Group Singing as a Therapy during Diabetes Training--A Randomized Controlled Pilot Study.

Comprehensive diabetes treatment has been shown to reduce quality of life in diabetic patients. However, there is evidence to suggest that group singing can have positive effects on quality of life in various clinical settings. In this randomized controlled pilot study, the effect of singing as a therapy to reduce stress and improve quality of life was investigated in insulin-dependent diabetic patients, undergoing a lifestyle intervention program. Patients from the singing group felt less discontented following treatment. This effect, however, was lost after 3 months. No effect on serum cortisol and plasma adrenocorticotropic hormone (ACTH) levels could be seen when comparing the singing group with the control group, although reduced levels of ACTH and cortisol 3 days after treatment could be found and were still present after 3 months within the group of patients who undertook singing as a therapy. Singing led to an increase in bodyweight, which interestingly had no effect on glucose control or methylglyoxal levels. Therefore, singing during a lifestyle intervention program for insulin-dependent diabetic patients had a short lasting and weak effect on patients' mood without affecting glucose control, but no significant effect on stress related hormones.

Validation of WHO classification-based Prognostic Scoring System (WPSS) for myelodysplastic syndromes and comparison with the revised International Prognostic Scoring System (IPSS-R). A study of the International Working Group for Prognosis in Myelodysplasia (IWG-PM).

A risk-adapted treatment strategy is mandatory for myelodysplastic syndromes (MDS). We refined the World Health Organization (WHO)-classification-based Prognostic Scoring System (WPSS) by determining the impact of the newer clinical and cytogenetic features, and we compared its prognostic power to that of the revised International Prognostic Scoring System (IPSS-R). A population of 5326 untreated MDS was considered. We analyzed single WPSS parameters and confirmed that the WHO classification and severe anemia provide important prognostic information in MDS. A strong correlation was found between the WPSS including the new cytogenetic risk stratification and WPSS adopting original criteria. We then compared WPSS with the IPSS-R prognostic system. A highly significant correlation was found between the WPSS and IPSS-R risk classifications. Discrepancies did occur among lower-risk patients in whom the number of dysplastic hematopoietic lineages as assessed by morphology did not reflect the severity of peripheral blood cytopenias and/or increased marrow blast count. Moreover, severe anemia has higher prognostic weight in the WPSS versus IPSS-R model. Overall, both systems well represent the prognostic risk of MDS patients defined by WHO morphologic criteria. This study provides relevant in formation for the implementation of risk-adapted strategies in MDS.

Monosomal karyotype in MDS: explaining the poor prognosis?

Monosomal karyotype (MK) is associated with an adverse prognosis in patients in acute myeloid leukemia (AML). This study analyzes the prognostic impact of MK in a cohort of primary, untreated patients with myelodysplastic syndromes (MDS). A total of 431 patients were extracted from an international database. To analyze whether MK is an independent prognostic marker in MDS, cytogenetic and clinical data were explored in uni- and multivariate models regarding overall survival (OS) as well as AML-free survival. In all, 204/431 (47.3%) patients with MK were identified. Regarding OS, MK was prognostically significant in patients with ≤ 4 abnormalities only. In highly complex karyotypes (≥ 5 abnormalities), MK did not separate prognostic subgroups (median OS 4.9 months in MK+ vs 5.6 months in patients without MK, P=0.832). Based on the number of abnormalities, MK-positive karyotypes (MK+) split into different prognostic subgroups (MK+ and 2 abnormalities: OS 13.4 months, MK+ and 3 abnormalities: 8.0 months, MK+ and 4 abnormalities: 7.9 months and MK+ and ≥ 5 abnormalities: 4.9 months; P<0.01). In multivariate analyses, MK was not an independent prognostic factor. Our data support the hypothesis that a high number of complex abnormalities, associated with an instable clone, define the subgroup with the worst prognosis in MDS, independent of MK.

Survival, prognostic factors and rates of leukemic transformation in 381 untreated patients with MDS and del(5q): a multicenter study.

