Browsing by Author "Tosun, G"
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Item Relationship Between Abdominal Muscle and Pelvic Floor Muscle Activation in Elderly Individuals with Urinary IncontinenceDönbak, BS; Seçer, MB; Aktas, M; Tosun, OC; Kara, B; Tosun, GIntroduction and HypothesisThe aim of our study is to examine the relationship between abdominal muscles and pelvic floor muscles (PFM) activation in elderly individuals with urinary incontinence (UI).MethodsThis cross-sectional study was conducted with 43 elderly individuals (27 women, 16 men) with UI in a nursing home. Superficial electromyography (EMG) was used to assess the contraction and relaxation activities of the PFM and abdominal muscles (rectus abdominis, transversus abdominis, internal obliques, external obliques). The Overactive Bladder Awareness Questionnaire (OAB-V8) and the Urogenital Distress Inventory Short Form (UDI-6) were used to assess incontinence symptoms and severity. The Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI) was used to evaluate the level of self-efficacy. Quality of life was assessed using the Incontinence Impact Questionnaire Short Form (IIQ-7) and the Incontinence Quality of Life Scale (I-QOL). Chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation analysis were used for statistical analysis.ResultsA moderate positive correlation was found between PFM work MVC and RA work MVC (r 0.540, p 0.001), IO work MVC (r 0.485, p 0.002), and RA rest MVC (r 0.441, p 0.006). When analyzed by gender, significant differences were found in the average activity of RA contraction, average activity of EO contraction, and normalized MVC values (p 0.035, p 0.048, p 0.001). When analyzed by incontinence type, significant differences were found in the TA relaxation MVC and average activity of IO contraction (p 0.006, p 0.011).ConclusionsThere is a relationship between the functions of PFM and abdominal muscles in individuals with UI. Additionally, EMG data during both abdominal and PFM contractions are higher in men at this age. Incontinence type may affect abdominal muscle function.Item ADENOID CYSTIC CARCINOMA OF THE BARTHOLIN'S GLAND: REPORT OF TWO CASESGokcu, M; Cingillioglu, B; Tosun, G; Adiyeke, M; Sanci, MItem Exercise Position to Improve Synergy Between the Diaphragm and Pelvic Floor Muscles in Women With Pelvic Floor Dysfunction: A Cross Sectional StudyDayican, DK; Keser, I; Tosun, OC; Yavuz, O; Tosun, G; Kurt, S; Secer, MBObjective: This study aimed to investigate the synergy between the diaphragm and pelvic floor muscles (PFM) according to different exercise positions in women with pelvic floor dysfunction. Our secondary aim was to determine the short-term effects of single-week pelvic floor muscle training (PFMT) program on diaphragmatic function. Methods: The cross-sectional study included 64 women with pelvic floor dysfunction. The participants' diaphragm and abdominal muscle functions during voluntary PFM contraction and relaxation were assessed by surface electromyography and ultrasonography. The surface electromyography assessments were performed in supine (P1), crawling (P2) and sitting (P3) positions. A single week-PFMT was conducted on women who agreed to determine the short-term responses of the diaphragm function. The muscle functions according to exercise positions were compared with Friedman Analysis of Variance, and the short-term effects of single-week PFMT on diaphragm function was analyzed with Wilcoxon Signed-Ranks Test. Results: The diaphragm activity during voluntary PFM contraction was highest in P2 before and after single-week PFMT (P < .001). Positive significant correlations were found between the activities diaphragm and abdominal muscles in different exercise positions (P < .05). After single-week PFMT, diaphragm thickness increased (P = .030) in P1, but diaphragm activity did not change in all 3 exercise positions (P > .05). Conclusion: The synergy between the diaphragm and PFM was greater in the crawling position in women with pelvic floor dysfunction. The abdominal muscles seemed to contribute to maintaining this synergy. Therefore, PFMT combined with diaphragmatic breathing exercises in the crawling position should be considered. In addition, single-week PFMT may positively affect diaphragm function in the short-term.Item Does Phase of the Menstrual Cycle Affect Balance and Postural