Comparison of urethral parameters in females presenting cystoceles with and without stress urinary incontinence based on dynamic magnetic resonance imaging: are they different?

PURPOSE: To compare urethral parameters between cystocele patients with and without stress urinary incontinence (SUI) and explore factors influencing SUI in cystocele patients via dynamic MRI. METHODS: The two-dimensional parameters evaluated included the paravaginal defects, levator ani muscle defects, urethral length, urethral funnel shape, bladder neck funnel width, bladder neck funnel depth, urethral angle, posterior vesicourethral angle, and anterior bladder protrusion. The three-dimensional parameters included the proximal urethra rotation angle, the distal urethra rotation angle, bladder neck mobility, urethral midpoint mobility, and external urethral meatus mobility. The independent samples t test was used for continuous variables, and the chi-square test was used for categorical variables. Binary logistic regression was used to identify factors independently associated with SUI in cystocele patients. RESULTS: The baseline parameters were similar between the 2 groups. Cystocele patients with SUI had a significantly higher point Aa (1.63 ± 1.06 cm vs. 0.81 ± 1.51 cm, p = 0.008); more anterior bladder protrusion (33.3% vs. 11.4%, p = 0.017); greater bladder neck mobility (36.38 ± 11.46 mm vs. 28.81 ± 11.72 mm, p = 0.005); mid-urethral mobility (22.94 ± 6.50 mm vs. 19.23 ± 6.65 mm, p = 0.014); and external urethral meatus mobility (22.42 ± 8.16 mm vs. 18.03 ± 8.51 mm, p = 0.022) than did cystocele patients without SUI. The other urethral parameters were similar in the groups (p > 0.05). Binary logistic regression showed that bladder neck mobility was independently associated with SUI in females with cystoceles (odds ratio, 1.06; 95% CI 1.015-1.107; p = 0.009). CONCLUSION: Cystocele patients with SUI have a higher point Aa, more anterior bladder protrusion, and greater urethral mobility than those without SUI. Bladder neck mobility is independently associated with SUI in females with cystoceles. REGISTRATION NUMBER: NCT03146195.

Pubococcygeal Line Versus H-line as MR Defecography Reference for Bladder Descent.

INTRODUCTION AND HYPOTHESIS: Magnetic resonance defecography imaging techniques have been used widely to study pelvic floor function and diagnose pelvic organ prolapse (POP). The aim of this study was to investigate the diagnostic accuracy of the H-line to detect bladder descent compared with the current landmark, the pubococcygeal line (PCL). METHODS: In this retrospective cohort study, patients who underwent MR defecography in our medical center and were diagnosed with moderate to severe cystocele by radiological measurements were recruited. One rest image and one maximum evacuation image for each subject were used for the following measurements: bladder base perpendicular distance from the genital hiatus (GH), indicative of clinically significant bladder descent, PCL as the current radiological reference line, and the H-line, or minimal levator hiatus line, indicative of pelvic floor muscle and connective tissue support. Subjects were categorized as having clinically significant cystocele if the "bladder base" reached within 1 cm or lower of the GH (stage II or higher cystocele). A comparison was performed to assess differences and predictive capabilities of the reference lines relative to the GH measure. RESULTS: Seventy subjects were included, 30 with clinically significant bladder descent based on distance to GH. Women with bladder descent were older (64.0 ± 11.8 vs 51.2 ± 15.6, p < 0.001), had increased parity (3 [1-7] vs 2 [0-5], p = 0.009), and had a bladder that descended lower than the H-line at rest (1.9 ± 0.5 vs 2.2 ± 0.4, p = 0.003) and evacuation (-2.4 ± 1.6 vs -0.7 ± 1.1, p < 0.001). Multivariate regression analysis confirmed that age, length of the H-line at evacuation, the perpendicular distances between the H-line and the lowest bladder point at rest, and the PCL to the lowest bladder point at evacuation significantly correlated with bladder descent. Receiver operating characteristic analysis was used to identify a measurement threshold to diagnose clinically significant cystocele for both measurements, bladder base to the H-line: -1.2 (80.0, 72.5) area under the curve (AUC) 0.82, and bladder base PCL: -3.3 (77.8, 79.5) AUC 0.86. CONCLUSION: Our data support the application of using the minimal levator hiatus plane and specifically the H-line as a reliable landmark to diagnose bladder descent using MR defecography imaging.

Maternal and neonatal consequences of cystocele and rectocele in the delivery process.

