Sacrospinous hysteropexy with an autologous rectus fascia sling for treatment of advanced apical pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: There is a great interest in avoiding mesh usage in vaginal surgeries. We propose using the autologous rectus fascia to repair apical vaginal prolapse in a similar way it has been successfully used in urinary stress incontinence surgery. This study aims to demonstrate the technique of sacrospinous hysteropexy using autologous rectus fascia for apical pelvic organ prolapse (POP) treatment. METHODS: We present a video of a 63-year-old female with stage IV pelvic organ prolapse and urinary obstruction. A rectus fascia sling of approximately 90 × 10 mm was harvested through a Pfannenstiel incision. It was used in vaginal surgery to suspend the cervix and fix the apical POP. RESULTS: The patient resumed her usual activities after 1 week and waited 2 months to resume physical activities and sexual intercourse. She is satisfied at 6 months follow-up, without complications or prolapse recurrence. CONCLUSION: The sacrospinous hysteropexy using autologous rectus fascia is a feasible technique with excellent results and low risk of complication. Further studies are required to compare POP repair using autologous rectus fascia and polypropylene meshes.

Impact of COVID-19 in Female Urology.

This review discusses the impact of COVID-19 in Female Urology, revises the most important disorders in this field and how their diagnosis and treatment may be modified due to the current pandemic. The text also discusses new options such as telemedicine and what clinical situations within Female Urology should be of utmost importance for the urologist to be careful about. We also discuss how surgeries are being postponed are resumed according to the local scenario.

Effects of testosterone supplementation on prevention of age-related penile remodeling.

Erectile dysfunction develops among 46.2% of men between 40 and 70 years. Studies demonstrated substitution on detrusor muscle by collagen due testosterone deprivation. It is clear the correlation among aging and oxidative stress, accelerating apoptosis process in many tissues. This study aims to demonstrate the collagen substitution over the muscle fibers on muscle structure of rat's penis and the effects of testosterone supplementation. Sixteen senescent Wistar rats were divided into two groups: treatment (receiving standard supplementation testosterone dose) and control (receiving equivalent saline solution). Testosterone was dosed on D0 and D56 of study. All penises were prepared with picrosirius colored histology; stereology was applied to determine the volumetric density of collagen fibers (Vv). Analysis of variance demonstrated testosterone group's replacement therapy to be effective, while the androgenic decline continued by the time of experiment in control group (p < 0.05). Testosterone group had Vv of 20.6%, lower than control group (47.8%); t-test (p < 0.001). Pearson's correlation demonstrated an inverse correlation between the Vv and testosterone's levels (p < 0.001). This is a pioneer study on demonstration of structural alterations over the cavernous corpora muscle caused by deprivation of testosterone on elderly rat. These finding implicate that the testosterone levels can influence, not only the libido, but also the erectile function.

Highly purified collagen coating enhances tissue adherence and integration properties of monofilament polypropylene meshes.

INTRODUCTION AND HYPOTHESIS: Complications related to tissue integration of polypropylene implants used in the treatment of pelvic organ prolapse are relatively prevalent. Collagen, a biocompatible, less immunogenic material with modulating properties on the inflammatory process, may improve polypropylene integration. The objective was to study biomechanical and histological effects of monofilament polypropylene mesh coated with purified collagen gel. METHODS: Forty rats were implanted with two fragments of polypropylene mesh in their abdominal walls (one on each side of the linea alba). One of the fragments had a collagen gel coating (group I) while the other one did not (group II). The animals were euthanized at 7, 14, 90, and 180 days after implantation and their abdominal walls were excised for analysis. RESULTS: The biomechanical study showed that mesh adherence to neighboring tissue increased significantly in group II (p < 0.05). Acute (p < 0.001) and chronic (p = 0.004) inflammatory responses as well as granulation tissue formation (p = 0.001) were less intense in group II at 7 and 14 days. Granulomatous inflammation and foreign body reaction was less significant at 7 days in group II (p = 0.029 and p < 0.001). The birefringence analysis showed higher mean brightness density in the late phase of implantation in group II meshes (p = 0.000). CONCLUSION: Polypropylene mesh coated with purified collagen gel increases adherence to tissue, promotes a less intense and lasting inflammatory response and triggers a greater organization and packing arrangement of collagen fibers in the late phase of implantation.

