Prognostic significance of solid growth in endometrioid endometrial adenocarcinoma.

BACKGROUND: Endometrioid endometrial cancer is the most common histological subtype of endometrial adenocarcinoma. In the FIGO grading scheme, both architectural and nuclear grade are taken into consideration. However, the specific impact of solid growth alone on endometrioid endometrial adenocarcinoma outcome is not well documented. We sought to assess the degree of impact of solid growth on lymphovascular space invasion (LVSI), myometrial invasion, tumor size, FIGO stage, lymph node metastasis (LNM), relapse-free survival (RFS) and disease-specific survival (DSS). METHODS: Paraffin blocks of 269 patients treated for endometrioid endometrial cancer were retrospectively analyzed with morphometry for solid growth percentages. RESULTS: A statistically significant cut-off value of 1% solid growth was found for predicting LNM and advanced stage (III or IV), myometrial invasion and LVSI (p < 0.001) and a cut-off value of 8% was found for predicting adverse survival outcome (p < 0.001). The mean DSS was significantly higher in patients with < 6% solid growth compared to patients with 6-50%, 51-75% and > 75% solid growth (p < 0.001). Although, the mean RFS and DSS were lowest in patients with 51-75% solid growth, this did not reach statistical significance in comparison to 6-50% and > 75% (p > 0.05). CONCLUSION: Although > 75% solid growth was most significantly associated with many of the adverse prognostic factors, this subset did not provide prognostic superiority in predicting adverse survival when compared to subsets within 6-75% solid growth. In conclusion, although no statistically significant difference in survival was found among subdivisions of architectural grades 2 and 3, solid growth, especially ≥ 8%, appeared to be an independent prognostic factor for survival in patients with early-stage endometrioid endometrial cancer.

Evaluation of Toll-Like Receptor Expression with Clinicopathologic Variables in Endometrium Cancer.

OBJECTIVES: Clinical evidence supports the association of toll-like receptor (TLR) with abnormal cell proliferation and cancer. In this study, we investigated the expression of TLRs 2, 4, 5, and 6 in healthy endometrium and endometrium cancer to study the relationship of these receptors' expression with carcinogenesis. METHODS: Patients who had undergone a hysterectomy owing to endometrium cancer (group 1, 66 patients), endometrial hyperplasia (group 2, 14 patients), and other reasons besides endometrium cancer (group 3, 20 patients as controls) were included. The cases in the first group were classified by histological type of the cancer, stage, grade, and size of the tumor. In all the cases, expressions of TLRs 2, 4, 5, and 6 were assessed, and the relationship of these receptors with clinicopathologic signs was analyzed. For immunohistochemical staining, nuclear and cytoplasmic stainings were considered positive. A Chi-squared test was used to assess the correlation of the groups. A p<0.05 was considered significant. RESULTS: The mean ages of patients in groups 1, 2, and 3 were 59.8 (range 33-83), 48.3 (range 40-59), and 53.4 (range 38-84) years, respectively. All types of TLRs were highly expressed in both types of endometrium cancer (groups 1 and 2). TLR expression was observed with a ratio of 87.9% in group 1, 100% in group 2, and 35% in group 3. There was a statistically significant association of TLR 2 among the three groups (p=0.000). TLR 6 expression in both group 1 and group 2 was significantly higher than that in the control group (p=0.000, p=0.000, respectively). In addition, TLR 6 was higher in cases with late-stage cancer (p=0.033). Regarding tumor grade and the size of the tumor, no association was found between TLR 2 and TLR 6. CONCLUSION: TLR 2 and TLR 6 were significantly more expressed in cases with endometrium cancer and endometrial hyperplasia. In addition, the presence of TLR 6 may indicate the presence of late-stage endometrial cancer.

Pelvic radiotherapy does not deteriorate the quality of life of women with gynecologic cancers in long-term follow-up: A 2 years prospective single-center study.