The study aimed to investigate the effects of cystocele and rectocele on the stages of vaginal birth and maternal and newborn outcomes. A total of 672 multiparous pregnant women between the ages of 18 to 40 who underwent normal vaginal delivery in our tertiary center between November 2022 and February 2023, were included in this prospective study. Among the participants, 348 (51.8%) had no abnormalities, 78 (11.6%) had rectocele only, 112 (16.7%) had cystocele only, and 134 (19.9) had both cystocele and rectocele. Patients with the coexistence of cystocele and rectocele experienced a notably extended duration for both the first stage and second stage of labor, although the extension in the second stage was not statistically significant. Among the maternal complications, the development of maternal laceration and chorioamnionitis was significantly more common in the patient group with cystocele and rectocele compared to the other groups. When the groups were assessed for postpartum bleeding, while the bleeding risk increased from the normal group to the rectocele + cystocele group, this increase was not statistically significant. There was no difference between the groups in terms of neonatal outcomes. The delivery time of pregnant women with cystocele and rectocele, in the absence of additional risk factors, was determined to be significantly longer than that of the control group. We think that these patients should receive more vigilant monitoring, and this criterion should be kept in mind when assessing the indication for a cesarean section.

Hernia vesical inguinoescrotal incarcerada: manejo quirúrgico / Incarcerated inguinoscrotal bladder hernia: surgical management

RESUMEN La hernia vesical es una entidad asociada a la hernia inguinal, con predisposición de lado derecho, en un porcentaje de 0,5 a 3%, hasta 10% en hombres, y a partir de la quinta a séptima década de vida1. La mayoría son pequeñas; la fisiopatología más común es la obstrucción mientras que la hiperplasia prostática es la principal etiología. La presentación clínica es poco específica, y el diagnóstico es en la mayoría de los casos transoperatorio. Se presenta el caso de un paciente de género masculino de 64 años, con antecedente patológico de enfermedad de Parkinson, hernia inguinal izquierda reducible hace 5 años. Acudió a consulta médica por manifestar dolor abdominal de moderada intensidad, más aumento de volumen en región inguinoescrotal izquierda. Al realizar el examen físico se constató una hernia inguinoescrotal izquierda no reducible. Con el diagnóstico de hernia inguinal incarcerada se realizó una exploración quirúrgica, con hallazgos de hernia inguinoescrotal de gran tamaño con contenido vesical y epiplón incarcerado con cambios de coloración. Se realizó entonces la reparación de la hernia. La evolución posoperatoria fue satisfactoria sin complicaciones.

ABSTRACT Bladder hernia is a condition associated with inguinal hernia, usually right-sided, in 0.5 to 3% of the cases and up to 10% in men between the fifth and seventh decade of life. Most hernias are small; the most common pathophysiology is obstruction while prostatic hyperplasia is the main etiology. The clinical presentation is unspecific, and the diagnosis is usually made during surgery. We report the case of a 64-year-old male patient with a history of Parkinson's disease and reducible left inguinal hernia 5 years before, who sought medical advice due to abdominal pain of moderate intensity, with increased volume in the left inguinoscrotal region.On physical examination a diagnosis of left-sided non-reducible inguinoscrotal hernia was made. With the diagnosis of incarcerated inguinal hernia the patient underwent surgical exploration which showed a large inguinoscrotal hernia containing the bladder and incarcerated omentum with color changes. The hernia was repaired, and the patient evolved with favorable outcome.

Comparação entre os resultados da urinálise e dosagens bioquímicas urinárias de amostras de urina coletadas pelas técnicas de cistocentese guiada por ultrassom e sondagem uretral em cães / Comparison between the results of urinalysis and urinary biochemical tests of urine samples collected by techniques ultrasound-guided cystocentesisand urethral catheterization in dogs

Objetivou-se no presente estudo comparar as técnicas de coleta de urina via sondagem uretral e cistocentese guiada por ultrassom, afim de verificar se o método de coleta pode influir nos resultados laboratoriais. Foram utilizados 12 cães machos, sem histórico de enfermidades, dos quais coletou-se cinco mililitros (mL) de urina via sondagem uretral e cinco mL via cistocentese guiada por ultrassom, ambas no mesmo momento. Posteriormente foi realizada a análise física (cor, odor, densidade, turbidez), química (urobilinogênio, glicose, corpos cetônicos, bilirrubina, proteína, nitrito, pH, sangue e leucócitos) e sedimentoscopia (avaliação de 10 campos de luz, objetiva de 40x). Cilindros urinários, cristais, corpúsculos gordurosos, espermatozoides, bactérias e células vesicais foram classificados qualitativamente como: ausentes (0), discretos (1), moderados (2) e intensos (3). Hemácias, leucócitos, e células de descamação foram quantificadas a partir da média dos campos analisados. As análises bioquímicas de microalbuminúria, creatinina e proteína total urinárias foram realizadas a partir do sobrenadante urinário, removido das amostras após centrifugação, e utilizados kits reagentes, conforme recomendação do fabricante, sendo a leitura em espectrofotômetro. Em todos os testes realizados os valores de p encontrados foram superiores 0,05 (p>0,05), excluindo-se a possibilidade de haver diferenças significativas dos resultados laboratoriais obtidos pelas duas formas de coleta.

