[Urethral erosion secondary to the placing of tension-free vaginal tape. A case report]. / Erosión uretral secundaria a la colocación de una cinta vaginal libre de tensión. Reporte de un caso.

UNLABELLED: Tension free vaginal tape is a minimally invasive surgical procedure for urinary incontinence treatment. Urethral erosion is an uncommon complication which presents in around 0.9% of the cases after the procedure. CASE: Female of 68-year-old with an urodynamic diagnosis of type II stress urinary incontinence treated surgically with a tension free vaginal tape in February 2003 without any intraoperative complications. In the post-op she had acute urinary retention for one week, needing a transurethral catheter. Three months after surgery she reported dysuria, hematuria, frequency and urgency; the physical examination was normal with a positive urine culture to Escherichia coli sensitive to Nitrofurantoine. A cystoscopy was performed with the following findings: the tape was found in 25% of the right lower quadrant mid third of the urethra, the tape was cut vaginally without any further complications.

[Mechanical changes of the detrusor after antiincontinence surgery]. / Cambios mecánicos del detrusor posteriores a la corrección quirúrgica de la incontinencia urinaria genuina de esfuerzo.

BACKGROUND: Stress urinary incontinence is secondary to an intrinsic defect in the closure or a lack of urethral support; the treatment is surgical and this may affect vesical voiding by creating an obstruction, modifying the contraction power at opening and the mechanical properties of the detrusor. OBJECTIVES: To know if there are changes in the contractile characteristics of the detrusor in order to maintain an efficient voiding after surgical correction of the urinary incontinence. MATERIAL AND METHODS: This was a cohort study of the urodynamic variables, mechanical work and energy of the detrusor, during cystometric and pressure-flow analysis, before and after antiincontinence surgery. Forty-five patients were included with urodynamic study before surgery and another one between 6 weeks and 6 months. We analyzed these data using student T test and ANOVA. RESULTS: The average and maximum flow rates, voiding efficient and velocity of the detrusor decreased. The pressures of the detrusor, the opening power and energy increased significantly after the surgery. These changes were more important in the Burch group. The 24.4% of the patients presented de novo hyperactive bladder; before surgery these patients had detrusor's pressures, voiding power and energy significantly greater. CONCLUSION: There are changes in the mechanical properties of the detrusor after antiincontinence surgery; the detrusor needs a greater energy output to defeat urethral resistance and to maintain the vesical voiding, these were better in patients with Burch procedure and with overactive bladder.

[Urolithiasis and pregnancy. Presentation of results and management norm at the National Institute of Perinatology]. / Urolitiasis y embarazo. Presentación de resultados y norma de manejo en el Instituto Nacional de Perinatología.

AIMS: Urolithiasis associated to pregnancy has an incidence of 1:1,500. It is more frequent in multiparity patients and is a risk factor for preterm labor in more than 40%. OBJECTIVES: To know the incidence of urolithiasis associated to pregnancy at the National Institute of Perinatology; to determine the prevalence of: symptoms and signs, hydronephrosis, urinary tract infections, uropathogens, use of catheters and perinatals results. METHODS: A cohort study was made from January 1998 to October 2003, to identify pregnant patients with urolithiasis. The clinical files were reviewed; Fisher's exact test was used for statistical analysis. RESULTS: Twenty-one patients were diagnosed with urolithiasis; 71% had lumbar pain; 57.1% hematuria; 47.6% bilateral urolithiasis; and 33% bilateral hydronephrosis. All the patients who had lumbar pain, hematuria or were catheterized developed urinary tract infection, even with antibiotics prophylaxis. The 52.4% had at least one urinary tract infection episode. The average gestational age at birth was 38.5 weeks (+/- 5.6 weeks). The 84.22% were preterm births. CONCLUSION: Our incidence is similar to the one reported in the literature. The 71.26% has at least one of the symptoms from the classic triad of urolithiasis. The prevalence of urinary tract infection in these patients is very high therefore; antibiotics prophylaxis and urine cultures are required. A lower prevalence of preterm births was obtained. A flow chart for diagnosis and follow-up was presented in order to decrease and to face the possible complications of this pathologic entity.

[Effect of pelvic floor exercise during pregnancy and puerperium on prevention of urinary stress incontinence]. / Efecto de los ejercicios del piso pélvico durante el embarazo y el puerperio en la prevención de la incontinencia urinaria de esfuerzo.

BACKGROUND: The main factor for the appearance of urinary stress incontinence in almost all women is pregnancy and vaginal childbirth. The pelvic floor exercises have been described for the treatment of urinary stress incontinence. OBJECTIVE: To determine with a randomized controlled trial if the pelvic floor exercises during pregnancy and late puerperium diminish the prevalence of urinary stress incontinence at 28 and 35 gestational week and at 6 weeks after childbirth. MATERIAL AND METHODS: The study was made with nulliparous, pregnant women who realized pelvic floor exercises during pregnancy and after birth. 72 women were studied, 52.7% realized pelvic floor exercises and 47.2% did not. RESULTS: The urinary stress incontinence frequency at the 28 gestational week in the no exercises group was 17.2%, and at the 35 gestational week of 47% and at 6 weeks after childbirth was of 47%, while in the exercises group was 0, 0 and 15%, respectively. Moreover there were statistically significant differences between both groups regarding the presence of urinary stress incontinence, that is, the group that realized exercises presented less incontinence at the 28 and 35 gestational weeks and at 6 weeks after childbirth. CONCLUSIONS: The results of this study concluded that the pelvic floor exercises during pregnancy and after childbirth prevent the urinary stress incontinence at this time.

Incontinencia urinaria de esfuerzo. Comparación de cuatro métodos de cistouretropexia: seguimiento a dos años / Stress urinary incontinence. comparison of four cysto-urethropexy methods: two year follow up

Se evalúan los resultados obtenidos en un seguimiento mínimo de dos años en 597 pacientes con Incontinencia urinaria de Esfuerzo (IUE) o Genuina sometidas a corrección quirúrgica, de febrero de 1984 a mayo de 1991 en la Clínica de Uroginecología del Hospital de Ginecoobstetricia " Luis Castelazo Ayala" del IMSS. A las pacientes se les estudió conforme a las normas del servicio publicadas previamente. Se realizaron 379 cirugías con técnicas de Pereyra, 90 tipo Burch, 68 de Powell y 60 de Marshall-Marchetti-Krantz. La vía vaginal o combinada se indicó en las pacientes con alteraciones de la estática pelvigenital y la vía abdominal en aquellas con patología uterina o anexia que ameritaban laparotomía. El índice total de complicaciones fue de 15.3 por ciento. El porcentaje de curación a dos años fue de 87.06 por ciento para todos los procedimientos, obteniéndose los mejores resultados con las técnicas de Burch y Pereyra con 90 y 89.5 por ciento respectivamente, aunque no existió diferencia estadísticamente significativa entre las cuatro técnicas realizadas con una p>ó = 0.1 y X² 6.15. Se concluye que las técnicas abdominales y combinadas de cistouretropexia para corregir la IUE son eficaces y gran parte del éxito de la cirugía depende de la selección correcta de la paciente y la realización meticulosa de la técnica quirúrgica