Estrogen therapy influence on periurethral vessels in postmenopausal incontinent women using Dopplervelocimetry analysis.

UNLABELLED: Lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial trophism, resulting in negative effects on continence in postmenopausal women. Therefore, the use of estrogens in these patients may revert these alterations and lead to an expressive improvement of the urinary symptoms. OBJECTIVE: Study the effect of topical estrogen therapy (conjugated equine estrogens, estriol or promestriene) in periurethral vessels detected by Dopplervelocimetric analysis using, as parameters: the number of vessels, resistance and pulsatility indexes, as well as the minimum diastolic value. METHODS: Forty-one postmenopausal women with stress urinary incontinence were randomized into three groups according to different types of topical estrogen received during 3 months. Group 1 received conjugated equine estrogens, group 2 received estriol and group 3 received promestriene. Periurethral Dopplervelocimetry analysis was done before estrogen administration and during treatment in all groups. RESULTS: We observed an increase in the number of the periurethral vessels in group 1 and group 2, being higher in group 1 than in group 2. The pulsatility index remained unchanged in all three groups. The resistance index at the periurethral vessels reduced only at the conjugated estrogen group (group 1). In this same group we noticed an increase in the mean minimal diastolic value, meaning a better periurethral vascularization. CONCLUSION: Topical conjugated equine estrogens and estriol were effective in increasing the number of periurethral vessels in postmenopausal women with urinary stress incontinence, with the conjugated equine estrogens being the most effective intervention studied.

Urodynamic and ultrasonographic evaluation after continence surgery.

Our objective was to evaluate urodynamic and ultrasonographic findings after continence surgery. The study consisted of three groups of women according to the surgery performed: group I (Burch colposuspension) with 12 patients; group II (Kelly-Kennedy plication) with 10 patients; and group III (Gittes surgery) with 9 patients. Urodynamic study was done preoperatively and after surgery (on the 7th and 30th postoperative days, and at least 6 months after surgery) and ultrasonography of the bladder neck was performed to evaluate its position in relation to the inferior edge of the pubic symphysis and its mobility, both preoperatively and after surgery (30th postoperative day). All patients remained continent. We observed an increase in the first desire to void and maximum cystometric capacity after 6 months in groups I and II, respectively. There was no change in the urethral closure pressure profile in the three groups. Elevation of the bladder neck and decrease of its mobility were found by ultrasonography. Urinary continence after surgery is not the result of alterations in the urethral closure pressure profile, but rather of an elevation in the bladder neck and limitation of its mobility, which probably improves the abdominal pressure transmission rate to the proximal urethra.

Tratamento cirúrgico da incontinência urinária de esforço: análise de resultados pelas vias abdominal e vaginal / Surgical treatment of stress urinary incontinence: analysis of the results by abdominal or vaginal pathways

OBJETIVO. Propoe-se, neste trabalho, analisar os resultados pós-operatórios de 367 cirurgias para correçao de incontinência urinária de esforço, quanto à época de aparecimento e ocorrência de recidivas. MATERIAL E MÉTODO. Os casos foram reunidos em quatro grupos: A = 206 (56,1 por cento) casos - cirurgia de Kelly-Kennedy; B = 37 (10,1 por cento) - cirurgia de Kelly- Kennedy associada à histerectomia vaginal; C = 95 (25,9 por cento) - cirurgia de Burch e, finalmente, D = 29 (7,9 por cento) - cirurgia de Burch associada à histerectomia total abdominal. RESULTADOS. O tempo de seguimento pós-operatório variou de 1 a 194 meses, com média de 31 meses. Observou-se incidência de recidivas de 20,1 por cento no grupo D e de 10,8 por cento no grupo B. Em 68,7 por cento das cirurgias por via vaginal e em 82,3 por cento pela abdominal, as recidivas ocorreram em menos de três anos. CONCLUSAO. Nao houve diferença estatisticamente significante no aparecimento de recidivas pós-operatórias nos três grupos estudados. A maior parte das recidivas ocorreu nos primeiros três anos após a cirurgia.

[Surgical treatment of stress urinary incontinence: analysis of the results by abdominal or vaginal pathways]. / Tratamento cirúrgico da incontinência urinária de esforço: análise de resultados pelas vias abdominal e vaginal.

BACKGROUND: The postoperative results of 367 surgical interventions for the correction of urinary stress incontinence were analyzed in terms of time of onset and occurrence of relapses. MATERIAL AND METHOD: The cases were assigned to four groups: A = 206 cases of Kelly-Kennedy surgery (56.1%); B = 37 cases of Kelly-Kennedy surgery associated with vaginal hysterectomy (10.1%); C = 95 cases of Burch surgery (25.9%), and finally, D = 29 cases of Burch surgery associated with total abdominal hysterectomy (7.9%). RESULTS: Postoperative follow-up ranged from 1 to 194 months, with a mean of 31 months. The incidence of relapses was 20.7% in group D, and 10.8% in group B. In 68.7% of the surgical interventions by vaginal route and in 82.3% of interventions by abdominal route, the relapses occurred within less than three years. CONCLUSION: The results were not different in the groups. The relapses occurred within less than three years in most cases.