PURPOSE: To evaluate the emotional, sexual and health-related quality of life (HRQoL) concerns of the women with gynecologic malignancy treated with curative radiotherapy (RT). PATIENTS AND METHODS: A 100 women with diagnosis of gynecologic malignancy were prospectively enrolled. HRQoL at baseline, at the end of RT and during follow-up was assessed using European Organization for Research and Treatment of Cancer QoL Questionnaire-C30 (EORTC QLQ-C30), EORTC QLQ-cervical cancer module 24, and Hospital Anxiety and Depression Scale. RESULTS: The appetite loss, diarrhea, fatigue, dyspnea, insomnia, nausea and vomiting, pain scores, and sexual activity and sexual enjoyment scores were deteriorated after RT (P = 0.02 for pain scores and P < 0.001 for all other). Body image scores were higher in patients with endometrial cancer (P < 0.01). The emotional function, nausea and vomiting, body image and symptom experience scores were higher in patients who underwent chemotherapy (P = 0.04 and P = 0.01). All the complaints of patients improved during follow-up period. The global health status scores and the level of depression deteriorated in patients with locoregional recurrent disease and distant metastasis. The anxiety (P = 0.001) and depression (P = 0.007) levels were higher in basal and after-RT visits but then decreased through the subsequent follow-up visits. CONCLUSION: Although pelvic RT deteriorated HRQoL in patients with gynecologic malignancy, HRQoL improved during the follow-up period. The progressive disease had a negative impact on HRQoL.

Management of intra-abdominally translocated contraceptive devices, is surgery the only way to treat this problem?

This study was a multi-centre retrospective review of patients with uterine perforation caused by intrauterine contraceptive devices (IUDs). A total of 15 patients were registered, in a seven year period. Among them, five were asymptomatic and the rest were symptomatic. Asymptomatic patients were managed conservatively, except in one case in which the patient requested surgery because she also wanted a tubal ligation. Symptomatic patients all underwent surgery. All the surgeries were elective and all the surgical procedures were initiated laparoscopically. There were seven complications in the surgically managed group: conversion to laparotomy (n = 3), bowel injury (n = 2), bladder injury (n = 1), and wound infection (n = 1). Mild and severe adhesions (81.8%), and abscess (18.1%) formation related to translocated IUD (TIUD) were observed during surgery. All the patients were uneventful at 1 to 5 years of follow-up. A TIUD, by causing adhesions, complicates future laparoscopic surgery and increases the likelihood of conversion to laparotomy. While surgery is indicated to prevent TIUD-induced adhesive complications, it may also be the cause of both adhesions and complications, resulting in a vicious cycle. Some asymptomatic women, especially elderly patients with comorbidities, may not need or may be better managed without treatment. Impact statement In this study we try to find an answer for the question of "Should removal of a translocated intrauterine contraceptive device (TIUD) routinely be performed even if patients are asymptomatic?" From only the theoretical point of view there were some reports supporting conservative management in asymptomatic patients. The other studies addressing this issue were case reports including few patients with a short-term follow-up. The novelties of the present study include multi-centre design, detailed clinical and surgical information about the patients and the long period of follow-up. Most clinicians have limited experiences in managing TIUD because perforation is a rare event. So it can be difficult to know exactly what the surgeon will encounter intraoperatively. We undertook this study with the aim of providing a perspective about patients with TIUD for those faced with this situation. This is a descriptive study reporting 15 cases of TIUDs and management. Asymptomatic patients were managed conservatively, and symptomatic patients were operated. There are important implications resulting from this study that in asymptomatic patients leaving the IUD in place may be a reasonable option, mostly as the risk of surgical intervention is quite high with a high rate of complications with surgical management.

Does lymphadenectomy have influence on postoperative body fluid distribution?

OBJECTIVE: We compared the fluid volume parameters in women undergoing gynaecological surgery for benign and malignant conditions before and after surgery using bioelectrical impedance vectors. STUDY DESIGN: A total of 181 patients were enrolled. In all, 89 patients had surgery for benign conditions and 92 patients underwent oncological procedures, including lymph node dissection, for malignant diseases. Bioelectrical impedance analysis (BIA) parameters were measured on the day of hospitalisation before any treatment and at 24h and 1 month after the surgical intervention. The BIA parameters measured included extracellular water (ECW), intracellular water (ICW), and total body water (TBW). RESULTS: TBW increased significantly 1 month after surgery in all cases (p<0,05 in both group). ECW was significantly higher (p<0.05) and ICW was significantly lower (p<0,05) in the malignant group than the benign group. CONCLUSION: Radical gynaecological surgeries, including lymph node dissection, have a greater effect on body water distribution than surgeries performed for benign conditions.

Can the suburethral mesh angle be used to predict trans-obturator tape results?

