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Introdução: O assoalho pélvico tem como objetivo sustentar órgãos internos, principalmente o útero, a bexiga e o reto, porém qualquer alteração na cavidade pélvica pode resultar em disfunção dessa região e descida patológica dos órgãos, características dos prolapsos genitais. A fisioterapia melhora os sintomas relacionados ao prolapso genital, bem como a força muscular do assoalho. Objetivo: Identificar os procedimentos fisioterapêuticos mais utilizados e de melhor eficácia comprovada no tratamento dos prolapsos. Métodos: Foi realizado um levantamento de artigos científicos e teses em bancos de dados, nos quais foram encontrados 716 estudos. Destes, 9 foram selecionados, sendo 3 do tipo ensaio clínico randomizado controlado, 1 quaseexperimental do tipo antes e depois e 5 do tipo revisão, publicados nos últimos 20 anos e relacionados ao tema proposto. Resultados: Participaram dos estudos clínicos 430 mulheres no total, que foram submetidas a intervenções como: cinesioterapia, exercícios hipopressivos e eletroestimulação transvaginal. Os estudos de revisão mencionam os efeitos do biofeedback e da cinesioterapia no manejo dos prolapsos. Conclusão: Das abordagens analisadas a cinesioterapia e os exercícios hipopressivos são os mais efetivos para o tratamento do prolapso genital, porém mais estudos são necessários para avaliar o real impacto desses recursos. (AU)
Introduction: The pelvic floor is intended to support internal organs, especially the uterus, bladder and rectum. However, any alteration in the pelvic cavity may result in dysfunction of the pelvic floor and pathological falling of the organs, characteristic of genital prolapses. Physical therapy improves symptoms related to genital prolapse as well as muscle strength of the floor. Objective: The aim of this study was to identify the most widely used physiotherapeutic procedures with proven efficacy in the treatment of prolapses. Methods: A survey of scientific articles and theses in databases was carried out, in which 716 studies were found. Of these, 9 were selected, 3 of which were randomized controlled clinical trials, 1 quasi-experimental and 5 reviews, published in the last 20 years. Results: A total of 430 women participated in the clinical studies, who underwent interventions such as: kinesiotherapy, hipopressive exercises and transvaginal electrostimulation. The review studies mention the effects of biofeedback and kinesiotherapy in the management of prolapses. Conclusion: From the approaches analyzed kinesiotherapy and hipopressive exercises are the most effective for the treatment of genital prolapse, but more studies are necessary to evaluate the real impact of these resources. (AU)
Subject(s)
Humans , Female , Physical Therapy Modalities , Pelvic Organ Prolapse , Rehabilitation , Pelvic FloorABSTRACT
RESUMEN Introducción y objetivos: Los síntomas de climaterio junto con el prolapso genital en la mujer que envejece, afectan la función sexual y la calidad de vida relacionada con la salud. El objetivo de este estudio fue describir la función sexual y la calidad de vida relacionada con la salud en mujeres climatéricas con prolapso genital según características sociodemográficas y clínicas. Métodos: Diseño descriptivo de corte transversal, sobre una muestra consecutiva de 45 mujeres climatéricas inscritas en dos Centros de Salud Familiar de la región de Ñuble, se seleccionaron a todas aquellas entre 42 y 60 años de edad, con diagnóstico clínico o ecográfico de prolapso genital, con vida sexual activa los últimos 6 meses y sin terapia hormonal de reemplazo. Para evaluar la función sexual se aplicó el Índice de Función Sexual Femenina y para la calidad de vida relacionada con la salud el Menopause Rating Scale. Se utilizó estadística descriptiva, y para analizar la diferencia entre las variables se aplicaron las pruebas estadísticas Chi-cuadrado y Test Exacto de Fisher. En todos los casos se consideró un nivel de significancia p<0,05. Los datos fueron analizados con el software estadístico SPSS v. 23. Resultados: Se observó una diferencia estadísticamente significativa entre escolaridad y función sexual (p= 0,005) y el tipo de parto y la calidad de vida relacionada con la salud (p=0,034). Conclusiones: El nivel educacional se podría considerar como factor protector de la función sexual.
SUMMARY Introduction and objectives: The climacteric symptoms together with genital prolapse in the aging woman, affects the sexual function and the health related quality of life. The objective of this study was to describe sexual function and health related quality of life in climacteric women with genital prolapse according to sociodemographic and clinical characteristics. Methods: Descriptive cross-sectional design, on a consecutive sample of 45 climacteric women enrolled in two Family Health Centers of the Ñuble region, were selected all those between 42 and 60 years of age, with a clinical or ultrasound diagnosis of genital prolapse, with active sexual life the last 6 months and without hormone replacement therapy. To evaluate sexual function the Index of Feminine Sexual Function was applied and for the health related quality of life the Menopause Rating Scale was applied. Descriptive statistics were used, and to analyze the difference between the variables, the Chi-square and Fisher's Exact test were applied. In all cases a level of significance was considered p <0.05. The data was analyzed with the statistical software SPSS v. 23. Results: A statistically significant difference was observed between schooling and sexual function (p = 0.005) and type of delivery and health related quality of life (p = 0.034). Conclusions: The educational level could be considered as a protective factor of sexual function.
