for use in the Turkish population. The scale exhibited strong psychometric properties to assess perceived female genital image. It might be reliably used in genital cosmetic surgeries and in a variety of gynecologic conditions.Öğe Labial Cutaneous Flap Interposition in the Treatment of Recurrent Vesicovaginal Fistula(Mary Ann Liebert, Inc, 2019) Başbuğ, Alper; Doğan, Ozan; Kaya, Aşkı Ellibeş; Akar, Bertan; Gümüştaş, Gökhan; Çalışkan, ErayBackground: Recurrent vesicovaginal fistula (VVF) repair can be very difficult. Most gynecologists prefer the vaginal route because of the complexity of the abdominal approach. This article presents a simple procedure-a minimally invasive approach-labial cutaneous flap intertposition, that was used to treat an elderly patient with VVF. A cutaneous flap has good vascularity, allows augmentation of the bladder, and permits a vaginal approach. Case: A 72-year-old woman had VVF due to prolonged obstructed labor 30 years prior and had undergone transvaginal primary layered repair for this reason. Later on, she underwent total abdominal hysterectomy (TAH) and sacrocolpopexy to address uterine prolapse and cystocele. VVF developed after the TAH and sacrocolpopexy procedures. After the first postoperative month, she had recurrent urinary incontinence. A fistula between the bladder neck and vagina was noted when she had a vaginal examination and cystoscopy. A cutaneous labial flap was used to repair this recurrent VVF. Results: The labial cutaneous flap for repair of this patient's VVF was used successfully. The patient had no more evidence of recurrent VVF or voiding abnormalities after this procedure. Conclusions: Labial cutaneous tissue can be used to create a successful interposition flap during repair of recurrent VVF, particularly in elderly patients.Öğe Mikro Besin Takviyesinin Maternal–Fetal Sonuçlara Etkisi: D vitamini, Kalsiyum ve Magnezyum(2018) Doğan, Ozan; Kaya, Aşkı Ellibeş; Pulatoğlu, Çiğdem; Akar, Bertan; Başbuğ, Alper; Çalışkan, ErayAmaç: Fetal ve maternal sağlığa olumlu etkileri olması nedeniyle gebelik döneminde artan ihtiyaçla orantılı olarak vitamin ve mineral desteğine ihtiyaç vardır. Bu çalışmada mikro besin takviyesi olarak D vitamini, Kalsiyum (Ca) ve Magnezyum (Mg) desteği alan gebelerin postnatal sonuçlarını ve gebelik komplikasyonlarını araştırmak amaçlandı.Gereçler ve Yöntem: Yapılan bu prospektif, longitudinal ve kalitatif çalışmaya Ocak 2016 ve Ocak 2018 tarihleri arasında 18-40 yaş arası toplam 2114 hasta dahil edilmiştir.Bulgular: Maternal yaş aralığı tüm hasta grupları için 28.11 6.12‘ dir. Multivitamin kullanan grubun yaş ortalaması D vitamini grubuna göre daha düşük saptandı(p 0.001). Yalnızca Mg ve D vitamini kullanan grupta yüksek lisans seviyesinde eğitim görenler daha fazlaydı(p0.001). Mg, Ca, D vitamini ve multivitamin kullananımı ile gebelik komplikasyonları arasında anlamlı ilişki bulunamadı. Multivitamin kullanan gebelerde LGA daha fazla görüldü(p0.038). İlk gebelik yaşı Ca ve mulivitamin kullanan grupta Mg ve D vitamini kullanan gruba göre daha düşük bulunmuştur(p0.001).Sonuç: Annenin sağlıklı bir gebelik geçirmesi, maternal komplikasyonlardan korunması, fetusun büyüme ve gelişmesi için annenin düzenli beslenmesinin yanı sıra vitamin ve mineral takviyesi önemlidir. Bu takviyelerin literatürde gösterilmiş olan yararlarını desteklemek ve rutin kullanımda yer vermek için daha çok prospektif çalışmaya ihtiyaç vardır.Öğe A Novel Technique for Mapping the Vascularity of Labia Minora Prior to Labiaplasty: Cold Light Illumination(Georg Thieme Verlag Kg, 2018) Kaya, Aşkı Ellibeş; Doğan, Ozan; Yassa, Murat; Başbuğ, Alper; Çalışkan, ErayObjective Aim of the study was to assess the feasibility of a novel technique to determine the vascularity of labia minora prior to labiaplasty. Methods A cold light source employed in laparoscopic procedures was used to illuminate the outer surface of the labia minora as described in this prospective descriptive study. Results Of the patients, 46.1% (n = 41) had upper third prominence, 36% (n = 32) had middle third prominence, and 18% (n = 16) had lower third prominence according to the Banwell classification of morphologies. Right labia minora width was 0-2 cm in 51.7% (n = 46), 2-4 cm in 