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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 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 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 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 A randomized prospective comparison of the needleless mini-sling hammock and U-shape configurations for management of stress urinary incontinence: 60-month follow-up results(Springer Heidelberg, 2024) Dogan, Ozan; Basbug, Alper; Eren, Ecem; Yassa, MuratObjectiveTo compare needleless mini-slings placed in a retropubic (U-shape) or trans-obturator (hammock-shape) configuration for treating stress urinary incontinence at 60th month.MethodsAll surgeries, conducted by a senior surgeon, involved objective and subjective assessments preoperatively and at 6, 12, 18, and 60 months postoperatively using cough-stress tests, ICIQ-SF, PGI-I, and a Likert scale.ResultsAfter 60 months, no significant differences were found in cure rates, mesh complications, or reinterventions between U-shaped and hammock-shaped groups. However, a significant decrease in cure rates was observed at 18 and 60 months in both groups. Notable differences in ICIQ-SF, Likert scale, and PGI-I scores were seen in the hammock-shaped group, while the U-shaped group showed differences in ICIQ-SF and PGI-I scores, but not in the Likert scale.ConclusionGiven the lack of significant differences, asserting the superiority of either retropubic (U-shape) or transobturatorly (hammock-shape) needleless mini-slings for treating stress urinary incontinence is challenging.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.