Control?Elvan, A; Kirisçi, S; Seçer, MB; Tosun, ÖÇ; Tosun, G.The aim of the study is to examine the effects of menstrual cycle phases (MCP) on balance and postural control. The study was carried out with 63 volunteer women. Digital ovulation kits and, a Menstrual Cycle Regularity Questionnaire (MCRQ) to detect menstrual cycle regularity and duration, Premenstrual Syndrome Questionnaire (PMSQ) to question the presence of premenstrual syndrome, Menstruation Attitude Questionnaire (MAQ) to assess menstrual attitudes, International Physical Activity Questionnaire Short Form (IPAQ-SF) to question physical activity level was used. Balance and postural oscillation were evaluated with Balance Master balance and performance test device and Tekscan MatScan & TRADE; Pressure Mat System, respectively. All evaluations were repeated twice, in the preovulatory period and the postovulatory period. When the evaluations of the preovulatory period and the postovulatory period were compared, there was %3 increase in the percent weight-bearing of the non-dominant extremity (p = 0.01) and %2.5 decrease in the percent weight-bearing of the dominant limb in the postovulatory period (p = 0.01). %8 increase in functional reach distances was detected in the postovulatory period (p < 0.01). It was determined that there was %7.4 decrease in the oscillation rate of the center of gravity in the static stance with eyes open and %9 decrease in the static stance with eyes closed in the postovulatory period (p = 0.35, p = 0.18, respectively). It has been determined that the balance and postural control of young women are negatively affected in the preovulatory period and the function improved from the preovulatory period to the postovulatory period.Item Do levels of self-efficacy affect urinary incontinence, falls, quality of life, sleep, and physical activity in elderly people with urinary incontinence?Secer, MB; Tosun, ÖÇ; Tosun, GBackground Our study aims to determine whether different self-efficacy (SE) levels affect urinary incontinence symptoms, falls, quality of life, sleep, and physical activity in elderly individuals with incontinence. Our secondary aim is to examine the relationship between SE levels and urinary incontinence severity, quality of life, sleep status, fear of falling, and physical activity level. Methods One hundred twenty elderly individuals (median age: 71 years) with urinary incontinence participated in the cross-sectional study. Participants were divided into 3 groups as levels of low, moderate, and high according to their Geriatric SE Index for Urinary Incontinence (GSE-UI). Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Incontinence Quality of Life Scale (I-QOL), Pittsburgh Sleep Quality Index (PSQI), Fall Efficacy Scale (FES), Rapid Assessment Physical Activity (RAPA), and International Physical Activity Questionnaire Short Form (IPAQ-SF) assessments associated with incontinence were performed. Data were analyzed using Mann-Whitney U, Kruskal-Wallis tests, and Spearman's correlation. Results A significant difference was found in UDI-6, IIQ-7, I-QOL, and FES belonging to three groups according to GSE-UI levels (p <0.01, p <0.01, p <0.01). It was determined that the group with low GSE-UI level had the highest incontinence symptoms, fear of falling, and the lowest quality of life statistically significant. A negative moderate significant correlation was found between GSE-UI scores and UDI-6 (r: - .67, p <0.01), IIQ-7 (r: - .67, p <0.01), and FES (r: - .46, p <0.01). Conclusion In elderly individuals with urinary incontinence, the level of SE may affect incontinence symptoms, severity, fear of falling, and quality of life and may be an important factor for incontinence. An increased level of SE may lead to positive effects on the user interface. Further studies in this field are needed.Item Are pelvic floor muscle function, quadriceps femoris muscle, gluteus medius muscle, hand grip strength and functional performance affected by incontinence types in elderly people with urinary incontinence?Seçer, MB; Tosun,ÖÇ; Tosun, GAim The aim of this study is to examine the relationship between incontinence type and pelvic floor muscle function, gluteus medius muscle, quadriceps femoris muscle, hand grip strength, functional performance and balance in elderly people with incontinence. Materials and methods This cross-sectional study was conducted in a nursing home