Clinical preferences and treatment attitudes among urologists, gynecologists, and geriatricians: An independent online questionnaire survey for comparison of treatment choices in the management of overactive bladder.

OBJECTIVE: Overactive bladder (OAB) is a common clinical problem with associated morbidities both in men and women. Although real-life management strategies have been examined among urologists (URO), treatment choices may differ between different specialties. In the present study, an online survey was conducted to determine and compare the management strategies and clinical preferences of UROs, obstetricians/gynecologists (OB/GYN), and geriatricians (GER) in the treatment of OAB in their daily practices. METHODS: Between December 2020 and February 2021, an online questionnaire was sent to URO, OB/GYN, and GER specialists/residents. Current strategies and attitudes toward treatment of OAB in patients <65 years were compared between URO and OB/GYN, whereas the responses were compared between all three specialties in patients ≥65 years. RESULTS: A total of 733 specialists/physicians (433 URO, 236 OB/GYN, and 64 GER) completed the online survey. Patients with OAB were more likely to present to URO compared to OB/GYN and GER (p = 0.001). A combination of behavioral modification and pharmacotherapy (antimuscarinics and/or beta-3 agonists) were chosen for the initial treatment of patients with OAB in both specialties with a significantly higher proportion by URO than by OB/GYN (51.9% vs. 38.1%; p = 0.001). Antimuscarinics were the most frequently prescribed medications by both the URO and OB/GYN specialties (81.8% vs. 78.4%; p = 0.27). Combination therapy with antimuscarinics was preferred more often by URO (91.5% vs. 77.1%; p = 0.001) when no or an inadequate response after initial treatment occurred. Multiple medication use, comorbidities, and risk of cognitive side effects affected medication preference by all specialists, especially by GER (p = 0.018). CONCLUSIONS: Patients with OAB present to UROs, OB/GYN and GER more frequently compared to other specialities. Although antimuscarinics and beta-3 adrenoceptor agonists are equally recommended as first-line pharmacotherapy for OAB, antimuscarinics were preferred for most patients as the initial molecule by all specialties. Beta-3 agonists are increasingly preferred for elderly patients.

Complete labial fusion causing urinary retention in a postmenopausal woman.

Labial fusion or labial adhesion can rarely be encountered postmenopausal and may be diagnosed in advanced stages especially in sexually inactive women. It may be a rare cause of voiding dysfunction or urinary retention. We present a case of a postmenopausal woman presenting with urinary retention due to complete labial fusion. The patient was treated both with topical estrogen and surgical separation of labial fusion. No recurrences developed after the procedure. Topical estrogen treatment may not resolve adhesions in postmenopausal women and invasive procedures may be necessary to resolve urinary retention.

Effect of the COVID-19 pandemic and social distancing measures on the sexual functions of women treated for vaginismus (genitopelvic pain/penetration disorder).

INTRODUCTION AND HYPOTHESIS: Female sexual function is influenced by the emotional and hormonal state. COVID-19 has been the major global health crisis of our time with high psychosocial impact. Vaginismus is a form of female sexual dysfunction and a subset of genitopelvic pain/penetration disorder in which any form of vaginal penetration is painful or impossible. Our aim was to evaluate the effect of the COVID-19 pandemic on sexual function of women treated for vaginismus. MATERIALS AND METHODS: All women treated using dilators between 2018-2019 were included. Data obtained 3 months after comfortable penetration and during the pandemic via telephone interview were compared. The Female Sexual Function Index (FSFI), Golombok-Rust Inventory of Sexual Satisfaction (GRISS), and Beck Depression Inventory (BDI) were used to evaluate sexual function and depression. Frequency of sexual intercourse and pain was compared using a visual analogue scale. RESULTS: Seventy-seven women were included. Mean duration of treatment and number of treatment sessions were 3.5 ± 2.6 months and 4.2 ± 2.6, respectively. There were significant improvements in the FSFI desire, arousal, orgasm, and pain subscales and total score and in the GRISS infrequency, noncommunication, avoidance, non-sensuality, and vaginismus subscales and total score during the pandemic. The GRISS dissatisfaction and anorgasmia subscales and BDI score significantly worsened. Mean frequency of sexual intercourse was 2.3 ± 1.8/week and did not change significantly. Pain scores decreased during the pandemic (2.7 ± 2.8) compared to post-treatment (6.2 ± 2.9). CONCLUSION: Although frequency of sexual intercourse was not affected and pain scores and FSFI total and subscale scores improved, satisfaction and orgasm were adversely affected, which may be attributed to increased stress and anxiety during the pandemic.