Myelodysplastic syndromes (MDS) with del(5q) are considered to have a benign course of the disease. In order to address the issue of the propensity of those patients to progress to acute myeloid leukemia (AML), data on 381 untreated patients with MDS and del(5q) characterized by low or intermediate I International Prognostic Scoring System (IPSS) risk score were collected from nine centers and registries. Median survival of the entire group was 74 months. Transfusion-dependent patients had a median survival of 44 months vs 97 months for transfusion-independent patients (P<0.0001). Transfusion need at diagnosis was the most important patient characteristic for survival. Of the 381 patients, 48 (12.6%) progressed to AML. The cumulative progression rate calculated using the Kaplan-Meier method was 4.9% at 2 years and 17.6% at 5 years. Factors associated with the risk of AML transformation were high-risk World Health Organization adapted Prognostic Scoring System (WPSS) score, marrow blast count >5% and red-cell transfusion dependency at diagnosis. In conclusion, patients with MDS and del(5q) are facing a considerable risk of AML transformation. More detailed cytogenetic and molecular studies may help to identify the patients at risk of progression.

Impact of adjunct cytogenetic abnormalities for prognostic stratification in patients with myelodysplastic syndrome and deletion 5q.

This cooperative study assessed prognostic factors for overall survival (OS) and risk of transformation to acute myeloid leukemia (AML) in 541 patients with de novo myelodysplastic syndrome (MDS) and deletion 5q. Additional chromosomal abnormalities were strongly related to different patients' characteristics. In multivariate analysis, the most important predictors of both OS and AML transformation risk were number of chromosomal abnormalities (P<0.001 for both outcomes), platelet count (P<0.001 and P=0.001, respectively) and proportion of bone marrow blasts (P<0.001 and P=0.016, respectively). The number of chromosomal abnormalities defined three risk categories for AML transformation (del(5q), del(5q)+1 and del(5q)+ ≥ 2 abnormalities) and two for OS (one group: del(5q) and del(5q)+1; and del(5q)+ ≥ 2 abnormalities, as the other one); with a median survival time of 58.0 and 6.8 months, respectively. Platelet count (P=0.001) and age (P=0.034) predicted OS in patients with '5q-syndrome'. This study demonstrates the importance of additional chromosomal abnormalities in MDS patients with deletion 5q, challenges the current '5q-syndrome' definition and constitutes a useful reference series to properly analyze the results of clinical trials in these patients.

[30 year-old patient with multiple pelvic lesions and fecal incontinence]. / Multiple Raumforderungen bei einem 30-Jährigen mit Stuhlinkontinenz.

In a 30 year-old patient with subacute loss of bowel control and perianal anesthesia radiologic examination showed multiple bone lesions. The results of a bone marrow aspiration showed acute myeloid leukemia M2 with translocation t(8,21) associated with granulocytic sarcoma. The patient was treated with high dose chemotherapy and had a complete remission after autologous stem cell transplantation.

[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.

