Factors involved in changes in the levator ani during pregnancy.

INTRODUCTION AND HYPOTHESIS: Levator ani muscle (LAM) dimensions increase during pregnancy to allow the delivery of the fetus. The objective was to investigate which factors are involved in LAM modifications during pregnancy. METHODS: A prospective longitudinal observational study was conducted between July 2015 and March 2018. Ninety-nine nulliparous pregnant women were included. Data on the physical examination, 4D transperineal ultrasound and hormonal concentrations (progesterone, oestradiol and relaxin) were collected during the first and third trimesters. RESULTS: We found higher hiatal dimensions at the beginning of pregnancy than in other studies with nonpregnant women. Increases in the levator ani hiatal (LH) dimensions were observed at contraction (1.01 ±1.96 cm2), rest (0.82 ± 2.51 cm2) and on Valsalva (2.36 ± 3.64 cm2) throughout pregnancy. The distensibility in the third trimester was higher than in the first trimester (5.79 vs 4.24 cm2; p=0); however, the contractility was lower (-3.32 vs -3.5 cm2; p=0.04). Women with lower scores on the Modified Oxford Grading Scale in the third trimester presented with lower contractility in the LAM. A larger LH at the end of pregnancy was associated with age and body mass index. Eleven women developed ballooning during pregnancy; in these women, relaxin was higher in both trimesters than in women without ballooning, but these results were not statistically significant. The linear models to predict third-trimester Valsalva LH, distensibility and contractility were not conclusive and did not show any factors to predict LAM modifications during pregnancy. CONCLUSIONS: Hormones could play a role in modifying the muscle properties of LAM from the beginning of pregnancy, but we did not find an association between LAM measurements and hormone concentration in this study.

Hormonal Influence in Stress Urinary Incontinence During Pregnancy and Postpartum.

Hormonal changes have been proposed as an etiological factor of stress urinary incontinence (SUI) during pregnancy. Our main objective was to demonstrate the role of hormones in SUI development during pregnancy and postpartum. A prospective longitudinal study was designed. Primiparous women without previous urinary incontinence symptoms were included. Symptoms and Quality of Life (QoL) Questionnaires, physical examinations, and hormone concentration (progesterone, estradiol, and relaxin) were collected twice during pregnancy and three times during postpartum. Logistic regression models, with Wald's forward variable selection method, were used. Prevalence of SUI was 11% in the first trimester, 50% in the third trimester, and 16.4% at 6 months postpartum. The risk of developing SUI throughout pregnancy is higher in women with higher progesterone concentration in the first trimester (OR 1.38, 95% CI 1.06-1.81, p < 0.05) and it is lower in women with stronger pelvic floor muscles in the first trimester (OR 0.35, 95% CI 0.17-0.72, p < 0.05). When occurred during pregnancy, SUI has a 14-fold higher risk of persistence 6 months after birth. In addition, the severity of these symptoms is also an independent risk factor for SUI persistence at 6 months postpartum (OR 1.41, 95% CI 1.15-1.73, p < 0.05). Quality of Life was affected for pregnant women with SUI symptoms. SUI is a highly prevalent condition during pregnancy, affecting the QoL of women in many areas. Higher concentration of progesterone can play a role in SUI development during pregnancy. The presence and severity of SUI during pregnancy are risk factors for the persistence of symptoms 6 months postpartum. Sustaining an optimal pelvic floor muscle strength could prevent SUI during pregnancy.

Influence of Bowel Habit and Hormonal Changes on the Development of Hemorrhoidal Disease During Pregnancy and the Postdelivery Period: A Prospective Cohort Study.

