Abstract: Aim: To compare the perioperative outcomes of traditional abdominal hysterectomy (TAH), total laparoscopic hysterectomy (TLH), and robotic-assisted hysterectomy (TRH) for endometrial cancer staging, which is the most common gynecological cancer type in Turkey Materials and Methods: Fifty eight women who underwent endometrial cancer staging surgery were performed by a same gynecologic oncologist (E.B.) from February 2015 to May 2016 in Sağlık Bilimleri University Adana Numune Hospital. The primary outcome measure was perioperative complications. The secondary outcome were operative time, postoperative hemoglobin drop, blood transfusion rates and length of the hospital stay. Results: Three groups were identified.(TAH, n=23; TLH, n=10; TRH, n=25) There were no statistically significant differences between the groups in terms of age, parity, grade and depth of myometrial invasion. Overall complication rate was higher in TAH group. TRH and TLH patients were less likely to have renal failure, urinary tract infection and postoperative fever compared to TAH patients. A significantly lower drop in hemoglobin was detected in the TRH group compared with the other groups. (p= 0,797) Mean operative time was longer in TRH cases than TLH and TAH cases (300, 230, 165 minutes, respectively). The median lengths of hospitalization for TAH, TLH, and TRH patients were 5, 3, and 2 days, respectively (p < 0.0001). There were significantly fewer blood transfusion requirements in minimal invasive surgery groups (0/10 case in TLH and 3/25 cases in TRH) than traditional approaches (5/23 cases in TAH ). Conclusions:With our short term initial experience, minimally invasive surgical approach resulted in superior perioperative outcomes. Despite longer operative times, the results from this study suggest that robotic-assisted surgical staging in the management of endometrial cancer is both feasible and associated with a shorter length of hospitalization.

Background/aim To investigate the risk of de novo stress urinary incontinence (SUI) occurrence in women who were treated for pelvic organ prolapse (POP) with sacrospinous ligament fixation (SSLF) in addition to vaginal hysterectomy (VAH) and antero-posterior colporrhaphy (CAP) over a 24-month follow-up period. Materials and methods A prospective randomized study was designed. Women without occult or obvious SUI were randomized into either one of the study groups: Group 1: VAH + CAP, and Group 2: VAH + CAP + SSLF. Postoperatively, the patients were reevaluated for de novo SUI occurrence. Results A total of 150 women were analyzed [G1 = VAH + CAP (n: 77) and G2 = VAH + CAP + SSLF (n: 73)]. Mean age, parity, body mass index, menopausal status, and preoperative POP degree, grade 1 and grade 2-3 cystocele and rectocele frequencies were similar between the 2 groups. During follow-up period, de novo SUI developed in 7 patients (9.1%) of Group 1, and in 6 patients (8.2%) of Group 2 (P > 0.05). In Groups 1 and 2, POP recurrence occurred in 5 (6.4%) vs. 1 (1.3%) cases,respectively (P < 0.05). Conclusion In patients undergoing surgery for POP, the addition of SSLF did not result in an increased rate of de novo SUI. Careful patient selection, and informing the patients about the risks and benefits of the planned surgical procedure are essential steps in each case of POP.

Objective: In cases of ovarian torsion (OT), reperfusion injury may further damage ovarian tissue. Tadalafil and sildenafil are phosphodiesterase-5 (PDE-5) inhibitors that are primarily used for treatment of erectile dysfunction and pulmonary hypertension. In this study, the authors investigated the effects of these agents in preventing ovarian ischemia-reperfusion injury in a rat OT model. Materials and Methods: A total of 48 young adult female Wistar Albino rats were randomized into six groups (n=8 in each group); group 1: control sham operated, group 2: sildenafil one mg/kg, group 3: tadalafil one mg/kg, group 4: sildenafil one mg/kg + ischemia/reperfusion, (I/R) two hours of ischemia and two hours of reperfusion and a single dose of oral one mg/kg sildenafil one hour before I/R, group 5: I/R, and group 6: tadalafil one mg/kg + YR two hours of ischemia and two hours of reperfusion and a single dose of oral one mg/kg tadalafil one hour before I/R. Histopathologic evaluation was performed and scored according to the degree of congestion, edema, and hemorrhage. Total histological score (THS), tissue protein carbonyl (PC), malondialdehyde (MDA) levels, and catalase (CAT) activity were also calculated. Results: Group 4, group 5, and group 6 had similar congestion, edema and THS (p > 0.05). Group 6 had significantly lower hemorrhage score, when compared with group 5 (p = 0.03). Mean PC, MDA levels, and CAT were similar between groups 4, 5, and 6 (p > 0.05). Conclusions: Tadalafil was associated with a decreased tissue hemorrhage score in I/R injury in rat ovarian torsion model.

