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    ÇOCUKLAR İÇİN ÖZEL GEREKSİNİM RAPORU (ÇÖZGER)’NA BAŞVURAN OLGULARIN PSİKİYATRİK TANI VE ÖZEL GEREKSİNİM DÜZEYLERİNİN ÖNCEKİ YÖNETMELİKTEKİ TANI VE ÖZÜR ORANLARI İLE KARŞILAŞTIRILMASI: RETROSPEKTİF ÇALIŞMA
    (2022) Akar, Bertan; Doğan, Ozan; Köle, Emre; Caliskan, Eray
    Amaç: Tekrarlayan implantasyon başarısızlığı (RIF) zorlu bir gerçek olduğundan, bu sorunun üstesinden gelmek için farklı terapötik immünomodülatör ajanların etkileri araştırılmaktadır. Bu çalışma, intralipidin RIF'li IVF hastalarının gebelik sonuçları üzerindeki etkisini değerlendirmeyi amaçlamıştır. Yöntem: Katılımcıların 116'sı sadece kısa antagonist protokolünü alan kontrol grubuna, 106'sı ise intravenöz lipid (SMOFlipid®) verilerek intralipid grubunda yer aldı. İntralipid, embriyo transferinin olduğu gün, pozitif gebelik testinin olduğu gün verildi ve gebeliğin onuncu haftasına kadar haftalık olarak devam edildi. İmplantasyon oranı, biyokimyasal gebelik oranı, klinik gebelik oranı ve canlı doğum oranı değerlendirildi. Bulgular: Pozitif gebelik testi, klinik gebelik oranı ve canlı doğum oranı İntralipid grubunda istatistiksel olarak anlamlıydı (p<0,001) (sırasıyla %50,9'a karşı %22,4, %41.5'e karşı %19,8, %29,2'ye karşı %10,3) ). İmplantasyon, spontan abortus, çoğul gebelik ve kimyasal gebelik oranları açısından gruplar arasında anlamlı fark yoktu (p>0.05). Sonuç: Bu çalışma, intralipid tedavisinin, sadece standart IVF protokolü uygulanan hastalara kıyasla RIF'li hastalarda daha iyi gebelik sonuçlarına sahip olduğunu ortaya koymuştur. RIF'li hastalarda intralipidin rutin kullanımını önermek için daha ileri prospektif çalışmalara ihtiyaç vardır.
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    Expectant management vs. cerclage in cases with prolapsed or visible membranes in the second trimester: is 24 weeks gestation threshold critical?
    (Walter De Gruyter Gmbh, 2024) Kole, Emre; Akar, Bertan; Dogan, Yasemin; Yalcinkaya, Leylim; Doger, Emek; Caliskan, Eray
    Objectives: The aim of this study was to compare the efficacy of cervical cerclage with spontaneous follow-up strategy on pregnancy duration and neonatal outcomes in women with visible or prolapsed fetal membranes. Methods: Patients who were referred to a single tertiary care centre between 1st January 2017 and 31st December 2022 were included in this comparative, retrospective cohort study. Patients were divided into two groups, those undergoing cerclage and those followed with no-cerclage. The range of pregnancy weeks for cerclage is between 18th and 27+6 weeks. Results: A total of 106 cases were reviewed and nine were excluded. Based on shared decision making, cervical cerclage was performed in 76 patients (78.3 %) and 21 patients (21.6 %) were medically treated in no-cerclage group if there was no early rupture of the fetal membranes. The gestational age at delivery was 29.8 +/- 6 [Median=30 (19-38)] weeks in the cerclage group and 25.8 +/- 2.9 [Median=25 (19-32)] weeks in the no-cerclage group (p=0.004). Pregnancy prolongation was significantly longer in the cerclage group compared to the no-cerclage group (55 +/- 48.6 days [Median=28 (3-138)] vs. 12 +/- 17.9 days [Median=9 (1-52)]; p<0.001). Take home baby rate was 58/76 (76.3 %) in cerclage group vs. 8/21 (38 %) in no-cerclage group. In the post-24 week cerclage group the absolute risk reduction for pregnancy loss was 50 % (95 % CI=21.7-78.2). Conclusions: Cervical cerclage applied before and after 24 weeks (until 27+6 weeks) increased take home baby rate in women with visible or prolapsed fetal membranes without increasing adverse maternal outcome when compared with no-cerclage group.