Subject(s)
Humans , Female , Middle Aged , Quality of Life , Sexual Behavior , Women's Health , Uterine Prolapse/psychology , Climacteric , Menopause , Cross-Sectional Studies , Surveys and Questionnaires , Health Status IndicatorsABSTRACT
RESUMEN La enfermedad renal crónica (ERC) se observa en aproximadamente el 4% de las mujeres en edad fértil, pero el embarazo suele ser infrecuente en este grupo de pacientes, principalmente en aquellas con enfermedad renal crónica terminal (ERCT), reportándose entre el 1% al 7%. Los efectos de la enfermedad renal y su tratamiento pueden, a su vez, afectar el embarazo, incluido el desarrollo del feto, teniendo alta frecuencia las complicaciones perinatales. Es una patología que durante la gestación tiene una alta morbimortalidad para el binomio, por lo cual la cooperación interdisciplinaria intensiva de nefrólogos y obstetras es imprescindible para el manejo exitoso de la embarazada en esta condición. Se presenta el caso de una paciente con diagnóstico de ERCT antes de la concepción, manejo de su patología y seguimiento hasta la finalización del embarazo.
SUMMARY Introduction and objectives: The climacteric symptoms together with genital prolapse in the aging woman, affects the sexual function and the health related quality of life. The objective of this study was to describe sexual function and health related quality of life in climacteric women with genital prolapse according to sociodemographic and clinical characteristics. Methods: Descriptive cross-sectional design, on a consecutive sample of 45 climacteric women enrolled in two Family Health Centers of the Ñuble region, were selected all those between 42 and 60 years of age, with a clinical or ultrasound diagnosis of genital prolapse, with active sexual life the last 6 months and without hormone replacement therapy. To evaluate sexual function the Index of Feminine Sexual Function was applied and for the health related quality of life the Menopause Rating Scale was applied. Descriptive statistics were used, and to analyze the difference between the variables, the Chi-square and Fisher's Exact test were applied. In all cases a level of significance was considered p <0.05. The data was analyzed with the statistical software SPSS v. 23. Results: A statistically significant difference was observed between schooling and sexual function (p = 0.005) and type of delivery and health related quality of life (p = 0.034). Conclusions: The educational level could be considered as a protective factor of sexual function.
Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications , Renal Dialysis , Renal Insufficiency, Chronic , Ultrasonography , Peritoneal Dialysis , Fetal Growth Retardation/diagnostic imagingABSTRACT
INTRODUCCIÓN Y OBJETIVOS: El prolapso genital afecta hasta al 50% de las mujeres a nivel mundial, su calidad de vida, percepción corporal y vida sexual. A las pacientes de edad avanzada frecuentemente les ofrecemos técnicas quirúrgicas obliterativas para su manejo. El objetivo fue evaluar los resultados de las técnicas obliterativas basados en nuestra experiencia local. MÉTODOS: análisis retrospectivo de pacientes tratadas con técnicas obliterativas en nuestro hospital entre los años 2008 y 2016. RESULTADOS: se incluyeron 78 pacientes, la edad promedio fue de 74.5 años, 11.5% de las pacientes presentaba comorbilidad de mayor riesgo quirúrgico, 24% eran pacientes histerectomizadas por prolapso y 30.8% presentaba incontinencia de orina al momento de la cirugía. El tiempo quirúrgico promedio fue 52 minutos, 73.1% de las cirugías fueron con técnica de LeFort y 5.1% presentó complicaciones postquirúrgicas precoces. Se contactaron telefónicamente 59 pacientes, 90% refirió mejor calidad de vida, 92% satisfacción con la cirugía, 3.4% recidiva del prolapso y 44% incontinencia urinaria, en su mayoría moderada o severa. La recidiva reportada estuvo acorde a lo reportado en la literatura, pero la incontinencia de orina reportada fue muy alta respecto a lo reportado y de predominio de urgencias. CONCLUSIÓN: las técnicas obliterativas son efectivas en el tratamiento quirúrgico del prolapso y el principal problema postquirúrgico a largo plazo asociado fue la incontinencia de orina de urgencias.