BACKGROUND: Hemorrhoidal disease in women during pregnancy is common in clinical practice. However, prospective data on its real prevalence and women's demographics are scarce. OBJECTIVE: The aim of this study was to determine the prevalence of hemorrhoidal disease during pregnancy and to assess its impact on quality of life. In addition, this study aimed to identify the relationship between patients' characteristics, bowel habits, hormonal changes, and the presence of symptomatic hemorrhoids. DESIGN: This is a prospective longitudinal cohort study. SETTING: This study was conducted in the Obstetrics Department for pregnancy follow-up. PATIENTS: The patients evaluated were a cohort of pregnant women. INTERVENTION: The study was designed to follow a homogeneous cohort of women for 15 months. Visits took place in the first and third trimesters of pregnancy, and 3 and 6 months after delivery. Women's demographics (age, medical history, bowel habit, Bristol stool scale) and serum determination of pregnancy-related hormones (estrogen, progesterone, and relaxin) were determined. MAIN OUTCOME MEASURES: The primary outcome was the development of hemorrhoidal disease. RESULTS: Overall, 109 women (mean age, 31.2 ± 5.4 years) were included in the study. The prevalence of symptoms and physical findings of hemorrhoidal disease was present in 11% in the first trimester, 23% in the third trimester, 36.2% at 1 month after delivery, and 16.9% at 3 months after delivery. A medical history of hemorrhoidal disease was significantly associated with the diagnosis of hemorrhoids in the first trimester (p < 0.0001) and third trimester (p = 0.005). Symptoms of constipation were associated with this clinical disorder in the first trimester (p = 0.011) and the third trimester of pregnancy (p = 0.022). No association was found between hormonal changes and the development of hemorrhoidal disease. LIMITATIONS: A larger sample would provide more information. CONCLUSIONS: The prevalence of women with hemorrhoidal disease increases during pregnancy and after delivery. A history of hemorrhoidal disease and constipation is significantly associated with the diagnosis of symptomatic hemorrhoidal disease. See Video Abstract at http://links.lww.com/DCR/B504. INFLUENCIA DEL HBITO INTESTINAL Y LOS CAMBIOS HORMONALES EN EL DESARROLLO DE LA ENFERMEDAD HEMORROIDAL DURANTE EL EMBARAZO Y EL PERODO POSTERIOR AL PARTO UN ESTUDIO DE COHORTE PROSPECTIVO: ANTECEDENTES:La enfermedad hemorroidal en mujeres durante el embarazo es común en la práctica clínica. Sin embargo, hay escasos datos prospectivos sobre su prevalencia real y la demografía de las mujeres.OBJETIVO:El objetivo fue determinar la prevalencia de enfermedad hemorroidal durante el embarazo y evaluar su impacto en la calidad de vida. Además, identificar la relación entre las características de los pacientes, los hábitos intestinales, los cambios hormonales y la presencia de hemorroides sintomáticas.DISEÑO:Estudio prospectivo de cohorte longitudinal.AJUSTE:Este estudio se realizó en el Departamento de Obstetricia para el seguimiento del embarazo.PACIENTES:Una cohorte de mujeres embarazadas.INTERVENCIÓN:El estudio se diseñó para realizar un seguimiento de una cohorte homogénea de mujeres durante 15 meses. Las visitas se realizaron en el primer y tercer trimestre del embarazo, y a los 3 y 6 meses después del parto. Se determinaron los datos demográficos de las mujeres (edad, antecedentes médicos, hábito intestinal, escala de heces de Bristol) y la determinación sérica de hormonas relacionadas con el embarazo (estrógeno, progesterona y relaxina).PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue el desarrollo de enfermedad hemorroidal.RESULTADOS:Se incluyó en el estudio a 109 mujeres (edad media, 31,2 ± 5,4 años). La prevalencia de síntomas y hallazgos físicos de enfermedad hemorroidal estuvo presente en 11% en el primer trimestre, 23% en el tercer trimestre, 36,2% 1 mes después del parto y 16,9% 3 meses después del parto. Un historial médico previo de enfermedad hemorroidal se asoció significativamente con el diagnóstico de hemorroides en el primer trimestre (p <0,0001) y tercer trimestre (p = 0,005). Los síntomas de estreñimiento se asociaron con este trastorno clínico en el primer trimestre (p = 0,011) y el tercer trimestre del embarazo (p = 0,022), respectivamente. No se encontró asociación entre los cambios hormonales y el desarrollo de enfermedad hemorroidal.LIMITACIONES:Una muestra más grande proporcionaría más información.CONCLUSIONES:La prevalencia de mujeres con enfermedad hemorroidal aumentó durante el embarazo y el posparto. El antecedente de enfermedad hemorroidal y estreñimiento se asociaron significativamente con el diagnóstico de enfermedad hemorroidal sintomática. Consulte Video Resumen en http://links.lww.com/DCR/B504.

Transperineal anal sphincter complex evaluation after obstetric anal sphincter injuries: With or without tomographic ultrasound imaging technique?

