Researcher:
Urman, Cumhur Bülent

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Faculty Member

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Cumhur Bülent

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Urman

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Urman, Cumhur Bülent

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2012 - 2019902020 - 202318

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Now showing 1 - 10 of 108
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    Dynamic view of assisted reproduction in Turkey from 1996 to 2020
    (Elsevier Sci Ltd, 2022) Balaban, Basak; Yakın, Kayhan; Urman, Cumhur Bülent; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; 106822; 12147
    Research Question: What are the trends and changes in patient demographics and practices in treatment with assisted reproductive technology (ART) in Turkey over 25 years? Design: Data on patient demographics, cycle characteristics and clinical outcome of 29,541 cycles in 22,867 women who underwent treatment with ART between 1996 and 2020 were analysed according to calendar years. Regression and interrupted time series analysis were used to assess changes in patient characteristics, trends and effects of interventions on outcome. Results: From 1996 to 2020, the average age of women undergoing treatment with ART increased from 32.1 to 36.0 years (r = 0.96), the proportion of women over 40 more than tripled (9% versus 28.7%; r = 0.97) and the average duration of infertility at presentation dropped from 8.4 to 4 years (r = -0.98) (P < 0.0001, for all). Diminished ovarian reserve became the major indication by 2015. Gonadotrophin-releasing hormone antagonists dominated ovarian stimulation by 2009. The average number of oocytes retrieved decreased from 11.5 to 7.8 (r = -0.86, P < 0.0001). Blastocyst-stage transfers gradually increased, comprising 51% of all transfers in 2020 (r = 0.86, P < 0.0001). The mean number of embryos transferred decreased from 3.9 to 1.5. Clinical pregnancy rates (CPR) per embryo transfer remained stable for fresh transfers (range: 31.6-43.9%) but increased from 13% to 30.3% in cryopreserved transfers. The estimate of effect of blastocyst vitrification was significant (P = 0.001). The multiple birth rate declined from 30.4% to 7.1%. Conclusions: Remarkable changes were seen in patient demographics, treatment indications, and clinical and laboratory practices. Increased use of single embryo transfer and improvements in cryopreservation techniques helped maintain high CPR while reducing multiple births.
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    The clinical utility of a pulsed bipolar system and its electrosurgical device during total laparoscopic hysterectomy
    (Mary Ann Liebert, Inc., 2017) N/A; N/A; Mısırlıoğlu, Selim; Türkgeldi, Engin; Boza, Ayşen; Öktem, Özgür; Ata, Mustafa Barış; Urman, Cumhur Bülent; Taşkıran, Çağatay; Doctor; Faculty Member; Doctor; Faculty Member; Faculty Member; Faculty Member; Faculty Member; N/A; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; 329649; N/A; 102627; 232576; 12147; 134190
    Objective: The aim of this research was to evaluate the efficacy and safety of the PlasmaKinetic (PK) PKS OMNI (R) (Gyrus ACMI, Maple Grove, MN) sealing device in laparoscopic hysterectomy. Materials and Methods: For this retrospective observational study, 60 patients who underwent multiport total laparoscopic hysterectomy between January 2014 and January 2015 in a tertiary-care university-based teaching hospital and an academically affiliated hospital were included in this study. The PKS OMNI is a bipolar electrosurgical device that takes energy from a PK generator workstation G400. This pulsed wave system has two different modes; cutting (High Cut 1,2,3) and coagulation (Vaporization 1,2,3). Results: Records of 60 patients were analyzed. The median age was 50 (range: ages 40-84), median body mass index was 26kg/m(2) (range: 22-32kg/m(2)), and median parity was 2 (range: 1-8). The median total operation time was 100 minutes (range: 70-240 minutes), estimated blood loss was 80mL (range: 30-250mL), and uterine weight was 207g (range: 50-900g). Degree of Surgical Difficulty and postoperative pain scores at rest were evaluated with a visual analogue scale system, from 0 to 10, and the medians of these scores were 5 (range: 3-7) and 4 (range: 2-6), respectively. The median recovery time of bowel movement was 16 hours (range: 8-26 hours), median spontaneous urination time was 7 hours (range: 4-29 hours), and median postoperative mobilization time was 8 hours (range: 6-10 hours). Conversion to laparotomy was needed in 1 patient due to severe pelvic adhesions. The median duration of hospital stay was 2 days (range: 2-4 days). Vaginal cuff dehiscence was detected in 1 (1.7%) patient who engaged in sexual intercourse on the 122nd day after surgery. Cuff cellulitis in 1 (1.7%) patient and unexplained fever in 1 (1.7%) patient were the other recorded complications. The median follow-up time was 12 months (range: 6-17 months). Conclusions: The PKS OMNI is a novel, underused energy modality that promotes quick recovery and acceptable operation time with minimal blood loss.
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    A comprehensive comparative transcriptional and translational analyses of the impact of ovarian response type, stimulation protocol and mode of trigger on the luteal function
    (Elsevier Science Inc, 2018) Seyhan, A; Yakın, Kayhan; Ata, Mustafa Barış; Öktem, Özgür; Bildik, Gamze; Urman, Cumhur Bülent; Faculty Member; Faculty Member; Faculty Member; Teaching Faculty; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 106822; 182910; 102627; N/A; 12147