Purpose: To investigate the relationship between neonatal birth weight (NBW) and intrapartum maternal mean platelet volume (MPV). Materials and Methods: A total of 650 women who had a live birth at the Etlik Zubeyde Hamm Women's Health Education and Research Hospital in Ankara were divided into three groups according to the babies' birth weight adjusted for gestational week: 145 delivered small for gestational age (SGA) (< 10th percentile), 363 delivered appropriate for gestational age (AGA) (10-90th percentile), and 142 delivered large for gestational age (LGA) babies (> 90th percentile). Maternal MPV value of the women were taken into account together with demographic values, body mass index (BMI), and gestational age at delivery and birth weight. Results: MPV was found to be significantly higher in the mothers of LGAbabies (9.6 +/- 1.11) in comparison to SGA (9.38 +/- 1.03) andAGA (9.36 +/- 1.09) babies in the statistical analysis (p = 0.009). More than 9.65 fL value of intrapartum maternal MPV was associated with LGA. Conclusion: MPV was increased in the intrapartum period in women who delivered LGA babies.

OBJECTIVES:The aim of the study was to assess the usefulness of various tumor markers (CA125, HE4, bcl2) measured in serum, urine and saliva in the differential diagnosis of adnexal masses. MATERIAL AND METHODS:Our study was conducted at the Başkent University Medical School, Department of Obstetrics and Gynecology, Ankara, Turkey, between November 2010 and March 2011. Fifty patients with a suspicion of malignant adnexal mass and 30 controls were included in the study. Serum and urine CA-125, HE4, and bcl2 levels were evaluated for their role in the diagnosis of epithelial ovarian cancer (EOC). RESULTS:Serum CA-125 and HE4 levels, and urine HE4 levels were significantly higher in malignant cases as compared to controls (p < 0.05). Mean levels of bcl2 in saliva and urine were similar in malignant cases and controls (p > 0.05). CONCLUSIONS:We demonstrated that serum CA125, serum HE4 and urine HE4 levels were elevated in patients with ovarian cancer. These findings should be assessed in future studies with larger sample sizes in order to reach more definite conclusions.

OBJECTIVETo evaluate the clinical and surgical outcomes of intestinal resection during primary debulking surgery for ovarian cancer.MATERIAL AND METHODSThis retrospective study was conducted at Zekai Tahir Burak Women's Health Training and Research Hospital between 2009 and 2013. The patients who underwent intestinal resection during debulking surgery for stage 3 ovarian cancer were included in the analysis. Data regarding patient age, body mass index, tumor histology, disease stage, the site of intestinal resection, all postoperative complications, duration of intensive care unit admission and hospital stay were collected and analyzed.RESULTSA total of 22 patients with a mean age of 53.4 years were included in the study. Optimal cytoreduction was achieved in 14 (63%) patients. Transverse colectomy was the most common type of intestinal resection (63%). The most common postoperative complication was transfusion of blood products (63%). No postoperative mortality was observed.CONCLUSIONIntestinal resection is a crucial part of debulking surgery for advanced ovarian cancer, with acceptable complication rates. Despite the limited number of patients, the results obtained from the present study are comparable with previous reports.

Objective: To investigate the awareness about human papillomavirus (HPV) and acceptance of HPV vaccine among women who present to gynecology outpatient clinics at a tertiary referral hospital in South Mediterranean region of Turkey.Materials and Methods: A total of 426 women aging between 18 and 65 who applied to gynecology outpatient clinics between January and April 2015 were included in analysis in order to evaluate the awareness and knowledge about HPV infection and vaccination. In the present study, "Participant Knowledge Form" and "HPV Knowledge Evaluation Questionnaire" were used, which were developed by authors after analyzing the relevant literature. Study data were analyzed with SPSS 21 computer software. Descriptive statistics were presented as mean +/- standard deviation, and number (percentage).Results: Among 426 participants that were included in the study, mean age was 32.3 +/- 10.1 years. Two hundred and fifty-eight (60.6%) stated that they have not heard about HPV, whereas 168 (39.4%) stated otherwise. On the other hand, 141 participants (33.1%) heard about HPV vaccine. HPV vaccination was accepted by 182 (42.7%) participants, whereas 244 (57.3%) women did not accept vaccination.Conclusion: In the present study, it was concluded that women who present to gynecology outpatient clinics did not have adequate knowledge about HPV infection and HPV vaccination. For the purposes of public health education, written, verbal and visual educational programs should be implemented at schools, hospitals and internet.

Purpose. We present a case report of a woman with total POP and SUI who was treated with a technique utilizing vaginal hysterectomy followed by the placement of a four-arm synthetic polypropylene mesh implant system. Methods. An 81-year-old grand-multiparous woman presented to our clinic complaining of a vaginally protruding mass and urinary incontinence. A surgical approach including vaginal hysterectomy, anterior four-arm mesh implant, posterior large segment vaginal enterocele repair, and perineoplasty with levator ani fixation was planned. Results. The patient was discharged home at the second postoperative day. Follow-up visits at the first, 3rd, and 6th months were normal. There was complete symptomatic relief and objective cure of the POP and urinary incontinence symptoms. Conclusion. We believe that anterior four-arm mesh implant and large posterior repair should be considered after vaginal hysterectomy. Future studies are needed to evaluate the utility of this technique for treatment of POP.

