Vaginal prolapse surgery without mesh: findings from the CIRPOP-IUE multicenter study / Cirugía vaginal del prolapso sin malla. Estudio multicéntrico CIRPOP-IUE. Resultados

Objective: To evaluate the results of pelvic organ prolapse surgery with classic techniques based on native tissue and to analyze the correlation between objective (anatomical) cure and subjective (functional) cure. Material and methods: We performed a multicenter prospective epidemiological longitudinal cohort study. The study period was 22 months. The participating institutions consisted of 39 medical centers specialized in pelvic floor disorders (GISPEM group). The study population comprised women with symptomatic pelvic organ prolapse requiring surgical treatment. We report the results of pelvic organ prolapse surgery at 12 months after the intervention. Results: The study sample comprised 360 patients, of whom 307 were followed-up 12 months after surgery. If objective (anatomic) cure is defined as pelvic organ prolapse grade < 2 (descent to the vaginal introitus) according to the Baden-Walker classification, then 62% of the patients were cured at 12 months; this percentage increased to 89% when pelvic organ prolapse was grade ≤ 2. Eighty percent of patients were very satisfied with the results of pelvic organ prolapse surgery. The interclass correlation coefficient for patients and physicians was 0.582 (p < 0.001). Conclusions: In daily clinical practice, pelvic organ prolapse surgery based on classic techniques with native tissue leads to good results, with a moderate level of agreement between clinicians and patients on the outcome of surgery

Objetivo: evaluar los resultados de la cirugía del prolapso de órganos pélvicos con técnicas clásicas con tejidos propios y analizar la correlación entre curación objetiva o anatómica y curación subjetiva o funcional. Material y métodos: estudio epidemiológico, longitudinal, de cohortes, prospectivo y multicéntrico, de 22 meses de duración, donde participaron 39 consultas especializadas en suelo pélvico (grupo GISPEM) en mujeres con prolapso de órganos pélvicos sintomático con indicación de tratamiento quirúrgico. En este trabajo describimos, de forma específica, los resultados de la cirugía del prolapso de órganos pélvicos a los 12 meses de la intervención. Resultados: se incluyeron 360 pacientes en el total de la muestra, a 307 de las cuales se les realizó el seguimiento a los 12 meses tras la cirugía. Si consideramos como curación objetiva o anatómica el prolapso de órganos pélvicos de grado menor que 2 (descenso a nivel del introito vaginal), según la clasificación Baden-Walker, a los 12 meses de la cirugía el 62% de las pacientes estarían curadas, aumentando hasta el 89% si consideramos prolapso de órganos pélvicos de grado menor o igual a 2. El 80% de las mujeres se mostraron muy satisfechas con el resultado de la cirugía del prolapso de órganos pélvicos. El coeficiente de correlación intraclase entre las evaluaciones realizadas por pacientes y clínicos fue de 0,582 (p 0,001). Conclusiones: en condiciones de práctica clínica habitual, la cirugía del prolapso de órganos pélvicos con técnicas clásicas utilizando los tejidos propios proporciona buenos resultados, con moderada concordancia entre médicos y pacientes con respecto a los resultados de la cirugía

Clinical approach to occult urinary incontinence: Multicenter cohort study / Enfoque clínico de la incontinencia urinaria oculta: estudio multicéntrico de cohortes

Objective: To compare the impact of pelvic organ prolapse (POP) surgery with that of combined surgery for prolapse and stress urinary incontinence (SUI) in patients with no SUI symptoms and a positive stress test result. Material and methods: We performed a subanalysis of a prospective observational cohort study in 39 gynecological units specialized in pelvic floor disorders in Spain (CIRPOP-IUE). The study population comprised patients with symptomatic grade ≥II POP with an indication for treatment using vaginal surgery. All patients underwent a standard stress test, with and without reduction of the prolapse. Patients were classified into 3 groups (Group 1, SUI symptoms and positive stress test result; Group 2, absence of symptoms and positive stress test result; and Group 3, absence of symptoms and negative stress test result). Depending on the type of surgery performed, a descriptive analysis of symptoms before surgery and 1 year after was performed in group 2. Results: Group 2 comprised 87 patients (83 patients at the follow-up visit). Of these, 32 (38.5%) underwent surgery for prolapse only and 51 (61.4%) combined surgery for prolapse and urinary incontinence. De novo symptomatic SUI was recorded in 7.3% of patients who underwent combined surgery and in 29.2% of patients who underwent prolapse surgery only. Conclusion: Postsurgical urinary incontinence symptoms were less frequent in patients who underwent combined surgery for prolapse and incontinence

