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Öğe Characteristics of obstetric fistulas and the need for a prognostic classification system(Termedia Publishing House Ltd, 2010) Karateke, Ateş; Cam, Çetin; Özdemir, Arman; Guney, Buhara; Vatansever, Doğan; Çelik, CemIntroduction: To evaluate the need for a prognostic classification system for obstetric fistula (OF) with the data obtained by a voluntarily action for OF repair in a regional hospital and Niger, Africa. Material and methods: Obstetric fistula (OF) characteristics of 51 women with vesicovaginal fistula in a fistula campaign in Maradi Regional Hospital, Niger were evaluated. Initial basic gynecological examination, methylene blue (MBT) test and direct cystoscopy were used to describe the characteristics of the lesions. Demographic and clinical data were compared with the existing literature. Results: In 31 (60 %) cases were the sizes of the fistula greater than 4 cm. The urethra was circumferentially lost in 8 (15.7%) women. In 18 (35.3%) women the trigone was involved. Extensive fibrosis was present in 10 (19.6%) patients. Only in 11(21.6%) patients without any obliterating scarring, neither the trigone nor urethra were damaged. Five (9.8%) patients had severe infection. Five (9.8%) had multiple lesions. Thirty-four (66.6%) had a history of at least one previous attempt for fistula repair. A significant proportion of women were divorced or abandoned from their husband, and socially isolated. Conclusions: A simple, reproducible and universally accepted scientific classification or staging system for OF dealing with outcomes rather than anatomic landmarks should replace the present proposed classification systems for prognostic and ethical purposes.Öğe Fistula Campaigns-Are They of Any Benefit?(Elsevier Taiwan, 2010) Cam, Çetin; Karateke, Ateş; Özdemir, Arman; Güneş, Candemir; Çelik, Cem; Guney, Buhara; Vatansever, DoğanObjective Evaluation of the problems encountered during a voluntarily fistula campaign in a regional hospital of Niger (Africa) Materials and Methods Women underwent basic gynecological examination, methylene blue testing, and/or direct cystoscopy as necessary According to their clinical condition, women were informed and surgical options offered as appropriate Operations were performed under spinal or epidural anesthesia Immediate postoperative outcomes were followed during the stay of the surgical team in the country Results A total of 62 women were examined and 11 had causes of incontinence other than obstetric fistula In 9 8% of the women, severe local infection precluding any surgical intervention was evident In 58 8% of patients, the trigonal region and/or urethra were irreversibly damaged A proportion of patients (9 8%) with large lesions and intact urethra that were offered vaginal layered closure refused the intervention Of the women that were operated on (21 6%), six underwent vaginal layered closure with Martius fat flap and five women underwent a combined abdomino vaginal approach Conclusion It is extremely difficult to meet the needs of this global problem with short term programs and volunteers Directing these efforts to specialist fistula centers and creating reliable scientific evidence should be the main goal [Taiwan J Obstet Gynecol 2010,49(3) 291-296]Öğe Postpartum sexual function of women and the effects of early pelvic floor muscle exercises(Wiley, 2010) Çitak, Nevin; Cam, Çetin; Arslan, Hediye; Karateke, Ateş; Tuğ, Niyazi; Ayaz, Reyhan; Çelik, CemObjective. To evaluate the effects of early pelvic floor muscle training after vaginal delivery on sexual function. Design. Prospective randomized study. Settings. Urogynecology clinic of a tertiary medical center in Istanbul, Turkey. Population. Total of 75 primiparous women. Methods. Pelvic floor-muscle strength was assessed during rest and straining in primiparous women in their 4th postpartum month, after which the women were randomized into training (n = 37) and control (n = 38) groups. Patients were re-evaluated in the 7th postpartum month. Main outcome measures. Female sexual function and pelvic muscle strength scores. Results. Desire, pain and total female sexual index scores were significantly higher in the 7th month compared to 4th month in both groups (p < 0.05). However, sexual arousal, lubrication, orgasm, and satisfaction scores were improved in the 7th month in the training group (paired t-test, p < 0.001), but not significantly in the control group (p > 0.05). All domains except satisfaction were significantly higher in the training group compared with the controls. Pelvic floor-muscle strength was found to be increased in the 7th month in the training group (Wilcoxon rank test, Z = 4.123, p < 0.001), whereas there was no significant difference between the 4th and 7th month measurements in the controls (p > 0.05). Conclusion. Pelvic floor-muscle training improves pelvic floor-muscle function, and starting after the puerperal period, exercise appears to have positive effects on female sexual function.Öğe Radical trachelectomy in late pregnancy: is it an option?(Elsevier Science Bv, 2010) Karateke, Ateş; Cam, Çetin; Çelik, Cem; Baykal, Bahar; Tuğ, Niyazi; Özbaşlı, Esra; Tosun, Ozgur Aydin[No Abstract Available]Öğe Responsiveness of urogynecologic quality of life measurements to change after radical gynecologic surgery(Springer Heidelberg, 2011) Cam, Çetin; Çelik, Cem; Yıldırım, Gazi; Tuğ, Niyazi; Cam, Meltem; Karateke, AteşIn order to assess the responsiveness of short forms of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) in a subset of women undergoing radical operations for gynecologic cancer. Women with cervical cancer without any abnormal urodynamic abnormalities who had undergone Class III hysterectomy were included in the study. All women underwent urodynamic investigation and completed the IIQ-7 and UDI-6 questionnaires pre-operatively and post-operatively in the sixth month. Twenty-eight patients were enrolled and general and subscale scores of the questionnaire were calculated in the study between February 2008 and September 2008. Class III hysterectomy was performed in 28 women with stage Ib cervical carcinoma. Scores of IIQ-7 and the irritative and obstructive subscales of UDI-6 in the sixth post-operative month were significantly higher than the pre-operative scores. The Cronbach's alpha was 0.84. Cystometric parameters were in concordance with these changes in the questionnaire scores. The IIQ-7 and UDI-6 questionnaires are sensitive to changes in patients who have undergone radical oncologic operations because their life impact of incontinence may be affected. Validated questionnaires are reasonable measures to detect these changes, which are confirmed by urodynamic findings.
