Background: We aimed to investigate the outcomes of anterior and posterior approaches in patients who underwent sacrospinous ligament fixation for apical prolapse. Methods: The study included hysterectomized women with grade ≥2 apical prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system, who presented to our center between 2019 and 2022. Out of the 48 patients included in the study, 24 underwent posterior bilateral sacrospinous ligament fixation (PB-SSLF), while the other 24 underwent anterior bilateral sacrospinous ligament fixation (AB-SSLF). Postoperative anatomical recurrence of anterior vaginal wall prolapse, according to the POP-Q system, was defined as follows: cystocele ≥ stage II (Aa or Ba ≥–1 cm), recurrent apical prolapse ≥ stage II (C ≥–1 cm), and posterior vaginal wall prolapse ≥ stage II (Ap or Bp ≥–1 cm). Postoperative follow-up visits were scheduled routinely at 1, 3, 6, and 12 months after the operation, and then annually. Complications were recorded according to the Clavien-Dindo classification. Rates in the groups were compared using the Chi-square test. Independent two-group comparisons of numerical variables were performed using the Student t-test when the normal distribution assumption was met and the Mann-Whitney U test when the assumption was not met. The significance level (alpha) was set at p < 0.05. Results: No significant difference was observed in terms of postoperative anterior recurrence between the groups that underwent bilateral anterior and posterior SSLF (16.7% each). Regarding the operation durations, the group that underwent AB-SSLF had longer operation times compared to the group that underwent PB-SSLF (80 minutes and 42.5 minutes, respectively). A higher incidence of postoperative urinary dysfunction was observed in patients who underwent anterior bilateral sacrospinous ligament fixation (p = 0.012). No grade 3b or higher complications were observed according to the Clavien-Dindo classification. Conclusions: AB-SSLF is an effective method in the surgical treatment of apical and anterior pelvic prolapse. However, the anterior compartment failure rate is still a limitation. Further research is required to investigate its long-term efficacy.

Background/Aim: Recognition and assessment of apical vaginal support defects remains a significant challenge in the evaluation and management of prolapse because there are no consensus or guidelines address the degree of apical support loss at which an apical support procedure should routinely be performed. The aim of this study was to evaluate whether preoperative genital hiatus (GH), perineal body (PB), and total vaginal length (TVL) are associated with prolapse recurrence after apical prolapse surgery. Methods: Our cohort study included 98 patients who underwent vaginal hysterectomy apical suspension due to uterovaginal prolapse of grade 2 or higher according to Pelvic Organ Prolapse Quantification (POP-Q) staging between 2020 and 2021. Patients with a history of gynecologic malignancy, those who could not tolerate surgery or anesthesia, those who had previously undergone pelvic organ prolapse surgery, those with concomitant stress urinary incontinence, and those with abnormal cervical smear results were excluded. Patients were followed for 2 years at intervals of 3 months in the first year after the surgery. The last POP-Q was performed 24 months after surgical intervention. Surgical failure or recurrence was defined as apical descent greater than one third of the total vaginal length, anterior or posterior vaginal wall past the hymen, subsequent surgery, or bothersome vaginal bulge. Patients were given the Pelvic Organ Prolapse Symptom Score (POP-SS) questionnaire before surgery and 6 months postoperatively, and the severity of symptoms was compared between the groups with and without postoperative recurrence. Logistic regression (LR) analysis was performed to determine the factors affecting recurrence. Areas under the ROC curve were calculated as a differential diagnosis for the presence of recurrence, and the predictive value (cut-off) of variables was determined using sensitivity, specificity, positive predictive value, negative predictive value, and LR (+) values. Results: While surgery was successful in 80 patients, genital relapse was seen in 18 patients. The mean preoperative perineal body was 3.05 (0.28) cm, mean preoperative GH was 3.9 (0.39) cm, and mean preoperative TVL was 8.54 (1.33) cm. The mean GH of the group with recurrence was significantly higher than the group without recurrence (P=0.004). The mean preoperative POP-SS score was 15.14 (1.86), and the postoperative POP-SS score was 4.01 (3.74). The postoperative POP-SS score mean of the recurrence (+) group was significantly higher than the group without recurrence (P<0.001). For the genital hiatus, the cut-off >4 cm had a sensitivity of 61.11%, specificity of 76.25%, positive predictive value of 36.70%, negative predictive value of 89.70%, and LR (+) value of 2.57. For POP-SS Preop-Postop Change %, the cut-off 4 cm is a strong predictor of apical support loss. This simple measurement can be used to screen for apical support loss and further evaluate apical vaginal support before planning a hysterectomy or prolapse surgery. '+st+' Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010 Nov;116(5):1096-100. doi: 10.1097/AOG.0b013e3181f73729. PMID: 20966694. DOI: https://doi.org/10.1097/AOG.0b013e3181f73729 Brown HW, Hegde A, Huebner M, Neels H, Barnes HC, Marquini GV, et al. International urogynecology consultation chapter 1 committee 2: Epidemiology of pelvic organ prolapse: prevalence, incidence, natural history, and service needs. 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Aim: To evaluate the predictive value of preoperative ratio of neutrophils to lymphocytes (NLR) in distinguishing between benign and malignant masses, as inflammation plays a significant role in the development and emergence of cancer. Material and Method: This retrospective study included 155 patients who underwent surgery due to an adnexal mass between December 2020 and December 2021 (55 were malignant, 100 were benign). Age, parity, tumor stage, chemotherapy, CA 125, CRP, neutrophils, lymphocytes, NLR, were recorded. The Mann-Whitney, the Chi-square test and multiple linear regression were used. The cut-off values of the variables were determined by calculating the areas under the receiver operating characteristic curve (ROC) for the purposes of differential diagnosis in the presence of malignancy, and by analyzing the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood-ratio (LR) (+) values. A P-value of 2.79 for NLR; sensitivity was found to be 59.36%, specificity 75.51%, positive predictive value (PPV) 58.44, negative predictive value 75.58, LR (+) value 2.3. At cut-off> 36.9 for CA-125; sensitivity was 80.00%, specificity was 78.63%, positive predictive value was 67.72%, negative predictive value was 87.53%, LR (+) value was 3.73. Conclusion: The primary outcome of our study is that the likelihood of malignancy in a patient with an NLR value of>2.79 is 2.3 times higher than in a patient with an NLR value of 36.9 is 3.73 times higher than in a patient with a CA-125 value of <36.9.