INTRODUCTION AND OBJECTIVES: Genital prolapse affects up to 50% of women worldwide, their quality of life, body perception and sex life. For older patients, we often offer obliterative surgical techniques to manage it. The objective was to evaluate the results of the obliterative techniques based on our local experience. METHODS: retrospective analysis of patients treated with obliterative techniques in our hospital between 2008 y 2016. RESULTS: 78 patients were included, with an average age of 74.5 years, 11.5% of the patients had comorbidities of high surgical risk, 24% were previously hysterectomized because of genital prolapse and 30.8% had urinary incontinence at the time of the surgery. Average surgical time was 52 minutes, 73.1% of the surgeries were performed with the LeFort technique and 5.1% presented early postoperative complications. 59 patients were contacted by telephone, 90% reported better quality of life, 92% were satisfied with the surgery, 3.4% had recurrence of the prolapse and 44% reported urinary incontinence, mostly moderate or severe. The reported relapse was in line with what was reported in the literature, but the reported urinary incontinence was very high compared to what was reported, and was predominantly urge incontinence. CONCLUSION: obliterative techniques are effective in the surgical treatment of genital prolapse and the main long term problem after surgery was urge incontinence.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Urogenital Surgical Procedures/methods , Pelvic Organ Prolapse/surgery , Quality of Life , Urogenital Surgical Procedures/adverse effects , Urinary Incontinence/etiology , Vagina/surgery , Treatment Outcome , Patient Satisfaction , Operative TimeABSTRACT
La Sociedad Peruana de Obstetricia y Ginecología (SPOG) ha desempeñado un importante papel en el desarrollo de la ginecología en el Perú, y ha contribuido de manera significativa en la unificación de la obstetricia y ginecología en los diferentes hospitales públicos del país, ya que antes los hospitales y servicios públicos brindaban atención o bien solo obstétrica o solo ginecológica. La SPOG, a través de la revista, congresos, cursos, simposios y mesas redondas, siempre ha dedicado sus mejores esfuerzos por poner los últimos avances de la ginecología al alcance de los médicos peruanos.
The Peruvian Society of Obstetrics and Gynecology (SPOG) has had a relevant role in the development of Gynecology in Peru and has contributed in the unification of services of Obstetrics and Gynecology in our public hospitals that used to be separated. The SPOG has facilitated updating the science of Gynecology in our associates trhough its Journal, meetings, courses, symposia and round tables in the specialty in order to give our patients the best care, with efficacy and warmth.
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Objetivo: Evaluar la utilidad del Biofeedback perineal en las disfunciones del piso pélvico. Método: Se realizó una búsqueda bibliográfica en las bases de datos electrónicas Pubmed, Ovid, Elsevier, Interscience, EBSCO, Scopus, SciELO. Resultados: La reeducación de los músculos del suelo pélvico, con técnicas de biofeedback, es el tratamiento conservador más utilizado para las mujeres con síntomas de incontinencia urinaria de esfuerzo o con prolapsos del piso pélvico. El biofeedback ayuda a la realización correcta de los ejercicios, y es especialmente útil en los pacientes que tienen dificultades en la localización de la musculatura perineal. Conclusiones: En el biofeedback los ejercicios musculares del suelo pélvico se realizan, asistidos por un equipo que traduce la contracción muscular en una señal gráfica, acústica o ambas, para que el paciente y el fisioterapeuta perciban el trabajo realizado. La introducción del biofeedback en las técnicas de rehabilitación perineal han mejorado los resultados, siendo hoy por hoy la técnica más eficaz en la recuperación perineal.
Objective: To evaluate the usefulness of perineal Biofeedback in pelvic floor dysfunction. Methods: Ca bibliographic search in electronic databases PubMed, Ovid, Elsevier, Interscience, EBSCO, Scopus, SciELO. Results: The rehabilitation of the pelvic floor muscles with biofeedback techniques, conservative treatment is most commonly used for women with symptoms of urinary incontinence or pelvic floor prolapse. Biofeedback helps the successful completion of the exercises, and is especially useful in patients who have difficulty in locating the perineal musculature. Conclusions: In the biofeedback of pelvic floor muscle exercises are performed assisted by a team that translates muscle contraction in a graphic, sound or signal both to the patient and physiotherapist perceive their work. The introduction of biofeedback in perineal rehabilitation techniques have improved outcomes, still today, the most effective in the perineal recovery technique.
Objetivo: Para avaliar a utilidade da perineal Biofeedback em disfunção do assoalho pélvico. Método: Ca pesquisa bibliográfica em bases de dados eletrônicas PubMed, Ovid, Elsevier, Interscience, EBSCO, Scopus, SciELO. Resultados: A reabilitação dos músculos do assoalho pélvico, técnicas de biofeedback, o tratamento conservador é mais comumente usado para mulheres com sintomas de incontinência urinária ou prolapso do assoalho pélvico. Biofeedback ajuda a conclusão bem sucedida dos exercícios, e é especialmente útil em pacientes que têm dificuldade em localizar os músculos perineais. Conclusões: Em biofeedback os exercícios músculos do pavimento pélvico são realizadas assistida por uma equipa que traduz a contração muscular em um gráfico, sinal acústico ou ambos para o paciente eo terapeuta perceber o trabalho. A introdução de biofeedback em técnicas de reabilitação perineais melhoraram os resultados, sendo hoje o mais eficaz na técnica de recuperação perineal.
