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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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    Comparison of maternal and perinatal outcomes of pregnancies with frozen and fresh embryo transfers at term pregnancy Frozen and fresh embryo transfer results
    (Bayrakol Medical Publisher, 2022) Horasanli, Jule Eric; Energin, Hasan; Ferlibas, Enes
    Aim : In our study, we aimed to compare maternal and perinatal outcomes of frozen and fresh embryo transfers, induced by single or double embryo transfer with in vitro fertilization (IVF) at term pregnancy. Material and Methods: After obtaining ethics, our study was performed retrospectively assessing pregnancies in women between the ages of 18 and 40 induced with single or double embryo transfer with IVF between the years 2010 and 2020. Maternal outcomes such as oligohydramnios, polyhydramnios, preeclampsia, placenta previa, placenta accreta syndrome (PAS). and hysterectomy were examined in all groups. Perinatal outcomes including birth weight, time of delivery, small for gestational age (SGA), large for gestational age (LGA), appropriate for gestational age (AGA), preterm labor, Apgar score of infant at five minutes, and intensive care requirement were also investigated. Results: No difference was observed in terms of oocyte number collected, neonatal intensive care requirement. Apgar scores. postpartum hysterectomy, and blood transfusions. There was no difference between the groups in birth weight, preterm labor, and delivery time. There was no significant difference between the groups in SGA, LGA, and AGA. Polyhydramnios and oligohydramnios were significantly higher in the fresh transfer group (p - 0.006 and p - 0.006, respectively). Among perinatal parameters, the frequency of placenta previa was significantly higher in the frozen transfer group (p - 0.001). The frequency of placenta accreta and preeclampsia was not significantly different. Discussion: Placenta previa was higher in the frozen transfer group, suggesting frozen embryo transfer increases the risk of placenta previa. Oligohydramnios and polyhydramnios were higher in the fresh transfer group.
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    Effect of anterior repair on sexual function in heterosexual couples
    (Springer London Ltd, 2023) Energin, Hasan; Horasanli, Jule Eric
    Introduction and hypothesis Little is known about the impact of native tissue repair techniques on heterosexual intercourse. This study was aimed at investigating the effect of anterior colporrhaphy on women's and their partners' sexual function.Methods Sexually active women with a male partner who were diagnosed with anterior wall prolapse without any incontinence were prospectively recruited from a single academic center. Demographic data were collected and a Pelvic Organ Prolapse Quantification examination was performed. Before and 3 months post-operatively, women completed two validated questionnaires to assess sexual function, the International Consultation on Incontinence Questionnaire Vaginal Symptoms short form (ICIQ-VS SF) 55, and the Female Sexual Function Index (FSFI), and their male partners completed the International Index of Erectile function-5. Pre-and post-operative results were compared using a paired t test.Results This study was conducted in the gynecology department of a university hospital between May 2022 and June 2023, where 50 heterosexual couples were enrolled and underwent isolated anterior repair. The mean age of women and their partners were 44.3 +/- 5.12 and 48.1 +/- 5.81 respectively. Overall, female sexual function improved significantly from pre-to 3 months postoperatively with a decrease in ICIQ-VS SF scores from 13.3 +/- 3.27 to 1.7 +/- 1.1 (p < 0.05) and an increase in FSFI scores from 21.74 +/- 9.37 to 29.28 +/- 9.97 (p < 0.05). The only domain that did not improve was sexual pain. For their male partners, there was a similar significant improvement in sexual function with an increase in scores from 48.71 +/- 8.71 to 60.68 +/- 8.63 (p < 0.05).Conclusions Isolated anterior repair was associated with improved short-term sexual function amongst heterosexual couples.
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    The haemodynamic effects of umbilical cord milking in term infants: a randomised controlled trial
    (Wolters Kluwer Medknow Publications, 2023) Tekin, Mehmet; Gokdemir, Mahmut; Toprak, Erzat; Silahli, Musa; Energin, Hasan; Gokmen, Zeynel
    Introduction: Umbilical cord milking (UCM) is a method that allows for postnatal placental transfusion. The benefits of UCM have been demonstrated in some studies, but knowledge about its haemodynamic effects in term infants is limited. The aim of this study was to evaluate the haemodynamic effects of UCM in term infants. Methods: In this prospective, randomised controlled study, 149 healthy term infants with a birth week of >= 37 weeks were randomly assigned to either the UCM or immediate cord clamping (ICC) group. Blinded echocardiographic evaluations were performed in all the neonates in the first 2-6 h. Results: Superior vena cava (SVC) flow measurements were higher in the UCM group compared to the ICC group (132.47 +/- 37.0 vs. 126.62 +/- 34.3 mL/kg/min), but this difference was not statistically significant. Left atrial diameter (12.23 +/- 1.99 vs. 11.43 +/- 1.78 mm) and left atrium-to-aorta diastolic diameter ratio (1.62 +/- 0.24 vs. 1.51 +/- 0.22) were significantly higher in the UCM group. There were no significant differences in other echocardiographic parameters between the two groups. Conclusion: We found no significant difference in the SVC flow measurements in term infants who underwent UCM versus those who underwent ICC. This lack of significant difference in SVC flow may be explained by the mature cerebral autoregulation mechanism in term neonates.
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    How should we enter peritoneum in vaginal hysterectomy?