OBJECTIVES: "Significant" obstetric anal sphincter injuries (OASIS) have been defined as visible defects of at least 30° in at least 4/6 slices using tomographic ultrasound imaging (TUI) with transperineal ultrasound (TPUS). The objective of this study was to assess if TUI is mandatory for the evaluation of OASIS. METHODS: Patients with a history of OASIS were evaluated by performing 3D-endoanal ultrasound (EAUS) and 3D-TPUS with and without TUI. Any damage to the internal (IAS) or external (EAS) anal sphincters was recorded and scored using the Starck's and the Norderval's systems. Intraobserver and inter-techniques correlations were calculated. RESULTS: From September 2012 to May 2015, 63 women, mean age 32.5 ± 4.6 years, with OASIS (3a: 26 pts., 41.3 %; 3b: 26 pts., 41.3 %; 3c: 6 pts., 9.5 %, 4: 4 pts., 6.3 %, "button hole" tear: 1 pt., 1.6 %). Inter-technique and intraobserver correlations were excellent (TUI: k = 0.9; sweeping technique: k = 0.85; EAUS: k = 0.9) in determining OASIS. Using the Starck's Score, excellent correlation was found for both TPUS modalities (TUI: k = 0.86; sweeping technique: k = 0.89). However, for the different individual parameters, the correlation was moderate for EAS depth (TUI: k = 0.44; sweeping technique: k = 0.5) and good for IAS depth (TUI: k = 0.7; sweeping technique: k = 0.78). Similar results were found using the Norderval's classification. CONCLUSIONS: OASIS can be assessed by TPUS without TUI technique, dragging the rendered box and following the anal canal from the anal verge to the anorectal junction in the longitudinal plane and describing findings.

Ethanol Sclerotherapy versus Laparoscopic Surgery for Endometrioma Treatment: A Prospective, Multicenter, Cohort Pilot Study.

STUDY OBJECTIVE: To compare the cost-effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy versus laparoscopic surgery for benign-appearing ovarian endometrioma. DESIGN: Prospective, cohort pilot study. SETTING: Multiple centers, Spain. PATIENTS: Forty patients with suspected ovarian endometrioma identified by US, with a maximum diameter of 35 to 100 mm, of whom 33 met inclusion criteria. INTERVENTIONS: The study group (n = 17) underwent US-guided aspiration plus sclerotherapy with ethanol, and the control group (n = 14) underwent laparoscopic cystectomy. MEASUREMENTS AND MAIN RESULTS: Recurrence, complications, and direct costs were compared. One of 17 sclerotherapy patients recurred (5.9%) compared with 4 of 14 laparoscopic surgery patients (28.6%) (odds ratio 0.18, 0.01-1.53). No serious adverse effects (Clavien-Dindo ≥ III) were observed in the sclerotherapy group; 1 patient in the surgery group had a Clavien-Dindo IIIb complication. Median hospital direct costs were significantly lower in the sclerotherapy group than those in the surgery group-266 euros versus 2189 euros. CONCLUSION: Ethanol sclerotherapy seems to be cost-effective for endometrioma and also appears to reduce complications. In this pilot study, recurrence was not higher than with conventional surgery.

Anatomic and functional evaluation of the levator ani muscle after an obstetric anal sphincter injury.

PURPOSE: To study the relationship between symptoms of anal incontinence (AI) and the anatomy and functionality of the levator ani muscle in women with a history of obstetric anal sphincter injury (OASI). METHODS: This is a cohort study including patients with OASI from 2013 to 2016. Patients were assessed by a physical examination, endoanal ultrasound using Starck Scale, perineometry and 4D transperineal ultrasound. AI in all patients was measured with the Wexner scale. Correlation between variables has been analyzed in these patients. RESULTS: 72 patients were analyzed: 28 with a IIIA degree tear, 26 with a IIIB, 13 with a IIIC and 5 with a IV. 38 patients showed a residual anal sphincter (AS) defect on endoanal ultrasound with an average Starck score of 6.5 ± 3.7. 21 patients expressed AI, with an average Wexner score of 4.1 ± 2.4. In 27 (37.5%) patients, a levator ani avulsion was observed: 17 unilateral and 10 bilateral. Patients with a levator ani defect had weaker pelvic floor muscle (PFM) function. These differences were statistically significant with perineometry (p = 0.01 and p = 0.03) but not for the Oxford test (p = 0.08). Patients with a residual AS defect as well as an injury to the levator ani muscle expressed greater AI symptomatology than patients with residual sphincter injury who maintain the integrity of the levator ani: Wexner 4.9 0.9 vs 3.3 1 (p = 0.02). CONCLUSIONS: The PFM has correlation with AI symptom development in patients with a history of OASI. Therefore, we suggest a key role of anatomical and functional assessments of the levator ani muscle in these patients.

Reducing postoperative catheterisation after anterior colporrhaphy from 48 to 24 h: a randomised controlled trial.