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

Objetivos: Revisar la eficacia de la urodinamia monocanal realizada con corrección del prolapso genital severo, mediante valva de Bresky, en la pesquisa de incontinencia de orina oculta, como prueba prequirúrgica, para planificar una corrección mediante cinta submediouretral concomitantemente con la cirugía de prolapso. Paciente y Método: Pacientes ingresadas a la Unidad de Uroginecología de Clínica Las Condes, entre enero del 2006 y diciembre del2007, debido a cistocele grado III o IV. Pacientes sin antecedentes de cirugía de prolapso o incontinencia de orina. Se realiza una urodinamia monocanal con corrección del prolapso mediante una valva de Bresky. Se realiza medición de presión de retro-resistencia uretraly cistometría. En aquellas mujeres en que se descarta la presencia de incontinencia oculta, se realiza corrección del prolapso mediante malla Prolift. En aquellas en que se encuentra incontinencia oculta, se coloca concomitantemente, una cinta sub-medio uretral profiláctica, para evitar la aparición de incontinencia de orina en el postoperatorio. Resultados: De las treinta y ocho mujeres que cumplieron el criterio de ingreso a este estudio, 14 (36,8%) no registraron presencia de incontinencia de esfuerzo oculta durante la urodinamia. En las 24 (63,2%) restantes se evidenció incontinencia de orina de esfuerzo. Tipo I, en 1; tipo II en 12; tipo III en 1; tipo II+III en 10. Durante la cistometría 3 de ellas registraron un detrusor hiperactivo asintomático. En 1(4,2%) de las 24 pacientes sometidas a cirugía profiláctica de incontinencia, se registró falla, con escapes de orina durante el postoperatorio inmediato. El resto (23) no presentó incontinencia durante el postoperatorio inmediato, temprano, ni tardío, completando un período de observación entre 4 y 24 meses. En las 14 mujeres con cirugía sólo para el prolapso, tampoco se registró aparición de incontinencia. Conclusiones: La urodinamia con corrección del prolapso genital severo, mediante valva de Bresky, es un método eficiente en la detección de incontinencia de orina oculta. Lo que nos permite planificar una posible cirugía anti-incontinencia profiláctica. Que según nuestra experiencia, es un método seguro y eficaz. De esta forma, se entrega una solución integral, a un problema del suelo pelviano que frecuentemente se asocia, por compartir los mismos factores de riesgo y que significa un alto grado de deterioro de la calidad de vida (AU)

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 prolapsed 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 (AU)

[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.

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

Objetivo: Revisar nuestra experiencia inicial en la corrección de la incontinencia de orina de esfuerzo, con el nuevo sistema TVT-Secur. Revisar la efectividad y seguridad de esta técnica. Método: Entre enero y mayo del 2007, se realizaron 16 TVT-Secur (Women’s Health & Urology, Ethicon, Johnson & Johnson) a pacientes de la Unidad de Uroginecología y Cirugía Vaginal, del Departamento de Ginecología y Obstetricia de la Clínica Las Condes. En 6 pacientes la cinta se situó en 'V' y en 10 en 'U'. La mediana de edad para el grupo fue de 52 años, índice de masa corporal 29, paridad 3. En todas se realizó estudio urodinámico previo como parte del estudio y selección preoperatoria. Todas debían tener al menos un año de incontinencia de orina de esfuerzo, y ninguna debía tener corrección quirúrgica previa. Resultado: La mediana de tiempo operatorio fue de 10 minutos, con un rango entre 8 y 15 minutos. No se presentaron complicaciones durante el acto operatorio, ni en el postoperatorio inmediato, temprano y tardío. La EVA registrada a las 12 horas fue de 1 a 2. Se obtuvo corrección de la incontinencia de orina de esfuerzo en todas las pacientes. El tiempo de seguimiento fue entre 1 y 4 meses, con una mediana de 2 meses. Todas expresaron estar conformes con los resultados de la cirugía y la recomendarían a otras pacientes en igual situación. Conclusiones: Según nuestra experiencia inicial, el nuevo sistema TVT-Secur, aparece como eficaz y seguro, en la quirúrgica de la incontinencia de orina de esfuerzo. Sin embargo, sólo el seguimiento a largo plazo, y la incorporación de nuevos pacientes al estudio, permitirá determinar el mantenimiento de estos buenos resultados en el tiempo (AU)

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 Clínica 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 (AU)

Estudio urodinámico en la evaluación de la incontinencia urinaria femenina, con el nuevo sistema MoniTorr MR (urodinamia monocanal con medición de presión de retro-resistencia uretral). Experiencia con 100 pacientes / Urodynamic study in the female urinary incontinence evaluation, with the new monitorrmr system (nonmultichannel urodynamic urethral retro-resistance pressure measure). Experience with 100 patients