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    Female Sexual Function Index Outcome After Posterior Vaginal Tightening Approach and Anterior Cervical Ring Repair when Indicated
    (Springer, 2025) Kole, Emre; Akar, Bertan; Deniz, Alparslan; Kole, Merve Cakir; Aslan, Erdogan; Caliskan, Eray
    BackgroundFemale sexual dysfunction is believed to be associated with pelvic floor dysfunction in most cases. However, correcting prolapse does not always necessarily correct sexual function. The reason for this might be secondary to disregarding anatomically relevant structures during surgical interventions. We aimed to demonstrate that posterior vaginal tightening approach avoiding anteriorly located structures, such as clitoral complex, would yield better results in terms of sexual function.MethodsFifty-seven postmenopausal women with primary complaints of vaginal laxity and Grade I and II prolapse were operated. All patients received posterior vaginal tightening operation, and a cervical ring repair was utilized when indicated (n:25). Perineal repair was done if there was any defect (n:13). Levator plication is not done in any patients. FSFI (Turkish Version) was applied to each patient prior to surgery and at 6th month postoperatively. A Likert-type scale is also utilized to assess the patient satisfaction from the procedures.ResultsAll the domains and the total score of FSFI were observed to be improved. Only the improvement in the pain domain scores was not statistically significant. Satisfaction of the patients from the surgery on a Likert scale was so as to: very satisfied 27 (47.4%), satisfied 12 (21.1%), neither satisfied nor dissatisfied 8 (14%), dissatisfied 5 (8.8%), very dissatisfied 1(1.7%).ConclusionSexual function of women with vaginal laxity can be improved when vulvovaginal erotogenic complex is not disrupted. This can be achieved via a posterior approach while maintaining successful anatomic correction of both posterior and anterior compartments.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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    Hymenoplasty Experience: Factors Associated with Dehiscence (Hymenoplasty Complications)
    (2025) Cömert, Erhan; Köle, Emre; Saraç, Ömer Doğukan; Doğan, Ozan; Caliskan, Eray
    Purpose: To evaluate outcome of hymenoplasties in private clinics and investigate the factors affecting the risk of dehiscence Method: A retrospective cross-sectional survey of Obstetrics and Gynecology specialists trained over the last five years was conducted. Specialists from private clinics completed surveys on hymenoplasties performed. Rates and types of complications were requested and factors associated with wound dehiscence in patients undergoing permanent hymenoplasty was investigated with multivariate analysis. Results:. A total of 968 patients were included. Hymenoplasty was performed for revirgination in 874 cases (90.2%), incision of the hymen for gynecological procedures in 82 (8.4%) cases and trauma in 12 cases (1.2%). Complications included wound dehiscence (26.1%), infection (1.7%), bleeding (1.7%), pain (1.5%), itching (1.4%) and dyspareunia (0.5%). The technique was permanent in 714 cases and temporary in 254 cases. Among the permanent hymenoplaty cases, multivariate logistic regression analysis showed that obesity (OR=3.1, 95%CI: 1.5-6.2, p=0.001) and tobacco use (OR=2.2, 95%CI: 1.3-3.8, p=0.003) increases the risk of dehiscence. Sedation decreased the risk of dehiscence when compared to local infiltration anesthesia (OR=0.56, 95%CI: 0.33-0.99, p=0.04). Every decrease in the polyglactin suture caliber decreased the risk of dehiscence (OR=0.22, 95%CI: 0.16-0.3, p<0.001) This study showed that using 5.0 sutures, omitting infiltration anesthesia, and avoiding tobacco use may help decrease wound dehiscence after hymenoplasty.
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    Is it possible to predict severe postpartum hemorrhage and the need for massive transfusion in placenta previa cases?
    (Via Medica, 2025) Kole, Emre; Akar, Bertan; Doger, Emek; Kole, Merve Cakir; Anik, Yonca; Caliskan, Eray
    Objectives: The aim was to construct a reliable working model for patients with placenta previa (PP) that aids in the prediction of postpartum bleeding potential with data from antenatal imaging studies using both ultrasound (US) and magnetic resonance imaging (MRI). Material and methods: Forty-three patients with PP were evaluated initially with the US and then by 3-Tesla MRI. The placenta accreata index (PAI) was used during the US evaluation in order to define the risks. Uterine bulging, heterogeneous signal, dark placental bands, focal interruption of myometrium and tenting of bladder wall were regarded as predictive criteria in MRI evaluation. The correlation between the findings from US and MRI studies and subsequent haemorrhage, < 1000 mL, > 1000 mL and severe haemorrhage (> 2000 mL) and massive transfusion [> 5 units of red blood cells (RBC)] were used to build this predictive model. The findings from the imaging studies were also confirmed histopathologically. Results: In the multivariate analysis of data from patients stratified by bleed size either < 1000 mL or > 1000 mL, none of the MRI and ultrasound findings were found to be predictive. The multivariate analysis was done using the second stratification cut-point of 2000 mL, in patients bleeding > 2000 mL PAI values [OR: 2.3 (1.4-3.8)] and overall MRI reported placenta accreata spectrum [OR: 4.9 (1.8-12.9)] were found to be predictive. While MRI findings were not discriminative between transfusion groups, grade 3 loculation on US examination was found to be predictive for the need of transfusion of > 5 units [OR: 67.5 (8.2-549.4)]. There were no cases needing hysterectomy. Conclusions: Ultrasound and MRI findings in cases of PP can be helpful in predicting postpartum bleeding.
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    Labiaplasty Outcomes and Complications in Turkish Women: A Multicentric Study
    (Springer London Ltd, 2024) Koele, Emre; Dogan, Ozan; Arslan, Gaye; Koele, Merve cakir; Aslan, Erdogan; Caliskan, Eray
    Introduction and HypothesisWe aimed to evaluate the outcomes, complication rates, and complication types of different labiaplasty techniques.MethodsIn this cross-sectional retrospective study, a total of 2,594 patients who underwent surgery owing to hypertrophy or asymmetry of the labium minus were retrospectively analyzed. Data were collected by individual interviews with 43 experts from different centers. The patients were between 18 and 50 years of age. During the interview information about the presence and nature of complications, and about concomitant or revision surgeries, were gathered. The surgeons who performed these surgeries were also questioned about their training and surgical experience.ResultsThe most frequently observed complication was complete dehiscence, accounting for 29% of all complications. Complete dehiscence was most commonly seen after wedge resection (16 cases). The second most common complication was labium majus hematoma, accounting for 12.5% of all cases. Among the labiaplasty techniques, wedge resection had the highest complication rate at 3% (26 cases out of 753 patients). This was followed by composite labiaplasty at 1.2% (5 cases out of 395 patients), Z-plasty at 0.8% (1 case out of 123 patients), and trimming labiaplasty at 0.5% (7 cases out of 1,323 patients).ConclusionConsidering the heterogeneity and low quality of the existing studies on this subject, this study provides valuable information for surgeons practicing in this field. However, further research is clearly warranted as female genital aesthetic procedures are being performed with a steadily increasing trend.