[Irritative bladder symptoms after vaginal delivery or c-section]. / Sintomas urinários irritativos após parto vaginal ou cesárea.

OBJECTIVE: This study intended to investigate the frequency of irritative bladder symptoms three years after delivery in women previously interviewed in the third trimester of pregnancy and its correlation to mode of delivery, parity, maternal age, birth weight, episiotomy and forceps. METHODS: From 340 women previously evaluated at the third trimester of pregnancy, 120 were interviewed three years after delivery, between June and October 2006. Correlation of postpartum irritative bladder symptoms and mode of delivery (exclusively vaginal or c-section), parity, maternal age, birth weight, episiotomy and forceps was analyzed. Associations between irritative bladder symptoms and obstetric parameters were assessed by the Fisher's exact test and Chi-square (p< 0.05). RESULTS: The study group consisted of 37.5% primiparous and 62.5% multiparous women. Mode of delivery was exclusively vaginal in 53 women and exclusively c-section in 42. No statistical difference was found between irritative bladder symptoms and mode of delivery and parity. No statistical difference was found between irritative symptoms and maternal age (> 35), birth weight (>or= 4000 g), episiotomy and forceps. CONCLUSION: After childbirth, dysfunction of the lower urinary tract, characterized by irritative bladder symptoms, was not associated with mode of delivery, parity, maternal age, birth weight, episiotomy and forceps.

Treatment of Anterior Vaginal Wall Prolapse Using Transvaginal Anterior Mesh With Apical Fixation: A Prospective Multicenter Study With up to 2 Years of Follow-up.

PURPOSE: To evaluate the safety and efficacy of a surgical polypropylene mesh for correction of anterior vaginal prolapse, with or without apical defects, by providing simultaneous reinforcement at the anterior and apical aspects of the vagina with a single-incision approach. METHODS: This was a prospective, multicenter, single-arm study involving women with baseline stage ≥2 anterior and/or apical vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system. The primary endpoint was defined as achievement of POP-Q stage ≤1 status. Additionally, patient-reported outcomes were assessed using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). The device under evaluation was Calistar A, which is fixed posteriorly to the sacrospinous ligaments with a novel tissue-anchoring system (TAS) and anteriorly to the obturator internus muscles. Postoperative follow-ups were scheduled at 7 days and at 6, 12, and 24 months. RESULTS: Ninety-seven women were treated and assessed for the primary outcome. They were followed for up to 2 years (n=43), with a median of 12 months. Objective cure was achieved in 86 of the 97 patients (88.7%) (P<0.0005). The mean reduction in the ICIQ-VS scores was in the range of 70%-90% for every time point (P<0.05). No bleeding or surgical revision was reported. Mesh exposure occurred in 7 patients (7.2%), urinary retention in 5 (5.2%), de novo dyspareunia in 3 (3.1%), and urinary tract infections in 7 (7.2%). CONCLUSION: This midterm follow-up showed that apical and anterior vaginal reinforcement with a polypropylene implant fixed with a TAS provided good anatomical correction, with no major complications.

[Prevalence of urinary symptoms in the third trimester of pregnancy]. / Prevalência de sintomas urinários no terceiro trimestre da gestação.

BACKGROUND: This study evaluated the prevalence of irritative bladder symptoms of women in the third trimester of pregnancy and the correlation to parity and route of delivery. METHODS: Between June and October 2003, 340 women attending the prenatal clinic at the Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) were selected for study. RESULTS: On the total, 80.6% presented nocturia, 70.3% presented urinary frequency and 44.4% presented urgency. No statistic correlation was observed between irritative bladder symptoms and route of delivery however, when considering parity, nocturia and urinary frequency were significantly more frequent in multiparous women. CONCLUSION: In the population under study pregnancy per se was associated to a high prevalence of irritative bladder symptoms.

Analysis of electrocautery generated smoke by chromatographic-mass spectrometry.