Objetivos: Correlacionar el diagnóstico clínico de la incontinencia urinaria con los resultados de la cistometría (LPP) y URP, obtenidas por medio de urodinamia monocanal. Evaluar la tolerancia de los pacientes a este examen. Paciente y método: Entre agosto y diciembre del 2006, se realizaron 100 urodinamias monocanal con medición de URP, en las pacientes que consultaron por diagnóstico clínico de incontinencia de orina, en la Unidad de Uroginecología y Cirugía Vaginal, de Clínica Las Condes. Se correlacionó el diagnóstico clínico con los resultados de la urodinamia. Se aplicó una escala de tolerancia subjetiva del examen, donde 0 es la mayor tolerancia y 10 la menor. Resultados: De las 66 pacientes con clínica de incontinencia de orina de esfuerzo: 10 fueron tipo 0, 2 tipo I, 23 tipo II, 1 tipo III, 17tipo II+III, 1 detrusor hiperactivo, 5 tipo 0+detrusor hiperactivo, 3 tipo II+detrusor hiperactivo, 4 II+III+detrusor hiperactivo. De las 15pacientes con IOM: 6 urodinamias fueron tipo 0, 2 tipo II, 2 tipo II+III, 3 detrusor hiperactivo, 1 tipo II+detrusor hiperactivo y 1 tipoIII+detrusor hiperactivo. De las 16 pacientes con urge incontinencia: 2 normal, 4 II+III, 7 detrusor hiperactivo, 1 II+detrusor hiperactivo y2 II+III+detrusor hiperactivo. En 3 pacientes se solicitó una urodinamia como parte del estudio pre-operatorio, por corresponder respectivamente a dos casos de prolapso de cúpula y un cistocele, todos grado IV (POP-Q), con una gran potencialidad de incontinencia de orina después de la corrección. Presentaron respectivamente una incontinencia de esfuerzo tipo III+detrusor hiperactivo, una tipo II+III y una urodinamia normal. Todas las pacientes identificaron una tolerancia que clasificaron como 2 o 3 (escala de 0 a 10, donde 0 corresponde al grado mayor tolerancia y 10 al grado de menor tolerancia).Conclusiones: La urodinamia monocanal más la medición de la URP es un examen complementario de gran utilidad en la objetivación y clasificación del diagnóstico de la incontinencia urinaria, sospechada por la clínica. Permite al médico planificar la solución adecuada para cada caso y tiene un alto grado de tolerancia en las pacientes (AU)

Objective: To compare the clinical diagnosis of the urinary incontinence with the results of LPP and URP obtained by non-multichannel urodynamic. To evaluate the tolerance of the patients to this examination. Pathient and Method: Between August and December 2006, 100 urodynamics were made in patients with clinical diagnosis of urinary incontinence, in the Urogynecology Unit of Clínica Las Condes. The clinical diagnosis was compared with the urodynamic results. A subjective tolerance scale was applied (0 was greater tolerance and 10 was maximum discomfort).Results: In 66 patients with clinical diagnosis of IUS, the urodynamic registered 10 Type 0, 2 (I), 23 (II), 1 (III), 17 (II+III),1 hyperactive detrusor, 5 (0+ hyperactive detrusor), 3 (II+hyperactive detrusor) and 4 (II+III+hyperactive detrusor). In 15 with Mixed urinary incontinence, the urodynamic showed 6 (Type 0), 2 (II), 2 (II+III), 3 hyperactive detrusor, 1 (II+hyperactive detrusor) and 1 (III+hyperactive detrusor). In 16 patients with urgency incontinence, urodynamic showed 2 normal, 4 (II+III), 7 hyperactive detrusor, 1 (II+hyperactive detrusor) and 2 (II+III+hyperactive detrusor). In 3 patients (two vaginal cuff prolapse and one cistocele, degree IV POP-Q) the urodynamic was indicated in the pre-surgery study considering a great potentially incontinence after correction. Respectively, the patients presented: IUS typeIII+hyperactive detrusor, IUS type II+III and one normal. All patients expressed 2 and 3 degree tolerance (subjective scale: 1 major tolerance and 10 a minor tolerance). Conclusions: The MoniTorrMR urodynamic is a complementary examination very useful in the study of the urinary incontinence. It allows planning the solution adapted for each case and has a high degree of tolerance in the patients (AU)