with 78 elderly people with stress (SUI, n: 20), urgency (UUI, n: 27) and mixed (MUI, n: 31) urinary incontinence. Urogenital Distress Inventory-6, Incontinence Impact Questionnaire Form-7, Overactive Bladder-8 were used to evaluate incontinence symptoms and severity. Superficial electromyography was used to evaluate the function of the PFM. A hand dynamometer was used to evaluate hand grip strength, and a digital manual muscle tester was used to evaluate quadriceps femoris (QF) and gluteus medius muscle strength. Short Physical Performance Battery and Time Up and Go Test were performed for functional performance. Results There was no significant difference between PFM contraction and relaxation functions, gluteus medius, QF muscle strength, functional performance (p > 0.05) but hand grip strength was highest in the group with UUI (ptotal: 0.022). The group with the highest rate of low hand grip strength is MUI (38.7%). A weak positive correlation was found between QF muscle strength and PFM Work Average value in the MUI group (r: 0.370, p: 0.048). In the MUI group, a moderate positive correlation was found between hand grip strength and gluteus medius muscle strength (r: 0.499, p: 0.005). Conclusion Our findings show that hand grip strength is related to the type of incontinence in the elderly people. The average hand grip strength was highest in the elderly people with UUI. Additionally, there was a positive relationship between gluteus medius and hang grip strength in MUI. It may provide guidance for evaluation and risk factors in elderly people with incontinence.Item Lymphovascular space invasion and cervical stromal invasion are independent risk factors for nodal metastasis in endometrioid endometrial cancerSolmaz, U; Mat, E; Dereli, M; Turan, V; Gungorduk, K; Hasdemir, P; Tosun, G; Dogan, A; Ozdemir, A; Adiyeke, M; Sanci, MAimsThe purpose of this study was to investigate the potential roles of pathological variables in the prediction of nodal metastasis in women with endometrioid endometrial cancer (EC). Materials and MethodsWomen who underwent surgery for endometrioid EC between 1995 and 2012 were retrospectively reviewed. Those who underwent prior neoadjuvant chemotherapy or radiotherapy and inadequate lymphadenectomy as well as those with nonendometrioid histology, synchronous cancers, International Federation of Gynecology and Obstetrics stage IV disease, gross uterine serosal and/or gross adnexal involvement were excluded. Lymph node dissemination was defined as occurring in the following circumstances: (i) when nodal metastasis with pelvic and/or para-aortic (P/PA) lymph node dissection (LND) was performed or (ii) when there was recurrence in the P/PA lymph nodes after a negative LND or when LND was not performed. Univariate and multivariate logistic regression models were used to identify the pathological predictors of lymphatic dissemination. ResultsA total of 827 women with endometrioid EC were assessed; 516 (62.4%) of whom underwent P/PA LND and 205 (24.8%) underwent P LND. Sixty-seven (13%) women in the P/PA LND group and 5 (2.4%) in the P LND group had positive lymph nodes. Multivariate analysis confirmed cervical stromal invasion (OR 4.04, 95% CI 2.02-8.07 (P<0.001)) and lymphovascular space invasion (LVSI) (OR 110.18, 95% CI 38.43-315.87 (P<0.001)) as independent predictors of lymphatic dissemination. ConclusionCervical stromal invasion and LVSI are highly associated with LN metastasis. These markers may serve as a surrogate for nodal metastasis.Item Adaptation, validity and reliability of geriatric self-efficacy index for urinary incontinence (GSE-UI) in geriatric incontinentsSeçer, MB; Seçer, E; Mutlu, EK; Tosun, ÖÇ; Tosun, GPurpose The purpose of this study was to translate and culturally adapt the GSE-UI for use with a Turkish population and to determine its validity and reliability. Methods 120 elderly with UI aged 60 and over years (mean 72.89 +/- 9.59 years) participated in this study. An interview was held to determine the type, severity and frequency if any, incontinence. Then, the Mini-Mental State Examination, IIQ-7, UDI-6 and I-QOL questionnaires were administered to the participants. After translating the tool to Turkish, test and retest was performed with an interval of 7-14 days. Results The internal consistency of the first test of the GSE-UI-Turkish was excellent, with a Cronbach alpha of 0.95. The test-retest reliability of the GSE-UI-Turkish was found to be excellent (ICC = 0.94, 95% CI 0.92-0.96). The correlation coefficient between the GSE-UI-Turkish and the UDI-6, IIQ-7, I-QOL were found to be good to excellent (r = 0.68, r = 0.67, r = 0.81, r = 0.45, respectively; p < 0.0001). Conclusion Results of our study GSE-UI of Turkish version, self-efficacy evaluation in geriatric incontinence was a valid and reliable survey that can be used in clinical practice.Item Is there a synergistic relationship between diaphragm and pelvic floor muscles in pregnant women?