Journal of the Turkish German Gynecological Association最新文献

{"title":"What is your diagnosis?","authors":"Mrudula Chandrupatla, Mishu Mangla, Ariyanachi Kaliappan, Seetu Palo, Aparna Setty, Geetha Sulochana Gopidas, Punnapa Raviteja, Deepa G","doi":"10.4274/jtgga.galenos.2025.2024-12-3","DOIUrl":"10.4274/jtgga.galenos.2025.2024-12-3","url":null,"abstract":"","PeriodicalId":17440,"journal":{"name":"Journal of the Turkish German Gynecological Association","volume":" ","pages":"309-313"},"PeriodicalIF":1.4,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12676979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility sparing surgery for malignant ovarian sex-cord stromal tumors: long-term obstetric and oncologic outcomes.","authors":"Mehmet Tunç, Hüseyin Akıllı, Asuman Nihan Haberal Reyhan, Esra Kuşçu, Göğşen Önalan, Nejat Özgül, Ali Haberal, Ali Ayhan","doi":"10.4274/jtgga.galenos.2025.2025-9-11","DOIUrl":"10.4274/jtgga.galenos.2025.2025-9-11","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the oncological and reproductive outcomes of patients with ovarian sex-cord stromal tumors (SCSTs) treated with fertility sparing surgery (FSS).</p><p><strong>Material and methods: </strong>This retrospective study included patients diagnosed with malignant ovarian SCSTs between February 2007 and June 2020 at Başkent University Hospital, Ankara. All patients underwent FSS, which preserved at least one ovary and the uterus. Data on demographics, surgical and pathological features, adjuvant treatments, follow-up, recurrence, survival, and obstetric outcomes were collected. Follow-up continued until September 2025, with survival analyses performed using Kaplan-Meier and Cox regression methods.</p><p><strong>Results: </strong>The median age of the 35 included patients was 29.0 years, with a median follow-up of 141.0 months. Recurrence occurred in 17.1%, and disease-related mortality was 8.6%. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 85.7% and 97.1%, respectively. No significant factors influenced DFS, while adjuvant therapy impacted OS in univariate analysis. All patients maintained regular menstrual cycles post-treatment. Nine patients conceived (36.0%), resulting in 12 pregnancies and 6 live births (50.0%). Chemotherapy did not significantly affect fertility outcomes.</p><p><strong>Conclusion: </strong>FSS in patients with ovarian SCSTs demonstrated favorable oncologic and reproductive outcomes. Larger, prospective multicenter studies are necessary to optimize management strategies and establish definitive guidelines for fertility preservation in this patient population.</p>","PeriodicalId":17440,"journal":{"name":"Journal of the Turkish German Gynecological Association","volume":" ","pages":"297-303"},"PeriodicalIF":1.4,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12676987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of the #Enzian classification via ultrasound compared to laparoscopic findings in endometriosis: a retrospective cohort study.","authors":"Zahra Asgari, Aynaz Boostan, Reyhaneh Hosseini, Behnaz Ghavami, Behareh Khakifirooz, Leila Bayani, Reza Mardani, Amirhossein Hajialigol, Pegah Rashidian","doi":"10.4274/jtgga.galenos.2025.2025-7-2","DOIUrl":"10.4274/jtgga.galenos.2025.2025-7-2","url":null,"abstract":"<p><strong>Objective: </strong>To assess the diagnostic performance of the ultrasound-based #Enzian classification in comparison with laparoscopic surgical findings in patients with endometriosis.</p><p><strong>Material and methods: </strong>This retrospective cohort study included patients who underwent laparoscopic excisional surgery for endometriosis between September 2023 and October 2024. Preoperative transvaginal ultrasound assessments were performed using the International Deep Endometriosis Analysis protocol, with findings recorded according to the updated #Enzian classification. Diagnostic performance was evaluated through sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. Statistical analyses were conducted using SPSS version 26.0.0.0, with statistical significance set at p<0.05.</p><p><strong>Results: </strong>The study included 66 patients. The #Enzian classification demonstrated the highest diagnostic accuracy in compartments FA and FB (98.82% and 98.59%, respectively), both with perfect sensitivity and minimal false positives. The left ovary (O left) also showed strong performance (92.87% accuracy). In contrast, compartment A had low sensitivity (12.12%) despite a low false-positive rate. Compartments B left and C exhibited good accuracy (86.82% and 91.88%), with minimal false positives and moderate sensitivity. Variable results were observed in compartments O right and T. Although sensitivity was incomplete for FU, FI, and FO, specificity remained high across these subgroups.