ABSTRACT
Lower urinary tract symptoms (LUTS) are highly prevalent, and their treatment is mainly focused on the control of symptoms. Histamine intolerance (HIT) has been related to a variety of systemic symptoms. DAO deficiency has been identified as a significant factor contributing to histamine intolerance (HIT). Preclinical evidence indicates the involvement of histamine in the lower urinary tract. This study aimed to assess the prevalence of diamine oxidase deficiency (DAO) in a prospective cohort of 100 patients with at least moderate LUTS. A genetic study of four single nucleotide polymorphisms (SNPs) (c.-691G>T, c.47C>T, c.995C>T, and c.1990C>G) was performed. HIT was found in 85.9% of patients. The prevalence of at least one minor allele in the SNPs analyzed was 88%, without gender differences. Storage symptoms were more intense in the presence of HIT as well as asthenia and neurological and musculoskeletal symptoms. The presence of minor alleles of the AOC1 gene was associated with a higher intensity of symptoms. Minor alleles from c.-691G>T and c.47C>T SNPs were also associated with a greater severity of obstructive symptoms. Thirty-one percent of patients presented the four SNPS with at least one associated minor allele. The relationship between HIT and LUTS in a mixed population of men and women found in this study supports further investigations to define the pathophysiology of histamine in LUTS.
ABSTRACT
OBJETIVO: Evaluar las complicaciones de las mallas de polipropileno en la patología del suelopélvico femenino.MÉTODOS: Análisis retrospectivo de las pacientes intervenidasen el Servicio de Urología de nuestro hospitalde patología del suelo pélvico: IOE, cistocele, rectoceley enterocele, mediante cirugía mínimamente invasivaentre marzo de 2002 y octubre de 2008.Se valoraron: complicaciones, efectividad de la técnicay distribución del impacto de resultados. Para el análisisestadístico se utilizó el programa SPSS y la curva deimpacto se estimó por el método de Cox.RESULTADOS: Se intervinieron 363 pacientes. De las363 pacientes, 290 (79.9%) padecían de incontinenciade orina de esfuerzo, 37 (10.2%) cistocele, 33 (9.4%)IOE y cistocele, 1(0.3%) IOE y enterocele, 1(0.3%)cistocele y enterocele y 1 (0.3%) cistocele, enteroceley rectocele. Las intervenciones realizadas fueron las siguientes:34 (9.4%) mallas de compartimento anteriory medio, 1 (0.3%) malla de compartimento medio yposterior, 253 (69.7%) TOT, 35 (9.6%) TOT y malla decompartimento anterior y medio, 1 (0.3%) TOT y mallade compartimento medio y posterior, 36 (9.9%) TVT y 3(0.8%) TVT y malla de compartimento anterior y medio.La mediana de seguimiento fue de 36 (3-90) meses.Se complicaron 50 (13.8%) de las pacientes: 21 (42%)síntomas irritativos del tracto urinario inferior, 10 (20%)exteriorización de la malla, 3 (6%) fascitis necrotizantes,3 ( 6%) abscesos en fosa obturatriz , raíz del muslo ovagina, 5 (10%) dolor pélvico crónico, raíz del musloo dispareunia, 2 (4%) hematoma y sangrado, 3 (6%)infecciones urinarias, 1 (2%) intravesicalización de lamalla, 2 (4%) síntomas obstructivos.Globalmente los procedimientos fueron efectivos en350 (96.4%) pacientes. El impacto de las complicacionesse manifestó en los 10 primeros meses después dela intervención. CONCLUSIONES: Las mallas de polipropileno son muyefectivas en el tratamiento de las afecciones del suelopélvico femenino. En poco más del 10% aparecencomplicaciones que se resuelven espontáneamente ocon tratamiento médico en la mayoría de los casos. Untercio de las complicaciones son subsidiarias de cirugíaextirpando total o parcialmente la malla, sin que afecte a los resultados de la intervención (AU)
OBJECTIVES: To assess the complications of polypropylene mesh in the treatment of female pelvicfloor disorders.METHODS: Retrospective study of patients with pel-vicfloor pathology (SUI, cystocele, rectocele, enteroce-le)undergoing pelvic floor intervention with surgical meshesfrom March 2002 to October 2009.We evaluated complications, effectiveness of thetechnique and distribution of the impact of the results.For statistical analysis SPSS software was used and thecurve of impact was estimated by Cox model.RESULTS: We analyzed 363 patients. Of these 363patients, 290 (79.9%) suffered from Stress Urinary Incontinence,37 (10.2%) cystocele, 33 (9.4%) SUIand cystocele, 1 (0.3%) SUI and enterocele, 1 (0.3%)cys-tocele and enterocele and 1 (0.3%) cystocele,enteroce-le and rectocele. The interventions done were:34 (9.4%) anterior and middle compartment meshes,1 (0.3%) middle and posterior compartment meshes,1 (0.3%) TOT and middle and posterior com-partmentmesh, 36 (9.9%) TVT and 3 (0.8%) TVT and anteriorand middle compartment mesh. The median fo-llow-upwas 36 (3-90) months.50 patients (13.8%) presented complications: 21 (42%)had lower urinary tract irritative symptoms, 10 (20%)externalization of the mesh, 3 (6%) necrotizing fascitis,3 (6%) obturator fossa, thigh root or vaginal abscess, 5(10%) chronic pelvic pain, thigh pain or dyspareunia, 2(4%) bruising and bleeding, 3 (6%) urinary tract infections,1 (2%) mesh entering bladder and 2 (4%) obstructivesymptoms.The procedures were effective in 350 (96.4%) patients.The impact of complications was manifested in the first 10 months after surgery. CONCLUSIONS: Polypropylene meshes are very effective in the treatment of female pelvic floor disorders.Approximately 10% of the patients had complicationsthat resolved spontaneously or with medical treatment inmost cases. One third of the complications are subsidiariesof surgery, by removing the mesh totaly or partialy, without affecting the intervention results (AU)