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Background & objectives: In India, community based data on chronic obstetric morbidities (COM) are scanty and largely derived from hospital records. The main aim of the study was to assess the community based prevalence and the factors associated with the defined COM - obstetric fistula, genital prolapse, chronic pelvic inflammatory disease (PID) and secondary infertility among women in Nashik district of Maharashtra State, India. Methods: The study was cross-sectional with self-reports followed by clinical and gynaecological examination. Six primary health centre areas in Nashik district were selected by systematic random sampling. Six months were spent on rapport development with the community following which household interviews were conducted among 1560 women and they were mobilized to attend health facility for clinical examination. Results: Of the 1560 women interviewed at household level, 1167 women volunteered to undergo clinical examination giving a response rate of 75 per cent. The prevalence of defined COM among 1167 women was genital prolapse (7.1%), chronic PID (2.5%), secondary infertility (1.7%) and fistula (0.08%). Advancing age, illiteracy, high parity, conduction of deliveries by traditional birth attendants (TBAs) and obesity were significantly associated with the occurrence of genital prolapse. History of at least one abortion was significantly associated with secondary infertility. Chronic PID had no significant association with any of the socio-demographic or obstetric factors. Interpretation & conclusions: The study findings provided an insight in the magnitude of community-based prevalence of COM and the factors associated with it. The results showed that COM were prevalent among women which could be addressed by interventions at personal, social and health services delivery level.
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Objetivos: Demostrar la importancia de reducir el prolapso de grado alto (POPQ >+3) en la evaluación clínica y urodinamia, buscando la presencia de incontinencia urinaria oculta; y planear el tratamiento de ambas patologías (prolapso e incontinencia urinaria de esfuerzo - IUE) en el mismo acto quirúrgico para evitar la IUE después de la corrección solo del prolapso. Diseño: Estudio retrospectivo y descriptivo. Institución: Urología, Clínica San Pablo, Sede Surco, Lima Perú. Participantes: Mujeres con prolapso genital. Intervenciones: Entre julio de 2009 y junio 2012, a 40 pacientes entre 43 y 78 años (edad media de 62,9 años), con prolapso genital grado III y IV, se les redujo el prolapso con gasas, tanto en la evaluación clínica como en el estudio urodinámico (clasificación IUE, según la Sociedad Internacional de Continencia - SIC). Principales medidas de resultados: Incontinencia oculta. Resultados: Se encontró 19 pacientes (47,5%) con incontinencia oculta diagnosticada en la evaluación clínica. El grado del prolapso evaluado, de acuerdo al POP-Q, fue +III en 14 (73,7%), +IV en 5 (26,3%); el tipo de IUE según la SIC fue I en 11 (57,9%), II en 7 (36,9%) y III en 1 (5,2%); no hubo IUE tipo IV. Conclusiones: La reducción del prolapso de alto grado POPQ>+III debe ser hecha rutinariamente en la evaluación por el ginecólogo y uroginecólogo, y en la urodinamia, de manera de detectar la incontinencia oculta para la planificación de ambas patologías en un solo acto quirúrgico. De esta manera se evitará una segunda intervención para corrección de la IUE, así como los consecuentes problemas médicos-legales. No todos los pacientes con prolapso genital tienen incontinencia oculta.
Objectives: To demonstrate the importance of reducing the high grade vaginal prolapse (POPQ> +III) in clinical and urodynamic evaluation when determining the presence of occult stress urinary incontinence and planning treatment of both conditions (prolapse and stress urinary incontinence - SUI) in the same surgical procedure in order to avoid SUI following correction of prolapse alone. Design: Retrospective and descriptive study. Setting: Urology, Clinica San Pablo, Sede Surco, Lima, Peru. Participants: Women with genital prolapse. Interventions: Between July 2009 and June 2012, in 40 patients 43-78 year-old (median 62,9 years) genital prolapse grade III-IV was reduced with gauze during both clinical evaluation and urodynamic study (SUI classification according to Continence International Society - SIC). Main outcome measures: Occult stress incontinence. Results: During clinical evaluation occult urinary stress incontinence was found in 19 patients (47.5%). Degree of prolapse according to POP-Q was +III in 14 (73.7%), +IV in 5 (26.3%); SUI according to SIC was I in 11 (57.9%), II in 7 (36.9%) and III in 1 (5.2%); there was no SUI type IV. Conclusions: Reduction of high grade vaginal prolapse (POPQ> +III) must be done by the gynecologist and urogynecologist during both routine clinical evaluation and urodynamic evaluation in order to either detect occult incontinence, plan correction of both conditions in one surgical act, and avoid a second operation for SUI correction and resulting legal issues. Not all patients with vaginal prolapse present occult stress urinary incontinence.