</p><p><strong>Conclusion: </strong>The #Enzian ultrasound classification provides a reliable diagnostic framework, demonstrating high accuracy across multiple compartments. It is recommended that future studies include larger sample sizes and longitudinal design to further validate these findings.</p>","PeriodicalId":17440,"journal":{"name":"Journal of the Turkish German Gynecological Association","volume":"26 4","pages":"276-283"},"PeriodicalIF":1.4,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12676988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic management of a mature cystic teratoma in the fallopian tube.","authors":"Ali Akdemir, Cihan Mutu, Gürdeniz Serin, Necmettin Özdemir","doi":"10.4274/jtgga.galenos.2025.2024-12-1","DOIUrl":"10.4274/jtgga.galenos.2025.2024-12-1","url":null,"abstract":"<p><p>Our objective is to present the laparoscopic management of a mature cystic teratoma originating from the fallopian tube and to discuss different surgical approaches. A 28-year-old nulliparous woman presented with right groin pain, and after the diagnostic evaluation, laparoscopic exploration was performed for diagnosis and treatment. Intraoperative findings revealed a 4-5 cm cyst protruding from the right tubal fimbrial ostium was identified, originating from the tubal cavity without ovarian connection. The cyst was successfully extracted through milking technique, preserving the fallopian tube. Mature cystic teratomas of the fallopian tube are extremely rare, with approximately 75 cases reported in the literature. When located near the fimbrial end, direct extraction with tubal preservation is feasible, particularly important for patients desiring future fertility. This case demonstrates successful conservative laparoscopic management preserving tubal function.</p>","PeriodicalId":17440,"journal":{"name":"Journal of the Turkish German Gynecological Association","volume":" ","pages":"316-318"},"PeriodicalIF":1.4,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12676978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of vNOTES hysterectomy in patients with enlarged uteri: a single-center experience.","authors":"Candost Hanedan, Hande Nur Öncü, Neslihan Öztürk, Gökçen Ege, Oğuz Kaan Köksal, Vakkas Korkmaz","doi":"10.4274/jtgga.galenos.2025.2025-4-3","DOIUrl":"10.4274/jtgga.galenos.2025.2025-4-3","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility, safety, and surgical outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy in patients with enlarged uteri due to benign, premalignant, and malignant conditions.</p><p><strong>Material and methods: </strong>Patients who underwent vNOTES hysterectomy at a tertiary gynecologic oncology center were included. Patients with large uteri (>280 g or equivalent to >12-week size) were included regardless of prior cesarean delivery, obesity, nulliparity, or the presence of premalignant or malignant pathology. Demographic data, surgical outcomes, and complication details were analyzed. Complications were classified as minor or major.</p><p><strong>Results: </strong>The cohort consisted of 46 women with a median age of 54 (40-74) years, and median body mass index 31 (21-51) kg/m². A history of previous abdominal surgery was present in 58.7%, and 21.7% (10/46) had previously undergone cesarean section. The median operative time was 56 (35-95) minutes, and the median uterine weight was 410 (280-1036) grams. The overall conversion and complication rates were both 4.3% (n=2). No major complications were observed. Minor complications included intraoperative bleeding controlled without transfusion and postoperative vaginal bleeding managed conservatively. The median hospital stay was 30 (16-72) hours. All patients were discharged without requiring reoperation during the postoperative period.</p><p><strong>Conclusion: </strong>vNOTES hysterectomy was a feasible and safe, minimally invasive approach for patients with enlarged uteri, including those with obesity, prior abdominal surgery, and premalignant or malignant indications. It provides favorable surgical outcomes with low complication and conversion rates. This study supports the use of the vNOTES technique with a broader adoption in patients with large uteri.</p>","PeriodicalId":17440,"journal":{"name":"Journal of the Turkish German Gynecological Association","volume":" ","pages":"284-288"},"PeriodicalIF":1.4,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12676990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between serum estradiol and progesterone levels one day before frozen embryo transfer and pregnancy rates in artificially prepared frozen embryo cycles: are there any threshold serum hormone levels to predict pregnancy in luteal support by the vaginal and subcutaneous route combined?","authors":"Levent Dikbaş, Michael H Dahan","doi":"10.4274/jtgga.galenos.2025.2025-1-13","DOIUrl":"10.4274/jtgga.galenos.2025.2025-1-13","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the potential influence of serum estradiol (E₂) and progesterone (P₄) levels, measured one day before artificially prepared frozen embryo transfer (FET), on pregnancy rates in women who received combined vaginal and injectable P₄.