Dr. Alpaslan Caliskan Clinic

 Joanne's Patient Review: Stress Incontinence⭐⭐⭐⭐⭐  

17 Years of Experience in Pelvic Floor and Pelvic Reconstructive Surgery

Dr. Alpaslan Caliskan has been a fully ECERPS (European Center of Excellence for Reconstructive Pelvic Surgery) Certified Pelvic Floor Surgeon since May 2103.

He underwent an excellent surgical training in famous European urogynecology departments, performed more than 5000 reconstructive pelvic floor surgeries in this field, is able to manage, organize and operate all urogynecological cases. 

Dr. Alpaslan Caliskan enjoys a special professional prestige, being particularly known and appreciated by his activity in all medical centers in the country.

Dr. Alpaslan Caliskan performs ONLY Reconstructive Pelvic Floor Surgeries !

Who are our patients? 

Half of parous (having given birth one or more times) women can experience pelvic floor problems at some point in their lives.

Our patients usually complain as follows:

"I can't hold my urine, I urinate every hour, I know almost every toilet, I can't go out because of the fear, I can't go to my neighbor, I feel like I have urine all the time, I go to the toilet frequently at night, I have back and groin pain that don't go away, I can't control my stool as before, I have to support it with my finger while doing it. And off course; there's something coming down below, something's coming out"

Because of high recurrence rates and low patient satisfaction in the past, surgeons have still been searching for the ideal technique for POP surgery. Patients, who need and desire the POP therapy, are often said: you are either too young for a comprehensive surgery or too old to try. 

 

In many cases only a 60-gram uterus is blamed for sagging and yet removed as a routine procedure. After excision of excessive vaginal tissue, the remaining damaged tissue is often stitched again to each other.

Those techniques are unphysiological and unfit for most of the cases, and thus, cannot cure the symptoms or the exact anatomy in a proper way, Then, the consequence is: recurrence rates of up to 60% or worse. Furthermore, patients and physicians avoid such surgeries. Effective Long-lasting and accurately restoring all defects is a big challenge. 

Presentation by Dr. Alpaslan Caliskan at the 12th International Society of Pelvi-Perineology Congress (ISPP)

Pelvic Organ Prolapse (POP) and Integral Theory Based Surgeries

Pelvic Organ Prolapse (POP) is characterized by a descent of the pelvic organs: uterus, vagina, bladder, rectum and small bowel. In most cases concomitant urinary, defecation, sexual problems or pelvic pain are present. POP increases with age and causes great impact on quality of life. The estimated lifetime risk of surgery for either incontinence or POP in women is 20%

In 1990 Petros and Ulmsten created a new vaginal procedure for pelvic floor surgery based on the Integral Theory which states; this problem can only be solved by a sufficient operation enabling restoration of the natural anatomy by renewing all damaged and weakened connective tissue with synthetic graft material. There is no sense and no success in using weakened, damaged tissues, as it is still done.

Myself and my German colleague Prof. Dr. Klaus Goeschen have further developed individual techniques, which are published in many prestigious journals in the field, "Integral Theory-Based Surgeries"; and I performed over 5000 cases nearly in 17 years.

With the new treatment techniques in pelvic floor surgery, which we call "Pelvic Reconstructive Surgery", uterine, urinary bladder prolapse, sagging of the last part of the large intestine, urinary bladder dysfunction and urinary incontinence problems can be operated effectively and successfully.

Surgical Mesh in Pelvic Reconstructive Surgery 

Surgical mesh is a medical product that is applied to establish additional support when repairing and renewing weakened or damaged tissue. Surgical mesh is made usually from synthetic or biological materials.

Reconstructive pelvic floor surgery is a fascia and ligament surgery (connective tissue). Without the synthetic mesh, there would be no effective, permanent, anatomical, physiological repair. 


Should I worry about using mesh? 

We reconstruct all damaged compartments simultaneously by using artificial mesh (synthetic). Mesh related complications, particularly “erosion”, is a major discussion regarding POP surgery.

Because of these concerns, surgical mesh has been banned only in the UK, Australia and Commonwealth countries, but surgical mesh has still been used in the rest of the world, including the USA (except transvaginal mesh kits) and Europe for pelvic reconstructive surgeries.

The problem isn't the mesh, it's how it's applied. Industrial, prefabricated and standard size mesh kits are widely used for every defect and each patient. However, this is one of the main problems according to our opinion. Patients and defects are not standard. Therefore, shrinkage, contraction, pain, pain during intercourse and erosion are inevitable.

The following are also important and substantially impact the result of the surgery:

• How well patients are prepared before the surgery,
• The technique and experience of the treating doctor,
• The location and the amount of mesh that will be used

We use self-tailored lightweight macropore monofilament polypropylene meshes and are cutting the mesh off during the surgery appropriately for the defect. Our mesh related complication rates are about only 1% as minimal erosion, which is one of the lowest in the literature.

