Latin American consensus on uncomplicated recurrent urinary tract infection-2018.

An estimated 20-30% of adult women who experience an initial urinary tract infection (UTI) will have recurrent infection. In these patients, prophylaxis may be considered to improve their quality of life and control overuse of antibiotics. Despite this need, there is currently no Latin American consensus on the treatment and prophylaxis of recurrent UTIs. This consensus, signed by a panel of regional and international experts on UTI management, aims to address this need and is the first step toward a Latin American consensus on a number of urogynecological conditions. The panel agrees that antibiotics should be considered the primary treatment option for symptomatic UTI, taking into account local pathogen resistance patterns. Regarding prophylaxis, immunoactive therapy with the bacterial lysate OM-89 received a grade A recommendation and local estrogen in postmenopausal women grade B recommendation. Lower-grade recommendations include behavior modification and D-mannose; probiotics (Lactobacilli), cranberries, and hyaluronic acid (and derivatives) received limited recommendations; their use should be discussed with the patient. Though considered effective and receiving grade A recommendation, antimicrobial prophylaxis should be considered only following prophylaxis with effective non-antimicrobial measures that were not successful and chosen based on the frequency of sexual intercourse and local pathogen resistance patterns.

Evaluation and surgery for stress urinary incontinence: A FIGO working group report.

AIMS: To review available evidence regarding evaluation and treatment of stress urinary incontinence (SUI) and provide recommendations for management of urinary incontinence under specific conditions determined by the International Federation of Gynecology and Obstetrics (FIGO) Working Group. METHODS: The FIGO Working Group discussed the management of SUI during meetings and assessed the evidence. The search of evidence was performed using MEDLINE® and Cochrane databases as well as additional searches from societies and major organizations for additional guidelines and recommendations and hand searches from bibliographies. Initial searches from 1985 to December 31, 2012 extended until July 15, 2015. After review, recommendations are made based on levels of evidence according to the recommendations from Oxford EBM Center. RESULTS: Initial evaluation of SUI consists of history and physical examination; cough stress test, evaluation for urinary tract infections (UTI), assessment of urethral mobility, and post-void residual volumes (LOE 5). Urodynamic studies are not necessary to evaluate patients with uncomplicated SUI (LOE 1a). Conservative treatment should be tried prior to surgery and more importantly in areas of low resources (LOE 5). Midurethral slings (MUS), pubovaginal (traditional suburethral) slings (PVS), and Burch colposuspension are effective in treating SUI (LOE 1a). Patients with SUI with ISD or UUI appear to have lower cure rates than patients without (LOE 2-4). There are limited data on surgical outcomes under limited resources (LOE 5). CONCLUSIONS: MUS, PVS, and Burch colposuspension are effective treatments for SUI. Evidence for recommendations to treat patients in underserved low resource areas is lacking. Neurourol. Urodynam. 36:518-528, 2017. © 2016 Wiley Periodicals, Inc.

[Vaginal hysterectomy for the enlarged non-prolapse uterus using morcellation techniques and/or Deschamps needle: a retrospective cohort study]. / Histerectomía vaginal para úteros grandes y sin prolapso mediante morcelación y aguja de Deschamps.

OBJECTIVE: To compare surgical outcomes in women who underwent vaginal hysterectomy with enlarged (> 12 weeks size) and non-prolapsed uterus utilizing different morcellation techniques with or without concomitant Deschamps needle use to vaginal hysterectomy for prolapsed uterus. MATERIAL AND METHODS: Retrospective cohort study in women who underwent vaginal hysterectomy performed between January 2009 and June 2014 in the National Institute of Perinatology. The study group comprised 48 women who had vaginal hysterectomy with enlarged and non-prolapsed uterus in which were utilized different morcellation techniques with or without concomitant Deschamps needle use and 50 women who had vaginal hysterectomy for prolapsed uterus served as control. RESULTS: The groups had statistical difference in age, number of cesarean sections, body mass index (BMI), grade of prolapse (Point Cx and D with POPQ quantification system) and surgical prediagnosis (p < 0.001); mean uterus weight was 182.5 g and 106 g, respectively (p < 0.001), as well as for transverse and antero-posterior dimensions and realization of morcellation with or without use of Deschamps needle. Both groups had no statistical difference in preoperative hemoglobin, concomitant surgeries for incontinence and prolapsed, estimated blood loss, operation time, length of stay and complications. CONCLUSION: Vaginal hysterectomy utilizing different morcellation techniques with or without concomitant Deschamps needle use in women with enlarged and non-prolapsed uterus is safe, effective, and with similar complications to vaginal hysterectomies in prolapse uterus.