INTRODUCTION AND HYPOTHESIS: There is a distinct lack of literature on postoperative management after anterior colporrhaphy (AC). Our traditional postoperative protocol consisted of 24 h of indwelling catheterisation followed by 24 h of self-intermittent catheterisation. We hypothesised that a new protocol consisting of only 24 h of indwelling catheterisation might produce better results without additional complications. METHODS: From April 2014 to July 2017, all candidates for AC were randomised to catheter removal 24 or 48 h after surgery. The primary outcome was the postoperative urinary retention (POUR) rate. Secondary outcomes included: asymptomatic bacteriuria (AB), urinary tract infection (UTI) and postoperative pain after 24 h. RESULTS: A total of 79 patients were recruited. Thirty-seven and 40 patients were randomised to follow the 48-h protocol and the 24-h protocol respectively. There were no significant differences in relation to the POUR rate: 3 patients (8.1%) vs 1 (2.5%) in the 48-h vs the 24-h group respectively (p = 0.346). The UTI rate was 2 (8.1%) vs 0 patients respectively (p = 0.139) and the postoperative AB rate was 3 (9.1%) vs 0 patients (p = 0.106). In the postoperative pain evaluation, the visual analogue scale score was significantly higher in the 48 h group (0.35 vs 0.13, p = 0.02). CONCLUSIONS: According to our results, reducing the catheterisation from 48 to 24 h after AC does not increase the risk of POUR and decreases the rate of UTI, AB and postoperative pain. This new postoperative management protocol of pelvic floor surgery would improve postoperative outcomes and shorten the stay in hospital.

Correlación y concordancia entre la severidad de los síntomas de incontinencia urinaria de esfuerzo y los parámetros ecográficos de movilidad uretral / Correlation and concordance between the severity of stress urinary incontinence symptoms and ultrasound parameters of urethral mobility

Objetivo: valorar la correlación y concordancia entre la severidad de la incontinencia urinaria de esfuerzo y la movilidad ecográfica de la uretra. Sujetos y métodos: análisis retrospectivo de los datos clínico-ecográficos de las pacientes a las que se realizó ecografía uroginecológica desde el año 2008 al 2013. Todas respondieron el cuestionario de severidad de Sandvik. Se midió la movilidad uretral mediante ecografía. Se realizó un test de correlación de Spearman y el coeficiente kappa de Cohen entre el índice de Sandvik y el deslizamiento uretral. Resultados: se analizaron 152 pacientes. Existe una correlación positiva significativa entre el índice de Sandvik y la movilidad uretral. En cambio, existe un índice de concordancia bajo. Conclusiones: la ecografía uroginecológica es útil en el diagnóstico de la severidad de la incontinencia urinaria de esfuerzo por hipermovilidad uretral en aquellos pacientes con menor severidad. En los pacientes con mayor severidad, la prueba es poco reproducible (AU)

Objective: To assess the correlation and concordance between the severity of the symptoms of stress urinary incontinence and ecographical mobility of the urethra. Subjects and methods: Retrospective analysis of clinical and ultrasound data from the patients which had performed urogynaecological ultrasonography from 2008 to 2013. They all filled out the Sandvik questionnaire. Sonographic measurement of urethral mobility was performed. We performed a Spearman correlation test and Cohen’s Kappa test between the Sandvik index and the urethral sliding. Results: A total of 152 patients were analyzed. There is a positive correlation between the Sandvik index and urethral mobility. Nevertheless, there is a low concordance. Conclusions: Urogynecological ultrasound is useful to diagnose the severity of stress urinary incontinence caused by hypermobility in patients with less incontinence. In patients with more severity, the measurement of hypermobility is not reproducible (AU)

Contasure-needleless® compared with Monarc® for the treatment of stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: For the treatment of stress urinary incontinence (SUI), various retropubic and transobturator techniques have demonstrated high cure rates. Single-incision tapes, such as Contasure-Needleless® (C-NDL), have demonstrated similar cure rates to the inside-out transobturator sling (TVT-O®). The aim of this study was to analyse if C-NDL® is equally as effective as an outside-in transobturator sling (Monarc®) for the treatment of SUI. METHODS: We carried out a prospective, single-centre, randomised trial. The results were analysed for a non-inferiority test with a minimum postoperative follow-up of 12 months. The objective and subjective cure rates were evaluated by a stress test and a postoperative Sandvik Severity Index respectively. Patient satisfaction and operative complications were registered. The cure was defined by a negative stress test and SSI 0. RESULTS: A total of 187 patients were included, 89 and 98 undergoing C-NDL® and Monarc® respectively. Epidemiological and clinical data did not show and significant differences between both groups except a high prevalence of women who smoke (15.7% C-NDL® vs 6.1% Monarc®, p 0.03). The negative stress test was negative in 72 patients (80.9%) in C-NDL® compared with 85 (88.5%) in Monarc® (p 0.082). The SSI was 0 in 47 (66.2%) for C-NDL® and 61 (70.1%) for the Monarc® group (p 0.01). There were 14 (16.1%) and 8 (8.3%) dissatisfied patients for the C-NDL® and Monarc® groups respectively (p 0.068). The rate of complications was similar in both groups. CONCLUSIONS: According to the non-inferiority test, C-NDL® is not inferior to Monarc® (post-surgical SSI test), but it is inferior in the comparison of a negative stress test and patient satisfaction.

