The low hemoglobin values at third trimester gestation were associated with low birth weight and length in Turkish women. The anemia can be a direct cause of deterioration of in utero fetal growth due to lack of oxygen flow to placental tissue or can be an indirect indicator of maternal nutrition deficit. In both circumstances this study reveals that treatment of anemia is directly correlated with better fetal outcomes.

Mixed incontinence and pelvic pain improved significantly in patients after RALUSLS or RALSC. In RALUSLS patients, urgency, frequency, and urge incontinence also improved, whereas additional improvement in nocturia and dyspareunia was evident only in RALSC patients. De novo LUTS developing after these procedures, especially after RALSC, necessitate careful patient consultation prior to surgery.

Objective:Overactive bladder (OAB) affects 16.9% of women in the United States. Percutaneous tibial nerve stimulation (PTNS) is a third-line treatment for patients who are refractory to behavioral and pharmacologic therapies. We aimed to evaluate the effects of PTNS on urinary symptoms in patients diagnosed as having refractory OAB and investigate the cost of medications and clinical visits before and after PTNS treatment.Material and Methods:We reviewed 60 women with refractory OAB treated with PTNS. Episodes of urinary frequency, leakage, urgency, and nocturia; number of follow-up visits; and medications were recorded. The mean quarterly drug, physician, nurse, and provider costs were calculated. The episodes of urinary symptoms, numbers of follow-up visits, and costs of medications and visits before and after PTNS were compared.Results:Of the 60 patients with refractory OAB, 24 patients who completed 12 weekly sessions of initial PTNS were evaluated. The number of urinary symptoms and follow-up visits significantly decreased after PTNS (p<0.05). The average quarterly medication cost decreased from $656.36±292.45 to $375.51±331.79 after PTNS (p=0.001). After PTNS, quarterly physician and nurse visit costs decreased from $81.73±70.39 to $25.89±54.40 and from $55.23±38.32 to $15.53±19.58, respectively (p<0.05). The quarterly total provider cost was similar before and after PTNS.Conclusion:PTNS treatment significantly improved urinary symptoms of patients with refractory OAB and reduced the costs of medications and physician and nurse visits.

The mini-sling procedure is a widely used, minimally invasive treatment for stress urinary incontinence. While bladder perforation and stone formation over the mesh is not an expected complication of the mini-sling procedure, in this case, we report on the management of bladder calculi formed over the mesh, which was passed through the bladder while applying the mini-sling procedure, and was eventually removed using holmium laser. Performing cystoscopy in patients with irritative and obstructive symptoms after the sling procedure will help confirm bladder perforation, and an endoscopic approach using holmium laser is an effective treatment. IntroductionStress urinary incontinence (SUI) is a common health problem. Conservative techniques, as well as pharmacological and surgical approaches, are used in the treatment of SUI. 1The aim of surgery is to correct the deficient urethral closure and to prevent incontinence.Ulmsten et al described a minimally invasive technique, a tension-free vaginal tape (TVT) for SUI, in 1996 and it has become the gold standard procedure.2 In 2001, Delorme et al described the transobturator tape implantation (TOT) method to avoid the risk of bladder and bowel perforation and major vascular injuries that can occur with TVT; 3 however, similar complications were observed.1 In 2006, a thirdgeneration of midurethral tapes -known as single-incision mini-slings -was introduced to reduce complications such as bladder perforation.1 The mini-sling procedure is a widely used, minimally invasive treatment for SUI; there are only a few reports on its complications. 4 Bladder perforation and stone formation over the mesh are not expected complications of mini-sling procedures. Further, the technique of removing an eroded tape from the bladder remains controversial. 6 In this case, we report on the management of bladder calculi formed over the mesh, which was passed through the bladder while applying the mini-sling procedure, and removed using holmium laser. Case reportA 46-year-old woman was admitted to our urology clinic for pelvic pain, dysuria, recurrent urinary tract infections, urinary frequency, and urgency. She had a history of stress urinary incontinence, which had been treated with a minisling procedure using a needleless device. The procedure had been performed at a different hospital four months prior and her complaints began after the procedure. Her urine examination demonstrated pyuria and microscopic hematuria. Extended-spectrum β-lactamase-producing (ESBL) Escherichia coli was detected in her urine culture and appropriate antibiotherapy was given. A 25 x 15 mm opacity at bony pelvis was observed on her plain X-ray radiography of the abdomen and a 3 x 2 cm bladder stone was seen on ultrasound (Fig. 1). With these findings, cystoscopy was performed under spinal anesthesia. A stone surrounding the polypropylene mesh at the right base of the bladder wall was observed. Stone over the mesh was fragmented using both holmium-YAG laser (Sphinx ® LISA laser, 80 W, 2120 nm, 0.5-4.5 J) an...

Available online xxxKeywords: Eclampsia Hypertensive encephalopathy Magnetic resonance imaging a b s t r a c t Introduction: HELLP syndrome (acronym comprised of hemolysis, elevated liver enzymes and low platelets) is seen in 0.1% of pregnant women. Posterior reversible encephalopathy syndrome (PRES) was reported to be 5% in patients with the HELLP syndrome. Atypical imaging appearances include contrast enhancement, hemorrhage and restricted diffusion on MRI.Aim: We aimed to improve clinicians' perception about brain lesions in the HELLP syndrome with imaging findings.Case study: Here, we present a case of an 18-year-old patient with a pregnancy of 24 weeks admitted with HELLP syndrome, with CT and MRI findings of PRES and intracerebral hematoma. MRI scan of the brain showed vasogenic edema in the occipital, frontal and parietal lobes bilaterally, basal ganglia and brainstem. An emergency cesarean section was successfully performed to end the pregnancy on the same day. Repeat MRI of the brain three days after initial admission showed partial improvement of the previous abnormalities with full clinical recovery.Results and discussion: The patient in this report had a variant form of PRES where the pathologic process encompassed both the posterior and anterior circulations.Conclusions: An appropriate multidisciplinary approach is the key for reducing the morbidity and mortality of PRES syndrome.