Occult urinary incontinence in women with severe prolapse evidenced by a minimally invasive test.

OBJECTIVES: To evaluate the urodynamic changes when a severe cystocele is correct by a vaginal valve to identify occult urinary incontinence. METHOD: Prospective study in 70 women at the Urogynecology and Vaginal Surgery Unit, in Clínica Las Condes. INCLUSION CRITERIA: Symptomatic cystocele degree III or IV. EXCLUSION CRITERIA: antecedent of incontinence and/o genital prolapse surgery; presence of urinary incontinence symptoms. In all patients the urethra retro-resistance pressure was measured by a non-multichannel urodynamic test with and without cystocele reduction by a vaginal Bresky valve. Additionally a cystometry was realized. RESULTS: In all patients the URP was normal when the severe cystocele was not reduced. When the severe cystocele was reduced in 50 (71.4%) women the URP was altered. The cystometry identify asymptomatic overactive detrusor in 8 women. Occult urinary incontinence in the 50 women was: Type I in 1, type II in 27, type III in 1, type II+III in 21. CONCLUSION: When a severe cystocele is reduced by a vaginal valve, urodynamic changes can be detected and women with occult urinary incontinence may be identified. These women may express symptoms of urinary incontinence when a prolapse surgery is realized.

Preservation of ovarian function in young woman with hodgkin disease by laparoscopic medial transposition before abdominal irradiation.

A case of retro-uterine bilateral ovarian medial transposition in a 24-year-old women with Hodgkin's IIIB disease with bilateral compromised para-iliac ganglia is presented. A laparoscopic ovarian transposition toward a retro-uterine location out of the reach of the main radiation beam was made. The proximal pole of both ovaries was fixed to the ipsilateral uterosacral ligament. Two metallic clips were used to mark each distal ovarian pole to verify final position with x-rays. Preservation of the ovarian function was documented by hormonal levels 3 months after completing radiotherapy and regular yearly follow-up, until now. Normal menstruation patterns, similar to pretreatment history were recorded.

Successful third consecutive TVT in a patient with two previous TVT failures.

BACKGROUND: During 10 years of use, the transvaginal tape (TVT) technique has proved highly effective for the treatment of stress urinary incontinence. There is limited published information about experience with repeated TVT placements. CASE: A 47-year-old multiparous woman presented with a history of two previous TVT sling procedures but persistent urinary incontinence. Persisting urinary incontinence was noted at six months after the first placement, and a second TVT placement was also unsuccessful. The preoperative urodynamic assessment showed type II and III urinary incontinence. The uterus was enlarged to the size of a 16-week pregnancy, and a hysterectomy was performed. At the same time, a third TVT sling procedure was performed using the standard free tension sling technique, leaving the arms uncut for 24 hours. The patient has remained continent during ten months of follow-up. CONCLUSION: According to our experience with this patient, the placement of a third TVT after two failures is safe and effective.

TVT versus TVT-O for minimally invasive surgical correction of stress urinary incontinence.

OBJECTIVE: The present work describes our experience in surgical correction of stress urinary incontinence, comparing both the TVT and the TVT-O techniques. METHOD: Between October 2001 and March 2004, 76 patients underwent the TVT procedure. Between January 2004 and January 2005, 98 surgical corrections of urinary incontinence were carried out using the TVT-O technique. RESULTS: Median operative time was 28 minutes for TVT and 7 minutes for TVT-O. Intraoperative complications for TVT occurred in 4 patients (6.6%): urinary bladder perforation in 3 patients (5%, p=0.0228) and parietal peritoneum perforation in 1 case (1.6%). No intraoperative complications took place during TVT-O. Immediate postoperative complications: transient urinary retention in TVT, 2 cases (2.6%) and overcorrection in TVT-O (1%) which was readjusted within 24 hours. There were no late complications after TVT. There were 2 cases (2.04%) with late complications in TVT-O. TVT and TVT-O resulted in correction of incontinence in 100% of the patients. CONCLUSION: TVT and TVT-O are two effective techniques for the correction of stress urinary incontinence. TVT-O would seem to be a technique much easier to perform resulting in less intraoperative complications.