47.2% (n = 42) and > 4 cm in 1.1% (n = 1) of cases. Left labia minora width was 0-2 cm in 52.8% (n = 47), 2-4 cm in 41.6% (n = 37) and > 4 cmin 5.6% (n = 5) of cases. The incidence of Anterior 2 and Posterior 1 vessels in the differentmorphologies were statistically significantly different (p = 0.007, p = 0.018). The Anterior 2 vessel was higher in the lower morphology group whereas the Posterior 1 vessel was higher in the upper morphology group. A central vessel was observed in 93.3% (n = 83) of patients in the left labium minus and the right labiumminus. The incidence of the Posterior 1 vessel was significantly higher in the left labium minus than in the right labium minus (p = 0.021). Discussion This novel technique to assess labial vascularity using a cold light source could be very useful to reduce dehiscence by avoiding excessive resection of highly vascularized tissue. Most units can easily access a cold light source, which can be used to assess labial vascularity prior to labiaplasty.Öğe Nukhal Fold Nomogramı, Kalp ve Santral Sinir Sis- tem Hastalıkları ile İlişkisi(2017) Kaya, Aşkı Ellibeş; Başbuğ, Alper; Akar, Bertan; Bender, Ada; Doğan, Ozan; Çalışkan, ErayAmaç: Nukhal fold kalınlığı birinci trimesterda ölçülen ense saydamlığının ikinci trimesterda devamı niteliğindedir. Özellikle anormal karyotip olan vakalar dâhil edilirse bazı sistemik hastalıklarla ilişkisi ve detaylı ultrasound için bir uyarı niteliği taşıması açısından önemlidir. Yöntem: Çalışmamız 2011-2017 yılları arasında Kocaeli Medikal Park hastanesinde takipleri yapılmış 16-24 haftalar arasındaki 1625 tekil normal karyotipli gebelerden oluşmaktadır. Gebelerin detaylı ultrasonografileri yapıldı. Her hafta için %5, %50, %95 percentil nukhal fold kalınlıkları hesaplanarak nukhal fold nomogramı oluşturuldu. Bulgular: Gebelik yaşı ile nukhal fold kalınlığı arasında pozitif korelasyon tespit edildi (p: 0,001, r:0,18). Tüm hastalar içinde 50 fetusta kardiak hastalık, 32 fetusta santral sinir sistemi patolojisi saptandı. Nukhal fold kalınlığı ile kardiovasküler hastalık arasında istatistiksel olarak anlamlı bir ilişki saptanmadı (p 0.98 and p0.05). Nukhal fold kalınlığı ile santral sinir sistemi hastalıkları arasında da istatistiksel olarak anlamlı bir ilişki saptanmadı (p0.55 and p0.05).Sonuç: Normal karyotipli fetuslarda nukhal fold kalınlığındaki artış, fetal kalp ve santral sinir sistemi hastalıkları ile artış göstermemektedirÖğe Predictive factors of methotrexate treatment success in ectopic pregnancy: A single-center tertiary study(Kare Publ, 2018) Pulatoğlu, Çiğdem; Doğan, Ozan; Başbuğ, Alper; Kaya, Aşkı Ellibeş; Yıldız, Ahmet; Temizkan, OsmanOBJECTIVE: It is controversial whether medical or surgical treatment options have more successful results in ectopic pregnancy treatment. Although high pretreatment serum hCG levels have been known to be the most important predictor, the appropriate treatment modality for a specific range of hCG level remains unclear. Furthermore, the variables that make a patient a bad candidate for single-dose methotrexate treatment is unclear. The aim of this study was to identify predictive factors associated with the success of single-dose methotrexate treatment in women with ectopic pregnancy. METHODS: In this retrospective study, 101 women with tubal ectopic pregnancies who had been treated with single-dose methotrexate were selected. The gestational ages, pretreatment hCG values, ectopic mass size, and fluid presence in the abdomen were compared between the groups. RESULTS: The mean age of the patients was 30.6 +/- 5.8 (range, 19-42) years, and the gestational age at first injection was 7.0 +/- 2.13 (range, 2.3-13.6) weeks. The overall treatment success rate was 77.2% (n=79). The mean duration of hospital stay was 4.21 +/- 1.89 days in the successfully treated group and 6.92 +/- 2.13 days in the failure group (p<0.05). The rate of treatment failure in patients with abdominal fluid was 37.8%, and it was 12.7% in the non-fluid group (p=0.03). hCG values on days 1, 4, and 7 were significantly higher in the unsuccessful group (3887-2589 mIU/mL, 2814-1287 mIU/mL, and 1119-285 mIU/mL, respectively; p<0.05). The cutoff hCG value, which determined the failure of methotrexate treatment, was found to be 1362 mIU/mL. CONCLUSION: In present study, patients with hCG value <1362 mIU/mL were found to be good candidates for methotrexate treatment. Although not strictly decisional, this hCG threshold level can be used to decide on the likelihood of methotrexate success or failure. Detection of abdominal fluid on ultrasonography also can be assessed as a bad prognostic factor, but size of ectopic mass does not correlate with methotrexate treatment success.