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Se reporta el caso de una recién nacida femenina de 26 días de edad, con mielomeningocele toracolumbar, hidrocefalia y prolapso genital. En el Instituto de Investigaciones Genéticas de la Facultad de Medicina de la Universidad del Zulia, Maracaibo, se analizaron 6 muestras de ácido desoxirribonucleico, correspondientes a afectada, madre, padre y 3 controles. En esta familia se interrelacionan la anomalía congénita y los factores de riesgo genético y ambiental, lo que permitió adecuado asesoramiento genético.
We report the case of a female newborn 26 days old with thoracolumbar myelomeningocele, hydrocephalus and genital prolapse. In Genetic Research Institute of the Faculty of Medicine, University of Zulia, Maracaibo, 6 samples of oxyribonucleic acid corresponding to affected mother, father and 3 controls were analyzed. In this family are interrelated congenital anomaly and genetic risk factors and environmental, allowing appropriate genetic counseling.
Subject(s)
Humans , Female , Infant, Newborn , Congenital Abnormalities , Neural Tube Defects , Spinal Dysraphism , Hysterectomy, Vaginal , Uterine Prolapse , Neural Tube , Risk Factors , Environmental HazardsABSTRACT
Objetivo: comparar la función sexual (FS) de mujeres con prolapso genital (PG) antes y después de su reparación quirúrgica. Métodos: investigación de tipo comparativa y aplicada, con diseño cuasi experimental, prospectivo y de campo, donde se evaluó la FS de mujeres con diagnóstico de PG antes y después del tratamiento quirúrgico con técnicas convencionales, mediante el Cuestionario Sexual para Prolapso genital e Incontinencia Urinaria versión corta (PISQ-12). Resultados: al comparar la FS antes y después de la cirugía reparadora del PG, se determinó que tanto la puntuación total del PISQ-12 (15,90 +/- 6,51 vs. 32,17 +/- 3,62) como las puntuaciones de las dimensiones respuesta sexual (5,87 +/- 2,80 vs. 10,97 +/- 2,80) y limitaciones sexuales femeninas (4,88 +/- 3,90 vs. 16,77 +/- 3,00) fueron significativamente más altas luego de la intervención quirúrgica (p<0,001), a excepción del indicador intensidad del orgasmo (0,80 +/- 0,71 vs. 0,87+/- 0,73; p= 0,722) y la dimensión limitaciones sexuales de la pareja (4,37 +/- 2,14 vs. 3,56 +/- 2,70; p=0,815) donde sus puntuaciones antes y después del tratamiento quirúrgico no fueron estadísticamente significativas (p>0,05). Conclusiones: Lls mujeres con PG presentan una pobre FS, la cirugía reparadora del PG por técnicas convencionales mejoró significativamente la FS de las pacientes con disfunción del piso pélvico, permitiéndoles obtener a estas mujeres una vida sexual más placentera, con mejoría de su calidad de vida.
Objective: to compare sexual function (SF) of women with genital prolapse (GP) before and after surgical repair. Methods: this is a comparative and applied research with quasi-experimental, prospective and field design, which evaluated the SF of women diagnosed with PG before and after surgical treatment with conventional techniques, by the short version of the Prolapse and Incontinence Sexual Questionnaire (PISQ-12). Results: when comparing the SF before and after surgical repair of GP, it was determined that both the total score of PIQS-12 (15.90 +/- 6.51 vs. 32.17 +/- 3.62) and the scores of the dimensions: sexual response (5.87 +/- 2.80 vs. 10.97 +/- 2.80) and female sexual limitations (4.88 +/- 3.90 vs. 16.77 +/- 3.00) were significantly higher after surgery (p<0.001), except the indicator: orgasm intensity (0.80 +/- 0.71 vs. 0.87 +/- 0.73, p = 0.722) and the dimension partner's sexual limitations (4.37 +/- 2,14 vs. 3.56 +/- 2.70, p=0.815) where their scores before and after surgery showed no statistically significant differences (p>0.05). Conclusions: women with GP exhibit a poor SF, surgical repair of GP by conventional techniques significantly improves the SF of patients with pelvic floor dysfunction, allowing these women get sexual life more pleasant, which will impact on improving their quality of life.
Subject(s)
Humans , Female , Adult , Middle Aged , Sexual Behavior , Uterine Prolapse/surgery , Quality of Life , Surveys and Questionnaires , Prospective Studies , Postoperative Period , Uterine Prolapse/physiopathology , Uterine Prolapse/psychology , Recovery of Function , Treatment OutcomeABSTRACT
Las disfunciones del piso pélvico comprenden la incontinencia urinaria de esfuerzo, el prolapso de órganos pélvicos y la incontinencia anal. Una de cada diez mujeres tendrá que ser sometida a una intervención quirúrgica por disfunciones del piso pélvico durante su vida. Además, entre el 30 por ciento y el 50 por ciento tendrá una recidiva de estas intervenciones. La maternidad es un factor que contribuye de manera importante en la presentación de estas disfunciones pelvianas. Aún no existe evidencia probada de que el parto vaginal sea un factor completamente decisivo para la presencia de disfunciones del piso pélvico. Existe intensa investigación acerca del embarazo y el parto y sus efectos sobre el piso pélvico, y acerca de si algunas de las acciones obstétricas pueden ser modificadas con el fin de protegerlo de los potenciales daños.