ABSRACT: PURPOSE: The primary aim of our study was to evaluate mesh movement on ultrasonography and to compare the relationship between suburethral mesh angle and incontinence recurrence. METHODS: This study was carried out at the University of Selcuk, Konya, Turkey, Beyhekim State Hospital, Konya, Turkey and the Mus State Hospital between September 2012 and January 2015. In total, the results from 109 patients were evaluated in the statistical analysis. The suburethral mesh angle (SMA) is the angle between the two arms of the trans-obturator tape (TOT) mesh under the urethra. This angle was measured at 10 days, 6 months and 1 year after surgery. Potential risk factors for incontinence recurrence and SMA were compared in logistic regression models. The best cut-off value for SMA was calculated to predict incontinence recurrence. RESULTS: The mean resting SMA did not change with time during follow-up (p = 0.373). However, when comparing coughing SMA values, the first day measurement was significantly different from the other measurements. Another comparison was performed according to the cSMA value at each visit. The difference was significant from the first day. Lung disease and the change in the SMA (cSMA) on day 10 were significant predictors of treatment failure. The cSMA on day 10 to predict first-year treatment failure was 10°, with 61% sensitivity and 96% specificity. CONCLUSIONS: Measurement of the SMA can be used as a prognostic factor in TOT surgery. Further research is required to determine the importance of SMA as a prognostic factor.

The role of human epididymis secretory protein E4 in patients with endometrial cancer and premalignant endometrial lesions.

We evaluated the concentrations of human epididymis secretory protein E4 (HE4) and Ca-125 in relation to clinicopathologic features in patients with endometrial cancer and premalignant endometrial lesions. Women with abnormal uterine bleeding (n = 167) who underwent endometrial sampling were divided into four groups. Group 1: endometrial cancer (n = 68), group 2: atypical endometrial hyperplasia (n = 12), group 3: endometrial hyperplasia without atypia (n = 39) and group 4: controls (n = 48). Women with endometrial cancer exhibited higher concentrations of HE4 levels than controls (91.4 pmol/L vs. 46.2 pmol/L, p < 0.001). HE4 levels were significantly higher in patients with lymphatic involvement, deep myometrial invasion, lymphovascular space involvement and non-endometrioid histology (p < 0.001). The sensitivity, specificity, positive and negative predictive values for HE4 in detecting endometrial cancer were 72.7%, 84.4%, 80% and 78.4%, respectively. Preoperative HE4 levels are more elevated in women with endometrial cancer than those with benign endometrium as well as in women with prognostic high-risk factors with endometrial cancer. HE4 may be used as an additional marker in combination with other clinicopathologic features for planning the treatment.

Is the Mean Platelet Volume a Predictive Marker of a Low Apgar Score and Insulin Resistance in Gestational Diabetes Mellitus? A Retrospective Case-Control Study.

INTRODUCTION: Gestational diabetes is defined as various degrees of glucose intolerance diagnosed or detected for the first time during pregnancy and is the most common metabolic complication of pregnancy. Early diagnosis and adequate treatment are important to prevent complications. Pre-eclampsia, polyhydramnios, fetalmacrosomia, and operative delivery are some of the complications seen in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM). AIM: The present study was designed to determine whether there was an association between Mean Platelet Volume (MPV) in predicting poor fetal outcome, insulin resistance, neonatal Apgar scores and gestational age for women with GDM. MATERIALS AND METHODS: In this retrospective study, we enrolled 101 pregnant women with GDM together with a group of 138 healthy controls. MPV, insulin and homeostatic model assessment (HOMA-IR) values were measured at 24-28 weeks of the pregnancy. An independent samples t-test was used to compare MPV values. Multivariate linear regression models were used to establish relations between MPV values, HOMA-IR, insulin levels and Apgar score. RESULTS: There was a significant positive correlation between MPV values, HOMA-IR and Insulin levels and a negative correlation with Apgar score at 1 min and 5 min in the GDM group (r=0.227, p=0.02; r=0.206, p=0.03; r=-0.485, p<0.001; and r=-0.399, p<0.001, respectively). In the multivariate logistic regression analysis, a high MPV value was most consistently associated with a low Apgar 1 min score (ß=-0.387, p=0.003) in the GDM group. An MPV of >8.0 fL had a sensitivity of 82% and a specificity of 75% for the prediction of GDM. CONCLUSION: We investigated the potential of MPV values in predicting low Apgar scores and insulin resistance in women with GDM.

