ABSTRACT
Resumen OBJETIVO: Determinar los cambios en el punto Aa del sistema POP-Q y en la prueba del Q-tip para hipermovilidad uretral y en los parámetros urodinámicos encontrados antes y 1 año después de la colocación de una cinta mediouretral. MATERIALES Y MÉTODOS: Estudio retrospectivo efectuado en pacientes a quienes se colocó una cinta mediouretral mediante acceso transobturador y retropúbico, por diagnóstico de incontinencia urinaria de esfuerzo, incontinencia urinaria mixta, incontinencia dual o con índice de riesgo de incontinencia urinaria de novo, posterior a cirugía de prolapso (R-CALC) mayor de 30%. RESULTADOS: Se estudiaron 200 pacientes de 51.59 ± 10.13 años de edad promedio. Conforme al grado de prolapso de órganos pélvicos, el estadio II tuvo una frecuencia de 57.5% (n = 115), el grado III de 21.5% (n = 43). En los hallazgos de la exploración física, previa a la cirugía, se encontró que 69% (n = 138) de las pacientes tuvieron una prueba de Q tip con hipermovilidad uretral (más de 30°). Al comparar el porcentaje de pacientes con hipermovilidad uretral posterior a 1 año de la cirugía, se observó disminución en las pacientes con hipermovilidad (p = 0.0001). La cuantificación del punto Aa en la escala del sistema POP-Q se encontró durante la exploración preoperatoria a 0.1 ± 1.17 cm respecto del himen y al año del procedimiento quirúrgico a -1.54 ± 1.18 cm, con p = 0.0001. CONCLUSIÓN: En todas las pacientes se demostró la disminución significativa del punto Aa en la revaloración del POP-Q de un estadio II a I posterior a la colocación de una cinta mediouretral; además de la disminución en el ángulo de movilidad uretral. No se observaron modificaciones significativas en los parámetros urodinámicos evaluados.
Abstract OBJECTIVE: To determine the changes in point Aa of the POP-Q system and in the Q-tip test for urethral hypermobility as well as in the urodynamic parameters found before and 1 year after mediurethral sling placement. MATERIALS AND METHODS: Retrospective study carried out in patients who were placed with a mediourethral tape by transobturator and retropubic access, by diagnosis of stress urinary incontinence, mixed urinary incontinence, dual incontinence or with risk index of de novo urinary incontinence after surgery. Prolapse (R-CALC) greater than 30%. RESULTS: 200 patients of 51.59 ± 10.13 years of average age were studied. According to the degree of pelvic organ prolapse, stage II had a frequency of 57.5% (n = 115), grade III with 21.5% (n = 43). In the physical examination findings, prior to surgery, it was found that 69% (n = 138) of the patients had a Q tip test with urethral hypermobility (more than 30°). When comparing the percentage of patients with urethral hypermobility after 1 year of surgery, a decrease was observed in patients with hypermobility (p = 0.0001). The quantification of point Aa on the scale of the POP-Q system was found during the preoperative examination at 0.1 ± 1.17 cm with respect to the hymen and one year after the surgical procedure at -1.54 ± 1.18 cm, with p = 0.0001. CONCLUSION: The significant decrease in point Aa in the reassessment of POP-Q from stage II to I after the placement of a mediourethral tape in all patients was demonstrated, in addition to the decrease in the angle of urethral mobility. No significant changes were observed in the urodynamic parameters evaluated.
ABSTRACT
OBJECTIVE: To evaluate how patients in the four diagnosis groups differ in their symptoms and other characteristic levels in female stress urinary incontinence METHOD: A retrospective chart review of 240 patients with stress urinary incontinence was performed. Patients were categorized as intrinsic sphincter deficiency (ISD) or stress urinary incontinence (SUI). Within these groups, patients with hypermobility were separated from those without hypermobility. And then just patients with hypermobility were compared. Information on several types of symptoms and characteristics were captured for all patients. RESULTS: There are nothing to do with among 4 each groups and 6 symptoms (frequency, urgency, postvoid dribbling, voiding difficulty, hematuria, recurrent infection) in stress urinary incontinence. Only in diabetic status and antiincontinence surgery did the diagnosis groups differ statistically. In diabetes, patient in the ISD without hypermobility tended to have a higher prevalence of diabetes than the other 3 groups (p=0.007). Patients in the ISD with hypermobility group were more likely to have antiincontinence surgery than thosein the SUI with hypermobility group (p=0.046). No other statistical comparisons were significant at the 0.05 level, although there is some evidence that patients in the ISD with hypermobility group were more likely to have a previous hysterectomy than those in the SUI with hypermobility group (p=0.072). Patients in the ISD without hypermobility group had the largest mean and median age among the four groups, and a statistically significant difference in age was detected across all groups (p<0.001). More specifically, the ISD without hypermobility group was significantly older than the SUI with hypermobility group. CONCLUSION: There was no statistically significant among 4 each group according to each 6 symptom in stress urinary incontinence. Of the variables, diabetes, antiincontinence surgery history, hormonal use, parity and age tended to have a statistically significant difference.
