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    Alternative surgical approach for the management of uterine prolapse in young women: Preliminary results
    (Wiley-Blackwell, 2013) Karatayli, Rengin; Balci, Osman; Gezginc, Kazim; Yildirim, Pinar; Karanfil, Fikriye; Acar, Ali
    AimTo demonstrate an alternative surgical approach for the management of uterine prolapse in young women by a technique that was previously defined for post-hysterectomy vaginal vault suspension in published work and also to demonstrate successful operative results. MethodsThe study population consisted of 12 women aged 28-41 years who had stage 4 uterine prolapse and who were surgically treated by abdominal hysteropexy using autogenous rectus fascia strips. Operative results and postoperative follow-up Pelvic Organ Prolapse Quantification and Prolapse Quality of Life results were recorded. ResultsMean age of patients was 35.54.1 years (range, 28-41). Mean parity in the study group was 2.6 +/- 1.0 (range, 1-5). Mean operation time was 32.0 +/- 5.2min (range, 25-42). All patients were discharged on the postoperative 3rd day and no complications were observed postoperatively. Mean follow-up period was 20 +/- 7.0 months (range, 12-36). All of the patients had complete remission for uterine prolapse and none of the patients had complaints related to the operation. ConclusionAbdominal hysteropexy operation using rectus fascia strips provides a safe and alternative approach for the management of uterine prolapse in young women who desire to preserve their uterus. But further analysis is needed to confirm our results.
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    Comparison of adnexal torsion in premenopausal and postmenopausal women and risk of malignancy
    (Bayrakol Medical Publisher, 2023) Balci, Osman; Energin, Hasan
    Aim: Adnexal torsion is one of the rare causes of lower abdominal pain, however, it is a common gynecological surgical emergency. Its prevalence is 2.7%. The incidence of torsion may be lower in post-menopausal women because of decreased risk of benign ovarian cysts and benign teratomas. Adnexal masses in post-menopausal patients are more likely to be malignant. However, there is not enough study to know precisely the risk of malignancy in post-menopausal patients with adnexal torsion. Material and Methods: This study was carried out in a tertiary center in Turkey. The study retrospectively analyzed 380 patients presented to our clinic with abdominal pain between January 2005 and January 2020 and underwent surgery for adnexal torsion. Results: The data were collected from patients records at a tertiary center in Turkey over a 15-year period. Three hundred eighty patients underwent surgery for adnexal torsion; 288 patients were premenopausal and 92 patients were postmenopausal. Fourteen ovarian malignancies and 11 borderline serous and mucinous tumors were reported; 11 (11.9%) ovarian malignancies were reported in post-menopausal patients and 3 (1.1%) d in premenopausal patients. There were 6 serous cystadenocarcinoma, 4 mucinous cystadenocarcinoma, and 4 granulosa cell tumors that had been reported as malignancy histopathologic subtype. Discussion: There is a longer delay in postmenopausal adnexal patients' treatment since postmenopausal adnexal torsion is an uncommon and unexpected gynecological emergency. Malignancy prevalence is high in the postmenopausal group, and surgeons should suspect malignancy in post-menopausal adnexal torsion patients.
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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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    Long-Term Results of an Imperforate Hymen Procedure that Leaves the Hymen Intact
    (Springer India, 2021) Acar, Ali; Ercan, Fedi; Balci, Osman; Elci Atilgan, Adeviye; Alan, Cemre; Niftiyev, Kemal
    Purpose of the Study The aim of this study was to show the clinical results of postoperative evaluation of cases of imperforate hymen that presented at our center during a 21-year period. Methods A Foley's catheter was inserted in 74 patients of imperforate hymen who reported to the Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, between January 1, 1996, and December 31, 2016 with history of pelvic pain. In each case, the hymen was opened via a circular incision from the central of the distended. A Foley's catheter was inserted, and estrogen cream was prescribed for application on the hymenal structure for 14 days. The catheter was removed after 14 days. Results The mean age of the patients at the time of this study was 28.3 +/- 2.6 years, and the mean age at diagnosis was 13.2 +/- 2.5 years. Twenty-nine (96.6%) patients had experienced vaginal bleeding during their first sexual intercourse experience, and one patient (3.4%) had not. Fourteen out of the 30 married women had become pregnant, of whom nine had delivered vaginally and five had delivered via a cesarean section. After undergoing renal ultrasound, none of the patients had any apparent anomalies. Only one patient had a uterine anomaly, which was a bicornuate uterus. Conclusion A circular incision with insertion of Foley's catheter prevents many social problems by preserving the hymen's architecture and allowing vaginal bleeding to occur during the first sexual intercourse experience.
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    Management of Adnexal Torsion: A 13-Year Experience in Single Tertiary Center
    (Mary Ann Liebert, Inc, 2019) Balci, Osman; Energin, Hasan; Gorkemli, Hueseyin; Acar, Ali
    Purpose: Adnexal torsion constitutes 2.7% of gynecological emergencies, it is more frequently seen in reproductive age. Delay in diagnosis and treatment may lead to loss of the ovary. In this study, we aimed to assess patients who had adnexal torsion and compare laparoscopy with laparotomy in the treatment of these patients and point the most appropriate surgery according to age groups of the patients and comparison of patient characteristics and management between adnexal torsion in postmenopausal and premenopausal patients. Materials and Methods: This study was carried out in Necmettin Erbakan University, Meram Medicine Faculty, Department of Obstetrics and Gynecology. The study retrospectively analyzed 380 patients presented to our clinic with abdominal pain between January 2005 and December 2017 and had surgery for adnexal torsion. Results: The study included 380 patients who had surgery for adnexal torsion. A total of 220 patients had laparoscopy and 160 patients had laparotomy. Laparoscopy group consisted of young patients with low parity, whereas laparotomy group consisted of 160 patients of which 92 (57.5%) were in menopause. Teratomas were the most common pathological finding followed by follicular cysts. Fourteen ovarian malignancies and 11 borderline tumors had been reported. Eleven ovarian malignancies had been reported in postmenopausal patients and three in premenopausal patients. Conclusion: Laparoscopic surgery is preferred for young patients who want to preserve their fertility, but postmenopausal ovarian masses presenting with torsion should be analyzed with frozen section whenever possible, if not possible or not conclusive, staging surgery is more appropriate especially if there is suspicion of malignancy.
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    Urinary Incontinence and Megalourethra Developing After Coitus in a Woman with a Normal Vagina
    (Mary Ann Liebert, Inc, 2012) Sert, I. Unal; Balci, Osman; Mahmoud, Alaa S.; Akan, Hakan
    Background: Urethral coitus leading to megalourethra in physiologically and anatomically normal women is a very rare phenomenon. Case: A 24-year-old woman, married for 5 years and having a 4-year-old child, presented with urinary incontinence to the urology clinic. She experienced urinary incontinence during sexual intercourse despite urinating beforehand. She also had spontaneous urinary incontinence during the day, for which she used similar to 1-2 pads daily. At her urogynecologic examination, no pathology was found in the vagina or cervix. The urethral meatus was noted to be as wide as the vaginal orifice. Results: She was treated successfully by amodified surgical technique based on the Martius technique. Conclusions: This modified surgical technique may be applied successfully in the treatment of megalourethra caused by urethral coitus.