Comparison of the Efficiency of Posterior Intravaginal Sling (PIVS) Procedure in Older and Younger Groups.

INTRODUCTION: Vaginal vault prolapsus is a challenging problem for the patients and physicians. There may be differences between young and elderly patients in terms of efficiency and safety of surgical procedures. AIM: The aim of our study was to compare the efficiency of the Posterior Intravaginal Sling (PIVS) procedure in older versus younger patient groups. MATERIALS AND METHODS: A total of 40 patients who underwent the PIVS procedure were chosen. Twenty of these patients were younger than 60 years of age (Group I) while the other 20 patients were 60 years of age or older (Group II). Preoperative Pelvic Organ Prolapsed Quantification (POP-Q) reference points were compared with postoperative data at the first year following surgery. Student's t-test was used to analyse continuous variables and the χ(2) test was used to analyse categorical data. The Mann-Whitney test was used for data that were not normally distributed. RESULTS: Anatomical cure rates were 90 percent in both groups (p=1.00). There were significantly greater improvements in POP-Q points in group I than group II. CONCLUSION: It could be concluded that PIVS as minimally invasive procedure for vaginal vault prolapsed and is effective in all age groups.

Urethral Coitus in a Case of Vaginal Agenesis - Is Only Vaginoplasty Enough to Treat the Urinary Problems?

Urethral coitus is an extremely rare condition. Megalourethra and urinary incontinence due to urethral coitus in vaginal agenesis are unusual manifestations because these patients usually present with primary amenorrhea before becoming sexually active and receive treatment. A 24-year-old woman came to our clinic because of primary amenorrhea, sexual dysfunction, dyspareunia, megalourethra and urinary incontinence five months after her marriage due to urethral coitus. Based on these clinical and radiological findings a diagnosis of Mayer-Rokitansky-Kuster-Hauser Syndrome was made and patient underwent modified McIndoe Vaginoplasty. The elasticity of female urethra permits repeated coitus, together with the physical damage can probably lead to incontinence. In this case, after eliminating the underlying cause of disease with vaginoplasty, no other treatment was required. The integrity of sphincteric function and structural support of urethra might be regained without subjecting the patient to aggressive reconstructive surgical procedures.

Sexual functioning before and after vaginal hysterectomy to treat pelvic organ prolapse and the effects of vaginal cuff closure techniques: a prospective randomised study.

OBJECTIVE: To evaluate sexual function in women before and after vaginal hysterectomy (VH) and to compare the effects of horizontal and vertical vaginal cuff closure on sexual function. STUDY DESIGN: Women with uterine prolapse of stage 2 or higher were included to this prospective, randomized study. All patients underwent VH with McCall Culdoplasty and patients were randomized into two groups in terms of the vaginal cuff closure technique employed which is either vertically (group 1, right to left) or horizontally (group 2, anterior to posterior). Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 Short Form was used to assess sexual function before and 6 months after surgery. RESULTS: A total of 78 women participated, 37 in group 1 and 41 in group 2. Significant improvements in were thus evident in both groups 1 (p=0.000) and 2 (p=0.000) after surgery; no significant between-group differences were evident. Overall, 61 women (78,2%) had improved PISQ-12 scores postoperatively, 11 (14,1%) scored the same pre- and post-operatively, and 6 (7,9%) scored lower postoperatively. Women who reported poorer sexual function postoperatively, or no improvement, had new-onset or worsening dyspareunia and/or incontinence. CONCLUSION: Most women with uterine prolapse of stage 2 or higher who underwent VH with prolapse repair experienced improved sexual lives postoperatively, regardless of the cuff closure technique used. Although VH to treat POP improves anatomical and sexual concerns, surgery per se may have negative effects on sexual function if new-onset or worsening dyspareunia or incontinence develop.

Diagnostic Value of Visual Examination of Cervical Polypoid Lesions and Predictors of Misdiagnosis.