[Posterior tibial nerve stimulation for pelvic floor dysfunction. Review]. / Estimulación del nervio tibial posterior como tratamiento de la disfunción del piso pélvico. Revisión de la bibliografia.

Pelvic floor dysfunction is a highly prevalent functional pathology that affects women and can present with different clinical symptoms that include urinary urgency with or without incontinence, diurnal and nocturnal frequency, urinary retention, fecal incontinence, obstructive defecation, sexual dysfunction and pelvic pain. Lately, concern arised as to offer patients an advanced therapy within an integral approach. This interest was first focused in sacral nerve root modulation, a key element for pelvic function. Neuromodulation is considered a normal characteristic of the nervous system that regulates or modifies the electric impulses that come from different nervous body tissues. Neuromodulation is carried out through sacral neurostimulation (SNS), posterior tibial nerve stimulation (PNTS), which are reversible non destructive therapies used for peripheric stimulation of nerves, ganglia, spinal medula and brain. Even though there is evidence of efficacy for sacral nerve stimulation at short, medium and long-term, there are two main concerns within this approach: invasivity and high cost. It seems posterior nerve tibial stimulation has the same neuromodulatory effect as the one obtained by sacral nerve stimulation through a less invasive route and lower cost.

[Prevalence of urinary incontinence in pregnant women with prenatal care at the National Institute of Perinatology Isidro Espinosa de los Reyes]. / Prevalencia de incontinencia urinaria en mujeres embarazadas con atención prenatal en el Institute Nacional de Perinatología Isidro Espinosa de los Reyes.

BACKGROUND: Urinary incontinence during pregnancy is relatively frequent and is seen in some cases as a normal event. Several authors estimate a prevalence of urinary incontinence during pregnancy of 58.1%. OBJECTIVE: To determine the prevalence of urinary incontinence in women at the National Institute of Perinatology Isidro Espinosa de los Reyes from March to May 2008. We also assessed the type, severity and frequency of involuntary loss of urine. PATIENTS AND METHODS: longitudinal study to determine the prevalence of urinary incontinence before and during pregnancy, by quarter, type, frequency and severity. RESULTS: The prevalence of urinary incontinence during pregnancy was 58.2% and before pregnancy was 34.7%. The odds ratio for the association of multiparity and incontinence before pregnancy was 1.7 (95% CI 1.2-2.5) and 2.0 (95% CI 1.4-2.9) to manifest during pregnancy. Patients under 26 years have an odds ratio for urinary incontinence of 0.67 (95% CI 0.4-0.9). CONCLUSION: The prevalence of urinary incontinence increases during pregnancy, multiparity is a risk factor for urinary incontinence and age under 26 is a protective factor.

[Suburethral cyst. A case report]. / Quiste suburetral. Reporte de un caso.