Öğe Proteinuria in preeclampsia: is it important?(Via Medica, 2018) Özkara, Attila; Kaya, Aşkı Ellibeş; Başbuğ, Alper; Ökten, Sabri Berkem; Doğan, Ozan; Çağlar, Mete; Kumru, SelahattinObjectives: Our aim is to evaluate the laboratory results arid proteinuria levels of preeclamptic women arid their relationships to maternal and fetal outcomes. Material and methods: One hundred preeclamptic pregnant women who gave birth in our clinic between 2013 and 2015 were included in our study retrospectively. The data collected from the patients included gestational week, age, gravidity, parity, abortus history, blood pressure, biochemical parameters, delivery method, maternal hospitalization time, cesarean indication, complications, blood products required, plasmapheresis use and dialysis need. The details about the newborns were recorded retrospectively. The relationships between preeclampsia signs and maternal and neonatal outcomes were analyzed. The protein amounts were analyzed via 24-hour collected urine analyses and spot urine analyses. Results: A statistically significant positive correlation was observed between neonatal intensive care unit needs and proteinuria levels. Fetal growth restriction, respiratory distress syndrome and sepsis were observed as the level of proteinuria increased, but the result was not statistically significant. Eclampsia was observed only in patients with massive proteinuria, and it was statistically significant. An increase in cesarean sections, placental abruptions, antihypertensive drug needs and blood product replacement rates was observed as the amount of proteinuria increased in preeclamptic women, but the results were not statistically significant. Conclusions: The severity of preeclampsia cannot be determined by the level of proteinuria. However, when massive proteinuria is detected, the clinician should be more cautious about maternal and fetal complications.Öğe A randomized comparison of a single-incision needleless (Contasure-needlelessA (R)) mini-sling versus an inside-out transobturator (Contasure-KIMA (R)) mid-urethral sling in women with stress urinary incontinence: 24-month follow-up results(Springer London Ltd, 2018) Doğan, Ozan; Kaya, Aşkı Ellibeş; Pulatoğlu, Çiğdem; Başbuğ, Alper; Yassa, MuratThere is a shortage of reliable data on the efficiency of the under-investigated mini-slings to treat stress urinary incontinence (SUI). We aimed to compare the effectiveness of the single-incision needleless mini-sling (SIMS) with the transobturator inside-out mid-urethral sling (TOT). Two hundred one women with clinically proven SUI were included in this single-center prospective randomized trial. The patients were randomly allocated to the groups. All surgeries were done by the same single surgeon. Examinations were done by one other blinded surgeon. The patients were followed up for 24 months. Objective cure was defined as the absence of SUI and negative cough-stress test. Subjective cure was defined as no stress leakage of urine after surgery in a validated questionnaire. Failure of the surgery was defined as the need for reoperation. Every complaint was categorized by the IUGA/ICS Classification of Prosthesis-related Complications. The objective (85.4% versus 89.9%, p = 0.362) and subjective (87.6% versus 89.9%, p = 0.636) cure rates were similar with the TOT and SIMS at the postoperative month 24, respectively. The mesh exposure 1 cm rate was 3.4% for both groups, and the mesh exposure > 1 cm rate was 2.2% for both groups. Overall failure rates were 3.4% and 2.2% for the TOT and SIMS group, respectively. No viscus organ perforation was noted. Complications with the SIMS procedure were less painful compared with TOT (p = 0.024). Single-incision needleless mini-slings exhibited similar cure rates as the trans-obturator mid-urethral slings from both the patient and clinician points of view in 24 months of follow-up. Mini-slings resulted in significantly less postoperative pain than trans-obturator mid-urethral slings.