The pelvic floor dysfunctions include urinary incontinence, pelvic organ prolapsed and anal incontinence. One in ten women will be subjected to surgery for pelvic floor dysfunction during their lifetime. In addition, between 30 percent and 50 percent will have a recurrence of these interventions. Motherhood is a factor that contributes significantly to the submission of pelvic dysfunctions. There is still no proven evidence that vaginal delivery is an absolutely crucial factor for the presence of pelvic floor dysfunction. There is extensive research on pregnancy and child birth and their effects on the pelvic floor and if some of the obstetric action scan be modified in order to protect it from potential damage.
Subject(s)
Humans , Female , Pregnancy , Fecal Incontinence/etiology , Urinary Incontinence/etiology , Pregnancy Complications , Pelvic Organ Prolapse/etiology , Fissure in Ano/etiology , Obstetric Labor Complications , Pelvic Floor , Risk FactorsABSTRACT
O prolapso genital é condição comum. Ocorre por fraqueza ou defeitos nos órgãos pélvicos de suspensão, que são constituídos de ligamentos, e/ou aqueles de sustentação, constituídos por fáscias e músculos. Sua avaliação constitui uma etapa importante do exame ginecológico, devendo, sempre que possível, ser classificado o grau de prolapso por meio de métodos padronizados. Atualmente, a quantificação é realizada por meio do POP-Q, preconizada pela Sociedade Internacional de Continência (ICS). Embora não seja uma afecção fatal, pode determinar sequelas importantes para a saúde da mulher, comprometendo sua qualidade de vida. Seu diagnóstico precoce previne o estágio final da doença. O tratamento pode ser conservador ou cirúrgico, dependendo do grau do prolapso, idade e estado clínico da paciente.
The pelvic prolapse is a common condition. It's occurs because of weakness or defects in the suspension pelvic organs - consisting of ligaments, and/or those of support, which consist of fascias and muscles. It's assessment is an important phase of the gynecological exam and, whenever possible, the degree of prolapse should be identified by means of standard methods. Currently the measurement is performed using POP-Q, as recommended by the International Continence Society (ICS). Although the disease is not considered fatal, it can determine serious sequela for women's health, affecting their quality of life. It's early diagnosis prevents the final stage of the disease. Treatment can be conservative or surgical depending on the degree of prolapse, and the patient age and medical condition.
Subject(s)
Humans , Female , Pelvic Organ Prolapse/surgery , Pelvic Organ Prolapse/classification , Pelvic Organ Prolapse/diagnosis , Pelvic Organ Prolapse/etiology , Uterine Prolapse , Diagnostic Techniques, Obstetrical and Gynecological , Pelvic Floor/physiopathology , Parity , Pessaries , Quality of Life , Risk FactorsABSTRACT
Se efectuó una investigación analítica, longitudinal y retrospectiva de una muestra de 110 mujeres de un total de 639 con diferentes afecciones de los órganos genitales, excluidas las sépticas, e intervenidas las primeras por vía vaginal durante el quinquenio 2005-2009, las cuales fueron asignadas a 2 grupos: el A, integrado por 37 pacientes sin prolapso genital (técnica de Peham-Amreich); y el B, conformado por 73 féminas con dicho prolapso (técnica de Heany) en estadios clínicos I y II-III, quienes fueron reagrupadas en subgrupos de 32 y 41 pacientes, respectivamente. En la serie se consideraron las variables: edad, sangrado peroperatorio, tiempo quirúrgico, estadía posoperatoria, complicaciones peroperatorias y posoperatorias, así como control ambulatorio (trigésimo día). Las integrantes del grupo A se ajustaron a requerimientos clínicos y ecográficos preseleccionados: útero móvil y equivalente en volumen al puño de un hombre adulto de biotipo medio, campo operatorio suficiente y normalidad en examen de anejos. Para el análisis estadístico se aplicó el test de Pearson, con valores de significación considerados en 3 categorías, a saber: I, p=0,05 (estándar); II, p=0,01 (alta) y III, p=0,001 (muy alta). Se demostró, con muy alta significación, que el prolapso genital es una afección privativa de mujeres de edad superior a 50 años. El resto de las variables escogidas careció de valor estadístico en este estudio.