Cinta trans-obturadora (TOT) en la corrección de la incontinencia de orina de esfuerzo. Experiencia de tres años con 200 pacientes / Trans obturator tape (TOT) for female stress incontinence. Experience with three years follow-up in 200 patients

Objetivo: Evaluar la seguridad y eficacia del TOT en el tratamiento de la incontinencia de orina de esfuerzo femenina, de acuerdo a nuestra experiencia. Paciente y Método: Estudio prospectivo de 200 pacientes a los que se realizó TOT en la Unidad de Ginecología del Departamento de Obstetricia y Ginecología del Hospital Barros Luco-Trudeau, entre enero del 2003 y octubre del 2006. Se utilizó malla de polipropileno, macroporo, monofilamento (Prolene). Mediana de edad 52 años, paridad 3. Resultados: El tiempo operatorio del TOT fue de 15 minutos (mediana). De las 200 pacientes, al mes se constató curación de la incontinencia de esfuerzo en 184 (92%), 6 (3%) casos mejoría, 10 (5%) casos falla de la cirugía. Se presentaron 3 complicaciones intraoperatorias, correspondiendo a lesión de vejiga. Una con la tijera durante la disección del espacio vesico-vaginal hacia el agujero obturador y dos con la aguja. Durante el postperatorio inmediato se evidenció un caso de obstrucción parcial de uretra por inflamación, dos casos de infección urinaria y tres casos con dolor de extremidades inferiores. Durante el postoperatorio tardío en una paciente con cura, como consecuencia de una caída violenta, se reinicia la incontinencia. Conclusión: De acuerdo a nuestra experiencia con 200 casos, el TOT se presenta como una técnica segura y eficaz en el tratamiento quirúrgico de la incontinencia de orina de esfuerzo

Objective: To evaluate the security and effectiveness of the TOT in the female incontinence surgical treatment according to our experience. Patient and Method: Prospective study of 200 patients underwent TOT at Gynecology Unit of the Obstetrics and Gynecology Department in Barros Luco-Trudeau Hospital between January 2003 and October 2006. Polypropilene, macropore, mofilament mesh (Prolene) was used. The mean age was 52 years old, parity 3. Results: The mean surgical time of TOT was 15 minutes. In 184 (92%) patients obtained cure, 6 (3%) improvement and 10 (5%) fails. Three cases of bladder injury occurred (one perforation with the scissor and two with TOT needle during the learning phase). During the immediately postoperative time: one case of partial urethral obstruction, two cases of urinary infection and three with pain of the legs. During the delayed postoperative time a case of fail was observed after trauma. Conclusion: According to our experience with 200 cases, the TOT appears as a safe and effective technique in the surgical treatment of the stress urinary incontinence

[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.

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

Objetivo: Revisar la seguridad y eficacia de la corrección de prolapso genital femenino con el nuevo sistema Prolift. Paciente y Método: Estudio prospectivo de 41 pacientes ingresados para corrección quirúrgica de prolapso anterior y/o posterior genital, entre julio del 2006 y mayo del 2007, en la Unidad de Uroginecología y Cirugía Vaginal de Clínica Las Condes. El periodo de observación fue hasta julio del 2007. Resultados: Se corrigieron 29 cistoceles: 13 grado II, 14 grado III y 3 grado IV. Treinta rectoceles: 12 grado II, 16 grado III y 3 grado IV. Cinco casos de prolapso de cúpula (malla total, anterior y posterior): 1 grado II y 4 grado IV. El tiempo quirúrgico para Prolift anterior fue de 40 minutos (30 a 50 minutos). Para Prolift posterior 30 minutos (20 a 40 minutos). Para Prolift Total en cúpula 60 minutos (40 a 70 minutos). No se registraron complicaciones durante el intraoperatorio. En el postoperatorio inmediato se registró un caso de hematoma perirectal en un paciente con malla posterior para corrección de rectocele. Se trató sólo con anti-inflamatorios. Durante el postoperatorio tardío se registró un caso de erosión vaginal y exposición de 0, 5 cms de malla en un caso de prolapso de cúpula, corregido con malla total. Se registraron 2 recidivas asintomáticas en prolapso de cúpula. Una de grado IV a grado III y otra de grado IV, que se presentó como cistocele grado II. La escala visual análoga del dolor en pacientes con Prolift anterior solamente, a las 12 horas 3-4, 24 horas 2 y 48 horas 1. En Prolift posterior solamente, a las 12 horas 4-6, 24 horas 3-4 y 48 horas 1-2. En los casos con Prolift anterior y posterior, y en los casos de prolapso de cúpula, los valores no variaron respecto a los de Prolift posterior. Respecto al grado de satisfacción preguntado durante el control a los 30 días, todas respondieron estar muy satisfechas. La media de seguimiento de las 41 pacientes fue de 7 meses (rango de 2 a 12 meses). Conclusión: Según nuestra experiencia la corrección del prolapso genital femenino con el Sistema Prolift es seguro y eficaz, sin embargo debemos tener presente que se requiere un seguimiento a largo plazo para registrar el mantenimiento de los buenos resultados