Öğe A randomized prospective comparison of the needleless mini-sling "hammock" and "U-shape" configurations for management of stress urinary incontinence: 18 month follow-up results(Springer Heidelberg, 2018) Doğan, Ozan; Başbuğ, Alper; Kaya, Aşkı Ellibeş; Pulatoğlu, Çiğdem; Yassa, MuratObjective To compare the efficacy of needleless mini-sling placed either retropubic (U-shape) or trans-obturator (hammock-shape) to treat stress urinary incontinence. Setting One hundred and twenty six women were randomized in a 2:1 ratio to receive hammock-shaped or U-shaped of Contasure-NDL. Methods All surgical procedures were performed by one senior surgeon experienced in anti-incontinence surgery with mesh. Cough-stress test was considered for objective outcome. Subjective outcomes consisted of International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Patient Global Impression of Improvement (PGI-I) and three-item Likert scale to measure satisfaction. Assessments were performed preoperatively and at postoperative 6th, 12th and 18th month. Results The objective cure rates at postoperative 6th and 12th month were significantly lower in U-shape group compared to hammock-shape group (85.4 vs. 96.4%; p = 0.034) and was comparable with hammock-shape group at 18 th month postoperative (90.2 vs. 96.4%, respectively; p = 0.216). The subjective cure rates at postoperative 6th, 12th and 18th month were similar between groups (90.2/90.2/100% vs. 96.4/96.4/96.4%, respectively; p > 0.05). Median of total ICIQ-SF scores was significantly lower in hammock-shaped group (1.62 +/- 2.92) compared to U-shape (3.80 +/- 2.64) at 18th month (p < 0.001). The rate of patients reported as very satisfied or satisfied to the Likert scale was 90.2% in U-shape group and 96.4% in hammock group. Patients' responses to PGI-I were majorly distributed to "much better" and "very much better" with a mean score of 1.93 +/- 2 in U-shape and 1.33 +/- 1 in hammock group at 18th month of follow-up (p < 0.001). Conclusion U-shape placement of needleless single-incision mini-sling mimicking the retropubic route did not satisfy in achieving the patient's goal when compared to hammock-shape placement.Öğe Relationship between adnexal mass and endometrial thickness in postmenopausal period(2018) Başbuğ, Alper; Doğan, Ozan; Yassa, Murat; Pulatoğlu, Çiğdem; Kaya, Aşkı Ellibeş; Çalışkan, ErayEndometrial cancer is the most common gynecological cancer. Increased postmenopausal endometrial thickness may be an indicator of endometrial cancer. Transvaginal ultrasound (TV-USG) is the primary imaging method for evaluating endometrial thickness in the postmenopausal period. The aim was to employ transvaginal ultrasonography in the evaluation of adnexal masses synchronously seen in postmenopausal women with increased endometrial thickness. The work was designed as a retrospective study. The medical records of 155 patients evaluated for increased postmenopausal endometrial thickness were examined. Ultrasonography had been performed on the women in the study for routine follow-up, postmenopausal hemorrhage, pelvic pain, pelvic mass on examination and family history of gynecological cancer. All patients had undergone endometrial evaluation with fractional dilatation and curettage (D & C) or pipelle endometrial sampling. Histopathological diagnosis was based on endometrial sampling results. Adnexal mass was present simultaneously in 17.4% (n 27) of the women included in the study, while 82.6% (n 128) had no gynecological pathology other than increased endometrial thickness. The endometrial thickness in the women with postmenopausal adnexal masses was greater than in those without adnexal mass (11.7 mm vs. 7.8 mm, p 0.009). Non-atypical and atypical endometrial hyperplasia was more frequent in the group with postmenopausal adnexal mass (11.1% vs. 2.8%, 11.1% vs. 3.79, p 0.03, p 0.04, respectively). Final histopathological evaluation of patients operated on for adnexal masses revealed tubo-ovarian abscess in 1.9% (n 1), benign ovarian tumor in 25.9% (n 7) and malignant ovarian tumor in 11.1% (n 3) of the patients. In postmenopausal women, adnexal masses can be seen simultaneously with increased endometrial thickness. In this regard, transvaginal ultrasound offers important opportunities for evaluation of both the endometrium and adnexa. Pre-surgery transvaginal ultrasound as well as multivariate serum markers may be used in evaluation models.