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 <60 had a sensitivity of 94.44%, specificity of 98.75%, positive predictive value of 94.40%, negative predictive value of 98.80%, and LR (+) value of 75.56. Conclusion: Apical vaginal support loss is highly associated with genital hiatus size. In particular, according to all study definitions, a Pelvic Organ Prolapse-Quantification measurement genital hiatus of >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.

Aims: To investigate whether there is a difference between serum tumor markers panel (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well-staged patients with borderline ovarian tumors (BOTs). Methods: Over the past 20 years (January 2001 to January 2021), the results of four tumor markers (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) have been clinically analyzed for for this retrospective cohort study of 156 patients who underwent surgery and were diagnosed with histopathology consistent with a borderline ovarian tumor. Results: The average age of patients with borderline ovarian tumors was determined to be 51.67 (4.726) years. Before the first surgery, high CA 125 levels (>35 U/l) were found in 53 patients (34%), high CEA levels (>4 ng/ml) were found in 24 patients (15.4%), high CA 19-9 levels (>37 U/ml) were found in 29 patients (18.6%), and high CA 15-3 (>30 ng/ml) levels were found in 12 patients (7.7%). The average CA 125 levels in tumors with serous histopathology [372.8 (1805.2)] were higher than those in tumors with mucinous histopathology (p=0.006). There was no statistically significant difference in tumor markers between tumors smaller than 8 cm and larger than 8 cm [(CA 125 p=0,257), (CEA p=0.9), (CA 19-9 p=0.295), (CA 15-3 p=0.404)]. Conclusion: Our primary outcome of the study is an increase in CA 125 levels, which indicates serous histopathology. Our secondary outcome is the higher levels of tumor markers, but it does not suggest larger tumors.

Background/Aim: Urogynecological symptoms, including pelvic pain, lower backache, feeling of bearing down, frequency, nocturia, urgency, stress incontinence, and urge incontinence, are common during pregnancy. But little has been reported regarding possible changes in lower urogenital tract anatomy and its effects in pregnancy. Therefore, the subject of this study is whether the incidence of urogynecological symptoms is higher when the uterus is retroverted in pregnancy. Methods: We enrolled 1432 pregnant women examined before the 20th week of pregnancy between January 2018 and March 2022. Patients were allocated into two groups according to whether the uterus was retroverted (n=226 (15.7%)) or anteverted (n=1206 (84.3%)). These two groups were compared regarding pelvic pain, lower backache, the feeling of bearing down, frequency, nocturia, urgency, stress incontinence, and urge incontinence. Results: Retroverted gravid uterus was noted in 11.8% (n=41) of nulliparae and 17% (n=185) of multiparae (P=0.021), with an overall prevalence of 15.7%. Of 1432 patients, the overall prevalence for frequency, urgency, nocturia, urge incontinence, stress incontinence, lower backache, pelvic pain, and feeling of bearing down were 31%, 26.7%, 18.2%, 5.4%, 7.5%, 6.9%, 56.4% and 7.5%, respectively. Between both groups, there were differences in frequency, urgency, nocturia and lower back pain. There were two patients with incarcerated gravid uterus with urinary retention. Conclusion: Patients with a retroverted uterus are more likely to experience the symptoms of lower back pain, frequency, nocturia, and urgency in the first half of pregnancy.

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