Vitamin D is an essential precursor to the steroid hormone calcitriol which mainly regulates calcium homeostasis. Moreover anti- proliferative, pro- apoptotic, anti- angiogenic effects of Vitamin D support the ideas of preventive role in various cancer. This study aimed to determine if there is a relationship between HPVDNA infection and cervical intraepithelial neoplasia and Vitamin D deficiency. As a result of the study the difference of 25-OH Vitamin D3 levels between HPVDNA positive group and the control group were statistically significant (p=0,009). According to results of our study, with the proven anti-inflammatory functions of Vitamin D, the deficiency of these molecule and its metabolites can be a possible reason for HPVDNA persistence and related cervical intraepithelial neoplasia.

The incidence of ovarian tumours in girls has been estimated as 2.6/100,000 cases annually, and malignant ovarian tumours coincide in about 1% of all childhood cancers (Al Jama et al. 2011). About ...

Aim: To evalute the efficacy of a levonorgestrel-releasing intrauterine device for the treatment of patients with heavy menstrual bleeding based on the PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy; hyperplasia-coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; not yet classified) system. Material and Methods: A retrospective study was performed of 110 cases that were grouped according to the PALM-COEIN classification system as those with or without structural abnormalities. For the 84 cases who completed 12 months of treatment, menstrual patterns, pictorial blood assessment chart (PBAC) scores, hemoglobin (Hb) values, and endometrial thickness changes were examined after 1,6 and 12 months. Independent sample t-tests,repeated-measures ANOVA, post-hoc Bonferroni adjustment and chi-squared tests were used for statistical evaluation. Results: After 12 months of treatment, 73.8% of cases achieved a normal menstrual pattern. The PBAC score decreased by 80.6% in the COEIN group and 83.9% in the PALM group. The PBAC scores and endometrial thicknesses were decreased (p<0.001) and the Hb values were increased (p<0.001) after 12 months of treatment, with no intergroup differences (p>0.05). The PBAC score was higher in the PALM group compared to the COEIN group at 1 month, but this difference disappeared by 6 months of treatment (p >0.05). Conclusion: The levonorgestrel-releasing intrauterine device has high levels of effectiveness in cases with or without structural uterine abnormalities.

Aim: Our aim was to compare the complete blood count indices in intrauterine growth restriction (IUGR) with healthy pregnant controls and to investigate whether any hematological changes have predictive value for the prediction of adverse pregnancy outcomes in IUGR. Material and Methods: Mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet large cell ratio (P-LCR) and red cell distribution width (RDW) levels f 35 pregnant women with isolated IUGR and 105 healthy pregnant women were retrospectively evaluated. Results: Wom n with IUGR had significantly higher MPV (mean 11.21 ± 0.99 vs. 9.99 ± 0.84; P<0.001), PDW (mean 14 ± 2.51 vs. 28.22 ± 6.99; P<0.001) and P-LCR (median 31.5 U/L vs. 44.7 U/L; P<0.001) values, when compared with controls. Statistically significant negative correlations were found between RDW and gestational age at birth (r:-0.39, p:0.02) and also between PCT and 1-min APGAR scores (r:-0.34, p:0.04). Conclusion: Cheap and easily measurable complete blood count indices including MPV, PCT, PDW, P-LCR and RDW levels may be valuable markers of IUGR.

Aim: To determine the utility of selected acute phase reactants to predict preterm delivery occurrence in patients with a diagnosis of threatened preterm labor. Material and Methods: Ninety one pregnant women aged 17-38 years and between 26 and 36+6 weeks of gestational age according to last menstrual period were included in the study. A control group comprising 83 healthy singleton pregnant women in similar gestational ages without any medical or obstetrical problems was included. The study group was further divided into two subgroups which had preterm delivery and term delivery. A total of three groups including controls were studied. The serum levels of zinc, copper, albumin, micro-C-reactive protein, ferritin and complete blood count were analyzed. Also, urinalysis and urine culture tests were performed for all participants. Groups were compared for acute phase reactants and p values less than 0.05 were considered statistically significant. Results: Study and control groups did not have any statistically significant difference in terms of gravidity, abortion, live births, maternal age and maternal body mass index (p>0.05). Forty-five (49.4%) women in the study group had term delivery, whereas forty-six (50.6%) had preterm delivery. Levels of albumin were statistically lower in the study group whereas ferritin levels were higher (p 0.05). Conclusion: The study showed that low serum albumin and high ferritin levels had an association with preterm delivery. These parameters can be used as additional markers with interleukin-6 and fetal fibronectin for preterm delivery prediction. Future studies with larger sample sizes are needed to clarify the association between acute phase reactant levels and preterm delivery prediction.

Borderline ovarian tumors (BOTs) constitute about a quarter of epithelial ovarian malignancies and require different treatment approaches. The present study aims to document the experience of a single center on the treatment outcome of women who had conservative or comprehensive surgery for BOTs.

To determine whether inherited thrombophilia affects components of second trimester combined aneuploidy screening test.