The objective of this study was to compare two techniques of urine collection, urethral catheterization and ultrasound-guided cystocentesis, in order to verify if the collection method may influence the laboratory results. Twelve male dogs were used, with no history of diseases, of which five milliliters (mL) of urine were collected by urethral catheterization and five mL by both at the same time. Subsequently, the samples underwent physical analysis (color, smell, density andturbidity), chemical analysis (urobilinogen, glucose, ketone bodies, bilirubin, protein, nitrite, pH, blood and leukocytes) and sedimentoscopy (evaluation of 10 light fields, 40x objective). Urinary casts, fatty corpuscles, spermatozoa, bacteria and bladder epithelial cells were classified qualitatively as absent (0), discrete (1), moderate (2) and intense (3). Red blood cells, leukocytes and desquamation cells were quantified from the mean of the analyzed fields. The urine supernatants were obtained after centrifugation and were used for biochemical analyzes of microalbuminuria, urinary protein and creatinine. The reagent kits were used as recommended by the manufacturer and the samples were read by spectrophotometry. All tests presented p values higher than 0,05 (p>0,05), excluding the possibility of significant differences between the laboratory results of both forms of urine collection.

Quiste congénito del conducto nasolacrimal/dacrio-cistocele: causa de dacriocistitis no diagnosticada / Congenital cyst of nasolacrimal duct/dacriocistocele: cause of non-diagnosed dacriocistitis

RESUMEN Se presenta dos casos de pacientes menores de 5 meses los cuales durante las primeras semanas de vida presentan descarga ocular muco-purulenta de manera recurrente. Posteriormente en la endoscopia se encuentra en los dos casos masas quísticas intranasales dando un diagnóstico de dacriocistocele más quiste congénito del conducto nasolagrimal. El dacriocistocele es una causa muy rara de obstrucción del conducto nasal y más raro cuando viene acompañado de un quiste congénito del conducto nasolagrimal. Debido a su rareza y a su sintomatología muchas veces atípica resulta en un diagnóstico complicado para el otorrinolaringólogo y para el oftalmólogo.

ABSTRACT Two cases of patients younger than 5 months are presented, who during the first weeks of life have recurrent muco-purulent ocular dis-charge. Subsequently, in endoscopy, in both cases, intranasal cystic masses were found, resulting in a diagnosis of dacryocystocele plus congenital cyst of the lacrimal duct. Dacryocystocele is an uncommon cause of nasal duct obstruction, but it becomes less common when accompanied by a congenital tear duct cyst. Due to its uncommonness and its often-atypical symptoms, it results in a complicated diagnosis for the ENT and the ophthalmologist.

Anestesia espinal con meperidina en paciente con hipersensibilidad a anestésicos locales / Spinal cord anesthesia with meperidine in a patient with hypersensitivity to local anesthesia

Introducción: La meperidina (o petidina) es un opioide sintético que tiene propiedades anestésicas locales bien conocidas, y ha sido utilizada por vía intratecal en cirugía general, urológica y obstétrica de forma segura. Este puede ser usado en anestesia espinal en paciente con hipersensibilidad a los anestésicos locales. Objetivo: Describir el manejo anestésico en una paciente con hipersensibilidad a los anestésicos locales con uso de meperidina intratecal. Presentación del caso: Se presenta una paciente femenina de 54 años de edad con historia previa de hipersensibilidad a los anestésicos locales, programada para colporrafia anterior, a la cual se le realiza una técnica regional, administrando meperidina intratecal. Para la analgesia posoperatoria se suministró diclofenaco de sodio en dosis única de 75 mg, por vía IV previo a la incisión. Conclusiones: Con la técnica descrita se logra un bloqueo sensitivo y motor adecuado, estabilidad de los signos vitales intraoperatoria y recuperación óptima en el posoperatorio inmediato. Es una alternativa más en el manejo de los pacientes con hipersensibilidad a los anestésicos locales(AU)

Introduction: Meperidine (or pethidine) is a synthetic opioid with well-known local anesthetic properties. It has been safely used intrathecally in general, urological and obstetric surgery. This can be used in spinal anesthesia in patients with hypersensitivity to local anesthetics. Objective: To describe anesthetic management of a patient with hypersensitivity to local anesthetics with the use of intrathecal meperidine. Case presentation: The case is presented of a 54-year-old female patient with a previous history of hypersensitivity to local anesthetics, scheduled for anterior colporrhaphy, who is performed regional technique, administering intrathecal meperidine. For post-operative analgesia, diclofenac sodium was administered intravenously in a single dose of 75 mg before the incision. Conclusions: The described technique allowed to achieve adequate sensory and motor block, stability of intraoperative vital signs, and optimal recovery in the immediate postoperative period. It is another alternative in the management of patients with hypersensitivity to local anesthetics(AU)

Colposuspensión anterior con fijación a malla transobturatriz: una nueva técnica para el tratamiento del colpocele anterior / Anterior colposuspension with transobturator mesh fixation: a new technique for the treatment of anterior colpocele

