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A b s t r a c tIntroduction: 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.

We present a case of a bladder stone which formed on the intravesical portion of tension free vaginal tape material secondary to bladder perforation. 8 years previously, a tension free vaginal tape (TVT) operation was performed. The patient was referred to hospital with persistent urinary infection and urinary incontinence. An intravesical stone that had formed on the TVT sling material was detected by cystoscopy and it was removed with the sling material by a supra pubic cystostomy approach. When evaulating patients presenting with urinary symptoms after a TVT procedure, bladder complications should be kept in mind.

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.

Aşırı aktif mesane tedavisinde trospiyum klorür ve tolterodin'in etkinliğini karşılaştırmak. Materyal ve Metod:Zeynep Kamil Eğitim ve Araştırma Hastanesi polikliniğine, ani idrar sıkışması, sık idrara çıkma (günde 8'den fazla), noktüri, idrar kaçırma şikayetlerinden biri veya birkaçı nedeniyle başvuran, ürodinamik testler sonucunda aşırı aktif mesane tanısı doğrulanmış ve trospiyum klorür veya tolterodin tedavisine başlanmış olan hastalar, tedavi başlangıcından en az 3 ay sonra geri çağrılarak, gündüz ve gece idrar sıklığı, kaçırılan idrarın iç çamaşıra etkileri sorgulandı.Bulgular: Her iki tedavi grubunun demografik verileri istatistiksel olarak benzer bulundu. Gruplara göre semptomlar arasında istatistiksel olarak anlamlı farklılık izlenmedi.Sonuç: Aşırı aktif mesane tedavisinde trospiyum ve tolterodin etkinlik bakımından benzer oranlara sahiptir.

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Objective:To determine whether semen and plasma presepsin values measured in men with normozoospermia and oligoasthenospermia undergoing invitro-fertilization would be helpful in predicting ongoing pregnancy and live birth.Methods:Group-I was defined as patients who had pregnancy after treatment and Group-II comprised those with no pregnancy. Semen and blood presepsin values were subsequently compared between the groups. Parametric comparisons were performed using Student’s t-test, and non-parametric comparisons were conducted using the Mann-Whitney U test.Results:There were 42 patients in Group-I and 72 in Group-II. In the context of successful pregnancy and live birth, semen presepsin values were statistically significantly higher in Group-I than in Group-II (p= 0.004 and p= 0.037, respectively). The most appropriate semen presepsin cut-off value for predicting both ongoing pregnancy and live birth was calculated as 199 pg/mL. Accordingly, their sensitivity was 64.5% to 59.3%, their specificity was 57.0% to 54.2%, and their positive predictive value was 37.0% to 29.6%, respectively; their negative predictive value was 80.4% in both instances.Conclusion:Semen presepsin values could be a new marker that may enable the prediction of successful pregnancy and/or live birth. Its negative predictive values are especially high.

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