External validation of a model predicting de novo stress urinary incontinence after pelvic organ prolapse surgery.

AIMS: De novo stress urinary incontinence (SUI) may develop after surgical correction of advanced pelvic organ prolapse (POP) in otherwise continent women. Prediction of which women with POP will develop SUI after the prolapse is corrected is difficult. We aimed to externally validate a previously described prediction model for de novo SUI after performing vaginal surgery for POP and to assess its clinical performance when used as a diagnostic test. METHODS: This retrospective cohort study included all continent women with ≥ stage 2 POP according to the POP-Quantification System who underwent reconstructive surgery for symptomatic POP. Surgical correction for prolapse of the anterior and/or apical compartment was performed using native tissue or vaginal mesh repair. Seven parameters of the prediction model including age at surgery, number of vaginal births, body mass index, preoperative stress test, previous continence procedure history, urine leakage associated with a feeling of urgency, and diagnosis of diabetes for each patient was provided from the medical records, and the predicted probability of de novo SUI after POP surgery was calculated. The primary outcome used to validate the prediction model was the presence of SUI 1 year after surgery. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive accuracy. A cut-off point of ≥ 50% was used to evaluate its clinical performance as a diagnostic test. RESULTS: Two hundred twenty-five women were suitable for analysis. The rate of de novo SUI was 5.3%. The predictive accuracy of the model in our population using the area under the ROC curve was 0.56 (95% confidence interval = 0.35-0.77). Its performance as a diagnostic test was poor (positive likelihood ratio = 1.20 and negative likelihood ratio = 0.89). CONCLUSIONS: Our clinical validation of this model showed that it did not have good clinical performance. We need future prospective studies to identify and incorporate additional markers of de novo SUI to improve the prediction capacity.

Contraception counselling during gynecology visit - does a questionnaire help?

OBJECTIVES: Women are at risk of unplanned pregnancy and inappropriate choice of contraception if not given effective contraception counselling. We aimed to understand the contraceptive needs of women, improve effective contraception counselling promoting modern contraception methods during gynecology outpatient visit using a contraception counselling questionnaire. MATERIAL AND METHODS: All reproductive-age women over 18 were given Contraception Counselling Project Form to fill in while in the waiting room. The form consisted of 15 questions evaluating patients' characteristics and contraceptive method used. Physicians evaluated these forms during the examination and an appropriate method was chosen. Forms of pregnant, postmenopausal and sexually inactive patients as well as forms with more than one answer missing were excluded. RESULTS: 778 questionnaires were accepted for evaluation. 340 women (43.8%) used modern contraception, 112 (14.4%) used interrupted coitus, 3 (0.4%) used calendar method. 738 women could be given adequate contraception counselling by the physicians. 215 women among 323 women (66.5%) who did not use modern contraception and did not desire pregnancy, were convinced to use modern contraception and 103 (91.9%) among 112 women who used interrupted coitus for contraception were convinced to use modern contraception. There was a significant relationship between age, education, working state, parity, number and type of delivery, previous OCP usage, resources of contraception and the preferred contraception method. CONCLUSIONS: More than half the women preferred to use modern contraception methods by means of contraception counselling questionnaire. Women's backgrounds significantly affected their choice of contraception method.

Necrotizing Fasciitis Complicating Transobturator Tape Operation.

Midurethral slings (MUSs) have been used successfully for the last 20 years in the treatment of stress urinary incontinence and accepted as the gold standard surgical procedure. High success rates and minimal invasiveness of surgery are among the most important advantages, but sometimes serious complications can occur during or after surgery. Although serious complications are rare after widely performed transobturator tape (TOT) operation, awareness, early diagnosis, and aggressive management are essential as they can progress with serious morbidity and mortality. In order to reduce the infectious complications after MUS procedures, in addition to sterility of the operating theater and the operating equipment, the type of mesh used and the preparation of the surgical site are crucial. We aimed to pre-sent the successful management of a case of necrotizing fasciitis in a TOT patient.