Introducción: la zona crítica de sostén apical de la fascia vesicovaginal es el anillo pericervical, el cual no existe en el caso de mujeres histerctomizadas. Por lo tanto, el análisis y el desarrollo de posibilidades terapéuticas para el cistocele con menores recidivas posteriores es un tema crítico en la cirugía uroginecológica. Objetivo: presentar una nueva técnica quirúrgica para el tratamiento del colpocele anterior. Material y método: se presentan los primeros diez casos de pacientes operadas con una nueva técnica quirúrgica en el tratamiento por vía vaginal del colpocele anterior. La técnica denominada CATO (C-colposuspensión, A-anterior, TO-transobturatriz) se basa en la reparación del defecto del colpocele anterior (sea este central, medial o pericervical) mediante tejido propio, el cual se fija a una neoestructura dada por el emplazamiento de una cinta de malla de prolene por vía obturatriz posterior. Resultados: no se registraron complicaciones intraoperatorias; hubo un hematoma vesicovaginal posoperatorio inmediato. En cuanto a los resultados funcionales, no se registraron disfunciones vesicales. En el seguimiento se destaca que todas las pacientes presentan puntos Aa y Ba normales. No se registran complicaciones de la malla utilizada. La técnica resulta segura, respeta la anatomía funcional y es reproducible para el ginecólogo vaginalista entrenado y con conocimiento del abordaje transobturatriz posterior. El seguimiento a largo plazo demostrará si esta nueva técnica desarrollada por nuestro equipo tiene un lugar que ocupar en el arsenal quirúrgico del tratamiento de la patología del piso pélvico.

Abstract Introduction: the critical area of apical support for the vesicovaginal fascia is the peri-cervical ring, which does not exist in women who have undergone hysterectomies. Thus, the analysis and development of new therapies for colpocele with smaller posterior relapse is critical for urogynecologic surgery. Objective: to present a new surgical technique for treatment of anterior colpocele Method: the study presents the first ten cases of women who were operated with a new surgical technique in treatment for anterior colpocele through the vagina. The technique under the name CATO (following the Spanish words: CATO (C-colposuspension, A-anterior, TO-transobturator) is based on repairing the anterior colpocele defect (central, medium or peri-cervical) using her own tissue, which is fixed to a new structure created by placing a mesh ribbon through a posterior transobturator. Results: no intraoperative complications were recorded; there was one case of immediate postoperative vesicovaginal hematoma. As to functional results, no vesical dysfunctions were recorded. Upon follow up, it is worth pointing out all patients show normal Aa and Bb stitches. Nos complications arose for the mesh used. The technique is safe, it respects functional anatomy and may be replicated by trained gynecologists who are familiar with the posterior transobturator approach. Long term follow up will reveal whether this new technique developed by our team may become part of the surgical toolkit for treating pelvic floor pathology.

Resumo Introdução: a zona crítica do suporte apical da fáscia vesicovaginal é o anel pericervical, que não existe nas mulheres histerectomizadas. Portanto, a análise e o desenvolvimento de possibilidades terapêuticas para o cistocele com menores recidivas posteriores é uma tema crítico na cirurgia uroginecológica. Objetivo: apresentar uma nova técnica cirúrgica para o tratamento do colpocele anterior. Material e método: apresentam-se os dez primeiros casos de pacientes operadas com uma nova técnica cirúrgica para tratamento por via vaginal da colpocele anterior. A técnica denominada CATO (Colpossuspensão, A-anterior, TO-transobturatoria) está baseada na reparação do defeito do colpocele anterior (seja central, medial ou pericervical) utilizando tecido próprio, que se fixa a uma neoestrutura dada pela colocação de uma tira de malla de prolene por via obturatriz posterior. Resultados: não foram registradas complicações intra-operatórias ou hematoma vesicovaginal pós-operatório imediato. Com relação aos resultados funcionais, não foram registradas disfunções vesicais. No seguimento se destaca que todas as pacientes apresentam pontos Aa e Ba normais. Não foram registradas complicações da malha utilizada. A técnica é segura, respeita a anatomia funcional e é reproduzível por ginecologista vaginalista treinado e com conhecimento da abordagem transobturatoria posterior. O seguimento em longo prazo demonstrará se esta nova técnica desenvolvida por nosso grupo de trabalho tem um lugar no arsenal cirúrgico no tratamento da patologia do piso pélvico.