Prevalence of Fecal Incontinence in Women During Pregnancy: A Large Cross-Sectional Study.

BACKGROUND: Although some studies have analyzed the prevalence of urinary incontinence during pregnancy, there are scarce data on the frequency and characteristics of fecal incontinence during this period. OBJECTIVE: The aim of this study was to determine the incidence and characteristics of women with fecal incontinence symptoms during early and late pregnancy, to evaluate its impact on quality of life, and to identify whether there is a specific clinical pattern that could identify patients at risk. DESIGN: This was a cross-sectional observational study. SETTINGS: The study was conducted at the maternity unit of a university tertiary care center. PATIENTS: Pregnant women undergoing obstetric follow-up were included in the study. MAIN OUTCOME MEASURES: A prospective study was conducted. All of the patients attending our maternity unit for obstetric ultrasound examination during the first and third trimesters were eligible for inclusion. Selected patients completed a self-reported questionnaire that included items on fecal incontinence, Wexner score, and stool consistency. Quality of life was assessed using the Medical Outcomes Study Short Form 36. RESULTS: The study included 228 consecutive pregnant women. Ninety-three patients (40.8%) had some episode of fecal incontinence in the 4 weeks before the survey, 15 patients with solid stool, 6 patients with liquid stools, and 72 with flatus. In these patients, the mean Wexner score was 3.82 (range, 2.0-13.0). In patients with incontinence, quality of life was significantly affected in most subscales of Medical Outcomes Study Short Form 36. There were no significant differences in the following variables between patients with and without symptoms of fecal incontinence, including age (p = 0.090), BMI (p = 0.094), history of previous deliveries (p = 0.492), trimester of pregnancy (p = 0.361), and Bristol Stool Form Scale (p = 0.388). LIMITATIONS: The cross-sectional design hampered identification of specific time at which the impact of pregnancy occurred. CONCLUSIONS: The prevalence of fecal incontinence is high during pregnancy with a notable impact on quality of life. There was no specific clinical pattern during pregnancy that could define patients at risk for fecal incontinence during this period of life.

Pelvic organ prolapse and stress urinary incontinence, do they share the same risk factors?

OBJECTIVE: To determine whether there are differences in the etiologies of two of the most common pelvic floor disorders (PFD), pelvic organ prolapse (POP) and stress urinary incontinence (SUI). STUDY DESIGN: This cross-sectional descriptive study included 1042 women, referred to a pelvic floor unit in a tertiary Spanish hospital, between 2008 and 2012. Subjects at their fist visit were interviewed and examined generally and specifically (medical and urogynecological history). Collected parameters included: age, weight, height, medical and surgical background (including in-depth obstetrical and gynecological characteristics). The participants were classified into 3 different groups (POP, SUI, and mixed pathology). Descriptive analyses of each variable and multinomial logistic regression were performed to determine factors associated with POP and SUI. RESULTS: Patients with POP were older, thinner, with greater parity and their newborns tended to be heavier. Furthermore, forceps, vaginal tears and vaginal surgeries were more common in the POP group. In contrast, family history was an important factor for the development of SUI, with a 6.45-fold increase (95% CI: 3.69-11.24). Two protective factors were identified for POP, cesarean section reduces the risk by 3 fold (OR=0.33) (95% CI: 0.13-0.85) whereas pelvic floor rehabilitation produces a 2 fold reduction (OR=0.49) (95% CI: 0.31-0.76). CONCLUSIONS: Our data study demonstrates differences in potential triggers and risk factors for POP and SUI. Cesarean section and pelvic floor rehabilitation have a protective effect on preventing the development of POP. Bringing up that a personal medical care and a specific urogynecological follow-up should be developed for those who are more susceptible or at risk of PFD.

Contasure-Needleless® single incision sling compared with transobturator TVT-O® for the treatment of stress urinary incontinence: long-term results.