Çiçek, S; Tosun,ÖÇ; Parlas, M; Bilgiç, D; Yavuz, O; Kurt, S; Seçer, MB; Tosun, G; Özer, M; Ileri, AObjective: The aim of this study is to examine whether there is a synergistic relationship between the diaphragm and pelvic floor muscles (PFM) in pregnant women. Material and Methods: Our study was carried out as a cross-sectional study in primigravid pregnants in the second and third trimesters. Superficial electromyography (EMG), 2D/3D ultrasonography (USG), pulmonary function test (PFT), PERFECT, maximum expiratory pressure (MEP) and inspiratory pressure (MIP) measurements were used to evaluate pelvic floor and diaphragm muscle functions during pregnancy. Mann-Whitney U test was used to show the change in the second and third trimesters, and Spearman correlation was used to determine the relationship. Results: No correlation was found between the EMG data of the PFM and diaphragm, or between the USG data of the PFM and diaphragm in all participants, in the second and third trimesters. In the third trimester of the study, diaphragmatic thickness and levator hiatal area (LHA) decreased and both diaphragm and PFM % MVC EMG parameters increased. In the third trimester, FVC, MIP, MEP decreased, and nonsignificant increase in FEV1, FEV1/FVC and peak ekspiratuar flow(PEF) were detected. A significant correlation was found between pelvic floor levator hiatal area USG and FEV1/FVC in both trimesters (r: 0,577p: 0,004). Conclusion: There may be a synergistic relationship between the diaphragm and PFM in pregnant women, the relationship may weaken as pregnancy progresses, and there may be no coactivation relationship between the two muscles. In order to prevent the occurrence of pelvic floor dysfunction during pregnancy and to increase the effect of rehabilitation programs, the relationship between the diaphragm and the PFM should be determined and more studies should be conducted.Item Does combining two evidence-based exercise programs in elderly people with incontinence have a triple effect on incontinence symptoms, balance and functional status?Seçer, MB; Tosun, OC; Akbayrak, T; Ilçin, N; Tosun, GBackgroundImproving pelvic floor muscle training (PFMT), balance and functional activity is recommended in the treatment of urinary incontinence (UI) in the elderly people. The aim of this study is to examine whether PFMT combined with Otago exercises is effective on symptoms, balance and functional status in elderly people with UI compared to PFMT alone.MethodsThis study is an assessor-blinded, randomized controlled trial. Participants with UI aged 65 and over living in a nursing home were randomly assigned to the intervention (IG) and control groups (CG). The intervention group attended an exercise program that included Otago exercises combined with PFMT. The control group was included in the PFMT program with different positions. The duration of exercise for both groups was 45-60 min per session three times a week for 12 weeks. UI symptoms and severity (Pelvic Floor Distress Inventory-20, bladder diary), PFM muscle function (superficial electromyography), balance (Berg Balance Scale), functional status (Senior Fitness Test) and fear of falling (Falls Efficacy Scale) were measured at baseline and after the intervention.ResultsThe median age of the IG (n: 22) and CG (n: 21) was 73.5 and 77 years, respectively. At baseline and after the intervention within the group, a significant improvement was observed in the PTDE-20 score (IG and CG, p: 0.00) and the 2-min step test in the IG (p: 0.02) and CG (p: 0.01). A significant decrease was found in the 2.45 m get up-and-go test, PFM work average onset, and PFM rest MVC EMG values (p: 0.01, p: 0.01, p: 0.00) in the IG. The PFM rest average value decreased (p: 0.04) in the CG.ConclusionThe findings of this study show that combining PFMT with