Subject(s)
Female , Humans , Diagnosis , Hematuria , Hysterectomy , Parity , Prevalence , Retrospective Studies , Urinary IncontinenceABSTRACT
PURPOSE: To evaluate the relationship between urethral hypermobility and Valsalva leak point pressure (VLPP), subjective symptom degree in women with stress urinary incontinence. MATERIALS AND METHODS: 229 patients who were diagnosed as stress urinary incontinence and had undergone all of standing cystourethrogaphy, urodynamic study including VLPP, and recording questionnaire of incontinence were included in this study. The subjective degree of stress urinary incontinence was graded to 3 grades by Stamey classification, and urethral mobility more than 2.0 cm on standing cystourethrography was determined as the urethral hypermobility. And patients were stratified 3 groups according to the VLPP of less than 60, 60 to 90 and greater than 90 cmH2O. Correlation between urethral hypermobility and VLPP, subjective symptom degree were evaluated. RESULTS: According to the VLPP of less than 60, 60 to 90 and greater than 90 cmH2O, urethral hypermobility was noted in 49.4%, 86.6%, 92.4%, respectively. The rate of urethral hypermobility increased according to VLPP does with statistical significance (p<0.05). And in subjective symptom grade I, II, III urethral hypermobility was noted in 75.0%, 79.7%, 61.0%, respectively. There was not significant correlation between urethral hypermobility and subjective symptom degree (p=0.15). CONCLUSION: Our results suggest that there is significant correlation between urethral hypermobility and VLPP. And in some of patients with stress urinary incontinence urethral hypermobility and intrinsic sphincter deficiency are coexist. However, we suggest that the preoperative evaluation for urethral hypermobility and intrinsic sphincter deficiency is needed to assess the surgical outcome more exactly in the patients with stress urinary incontinence.
Subject(s)
Female , Humans , Classification , Surveys and Questionnaires , Urinary Incontinence , UrodynamicsABSTRACT
PURPOSE: We evaluated the correlation of Valsalva leak point pressure, maximum urethral closure pressure, and urethral hypermobility in the diagnosis of genuine stress incontinence. MATERIALS AND METHODS: From January 1997 to January 1999, one hundred thirteen patients with genuine stress incontinence had undergone three measures determined in a standardized fashion. We compared three parameters with symptom grades of genuine stress incontinence. RESULTS: Of the total 113 patients, genuine stress incontinence were grade I in 39, II in 43 and III in 31. There were significant difference in the incidence between grade III and grade I or II in Valsalva leak point pressure, maximum urethral closure pressure, and urethral hypermobility(p<0.05). Valsalva leak point pressure was the most significnat correlation with symptom grade(r=0.4), but there were not correlation among Valsalva leak point pressure, maximum urethral closure pressure, and urethral hypermobility in grade III geniune stress incontinence patients and 66.7% of grade III genuine stress incontinence patients had urethral hypermobility. CONCLUSIONS: With these results, Valsalva leak point pressure is good indicator for intrinsic sphincter deficiency. But intrinsic sphincter deficiency should be diagnosed by composites of historic, urodynamic, anatomic, and other clinical factors.
Subject(s)
Humans , Diagnosis , Incidence , UrodynamicsABSTRACT
PURPOSE: To review the short-term result of Raz`s anterior vaginal wall sling as a treatment for intrinsic sphincter deficiency(ISD) and urethral hypermobility. MATERIALS AND METHODS: Twenty-three women who had intrinsic sphincter deficiency and urethral hypermobility were treated by AVL which employed an island of in situ anterior vaginal wall as a sling to support the bladder neck and mid-urethra. RESULTS: After a mean follow-up of 4.7(3-6)months, urinary incontinence was disappeared completely after the AVL. Complications included urinary retention in 6 patients, residual urine sensation in 5 patients which improved after intermittent catheterization. The other complication was low abdominal pain in 5 patients. CONCLUSIONS: It is suggested that AVL was effective treatment of ISD and urethral hypermobility with simple technique, low morbidity and high cure rate.