INTRODUCTION AND HYPOTHESIS: This study compared transobturator tension-free vaginal tape (TVT-O®) and Contasure-Needleless (C-NDL®) at long-term follow-up . METHODS: Non-inferiority, prospective, single-centre , quasi-randomised trial started in September 2006 and finished in April 2011 to compare C-NDL® with transobturator vaginal tape (TVT-O®) mesh in the treatment of stress urinary incontinence (SUI) . Epidemiological information, intraoperative and postoperative complications, subjective estimates of blood loss and pain levels were recorded. We also analysed the postoperative stress test, the subjective impression of improvement using the Sandvik Severity Index and the quality of life during follow-up using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) . RESULTS: Two hundred and fifty-seven women with primary SUI were scheduled to receive TVT-O® or C-NDL® and were followed up at least 3 years after the procedure . One hundred and eleven women in the C-NDL® group (84.7%) had a negative stress test, compared with 54 women (88.9%) in the TVT-O® group (p = 0.0065 for the non-inferiority test). The postoperative Sandvik Severity Index was 0 or better than the preoperative score in 90.7% of patients in the C-NDL® group and 95.4% of patients in the TVT-O® group (p = 0.0022). The complication rate was similar in both groups. There were significant differences (p = 0.02) in postoperative pain within the TVT-O® group. The degree of satisfaction was not statistically significant between the two groups. CONCLUSIONS: The outcomes for the C-NDL® group were similar to those of the TVT-O® group, adding the concept of "single incision tape" to the tension-free sling option.

Urinary incontinence during pregnancy. Is there a difference between first and third trimester?

OBJECTIVE: The aim of this study is to determine the prevalence and severity of urinary incontinence and to see if there are any differences between first and third trimester of pregnancy. STUDY DESIGN: A cross-sectional study of two groups of women was conducted. All patients attending our hospital for obstetric ultrasound examination during the first trimester (group 1=less than 13 weeks of pregnancy) and third trimester (group 2=up to 28 weeks of pregnancy) were eligible for inclusion. All participating women completed self-reported questionnaires: ICIQ-SF, PFDI-20 (UDI-6, CRADI-8, POPDI-6) and SF-36. The variables studied were biodemographic data and results from questionnaire responses. RESULTS: From March 2012 to May 2012, 224 consecutive pregnant women were included in this study: group 1 (n=58) and group 2 (n=166). The incidence of urinary incontinence during pregnancy is different in first and third trimester: 18.96% (11 of 58) and 39.76% (66 of 166) (p=0.008). 100% and 84.12% of women with UI in first trimester and third trimester respectively leak a small amount of urine. In 15.87% of group 2 the leakage was a moderate amount of urine. Participants mainly presented Stress UI (78.37%) and urge was only present in 12.16% of them. CONCLUSIONS: In conclusion, according to the results obtained, the prevalence of urinary incontinence in our population of pregnant women was 34.37%, which means that more than a third of the population of pregnant women is affected, and that this disorder is more common during the third trimester of pregnancy than during the first. The most common form was stress urinary incontinence, affecting 48.05% of the women. In all patients, leakage was slight-moderate that did not severely hamper their everyday life but did affect their physical, mental and social domains of their quality of life. Another problem, even more prevalent than incontinence itself, was the increase in urinary frequency, affecting 41.25% of the pregnant women and causing discomfort/distress in the 68.8%.

Tratamiento quirúrgico del prolapso genital mediante malla prolift® en pacientes con riesgo de recidiva / Surgical treatment of vaginal prolapse with prolift® mesh in patients with risk of recurrence

OBJETIVO: El objetivo de este trabajo es analizar los resultados obtenidos en nuestro centro en pacientes seleccionadas, con factores de riesgo de recidiva del prolapso genital. MÉTODOS: Serie de casos que incluye un total de 76 pacientes intervenidas, desde Julio del 2005 hasta Diciembre del 2009, de prolapso genital severo, con factores de riesgo de recidiva del prolapso genital. RESULTADOS: En el grupo Prolift® anterior se detectan, durante el seguimiento, 3 casos (6.8%) de recidiva sintomática del prolapso y 6 casos (13.6%) de aparición de prolapso de otro compartimento. En el grupo Prolift® posterior no se produce ningún caso de recidiva, pero existen 2 (10,52%) casos de prolapso de otro compartimento. En el caso del Prolift® total existen 2 (16.6%) casos de recidiva sintomática del prolapso. En cuanto a la urgencia miccional de novo: existen un total de 4 (5.33%) casos. 3 de ellos pertenecientes a la malla Prolift® anterior y 1 a la malla Prolift® total. No hemos detectado ningún caso de dolor, pélvico o en los puntos de inserción de la malla, severo que haya obligado a la reintervención por persistencia del mismo. CONCLUSIONES: El uso de mallas en la cirugía reconstructiva del suelo pélvico, en pacientes seleccionadas, con factores clínicos de riesgo de recidiva, es una buena opción de tratamiento para evitar o intentar disminuir las tasas de recidiva o reintervención descritas en la actualidad(AU)

