[Occult stress incontinence identified by preoperative urodynamic study in women with severe pelvic organ prolapse]. / Incontinencia urinaria oculta evidenciada por estudio urodinámico preoperatorio en pacientes con prolapso genital severo.

OBJECTIVE: To review the effectiveness of preoperative urodynamic study made with correction of the severe genital prolapse by Bresky valve in the diagnosis of urinary occult incontinence, in order to plan a correction with a prophylactic sub-mid urethral mesh in the prolapse surgery. PATIENTS AND METHOD: Patients of the Urogynecology and Vaginal Surgery Unit of Las Condes Clinic, between January 2006 and December 2007, with grade III or IV cystocele. A condition was patients without previous prolapse and/or incontinence surgeries. A non multichannel urodynamics test was made with prolapse correction by a Bresky valve. The urethra retro resistance measurement and cystometry was made. In the women in whom the occult urinary incontinence was discards the prolapse surgery was made with Prolift mesh. In the women with occult incontinence a prophylactic sub-mid urethral tape was applied in the prolapse surgery, to avoid the appearance of incontinence after surgery. RESULTS: Thirty eight women fulfilled the criterion to enter in this study, 14 (36.8%) of them did not register occult urinary incontinence in the urodynamic test. In the 24 (63.2%) with occult incontinence: Type I in 1: type II in 2: type III in 1 and type II+III in 10. During the cystometry 3 of them registered an asymptomatic hyperactive detrusor. In 1 (4.2%) of the 24 patients with prophylactic incontinence surgery, in the immediate postoperative time a failure was observed. The rest 23 women did not present incontinence during the observation period between 4 to 24 months. In the 14 women only with prolapse surgery incontinence was not registered. CONCLUSIONS: The preoperative urodynamic test with correction of severe genital prolapse by Bresky valve is an efficient method to detect the occult urinary incontinence. This allows planning a prophylactic incontinence surgery. According to our experience this method is safe and effective to avoid that the occult incontinence appears after a severe cystocele surgery repair and allows to given an integral solution to the pelvic floor problems that frequently sees associate, because they risk factors are the same to these conditions and both cause a high degree of deterioration of quality of life.

[Stress urinary incontinence surgical correction with third generation sub-mid-urethra sling: TVT-secur]. / Corrección quirúrgica de la incontinencia de orina de esfuerzo, con cinta sintética sub-medio-uretral de tercera generación: TVT-Secur.

OBJECTIVE: To review our initial experience with the new system TVT-Secur for the stress urinary incontinence. To evaluate the feasibility, efficacy and main advantages of the surgical correction with the new device. METHOD: Between January and May of 2007, 16 TVT-Secur (Women's Health & Urology, Ethicon, Johnson & Johnson) were made in patients of the Urogynecology Unit, of Clinica Las Condes. Six TVT-Secur were applied in "V" and 10 in "U". The median age was 52 years old, BMI 29, parity of 3. All patients were studied with urodynamic before surgery. All must have the urinary incontinence by more of one year and no must have previous surgical correction. RESULTS: The media surgical time was 10 minutes (8-15 minutes). Complications were not registered during intraoperative and immediate, early or delayed postoperative time. The visual analogue scale of pain was 1 to 2 at 12 hours. All patients were cured. The follow-up was between 1 and 4 months, 2 month media. All patients expressed satisfaction with the surgical results and they would recommend it to other patients in the same conditions. CONCLUSION: According to our initial experience, the new system TVT-Secur is feasible, safe and effective in the surgical correction of the SUI. However, only the long follow-up and the incorporation of new patients to the study, will allow to determine the permanence of these good results in the time.

[Prolift system in the correction of female genital prolapse]. / Sistema Prolift en la corrección del prolapso genital femenino.

OBJECTIVE: To review the security and effectiveness of female genital prolapse using the new Prolift system. PATIENT AND METHOD: Prospective study of 41 patients that have been submitted to correction of cystocele and/or rectocele or vaginal cuff, between July of 2006 and May of 2007 in the Urogynecology and Vaginal Surgery Unit of Clínica Las Condes. The period of observation was completed at July of 2007. RESULT: Anterior Prolift mesh was used in 29 cystocele: 13 degree II, 14 degree III and 3 degree IV. Thirty rectocele: 12 degree II, 16 degree III and 3 degree IV. Five cases of vaginal cuff prolapse (total mesh): 1 degree II and 4 degree IV. The media time of surgery was 40 minutes for anterior Prolift (30 to 50 minutes); 30 minutes (20 to 40 minutes) for posterior Prolift and 60 minutes for Total Prolift. They did not present intraoperative complications. During the immediate postoperative time a case of peri-rectal hematoma was observed in a patient with posterior mesh for the rectocele correction. It was treated with oral anti-inflammatory. During the delayed postoperative time a case of vaginal erosion and mesh exposition (0.5 centimeters) was observed in a case of vaginal cuff prolapse treated with a Total Prolift. Two asymptomatic recidivate vaginal cuff prolapse were registered; degree IV to III and a case degree IV that was recidivate to cystocele degree II. The visual analogue scale of pain in Anterior Prolift was 3-4 at 12 hours, 2 at 24 hours and 1 at 48 hours. In Posterior Prolift was 4-6 at 12 hours, 3-4 at 24 hours and 1-2 at 48 hours. In cases with Anterior and Posterior Prolift and in Total Prolift the results were the same of Posterior Prolift. All patients indicated satisfaction in the follow-up at 30 days. The media follow up in the 41 patients was 7 months (range of 2 to 12 months). CONCLUSION: According to our experience the correction of the female genital prolapse with Prolift system is safe and effective; nevertheless a long follow-up is required to observe the good results in the time.

[Tension free monofilament polypropylene mesh in cystocele and rectocele concomitant repair]. / Malla de polipropileno monofilamento libre de tensión en la reparación concomitante de cistocele y rectocele.

OBJECTIVE: We presented our experience in the concomitant correction of cystocele and rectocele with polypropylene monofilament mesh (Gynemesh PS), with transvaginal free tension technique. METHOD: During 2004 correction was made in 7 patients, Urogynecologic and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Medium age 54 years old, weight 64 kgs. In four patients we used a third mesh for correction of urinary incontinence by TVT-O. RESULTS: They don't present intraoperative complications, neither in immediate or delayed postoperative time. We not observed hematoma, infection, erosion or exposition mesh. Cure of cystocele and rectocele was in the 100% of patients. Complications have not appeared, 4 cases completed three months of observation, 2 cases two months and 1 case one month. DISCUSSION: The use of protesic polypropylene multifilament macropore mesh in the concomitant correction of cistocele and rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.