An analytic, longitudinal and retrospective investigation was carried out in a sample of 110 women from a total of 639 with different disorders of the genitals, excluding the septic ones. The former group had surgeries through vagina during the five year period 2005-2009, and were assigned to 2 groups: group A, formed by 37 women without genital prolapse (Peham-Amreich technique); and group B, formed by 73 women with this disorder (Heany technique) in clinical stages I and II-III, who were regrouped in subgroups of 32 and 41 patients, respectively. Variables such as: age, peroperative bleeding, surgical time, postoperative stay, peroperative and postoperative complications, as well as ambulatory control (thirtieth day) were considered in the series. The members of group A were adjusted to previously selected clinical and echographic requirements: mobile uterus and equivalent in volume to the fist of an adult man of average biotype, adequate operative field and normality in the adnexa examination. For the statistical analysis the Pearson test was applied, with significance values considered in 3 categories, that is: I, p=0.05 (standard); II, p=0.01 (high) and III, p=0.001 (very high). It was significantively demonstrated, that genital prolapse is an exclusive disorder of women over 50 years old. The rest of the chosen variables lacked statistical value in this study.
ABSTRACT
Prevenir el prolapso de la cúpula vaginal, empleando una técnica peroperatoria que consiste en fijar la cúpula vaginal a los ligamentos redondos, en el momento de realizar la intervención. Realizada la histerectomía, se procedió al cierre de la cúpula vaginal con puntos separados en número de 6 a 8 con material no absorbible, dependiendo de la amplitud de la vagina. Los cabos distales son utilizados para anudar horizontalmente los ligamentos redondos. La fijación de las dos paredes del extremo superior de la vagina, garantiza mayor estabilidad de la vagina y menor posibilidad de producir el prolapso de la cúpula y/o de las paredes anterior y posterior de la vagina. Servicio de Ginecología, Hospital Universitario de Caracas. Las 124 pacientes histerectomizadas y controladas anualmente en un lapso entre 2 y 27 años, con un promedio de 7 años, ninguna de ellas presentó prolapso de cúpula vaginal. Las histerectomías se realizaron en el ejercicio privado. En centros asistenciales públicos, es muy difícil hacer seguimiento y evaluar las pacientes, por razones múltiples. La histerectomía ocupa el primer lugar de las intervenciones ginecológicas, esto obliga a realizar la suspensión y fijación de la cúpula vaginal y simultáneamente corregir la patología asociada del aparato genital. El procedimiento que hemos empleado tuvo resultados muy favorables. La calidad de vida de las mujeres intervenidas quirúrgicamente no se desmejoró, como suele suceder cuando se produce el prolapso de la cúpula vaginal
To prevent vaginal vault prolapse, using a preoperative technique to fix the vaginal vault to the round ligaments in total abdominal hysterectomy, and identify associated pathology in the genital area. After hysterectomy, we proceed to the closure of the vaginal vault with interrupted sutures with non-absorbable material, in number of 6-8, depending of the amplitude of the vagina, the distal ends are used to tie horizontally bilateral round ligaments. The setting of the two upper walls of the vagina, ensures greater stability of the vagina and lower possibility of occurrence of prolapse of the dome and/or the anterior and posterior vaginal walls. Servicio de Ginecologia, Hospital Universitario de Caracas The 124 patients undergoing hysterectomy, checked annually over a period of time between 2 and 27 years, with an average of 7 years, neither had vaginal prolapse. Histerectomy is the firstone gynecological operation. It requires making the suspension and fixation of the vaginal vault and simultaneously correct the genital tract associated pathology. The procedure we used had very favorable results. We can not compare our results with other techniques, do to scarse national an international references. The quality of life of women surgically intervened did not deteriorated, as usually happens when there is prolapse of the vaginal vault
Subject(s)
Female , Hysterectomy, Vaginal/methods , Ligaments/transplantation , Gynecologic Surgical Procedures/methods , Uterine Prolapse/surgery , Uterine Prolapse/prevention & controlABSTRACT
