Turkish Journal of Obstetrics and Gynecology最新文献

{"title":"Flexible progestin-primed ovarian stimulation is a safe and effective alternative to GnRH antagonist protocol in PGT-A cycles.","authors":"Niyazi Emre Turgut, Sevinç Özmen, Emre Kar, Hasan Benli, Ercan Bastu","doi":"10.4274/tjod.galenos.2026.53926","DOIUrl":"10.4274/tjod.galenos.2026.53926","url":null,"abstract":"<p><strong>Objective: </strong>To test the hypothesis that flexible progestin-primed ovarian stimulation (fPPOS) is non-inferior to the gonadotropin-releasing hormone (GnRH) antagonist protocol in terms of safety and efficacy for patients undergoing controlled ovarian hyperstimulation and preimplantation genetic testing for aneuploidy (PGT-A).</p><p><strong>Materials and methods: </strong>This retrospective analysis included data from 548 cycles involving 367 women aged 35 to 45 years. The fPPOS and GnRH antagonist groups comprised 307 cycles (56%) and 241 cycles (44%), respectively. All participants underwent absolute blastocyst culture, trophectoderm biopsy, and PGT-A, with advanced maternal age as the sole indication. The primary outcomes were incidence of premature luteinizing hormone (LH) rise (>10 mIU/mL), cycle cancellation due to premature ovulation, and euploid blastocyst rate per injected metaphase II oocyte. Spearman's rho correlation and the generalized linear model (logit) were applied for statistical analysis.</p><p><strong>Results: </strong>The incidence of premature LH rise (8.2% versus 6.6%; p=0.302) and cycle cancellation due to premature ovulation (2% versus 0.4%; p=0.112) did not differ significantly between the fPPOS and GnRH antagonist groups. Maturation, fertilization, and blastulation rates were also similar (p>0.05). The euploid blastocyst rates per biopsy (50.12% versus 53.06%; p=0.317) and per injected metaphase II oocyte (23.84% versus 23.34%; p=0.231) were comparable between groups. Secondary outcomes, including rates of positive pregnancy tests, implantation, ongoing pregnancy, biochemical pregnancy losses, and early miscarriages, were also similar (p>0.05).</p><p><strong>Conclusion: </strong>The fPPOS protocol represents a viable alternative to the GnRH antagonist protocol for patients aged 35 years or older undergoing PGT-A.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"129-138"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677508","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":"Follicular fluid cytokine and homocysteine profiles in poor ovarian responders with and without sonographic endometrioma: A comparative study.","authors":"Bülent Erdem Şanlı, Esra Tığlı, İlke Özer Aslan, Neslihan Yıldırım Saral, Yiğit Çakıroğlu, Bülent Tıraş","doi":"10.4274/tjod.galenos.2026.14867","DOIUrl":"10.4274/tjod.galenos.2026.14867","url":null,"abstract":"<p><strong>Objective: </strong>To compare follicular fluid (FF) cytokine and homocysteine profiles in women with poor ovarian response (POR) undergoing in vitro fertilization (IVF), with and without sonographic endometrioma, and to explore potential inflammatory alterations associated with endometrioma in this population.</p><p><strong>Materials and methods: </strong>This prospective comparative study was conducted among 60 women diagnosed with POR who were undergoing IVF treatment. Participants were divided into two groups according to the presence of sonographic endometrioma: Group I included women without sonographic endometrioma (n=30) and Group II included women with sonographic endometrioma (n=30). FF samples were collected during oocyte retrieval and analyzed for inflammatory biomarkers. Concentrations of interleukin-1β (IL-1β), IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33, interferon-α2 (IFN-α2), IFN-γ, tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and homocysteine were measured using LEGENDplex multiplex assays and flow cytometry. Cytokine and homocysteine levels were compared between groups.</p><p><strong>Results: </strong>Most inflammatory cytokines, including IL-1β, IL-6, IL-8, IFN-γ, and MCP-1, showed lower levels in women with sonographic endometrioma compared with women without sonographic endometrioma. In contrast, TNF-α and IL-33 levels tended to be higher in the endometrioma group. Homocysteine levels were also lower in women with sonographic endometriomas. However, none of the observed differences reached statistical significance. Overall, the findings suggested distinct, albeit non-significant, inflammatory trends in the FF microenvironment of women with POR and sonographic endometrioma.