Cistopexia videoassistida em cadela com cistocele após prolapso uterino: relato de caso / Videoassisted cystopexy on a female dog with cystocele after uterine prolapse: a case report

O prolapso de vesícula urinária associado ao prolapso uterino é condição rara em cães e gatos. O tratamento preconizado para essa afecção é o reposicionamento anatômico das estruturas afetadas. No presente relato é descrito o manejo por meio de ovariossalpingo-histerectomia por celiotomia e, após dois dias, cistopexia videoassistida. Essa condição, conforme o conhecimento dos autores, não havia sido previamente descrita. A operação apresentou-se como possibilidade viável de tratamento, sem complicações pós-operatórias.(AU)

The urinary bladder prolapse associated with the uterus is a rare condition on dogs and cats. The recommended treatment is the anatomical repositioning of the affected structures by manual reduction or surgery procedure. The present report describes the management by video-assisted cystopexy two days after conventional ovariohysterectomy. This condition, according to the authors' knowledge, had not been previously described. The operation didn't showed postoperative complications, and presented itself as a viable treatment option.(AU)

Efficacy of Pelvisoft® Biomesh for cystocele repair: assessment of long-term results

Introduction and Hypothesis To our knowledge a study regarding the efficacy of Pelvisoft® Biomesh for cystocele repair has not previously been reported in the literature. The aim of our study was to assess the long-term efficacy, subjective outcomes and complications in the use of a non-synthetic porcine skin mesh graft (Pelvisoft® Biomesh) associated with transvaginal anterior colporrhaphy in the treatment of cystocele prolapse. Materials and Methods A retrospective study was performed at a single centre. Thirty-three women aged 35-77 years underwent cystocele repair using Pelvisoft® graft between December 2005 and June 2009. Twenty-nine women who underwent transvaginal cystocele repair with Pelvisoft® Biomesh for over a 2 years period were assessed. Four patients were lost to follow-up. Cystocele repair was performed via the vaginal route using Pelvisoft®Biomesh implant by inserting it in the anterior vaginal wall. The median follow-up time was 54.0 months. The rate of recurrence was 17.3%. A total of 6.9% of patients presented early mesh exposure treated by conservative treatment. The mean PFDI-20 score was 72.2. Among sexually active women, the mean PISQ 12 was 33.9 but 56.2% had dyspareunia. After surgery, 6 patients had de novo intercourse. Our results show that the use of Pelvisoft® biomaterial associated with anterior colporrhaphy for cystocele repair appears to be safe with acceptable failure and complication rates at long term. Nevertheless, an adverse impact on sexual function was reported by the majority of patients. .

Cinta tras-obturatriz (TOT) en el tratamiento de la incontienecia urinaria de esferzo en el Hospital Regional de Ica, Perú / Tape trans-obturator (TOT) in the treatment of female stress urinary incontinence in the Regional Hospital in Ica, Peru

Evaluar la seguridad y eficacia del TOT en el tratamiento de la incontionecia urinaria de enfuerzo femenina de acuerdo a nuestra exeriencia materiay Métodos:..

To evaleate the safety and efficacy of the TOT in the treatement of female stress urinary incontinence, according to our experience. Material and Methods:...

Colpopexia anterior con uretrosuspensión con monoprótesis sintética en el tratamiento simultáneo del cistocele y la incontinencia urinaria / Use of a synthetic monoprosthesis of monofilament, macropore, polypropylene mesh for the simultaneous cure of cystocele and the stress urinary incontinence

Objetivo: Describir la técnica quirúrgica y los resultados de la cura simultánea del cistocele e incontinencia urinariade esfuerzo (IUE) utilizando una monoprótesis de polipropileno monofilamento macroporosa, basado en el "Nazca TC POP Repair System". Material y Métodos: Estudio retrospectivo, descriptivo de tipo serie de casos. Se recolectaron los datos de 69 pacientes intervenidas en dos centros, uno público y otro privado, entre mayo 2007 y abril 2008 en Lima-Perú. Se recopilaron los datos de 56 pacientes hasta los tres meses post cirugía. Resultados: Las complicaciones más importantes fueron extrusión de malla en 4/69 (6%), recidiva del prolapso en 1/56 (2%), persistencia de la IUE 1/56 (2%, retención urinaria 11/69 (16%), infección urinaria en 16/69 (23%), infección de la cúpula en 9/69 (13%) y hematoma en 3/69 (4%). La curación del cistocele según el POP-Q a los tres meses fue de 53/56 (95%) y la satisfacción de las pacientes fue 96,42%. La cura subjetiva de la IUE fue: curada 48/56 (85,1%), mejorada 7/56 (12,5%) y no curada en 1/56 (1,78%). Conclusiones: El uso de esta monoprótesis puede significar un procedimiento seguro y eficaz para la corrección quirúrgica del cistocele y la IUE.

Objectives: To describe the technique for the simultaneous cure of cystocele and the stress urinary incontinence (SUI) using, polypropylene mesh, based on the "Nazca TC POP Repair System". Materials and methods: Retrospective, descriptive study, case series type. We included 69 patients, operated in two centres, a public and a private one, between May 2007 and April 2008 in Lima - Perú. We compiled the data of 56 patients until three months post surgery. Results: The most important complications were: mesh erosion 4/69 (5.7%), prolapse relapse 1/56 (1.7%), SUI persistence 1/56 (1.7%), urinary retention 11/69 (15.9%). We also had urinary tract infection 16/69 (23.18%), vaginal cupula infection 9/69 (13.04%) and hematoma 3/69 (4.34%). The cure rate with POP-Q system scores three months after surgery was 53/56 (94.64%) for cystocele and the patient satisfaction was 54/56 (96.42%). For SUI, the subjective efficacy for cure was 48/56 (85.71%), improvement in 7/56 (12.5%) and failure in 1/56 (1.78%). Conclusions: The use of monoprothesis can be an effective and sure procedure to repair the prolapse of anterior vaginal wall and SUI.