Objetivos: evaluar el impacto de la cirugía de prolapso de órganos pélvicos versus cirugía combinada de prolapso e incontinencia urinaria de esfuerzo en pacientes sin síntomas de incontinencia urinaria de esfuerzo y con test de esfuerzo positivo. Material y métodos: subanálisis de un estudio observacional multicéntrico de cohortes prospectivas. Se incluyeron pacientes con prolapso de órganos pélvicos sintomático, de grado II o superior, que iban a ser sometidas a cirugía del prolapso vía vaginal. Se realizó un test de esfuerzo estandarizado a todas las pacientes, con y sin prolapso de órganos pélvicos reducido. Todas las mujeres fueron clasificadas en tres grupos (Grupo 1: síntomas de incontinencia urinaria de esfuerzo y test de esfuerzo positivo, grupo 2: ausencia de síntomas y test de esfuerzo positivo y grupo 3: ausencia de síntomas y test de esfuerzo negativo). Se realizó un análisis descriptivo de los síntomas, antes de la cirugía y un año después, según el tipo de cirugía aplicada en las pacientes del grupo 2. Resultados: se incluyeron 87 pacientes en el grupo 2 (83 pacientes en la visita poscirugía). De estas, 32 (38,5%) y 51 (61,4%) fueron sometidas a cirugía solo de prolapso y combinada de prolapso e incontinencia, respectivamente. El 7,3% de las pacientes con cirugía combinada y el 29,2% de las pacientes con cirugía solo de prolapso, desarrollaron incontinencia urinaria de esfuerzo sintomática de novo. Conclusión: la presencia de síntomas de incontinencia urinaria tras la cirugía fue menos frecuente en el grupo sometido a cirugía combinada de prolapso e incontinencia

Pelvic floor symptoms and severity of pelvic organ prolapse in women seeking care for pelvic floor problems.

OBJECTIVE: The aim of the study was to estimate whether POP severity is related to lower urinary tract symptoms (LUTS) and symptoms of sexual difficulties, when evaluated with validated questionnaires. STUDY DESIGN: Multicentric cross-sectional study of 521 women seeking care for PFD in 35 specialized urogynecological clinics. Patients answered the EPIQ to detect symptoms of PFD. The severity of urinary incontinence and the OAB symptoms were measured by ICIQ-UI SF and BSAQ. POP anatomic severity was measured by the anatomic stage of each compartment, determined in pelvic examination in accordance with the IUGA-ICS terminology. A maximum POP stage (M-POP-S) was assigned to each patient: Group A, patients with no POP (stage 0-I); group B, M-POP-S stage II; and group C, M-POP-S stage III-IV. RESULTS: Pelvic examination demonstrated anatomic POP in 224 patients (stage from II to IV). 288 women (56.25%) were classified in group A (no prolapse); 102 (19.92%) group B (stage II); and 122 (28.83%) group C (stage III-IV). Several associations were found between studied variables and M-POP-S (age<55 years, menopause, number of vaginal deliveries, symptom of vaginal bulge, feeling of a bulge makes it difficult to have sexual relations, symptoms of stress urinary incontinence, nocturia and voiding difficulties), but the only variables independently associated were age, symptom of vaginal bulge and difficulty in having sexual relations due to feeling of a bulge. CONCLUSIONS: In patients seeking care for PFD, LUTS are not independently associated to the prolapse stage.

Mode of collection does not influence haematopoietic content of umbilical cord blood units from caesarean deliveries.

BACKGROUND: Collection strategy is the first step for collecting good quality cord blood units. There are two main different techniques for collecting cord blood from the umbilical vein: in the delivery room while the placenta is still in the utero by midwifes and obstetricians, or in an adjacent room after placental delivery by cord blood bank trained personal. Our aim was to evaluate the benefits and disadvantages between the two different cord blood collection strategies in caesarean deliveries. METHODS: We retrospectively analysed data of cord blood units collected from caesarean deliveries for a 3-year period. Caesarean section was performed with a low uterine transversal incision in all patients according to common obstetrical practice. Cord blood collection was performed before or after placental delivery. RESULTS: Obstetrical and umbilical cord blood data was obtained from 253 caesarean deliveries. No statistically significant difference was observed for obstetrical variables or cord blood variables except for Hct and platelets. CONCLUSIONS: We conclude both methods produce comparable TNC, CD34 and CFU counts of cord blood units collected from caesarean sections. Before placental delivery collection avoids the financial investment that generates the presence of cord blood banking personal in the maternity ward.