¿Es realmente el cistocele un factor de obstrucción infravesical? / Does cystocele have a role in bladder outlet obstruction?

Introducción: existen controversias con respecto a si la presencia de cistocele, y el grado de este, es un factor de obstrucción del tracto urinario inferior (TUI).Objetivos: valorar la relación entre el cistocele y la obstrucción infravesical. Material y métodos: evaluamos retrospectivamente a 200 mujeres sometidas a estudio urodinámico, entre diciembre de 2007 y diciembre de 2008.Se clasificó a las pacientes en 2 grupos: Grupo A: ausencia de cistocele (grado 0) y grado I. Grupo B: cistocele grado II-IV. Criterios de exclusión: 1. Ausencia de flujometría libre o volumen vaciado < 150 ml. 2. Existencia de patología neurológica. 3. Antecedentes de cirugía urogenital. Definimos obstrucción del TUI según los siguientes parámetros: volumen residual postmiccional (VRP) > 20%; flujo máximo (Qmáx) < 15 ml/s; y presión del detrusor en el flujo máximo (PDetQmáx) > 25 cmH2O. Resultados: el grupo A incluyó al 64,0% de las pacientes y el grupo B al 36% restante. Seapreció volumen residual postmiccional (VRP) patológico en el 26’6% en el grupo A y en el 40,3% en el grupo B (p= 0,04); Qmáx < 15ml/s en 15,6% en el grupo A y en el 27,8% en el grupo B (p= 0,03); PDetQmáx > 25 cmH2O en el 26,3% en el grupo A y en el 47,8% en el grupo B (p= 0,01). Conclusiones: existe una asociación estadísticamente significativa entre el cistocele y parámetros de obstrucción infravesical (AU)

Introduction: Controversy exists as to whether cystocele has a causative role in bladder outlet obstruction (BOO).Objective: To assess the relationship between cystocele and bladder outlet obstruction. Materials and methods: Two hundred women undergoing a urodynamic study from December 2007 to December 2008 were retrospectively assessed. Patients were divided into two groups: Group A: Patients with no cystocele (Grade 0) and Grade I cystocele Group B: Patients with Grade II-IV cystocele. Exclusion criteria: 1. Absence of flowmetry or voided volume < 150 ml.2. Neurological disorders. 3. History of urogenital surgery. Bladder outlet obstruction was defined as follows: Postvoid residue (PVR) > 20%; peak flow(Qmax) < 15 ml/sec; detrusor pressure at maximum flow (PdetQmax) > 25 cm H2O. Results: Group A included 64% of patients, and Group B the remaining 36%. A pathological PVR > 20% was found in 26.6% and 40.3% of patients in Group A and Group B respectively (p=0.04). A Qmax < 15 mL/sec was seen in 15.6% and 27.8% of Group A and Group B patients respectively (p=0.03). A PdetQmax > 25 cm H2O was found in 26.3% and 47.8% of Group Aand Group B patients respectively (p=0.01). Conclusions: A statistically significant association exists between cystocele and bladder outlet obstruction (AU)

Risk factors for pelvic organ prolapse.

OBJECTIVES: To evaluate the risk factors for pelvic organ prolapse (POP) and to determine the relationship between these risk factors and stage or other components of POP. METHODS: 244 patients with primary POP and 314 women without POP were included. Age, parity, smoking, body mass index (BMI), menopause, and hormone replacement therapy (HRT) were investigated. RESULT: Independent risk factors for POP included age over 70, parity higher than 3, and menopause. Age, parity, menopause, and HRT were significantly associated with stage of POP. Genital hiatus (GH) and perineal body (PB) showed a significant positive and negative correlation with age and parity, respectively. Menopause and HRT were also associated with them. CONCLUSION: Age, parity and menopause are possible risk factors of POP and associated with the lengths of GH and PB in POP women. Further, these risk factors and HRT are significantly correlated with the severity of the disease.