</p><p><strong>Conclusion: </strong>Women with POR and sonographic endometrioma showed altered trends in FF inflammatory-marker profiles compared with women without sonographic endometrioma; however, these differences were not statistically significant. Since the absence of sonographic endometrioma does not exclude endometriosis, the findings should be interpreted cautiously. Larger prospective studies that include IVF and assess embryological and reproductive outcomes are required to clarify the clinical significance of FF biomarkers in women with POR and endometrioma.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":"23 2","pages":"146-152"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164747","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":"Sphingosine-1-phosphate in ovarian hyperstimulation syndrome: Biomarker promise and therapeutic peril.","authors":"Syeda Muneeza Hyder, Farida Khan Kakar, Muhammad Talha, Mahnoor Umrani","doi":"10.4274/tjod.galenos.2025.32884","DOIUrl":"10.4274/tjod.galenos.2025.32884","url":null,"abstract":"","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":"23 2","pages":"199-200"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164777","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":"Comparative outcomes of abdominal, laparoscopic, and vaginal sacral colpopexy: A national analysis of apical suspension procedures (2014-2022).","authors":"Smit Bharat Solanki, Apurva B Pancholy, Vishal Pancholy","doi":"10.4274/tjod.galenos.2026.76906","DOIUrl":"10.4274/tjod.galenos.2026.76906","url":null,"abstract":"<p><strong>Objective: </strong>Sacral colpopexy is a well-established procedure for apical suspension, but the relative outcomes of abdominal, laparoscopic, and vaginal approaches remain debated. This study compared perioperative outcomes across these surgical routes using a national database and evaluated trends in robotic assistance.</p><p><strong>Materials and methods: </strong>We analyzed sacral colpopexy cases from the American College of Surgeons National Surgical Quality Improvement Program between 2014 and 2022. Patient demographics, complication rates, and surgical outcomes were compared among abdominal, laparoscopic, and vaginal procedures. Relative risks (RR) were adjusted for confounders. The utilization of robotic systems in laparoscopic procedures was examined.</p><p><strong>Results: </strong>Among 61,524 cases, 3,497 (5.7%) were abdominal, 22,752 (37.0%) laparoscopic, and 35,275 (57.3%) vaginal. Vaginal procedures were more common in older patients, while laparoscopic approaches predominated among younger and higher-body mass index patients. Non-Hispanic White patients most often underwent vaginal surgery (60.5%), whereas African American patients most frequently underwent laparoscopic procedures (6.4%). Laparoscopic sacral colpopexy had the lowest complication rate (7.8%), with fewer superficial surgical site infections, transfusions, readmissions, and reoperations. Adjusted analysis showed a lower risk with laparoscopic surgery compared with abdominal surgery [RR: 0.75, 95% confidence interval (CI): 0.67-0.85]. Vaginal surgery showed no significant difference compared with abdominal surgery (RR: 1.09, 95% CI: 0.97-1.21). Robotic assistance increased markedly, comprising 73.5% of laparoscopic procedures in 2022.</p><p><strong>Conclusion: </strong>Laparoscopic sacral colpopexy, particularly with robotic assistance, is associated with fewer perioperative complications compared with abdominal and vaginal approaches. These findings support minimally invasive techniques as preferred approaches for apical suspension, and further research is needed on long-term outcomes and cost-effectiveness.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"153-159"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151534","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":"Mutation analysis of the <i>FOXL2</i> and <i>BMP15</i> genes in patients with premature ovarian insufficiency.","authors":"Mehmet Burak Mutlu, Vehap Topçu, Şerife Esra Çetinkaya, Yaprak Üstün, Abdullatif Bakır, Cem Somer Atabekoğlu, Hatice Ilgın Ruhi, Halil Gürhan Karabulut","doi":"10.4274/tjod.galenos.2026.68957","DOIUrl":"10.4274/tjod.galenos.2026.68957","url":null,"abstract":"<p><strong>Objective: </strong>Premature ovarian insufficiency (POI) is defined by irregular menstrual cycles or amenorrhea before age 40 with elevated follicle-stimulating hormone (FSH) levels. We evaluated <i>FOXL2</i> and <i>BMP15</i> variants in Turkish women with POI and assessed the distribution of the <i>BMP15</i> promoter variant c.