Advantages of the Goeschen/Caliskan Techniques 

• High, until now unheard-of healing rates, also helps patients who have already been operated using different techniques
• We try to conserve a healthy uterus whenever possible. Pregnancy after operation is still possible
• Less post-operative pain
• No vaginal shortening and only small vaginal scars (minimal invasive vaginal surgery)
• Small vaginal incisions and wounds
• Short post-operative stay in hospital (1- 2 days)
• Quick return to daily life. On day after discharge from hospital, you can usually drive your car, cook, go shopping and look after your children. However, in some patients, recovery may take longer.
• Operation is suitable for women of any age
• Intervention through the vagina which is the natural way
• Fewer complications

The Importance of Preserving the Uterus

Contrary to many surgeons, in all of these surgeries one of the basic principles is "not removing the uterus". 

The uterus provides the form and stabilization of the pelvic floor and is located in the centre of the pelvic floor. All ligaments are gathered here. It is surrounded by important nerves, blood vessels, connective tissue, and muscles.

Within the complex architecture of the pelvic floor the uterus acts like the keystone of an arch, being an important insertion point for posterior ligaments and the downward muscle. 

• Removal of the uterus may cause a point of weakness in the posterior ligaments predisposing to prolapse of the vagina. This, in turn, may cause bladder problems in 18 % of patients who have had a hysterectomy.
• If the uterus is removed, the nourishment and support of the ligaments are blocked. Removing it makes it easy for this harmonious structure to collapse.

• In some rare cases, the uterus may need to be removed, which we already perform when necessary. However, removing a healthy uterus, on the contrary, will increase urinary problems in the future, the patient will have lost an important organ, and young patients will no longer be able to have children.

The uterus, the central anchoring point of the pelvic floor, acts like the keystone of a roof

For the above reasons we try to conserve a healthy uterus whenever possible. A hysterectomy by using the procedure of Goeschen/Caliskan is rarely necessary. Pregnancy after operation is still possible. However, we recommend then that delivery should take place by Caesarean section.

Figure: Hysterectomy may weaken the fascial (=fibrous connective tissue separating or binding together muscles and organs etc) side-wall support and the ligaments by removing a major part of its blood supply. Conservation of the uterus is important in the long-term prevention of vaginal prolapse and incontinence 

Our Success Rate

• Our actual anatomic success rate is about 98 – 99%, recurrence rate is less than 1%. 
• We operated patients of ages between 24 years and 90 years who had an indication and request for the surgery.

According to the results we published in the Pelviperineology Journal and the Central European Journal of Urology, we achieved the following success rates by using our (Integral Theory based) methods:

Condition

Success Rate

Patient Age Range:  24-90 Years

Objective Anatomic Success

95% - 98%

Stress Incontinence

95%

Urge Incontinence

78%

Pollakiuria (frequent, abnormal urination during the day)

85%

Nocturia (at night to pass urine)

80%

Urgency (sudden desire to urinate)

80%

Defecation Difficulties 

97%

Improvement of Quality of Life

90%

The most feared complication of patients is recurrence or worsening which in our series is less than 1%. This rate goes up to 60 % in classical surgeries.

Our modified surgery techniques according to Integral Theory lead to 98-99 %  of the anatomic cure rates and decrease in recurrence rate in long term series.

Behind this success lies repairing all defects at once, using the physiological vaginal route, protecting the uterus, using our own special techniques, not excise vaginal excessive skin, using synthetic tissue instead of your own damaged – weak tissues and long-term experience.

You can return to your daily life in a short time, unlike unphysiological abdominal techniques with limited effect.

The hospital where I work at has all advanced and modern care facilities and you can easily return your country after 2 postoperative nights.

Centers of Excellence - Reconstructive Pelvic Floor Surgeries

With more than 5000 Pelvic Floor Surgeries performed as of 2022, Dr. Alpaslan Caliskan is exceptionally experienced in the following highly specialized Reconstructive Pelvic Floor Surgeries:

• Pelvic organ prolapse,
• Descensus uteri (The uterus drops down towards the vagina)
• Cystocele,
• Rectocele,
• Enterocele,
• Vaginal Prolapse,
• Anal Prolapse,
• Stress Incontinence,
• Lower Urinary Tract Symptoms (nocturia, urgency, abnormal bladder emptying, frequency), 
• Idiopathic Fecal Incontinence,
• Stricture or changes of vagina due previous operations (Tethered vagina),
• Difficulty in Defecation
• Urge Incontinence

Facility and Surrounding 

Private Odak Hospital, where I accept my patients and operate, is a new, modern, boutique hospital and is provided in the equal quality with the Turkey's leading institutions, The facility has all healthcare services including intensive care unit, with 47 doctors and more than 350 staff provide you multidisciplinary healthcare.

Denizli, where I locate, is a Turkish provincial capital in the Aegean region, has 1,005,687 inhabitants (as of 2016) and interestingly is only 2 - 3hours drive away from important touristic places such as Bodrum, Izmir, Antalya, Marmaris, Fethiye etc.

Even the city of Pamukkale and the ruins of the ancient city of Hierapolis, which are on the UNESCO World Heritage List. So it can be an interesting choice both in terms of health and vacation. There is a shuttle service from the airport to the hospital at a very reasonable price.