Dr. Alpaslan Caliskan Clinic - Overview
Joanne's Patient Review: Stress Incontinence⭐⭐⭐⭐⭐
17 Years of Experience in Pelvic Floor and Pelvic Reconstructive
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
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
- 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
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.