OBJECTIVES: This study reviews occasions when cervical polyps removed in an outpatient setting proved not to be cervical polyps histologically. We aimed to identify any anatomical and/or clinical characteristics that predict 'incorrect diagnosis" in general practice. METHODS: A retrospective study of consecutive 345 patients who were initially diagnosed with cervical polyps based on a routine gynecological examination in an outpatient setting was included. After histopathological examination, the patients were divided into 2 groups: those with cervical (correct diagnosis, n = 307) and falsely diagnosed with cervical polyps (FDP, n = 38). These 2 groups were compared in terms of age, signs and symptoms, and size of the polypoid lesions. RESULTS: The initial clinical diagnosis was correct in 307, giving a positive predictive value of 89%. There were no significant difference between the groups with respect to age of patients (p = 0.59) and the size of the lesions (p = 0.42). According to our study, among misdiagnosed patients, nabothian cysts and cervicitis were the most common histological findings; FDPs were more often symptomatic (p < 0.001) and coexisted more frequently with inflammation or ulceration (p < 0.001). All FDPs were developing within the endocervical canal. There were no instances of FDPs that arise from ectocervix. Symptomatic polypoids have a higher risk of preliminary misdiagnosis (OR = 13.0; 95% confidence interval, 3.0-55.1). CONCLUSIONS: All cervical polypoid lesions must be sent to pathology because visual diagnosis is not sufficiently accurate to direct patient care.

Primary Ovarian Malignant Mixed Mullerian Tumour: A Case Report and Brief Review of Literature.

Malignant Mixed Mullerian Tumour of the Ovary (OMMMT), also referred to as carcinosarcoma is a very rare tumour accounting for less than 1% of all ovarian cancers. Due to the rarity of OMMMT, little is known about the disease course and outcome of women with these tumours. It is important to evaluate because of its aggressive behaviour with extremely unfavourable prognosis. These tumours are composed of both malignant epithelial and mesenchymal elements. Current data in the literature is still limited to small case series and case reports, therefore, its optimal treatment is somewhat controversial. In the current report, we introduce a case of OMMMT which was successfully treated with Platinum-based combination chemotherapy after optimal cytoreductive surgery. The clinical manifestations, pathologic characteristics, diagnosis and management of these tumours are reviewed here. Although the most effective treatment is currently unknown, optimal cytoreductive surgery and platinum-based chemotherapy appears to improve the outcomes. Despite the aggressive nature of this tumour and its poor response to the treatment, management works best when cancer is found early. The stage of the disease is the most important prognostic factor. Therefore, the crucial question is how to diagnose the cancer at earlier stages rather than seeking the optimal treatment.

Uterine Tumour Resembling Ovarian Sex Cord Tumour- A Rare Entity.

Uterine Tumour Resembling Ovarian Sex-Cord Tumours (UTROSCTs) are an extremely rare type of uterine body tumours arising from the endometrial stroma. Epidemiology, aetiology, pathogenesis, management and natural history of UTROSCTs are still a question of debate, as there is little available data in the literature. Although rare, the possibility of UTROSCTs should be kept in mind, when a patient presents with abnormal bleeding and an enlarged uterus. UTROSCTs appear dirty white/cream-coloured, gelatinous, well-circumscribed mass with smooth surface on macroscopic examination. We present a rare case of endometrial stromal tumour with sex-cord-like differentiation which was successfully treated by hysterectomy with bilateral salpingo-oophorectomy. The clinical manifestations, pathologic characteristics, diagnosis and management of these tumours are reviewed here.

Relations of Serum Visfatin and Resistin Levels with Endometrial Cancer and Factors Associated with its Prognosis.

BACKGROUND: The aims of this study were compare the serum visfatin and resistin levels between endometrial cancer (EC) patients and controls and evaluate their power to predict prognosis. MATERIALS AND METHODS: This prospective study was conducted between March 2013 to June 2014 on the Gynecologic Oncology Department of the University of Selcuk, Konya, Turkey. A total of 42 EC patients and 42 controls were included and assessed for differences in serum visfatin and resistin levels, along with prognostic factors. RESULTS: Endometrial cancer patients had significantly higher visfatin levels than control s (p: 0.011), associated with deep myometrial invasion (p: 0.019). In contrast the serum level of resistin did not significantly differ between EC patients and controls (p: 0.362). However, high resistin level in EC patients was associated with increase lymph node metastasis (p: 0.009). On logistic regression analysis, we found that serum visfatin elevation was associated with risk of myometrial invasion (OR: 1,091; 95%CI: 1.021- 1.166; p: 0.010) and serum resistin with risk of lymph node metastasis (OR: 1.018; 95%CI: 1.000- 1.035; p: 0.046). For myometrial invasion prediction, a serum visfatin level greater than 26.8 ng/mL demonstrated a sensitivity and specificity of 66.6 % and 96.4%, respectively. For lymph node metastasis prediction, the best cut-off for serum resistin level was 599ng/mL. A serum resistin level greater than this demonstrated a sensitivity and specificity of 87.5% and 77.1%, respectively. CONCLUSIONS: Our data suggest that serum visfatin is elevated in patients with EC and serum visfatin and resistin levels could be used to predict the risk of advance stage lesions.