OBJECTIVE: to analyze the chemical components of the smoke from electrocautery from coagulating muscle and liver tissues of pigs. METHODS: we collected smoke produced by electrocautery applied to porcine tissue in previously evacuated bottles, with qualitative and quantitative analysis of the compounds present through the hyphenated technique gas chromatography / mass spectrometry. RESULTS: there was a majority of decanal aldehyde in the fumes from the subcutaneous, muscle and liver tissues. Fumes of subcutaneous and muscular tissues also showed the presence of hexanal and phenol. In the fumes of subcutaneous and liver tissues we also found toluene and limonene and, finally, nonanal smoke was present in the muscle and liver tissues. CONCLUSION: there is increasing evidence showing that smoke from electrocautery used in subcutaneous, muscle and liver tissue is harmful to human health. Thus, there is need to reduce exposure to it or wear masks with filters capable of retaining these particles. OBJETIVO: analisar quimicamente os componentes da fumaça do eletrocautério, provenientes da coagulação de tecidos, muscular e hepático de suino. MÉTODOS: coleta de fumaça produzida por eletrocauterização de tecido porcino em frascos previamente evacuados com análise qualitativa e quantitativa dos compostos presentes, através de técnica hifenada, cromatografia a gás/espectrometria de massas. RESULTADOS: houve presença majoritária do aldeído decanal nas fumaças provenientes dos tecidos subcutâneo, muscular e hepático. Fumaças dos tecidos subcutâneo e muscular mostraram também a presença de hexanal e fenol. Nas fumaças dos tecidos subcutâneo e hepático foram encontrados ainda tolueno e limoneno e, por fim, nonanal estava presente nas fumaças dos tecidos muscular e hepático. CONCLUSÃO: há número crescente de evidências mostrando que fumaça proveniente de eletrocauterização de tecidos subcutâneo, muscular e hepático é nociva à saúde de seres humanos. Portanto, há necessidade de reduzir a exposição a ela ou usar máscara com filtro capaz de reter essas partículas.

Impact of COVID-19 in Female Urology

ABSTRACT This review discusses the impact of COVID-19 in Female Urology, revises the most important disorders in this field and how their diagnosis and treatment may be modified due to the current pandemic. The text also discusses new options such as telemedicine and what clinical situations within Female Urology should be of utmost importance for the urologist to be careful about. We also discuss how surgeries are being postponed are resumed according to the local scenario.

Effect of purified collagen on lipograft survival: experimental basis for periurethral lipoinjections.

PURPOSE: To assess whether the use of collagens with lipografts improves graft survival. MATERIALS AND METHODS: Thirty isogenic New Zealand rabbits were injected in the auricular area with either autologous fat alone or autologous fat associated with collagen. The animals were evaluated at 7, 30, and 90 days by histologic and morphometric methods together with measurements of the graft area and the number of adipocytes. RESULTS: Addition of collagen to the lipoinjection reduced the local inflammatory reaction and improved the graft's survival; e.g., for stress urinary incontinence. CONCLUSION: These results suggest that it is possible to increase the survival rate of the lipografts and improve their clinical applicability.

[Validation of the "International Consultation on Incontinence Questionnaire -- Short Form" (ICIQ-SF) for Portuguese]. / Validação para o português do "International Consultation on Incontinence Questionnaire -- Short Form" (ICIQ-SF).