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

[Trans obturator tape (TOT) for female stress incontinence. Experience with three years follow-up in 200 patients]. / Cinta trans-obturadora (TOT) en la corrección de la incontinencia de orina de esfuerzo. Experiencia de tres años con 200 pacientes.

OBJECTIVE: To evaluate the security and effectiveness of the TOT in the female incontinence surgical treatment according to our experience. PATIENT AND METHOD: Prospective study of 200 patients underwent TOT at Gynecology Unit of the Obstetrics and Gynecology Department in Barros Luco-Trudeau Hospital between January 2003 and October 2006. Polypropilene, macropore, mofilament mesh (Prolene) was used. The mean age was 52 years old, parity 3. RESULTS: The mean surgical time of TOT was 15 minutes. In 184 (92%) patients obtained cure, 6 (3%) improvement and 10 (5%) fails. Three cases of bladder injury occurred (one perforation with the scissor and two with TOT needle during the learning phase). During the immediately postoperative time: one case of partial urethral obstruction, two cases of urinary infection and three with pain of the legs. During the delayed postoperative time a case of fail was observed after trauma. CONCLUSION: According to our experience with 200 cases, the TOT appears as a safe and effective technique in the surgical treatment of the stress urinary incontinence.

[Minimal invasive surgery in female urinary incontinence: TVT-O]. / Cirugía mínimamente invasiva en la incontinencia urinaria femenina: TVT-O.

OBJECTIVE: We presented our experience in the application of Tvt-O, a surgical a new technic for SUI. METHOD: Between April and December 2004, 96 patients underwent Tvt-O surgery, in Uroginecology and Vaginal Surgery Unit of the Gynecology and Obstetrics Department, Las Condes Clinic. Median age was 54 years old, weight 65 kgs. Urodinamia test: SUI II 80 cases, SUI III 4, SUI 0 in 3, and mixed urinary incontinence 9. Gynecare TVT Obturator System technique was used, Ethicon Johnson & Johnson. It has three specific instruments: helical passers, plastic tubes fixed to mesh of prolene, and a guide for the introduction of the needle. RESULTS: Media time was 7 minutes (4 to 15). Other gynecological surgery was associated in 77 (80%). Complications did not appear during the surgical act. No injury to bladder and urethra was observed. We observed in immediate postoperative period only one complication (1.04%). It was urinary retention. One complication appeared (1.04%) in remote postoperative period, corresponding polypropylene tape exposition in the anterior vaginal wall. SUI solution was obtained in 100% of patients. The medium time of observation is 6 months, 51 cases have more than 6 months of observation. DISCUSSION: Tvt-O is a surgical SUI correction technique with promissory results. Like the other types of TOT, their effectiveness will have in the long term to be evaluated.

