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    Balci technique for suspending vaginal vault at vaginal hysterectomy with reduced risk of vaginal vault prolapse
    (WILEY, 2011) Balci, Osman; Capar, Metin; Acar, Ali; Colakoglu, Mehmet Cengiz
    Aim: The aim of this study was to evaluate the efficacy of a new technique of suspending the vaginal vault at vaginal hysterectomy (VH) for total uterine prolapse. Material and Methods: This prospective study included 65 patients (group 1) in whom VH was performed using the new technique and 110 patients (group 2) in whom VH was performed using the traditional method. Both groups were followed up for 4 years. The incidences of vaginal vault prolapse (VVP), total vaginal length (TVL) (location of vaginal cuff), intraoperative and postoperative complications and sexual function were compared. Results: There were no statistically significant differences between the two groups regarding age, parity, body mass index (BMI), blood loss, intraoperative and postoperative complications, and sexual function. One (1.5%) patient had VVP in group 1, whereas 12 (10.9%) patients had VVP in group 2. TVL in group 1 was 8.9 +/- 1.2 cm while in group 2 it was 5.9 +/- 0.8 cm. The operation times were 57 +/- 5 min and 76 +/- 9 min in group 1 and group 2, respectively. There was a statistically significant difference between the two groups regarding VVP (P = 0.022), TVL (P < 0.001) and operation time (P < 0.001). The two groups were also compared regarding anterior and posterior prolapse after 4 years: group 1 had less anterior and posterior prolapse (stage II or more) than group 2 (P = 0.041, P = 0.047), respectively. Conclusion: In this new technique, compared to the traditional technique, there was a lower incidence of VVP, greater TVL was achieved and the duration of the operation was shorter.
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    Does tenaculum application to the cervix during intrauterine insemination affect pregnancy rates?
    (TAYLOR & FRANCIS AS, 2009) Balci, Osman; Acar, Ali; Colakoglu, Mehmet Cengiz
    Intrauterine insemination (IUI) consists of sperm cell extraction from seminal plasma and artificial transfer into the uterine cavity. We investigated whether tenaculum application to the cervix during IUI affects pregnancy rates. A prospective study was done on 468 primary infertile women. Recombinant follicle stimulating hormone was used in ovulation induction. The women were divided randomly into Group 1 (n = 236) and Group 2 (n = 232) without and with tenaculum application to the cervix, respectively. After IUI, a five-minute sagittal plane uterine ultrasound scan was done in all cases. Uterine contraction was recorded. The women were evaluated for pregnancy rates. Uterine contraction was significantly higher in Group 2 (p < 0.001). In all, 24 patients in Group 1 (10.7%) and 38 in Group 2 (17.6%) achieved pregnancy (OR = 1.78, 95% CI 1.03-3.08; p = 0.038). Tenaculum application to the cervix increases immediate uterine contraction, but higher pregnancy rates may be obtained.
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    Effect of pre-amniocentesis counseling on maternal pain and anxiety
    (WILEY, 2011) Balci, Osman; Acar, Ali; Mahmoud, Alaa S.; Colakoglu, Mehmet Cengiz
    Aim: The aim of this study was to evaluate the levels of anticipated and perceived pain and anxiety in expectant mothers at the times of pre-counseling, post-counseling, and post-amniocentesis and to investigate the effect of pre-amniocentesis counseling on the level of pain and anxiety. Materials and Methods: This prospective study was carried out on 240 women with singleton pregnancies at mid-trimester. The maternal pain and anxiety levels associated with the procedure were evaluated using the visual analogue scale. Perceived pain and anxiety were assessed before and after counseling the pregnant woman about amniocentesis, and after amniocentesis. Results: Median anticipated pain levels before (pain 1) and after pre-procedure counseling (pain 2) were 5 and 4, respectively. The actual pain after the procedure (pain 3) was 3. Median levels of anxiety felt by the patients before (anxiety 1) and after pre-procedure counseling (anxiety 2) were 6 and 3, respectively, while the median anxiety after the procedure (anxiety 3) was 5. For the pain and anxiety measurements, the results for each of the comparison times were significantly different from the results for the other two comparison times (P < 0.001). Conclusion: Adequate pre-amniocentesis counseling effectively reduces the actual level of pain and anxiety felt by the mother undergoing mid-trimester amniocentesis.