OBJECTIVE: To translate into and validate for Portuguese the "International Consultation on Incontinence Questionnaire -- Short Form" (ICIQ-SF), a condition-specific quality-of-life questionnaire for patients with urinary incontinence. METHODS: Two Brazilians independently translated the original ICIQ-SF into Portuguese. These two translations were harmonized, and then checked by independent back-translation by two native English speakers. The harmonized translation was pre-tested in a pilot study on 20 patients. The final version of the ICIQ-SF in Portuguese was applied to 123 consecutive patients aged 16 or over (29 males and 94 females) with a complaint of urinary incontinence, who had sought the Department of Urogynecology and Uroneurology of the School of Medical Sciences of Unicamp. The Portuguese version of the King's Health Questionnaire (KHQ) was also applied to the same group. The psychometric properties of the questionnaire, such as reliability and construct validity were assessed. RESULTS: The median age was 53 years (range: 16 to 86). The mean retest interval for the ICIQ-SF was 14.37 days (range: 6 to 41). No changes from the original format of the ICIQ-SF were observed at the end of the process of translation and cultural adaptation. The internal consistency was high (0.88), as measured by the Cronbach alpha coefficient. The test-retest value was considered moderate to strong, as measured by the weighted Kappa index (range: 0.72 to 0.75) and Pearson correlation coefficient (0.89). The correlation between the ICIQ-SF and KHQ was considered to be moderate to good for most items (range: 0.44 to 0.77). The evaluation of the construct and concurrent validity was also satisfactory and statistically significant. CONCLUSIONS: The "International Consultation on Incontinence Questionnaire" (ICIQ-SF) was successfully translated into Portuguese and validated for application to Brazilian female and male patients complaining of urinary incontinence, with satisfactory reliability and construct validity.

[Transvaginal electrical stimulation of the pelvic floor in the treatment of stress urinary incontinence: clinical and ultrasonographic assessment]. / Eletroestimulação transvaginal do assoalho pélvico no tratamento da incontinência urinária de esforço: avaliações clínica e ultra-sonográfica.

BACKGROUND: The purpose of this study was to evaluate the efficacy of transvaginal electrical stimulation on the treatment of women with stress urinary incontinence (SUI) in selected cases. METHODS: Twenty two women with primary stress urinary incontinence diagnosed by urodynamic study were submitted to transvaginal electrical stimulation. The mean age was 49 years old (range 22 to 74). The treatment consisted of two weekly sessions of stimulation, each 20 minutes long, during 8 weeks. Women were evaluated through history, clinical and urogynecological exam, weekly registration of frequency of urinary leakage, stress test and transperineal ultrasound before and after treatment. A pulse of 700 sec. was used, frequency of 50 Hz and intensity varying from 12 to 53 mA according to the women's sensitivity. RESULTS: Eighteen of 22 subjects (81.7%) were satisfied with electrical stimulation and frequency of urinary incontinence reduced significantly (p<0.01). Stress test was negative in 77.2% of the women after treatment. Valsalva leak-point pressure was higher in 14 (63.3%) women after treatment, although not reaching statistical significance (p=0.37). Bladder neck mobility did not change significantly before and after electrical stimulation (p=0.30). CONCLUSION: Transvaginal electrical stimulation of the pelvic floor is an effective and safe treatment to women with SUI without sphincter deficiency, with significant reduction of the frequency of urinary leakage.

[Urethral leiomyoma during pregnancy: a case report]. / Leiomioma uretral durante a gravidez: relato de caso.

The authors report a case of urethral leiomyoma diagnosed during pregnancy, which was conservatively treated up to the 38th week, when the pregnancy was interrupted. Thirty days after delivery, exeresis of the lesion was performed from the upper border of the urethral meatus and sutured with interrupted delayed-absorbable suture. The patient evolved favorably and presented no lesion recurrence during three months of follow up.

Analysis of electrocautery generated smoke by chromatographic-mass spectrometry / Análise, mediante cromatografia/espectrometria de massas, da fumaça gerada por eletrocautério

ABSTRACT Objective: to analyze the chemical components of the smoke from electrocautery from coagulating muscle and liver tissues of pigs. Methods: we collected smoke produced by electrocautery applied to porcine tissue in previously evacuated bottles, with qualitative and quantitative analysis of the compounds present through the hyphenated technique gas chromatography / mass spectrometry. Results: there was a majority of decanal aldehyde in the fumes from the subcutaneous, muscle and liver tissues. Fumes of subcutaneous and muscular tissues also showed the presence of hexanal and phenol. In the fumes of subcutaneous and liver tissues we also found toluene and limonene and, finally, nonanal smoke was present in the muscle and liver tissues. Conclusion: there is increasing evidence showing that smoke from electrocautery used in subcutaneous, muscle and liver tissue is harmful to human health. Thus, there is need to reduce exposure to it or wear masks with filters capable of retaining these particles.

