A study of the objective benefits and safety of Er-YAG laser in the treatment of genitourinary syndrome of menopause.

The aim of this study is to evaluate changes in vaginal pH and epithelium maturation after erbium-doped yttrium aluminum garnet (Er-YAG) laser treatment, and to assess its safety and efficacy on the symptoms of genitourinary syndrome of menopause (GSM). This was a retrospective study conducted between November 2019 and April 2022 and included 32 women diagnosed with GSM who had not benefitted from lubrication treatment and could not or would not use estrogen. Patients received three sessions of Er- YAG laser. All patient data before and after treatment were obtained from computer records. Vaginal maturation index (VMI), maturation value (MV) and vaginal pH values of the patients before and after laser treatment were compared. We also evaluated post-procedural complications and symptoms. Mean age was 59.72 ± 5.66 years. After laser therapy, there was a significant decrease in vaginal pH (p < 0.001) and the proportion of parabasal cells in VMI (p < 0.001), while there was a significant increase in MV (p < 0.001) and the proportion of superficial cells in VMI (p < 0.001). In 84.4% of the patients, GSM-related symptoms regressed completely or decreased to a tolerable level. Patients in which symptoms disappeared completely had significantly lower mean age (p = 0.002) and duration of menopause (p = 0.009). The laser procedure resulted in complications including mucosal injury in 5 (15.6%) patients (all recovered spontaneously) and vaginal burning sensation in 2 (6.3%) patients. Vaginal Er-YAG laser treatment may be a safe and effective alternative treatment method in a population of women with GSM who do not want to or cannot use estrogen therapy.

Long-term efficacy of the single-incision mini-sling procedure using surgeon-tailored mesh.

OBJECTIVES: To evaluate the long-term efficacy of a surgeon-tailored single-incision mini-sling procedure (SIMS) for the surgical treatment of stress urinary incontinence (SUI) in terms of objective cure rates, quality of life, and cost-effectiveness. STUDY DESIGN: This retrospective study included 93 women with pure SUI who underwent surgeon-tailored SIMS. All patients were evaluated with a stress cough test and quality of life questionnaire (Incontinence Impact Questionnaire [IIQ-7]) at 1 month, 6 months, 1 year, and last follow-up visit (4-7 years). Early and late (after 1 month) complication rates and the reoperation rate were also evaluated. RESULTS: Mean operative time and follow-up duration were 12 ± 2.5 min and 5.7 years (4-7 years), respectively. Objective cure rates determined by the stress cough test were 83.8%, 94.6%, 93.5%, and 91.3% at 1 month, 6 months, 1 year, and last follow-up, respectively. IIQ-7 scores improved at every visit compared to the preoperative value. There were no cases of hematuria, bladder perforation, or major bleeding requires a blood transfusion. CONCLUSION: Our results suggest that the surgeon-tailored SIMS procedure has high efficacy and low complication rates and offers a practical and inexpensive alternative to commercial high-cost SIMS systems.

Surgical outcomes of intraabdominal versus vaginal approach for uterine manipulation during total laparoscopic hysterectomy.

Uterine manipulation is essential for moving the uterus and proper anatomical dissection without complications during total laparoscopic hysterectomy (TLH). Although many different uterine manipulators (UM) have been designed in the last few decades, there is still no "optimal UM" that is universally safe, efficient, and cost-effective. This study aimed to compare myoma screw (MS) and UM with regard to surgical outcomes and cost-effectiveness in patients who underwent TLH. In the current study, we describe an operation technique that uses a MS instead of a uterine manipulator during TLH and discuss the surgical outcomes of this method. The use of MS resulted in significantly shorter operation time with respect to UM for uterine manipulation during TLH regarding benign indications, with affordable costs. The use of MS is a safe and cost-effective alternative to the use of UM during TLH.

Eight-Hour Time-Restricted Feeding: A Strong Candidate Diet Protocol for First-Line Therapy in Polycystic Ovary Syndrome.