Suburethral cysts are rare, are formed from remnants of embryonic or blockage of the paraurethral glands, whose location in more than 85% of cases are found in the proximal two thirds and posterior and lateral to the urethra. The diagnosis is clinical and radiological studies are needed to demonstrate the absence of communication with the urethra. Once the diagnosis of suburethral cyst, surgery is the treatment of choice. Before its resection, the presence of a urethral diverticulum. Urethral injury is the most common surgical risk, as noted during surgery must be repaired immediately. So far it has not been reported urethra-vaginal fistula as a complication after repair. The present patient had a cyst in the distal third of Suburethral 4 x 2 cm, a 6-month follow-up remained asymptomatic, with no postoperative complication. The pathology reported wall 3 x 2.2 cm with a thickness of 0.3 cm, greyish, irregular, soft consistency. Microscopically identified transitional epithelium and foci of squamous metaplasia and focal chronic inflammation. According to the histopathological report, the transitional epithelium indicates the cyst Skene.

[Diagnosis and treatment alternatives to sexual disorders in women with urinary incontinence]. / Diagnóstico y alternativas de tratamiento de las alteraciones sexuales en mujeres con incontinencia urinaria.

BACKGROUND: One difficulty that a woman with urinary incontinence faces up is quality and control of her sexual life, the more it is complicated the more it affects her in different ways. These complications require, as well as medical treatment, evaluation and special psychological intervention to integrally recovery. OBJECTIVE: To know frequency and origin of sexual disturbances in women with urinary incontinence. PATIENTS AND METHODS: Demographical, confirmatory, descriptive, transversal, retrospective with non-experimental design study. Seventy patients, ranging from 21 to 59-years-old, with diagnosis of urinary incontinence were selected. Three groups were conformed: Group 1, patients with sexual dysfunction before the manifestation of urinary incontinence; Group 2, patients with sexual dysfunction due to urinary incontinence, and Group 3, patients with no sexual problems neither before nor after the urinary incontinence problem. Codified Clinical History Form on Female Sexuality was used to classify patients; diagnosis was performed with the DSM-IV-TR. RESULTS: Forty-six percent of patients had sexual dysfunctions (mainly dysrythmia and orgasmic disorder), 37% showed sexual disorder associated with urinary incontinence (dyspaurenia and hypoactive sexual desire), and 17% had no sexual problems. CONCLUSIONS: As proper appraisal will define intervention strategies, patients with medical sexual problems must be evaluated by a psychology to establish diagnose and for adequate approach.

[Urolithiasis and pregnancy]. / Urolitiasis y embarazo.

Urolithiasis disease during pregnancy fortunately is a relatively rare disease; nevertheless many times it complicates the diagnosis and treatment. This paper reviews the safety and efficacy of both and their relationships with mother and fetus and proposes different options for the urologist, gynecologist, and urogynecologist for the attention of pregnant women with suspicion of urolithiasis. The ultrasound seems to be the first-choice method during the pregnancy; it is available in many health centers and does not require too much experience for its interpretation. Intravenous urography, simple X-ray and magnetic resonance image with its limitations aid support to our clinical suspicion; additionally the uretheroscopy is the diagnostic and therapeutic method and can be used safely during the pregnancy; thus first-choice study is the ultrasound with changes in vascular resistance rates. Once diagnosis is established, conservative treatment is applied because the majority of patients has spontaneous elimination of stones (70 to 80%). Surgical intervention can be an option and when is needed, placement of an uretheral catheter JJ, percutaneous nephrostomy and uretheroscopy may be an option to definitive treatment.

[Vesicovaginal fistula. Experience at the Instituto Nacional de Perinatología]. / Fístula vesicovaginal. experiencia en el Instituto Nacional de Perinatologia.