Approach to Abnormal Uterine Bleeding in Adolescents

This article reviews the current understanding and management of abnormal uterine bleeding (AUB) in adolescents. It is hoped that this review will provide readers with an approach to the evaluation and treatment of mild to severe uterine bleeding. AUB is a common problem which has significantly adverse effects on an affected adolescent's quality of life. The most common underlying condition in AUB in adolescence is anovulation. During the evaluation, pregnancy, trauma and sexually transmitted diseases must be ruled out, regardless of history. It should be kept in mind that AUB during this period may be the first sign of underlying bleeding disorders. Although observation is sufficient in the mild form of AUB, at the other end of the spectrum life-threatening bleeding may necessitate the use of high doses of combined oral contraceptives, intravenous estrogen and/or interventional procedures.

Validation of the Turkish version of the ICIQ-FLUTS, ICIQ-FLUTS long-form, ICIQ-LUTS quality-of-life, and ICIQ-FLUTS sexual functions.

AIMS: To enable the use of ICIQ-FLUTS, ICIQ-FLUTS-long-form (ICIQ-FLUTS-LF), ICIQ-LUTS-quality-of-life (ICIQ-LUTSqol), and ICIQ-FLUTS sexual functions (ICIQ-FLUTSsex) in Turkish speaking women, questionnaires were translated into Turkish and validity, reliability, and sensitivity to change were evaluated in women suffering from urinary incontinence (UI). MATERIALS AND METHODS: Permissions were obtained from ICIQ Advisory Board, English versions of the questionnaires were initially translated into Turkish, then back-translated into English and translations were modified according to recommendations of ICIQ Advisory Board. Pilot testing was performed in 10 women. Validity (content/face validity and discriminant validity), reliability (test-retest reliability and internal consistency), and sensitivity to change were evaluated. RESULTS: A total of 58 women with UI completed ICIQ-FLUTS, ICIQ-LUTSqol, and the ICIQ-FLUTS-LF, and 37 who were sexually active completed ICIQ-FLUTSsex. All women completed same questionnaires 15 days later. More than 90% of women thought that the questions were clear, unequivocal, and comprehensive. Missing data were less than 1% indicating adequate content/face validity. Cronbach's α coefficients were .933 (ICIQ-FLUTS), .979 (ICIQ-LUTSqol), .865 (ICIQ-FLUTS-LF), and .863 (ICIQ-FLUTSsex), representing adequate internal consistency. Kappa values and intraclass correlation coefficient for individual items were over 0.70, indicating adequate test-retest reliability. A total of 52 healthy volunteers completed ICIQ-FLUTS and ICIQ-FLUTS-LF, 30 completed ICIQ-LUTSqol, and 30 sexually active healthy volunteers completed ICIQ-FLUTSsex. All four questionnaires had good discriminant validity. Twenty-eight women with UI were analyzed 3 months after treatment. There was significant improvement in four questionnaires in correlation with pre- and posttreatment bladder diary results showing good sensitivity to change. CONCLUSION: Turkish versions of four ICIQ modules were shown valid and reliable and can be used in Turkish speaking women in the evaluation of UI.

Diagnosis, management, and outcome of obstructed hemivagina and ipsilateral renal agenesis (OHVIRA syndrome): Is there a correlation between MRI findings and outcome?