-9C>G in a case-control setting.</p><p><strong>Materials and methods: </strong>Seventy-five women younger than 40 years with hypergonadotropic hypogonadism, primary/secondary amenorrhea, serum FSH ≥25 mIU/mL on two occasions at least four weeks apart, a normal 46,XX karyotype, and negative FMR1 CGG repeat testing were included. Women with prior ovarian surgery, pelvic chemotherapy/radiotherapy, or endocrine or autoimmune disease were excluded. <i>FOXL2</i> and <i>BMP15</i> coding regions and intron-exon junctions were analyzed by Sanger sequencing. <i>BMP15</i> c.-9C>G genotype frequencies were compared with 80 ethnically matched controls with normal ovarian function. Genotype-specific analyses compared CG versus CC + GG using Fisher's exact test, with odds ratios (ORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>No pathogenic POI-associated variants were detected in <i>FOXL2</i> or <i>BMP15</i>. The heterozygous <i>BMP15</i> c.-9C>G variant was identified in 34/75 patients; it occurred alone in 21, with c.308A>G in 12, and with c.352G>A in 1 patient. In the case-control comparison, the CG genotype was more frequent in POI than in controls (34/75, 45.3% vs. 15/80, 18.8%) and was associated with increased POI risk (OR=3.59, 95% CI: 1.74-7.40; p=0.0005).</p><p><strong>Conclusion: </strong>No pathogenic <i>BMP15</i> or <i>FOXL2</i> variant was identified. The <i>BMP15</i> c.-9C>G variant may be associated with susceptibility to POI in this Turkish cohort, but this finding requires confirmation in larger, unrelated, well-matched populations and functional studies.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"139-145"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869468","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":"Depression and anxiety among women with unwanted pregnancies seeking termination.","authors":"Mustafa Bakırcı, Çağlayan Ateş, Ekin Deniz Gümüştaş, Ethem Serdar Yalvaç","doi":"10.4274/tjod.galenos.2026.75668","DOIUrl":"10.4274/tjod.galenos.2026.75668","url":null,"abstract":"<p><strong>Objective: </strong>To compare depressive and anxiety symptoms in women with unwanted and planned pregnancies.</p><p><strong>Materials and methods: </strong>In this cross-sectional comparative study, we enrolled 220 pregnant women who presented to the Obstetrics and Gynecology Department of Yozgat Bozok University between January 2023 and June 2025. The study group comprised 120 women with unwanted pregnancies seeking elective termination before 10 weeks of gestation. The control group included 100 women with planned pregnancies. Socio-demographic and obstetric data were collected. Depressive and anxiety symptoms were assessed using the Beck Depression Inventory and Beck Anxiety Inventory, respectively.</p><p><strong>Results: </strong>Women with unwanted pregnancies had a significantly higher prevalence of depressive symptoms than women with planned pregnancies (46.7% vs. 28.0%; p=0.004). In contrast, there was no statistically significant difference in the prevalence or severity of anxiety symptoms between the groups (p=0.450). Women in the unwanted pregnancy group were significantly older, had higher parity and lower educational attainment, and were more likely to be unmarried (all p<0.001). Following termination, 20.8% of women had no future contraceptive plans, whereas 40% intended to use an intrauterine device.</p><p><strong>Conclusion: </strong>Unwanted pregnancy culminating in a request for termination is a potent risk factor for depressive symptoms, particularly among socioeconomically vulnerable women, but not necessarily for anxiety. These findings underscore the critical need to integrate mental health screening, especially for depression, and comprehensive, patient-centered contraceptive counseling into routine antenatal and post-abortion care services. Addressing the psychosocial needs of this population is essential for mitigating adverse mental health outcomes.