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Öğe Abdominal sacrohysteropexy in young women with uterovaginal prolapse - results of 20 cases(Sci Printers & Publ Inc, 2006) Demirci, Fuat; Özdemir, İsmail; Somunkıran, Aslı; Doyran, Gönül Duras; Alhan, Ali; Gül, BarışOBJECTIVE: To report the results of abdominal sacrohysteropexy with polypropylene mesh in young women who wish to retain their uteri following uterovaginal prolapse. STUDY DESIGN: Twenty young women underwent abdominal sacrohysteropexy and concomitant reconstructive surgery. The preoperative and postoperative protocols included a urogynecologic history, physical examination, voiding diary, 1-hour pad test, cough stress test, multichannel urodynamic studies and administration of a validated, prolapse-specific symptom inventory and quality of life instrument. RESULTS: Of the 20 patients with marked uterovaginal prolapse, 13 had urodynamic stress incontinence. Anterior and posterior vaginal wall prolapse and urodynamic stress incontinence recurred in 1 of 20 patients (5%) at a mean follow-up of 25 months. Nineteen patients stated that their sex life had improved, although 3 of them had dyspareunia. One patient was dissatisfied owing to persistent dyspareunia. The postoperative values on the symptom inventory and quality of life scores were significantly lower than the preoperative values. The low scores suggest satisfaction and no symptoms of prolapse. CONCLUSION: Abdominal sacrohysteropexy is effective and safe in the treatment of uterovaginal prolapse in women who wish to retain their uteri. It maintains a durable anatomic restoration, normal vaginal axis and sexual function. The success rate is excellent for correcting prolapse, and the complications are minimal.Öğe Comparison of Saline Infusion Sonohysterography and Hysteroscopy Findings in Patients With Abnormal Uterine Bleeding(Galenos Yayincilik, 2005) Alhan, Ali; Ozdemipr, Ismail; Somunkiran, Asli; Demirci, Fuat; Yucel, Oguz; Bahcebasi, TalatObjective: To establish the accuracy of saline infusion sonohysterography and hysteroscopy in diagnosing uterine pathology in women with abnormal uterine bleeding. Materials and Methods: A total of 39 women with abnormal uterine bleeding were recruited for the study and underwent transvaginal ultrasonography followed by saline infusion sonohysterography. During hysteroscopy, resection of the focal intracavitary lesion was performed. Endometrial sampling was obtained from all patients. Results: Sonohysterographic and hysteroscopic evaluation revealed 25 and 24 endometrial polyps, 7 each submucous myomas, 3 and 1 endometrial hyperplasia, 1 each synechia, and 3 and 6 normal findings, respectively. Comparison of histopathologic findings with other diagnostic tests revealed that hysteroscopy demonstrated a sensitivity of 97%, specificity of 72%, positive predictive value of 94%, negative predictive value of 83% and total sensitivity of 92%. Sonohysterography showed sensitivity of 97%, specificity of 29%, positive predictive value of 86%, negative predictive value of 85% and total sensitivity of 85%. Conclusion: In comparison with hysteroscopy, sonohysterography is a cheaper and easier procedure for detecting endometrial pathologies such as endometrial polyps and submucous myomas with its highly diagnostic value.Öğe Comparison of saline infusion sonohysterography and hysteroscopy findings in patients with abnormal uterine bleeding(2005) Alhan, Ali; Özdemir, Ismail; Somunkıran, Aslı; Demirci, Fuat; Yücel, Oǧuz; Bahçebaşi, TalatObjective: To establish the accuracy of saline infusion sonohysterography and hysteroscopy in diagnosing uterine pathology in women with abnormal uterine bleeding. Materials and Methods: A total of 39 women with abnormal uterine bleeding were recruited for the study and underwent transvaginal ultrasonography followed by saline infusion sonohysterography. During hysteroscopy, resection of the focal intracavitary lesion was performed. Endometrial sampling was obtained from all patients. Results: Sonohysterographic and hysteroscopic evaluation revealed 25 and 24 endometrial polyps, 7 each submucous myomas, 3 and 1 endometrial hyperplasia, 1 each synechia, and 3 and 6 normal findings, respectively. Comparison of histopathologic findings with other diagnostic tests revealed that hysteroscopy demonstrated a sensitivity of 97%, specificity of 72%, positive predictive value of 94%, negative predictive value of 83% and total sensitivity of 92%. Sonohysterography showed sensitivity of 97%, specificity of 29%, positive predictive value of 86%, negative predictive value of 85% and total sensitivity of 85%. Conclusion: In comparison with hysteroscopy, sonohysterography is a cheaper and easier procedure for detecting endometrial pathologies such as endometrial polyps and submucous myomas with its highly diagnostic value.Öğe The midurethral polypropylene sling for stress incontinence: 22-Month results of 81 patients(2005) Demirci, Fuat; Özdemir, İsmail; Alhan, AliObjective: The objective was to review a cost-effective procedure called the midurethral polypropylene sling (MPS) in the treatment of urodynamic stress incontinence (USI). Study design: A self-fashioned sling (7.5×1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia by a special needle carrier. The sling is placed around the urethra and its sutures are tied on the fascia. The procedure was performed on 81 patients. Of these patients, 73 had USI. The remaining 8 patients with uterine prolapse, who did not have USI, underwent the MPS prophylactically. Of 81 patients, 35 underwent the MPS alone, 46 underwent the MPS and abdominal or vaginal procedures. Results: Three patients had bleeding in excess of 300 ml necessitating a vaginal tamponade. One had hematoma and the other underwent a laparotomy. Urinary retention for more than 3 days was observed in 6 of the patients who had the MPS alone, in 7 of the patients who had both MPS and abdominal procedures, and in 13 of the patients who had MPS with vaginal procedures. The sling was cut in 3 patients due to persistent urinary retention. Of 73 patients with USI, 70 were completely cured (95.9%) at a mean of 22 months' follow-up. Conclusion: The cure rates and complications of the MPS were comparable to those of the tension-free vaginal tap (TVT) procedure for the treatment of USI. The procedure costs about US$ 9. We conclude that the MPS can be considered as an alternative to the TVT procedure. © Springer-Verlag 2005.Öğe A new, simple, safe, effective and cost-effective procedure for genuine stress incontinence: midurethral polypropylene sling(Wiley, 2003) Demirci, Fuat; Özdemir, İsmail; Yücel, Oğuz; Alhan, AliWe developed a cost-effective procedure for genuine stress incontinence (GSI) that has the advantages of the tension-free vaginal tape (TVT). The midurethral polypropylene sling procedure (MPS) is carried out under local anaesthesia. A self-fashioned sling (7.5 x 1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia using a needle and the sling is placed around the urethra. Ten patients underwent the MPS and were followed up for a mean of 6.2 months. All patients were cured. The short-term results of the MPS were comparable to those of the TVT. The procedure costs approximately US$9. We conclude that the MPS can be considered as an alternative to the TVT procedure.