Guidelines and enabling objectives for training primary healthcare providers, gynecologists and obstetric and gynecology residents in Female Pelvic Floor Medicine and Reconstructive Surgery.

AIM: For four decades, the training for fellows in Urogynecology has been defined by taking into account the proposals of the relevant international societies. Primary health care providers and general OB/GYN practitioners could not find validated guidelines for the integration of knowledge in pelvic floor dysfunctions. The FIGO Working Group (FWG) in Pelvic Floor Medicine and Reconstructive Surgery has looked for the consensus of international opinion leaders in order to develop a set of minimal requirements of knowledge and skills in this area. METHOD: This manuscript is divided into three categories of knowledge and skills, these are: to know, to understand, and to perform in order to offer the patients a more holistic health care in this area. RESULTS: The FWG reached consensus on the minimal requirements of knowledge and skills regarding each of the enabling objectives identified for postgraduate obstetrics and gynecology physicians and for residents in obstetrics and gynecology. CONCLUSIONS: Our goal is to propose and validate the basic objectives of minimal knowledge in pelvic floor medicine and reconstructive surgery. Neurourol. Urodynam. 36:514-517, 2017. © 2015 Wiley Periodicals, Inc.

Management of apical compartment prolapse (uterine and vault prolapse): A FIGO Working Group report.

AIM: Apical prolapse includes descent of the uterus, vagina cuff, or rarely solely of the cervix. It is estimated that women have an 11-19% life-time risk of undergoing surgery for POP. This rate is projected to increase over the next 2-3 decades. In this FIGO working group report we address the conservative and surgical treatment options for apical prolapse. METHODS: The FIGO working group "Pelvic Floor Medicine and Reconstructive Surgery" describes the different treatments for apical prolapse based on the literature evidence, the cost-effectiveness, the degree of difficulty and summed them up with an experts recommendation. RESULTS: Among the conservative treatment options, pessaries are the most successful options since centuries with a low complication rate and low costs. Among the vaginal operative procedures the sacrospinous ligament fixation (SSLF) and the uterosacral ligament suspension (USLS) show comparable outcomes and efficacy with a different, however, rather low complication pattern and a favorable cost-benefit profile. Sacrocolpopexy, independent on the open abdominal, laparoscopic, or robotic-assisted laparoscopic technique has a good durability and quality of life performance. The minimal invasive techniques are as effective as the open abdominal techniques and there is no difference in mesh exposure. CONCLUSION: Vaginal procedures are well described procedures with favorable outcomes and cost-benefit profiles. Sacral colpopexy has a high-effectivity; data on the route of performance and long-term outcome are awaited. The cost with mesh implants are higher compared to the operations with autologous tissue or any conservative treatment and further studies are recommended to evaluate the cure rates in the span of decades and the possible long-term mesh complications. Neurourol. Urodynam. 36:507-513, 2017. © 2015 Wiley Periodicals, Inc.

Recurrent pelvic organ prolapse: International Urogynecological Association Research and Development Committee opinion.

INTRODUCTION AND HYPOTHESIS: This committee opinion paper summarizes available evidence about recurrent pelvic organ prolapse (POP) to provide guidance on management. METHOD: A working subcommittee from the International Urogynecological Association (IUGA) Research and Development Committee was formed. The literature regarding recurrent POP was reviewed and summarized by individual members of the subcommittee. Recommendations were graded according to the 2009 Oxford Levels of Evidence. The summary was reviewed by the Committee. RESULTS: There is no agreed definition for recurrent POP and evidence in relation to its evaluation and management is limited. CONCLUSION: The assessment of recurrent POP should entail looking for possible reason(s) for failure, including persistent and/or new risk factors, detection of all pelvic floor defects and checking for complications of previous surgery. The management requires individual evaluation of the risks and benefits of different options and appropriate patient counseling. There is an urgent need for an agreed definition and further research into all aspects of recurrent POP.