AIM: To review the experience of a single tertiary center with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA syndrome) and evaluate if MRI findings correlate with outcome. METHODS: Patients (n = 32) diagnosed with OHVIRA syndrome between 2001 and 2019 were analyzed. Presenting symptoms, age of menarche, age at operation, MRI findings, management, and outcome were reviewed. In sagittal MRI planes, distance from hematocolpos to perineum was measured. Measurements were compared among patients who underwent single-stage vaginoplasty and hemihysterectomy. RESULTS: Mean age at diagnosis and mean age of menarche was 16.8 ± 6.4 (10-33) and 12.8 ± 1.0 (10-15). Main presenting complaints were abdominal pain/dysmenorrhea. Eighteen anomalies (56.3%) were on right side. Twenty-eight had ipsilateral renal agenesis, 3 patients had normal renal anatomy and one had unilateral multicystic dysplastic kidney. In MRI, 21 patients had hematocolpos, 11 patients had both hematocolpos and hematometra. 28 patients underwent single-stage vaginoplasty and vaginal septum resection. One had hemihysterectomy due to sepsis at presentation. Three patients had hemihysterectomy due to proximal vaginal septum and impossibility of vaginoplasty. During follow-up, 7 cases (21.9%) had married and 5 of these (71.4%) were pregnant or had delivered. Five patients had reoperation during follow-up. MRI images of 19 patients indicated mean distances from hematocolpos to perineum whom underwent vaginoplasty or hemihysterectomy were 33.9 ± 18.1 mm (10-79 mm) and 87.3 ± 11.0 mm (80-100), respectively (p = .009). CONCLUSIONS: Gold standard treatment of OHVIRA syndrome is single-stage vaginoplasty. Distance from hematocolpos to perineum in MRI may correlate with surgical outcome. Hemihysterectomy may be an alternative for extreme proximal vaginal septum or infectious complications.

Giant Vulvar Condylomata: Two Cases and a Review of the Literature.

INTRODUCTION: Giant vulvar condyloma is usually associated with the HPV subtypes 6 and 11 and is characterized by excessive growth of verrucous lesions on the genitals and/or perianal region. It may be observed in sexually inactive as well as sexually active women. Immunosuppression plays an important role in the development of the disease. PATIENTS AND METHODS: We report two cases of giant vulvar condyloma together with the review of the literature. RESULTS: One case was a 21-year old sexually inactive woman with a history of Type 1 Diabetes. Second case was a 20-year-old sexually active woman with a rapidly progressing disease and cervical dysplasia. Both cases were operated; all the condylomatous structures were resected with preservation of the anatomy and clitoral innervation and blood flow. Skin and subcuticular dehiscence was the only complication encountered in the first case. CONCLUSION: Main treatment of giant vulvar condyloma is surgical resection with maintenance of the vulvar anatomy. Preservation of especially the clitoral innervation as much as possible is very important.

Long-Term Follow-Up of a Patient with Spondylodiscitis after Laparoscopic Sacrocolpopexy: An Unusual Complication with a Review of the Literature.

Sacrocolpopexy is the gold standard treatment for apical compartment prolapse with reported success rates of 78-100%. Spondylodiscitis is a rare complication of sacrocolpopexy and includes a spectrum of spinal infections such as discitis, osteomyelitis, epidural abscess, meningitis, subdural empyema, and spinal cord abscess. Here we report a case of spondylodiscitis following laparoscopic sacrocolpopexy with long-term follow-up and discuss management of spondylodiscitis after abdominal sacrocolpopexy, with a review of the literature.

Quality of life and sexual function in obese women with pelvic floor dysfunction.

This prospective study was conducted in the urogynecology and gynecology outpatient clinics of Istanbul Faculty of Medicine from December 2014 to March 2015. The objective was to identify the association between obesity and sexual function and quality of life in women with pelvic floor dysfunction (PFD). A total of 387 sexually active women diagnosed with urinary incontinence and/or pelvic organ prolapse were included and categorized as obese (n = 200) or nonobese (n = 187). Mean body mass indexes were 25.7 ± 2.41 kg/m2 for nonobese women and 34.9 ± 3.92 kg/m2 for obese women. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 total score was significantly lower in obese (27.66 ± 7.12) than in nonobese women (30.18 ± 6.54) (p < .05). Quality of life mean scores were higher in obese women for both the Incontinence Impact Questionnaire total score (67.24 ± 26.8 versus 49.12 ± 27.5) and Urogenital Distress Inventory total score (65.02 ± 21.4 versus 55.07 ± 24.7) (p < .001). Obese women with PFD had symptoms for longer durations, had more frequent urinary incontinence, and worse sexual function and quality of life than nonobese women. Health-care professionals caring for obese women should be aware of the coexistence of obesity and PFD. Future studies should evaluate whether obesity-associated PFD can be reduced through successful weight reduction interventions.

Higher follicular fluid glycodelin levels are negatively correlated with embryonic development in assisted reproduction.