RESUMO Objetivo: analisar quimicamente os componentes da fumaça do eletrocautério, provenientes da coagulação de tecidos, muscular e hepático de suino. Métodos: coleta de fumaça produzida por eletrocauterização de tecido porcino em frascos previamente evacuados com análise qualitativa e quantitativa dos compostos presentes, através de técnica hifenada, cromatografia a gás/espectrometria de massas. Resultados: houve presença majoritária do aldeído decanal nas fumaças provenientes dos tecidos subcutâneo, muscular e hepático. Fumaças dos tecidos subcutâneo e muscular mostraram também a presença de hexanal e fenol. Nas fumaças dos tecidos subcutâneo e hepático foram encontrados ainda tolueno e limoneno e, por fim, nonanal estava presente nas fumaças dos tecidos muscular e hepático. Conclusão: há número crescente de evidências mostrando que fumaça proveniente de eletrocauterização de tecidos subcutâneo, muscular e hepático é nociva à saúde de seres humanos. Portanto, há necessidade de reduzir a exposição a ela ou usar máscara com filtro capaz de reter essas partículas.

Stress urinary incontinence 3 years after pregnancy: correlation to mode of delivery and parity.

The aim was to estimate the incidence of stress urinary incontinence 3 years after delivery and its correlation to mode of delivery and parity. A longitudinal cohort study was conducted with 120 women at the Antenatal Clinic at the State University of Campinas. There was a significant difference in the incidence of postpartum stress urinary incontinence (SUI) among patients with SUI during pregnancy (p > 0.0001). Women that were asymptomatic during pregnancy and had vaginal delivery developed SUI 2.4 times more frequently than after c-section (19.2% and 8.0%, respectively). The incidence of SUI after delivery dropped significantly in the primiparous (p = 0.0073) and multiparous 2-3 (p < 0.0001), but not in the multiparous with four or more deliveries (66.7% to 60.0%) (p = 0.5637). A significant correlation has been observed between parity and SUI (p = 0.0299). Pregnancy possibly predisposes to SUI 3 years after delivery as well as parity. No significant correlation has been demonstrated between mode of delivery and SUI.

[Lower urinary tract symptoms three years after delivery: a prospective study]. / Sintomas do trato urinário inferior três anos após o parto: estudo prospectivo.

PURPOSE: to evaluate the frequency of lower urinary tract symptoms (LUTS), three years after delivery in women previously interviewed at the third gestation trimester, and to compare the gestation and delivery impact on LUTS, analyzing the social and hygienic discomfort associated with micturition complaints. METHODS: analytical prospective study. In 2003, 340 pregnant women were selected in the pre-natal outpatient unit, and asked to answer a pre-tested questionnaire about LUTS and obstetric data. Three years after delivery, it was possible to get in touch by telephone with 120 of the 340 women who had been interviewed in the first study. They answered a second questionnaire about obstetric data, LUTS and its social impact. LUTS have been divided into stress urinary incontinence (SUI) and irritative urinary symptoms (IUS). McNemar's and chi-square tests were used for statistical analysis (p<0.05). RESULTS: SUI and nocturia have occurred in 57.5 and 80% of the pregnant women and the appearance of those symptoms after delivery, in 13.7 and 16.7%, respectively. Urge urinary incontinence has been significantly more frequent after delivery (30.5%) than in gestation (20.8%). Only 35.6% of the women with IUS presented social discomfort, but this rate has gone up to 91.4% in women with IUS associated with SUI. CONCLUSIONS: gestation, more than delivery, was associated with the appearance of SUI and nocturia, while the urge urinary incontinence was significantly higher after delivery. Most of the women have mentioned that SUI causes social problems.

[Translation into Portuguese, cross-national adaptation and validation of the Female Sexual Function Index]. / Tradução para português, adaptação cultural e validação do Female Sexual Function Index.