Background/aim: The optimal technique for vaginal vault prolapse correction has yet to be identified. This study aimed to evaluate the anatomic and functional outcomes of women who underwent vaginal natural orifice transluminal endoscopic high uterosacral ligament suspension (vNOTES HUSLS) or laparoscopic lateral suspension (LLS). Materials and methods: This retrospective study included symptomatic women with stage ≥2 vault prolapse who underwent vNOTES HUSLS or LLS between January 2019 and June 2022 at a tertiary center. The surgical efficacy, postoperative outcomes, complication rates, and recurrence frequencies of these procedures were compared. The primary outcomes of the study included anatomical success, patient-reported (subjective) success, and recurrence rates. Results: The study included 64 women, 32 of whom underwent vNOTES HUSLS and 32 of whom underwent LLS. Demographic characteristics and preoperative Pelvic Organ Prolapse Quantification (POP-Q) values were comparable (p > 0.05). The mean Patient Global Impression of Improvement (PGI-I) score did not differ significantly between the groups (1.6 ± 0.8 vs. 1.7 ± 0.7, p = 0.344). Improvements in terms of sexual function scores (p < 0.001) were observed postoperatively in both groups. No difference was observed in postoperative sexual questionnaires scores (p > 0.05). Vault suspension by vNOTES produced better results only for point Ba (most distal portion of the remaining upper anterior side of the vaginal wall) of the POP-Q score (p = 0.03). The incidence rates and types of postoperative complications and recurrences were similar between the groups. Conclusion: Both vNOTES HUSLS and LLS safely support the vault and restore the normal vaginal anatomy with similar effectiveness. Functional results were also similar and satisfactory between the groups.

Background: Progesterone is essential for maintaining pregnancy. Spiral arteries, providing blood flow to the placenta, undergo changes in early pregnancy, reducing uteroplacental resistance. Our study was aimed at investigating the relationship between the first trimester serum progesterone levels, spiral artery Doppler findings and pregnancy outcome. Methods: This observational retrospective cohort study included 126 pregnant women at 11–14 weeks of gestation, confirmed by last menstrual period and ultrasonography. Between 11–14 weeks, serum progesterone levels were measured and spiral artery pulsatility index (PI), resistive index (RI), peak systolic velocity (PSV) and systolic/diastolic ratio (S/D) values were recorded. Pregnant women were followed up until delivery, and serum progesterone levels and spiral artery Doppler findings were compared between patients with poor perinatal outcomes and others. Results: This study included 126 pregnancies, of which 13 patients were lost to follow-up. Miscarriage occurred in 2 of the pregnant women, stillbirth in 1, intrauterine growth retardation in 10 and preeclampsia in 5 of them. 6 infants developed respiratory problems and 3 infants developed jaundice. Seventeen of the infants were hospitalized in the neonatal intensive care unit. There was no statistically significant difference between serum progesterone, spiral artery PI, RI and S/D values of 86 uncomplicated and 27 complicated pregnant women. Conclusions: It is known that there is a strong relationship between the first trimester serum levels of progesterone, which is an important hormone for the healthy continuation of pregnancy, and the risk of miscarriage. The quantity and quality of placental and fetal circulation is determined by the changes that occur in the spiral arteries with pregnancy. Although a close relationship is known between both variables and pregnancy outcomes, no correlation could be established between them in terms of early detection of poor perinatal outcomes.