Efectividad de las cirugías para incontinencia urinaria de esfuerzo a 18-24 meses de su realización en pacientes atendidas en el Hospital Militar Escuela Doctor Alejandro Dávila Bolaños ADB en el período julio-diciembre 2009 / Effectiveness of surgery for stress urinary incontinence at 18-24 months of its implementation in patients treated at the Military Training Hospital Doctor Alejandro Dávila Bolaños ADB in the period July-December 2009

Se realizó un estudio descriptivo, de corte transversal, con el objetivo de determinar la Efectividad de la Cirugía de Burch y Colocación de cinta vaginal libre de tensión a 18-24 meses. La muestra estuvo constituida por 26 pacientes: 11 pacientes con Cirugía de Burch (42%) y 15 pacientes con Colocación de Cinta Vaginal libre de tensión (58%). Las pacientes con Cirugía de Burch y Colocación de Cinta Vaginal libre de tensión son predominantemente mujeres con edad entre 35 – 50 años (80% y 53%, respectivamente), y con antecedente de 1-3 partos (72% y 60%, respectivamente). Las pacientes con Cirugía de Burch no tienen comorbilidades asociadas (100%), mientras que las pacientes con Colocación de Cinta Vaginal libre de tensión son obesas en un 40%. Las pacientes con Cirugía de Burch presentaban cistocele en un 18% y rectocele en un 18 % previo a la cirugía. La efectividad de la Cirugía de Burch es comparable con la efectividad de la Colocación de Cinta Vaginal libre de tensión a 18-24 meses de su realización para tratamiento de Incontinencia Urinaria de Esfuerzo tanto por sus tasas de continencia subjetiva (82 % y 80%, respectivamente) como por sus tasas de continencia objetiva (91 % y 87 %, respectivamente). La Incontinencia de Urgencia es el tipo de incontinencia que complica a las pacientes que se les realizó Cirugía de Burch y/o Colocación de Cinta Vaginal libre de tensión, con frecuencia de presentación similares (9 % y 13 %, respectivamente). La Cirugía de Burch parece ser una técnica más segura para tratar la Incontinencia Urinaria de Esfuerzo por su menor tasa de complicaciones en comparación con la Colocación de Cinta Vaginal libre de tensión (18 % vrs. 40 %). La Colocación de Cinta Vaginal libre de tensión no es tratamiento del cistocele, resolviendo sólo en el 60 % de los casos...

Cura de rectocele por vía transanal: experiencia de la unidad de coloproctología del Hospital Universitario de Caracas / Transanal approach in the treatment of rectocele: experience of the coloproctology unit at the Hospital Universitario of Caracas

Determinar la eficacia de la técnica para cura del rectocele por vía transanal usando la máquina PPH®. Estudio realizado en la Unidad de Coloprotología del Hospital Universitario de Caracas. Estudio prospectivo, descriptivo, realizado entre mayo de 2007 y abril de 2009, cuya población estuvo conformada por 62 mujeres con diagnóstico de rectocele, que presentaban sintomatología importante de síndrome de defecación obstruida (SDO), a las cuales se realizó de estreñimiento tiempo de tránsito colónico (TTC), ciego móvil y defecografía. Fueron intervenidas 20 pacientes haciendo uso de la técnica vía transanal con máquina autosuturadora de 33 mm (PPH). El rectocele grado II ocupó el 77% de los casos. El principal motivo de consulta fue la sensación de evacuación incompleta 74% seguida de la digitalización con 41% ambos síntomas del síndrome de defecación obstruida. Entre las patologías asociadas se encuentran principalmente: hemorroides (59,3%), cistocele (46%), intususcepción o prolapso mucoso (49%). Todos los pacientes intervenidos fueron corregidos por técnica vía transanal haciendo uso de la máquina de PPH 33 mm, de los cuales a 40% se le realizó adicionalmente cura del tiempo posterior, 20% cecopexia y a 5% fistulotomía. El 59% de las pacientes presentó mejoría de los síntomas de defecación obstruida antes de los siete días del postoperatorio, y el resto entre 7 y 15 días. El 45% presentó dolor que cedió con AINES, 25% tuvo urgencia defecatoria y una paciente (5%) presentó estenosis anal resuelta posteriormente. Se demostró que la técnica para cura de rectocele por vía transanal con máquina PPH, tiene una tasa de éxito con resultados satisfactorios de un 95%, con complicaciones menores.