Otago exercises, two evidence-based interventions, is beneficial for effectively treating incontinence symptoms, balance and functional status in elderly people. Thus, a triple effect can be achieved with a single exercise training in the same treatment session and for the same duration.Clinical trial numberClinical trial number: NCT06331039.Item Is the function of the core muscles affected during pregnancy?Cicek, S; Tosun, OC; Parlas, M; Bilgic, D; Yavuz, O; Kurt, S; Secer, MB; Tosun, GIntroduction and hypothesisThe aim of our study is to examine the changes in core muscle functions during pregnancy.MethodsOur study was carried out in 67 primigravida pregnant women. Superficial electromyography (EMG) and non-invasive 2D/3D ultrasonography (USG) were used to evaluate core muscle (diaphragm, transversus abdominus [TA], internal oblique [IO]-external oblique [EO] muscles, pelvic floor muscles, multifidus) function during pregnancy. Pelvic floor muscle strength was also measured by a digital palpation method (PERFECT system). USG was used to measure expected fetal weight and the diastasis recti (DR) distance. Mann-Whitney U test was used to show changes in trimesters in the core muscles, and Spearman correlation analysis was used to determine the relationship.ResultsIn the third trimester, an nonsignificant increase in EMG parameters was observed in all of the core muscles. Although a statistically significant decrease was observed in muscle thickness values measured by EO and IO USG in the third trimester, DR was found to increase at all levels (p < 0.005). When we evaluated both trimesters and all pregnant women together, no relationship was found between all core muscles and pelvic floor muscles in the data evaluated by EMG and USG. We found a negative correlation in USG values between fetal weight and IO and the upper part of the rectus abdominus muscle, and a positive correlation between the EMG data of the EO and rectus abdominus muscles.ConclusionsIn women, the coactivation relationship between the core muscles may disappear during pregnancy. As the trimesters progress during pregnancy, a decrease in thickness and an increase in muscle activity can be observed in the core muscles. Pregnant women can be given exercise training for core muscles for protection in both the prenatal and postnatal periods. But more research needs to be done.Item Multicenter Analysis of Gestational Trophoblastic Neoplasia in TurkeyOzalp, SS; Telli, E; Oge, T; Tulunay, G; Boran, N; Turan, T; Yenen, M; Kurdoglu, Z; Ozler, A; Yuce, K; Ulker, V; Arvas, M; Demirkiran, F; Bese, T; Tokgozoglu, N; Onan, A; Sanci, M; Gokcu, M; Tosun, G; Dikmen, Y; Ozsaran, A; Terek, MC; Akman, L; Yetimalar, H; Kilic, DS; Gungor, T; Ozgu, E; Yildiz, Y; Kokcu, A; Kefeli, M; Kuruoglu, S; Yuksel, H; Guvenal, T; Hasdemir, PS; Ozcelik, B; Serin, S; Dolanbay, M; Arioz, DT; Tuncer, N; Bozkaya, H; Guven, S; Kulaksiz, D; Varol, F; Yanik, A; Ogurlu, G; Simsek, T; Toptas, T; Dogan, S; Camuzoglu, H; Api, M; Guzin, K; Caliskan, E; Doger, E; Cakmak, B; Ilhan, TTBackground: To evaluate the incidence, diagnosis and management of GTN among 28 centers in Turkey. Materials and Methods: A retrospective study was designed to include GTN patients attending 28 centers in the 10-year period between January 2003 and May 2013. Demographical characteristics of the patients, histopathological diagnosis, the International Federation of Gynecology and Obstetrics (FIGO) anatomical and prognostic scores, use of single-agent and multi-agent chemotherapy, surgical interventions and prognosis were evaluated. Results: From 2003-2013, there were 1,173,235 deliveries and 456 GTN cases at the 28 centers. The incidence was calculated to be 0.38 per 1,000 deliveries. According to the evaluated data of 364 patients, the median age at diagnosis was 31 years (range, 15-59 years). A histopathological diagnosis was present for 45.1% of the patients, and invasive mole, choriocarcinoma and PSTTs were diagnosed in 22.3% (n=81), 18.1% (n=66) and 4.7% (n=17) of the patients, respectively. Regarding final prognosis, 352 (96.7%) of the patients had remission, and 7 (1.9%) had persistence, whereas the disease was mortal for 5 (1.4%) of the patients. Conclusions: Because of the differences between countries, it is important to provide national registration systems and special clinics for the accurate diagnosis and treatment of GTN.