OBJECTIVE: The aim of this paper is to analyze the results obtained in pelvic floor surgery using a non-absorbable mesh in selected patients with risk factors of recurrent prolapse. METHODS: Case series including a total of 76 patients who were surgically treated for severe genital prolapse from July 2005 to December 2009, with risk factors for recurrence of genital prolapse. RESULTS: We detected 3 cases (6.8%) of symptomatic prolapse recurrence and 6 cases (13.6%) of prolapse of another compartment in the anterior Prolift® group. In the posterior Prolift® group there were no recurrences but there were 2 cases (10.52%) of prolapse of another compartment. In the total Prolift® group, there were 2 cases (16.6%) of symptomatic prolapse recurrence. As for de novo urgency, there were a total of 4 cases (5.33%), 3 in the anterior Prolift® group and 1 in the total Prolift ® group. We did not detect any case of severe pain in the pelvis or mesh insertion points that required reoperation due to persistence. CONCLUSIONS: The use of mesh in pelvic floor reconstructive surgery in selected patients with risk factors for recurrence is a good treatment option to prevent or attempt to reduce the recurrence or reoperation rates currently described(AU)

Surgical treatment of vaginal prolapse with Prolift® mesh in patients with risk of recurrence.

OBJECTIVE: The aim of this paper is to analyze the results obtained in pelvic floor surgery using a non-absorbable mesh in selected patients with risk factors of recurrent prolapse. METHODS: Case series including a total of 76 patients who were surgically treated for severe genital prolapse from July 2005 to December 2009, with risk factors for recurrence of genital prolapse. RESULTS: We detected 3 cases (6.8%) of symptomatic prolapse recurrence and 6 cases (13.6%) of prolapse of another compartment in the anterior Prolift® group. In the posterior Prolift® group there were no recurrences but there were 2 cases (10.52%) of prolapse of another compartment. In the total Prolift® group, there were 2 cases (16.6%) of symptomatic prolapse recurrence. As for de novo urgency, there were a total of 4 cases (5.33%), 3 in the anterior Prolift® group and 1 in the total Prolift® group. We did not detect any case of severe pain in the pelvis or mesh insertion points that required reoperation due to persistence. CONCLUSIONS: The use of mesh in pelvic floor reconstructive surgery in selected patients with risk factors for recurrence is a good treatment option to prevent or attempt to reduce the recurrence or reoperation rates currently described.

Úlcera vulvar de Lipschütz: diagnóstico diferencial de la úlcera vulvar en la paciente adolescente / Lipschütz ulcer: differential diagnosis of vulvar ulcers in adolescents

La úlcera vulvar de Lipschütz o ulcus vulvae acutum es una forma poco frecuente de úlcera genital que aparece en los labios menores de pacientes adolescentes. Son características la aparición de una o más úlceras dolorosas con fondo purulento y márgenes irregulares, acompañadas de síntomas sistémicos. La etiología de la úlcera de Lipschütz es desconocida, a pesar de que en publicaciones recientes se ha relacionado con la primoinfección por virus de Epstein-Barr, y el diagnóstico es por exclusión de otras causas más comunes de úlceras genitales. Por este motivo, es muy importante realizar un buen diagnóstico diferencial (AU)

Lipschütz ulcer, or acute ulceration of vulva, is an infrequently reported form of genital ulceration that appears in the labia minora of adolescent girls. Clinical features include one or more acutely painful ulcers with a purulent base and raised edges, accompanied by systemic symptoms. Although recent reports have related Lipschütz ulcers with Epstein-Barr virus primary infection, the etiology is unknown and the diagnosis is often made by exclusion of other causes of acute genital ulceration. Consequently, careful differential diagnosis is of the utmost importance (AU)

Contasure-Needleless compared with transobturator-TVT for the treatment of stress urinary incontinence.

INTRODUCTION: Single-incision devices for the treatment of stress urinary incontinence (SUI) have been introduced in the last few years. We report a comparison between Obturator Tension-free vaginal tape (TVT-O) and Contasure-Needleless (C-NDL). METHODS: One hundred and fifty-eight women with primary SUI were scheduled to receive TVT-O or C-NDL and follow-up during the first year. Epidemiological information, complications, blood loss, and pain level were recorded. We also analyze stress test and quality of life. RESULTS: Sixty-three (87.5%) C-NDL presented a negative stress test, compared with 54 (90%) of TVT-O (p value 0.015 for non-inferiority test). Sandvik Severity Index was 0 in 75.4% in the C-NDL group and 87.3% in the TVT-O (p < 0.015). Complication rate and degree of satisfaction were similar in both groups. Statistically, there were differences (p = 0.012) in postoperative pain in the TVT-O group. CONCLUSIONS: C-NDL provides similar outcomes as TVT-O after 1-year follow-up. It is necessary that long-term data confirm our results.

[Analysis of the efficacy and complications of the surgical treatment of stress urinary incontinence: retropubic and transobturator TVT. Our experience]. / Análisis de la eficacia y de las complicaciones en el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo: TVT retropúbico y obturador. Nuestra experiencia.