We aimed to investigate the effects of a 6-week program of 8 h time-restricted feeding (TRF) diet in polycystic ovary syndrome (PCOS), as determined by anthropometric, hormonal, metabolic profiles, and fecal calprotectin level. Thirty women diagnosed with PCOS underwent a 6-week 8 h TRF diet intervention. Age, anthropometric features (body mass index (BMI), waist-to-hip ratio (WHR)) and biochemical results were recorded. Free androgen index (FAI, defining hyperandrogenism) and the homeostatic model assessment-insulin resistance (HOMA-IR) were calculated. Baseline (pre-diet) and 6-week post-diet findings were compared. Mean age was 25.57 ± 2.67 years. BMI (p < 0.001) and WHR (p = 0.001) were found to have significantly decreased after the diet, as well as the percentage of patients defined to have hyperandrogenism (p = 0.016). Reproductive hormone levels, FAI (p < 0.001) and HOMA-IR (p < 0.001) were improved significantly. Metabolic parameters associated with glucose and lipid profiles were also significantly improved after the diet. Additionally, fecal calprotectin levels demonstrated a significant decrease from pre-diet to post-diet (p < 0.001). In conclusion, a 6-week diet intervention with 8 h TRF may be a suitable and effective intermittent fasting protocol that can be used as a first-line option in PCOS.

Evaluation of the effect of preoperative rectal misoprostol use on the postoperative outcomes of hysteroscopic myomectomy.

AIM: In this study, we aimed to evaluate the effect of using two doses of rectal misoprostol on postoperative results in hysteroscopic myomectomy. METHODS: This retrospective study was carried out at two hospitals in which the medical records of patients who underwent hysteroscopic myomectomy between November 2017 and April 2022 were evaluated, and subjects were grouped depending on the administration of misoprostol before hysteroscopy. In recipients, two rectal doses of misoprostol (400 µg) were administered, 12 h and 1 h before the planned operation. Outcomes evaluated were: postoperative reduction in hemoglobin (Hb), pain at 12 and 24 h (VAS score), and length of hospital stay. RESULTS: The mean age of 47 women in the study group was 27.38 ± 5.12 (range 20-38) years. Hb levels reduced significantly in both groups after hysteroscopic myomectomy (p < 0.001). In misoprostol recipients, VAS score was found to be significantly lower at 12 h (p < 0.001) and 24 h after the operation (p = 0.004). Multiple linear regression analyses for each of the outcomes revealed the following: greater myoma size was associated with greater Hb decrease (p = 0.010), misoprostol use was associated with lower 12th and 24th hour VAS scores (p < 0.001), longer duration of operation was associated with higher 12th and 24th hour VAS scores (p < 0.001), and finally, longer duration of operation was associated with prolonged hospital stay (p = 0.001). CONCLUSIONS: The use of two doses of rectal misoprostol before hysteroscopic myomectomy was effective in reducing postoperative pain. Prospective, population-based studies evaluating different uses of misoprostol in hysteroscopic myomectomy are needed.

In-bag abdominal manual morcellation versus contained power morcellation in laparoscopic myomectomy: a comparison of surgical outcomes and costs.

BACKGROUND: To compare the surgical outcomes and costs of in-bag abdominal manual morcellation (AMM) and contained power morcellation (PM) in laparoscopic myomectomy. METHODS: A total of 61 patients were divided into two groups based on their myomectomy specimen extraction methods: AMM group (n = 33) and electromechanical contained PM group (n = 28). The surgical outcomes and cost were compared between groups. During AMM, a glove bag (in 27 patients) and an endo bag were used (in 6 patients) according to the myoma size. RESULTS: Morcellation time (18 ± 9.2 min vs. 37.4 ± 14.1 min) and total operation time (100 ± 24.3 min vs. 127 ± 33.1 min) were significantly lower in the AMM group compared to those in the PM group. Other surgical outcomes, which were similar between groups, included delta hemoglobin, length of hospital stay and VAS score at 12 and 24 h postoperatively. There were no per- or postoperative complications in both group with no conversion to laparotomy. One patient was transfused with two units of erythrocyte suspension postoperatively in the PM group. Sarcoma was not diagnosed in any of the cases in both group. CONCLUSION: The in-bag AMM or contained PM for specimen extraction resulted in similar outcomes in terms of delta hemoglobin, postoperative pain intensity (VAS score at 12 and 24 h postoperatively), the need for additional analgesia, and the length of hospital stay; however, total operation time and morcellation time were significantly shorter in the AMM group, indicating a prominent advantage. Significant cost-effectiveness is also a critical advantage of in-bag AMM compared to containing PM.