BACKGROUND: The damage of the lower urinary tract is originated by complications of obstetric or gynecological surgery, which if not detected timely determines the formation of fistulas. OBJECTIVE: To analyze the experience in diagnosing and treating vesicovaginal fistulas attended at the gynecologic urology clinic of the Instituto Nacional de Perinatologia (INPer). MATERIAL AND METHOD: Retrospective study of 27 files of patients diagnosed with vesicovaginal fistula at the gynecologic urology clinic of the INPer from January 11 1992 trough December 31st 2005. The variables analyzed were age, parity, corporal mass index, surgical history, surgery performed to correct the fistula and postoperative evolution. Averages and standard deviation were calculated to describe data. RESULTS: Average age was 38.2 years. Abdominal hysterectomy (53.3%), followed by obstetric hysterectomy (33.3%), caused the most of complications. The most often used techniques to correct the fistula were Latzko operation, 19 patients (45.23%), and Sims' fistulectomy, 11 patients (26.19%). The most used drainage was Foley probes, with 9.1 days average of use. Urinary tract infection was the most common complication (6.7%). CONCLUSIONS. After our analysis, surgical treatment to patients with vesicovaginal fistula showed good results (71.4% of healing) with a minimum of complications (28.5% of recurrence).

[Ureteral injury at the National Institute of Perinatology]. / Lesiones ureterales atendidas en el Instituto Nacional de Perinatologia.

OBJECTIVES: To evaluate the incidence of ureteral injury at Instituto Nacional de Perinatologia and to know the variables associated to ureteral injury as a ginecoobstetric surgery complication, and to do a theme review. MATERIAL AND METHODS: We conducted a study including patients with ureteral injury from January 1st 1992 to July 1st 2005. Files were registered for age, parity, surgery associated to the injury, injury type, diagnostic time and methods, management type and evolution. The study was observational, transversal, and retrospective. We analyzed the results with descriptive statistics. RESULTS: We included 39,405 surgeries; a total of 32 injuries were identified, and in 41% the injured ureter was the left one, in 42% was the right one and both in 17%. We included patients from the Instituto and from another hospital. Mean age was 38.9 years, media 43 and mode 44 years. Principal surgery related was the gynecological histerectomy. Patients' evolution was satisfactory. The most frequent surgery to repair the ureter was the reimplantation, followed by the immediate reparation with simple stitches. CONCLUSIONS: The ureteral injury frequency was 0.04%, in relation principally with gynecological histerectomy. The most frequent injury type was the ligation in the distal third. In three cases there was a ureter-bladder fistula. The ureteral reimplantation was the most frequent surgical repair.

[Comparative study of overactive bladder prevalence in patients younger than 50 years with and without hyperprolactinemia]. / Estudio comparativo de la prevalencia de vejiga hiperactiva en pacientes menores de 50 años con y sin hiperprolactinemia.

OBJECTIVE: To determine if the hyperprolactinemia is associated with idiopathic overactive bladder. PATIENTS AND METHODS: We performed a transversal and analytic two groups study. We included all the patients whom plasma levels of prolactin were measured in the National Institute of Perinatology from March 1st to May 31, 2005 and fulfilled the selection criteria. To all these patients we applied a questionnaire of eight questions for the overactive bladder diagnostic. We used chi square statistical technique to establish if hyperprolactinemia is associated with the overactive bladder. RESULTS: One hundred sixty years patients were studied, establishing a relative prevalence of 2.82 (IC 95%: 1.45-3.17), determining association between the variables. CONCLUSIONS: hyperprolactinemia is associated with overactive bladder.

Dehiscencia de cistorrafia en pacientes con embolización de arterias uterinas por acretismo placentario: reporte de dos casos / Cistorraphy dehiscence in patients with uterine arteries embolization due to placentary acretism: report of two cases