OBJECTIVE: To investigate the possible effect of follicular fluid glycodelin levels on the quality of developing oocytes and subsequent in vitro embryo development. METHODS: Follicular fluid glycodelin levels of 145 patients undergoing assisted reproductive treatment were analyzed and the correlation between glycodelin levels and ART outcomes were evaluated. RESULTS: We found that glycodelin levels were negatively correlated with the number of high quality embryos on day 3 (r=-0.20, p=0.05). Additionally, higher glycodelin levels were correlated with higher FSH levels (r=0.18, p=0.04). However, glycodelin levels were not predictive for implantation (p=0.67) or ongoing pregnancy rates (p=0.99). CONCLUSION: Glycodelin in the follicular environment might be one of the factors that influence the competence of growing oocytes and affect the quality of subsequent in vitro embryo development.

Transobturator Tape Operation for the Treatment of Stress Urinary Incontinence in Postmenopausal Women Aged Over 65 Years.

OBJECTIVE: We compared success rates and complication rates in women aged less then and equal to or more than 65 years who had undergone transobturator tape (TOT) surgery for stress urinary incontinence (SUI). METHODS: This was a retrospective cohort study that included patients who underwent surgery to treat SUI. We separated patients into two groups according to age: younger than 65 years and equal to or older than 65 years. Exclusion criteria were patients with history of incontinence surgery, history of radical pelvic surgery, concomitant pelvic organ prolapse repair, detrusor overactivity, and less than 1 year of postoperative follow-up. The surgical procedures and pre- and postoperative evaluations including urodynamics were performed in a tertiary center. The primary objective was to assess the success rate, patient-reported satisfaction after surgery, and improvement in quality of life (QOL). The secondary outcome the assessment of complications. RESULTS: A total of 123 women, including 53 (43.1%) women aged less than 65 years, and 70 (56.9%) women aged 65 years and over with SUI who underwent TOT surgery between January 2004, and March 2013. After a median follow-up of 52 (IQR 31) months for the older patients and 54 (IQR 42) months for younger patients, cure rates and patients satisfaction rates were similar in both group (82.9 vs. 81.1%, P = 0.81 and 87.2 vs. 88.6%, P = 0.79, respectively). The improvement in QOL, which was confirmed with changes in Kings Health Questionnaire (KHQ) scores, was similar in both the older and younger women -209.6 (IQR 420.9) vs. -191.1 (IQR 379.4), P = 0.62, respectively). Postoperative complications were similar in both age groups. CONCLUSIONS: Transobturator tape surgery in the management of SUI is safe and efficient in improving QOL, has high success and patient satisfaction, and low postoperative morbidity rates even in women aged ≥65 years.

Effects of Transobturator Midurethral Sling Surgery on Sexual Functions: One-Year Follow-Up.

AIM: To evaluate sexual functions of women having stress urinary incontinence (SUI) preoperatively and 6 months and 12 months after undergoing a transobturator tape (TOT) ± pelvic organ prolapse (POP) surgery. METHODS: One hundred-ninety-five women with SUI ± POP were recruited and 150 sexually active women who had clinical ± urodynamic SUI and underwent TOT ± POP surgery were included in this prospective study. Urogynecologic symptoms were evaluated preoperatively, at 6 months, and 12 months by Female Sexual Function Index (FSFI). RESULTS: One hundred fifty women completed the study. Seventy-four underwent TOT-only and 76 underwent TOT + concomitant surgery. Mean total scores of FSFI were 21.7 ± 7.8, 22 ± 8.7, and 22.1 ± 8 in the preoperative period, postoperative 6, and 12 months, respectively. There was significant improvement in desire and total scores in the TOT-only group, whereas there was no significant difference in the TOT + concomitant surgery group except for significant worsening in the lubrication domain. The frequency of sexual intercourse increased while that of coital incontinence decreased after surgery. CONCLUSIONS: In our study, TOT was associated with decrease in coital incontinence and significant improvement in desire. In addition, there was significant improvement in FSFI desire and total scores in the TOT-only group, whereas no significant difference was observed in the TOT + concomitant surgery group except for the worsening of lubrication.

5-year experience in the diagnosis and treatment of occult urinary incontinence in women with pelvic organ prolapse.