To determinate the efficient of the transanal approach technique to cure rectocele using the PPH machine. Study performed in the Coloproctology Unit at the Hospital Universitario of Caracas. A prospective, descriptive, study carried out on 62 women with rectocele and symptoms of outiet obstruction syndrome (OOS), betwen may 2007 and april 2009. Colonic transit time (CTT), move cecum and defecografy was to each patient. Of these 62 patients, 20 were operated on using the transanal approach technique with the PPH machine and we determited the efficient of that. Of these 62 patients studied, rectocele grade II occupied 77%, the mean symptom was incomplete evacuated sensation (74%), following of digitalization (41%) both symptoms of OOS. We found other pathologies associated like hemorrhoids (59,3%), cistocele (46%), intususcepción or mucosal prolapse (49%). In all the patients operated we used the transanal approach with PPH machine 33 mm; of these patients, 40% we did posterior time cure. 20% cecopexy and 5% fistulotomy. A 59% improved the symptoms of OOS before 7 days and 41% between 7 and 15 days. A 45% of the patients had pain that relieved with AINES, 25% defecatory urgency and one patient stricture that was cure after. We demostrated that the transanal approach technique for rectocele using the PPH machine had low percentage of complications and good results.

Reparación del cistocele por vía vaginal con malla subvesical sin tensión: técnica y resultados / Tension-free vaginal mesh repair for anterior vaginal wall prolapse: technique and outcomes

Objetivos: Determinar la eficacia y tolerancia de la interposición de una malla de polipropileno monofilamento colocada sin tensión por vía vaginal bajo la vejiga para la corrección quirúrgica del cistocele, evaluando sus resultados anatómicos postoperatorios, la mejoría en la calidad de vida y sus complicaciones a mediano plazo. Pacientes y Método: El ensayo incluyó a 28 mujeres consecutivas (edad promedio 64 años), portadoras de cistocele grado II o III según la clasificación POP-Q, quienes fueron intervenidas entre septiembre de 2004 y octubre de 2006. Después de una completa disección de la vejiga y plicatura de la fascia perivesical, se labraron 2 túneles laterales hasta perforar la fascia endopélvica a cada lado; luego se configuró la malla de polipropileno monofilamento (Ginemesh®), dimensionada con un cuerpo central y dos ramas laterales, posicionándola sin tensión ni fijación bajo la vejiga, introduciendo y abandonando sus extensiones laterales hacia el espacio paravesical. Del total de la serie, 8 pacientes tenían cistocele G II (29 por ciento) y 20 tenían prolapso G III (71 por ciento); 11 mujeres presentaban además IOE (39 por ciento). El promedio de duración de la cirugía fue de 30 minutos. Como evaluación del resultado anatómico se utilizó la clasificación POP-Q. Para evaluar la satisfacción personal objetiva se usó el cuestionario validado de calidad de vida (I-QOL) al 3º, 6º y 12º mes post cirugía. El promedio de seguimiento fue de 18 meses (10-36).Resultados: La cirugía fue realizada sin problemas en todas las pacientes. La tasa de complicaciones tempranas fue de 7 por ciento (una erosión vaginal y 1 hematoma severo). No se reportó infección de la malla. La tasa de éxito fue de un 93 por ciento. Al sexto mes, el índice de satisfacción en la calidad de vida fue de 89 por ciento, al 12º mes fue de 86 por ciento...

Objectives: To determine the efficacy and tolerance of the introduction of a vaginal tension-free monofilament polypropylene mesh placed under the bladder for the surgical correction of cystocele. Patients and Methods: The trial included 28 consecutive women mean age 64 years), with diagnosis of grade II - III cystocele based on POP-Q classification, who were operated between September2004 and October 2006. Surgical technique include a complete dissection of the bladder and fixation of perivesical fascia. Two laterals tunnels were developed to pierce the lateral side of the endopelvic fascia at either side. Then a designed monofilament polypropylene mesh (Ginemesh ®), was placed without any tension free the bladder, positioning their lateral extensions into paravesical space. We evaluated the postoperative anatomical results, improvement in the quality of life and mid-terms complications. Results: Of the total series, 8 patients had G II cystocele (29 percent) and 20 had G III prolapse (71 percent ), 11women had also SUI (39 percent). Mean operative time for surgery was 30 minutes. Anatomical results were objectively measured with POP-Q classification. Evaluate of personal satisfaction was done by application of a validated questionnaire of quality of life (I-QOL) that was full filled at 3, 6 and 12months post surgery. Mean follow-up of the series was 18 months (10-36). No operative complication occurred. Early complication rate was 7 percent (a vaginal erosion and severe bruising ). No infection was reported in the mesh. The success rate for the series was 93 percent. At the sixth month, the rate of satisfaction in the quality of life was has been 89 percent and 86 percent at 12 months...