Resumen: ANTECEDENTES: La incidencia de percretismo varía de 5-7% y de ésta, 78% corresponde a complicaciones relacionadas con la cirugía. Hasta la fecha existen pocos casos reportados de dehiscencia de cistorrafia posterior a la embolización de arterias uterinas. CASOS CLÍNICOS: Caso 1. Paciente de 34 años, con embarazo de 36 semanas y diagnóstico de acretismo placentario. El tratamiento consistió en embolización de arterias uterinas e histerectomía subtotal, con lesión vesical reparada sin complicaciones. Dos semanas después del alta hospitalaria acudió a consulta por pérdida de orina y fiebre (pielonefritis aguda); se estableció el diagnóstico de dehiscencia de cistorrafia por tomografía y cistografía retrógrada. Se realizó cateterización ureteral bilateral, laparotomía exploradora con traquelectomía, resección de los bordes necróticos vesicales y cistorrafia. Caso 2. Paciente de 30 años, con embarazo de 37 semanas y acretismo placentario; se aplicó tratamiento similar al caso 1, del que devino una lesión vesical reparada sin complicaciones. Durante la hospitalización permaneció en vigilancia por hemorragia obstétrica e infección urinaria con mala evolución; dos semanas después tuvo pérdida de orina, por lo que se efectuaron: cistoscopia, tomografía y cistografía retrógrada. Se estableció el diagnóstico de dehiscencia de cistorrafia. Durante la cirugía se localizó el defecto por cistoscopia e histeroscopia, se cateterizaron los uréteres de ambos lados; posteriormente, mediante acceso laparoscópico, se resecaron los bordes vesicales necróticos y se complementó con cistorrafia. Ambas pacientes evolucionaron sin complicaciones. CONCLUSIÓN: La dehiscencia de cistorrafia en pacientes con embolización de arterias uterinas es una complicación excepcional. La sospecha diagnóstica y el tratamiento oportunos, con resección de los bordes necróticos y cistorrafia, se asocian con mayor tasa de éxito.

Abstract: BACKGROUND: The incidence of percretism is 5-7% with 78% of complications associated with surgical management. There are few reported cases of cystorraphy dehiscence after uterine arteries embolization. CLINICAL CASES: Case 1. A 34 years old patient with a pregnancy of 36 5/7 weeks and acretism; she was treated with uterine artery embolization plus subtotal hysterectomy with bladder injury repaired without complications. She was discharged, and in 2 weeks she consulted for vaginal urine loss and fever (acute pyelonephritis); cystorraphy dehiscence was diagnosed with support of tomography and retrograde cystography. Bilateral ureteral catheterization, laparotomy with trachelectomy plus resection of bladder necrotic edges and cystorraphy were performed. Case 2. A 30 years old patient with a pregnancy of 37 5/7 weeks and acretism; equal treatment of acretism was given with bladder injury repaired without complications. She was hospitalized in surveillance for obstetric haemorrhage and urinary infection with torpid evolution; she referred vaginal urine loss at 2 weeks, so cystoscopy, tomography and retrograde cystography were performed which diagnosed cystorraphy dehiscence. In surgery the bladder defect was located by cystoscopy and hysteroscopy and bilateral ureters were catheterized; subsequently, by laparoscopic approach necrotic bladder edges were resected and cystorraphy was performed. Both patients without complications and with successful postoperative evolution. CONCLUSION: Cystorraphy dehiscence in embolized patients is extremely rare; however, it should be considered as a possible complication. Diagnostic suspicion and timely management with resection of necrosis and new cystorraphy, achieve greater success.

[Low urinary tract infection and cystoscopic findings in Urogynecology Service in the Instituto Nacional de Perinatología]. / Infección de vías urinarias bajas y hallazgos cistoscópicos en el Servicio de Uroginecología del Instituto Nacional de Perinatología.