</p><p><strong>Material and methods: </strong>This retrospective cohort study analyzed the association between serum E₂ and P₄ levels on the day before FET in 167 cases prepared with hormone replacement therapy between February 2022 and October 2023. The primary outcomes assessed were the pregnancy and live birth rates. We modeled a cut-off serum value based on luteal support for pregnancy. Luteal support was through a combination of vaginal suppositories and subcutaneous injections. Multivariate logistic regression was used to test relationships between pregnancy outcomes and independent variables. Cut-off values were evaluated using receiver operating characteristic (ROC) analysis and percentile analysis.</p><p><strong>Results: </strong>No significant relationships were found between serum E₂ or P₄ levels on the day before FET and pregnancy rates. The mean E₂ level was 169.0±51.9 pg/mL for individuals who achieved conception and 177.7±56.9 pg/mL for individuals who did not conceive (p=0.45). The corresponding values for P₄ were 28.1±18.4 ng/mL and 31.2±25.4 ng/mL, respectively (p=0.73). No differences were observed in body mass index (BMI) or endometrial thickness between the groups. Cut-off values for predicting pregnancy using E₂ and P₄ could not be determined using ROCs. However, no one in the lowest 10^th percentile of serum P₄ levels conceived (range 10.0-15.6 ng/mL). When multivariate logistic regression was used, this finding lost significance suggesting that low serum levels are related to age, BMI, and/or other factors.</p><p><strong>Conclusion: </strong>In artificially prepared FET cycles, the serum E₂ and P₄ levels one day before embryo transfer do not significantly affect pregnancy rates in women with serum E₂ levels between 150-300 pg/mL and P₄ between 10-40 ng/mL when ROC was used for evaluation. However, percentile analysis suggests that serum P₄ levels should be more than 15.6 ng/mL when combined injectable and vaginal P₄ is used for programmed FET. Although this finding may be due to the confounding effects of age, BMI, and other factors affecting steroid metabolism, when controlled for in the multivariate logistic regression.</p>","PeriodicalId":17440,"journal":{"name":"Journal of the Turkish German Gynecological Association","volume":" ","pages":"157-166"},"PeriodicalIF":1.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric brachial plexus injury: risk factors and clinical follow-up results.","authors":"Oğuz Arslan, Burak Giray, Niyazi Tuğ","doi":"10.4274/jtgga.galenos.2025.2025-3-3","DOIUrl":"10.4274/jtgga.galenos.2025.2025-3-3","url":null,"abstract":"<p><strong>Objective: </strong>Obstetric brachial plexus injury is a significant cause of neonatal morbidity. The aim of this study was to evaluate the maternal and perinatal factors associated with plexus injury and to analyze clinical follow-up outcomes and parental caregiving burden.</p><p><strong>Material and methods: </strong>This study was conducted as a retrospective descriptive study at the maternity center of a tertiary hospital. Deliveries resulting in obstetric plexus injury between February 2018 and December 2023 were included in the study. Out of 27,695 live births, 28 infants with plexus injury were identified and analyzed.</p><p><strong>Results: </strong>Of the women who gave birth to infants with brachial plexus injury, 25 (89.3%) were aged 21-34 years, and 22 (78.6%) had a body mass index between 25 and 29.99 kg/m2. Of the cohort, 16 (57.1%) were multiparous, and 3 (10.7%) had gestational diabetes. In addition, 15 (53.6%) women underwent labor induction, and all had vaginal deliveries. Shoulder dystocia occurred in 11 deliveries (39.3%). Of the newborns with brachial plexus injury, 25 (89.3%) had Erb's palsy. The mean follow-up period for the infants was 12 (3-31) months. Injury recovery occurred in 24 babies (85.7%), while four babies (14.3%) experienced permanent injury. Regarding parental caregiving burden, 22 parents (78.6%) reported \"no to mild burden,\" while six parents (21.4%) reported a \"mild to moderate burden.\" No parents reported \"moderate to severe\" or \"severe burden\". All newborns with permanent damage developed shoulder dystocia at delivery (p=0.007).</p><p><strong>Conclusion: </strong>Most infants with plexus injury recovered, while permanent injury was linked to shoulder dystocia, and parental caregiving burden was generally low.</p>","PeriodicalId":17440,"journal":{"name":"Journal of the Turkish German Gynecological Association","volume":"26 3","pages":"204-211"},"PeriodicalIF":1.