Vaginal pessary in advanced pelvic organ prolapse: impact on quality of life.

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is a highly prevalent dysfunction of the pelvic floor affecting up to 40% of women. The symptoms of POP have a major impact on quality of life. Pessary treatment is a therapy option associated with high levels of satisfaction and few complications. OBJECTIVES: The objective was to assess the impact and efficacy of vaginal pessary use on the quality of life of women with advanced POP stages III and IV. MATERIALS AND METHODS: A multicenter, longitudinal, prospective observational study was conducted at the Urogynecology Sector of the Hospital Ipiranga and the Hospital Central of the Irmandade da Santa Casa de Misericórdia de São Paulo. A sociodemographic questionnaire was employed and two scales validated in Portuguese (ICIQVS and SF 12) were applied before and 6 months after pessary use. Student´s t test, Mann-Whitney test and Fisher´s exact test were applied, adopting a significance level of 0.05. RESULTS: The median age of participants was 71.5 (65-76) years and the median number of pregnancies was 4 (3-5). Deliveries were predominantly vaginal (82.5%). Women sexually active (16.49%) showed improvement in sexual function (78.6%). The participants showed improvement in vaginal symptoms (91.8%) and quality of life (92.8%) (p < 0.01) post-treatment. Of the total 97 women, the sample drop-out rate was 9.3% and 88 participants completed the two stages of the study. CONCLUSIONS: Vaginal pessary use had 90.7% efficacy, a high level of treatment satisfaction (75.3%), and a positive impact on the improvement of vaginal and sexual symptoms, quality of life, and mental health.

Comparative results of two techniques to treat stress urinary incontinence: synthetic transobturator and aponeurotic slings.

INTRODUCTION AND HYPOTHESIS: This study aims to analyze comparatively the efficacy and safety of synthetic transobturatory and aponeurotic retropubic slings, in the treatment of stress urinary incontinence (SUI) in women. METHODS: Patients were separated in a randomized way. Twenty-one patients were submitted to the operatory correction by the transobturatory sling technique, whereas 20 patients were operated by the retropubic sling technique. All patients were submitted to complete physical exam and urodynamic test. The "T" test and the Mann-Whitney U test were applied to establish comparisons between the two groups. Patients were followed-up for 12 months. RESULTS: Healing rate was 90.5% (19/21) and 95% (19/20), respectively after 12 months. The transobturatory group presented lesser complications rate than the retropubic group. CONCLUSIONS: The transobturatory and the aponeurotic slings techniques were equally effective for the treatment of SUI. The transobturatory sling has shown fewer complications and lesser surgical time than the aponeurotic sling technique.

[Risk factors for genital prolapse in a Brazilian population]. / Fatores de risco para o prolapso genital em uma população brasileira.

PURPOSE: to evaluate risk factors for the development of genital prolapse in the Brazilian population. METHODS: case-control study involving 316 patients submitted to prolapse staging, according to the pelvic organ prolapse quantification system. The patients were divided into two groups: in the Case Group there were 107 patients with prolapse at stage III or IV, and in the Control Group, 209 women at stage 0 or I. In the anamnesis, the selected women have been questioned about the presence of possible risk factors for genital prolapse, such as: age, menopause age, parturition, delivery type (vaginal, caesarean section or forceps), occurrence of fetal macrosomia, family history of genital dystopia in first degree relatives, chronic cough and intestinal constipation. RESULTS: The variables that were different between the groups were: age, body mass index, parturition, number of vaginal, caesarean section or forceps deliveries, newborn weight and positive family history for prolapse. Race, menopause age, chronic cough and intestinal constipation did not present differences between the groups. After logistic regression, only three variables have been shown to be independent risk factors: presence of at least one vaginal delivery, fetal macrosomia and positive family history for dystopia. Cesarean section was shown to be a protective factor. CONCLUSION: in the Brazilian population, the independent risk factor for genital prolapse were: personal antecedent of at least one vaginal delivery, fetal macrosomia and family history of dystopia.

Tratamento cirúrgico da incontinência urinária aos esforços por via transobturatória: resultados com Safyre-t / Surgical treatment for stress urinary incontinence of transobturator approuch: outcomes with Safyre-t

Safyre-t é um sling híbrido, utilizado no tratamento cirúrgico da incontinência urinária aos esforços (IUE), constituído de faixa monofilamentar de polipropileno entre duas colunas de silicone auto-fixável. A utilização da via transobturatória vem ganhando espaço no tratamento cirúrgico da IUE, devido ao fato desta via apresentar menores índices de complicações e maior reprodutibilidade cirúrgica. As publicações internacionais têm monstrado um interesse crescente em relação a esta nova via. Os resultados demonstram índices de cura semelhantes aos slings retro-púbicos, tidos como "padrão-ouro" para tratamento da IUE. O fato de se tratar de uma intervenção minimamente invasiva beneficia as pacientes em relação ao menor tempo cirúrgico, menor período de internação e não há necessidade de realização de cistoscopia intra-operatória. Os resultados aqui apresentados confirmam os benefícios acima citados

Prolapso de cúpula vaginal: tratamento cirúrgico minimamente infasivo com IVStm (Sacropexia Infracoccígea) / Vaginal vault prolapse: minimal surgical treatment with IVStm (Infracoccygeal Sacropexy)

O prolapso de cúpula vaginal continua sendo um dos maiores desafios da ginecologia cirúrgica contemporânea. Quando se estudam as técnicas consagradas pelas meta-análises, considerando as recidivas e o tempo de seguimento, verifica-se que apenas duas delas conseguem bons resultados a longo prazo: colpossacro fixação (abdominal ou laparoscópica) e colpopexia sacroespinhal. Outras técnicas não conseguem manter os resultados iniciais e tornam-se parte da história cirúrgica atual. Neste estudo aborda-se uma técnica minimamente invasiva, promissora e anatômica; conhecida como sacropexia infracoccígea, que utiliza material sintético (polipropileno multifilamentar) nos casos de prolapso da cúpula vaginal. Este tema é importante no contexto atual, pois essas técnicas são reprodutíveis e de baixo custo, além de propiciarem menor tempo de hospitalização, retorno mais rápido às funções normais e melhorarem a qualidade de vida destas pacientes que, dia a dia, tornam-se mais longevas