Cirugía mínimamente invasiva en la incontinencia urinaria femenina: TVT-O / Minimal invasive surgery in female urinary incontinence: TVT-O

Objetivo: Presentamos nuestra experiencia en la aplicación de TVT-O, en la corrección quirúrgica de la IOE. Método: Entre abril y diciembre 2004, se realizaron 96 TVT-O a pacientes de la Unidad de Uroginecología y Cirugía Vaginal, del Departamento de Ginecología y Obstetricia de la Clínica Las Condes. Mediana de edad 54 años, peso 65 kg. Test de urodinamia: IOE grado II 80 casos, IOE grado III 4, IOE grado 0 3, e IOM 9. Se utilizó el Sistema Gynecare TVT Obturador de Ethicon, Johnson & Johnson. Resultados: Mediana tiempo operatorio TVT-O: 7 minutos. Se asoció alguna cirugía ginecológica en 77. No se presentaron complicaciones durante el acto quirúrgico. No se observó daño de vejiga ni vías urinarias. Durante el postoperatorio inmediato se presentó sólo una complicación (1,04%) correspondiendo a retención urinaria, por sobrecorrección. Durante el postoperatorio tardío una complicación (1,04%), exposición de la cinta de polipropileno en la mucosa de la pared vaginal anterior. Se obtuvo solución de la incontinencia de orina de esfuerzo en las 96 pacientes. La mediana de seguimiento 6 meses, 51 casos con seguimiento mayor a 6 meses. Conclusiones: TVT-O es una técnica quirúrgica para el tratamiento de la IOE, con resultados muy promisorios. Al igual que los otros tipos de TOT, su eficacia deberá ser evaluada a largo plazo

Objective: We presented our experience in the application of Tvt-O, a surgical a new technic for SUI. Method: Between April and December 2004, 96 patients underwent Tvt-O surgery, in Uroginecology and Vaginal Surgery Unit of the Gynecology and Obstetrics Department, Las Condes Clinic. Median age was 54 years old, weight 65 kgs. Urodinamia test: SUI II 80 cases, SUI III 4, SUI 0 in 3, and mixed urinary incontinence 9. Gynecare TVT Obturator System technique was used, Ethicon Johnson & Johnson. It has three specific instruments: helical passers, plastic tubes fixed to mesh of prolene, and a guide for the introduction of the needle. Results: Media time was 7 minutes (4 to 15). Other gynecological surgery was associated in 77 (80%). Complications did not appear during the surgical act. No injury to bladder and urethra was observed. We observed in immediate postoperative period only one complication (1.04%). It was urinary retention. One complication appeared (1.04%) in remote postoperative period, corresponding polypropylene tape exposition in the anterior vaginal wall. SUI solution was obtained in 100% of patients. The medium time of observation is 6 months, 51 cases have more than 6 months of observation. Discussion: Tvt-O is a surgical SUI correction technique with promissory results. Like the other types of TOT, their effectiveness will have in the long term to be evaluated

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

Objetivo: Presentamos nuestra experiencia en la corrección de cistocele y rectocele concomitante, con malla de polipropileno monofilamento (Gynemesh PS), con técnica libre de tensión transvaginal. Método: Entre noviembre 2004 y enero 2005 se realizó corrección 7 pacientes, de la Unidad de Uroginecología y Cirugía Vaginal del Departamento de Ginecología y Obstetricia, de la Clínica Las Condes. Mediana de edad 54 años, peso 64 kg. En cuatro pacientes además se asoció una tercera malla para corrección de incontinencia de orina de esfuerzo, con técnica de TVT-O. Resultado: No se presentaron complicaciones intraoperatorias, ni en el postoperatorio inmediato ni tardío. No se observó hematoma, infección, ni exposición de la malla. Se obtuvo curación del cistoceley del rectocele en el 100% de las pacientes. No se han presentado a la fecha actual, completando3 meses de observación 4 casos, 2 meses 2 casos, y 1 mes un caso. Discusión: La utilización de mallas protésicas, de polipropileno monofilamento con macroporo en la corrección concomitante del cistocele y del rectocele, por vía transvaginal, con técnica libre de tensión, parece ser un procedimiento seguro y eficaz (AU)

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 (AU)

[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.