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":"23 2","pages":"122-128"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164721","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":"Intrauterine infusion and sub-endometrial injection of autologous platelet-rich plasma for thin endometrium: A systematic review and single-arm meta-analysis.","authors":"Zhichen Tan, Xing Wei, Maoquan Li","doi":"10.4274/tjod.galenos.2026.29932","DOIUrl":"10.4274/tjod.galenos.2026.29932","url":null,"abstract":"<p><p>To evaluate the efficacy and safety of autologous platelet-rich plasma (PRP), administered via intrauterine infusion or subendometrial injection, for improving endometrial thickness (EMT) and pregnancy outcomes in women with thin endometrium undergoing frozen-thawed embryo transfer (FET) cycles. A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library in accordance with preferred reporting items for systematic reviews and meta-analyses recommendations. Eligible studies investigating PRP treatment for thin endometrium in FET cycles were included. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies. Pooled mean differences (MD) for EMT and aggregated proportions for pregnancy outcomes were calculated using R software. Fourteen studies involving a total of 523 patients were analyzed. PRP administration was associated with a significant increase in EMT [MD=1.61 mm, 95% confidence interval (CI): 1.21-2.01, p<0.05]. The pooled clinical pregnancy rate following PRP treatment was 41.5% (95% CI: 29.6-53.9%). Corresponding rates for ongoing pregnancy, implantation, and miscarriage were 27.3% (95% CI: 19.7-35.0%), 22.9% (95% CI: 8.5-37.2%), and 5.3% (95% CI: 2.3-8.2%), respectively. Subgroup analyses suggested that heterogeneity was partly attributable to differences in study design and PRP administration route. Autologous PRP may be a safe and potentially effective adjunct to enhance endometrial receptivity and reproductive outcomes in women with thin endometrium. Although current evidence from single-arm studies provides a useful clinical reference, well-designed, large-scale randomized controlled trials are still needed to validate these findings.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"190-198"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207872","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":"Long non-coding RNA maternally expressed gene 3 (<i>MEG3</i>) rs4081134 gene polymorphism and preeclampsia risk.","authors":"Shaghayegh Saljoughi, Hasan Dana, Mahtab Norouzi, Hossein Shahraki Ghadimi, Marzieh Ghasemi, Mansooreh Zargar, Mohsen Saravani","doi":"10.4274/tjod.galenos.2026.06626","DOIUrl":"10.4274/tjod.galenos.2026.06626","url":null,"abstract":"<p><strong>Objective: </strong>Preeclampsia (PE), a significant challenge for health systems, is a hypertensive disorder of pregnancy. Some studies have suggested that long non-coding ribonucleic acids play a major role in the pathogenesis of PE by regulating the biological behaviors of maternal vascular smooth muscle cells and trophoblasts. In this study, the impact of the maternally expressed gene 3 (MEG3) rs4081134 gene polymorphism on susceptibility to PE has been evaluated.</p><p><strong>Materials and methods: </strong>We conducted a case-control study comprising 130 PE patients and 140 normotensive pregnant women with normal gestational outcomes. Genotype analysis was performed using the polymerase chain reaction-restriction fragment length polymorphism method.</p><p><strong>Results: </strong>A significant association was evident between the AA genotype and PE risk under the recessive model, indicating that these may serve as protective factors against the development of PE. No significant relationships were detected between other genotypes, genetic models, or allelic distributions and PE risk. Additionally, among pregnant women with PE, a notable correlation was observed between newborn birth weight and the rs4081134 polymorphism in the <i>MEG3</i> gene.</p><p><strong>Conclusion: </strong>We found a significant association between the AA genotype, as well as the recessive model of the <i>MEG3</i> rs4081134 gene polymorphism, and PE deployment. Among women diagnosed with PE, <i>MEG3</i> rs4081134 gene polymorphism was significantly associated with newborn's birth weight.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":"23 2","pages":"115-121"},"PeriodicalIF":1.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164839","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 effect of tinzaparin sodium and leuprolide acetate in an experimental mouse model of endometriosis: The rol of the WNT/beta-catenin pathway.","authors":"Yasemin Albak, Gamze Sönmez Ünal, Çağlar Yıldız, Meral Çetin, Sevgi Durna Daştan, Erkan Gümüş, Ahmet Şevki Taşkıran, Ali Çetin","doi":"10.4274/tjod.galenos.2025.93630","DOIUrl":"10.4274/tjod.galenos.2025.93630","url":null,"abstract":"<p><strong>Objective: </strong>Endometriosis is a benign condition driven by estrogen and inflammation in which endometrial-like tissue develops in ectopic locations. We aimed to determine whether non-steroidal agents acting on the WNT/beta-catenin signaling axis could provide therapeutic benefit in this disease.