[Endometrial ablation: comparative study between hysteroscopic resection and Novasure system]. / Ablación endometrial: estudio comparativo entre la resección histeroscópica y el sistema Novasure.

BACKGROUND: Many women experience menorrhagia episodes resistant to medical treatment requiring definitive surgical treatment. OBJECTIVE: To analyze the effectiveness of hysteroscopic endometrial resection versus Novasure system. MATERIAL AND METHODS: A descriptive and retrospective study comparing 20 patients who underwent endometrial ablation with Novasure vs 20 patients who underwent hysteroscopic endometrial resection. We analyzed the indication, age, time of surgery, the incidence of complications, satisfaction at 3, 6 and 12 months and technical failure. RESULTS: No significant differences were found in terms of failure to complete the technique, and satisfaction at 3, 6 and 12 months. But significant differences regarding the mean operation time, which was reduced to 15 minutes among Novasure system patients. This could influence the total costs of the procedure. CONCLUSION: There were no significant differences between the two methods in terms of efficacy and safety; however, the final costs seem to be higher for the Novasure system.

[Postpartum urinary and fecal incontinence in gemelar pregnancy according to route and mode of delivery]. / Incontinencia urinaria y fecal postparto en gestación gemelar según vla y tipo de parto.

BACKGROUND: The incidence of multiple pregnancies increased in the last two decades. Several studies seeking the incidence of pelvic floor pathology, particularly urinary incontinence and its risk factors, conclude that a previous cesarean and vaginal delivery even more, carry an increased risk for developing urinary and fecal incontinence, compared with patients nulligravida. OBJECTIVE: To determine the different risk factors for urinary incontinence after a twin pregnancy. PATIENTS AND METHODS: 331 women from 20 to 50 years of age without symptoms prior to pregnancy were interviewed, attending antenatal care of twin pregnancy in the Hospital La Paz, Madrid. The interview included the ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form). We recorded maternal age, gestational age, parity, episiotomy, weights of both newborns, the need for urinary protectors and fecal or gas incontinence. RESULTS: The prevalence of urinary incontinence postpartum according ICIQ-SF >0 was 23%; 20.4% in the caesarean group, 25.3% in the eutocic delivery group and 35.5% in the instrumental delivery group (p = 0.033). The prevalence of moderate to severe incontinence (ICIQ-SF >6) was 14.8%; 12.3% in caesarean group, 14.5% in the eutocic delivery group and 32.3% in the instrumental delivery group (p = 0.005). The prevalence of fecal incontinence was 3.4%; 4.8% in eutocic delivery group, 1.9% in the caesarean group and 9.7% in the instrumental delivery group (p = 0.058). CONCLUSIONS: The risk of urinary incontinence after a twin pregnancy was higher among patients who had an instrumental delivery when compared with patients with eutocic delivery or cesarean section. The total fetal weight and maternal age did not appear as risk factors in our study. Any woman who had an instrumental delivery for twins should be followed up by a pelvic floor specialist.