TVT versus TVT-O for minimally invasive surgical correction of stress urinary incontinence

OBJECTIVE: The present work describes our experience in surgical correction of stress urinary incontinence, comparing both the TVT and the TVT-O techniques. METHOD: Between October 2001 and March 2004, 76 patients underwent the TVT procedure. Between January 2004 and January 2005, 98 surgical corrections of urinary incontinence were carried out using the TVT-O technique. RESULTS: Median operative time was 28 minutes for TVT and 7 minutes for TVT-O. Intraoperative complications for TVT occurred in 4 patients (6.6 percent): urinary bladder perforation in 3 patients (5 percent, p = 0.0228) and parietal peritoneum perforation in 1 case (1.6 percent). No intraoperative complications took place during TVT-O. Immediate postoperative complications: transient urinary retention in TVT, 2 cases (2.6 percent) and overcorrection in TVT-O (1 percent) which was readjusted within 24 hours. There were no late complications after TVT. There were 2 cases (2.04 percent) with late complications in TVT-O. TVT and TVT-O resulted in correction of incontinence in 100 percent of the patients. CONCLUSION: TVT and TVT-O are two effective techniques for the correction of stress urinary incontinence. TVT-O would seem to be a technique much easier to perform resulting in less intraoperative complications.

Minilaparotomy hysterectomy assisted by self-retaining elastic abdominal retractor.

STUDY OBJECTIVE: To verify the efficacy and safety of minilaparotomy hysterectomy using a self-retaining elastic abdominal retractor. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Private hospital, department of obstetrics and gynecology. PATIENTS: One-hundred-fifty women, age 37 to 76 years, with benign uterine pathology or preinvasive neoplasia. INTERVENTION: Minilaparotomy hysterectomy assisted by a self-retaining elastic abdominal retractor. MEASUREMENTS AND MAIN RESULTS: The mean surgical time was 70 +/- 23.5 minutes (95% CI 63.1-70.7). There were no intraoperative complications. There was no need to extend the initial incision. Eight patients developed complications during the immediate postoperative period (fever in 2, hematoma of the surgical wound in 2, sub-aponeurotic seroma in 2, pubic edema in 1, and pulmonary embolism in 1). During the late postoperative period, a vaginal cuff dehiscence was reported. Mean postoperative hospital stay was 2.5 +/- 0.2 days (95% CI 2.4-2.6). CONCLUSION: Minilaparotomy hysterectomy assisted by a self-retaining abdominal elastic retractor is a safe and effective minimally invasive procedure. Also, it appears to be a good alternative to laparoscopic hysterectomy for institutions that do not have the required expensive equipment or for gynecologists who do not have laparoscopic experience.

Late postoperative urinary stress incontinence after a laparoscopic-assisted Vecchietti procedure for neovagina creation in a patient with Rokitansky syndrome: successful treatment with the TVT-O technique.

A case report of urinary stress incontinence after surgery in a 20-year-old patient with Mayer-Rokitansky-Küster-Hauser syndrome is presented. A neovagina was successfully created with a laparoscopic-assisted Vecchietti procedure. Fifteen months later, after normal and satisfactory sexual intercourse, the patient was seen for stress urinary incontinence. A second surgery consistent with the transobturator tension-free vaginal tape (TVT) system with nonelastic polypropylene suburethral TVT allowed full correction of the urinary symptoms.

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% 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.

Colpoperineoplasty in women with a sensation of a wide vagina.

BACKGROUND: In women complaining of a wide vagina and decreased sexual satisfaction we performed colporrhaphy--including perineoplasty in most cases. METHODS: Between November 2003 and October 2004, a total of 53 patients were selected for operation at the Urogynecology and Vaginal Surgery Unit, Las Condes Clinic, Chile. The patients were requested to assess the results of surgery in terms of experienced vaginal tightening and regained or enhanced sexual satisfaction. RESULTS: Six months after surgery, 94% experienced a tighter vagina and said they were able to achieve orgasm. Expectations were fulfilled in 74%, partially fulfilled in 21%, and not met in 5%. Only two patients (4%) regretted surgery, and two patients had minor surgical complications. CONCLUSION: In a selected group of women with acquired sensation of a wide vagina, colporrhaphy seems to improve symptoms and enhance sexual gratification in a majority of the women. A controlled trial with a longer follow-up is needed for a proper evaluation.