PURPOSE: to translate from English into Portuguese, adapt culturally and validate the Female Sexual Function Index (FSFI). METHODS: knowing the objectives of this research, two Brazilian translators have prepared a version each from the FSFI into Portuguese. Both versions have then been retro-translated into English by two English translators. After harmonizing the differences, they have been pre-tested in a pilot study. The final versions from the FSFI and from another questionnaire, the Short-Form Health Survey, which had already been translated and published in Portuguese, have then been simultaneously administered to one hundred patients, to test the FSFI psychometric proprieties concerning reliability (internal consistency and testing-retesting) and construct validity. Retesting was done after four weeks from the first interview. RESULTS: the process of cultural adaptation has not altered the Portuguese version of the FSFI, as compared to the original. The FSFI standardized Cronbach alpha was 0.96, and the evaluation by domains has varied from 0.31 to 0.97. As a measure of test-retest confidentiality, it was applied the intra-class coefficient, which has been considered strong and identical (1.0). Pearson's correlation coefficient between the FSFI and the Short-Form Health Survey was positive, but weak in most of the interrelated domains, varying from 0.017 to 0.036. CONCLUSIONS: the FSFI English version has been translated into Portuguese and culturally adapted, being reliable to evaluate the sexual response of Brazilian women.

Role of 17 beta-estradiol on type IV collagen fibers volumetric density in the basement membrane of bladder wall.

The authors quantified the type IV collagen fibers volumetric density in the basement membrane of bladder wall of ovariectomized rats with and without estradiol replacement. This study was conducted on 40 Wistar rats (3 months old) randomly divided in 4 groups: group 1, remained intact (control); group 2, submitted to bilateral oophorectomy and daily replacement 4 weeks later of 17 beta-estradiol for 12 weeks; group 3, sham operated and daily replacement 4 weeks later of sesame oil for 12 weeks; and group 4, submitted to bilateral oophorectomy and killed after 12 weeks. It was used in immunohistochemistry evaluation using type IV collagen polyclonal antibody to stain the fibers on paraffin rat bladder sections. The M-42 stereological grid system was used to analyze the fibers. Ovariectomy had an increase effect on the volumetric density of the type IV collagen fibers in the basement membrane of rat bladder wall. Estradiol replacement in castrated animals demonstrated a significative difference in the stereological parameters when compared to the castrated group without hormonal replacement. Surgical castration performed on rats induced an increasing volumetric density of type IV collagen fibers in the basement membrane of rats bladder wall and the estradiol treatment had a significant effect in keeping a low volumetric density of type IV collagen fibers in the basement membrane of rats bladder wall.

Experimental animal model for training transobturator and retropubic sling techniques.

INTRODUCTION: Suburethral slings have become the treatment of choice for stress urinary incontinence. However, the lack of experimental models for surgical training is a problem for beginners. We present a model for sling training and evaluate its acceptance by surgeons who have had prior experience. MATERIALS AND METHODS: There were 32 surgeons who performed the training program and filled out a questionnaire to evaluate the animal model. Eleven-month-old Santa Inês sheep were selected. The techniques used for minimally invasive transobturator and retropubic sling implantation were reproduced followed by cystoscopy. The anatomical similarities of sheep and humans were evaluated, in addition to the reproducibility of surgical techniques. RESULTS: As far as anatomical similarities of vaginal structures are concerned, 13 surgeons (40.6%) reported similarities and 18 (56.2%) reported a strong correlation. Concerning cystoscopy, 18 (56.2%) found similarities and 13 (40.6%) a strong similarity. As for the transvaginal sling, 10 (3.1%) reported similarities and 19 (59.3%) a strong similarity. Among those who had previous experience with transobturator slings, 91.6% considered that the model presented a similarity or strong similarity. Regarding the degree of recommendation, 9 surgeons (28.1%) would recommend it and 22 (68.7%) would strongly recommend it. CONCLUSION: Ninety-seven percent of the surgeons would recommend this experimental model for training purposes. To our knowledge this is the first description of a successful animal model for transobturator sling training.

Leiomioma uretral durante a gravidez: relato de caso / Urethral leiomyoma during pregnancy: a case report

The authors report a case of urethral leiomyoma diagnosed during pregnancy, which was conservatively treated up to the 38th week, when the pregnancy was interrupted. Thirty days after delivery, exeresis of the lesion was performed from the upper border of the urethral meatus and sutured with interrupted delayed-absorbable suture. The patient evolved favorably and presented no lesion recurrence during three months of follow up.