The inter-system association between the simplified pelvic organ prolapse quantification system (S-POP) and the standard pelvic organ prolapse quantification system (POPQ) in describing pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The objective of this study is to determine the association between the POPQ and a simplified version of the POPQ. METHODS: This was an observational study. The subjects with pelvic floor disorder symptoms underwent two exams: a POPQ exam and a simplified POPQ. To compare with the simplified POPQ, vaginal segments of the POPQ exam were defined using points Ba, Bp, C, and D. Primary outcome was the association between the overall ordinal stages from each exam. RESULTS: One hundred forty-three subjects with mean age of 56 +/- 13 years. Twenty three subjects were status post-hysterectomy. The Kendall's tau-b statistic for overall stage was 0.80, for the anterior vaginal wall the Kendall's tau-b was 0.71, for the posterior vaginal wall segment the Kendall's tau-b was 0.71, for the cervix the Kendall's tau-b was 0.88, for the posterior fornix/vaginal cuff the Kendall's tau-b was 0.85. CONCLUSIONS: There is substantial association between the POPQ and a simplified version of the POPQ.

An update of a former FIGO Working Group Report on Management of Posterior Compartment Prolapse.

BACKGROUND: The FIGO Working Group (FWG) in Pelvic Floor Medicine and Reconstructive Surgery (2012-2015) established a consensus among international opinion leaders in evaluating current evidence and providing practice recommendations. OBJECTIVES: To provide an update of the previous clinical opinion report on conservative and surgical treatment of posterior compartment prolapse. SEARCH STRATEGY: Search of evidence was performed using Pubmed, Embase, and Cochrane Library databases up to August 2018. SELECTION CRITERIA: Controlled trials on posterior colporrhaphy, site-specific defect, transanal, abdominal, laparoscopic, and mesh repair. DATA COLLECTION AND ANALYSIS: Collective consensus on surgical outcomes was based on a decision-making process during meetings and multiple group consultations. MAIN RESULTS: Basic evaluation and conservative treatment precede surgical management. Surgical techniques are performed by vaginal, transperineal, transanal, abdominal, or laparoscopic approach. The transvaginal surgical route without mesh appears superior to the transanal route. No conclusions can be drawn based on clinical studies or randomized controlled trials of posterior colporrhaphy and laparoscopic rectopexy. CONCLUSIONS: Management of rectocele should include patients' history, quality of life questionnaires, and, in case of complex anorectal symptoms, imaging and functional studies. Evidence on the best type of posterior vaginal wall repair is still scarce. Randomized controlled trials are needed to determine the best approach to achieve safe, effective, and long-term anatomical and functional outcomes.

Nuevos test de valoración dinámica de la función del piso pelviano en la mujer / Dynamic valoration new tests of the function of the women pelvic floor

La valoración clínica del piso pelviano, en la práctica gineco-obstétrica, esta habitualmente limitada al grado de lesión anatómica, sin considerar los aspectos funcionales de la musculatura perineal. Evaluamos una clasificación funcional (4) en el Test ddel Dispositivo Intravaginal (D.I.V.) procurando cuantificar y estandarizar la respuesta funcional del piso pelviano. se analizó la correlación del Test del Dispositivo Intravaginal (DIV) con la clasificación funcional y el tipo de lesión anatómica, comparándolos con el grupo control. Se estudiaron 185 pacientes, correspondiendo 65 (35,1].

Análisis de la clasificación funcional en la mujer (1ª parte) / Analysis of the functional classification in the woman 1

Análisis de la clasificación funcional del piso pelviano, determinando las medidas de Sensibilidad, Especificidad, su valor predictivo y su correlación con la clasificación anatómica y el TEST del dispositivo intravaginal(DIV)

Valoración dinámica de la función del piso pelviano en la mujer (nuevo test). (2da. parte) / Dynaamic valuation of the function of the pelvic fllor in the woman (new test) 2da. it leaves

La evaluación clínica del Piso Pelviano, en la práctica gineco-obstétrica, está habitualmente limitada al grado de lesión anatómica, sin considerar los aspectos funcionales de la musculatura perineal

Hábitos dietéticos y osteoporosis en la postmenopausia / Dietary habits and osteoporosis in the postmenopausia

Se estudió en 113 mujeres postmenopáausicas (PostM) el efecto de los componentes de una dieta normal, estas pacientes respondieeron a un cuestionario entre 600 mujeres, a quienes se le efectuó una densitometría(BMD) en Cleveland Menopause Clinic, dirigida por el Pro. Dr. Utian. Las mismas fueron divididas en dos grupos de acuerdo a la densidad mineral ósea (BMD) pacientes con ossteoporosis y pacientes sin osteoporosis o normales

