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    Conservative management of placental invasion anomalies with an intracavitary suture technique
    (Wiley, 2018) Acar, Ali; Ercan, Fedi; Pekin, Aybike; Atilgan, Adeviye Elci; Sayal, Hasan Berkan; Balci, Osman; Gorkemli, Hueseyin
    Objective: To assess the efficacy and safety of a new surgical suture technique for uterine preservation among patients with placental invasion anomalies. Methods: The present prospective case series included women diagnosed with placental invasion anomalies undergoing cesarean deliveries who desired future fertility at the obstetrics department of a Turkish university hospital between January 10, 2013, and April 20, 2017. Patients were diagnosed with ultrasonography and Doppler ultrasonography; the type of placental invasion anomaly (placenta accreta, increta, or percreta) was confirmed intraoperatively. Surgical management involved an intracavitary suture technique after the proximal branch of the uterine artery was clamped and utero-ovarian anastomoses had been blocked. Outcomes included units of blood transfused, intraoperative and postoperative adverse events, duration of hospital admission, and hysterectomy rate. Results: There were 62 patients included. The mean operative blood loss was 1350 +/- 750mL (range 600-5000 mL). Blood transfusion required a mean of four units (range 2-15). Bleeding was controlled with the intracavitary sutures in 58 (94%) patients. Three patients experienced postoperative wound infections and two patients developed endometritis that required therapy with broad-spectrum antibiotics. The mean length of hospital stay was 3.61.6 days (range 2-11). None of the patients required reoperation after the initial surgery. Conclusion: The novel uterus-sparing suture technique was highly effective among patients with placental invasion anomalies.
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    Cystocele Repair with Platelet-Rich Plasma
    (Springer India, 2021) Atilgan, Adeviye Elci; Aydin, Arif
    Cystocele is the most common vaginal wall prolapse with high incidence of recurrence after operation. Our aim in this study was to show the effectiveness of using platelet-rich plasma with cystocele repair. Patients were assigned to 2 groups: (1) cystocele repair only and (2) cystocele repair with platelet-rich plasma injection. Each group consisted of 28 patients. There were no significant differences between the groups in terms of demographics features. They were re-assessed 4 weeks later, 6 months later and annually with the standard Pelvic Organ Prolapse Quantification system to detect anatomic recurrence, the Pelvic Floor Distress Inventory for assessment of symptomatic recurrence and Patient Impression of Global Improvement questionnaire for assessment of subjective success. At the end of the 48-month follow-up period, the results were compared between the groups. The main outcome was low recurrence rate with platelet-rich plasma administration and secondary outcome was lower Pelvic Floor Distress Inventory scale score and higher Patient Impression of Global Improvement questionnaire results. The decrease in prolapse symptoms ascertained with the Pelvic Floor Distress Inventory scale was more significant in group 2 (6 vs. 2,p = 0.002), reoperation rate for symptomatic cystocele recurrence was significantly lower in group 2 (5 (17.8%) vs. 1 (3.5%),p = 0.001) and also subjective success evaluated with Patient Impression of Global Improvement scale was significantly higher in group 2 (21 vs. 25,p = 0.012). Considering mesh complications, platelet-rich plasma administration may be a good alternative to prevent cystocele recurrence. However, further research is needed to evaluate the safety and efficacy of this treatment.