    Objective: We aimed to compare molecular characteristics of the luteal granulosa cells between natural vs. stimulated IVF cycles in good and poor-responders. Design: Translational research study. Materials and Methods: Luteinized granulosa cells were obtained from good (n=154) and poor responder (n=64) IVF patients comparable for age, type and dose of gonadotropin and IVF etiology. Good-responders (4-15 oocytes) underwent natural (n=22), GnRH agonist (long protocol n=44) and antagonist IVF cycles triggered with rec-hCG (n=46) or GnRH agonist leuprolide acetate (n=42). Poor-responders fulfilling the Bologna criteria consisted of 64 patients undergoing GnRH antagonist protocol triggered with hCG (n=36) or hCG+GnRH agonist (n=28). Results: In the good-responders, natural cycle (NC) granulosa cells were significantly more viable (88%) compared to the stimulated IVF cycles (66%, 64% and 37% for agonist and antagonist cycles triggered with hCG and agonist respectively, p<0.05). The mRNA expression of steroidogenic enzymes (SCC, stAR, 3B-HSD, 17B-HSD and aromatase), LH receptor and VEGF and in vitro E2 and P productions were comparable between hCG-triggered agonist and antagonist cycles, but significantly higher than NC in the first days of culture. However, on the following days their hormone productions and viability began to decline very rapidly with the most drastic decrease being observed in the agonist triggered cycles. By contrast, NC granulosa cells maintained their viability and produced E 2 and P in increasing amounts in culture up to six days. The expression of anti-apoptotic genes (AKT-1, BCL2-L2) were significantly lower, and pro-apoptotic genes (BAD, BID, BAX, Cas3) were significantly higher in the stimulated cycles particularly in the agonist triggered ones compared to NC granulosa cells. Pulse exposure to cisplatin induced apoptosis only in a small fraction of the cells from the NCs whereas the same exposure caused massive apoptosis in the cells of the stimulated cycles (27% vs. 78% respectively, p<0.01). In the poor-responders both viability and steroidogenic activity of the cells were more severely reduced compared to the antagonist cycles of the good-responders. There were no significant differences between hCG and hCG+agonist triggered cycles in terms of viability, hormone production, VEGF and LH receptor expressions in the luteal granulosa cells. Conclusions Reduced survival and increased apoptosis of luteal granulosa cells leading to defective steroid production in stimulated cycles in comparison to natural ones may at least in part explain why luteal phase is defective and requires exogenous P supplementation for support in these cycles. Also dual trigger does not appear to improve luteal function in the poor-responders. 
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    Role of three-dimensional ultrasound in gynecology
    (Springer India, 2015) N/A; N/A; N/A; N/A; Türkgeldi, Engin; Urman, Cumhur Bülent; Ata, Mustafa Barış; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 329649; 12147; 182910
    Three-dimensional ultrasound (3D USG) is a fast-evolving imaging technique that holds a great potential for use in gynecology. Its sensitivity and specificity is reported to be close to 100 % for diagnosing congenital uterine anomalies, comparable with those of magnetic resonance imaging (MRI) and laparoscopy. With 3D USG, a coronal view of the uterus can be obtained, clearly outlining the external contour of the uterus and providing accurate information about the shape of the cavity. Although 3D USG may not perform well in thin endometria, combining it with saline infusion sonography (SIS) overcomes this problem. Research shows that 3D USG is more sensitive and specific than two-dimensional ultrasound (2D USG) in defining and mapping uterine lesions, such as fibroids, adenomyosis, and intrauterine synechia. In cases of suspected malignancy, 3D USG is mainly used in the initial evaluation of patients. Measuring various indices and mapping vascular architecture with 3D power Doppler have been proposed for evaluating adnexal masses. Although some studies raised hope, no consensus is reached about its use, success, and limitations. In urogynecology, translabial 3D USG is proved to be a valuable tool, as it provides instant access to the axial plane, which clearly depicts the relationship of the vagina, urethra, rectum, and the muscular pelvic floor. Studies report no significant differences between translabial 3D USG and MRI measurements for evaluation of the pelvic floor. In conclusion, adding 3D USG to routine gynecological workup can be beneficial for clinicians, as it provides fast and accurate results in a relatively cost-effective setting.
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    Intraoperative endoscopic ultrasound guidance for laparoscopic excision of invisible symptomatic deep intramural myomas
    (Taylor & Francis Inc, 2018) Boza, Ayşen; Aksu, Sertan; Arslan, Tonguç; Urman, Cumhur Bülent; Ata, Mustafa Barış; Taşkıran, Çağatay; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 12147; 182910; 134190