OBJECTIVE: Our aim was to analyze our five-year experience in the diagnosis and treatment of occult urinary incontinence in women with pelvic organ prolapse. STUDY DESIGN: The medical records of all patients who were admitted to the Division of Urogynecology of Istanbul Faculty of Medicine between January 2008 and December 2013; in total, 1600 patients were retrospectively evaluated. The study population included 287 patients who had prolapse beyond the hymen and underwent two consecutive urodynamic studies with and without prolapse reduction. Demographic data, medical records, physical examination, full urogynecologic examination, urodynamic investigations, treatment modality, the results of the treatment and King's Health Questionnaire scores before treatment and at one-year follow-up were recorded. RESULTS: Eighty-five of 287 patients (29.6%) were continent, 20 (23.5%) of whom had occult stress urinary incontinence during cystometry. Among these 20 patients, 17 underwent anti-incontinence surgery; 12 were satisfied with their surgery and had no postoperative urinary leakage. Twenty (23.5%) patients had overactive bladder symptoms during urodynamic studies after prolapse reduction. King's Health Questionnaire scores before and after the operation, showed that health status of 12 patients was better, 1 patient was unsatisfied after the treatment, 2 patients' scores did not change and 2 patients were lost to follow up. CONCLUSIONS: In conclusion, the prevalence of occult urinary incontinence was 23.5% when using urodynamics with prolapse reduction. 12 of the 17 patients diagnosed with occult urinary incontinence were satisfied with surgery and had no postoperative urinary leakage.

Effect of infertility on quality of life of women: a validation study of the Turkish FertiQoL.

The fertility quality of life (FertiQoL) measure specifically evaluates the impact of fertility problems in various life areas. The aim of this study was to examine the relationship between FertiQoL and the hospital anxiety and depression scale (HADS) in the Turkish population. All female patients who underwent various fertility treatments in our infertility clinic from May 2011 to May 2014 were approached to participate in the study and 389 completed the questionnaires. Our results showed that the four core scales of the FertiQoL measure had a Cronbach's α value that was between 0.70 and 0.89. Two scales (anxiety and depression) of HADS both had a Cronbach's α value of 0.80. These values present a reliable usage of FertiQoL and HADS measures (α > 0.60). Significant negative correlations were found between the FertiQoL scales and HADS scales, ranging from -0.27 (between relational scale of FertiQoL and anxiety scale of HADS) to -0.65 (between mind-body scale of FertiQoL and depression scale of HADS). The results of this study provide supportive data to confirm that the Turkish version of FertiQol can accurately evaluate QoL in women who seek fertility treatment in Turkey.

Comparison of 2 Methods of Vaginal Cuff Closure at Laparoscopic Hysterectomy and Their Effect on Female Sexual Function and Vaginal Length: A Randomized Clinical Study.

STUDY OBJECTIVE: To compare the effects of the laparoscopic approach versus the vaginal route for the management of vaginal cuff closure during total laparoscopic hysterectomy on female sexual function in premenopausal patients with benign gynecologic conditions. DESIGN: A prospective study with a randomized, double-blind design (Canadian Task Force Classification I). SETTING: A university hospital. PATIENTS: Patients who were scheduled to have total laparoscopic hysterectomy because of benign conditions. INTERVENTIONS: Patients were randomized to vaginal cuff closure via the vaginal route versus the laparoscopic approach. The study included a total of 70 patients; 34 underwent the laparoscopic approach in the management of vaginal cuff closure, and 36 underwent the vaginal route. MEASUREMENTS AND MAIN RESULTS: Female sexual function and vaginal length were measured. The duration of total surgery was significantly shorter in the laparoscopic approach group compared with the vaginal route group (112.2 ± 36.5 vs 122.7 ± 53.6, p < .05). The total Female Sexual Function Index scores preoperatively and 3 months postoperatively were similar between the laparoscopic approach and vaginal route groups (all p > .05). Vaginal lengths 3 months postoperatively were significantly longer in the laparoscopic approach group compared with the vaginal route group (8.39 ± 0.90 vs 7.34 ± 1.17, p < .05). The duration of cuff closure was significantly shorter in the vaginal route group compared with the laparoscopic approach group (8.92 ± 2.23 vs 7.51 ± 2.5, p < .05). Preoperative vaginal lengths were significantly longer in comparison with 3 months postoperatively both in the laparoscopic approach and the vaginal route groups (all p < .05). The preoperative total Female Sexual Function Index scores were significantly higher in comparison with 3 months postoperatively both in the laparoscopic approach and the vaginal route groups (all p < .05). CONCLUSION: The results of this study indicate that the laparoscopic approach for vaginal cuff closure might be preferable because of better postoperative vaginal length and a shorter duration of total surgery time.