Öğe Surgical anatomy of the pectineal ligament during pectopexy surgery: The relevance to the major vascular structures(2020) Pulatoğlu, Çiğdem; Doğan, Ozan; Medişoğlu, Mahmut Sabri; Yassa, Murat; Kaya, Aşkı Ellibeş; Selçuk, İlker; Bayık, Rahime NidaObjective: During pectopexy surgery, the prolapsed uterus or the vaginal apex is fixed to the pectineal ligament. The anatomic structures found in thelateral part of the prevesical and paravaginal space above the obturator fossa, raise the importance of the surgical steps required to prevent complications.This study was conducted to evaluate the proximity of vascular structures to the pectineal ligament.Materials and Methods: The distances between the surgical suturing area during pectopexy surgery and the external iliac vein, pubic anastomotic vessel(corona mortis) and obturator canal were measured bilaterally in seven fresh female cadavers.Results: The total length of the pectineal ligament was 5.9±0.76 cm on the left and 6.5±1.14 cm on the right side; the midpoint of the pectineal ligamentwas 2.8±0.52 cm on the left and 3.6±0.47 cm on the right side. From the midpoint of the left pectineal ligament, the mean distance to the left externaliliac vein was 1.04±0.23 cm, to the left corona mortis it was 2.15±0.48 cm, and to the left obturator canal it was 3.12±0.95 cm. From the midpoint of theright pectineal ligament, the mean distance to the right external iliac vein was 1.25±0.43 cm, to the right corona mortis it was 2.37±0.63 cm, and to theright obturator canal it was 3.57±0.93 cm.Conclusion: The anatomic findings of the study confirmed that the pectineal ligament was in close association with main vessels. The external iliac veinwas measured as the closest anatomic structure to the pectineal ligament. Surgeons must be careful to minimize life-threatening complications because of the proximity of the pectineal ligament to main vessels.Öğe Unilateral ovarian leiomyoma in a 14-year-old adolescent: A rare case report(2018) Kaya, Aşkı Ellibeş; Ökten, Sabri Berkem; Başbuğ, Alper; Gamsızkan, Mehmet; Doğan, Ozan; Baki, HasanLeiomyomlar sıklıkla uterusta rastlanan benin mezenkimal tümörlerdir. Uterin leiomyomlar kadınlarda görülen pelvik kitlelerin en sık nedenlerinden olsa da, over kaynaklı leiomyomlar oldukça nadir görülmekle birlikte bütün over kaynaklı benin tümörlerin yalnızca %0,5 ila %1'ini oluşturmaktadır. Genellikle 20-65 yaş grubunda görülmekte olup, %85'ini premenopozal dönemdeki kadınlar oluşturmaktadır. Bu olguda kliniğimize 6 aydır devam eden bilateral alt kadran karın ağrısı nedeniyle başvuran 14 yaşındaki bir kız çocuğunu sunduk. Ultrasonografik görüntülemede uterus arka duvar komşuluğundan sağ adneksiyal bölgeye uzanım gösteren, uterin ekojenitesi olan solid görünümde 6x5,5 cm boyutlarında bir kitle izlendi. Kitlenin kaynağının ultrason ve magnetik rezonans görüntüleme ile net belirlenememesi üzerine tanısal laparoskopi uygulandı. Sol over kaynaklı kitle laparotomi ile çıkarılıp patolojiye gönderildiğinde patoloji sonucu ovaryen leiomyom ile uyumlu çıktı. Bildirilen vakalar içinde 14 yaşında olarak en genç vakalardan biri olma özelliği yanı sıra 20 yaş altı olup, genelde rastlanandan farklı olarak unilateral karakter taşıması ile farklılık göstermektedir.Öğe Uterine Prolapse during First Trimester Managed with Vaginal Pessary(2018) Doğan, Ozan; Başbuğ, Alper; Kaya, Aşkı Ellibeş; Başbuğ, Derya; Pulatoğlu, ÇiğdemUterine prolapse during pregnancy is a rare condition with an estimated incidence of1:10,000–15,000 pregnancies. Premature labor and delivery are the most prevalent complicationsin pregnancies with pelvic organ prolapse. Various treatment methods from conservativeapproaches to surgery are possible. In this paper we report a 27 year-old patientwho was treated with Arabin pessary due to uterine prolapse in the first trimester.