</p><p><strong>Materials and methods: </strong>Forty adult female mice underwent surgical creation of endometriotic implants and were then distributed into five experimental arms: untreated controls, early leuprolide (leup1d), early tinzaparin (tnz1d), delayed leuprolide (leup7d), and delayed tinzaparin (tnz7d). Early treatment groups received drug treatment beginning at postoperative hour 24, whereas delayed groups began treatment on postoperative day 8. At two weeks post-surgery, lesions were harvested for RNA extraction and transcript profiling. Tissues were also processed for hematoxylin-eosin staining with semi-quantitative grading. Immunostaining was performed using antibodies against HIF1a and WNT2.</p><p><strong>Results: </strong>The tnz7d group exhibited decreased inflammatory markers, while the leup7d group displayed reduced epithelial content; both changes resulted in lower disease severity scores. WNT2 and HIF1a immunostaining revealed greater reductions in score in the tnz7d group compared with controls and other treatment arms, but these differences were not statistically significant.</p><p><strong>Conclusion: </strong>Further investigation is warranted to determine how tinzaparin sodium and leuprolide acetate modulate the WNT/β-catenin axis for the management of endometriosis.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"56-63"},"PeriodicalIF":1.5,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087519","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":"Role of postoperative renal ultrasound in identifying ureteral injury despite normal intraoperative jet flow.","authors":"Sercan Kantarcı, Alaattin Karabulut, Uğurcan Dağlı, Pınar Tuğçe Özer, Fatih Yıldırım, Alper İleri, Adnan Budak, Abdurrahman Hamdi İnan","doi":"10.4274/tjod.galenos.2026.32784","DOIUrl":"10.4274/tjod.galenos.2026.32784","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the diagnostic utility of early postoperative renal ultrasound in detecting ureteral injury in patients who had undergone total laparoscopic hysterectomy (TLH) for benign indications, despite documented normal intraoperative ureteral jet flow on cystoscopy.</p><p><strong>Materials and methods: </strong>In this retrospective cohort study at a high-volume tertiary center, data from 3,170 patients who underwent TLH between January 2022 and October 2025 were analyzed. Inclusion required normal bilateral ureteral jet flow on routine intraoperative cystoscopy, a renal ultrasound within the first 24 postoperative hours, and at least 30 days of clinical follow-up. The primary outcome was the diagnostic yield of postoperative ultrasound for identifying ureteral injuries not apparent during surgery. Injuries were confirmed by advanced imaging or surgical exploration.</p><p><strong>Results: </strong>The overall ureteral injury rate was 0.79% (n=25). Of these injuries, eight were diagnosed intraoperatively, while seventeen occurred despite documented normal bilateral ureteral jet flow during the procedure. Among the latter group, renal ultrasonography performed on postoperative day 1 detected 14 injuries, representing 56% of all injuries. Three injuries (12%) presented later, around postoperative day 10, and were not identified on initial imaging. Early postoperative ultrasonography demonstrated good sensitivity and a high negative predictive value as a screening tool. Comparison with preoperative baseline imaging enhanced diagnostic performance in identifying new-onset obstruction, particularly newly developed pelviectasis.</p><p><strong>Conclusion: </strong>Normal intraoperative ureteral jet flow does not preclude ureteral injury, particularly those with delayed presentation, such as thermal damage. Early postoperative renal ultrasonography is a valuable non-invasive screening tool that identifies a significant proportion of injuries missed by cystoscopy alone. Comparative evaluation of routine postoperative ultrasonography with preoperative imaging may provide a meaningful contribution to the early diagnosis of ureteral injury following TLH.</p>","PeriodicalId":45340,"journal":{"name":"Turkish Journal of Obstetrics and Gynecology","volume":" ","pages":"40-46"},"PeriodicalIF":1.5,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208016","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}