Reparación de polapso vaginal anterior con malla de prolene / Anterior vaginal prolapse repair with prolene mesh

ANTECEDENTES: La reparación del prolapso vaginal anterior presenta una alta tasa de recurrencia. La colporrafia anterior con malla de prolene es una buena alternativa quirúrgica que ha obtenido buenos resultados a largo plazo. OBJETIVO: Evaluar el resultado anatómico y la evolución de la colporrafia anterior con malla de prolene. MÉTODO: Estudio de cohorte prospectivo para evaluar el resultado quirúrgico. RESULTADOS: Ingresaron 35 pacientes con una edad promedio de 61,4 años; 85,7% de ellas estaba en postmenopausia y 3% utilizaba terapia hormonal de reemplazo. La principal patología asociada fue la incontinencia de orina de esfuerzo (54,3%). El estado del piso pelviano preoperatorio correspondió a 31,4% cistocele grado II, 48,6% cistocele grado III y 20% cistocele grado IV. Se asoció prolapso uterino en 88,6% de los casos y 74,3% con prolapso de la pared posterior. No hubo complicaciones intraoperatorias. Hubo complicaciones postoperatorias en 4 pacientes (11,4%). Una paciente presentó erosión de la malla (2,9%). El seguimiento fue de 1 a 11 meses. En la evaluación postoperatoria de las pacientes con cistocele grado II 80% corrigió a grado 0; para cistocele grado III 72% corrigió a grado 0. Un 11% llegó a grado I y 17% grado II. Para el grupo con cistocele grado IV, 71% resultó en grado 0 y 29% grado II. CONCLUSIÓN: La técnica presentada solucionó un severo problema de calidad de vida de las pacientes afectadas. Se requiere un mayor número de casos y tiempo de seguimiento para su recomendación definitiva.

BACKGROUND: Repair of anterior vaginal prolapse present a high rate of recurrence. Anterior colporrhaphy plus prolene mesh is a surgical option with optimal long term results. OBJECTIVE: To evaluate anatomical results and evolution of anterior colporrhaphy with prolene mesh. METHOD: A prospective cohort study was made to evaluate the surgical outcomes. RESULTS: 35 patients were recruited with a median age of 61.4 years. 85.7% of them were in postmenopausal status and 3% were using hormone replacement therapy. Stress urinary incontinence was associated in 54.3% of the cases. The pelvic floor stage at entry was 31.4% cysthocele stage II, 48.6% stage III and 20% cysthocele stage IV. Uterine prolapse was present in 88.6% of cases and the posterior wall was compromised in 74.3%. There were no intraoperatory complications. Postoperatory complications occurred in 4 patients (11.4%). Only in one case the mesh eroded (2.9%). The follow up was from 1 to 11 months. Of the patients with cysthocele stage II at the moment of evaluation, 80% were at stage 0. For cysthocele stage III 72% turned to stage 0. 11% turned to stage I and 17% to stage II. The cases that presented cysthocele stage IV 71% were at stage 0 and 29% at stage II. CONCLUSION: This technique solved an important quality of life problem of the affected patients. A higher number of cases and time of follow up is needed to recommend this technique definitely.

Tension free monofilament macropore polypropylene mesh (Gynemesh PS) in female genital prolapse repair

OBJECTIVES: To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transvaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100 percent of patients, with a pursuit between 1 and 8 months. DISCUSSION: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.

Prolapso genital incidencia y casuística: Hospital Naval de Guayaquil 1995-2000 / Incidence of genital prolapse and casuistry: Naval Hospital of Guayaquil 1995-2000

El prolapso es motivo frecuente de consulta para en Ginecología y la mayoría de las mujeres que lo padecen sobrepasan los 50 años.Se realizó un estudio retrospectivo, descriptivo y longitudinal desde 1995 al 2000 en el hospital Naval de Guayaquil.El objetivo: Conocer los factores causales más comunes.Comprobar la importancia de la relación entre los antecedentes gineco-obstétricos y el desarrollo del prolapso genital.Identificar el tipo de tratamiento quirúrgico y las complicaciones que se presentaron al momento de la resolución en las pacientes internadas en el hospital Naval de Guayaquil (HOSNAV).Se encontraron 65 casos en el estudio de 6 años, la edad media de presentación fue 57 años 8 meses, se demostró que mientras más se acerquen a la etapa del climaterio, la incidencia de prolapso genital aumenta en forma proporcional. El factor causal que se relaciona al desarrollo de prolapsos es la multiparidad y los partos distócicos.

Prolapse is frequent reason of consultation to the gynecologist and most common in women over 50 years. We carried out a retrospective, descriptive and longitudinal study between the years of 1995 to 2000 in the Naval Hospital of Guayaquil with the objective of finding out the most common risk factors, to check the importance of the relationship between the Gynecologic clinical history and the development of the genital prolapse, and to identify the type of surgical treatment and the complications that were presented.There were 65 cases in the 6 year-old study, the age of presentation was 57 years 8 months, it was demonstrated that while more they come closer to the stage of the climaterium, the incidence of genital prolapse increased. The risk factor that is related to the development of prolapse is the multiparty and the distosic childbirths.