    The aim of this study was to evaluate the feasibility of intraoperative endoscopic ultrasound guidance for excision of symptomatic deep intramural myomas that are not otherwise visible at laparoscopy. Seventeen patients with symptomatic deep intramural myomas who underwent laparoscopic myomectomy with intraoperative endoscopic ultrasound guidance were followed up and reported. All myomas were removed successfully. The endometrium was breached in one patient. All patients were relieved of their symptoms and three patients presenting with infertility conceived. There were no short- or long-term complications associated with the procedure. One patient who had multiple myomas necessitated intravenous iron treatment prior to discharge. Laparoscopic removal of small symptomatic deep intramural myomas is facilitated by the use of intraoperative endoscopic ultrasound that enables exact localisation and correct placement of the serosal incision. IMPACT STATEMENT What is already known on this subject: When the myoma is symptomatic, compressing the endometrium, does not show serosal protrusion and is not amenable to hysteroscopic resection, laparoscopic surgery may become challenging. What do the results of this study add: The use of intraoperative endoscopic ultrasound under these circumstances may facilitate the procedure by accurate identification of the myoma and correct placement of the serosal incision. What are the implications of these findings for clinical practice and/or further research: Intraoperative ultrasound should be more oftenly used to accurately locate deep intramural myomas to the end of making laparoscopy feasible and possibly decreasing recurrence by facilitating removal of otherwise unidentifiable disease.
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    Utilization of the Bologna criteria: a promise unfulfilled? A review of published and unpublished/ongoing trials
    (Elsevier, 2018) Boza, Ayşen; N/A; Yıldız, Şule; Mısırlıoğlu, Selim; Yakın, Kayhan; Urman, Cumhur Bülent; Faculty Member; Doctor; Faculty Member; Faculty Member; School of Medicine; N/A; School of Medicine; School of Medicine; N/A; Koç University Hospital; N/A; N/A; 134205; N/A; 106822; 12147
    Objective: To study the use of the Bologna criteria (BC) for the definition of poor ovarian responders (POR) in clinical practice and research. Design: Systematic review of published and unpublished/ongoing trials between January 2012 and August 2017 on POR. Setting: Not applicable. Patient(s): Not applicable. Intervention(s): The databases were searched using the relevant medical subject headings including all subheadings. The search was limited to humans and English language. The references of the included studies were cross-searched for possibly missed articles. Only clinical trials providing an evidence level >= III were included. Case reports, review, letters, and hypothetical articles were excluded. Main Outcome Measure(s): Extracted studies were divided into two groups: studies in which the BC were used or not. Result(s): One hundred nine published clinical studies analyzing a total of 30,540 women and 112 unpublished/ongoing trials were identified. The BC were used to define POR in 56 (51%) of the published and 44 (39%) of the unpublished trials. The use of the BC gradually increased from 29% to 53% from 2012 to 2017. Asian researchers were more likely to use the BC compared with European and North American researchers (65%, 49%, and 23%, respectively). Neither the design of the study nor the impact factor of the publishing journal was correlated with the use of the BC. Conclusion(s): There is still reluctance to use the BC for the definition of POR, which makes it difficult to combine data from small studies and reach a meaningful conclusion. (C) 2017 by American Society for Reproductive Medicine.
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    The expressions of ovarian steroidogenic enzymes do not increase proportionally after FSH, creating a shunting that promotes progesterone output in the granulosa cells without luteinization
    (Oxford University Press (OUP), 2016) Seyhan, A.; Keles, I.; Balaban, B.; N/A; N/A; N/A; N/A; Akın, Nazlı; Bildik, Gamze; Urman, Defne; Urman, Cumhur Bülent; Öktem, Özgür; Master Student; Teaching Faculty; Master Student; N/A; Faculty Member; Faculty Member; Graduate School of Health Sciences; School of Medicine; Graduate School of Health Sciences; N/A; School of Medicine; School of Medicine; N/A; N/A; N/A; N/A; 12147; 102627
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    Effect of hemostatic method on ovarian reserve following laparoscopic endometrioma excision; comparison of suture, hemostatic sealant, and bipolar dessication. a systematic review and meta-analysis
    (Oxford Univ Press, 2015) Ata, A. Seyhan; N/A; Ata, Mustafa Barış; Türkgeldi, Engin; Urman, Cumhur Bülent; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; Koç University Hospital; 182910; 329649; 12147
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    Laparoscopic removal of bladder from the uterine niche with retrograde dissection
    (Elsevier, 2015) N/A; N/A; Mısırlıoğlu, Selim; Türkgeldi, Engin; Taşkıran, Çağatay; Urman, Cumhur Bülent; Doctor; Faculty Member; Faculty Member; Faculty Member; N/A; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; N/A; N/A; N/A; 329649; 134190; 12147
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    DHEA for poor responders: can treatment be justified in the absence of evidence?
    (Elsevier Sci Ltd, 2012) Urman, Cumhur Bülent; Yakın, Kayhan; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 12147; 106822
    Evidence-based medicine is the application of Science to the practice of healthcare, leading to reproducibility and transparency in the Science supporting healthcare practice. Dehydroepiandrosterone (DHEA) has been proposed as a treatment for improving ovarian reserve in poor responding women undergoing IVF. However, there is a lack of evidence of its effectiveness as data is derived mostly from retrospective studies and one questionable randomized trial. DHEA appears to be devoid of major side effects, however, due lack of data supporting its effectiveness, its wide scale use cannot be currently recommended.