A Valuable Option in the Management of Female Recurrent Stress Urinary Incontinence: Re-Adjustable Sling (Remeex Sling System).

INTRODUCTION: This study was conducted to evaluate the effectiveness and safety of adjustable slings in the treatment of recurrent stress urinary incontinence (SUI) after mid-urethral sling (MUS) failure. MATERIALS AND METHODS: A prospective study was performed among women with recurrent SUI at the Urogynecology Division of Istanbul School of Medicine between February 2010 and March 2015. All women were preoperatively evaluated with detailed urogynecologic evaluations, which included pelvic examination, Q-tip test, pad test, urodynamic studies and a compilation of the Kings Health Questionnaire (KHQ). Postoperative follow-up was performed at 1, 6 and 12 months and annually thereafter. Our primary outcome was objective cure and patient's satisfaction with treatment. Secondary outcomes included perioperative complications and adverse events. RESULTS: Nineteen women were included in the study. The patients' mean age was 55.3 ± 6.9 years (range 43-66 years). The median follow-up time was 20.7 ± 14.0 months (range 6-55 months). The overall cure and improvement rates were 84.2 and 10.5%, respectively. In the satisfaction questionnaire, 15 (79%) patients responded that they were very satisfied and 3 (15.7%) were moderately satisfied. Sling tension re-adjustment was needed during follow-up in 1 patient (5.3%), 13 months after the initial surgery. The preoperative mean KHQ score was 545.9 ± 243.0 and changed to 237.0 ± 217.5 (p < 0.05). Postoperative complications were slight and easily manageable. CONCLUSIONS: Recurrent SUI is a challenging condition in urogynecology. The Regulation Mechanical External (Remeex) system has been found to be effective in the treatment of recurrent SUI after MUS failure with acceptable adverse effects. The Remeex system has the advantage of re-adjustment as a valuable option in the long-term management of patients.

Randomized trial of long-term effects of percutaneous tibial nerve stimulation on chronic pelvic pain.

OBJECTIVE: To evaluate the long-term effects of percutaneous tibial nerve stimulation (PTNS) on quality of life in women with chronic pelvic pain. MATERIALS AND METHODS: Thirty-three women with chronic pelvic pain were randomized into PTNS (n = 16) or control (n = 17) groups. In PTNS group, weekly PTNS in 30-min sessions for 12 weeks was performed whereas the control group received no stimulation. Present pain intensity-visual analog scale (PPI-VAS), short-form McGill pain questionnaire (SF-MPQ), and SF-36 were used at baseline, 12-week, and 6-month follow-up for the evaluation of pain intensity and quality of life. RESULTS: Two women (12.5 %) were cured, 7 (43.8 %) were much improved, 6 (37.5 %) were the same and 1 (6.3 %) was worse after PTNS. Two women (11.8 %) were improved, 10 (58.8 %) were the same, and 5 (29.4 %) were worse in the control group. Mean PPI-VAS of PTNS group at baseline, 12 weeks, and 6 months was 8.4 ± 1.1, 3.8 ± 3.5 and 4.5 ± 3.7, respectively. There was a significant improvement in PPI-VAS scores of PTNS group whereas no change was observed in the control group. There was a slight increase in the PPI-VAS scores of the PTNS group at 6-month, but the difference was not statistically significant. There was significant improvement in all domains of SF-MPQ and SF-36 in PTNS group with continuing effects at 6 months whereas no significant change was observed in the control group. CONCLUSION: PTNS is a minimally invasive treatment method that leads to decrease in pain severity and improvement in quality of life in women with chronic pelvic pain with effects continuing at 6 months.