INTRODUCTION: The pathogenesis of urinary tract infection and related to the host and pathogens. There are three associated factors: incontinence, cystocele and residual urine. OBJECTIVES: To know the prevalence of urinary tract infections and uropathogens in urogyneacologic patients of the Instituto Nacional de Perinatología describe the cystoscopic findings in patients with positive urocultures and antibiogram. METHODS: This is a retrospective study involving urogyneacologic patients with positive urine cultures from 1998 to 2001. Positive culture was a growth of only one microorganism more than 100,000 colonies. The antibiogram and patients files were reviewed in order to know: Symptoms, indications, diagnostic and cystoscopic findings; their distribution and differences were analyzed. RESULTS: From 3,433 urine cultures, 540 were positive (16% prevalence). Uropathogens distribution was: E. coli 70%, Klebsiella pneumoniae 6.3%, Pseudomonas aeruginosa 4.3%. The antibiogram showed resistance to beta-lactamics and third generation cephalosporin (96.59% and 85.17%). The most frequent indications were: incontinence, irritative symptoms, urethral hypermovility and pelvic organ prolapse. Urethrothrigonitis was the most frequent cystoscopic finding. Mixed urinary incontinence and urethral hypermotility were the only findings to have a important difference. CONCLUSIONS: There is a change in the uropathogens prevalence and in their antibiotic resistance. This must be considering in the treatment of urogyneacologic patients with urinary tract infections. To ensure the best outcome we must ask for a urine culture with antibiogram. The additional use of anti-inflammatory agents is convenient in the presence of urethrothrigonitis in urogyneacologic patients with urinary tract infections.

Giant intravesical calculus during pregnancy.

Urolithiasis is commonly found during pregnancy; but the presence of a giant vesical calculus during pregnancy is a very rare entity, associated with several potential obstetric complications. A 25-year-old primigravida at 25 weeks of gestational age was referred to our tertiary care unit because she presented a giant hyperechoic intravesical mass and inability to pass urine with suprapubic pain since 2 days. An open cystolithotomy revealed a huge intravesical calculus. The patient continued with her pregnancy until full term without adverse perinatal outcomes.

Prostaglandina E2 intracervical como preinductor del trabajo de parto en pacientes con muerte fetal pretérmino / Prostaglandin E2 intracervical as pre -inducer of labour in patients with pre-term fetal death

Se realizó un estudio comparativo para evaluar los efectos de la PGE2 como preinductor; en el Instituto Nacional de Perinatología, de febrero de 1992 a diciembre de 1993. En él se incluyeron pacientes con muerte fetal de la semana 21 a la 36 de la gestación, con un índice de Bishop menor o igual a 4. Se dividieron en 2 grupos: 23 pacientes en Grupo A con edad gestacional de 21 a 27 y 22 paciente en Grupo B de 28 a 36 semanas de gestación. En ambos grupos se aplicó la dinoprostona, análogo sintético de la PGE2 en gel intracervical y se evaluó la respuesta después de una aplicación. El intervalo inducción-explusión en el grupo A fue de 12 h y en su control de 24 h con una diferencia estadísticamente significativa de P < 0.001. En el grupo B el intervalo inducción-explusión fue de 9 h y en el grupo testigo de 16.5 h observándose igualmente una diferencia estadísticamente significativa con un P< 0.001. Con los hallazgos mencionados se puede concluir que la dinoprostona (PGE2) en dosis única de 0.5 mg por vía intracervical, como preinductor del trabajo de parto acorta el intervalo inducción-explusión

Fístula urogenital: experiencia institucional / Urogenital fistula: Institutional experience

Se muestra la experiencia institucional de Marzo de 1992 a Mayo de 1993. Se estudiaron 11 pacientes con diagnóstico de fístula, de las cuales una fue vesico-uterina, dos urétero-vaginales y ocho vesico-vaginales. Solo a ocho pacientes se les realizó corrección quirúrgica, una de estas se abordó por la vía vaginal y siete por la vía abdominal. De las pacientes con abordaje abdominal, dos casos fueron urétero-neocistostomías. El fracaso quirúrgico se presentó en dos casos, ambos con abordaje abdominal. Estos datos ponen de manifiesto que la fístula urogenital es una complicación frecuente en pacientes sometidas a procedimientos quirúrgicos ginecológicos. El éxito quirúrgico probablemente depende más de la técnica quirúrgica que a la vía de abordaje

Incontinencia urinaria genuina de esfuerzo: análisis de dos técnicas quirúrgicas: Pereyra y Burch / Genuine stress urinary incontinence. analysis of two surgical techniques: Pereyra's and Burch's