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twin pregnancy: adolescents versus adults.","authors":"Shaymaa Kadhim Jasim, Rusul Daad, Abbas Oweid Olewi, Hayder Al-Momen, Rand Almomen","doi":"10.4274/jtgga.galenos.2025.2025-5-11","DOIUrl":"10.4274/jtgga.galenos.2025.2025-5-11","url":null,"abstract":"<p><strong>Objective: </strong>Various nations, and this could create a new era of very young mothers which apply an additional pressure on obstetrical and neonatal health system. In cases of twin pregnancy, the burden would be maximized. The aim was to highlight the differences of obstetrical and neonatal outcomes of twin adolescent pregnancy compared to adults.</p><p><strong>Material and methods: </strong>Data were collected prospectively over five years from a tertiary obstetric and neonatal center. Two categories of twin pregnancies were formed from adolescents as the case group and adults as controls.</p><p><strong>Results: </strong>The adolescent group included 59 women and adults numbered 782. The adolescents had significantly higher rates of very preterm delivery, defined as gestational age [(GA) 28≤32 weeks] [odds ratio (95% confidence interval) 2.64 (1.26-3.92)], p<0.05], and significantly lower mean GA than adults (36.6±4.1 versus 37.8±2.6, weeks respectively). Babies delivered to adolescents had significantly lower mean birth weight (1936.5±0.604 g), birth height (43.4±4.3 cm), and occipitofrontal circumference (OFC) (30.8±3.3 cm). Moreover, there was a significantly higher frequency of neonates with APGAR score <7 at the fifth minute [31 (52.54)], low birth weight [53 (89.83)], and neonatal intensive care unit (NICU) admission [38 (64.41)].</p><p><strong>Conclusion: </strong>Twin adolescent pregnancy had significantly elevated metrics for obstetric and neonatal complications, which were especially notable for very preterm delivery, low neonatal birth weight and short birth length, and reduced OFC, APGAR score <7 at the fifth minute, and NICU admission rate.</p>","PeriodicalId":17440,"journal":{"name":"Journal of the Turkish German Gynecological Association","volume":"26 3","pages":"174-179"},"PeriodicalIF":1.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of research on vulvar intraepithelial neoplasia: towards precision diagnostics and risk stratification.","authors":"Mario Preti, Niccolò Gallio, Jacob Bornstein, Elmar Joura, Koray Görkem Saçıntı, Pedro Vieira Baptista","doi":"10.4274/jtgga.galenos.2025.2025-7-5","DOIUrl":"10.4274/jtgga.galenos.2025.2025-7-5","url":null,"abstract":"<p><p>Vulvar intraepithelial neoplasia (VIN) represents a heterogeneous group of premalignant lesions arising through distinct human papillomavirus (HPV)-associated and HPV-independent pathways. Despite well-characterized differences in etiology, prognosis, and progression risk, current management remains largely uniform and predominantly surgical. This one-size-fits-all approach neglects opportunities for individualized care and exposes patients, particularly younger women and those with multifocal disease, to potentially avoidable psychosexual morbidity. Recent advances in molecular pathology, including immunohistochemistry, genomic profiling, DNA methylation analysis, and copy number alteration detection, offer promising avenues for refining diagnostic precision and enabling risk stratification. Integration of markers such as p16INK4a, p53, and emerging methylation panels into diagnostic workflows may improve differentiation between lesion subtypes, guide surveillance, and identify candidates for conservative therapy. Moreover, the unique pathogenesis of vulvar high-grade squamous intraepithelial neoplasia, which diverges from squamocolumnar junction (SCJ)-driven models seen in other HPV-associated cancers, highlights the need for focused research on host-virus interactions and early oncogenic events in non-SCJ epithelium. Future directions include non-invasive sampling methods, molecularly-guided surveillance protocols, therapeutic HPV vaccines, and combined immunomodulatory treatments to reduce the burden of excisional therapy. Establishing precision-based approaches for VIN could not only preserve vulvar integrity and function but also improve oncological outcomes through targeted prevention and early intervention strategies.</p>","PeriodicalId":17440,"journal":{"name":"Journal of the Turkish German Gynecological Association","volume":" ","pages":"230-234"},"PeriodicalIF":1.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is your diagnosis?","authors":"Kavita Khoiwal, Shalini Bose, Ravi Hari Phulware, Manisha Perka, Jaya Chaturvedi","doi":"10.4274/jtgga.galenos.2025.2024-11-3","DOIUrl":"10.4274/jtgga.galenos.2025.2024-11-3","url":null,"abstract":"","PeriodicalId":17440,"journal":{"name":"Journal of the Turkish German Gynecological Association","volume":" ","pages":"235-237"},"PeriodicalIF":1.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}