Actividad física y osteoporosis en mujeres postmenopáusica / Physical activity and ossteoporosis in postmenopausical women

La relación entre el buen estado físicao, ejercicio regular y densidad mineral ósea (BMD) de columna lumbar y cuello de fémur, fueron estudiadas en 60 pacientes, entre 113 mujeres psotmenopáausicas de Cleveland Menopause Clinic, dirigida por el Dr. Utian. En cada sujeto se evaluó la masa ósea por densitometría, midiendo el contenido mineral óseo. Se incluyeron sólo las pacientes de tipo corporal normal. Se objservó una diferencia estadisticamente significativa, entre mujeres de vida activa y sedentaria, en relación a pacientes con y sin osteoporosis

Displasias glandulares de cuello uterino / Glandular dysplasia of cervix uteri

De las once pacientes con displasia glandular, nueve presentaron lesión escamosa asociada, tres AIS y adenocarcinomas invasores, Todas las lesiones de displasia fueron negativas para p53. Dos de las displasias expresaron MIB-1 mayor de 5 por ciento y siete fueron positivas para CEA

Tratamiento conservador en el carcinoma de endometrio estadio inicial en pacientes estériles / Conservative treatment of endometrial carcinoma in sterile patients

Se presentan 5 casos de mujeres que presentaban un adenocarcinoma de endometrio, estadio inicial y que fueron tratadas con acetato de medroxiprogesterona con el fin adicional de preservar su potencial de fertilidad. Habían consultado todas por esterilidad y, durante su estudio, se les diagnosticó un adenocarcinoma de endometrio por biopsia endometral. Se completó la evaluación del resto del endometrio con histeroscopias en 4 casos y con raspado uterino el restante. Clínicamente eran estadios iniciales: en cuatro casos se trataba de un adenocarcinoma bien diferenciado G1 y en un caso semidiferenciado G2. Cuatro pacientes fueron tratadas con acetato de medroxiprogesterona en dosis de 500 mgs por día y con 200 mgs por día la restante. Se realizaron controles histológicos cada dos meses y el tiempo de duración del tratamiento fue de 3 meses en dos casos, de 4 meses en otros dos y de 9 meses en el restante. En 4 mujeres se obtuvo remisión completa del adenocarcinoma. Tres de éstas continuaron con sus estudios y tratamiento de la esterilidad y lograron embarazos que llegaron a término, una paciente en dos oportunidades. Hasta la actualidad ninguna tuvo una recurrencia y el tiempo de seguimiento mínimo es de 30 meses. La cuarta paciente debió abandonar el tratamiento por esterilidad y a los dos años tuvo una recidiva del adenocarcinoma por lo que se le realizó una anexohisterectomía total, comprobándose en la pieza operatoria que se trataba de un adenocarcinoma moderadamente diferenciado G2 y que infiltraba hasta el tercio medio del miometrio. Mantiene curación clínica luego de 42 meses de seguimiento. El tratamiento conservador con progestágenos como primera línea en pacientes que padecen un adenocarcinoma bien diferenciado G1 estadio inicial ofrece la posibilidad de preservar la fertilidad sin disminuir la gran tasa de curación, de estos tumores, alcanzada con la terapia quirúrgica convencional

Detección de hipotiroidismo subclínico en pacientes climatéricas / Subclinic hypothyrroidism detection in postmenopausal women

El hipotiroidismo aumenta su frecuencia con la edad. Las formas asintómaticas podrían ser detectadas mediante las determinaciones de Thyroid Stimulating Hormone (TSH) bajo el Test de THR (Thyroid Releasing Hormone) en los primeros estadios. La incidencia del hipotiroidismo subclínico (SCH) en la etapa del cimaterio no es bien conocida. El objetivo de este trabajo es realizar mediante la determinación de TSH, un "Screening" del Hipotiroidismo Subclínico (SCH) En 209 pacientes se determinaron valores de TSH, T3, T4 y anticuerpos antitiroideos y además se realizó ultrasonografía tiroidea

Citopunción ecoguiada de lesiones mamarias no palpables. Ventajes y limitaciones / Cytopuncture guided of nonpalpable breast lessions. Advantes and limitations

La nueva imagenología mamaria ha descubierto un grupo de lesiones no palpables que puede alcanzar hasta el treinta por ciento de los casos examinados