Serum levels of neopterin in gestational diabetes mellitus: the relationship with Apgar scores.

PURPOSE: This study was designed to evaluate neopterin levels and low Apgar scores in pregnancies with gestational diabetes mellitus (GDM) vs. normal control pregnancies. METHODS: We carried out a cross-sectional study by enrolling 81 pregnant women with GDM and 38 pregnant women without GDM. RESULTS: Maternal and cord blood neopterin levels were higher in women with GDM. There was a significant positive association between fasting blood glucose levels and maternal serum neopterin levels. The results of 50-g oral glucose challenge tests revealed a correlation between maternal and cord neopterin levels. Pregnancies complicated by GDM exhibited lower fetal Apgar scores than those of control subjects. The levels of cord blood neopterin were inversely correlated with an fetal Apgar score of 1 min in patients with GDM. CONCLUSIONS: Patients with GDM had higher maternal and cord blood neopterin levels, and the cord blood neopterin levels are inversely associated with lower Apgar scores in women with GDM. The neopterin levels might be potential predictors of low fetal Apgar scores in women with GDM.

Effect of the percentage of body fat on surgical, clinical and pathological outcomes in women with endometrial cancer.

AIM: This study used the measure of percentage of body fat (%BF) to define obesity and evaluated the effect of percentage of %BF on clinical, surgical and pathological features in women with endometrial cancer. METHODS: Between 2011 and 2013, bioelectrical impedance analysis and body size measurements of 94 patients whose endometrial biopsy revealed endometrial cancer were obtained. Patients were divided into two groups according to body mass index (BMI) (normal, < 30 kg/m(2); elevated, ≥ 30 kg/m(2)), and also classified by %BF (normal, < 32%; elevated, ≥ 32%). RESULTS: The patients' mean age was 55.0 ± 10.9 years. Mean %BF and BMI were 40.8% ± 9.8% and 32.9 ± 7.5, respectively. Eighty-three (88%) patients were obese according to %BF; 54 (57%) were obese according to BMI. Patients with elevated %BF were more likely to have less than 50% myometrial invasion (P = 0.004). Significantly more para-aortic lymph nodes were retrieved in patients with normal %BF or BMI (P < 0.001, P < 0.001). Patients with elevated %BF had longer operating times (P = 0.043) and were more likely to have stage I disease than patients with normal %BF (P < 0.001). CONCLUSION: Endometrial cancer patients with an elevated %BF are more likely to have stage I disease and less than 50% myometrial invasion than patients with normal %BF. Defining obesity by BF may provide better estimation of obesity prevalence in patients with endometrial cancer and further understanding the relationship between BF with endometrial cancer may give more information about the effects of obesity on endometrial cancer.

Is the simple closure technique effective in the treatment of genital fistulas?

Aim. Genitourinary fistulas are bothersome clinical entities not only for the patient but also for the treating surgeon as well. A lot of surgical procedures have been proposed; however, most of the fistulas can be easily treated with plain surgical techniques, such as the simple surgical closure of the fistula tract. Material and Method. The study was carried out in the urogynecology department of Ankara Etlik Zübeyde Hanim Maternity Training and Research Hospital. The study included 12 cases with vesicovaginal fistulas and 15 cases with rectovaginal fistulas. Twenty-six patients underwent simple surgical closure technique. The age, the referral time to the hospital, the longest diameter of the fistula opening, the hospitalization time, the follow-up period and identifiable risk factors of the patients were evaluated. Results. Caeserean section was detected as primary risk factor for vesicovaginal fistulas and prolonged labor was detected as the most important risk factor for rectovaginal fistulas. In our study, we found that the simple closure technique cured 91% of vesicovaginal fistulas and 93% of rectovaginal fistulas. Conclusion. The simple closure technique has very high cure rates for both vesicovaginal and rectovaginal fistulas when the longest diameter of the fistula openings is ≤5 mm.