Se estudiaron 229 pacientes operadas por Incontinencia Urinaria Genuina de esfuerzo, a través de dos técnicas quirúrgicas, y se analizaron los factores de riesgo: edad, gestas paras y patología ginecológica agregada. Se dividieron en dos grupos: El Grupo I formado por pacientes operadas con la Técnica de Pereyra (136) y el Grupo II operadas con la técnica de Burch (93). No se encontraron diferencias entre las características generales de las pacientes en ambos grupos; las patologías agregadas más frecuentes para el Grupo I fueron alteraciones de estática pélvica y para el Grupo II, la miomatosis uterina. Técnicamente no se encontraron ventajas entre una cirugía y otra, independientemente de las indicaciones para una de ellas

Valor de la prueba del hisopo en pacientes con incontinencia urinaria / Evaluation of Q-tip test in urinary incontinence patients

Se evaluó la utilidad de la prueba del hisopo en la movilidad de la unión uretrovesical. Se realizó un estudio retrospectivo en 183 expedientes de las pacientes que acudieron a la Clínica de Urología Ginecológica del Instituto Nacional de Perinatología, con diagnóstico de incontinencia urinaria, de marzo de 1994 a mayo de 1995. A todas la pacientes se les realizo historia clínica, examen físico que incluyó prueba del hisopo, prueba de la tos y examen neurológico, así como urocultivo, cistouretroscopia y estudio de urodinamia. Mediante la prueba del hisopo se evaluó el grado de descenso de la unión uretrovesical. Para el análisis se dividió en tres grupos de acuerdo al dignóstico: grupo I, incontinencia urinaria de esfuerzo; grupo II, incontinencia urinaria mixta y grupo III, incontinencia urinaria recurrente. El ánalisis estadístico se realizó, mediante la prueba de t de Student, análisis de varianza (ANOVA) y de correlación. La edad promedio fue de 46.3 años (29-72), la mayoría de las pacientes fueron multíparas, 72 menopáusicas, 48 con tratamiento hormonal sustitutivo. Con la prueba del hisopo no se encontro diferencia estadísticamente significativa entre los tres grupos de acuerdo al diagnóstico. Según el grado de cistocele, en el grupo I se encontró que las pacientes con cistocele II tuvieron un mayor desplazamiento, lo que fue estadísticamente significativo. En el grupo II de igual manera y para el grupo III no se encontró diferencia. La prueba del hisopo muestra la posición y movilidad de la uretra de acuerdo a los defectos anatómicos de la pared anterior de la vagina, pero no establece diagnósticos

Evaluación del posoperatorio de los diferentes procedimientos quirúrgicos para incontinencia urinaria genuina de esfuerzo: estudio retrospectivo / Evaluation of post-operative period in different surgical procedures for stress urinary incontinence. retrospective study

Se evaluaron las diferentes técnicas quirúrgicas y su seguimiento a 12 meses. Se realizó un estudio retrospectivo de febrero de 1993 a junio de 1994 en la Clínica de Urología Ginecológica del Instituto Nacional de Perinatología, incluyéndose 144 expedientes de las cirugías realizadas en este lapso, de los cuales se evaluaron 107 y se excluyeron 37 por no tener información completa. Se evaluó edad, paridad, estado hormonal, diagnóstico preoperatorio por urodinamia, tratamiento quirúrgico y seguimiento a 12 meses. La edad promedio fue de 45.5 años, se realizaron 53 operaciones de Pereyra, 47 operaciones de Burch modificado por Tanagho, cinco operaciones de kelly y dos de cabestrillo. No se observó diferencia estadísticamente significativa en cuanto a las complicaciones. La recuperaión de la función vesical de vaciamiento es igual a lo informado por otros autores. La recidiva fue de 9.4 por ciento en la operación de pereyra y 10.6 por ciento en la operación de Burch. La operación de burch no presentó una mayor tasa de éxito que la operación Pereyra