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.

Em que ponto estamos? Sessenta anos de reformas institucionais na Itália (1946-2005) / Where are we in history? Sixty years of institutional reforms in Italy (1946-2005)

The aim of this article is to show how the reforms adopted by Italy in the 1990s resulted from decades of experience during the countryÆs Republican period (1946-2005). The article focuses on the successful electoral and regimental reforms in order to "unveil" the underlying logic in the reform dynamics during the period under study. Having acknowledged the prevailing intent of reforming in order to strengthen the governmentÆs position, I tackle the problem of finding empirical evidence for demonstrating the degree to which the various reforms point in this direction. Despite the efforts and results, the article shows that the Italian transition is still apparently unfinished, due to the inconsistency with which the reforms were pursued in the electoral and Parliamentary arenas.

Dans cet article, on cherche à montrer comment les réformes adoptées en Italie dans les années 1990 sont le fruit d'un long chemin parcouru pendant la période républicaine (1946-2005). D'un côté, on étudie les réformes électorales et réglementaires réussies afin de "découvrir" la logique sous-jacente au dynamisme réformateur de cette période. Une fois reconnue l'intention prédominante de réformer pour renforcer la position du gouvernement, on recherche des évidences empiriques confirmant comment les réformes implantées vont dans ce sens. On verra que, malgré les efforts poursuivis et les résultats obtenus, la transition italienne semble encore inachevée à cause de l'incohérence qui a marqué leur implantation dans l'arène électorale et dans l'arène parlementaire au long des années.

Rotura hepática espontánea en síndrome de HELLP / Spontaneous hepatic rupture in HELLP syndrome

Informamos de un tercer caso de hematoma subcapsular hepático roto, en una mujer gestante que cursando 36 semanas de embarazo presentó un síndrome de Hellp. En el período de marzo 1991 a septiembre, 2002 hubo un total de 85.791 partos, con 3 casos de hematoma subcapsular hepático roto, lo que da una incidencia de 1 en 28.597 partos. No se presentaron casos de muerte materna, pero solo 1 de los recién nacidos sobrevivió.

Fasceitis necrotizante después del nacimiento por cesárea / Necrotizing fasciitis later of the birth by cesarean

Informamos de un caso de fasceitis necrotizante posterior a una cesárea.

O conteúdo da produção legislativa brasileira: leis nacionais ou políticas paroquiais? / The content of Brazilian legislative output: national laws or pork barrel politics?

This article analyzes whether the pork barrel political approach really exists in the context of legislative output by the Brazilian Congress. According to the author's argument, in the case of medium-large districts, multi-member districts (MMDs) increase the costs of investment in pork barrel bills of law. In addition, members of the Brazilian Congress face high legislative output costs that increase the incentives to avoid pork barrel strategies. The author investigates hypotheses on bills that were either approved or rejected by Congress, as well as those vetoed by the Executive, from 1991 to 2002. The results provide significant evidence for the author's theoretical argument. The study concludes that: (1) pork barrel bills are quantitatively insignificant in Brazil; (2) members of the Brazilian Congress invest much of their time and effort in pursuit of broader interests; and (3) seniority and internal law-making procedures can explain approved versus rejected distributive bills.

Dans cet article, on cherche à savoir si le pork barrel existe effectivement dans le cadre de la production législative du Congrès National brésilien. On part de la supposition que les MMDs (multi-member districts) districts d'importance moyenne et élevée surévaluent les coûts d'investissement dans les projets de pork barrel. En outre, les parlementaires brésiliens sont face à des coûts de production législative qui découragent les stratégies à esprit de clocher. On examine ces hypothèses sur la base de la législation approuvée et rejetée par le Congrès, y compris celles que le Président a rejetées pendant la période 1991-2002. D'où on peut conclure que: 1) les projets de pork sont insignifiants du point de vue quantitatif; 2) le parlementaire passe la plupart de son temps et gaspille ses efforts sur des questions qui visent à satisfaire des intérêts vagues; 3) la carrière du parlementaire et des facteurs internes propres au processus de décision peuvent expliquer le rejet ou l'approbation des projets de distribution.