    (Bayrakol Medical Publisher, 2022) Demir, Emine Tueren; Energin, Hasan
    Aim: Anterior and posterior entrances to the peritoneal cavity are essential steps in vaginal hysterectomy. The objective of this study was to compare surgical techniques and results in women who had primarily anterior colpotomy or primarily posterior colpotomy to enter the peritoneum in vaginal hysterectomy. Material and Methods: We analyzed the data of 90 women who underwent vaginal hysterectomy by the same surgical team in a university hospital between 2017 and 2021. The patients have divided into two groups: primarily anterior colpotomy or primarily posterior colpotomy. Operation time, amount of bleeding, and complication rates were compared between the two groups. Results: First anterior colpotomy was performed in 44 patients, and the first colpotomy posterior was performed in 46 patients. Patient characteristics were similar in both groups. The mean age of the patients was 63.6 +/- 8.6 years, and the mean number of pregnancies was 3.07 +/- 1.05. The mean preoperative and postoperative hemoglobin difference was 1.5 +/- 0.6 g/dl. The mean uterine length was 9.33 +/- 2.07 cm, and the mean uterine weight was calculated as 118.1 +/- 42.2 g. The operation time was significantly shorter in the first colpotomy posterior group (67.5 +/- 7.7 min vs. 78.1 +/- 12.6 min p<0.05). While no significant complications were observed in the first posterior colpotomy group, one bladder injury was observed in the first anterior colpotomy group. Discussion: In a vaginal hysterectomy, when posterior colpotomy is performed first, Entrance into the peritoneal cavity is safer and quicker. Thus, surgeons feel more comfortable and secure while performing a vaginal hysterectomy and return to abdominal procedures minimally.
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    Image-guided drainage management of tubo-ovarian abscess and the role of C-reactive protein measurements in monitoring treatment response: a single-center experience
    (Springer Heidelberg, 2023) Demir, Emine Turen; Energin, Hasan; Kilic, Fatma
    PurposeWe aimed to compare the results of image-guided drainage in addition to antibiotic therapy (antibiotherapy) with antibiotherapy alone in the treatment of tubo-ovarian abscesses (TOAs) and evaluate C-reactive protein (CRP) levels in predicting the success of antibiotherapy.MethodsThis was a retrospective study of 194 patients hospitalized with TOA. Patients were divided into the following two groups: those who underwent image-guided drainage in addition to parenteral antibiotherapy and those who did not undergo image-guided drainage and received antibiotherapy alone. CRP levels on the day of admission (day 0), day 4 of hospitalization (day 4), and day of discharge (last day) were recorded. The percentage of decrease in CRP levels during day 4 and the last day compared with that on day 0 was calculated.ResultsA total of 106 patients (54.6%) underwent image-guided drainage with antibiotherapy, whereas 88 patients (45.4%) did not undergo drainage and received antibiotherapy alone. At admission, the mean CRP level was 203.4 (& PLUSMN; 96.7) mg/L and was similar in both groups. The mean decrease in the CRP level on day 4 compared with that on day 0 was 48.5% and was statistically higher in the group that underwent image-guided drainage. Antibiotherapy failed in 18 patients, and a statistically significant difference was observed between treatment failure and the rate of decrease in the CRP level on day 4 compared with that on day 0. According to the receiver operating characteristic (ROC) analysis, if the CRP level measured on day 4 decreased by < 37.1% compared with that on day 0, the probability of treatment failure would increase (area under the curve = 0.755; 95% confidence interval, 0.668-0.841; sensitivity, 73.6%; specificity, 60%).ConclusionsImage-guided drainage combined with antibiotherapy in the treatment of TOA has high success rates, lower recurrence rates, and lower surgical requirement, and the mean decrease in the CRP level on day 4 can be monitored at treatment follow-up. In patients receiving antibiotherapy alone, if the CRP level on day 4 decreases by < 37.1%, the treatment protocol should be changed.
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    Incidence of unexpected leiomyosarcoma in a Turkish province: a retrospective multi-centre study in a low income setting
    (Taylor & Francis Inc, 2022) Tasdemir, Umit; Ceran, Mehmet Ufuk; Dirican, Aylin Onder; Akar, Serra; Celik, Cetin; Energin, Hasan; Gorkemli, Huseyin
    The aim of the current study was to estimate the incidence of unexpected leiomyosarcoma (LMS) in patients who underwent surgery due to leiomyomas in Konya province, and to contribute to the literature discussing comparisons with similar studies. The digital archives of eight high-volume hospitals were studied for surgeries performed due to leiomyomas between January 2012 and January 2019, and leiomyosarcoma incidence was calculated based on the data obtained. Twenty-one patients in 3703 cases were found to have unexpected leiomyosarcoma, which means we can expect one leiomyosarcoma in 176 (0.56%) surgeries. Six more malignant tumours were detected among the remaining cases. Thus, our study estimated the incidence of unexpected leiomyosarcoma as 1/176 (0.56%), which is higher than most of the studies in the literature justifying the debate started by the FDA in 2014. As the tumour biology is not yet clear, and the incidence of unexpected leiomyosarcoma tends to be so high, the key focus must be to try to detect uterine leiomyosarcomas preoperatively for robust patient care.IMPACT STATEMENT What is already known on this subject? The incidence of unexpected leiomyosarcoma varies widely from 1/498 to 1/8300 depending on the study method and the type of procedure, and there is still controversy, even after the FDA statement that led to a major restriction in laparoscopic surgeries due to concerns about inadvertent morcellation of leiomyosarcomas. What do the results of this study add? To the best of our knowledge, the current study found the highest incidence of unexpected leiomyosarcoma, and consequently a serious evaluation of all patients undergoing surgery due to leiomyomas preoperatively considering a leiomyosarcoma candidate is recommended. What are the implications of these findings for clinical practice and/or further research? Studies on tumour biology and novel markers must be supported for accurate preoperative diagnosis of leiomyosarcoma.
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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.