ABSTRACT
La extrofia vesical es un defecto grave del cierre de la pared abdominal poco frecuente asociado a malformaciones genitourinarias que precisa de un tratamiento quirúrgico en las primeras 48 horas. La técnica de Mitrofanoff se define como un reservorio urinario de baja presión con un mecanismo eferente sondable diferente de la uretra con un conducto cateterizable de comunicación con el exterior en la pared abdominal. Se presenta el caso de una gestante de 38 años con antecedente de extrofia vesical congénita corregida al nacimiento con una vesicostomía urinaria continente según la técnica de Mitrofanoff. El embarazo evoluciona favorablemente sin complicaciones hasta la semana 38 en que se produce un prolapso de cordón que obliga a adelantar la cesárea que tenía programada para el día siguiente sin complicaciones durante la misma. La evolución tanto de la madre como del niño fueron satisfactorias (AU)
Bladder exstrophy is a rare anterior midline defect resulting into complex genitourinary malformations witch require complex surgical treatment usually in the first 48 hours of the delivery. Mitrofanoff s technique is a low pressure urinary reservory with a catheterizable urinary conduit from the bladder to the abdominal wall. We present a case of a 38 year old pregnant women who had undergone a continent urinary diversion (based on Mitrofanoff ́s technique) in the childhood for the treatment of abladder exstrophy. The curse of the pregnant is normal until the 38th week moment in whitch we have to made an emergency cesarean section without complications due to a cord prolapsed the day before we have planned to made the elective cesarean. Mother ́s and the child evolution were satisfactory (AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Bladder Exstrophy/surgery , Urinary Reservoirs, Continent , Pregnancy Complications/diagnosis , Cesarean Section , Pregnancy Outcome , UreterostomyABSTRACT
OBJECTIVE: The main aim of this study is to determine the improvement in quality of life in patients who have undergone radical surgery because of severe endometriosis. PATIENTS AND METHODS: This nonrandomized interventional study (quasi experimental) was carried out between January 2009 and September 2014. A total of 46 patients with diagnosis of severe endometriosis were included. Radical surgery, including hysterectomy, was performed. Acting as their own control group, the patients were asked to fill in a validated questionnaire of quality of life [Endometriosis Health Profile-5 (EHP-5)] and a visual analog scale of pain at the moment of the preoperative visit (one month prior to surgery) and six months after the surgery. RESULTS: Radical surgery for endometriosis was performed in 46 patients at our center over the period of six years. Among the patients, 73.9% of them had undergone previous surgery for endometriosis. In 82.6% of cases, a complete laparoscopic resection was carried out. Gastrointestinal tract resection was performed in 21.7%, and urinary tract resection was necessary in 8.7%. The mean age of the patients was 38.6 years. The rate of complications was 30.4%. Six months after the surgery, all items of the EHP-5 questionnaire had a lower score, which means an improvement in all aspects of quality of life related to endometriosis. The difference obtained between the scores before and after the surgery was statistically significant. The mean visual analog scale score before the surgery was 8.5, whereas it decreased to 1.4 after the surgery (P < 0.001). CONCLUSION: Performing a radical surgery is a difficult decision to make; however, it can provide optimal results in terms of improvement of quality of life and, therefore, should be considered when conservative therapy fails.
ABSTRACT
BACKGROUND: Endometriosis nodes are observed in extra pelvic locations, particularly in gynaecological scars, with the abdominal wall being one of the most frequent locations. The main objective of the study is to review patient characteristics of cases of endometriosis nodes in gynaecological scars. METHODS: A retrospective, observational and descriptive study with a cohort of patients from Hospital 12 de Octubre was conducted from January 2000 to January 2012. We analysed all of the patients who presented with an endometriosis node in a gynaecological scar presentation who had undergone surgery in that period. Descriptive data were collected and analysed. RESULTS: A total of 17 patients with an anatomopathological diagnosis of an endometriosis node in a gynaecological scar were found. The following variables were studied: the age at diagnosis (32.5 years +/- 5.5 years), personal and obstetric history, time from surgery to diagnosis (4.2 years +/- 3.4 years), symptoms (a painful mass that grows during menstruation is the most frequent symptom in our patients), technical analyses by computed tomography (CT), magnetic resonance (MR) or fine needle aspiration (FNA) (77% of the patients), node size (2.5 cm +/- 1.1 cm) and location (caesarean scar, 82%; episiotomy scar, 11.7%; and laparoscopic surgery port, 5.8%), involvement of adjacent structures (29% of the patients), treatment (exeresis with a security margin in all the patients) and other endometriosis locations (14% of the patients). CONCLUSIONS: A high level of suspicion is required to diagnose gynaecological scar endometriosis, which should be suspected in the differential diagnosis of scar masses in reproductive-aged women. Several theories have been proposed to explain the formation of endometriosis nodes in extrauterine localizations. The two of them that seem to be more plausible are the metaplasia and transport theories. Imaging with ultrasound, CT and MR facilitate the diagnosis. FNA could be used for preoperative diagnosis. Treatment must be by node resection with a security margin. In some cases, surgery could be combined with hormonal treatment.