OBJECTIVES: To evaluate the differences in results and complications between retropubic and obturator TVT. METHODS: Descriptive prospective study including 245 patients who underwent retropubic TVT and 90 obturator TVT after the diagnosis of stress urinary incontinence by means of clinical history, physical examination and urodynamic tests. Continence outcomes and Intraoperative/post operative complications were recorded. RESULTS: There were intraoperative complications in 12.65% of the retropubic TVT and 1.11% of the obturator TVT (p = 0.002). Immediate post operative complications appeared in 24.5% of the retropubic TVTs and 12.2% of the obturator TVTs: severe anemia (0.4 vs. 1.1%), inguinal pain (1.2 vs. 4.4%), hematoma (1.6 vs. 0%), urinary tract infection (12.2 vs. 4.4%), and acute urinary retention (8.9 vs. 2.2%) (p = 0.018). Complications during follow-up: partial exteriorization of the mesh (0.81 vs. 1.11%) and de novo urgency incontinence (9.38 vs. 4.44%) (p = 0.031). Post operative results were similar for both groups: 90.2% vs. 91.1% cured (p = 0.046), improvement in 8.2% vs. 6.7% (p = 0.18) and failure in 1.6% vs. 2.2% (p = 0.57). CONCLUSIONS: The obturator TVT seems to be preferable to retropubic TVT because it offers a lower complications rate without differences in post operative results in the short-term.

Análisis de la eficacia y de las complicaciones en el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo: TVT(R) retropúbico y obturador. Nuestra experiencia / Analysis of the efficacy and complications of the surgical treatment of stress urinary incontinence: retropubic and transobturator TVT(R). Our experience

Objetivo: Valorar diferencias respecto a resultados y complicaciones entre TVT® retropúbico y obturador. Métodos: Estudio descriptivo prospectivo; 245 pacientes con TVT®-retropúbico y 90 con TVT®-obturador diagnosticadas de incontinencia urinaria de esfuerzo mediante historia clínica, exploración y urodinamia. Se recogen complicaciones intraoperatorias y postoperatorias además de los resultados de continencia urinaria. Resultados: Complicaciones intraoperatorias en el 12.65% de TVT®-retropúbico y en el 1.11% de TVT®-obturador (p=0.002). Complicaciones durante el postoperatorio inmediato en el 24.5% de TVT®-retropúbico y en el 12.2% de TVT®-obturador : anemia severa (0.4 vs 1.1%), dolor inguinal (1.2 vs 4.4%), hematoma (1.6 vs 0%), infección urinaria (12.2 vs 4.4%) y retención urinaria (8.9 vs 2.2%) (p=0.018). Complicaciones durante el seguimiento: exteriorización parcial de malla (0.81 vs 1.11%) e incontinencia de urgencia de novo (9.38 vs 4.44%) (p=0.031). Resultados postquirúrgicos similares para ambos grupos: “curación” 90.2% vs 91.1% (p=0.046), “mejoría” 8.2% vs 6.7% (p=0.18) y “fracaso” 1.6% vs 2.2% (p=0.57). Conclusiones: TVT®-obturador parece ser preferible a TVT®-retropúbico al ofrecer una menor tasa de complicaciones sin existir diferencias en cuanto a resultados postquirúrgicos a corto plazo (AU)

Objectives: To evaluate the differences in results and complications between retropubic and obturator TVT. Methods: Descriptive prospective study including 245 patients who underwent retropubic TVT and 90 obturator TVT, after the diagnosis of stress urinary incontinence by means of clinical history, physical examination and urodynamic tests. Continence outcomes and Intraoperative/post operative complications were recorded. Results: There were intraoperative complications in 12.65% of the retropubic TVT and 1.11% of the obturator TVT (p = 0.002). Immediate post operative complications appeared in 24.5% of the retropubic TVTs and 12 .2% of the obturator TVTs: severe anemia (0.4 vs. 1.1%), inguinal pain (1.2 vs. 4.4%), hematoma (1.6 vs. 0%), urinary tract infection (12.2 vs. 4.4%), and acute urinary retention (8.9 vs. 2.2%) (p = 0.018). Complications during follow-up: partial exteriorization of the mesh (0.81 vs. 1.11%) and de novo urgency incontinence (9.38 vs. 4.44%) (p = 0.031). Post operative results were similar for both groups: 90.2% vs. 91.1% cured (p = 0.046), improvement in 8.2% vs. 6.7% (p = 0.18) and failure in 1.6% vs. 2.2% (p = 0.57). Conclusions: The obturator TVT seems to be preferable to retropubic TVT because it offers a lower complications rate without differences in post operative results in the short-term (AU)