Evaluar la prevalencia del prolapso genital, factores relacionados, tratamiento y complicaciones en pacientes hospitalizadas durante el año 2003. Estudio descriptivo, retrospectivo, epidemiológico. Se revisaron los libros de admisiones desde el 01/01/2003 hasta 31/12/2003, seleccionando las pacientes con alteraciones del piso pélvico. Se evaluaron los factores asociados: edad, embarazos, partos, incontinencia urinaria de esfuerzo (IUE), fibromatosis uterina, intervenciones ginecológicas previas. Se clasificaron los tipos y grados de prolapsos, tratamientos y complicaciones. De 21 144 ingresos para 2003, se seleccionaron 2 616 con edad ≥ 35 años, de las cuales 423 fueron casos ginecológicos con patología quirúrgica y sólo 47 (11 por ciento) presentaron prolapso. El promedio de edad fue 56,65 ± 11,5 años, el 93 por ciento refirió síntomas de peso, tumor vaginal o incontinencia urinaria. El promedio de embarazos 5,7 ± 3,2 y de partos 4,9 ±2,6. Los factores asociados más frecuentes fueron la fibromatosis uterina en 11 por ciento y la histerectomía abdominal previa en 8,5 por ciento. El tipo de prolapso más frecuente fue el histerocele (51 por ciento), cistocele II y III º + rectocele (36 por ciento) y de cúpula vaginal (11 por ciento). La intervención quirúrgica más realizada fue histerectomía vaginal, en menor número la histerectomía abdominal, colposuspención de Burch, sacropexia y colpoperineoplastia. Hubo 14 por ciento de complicaciones intraoperatorias. La frecuencia de hospitalizaciones para corrección de prolapso genital es muy baja, el histerocele avanzado sintomático es el más frecuente, son pacientes de edad avanzada, multíparas, los factores relacionados la fibromatosis uterina y la histerectomía abdominal previa. La intervención más realizada la histerectomía vaginal y el porcentaje de complicaciones intraoperatorias fue importante
To assess the prevalence of genital prolapse, related factors, treatment and complications in patients hospitalized during 2003. Descriptive, retrospective, epidemiologic. We reviewed the books of admissions from 01/01/2003 until 31/12/2003, by selecting patients with pelvic floor disorders. We evaluated the factors associated with age, pregnancy, childbirth, urinary incontinence, uterine fibromatosis, prior gynecological interventions. Ranked the types and degrees of prolapse, treatments and complications. Of 21 144 income for 2003 was 2 616 identified with age ≥ 35 years, of which 423 were cases with gynecologic surgical pathology, and only 47 (11 percent) had prolapse. The average age was 56.65 ± 11.5 years, 93 percent said weight symptoms, urinary incontinence or vaginal tumor. The average pregnancy 5.7 ± 3.2 and 4.9 ± 2.6 births. The associated factors were the most frequent uterine fibromatosis in 11 percent after abdominal hysterectomy and 8.5 percent. The most common type of prolapse was histerocele (51 percent), II and III cystocele rectocele II º (36 percent) and vaginal vault (11 percent). The surgery was performed more vaginal hysterectomy, fewer abdominal hysterectomy, Burch colposuspencion, sacropexia and colpoperineoplastia. There were 14 percent of intraoperative complications. The frequency of hospitalization for correction of genital prolapse is very low, the advanced histerocele is the most common symptoms are the elderly, multiparous, related factors and the uterine fibromatosis after abdominal hysterectomy. The most accomplished vaginal hysterectomy and the rate of intraoperative complications was significant
Subject(s)
Adult , Middle Aged , Hysterectomy, Vaginal/methods , Pelvic Floor , Uterine Prolapse/surgery , Uterine Prolapse/diagnosis , Uterine Prolapse/therapy , Fibromatosis, Abdominal/pathology , Urinary Incontinence, Stress/pathologyABSTRACT
Evaluar la prevalencia de la disfunción del piso pélvico, factores relacionados, tratamientos y evolución en pacientes gineco-obstétricas de un hospital privado. Estudio descriptivo, retrospectivo, epidemiológico. Se revisaron 4555 historias desde 1998 a 2008 y se seleccionaron 430 con alteraciones del piso pélvico. Se evaluaron los factores asociados: edad, embarazos, partos, distocias, episiotomías, peso máximo fetal, masa corporal, incontinencia urinaria de esfuerzo, infecciones urinarias bajas recurrentes, alteraciones tiroideas, diabetes, fibromatosis uterina, menopausia, intervenciones ginecológicas previas, estreñimiento, trabajos forzados, tos crónica y uso de fajas. Se clasificaron los tipos y grados de prolapsos, tratamientos y complicaciones. Instituto Médico Quirúrgico Ribas. Los Teques, Estado Miranda, Venezuela. Promedio de edad 47,72 ± 11,88 años. Incidencia de disfunción 9,4 por ciento; en 72 por ciento fue un hallazgo del médico, 73,2 por ciento referían incontinencia urinaria de esfuerzo, 18 por ciento infecciones urinarias bajas recurrentes, paridad promedio 3,86 ± 2,59; 21,4 por ciento distocias y 48,8 por ciento episiotomías. Diagnóstico de prolapso 97,4 por ciento, grado II más frecuente 73,3 por ciento. Entre los factores relacionados se encontró: masa corporal elevada, fibromatosis uterina, estreñimiento e intervenciones anteriores. Se indicó tratamiento conservador en 67,3 por ciento, cirugía vaginal 8 por ciento y abdominal 11 por ciento. La incidencia de disfunciones es baja, el cistocele grado II es el más frecuente y está relacionados con incontinencia urinaria de esfuerzo, infecciones urinarias bajas recurrentes, grupo etario entre 40 y 50 años, multiparidad, mayor índice de masa corporal, estreñimiento, fibromatosis uterinas e intervenciones pélvicas previas. El tratamiento más aceptado es la rehabilitación muscular
To evaluate the prevalence of pelvic floor dysfunction, related factors, treatment and evolution in gyneco-obstetric patients in a private hospital. A descriptive, retrospective, epidemiologic study. 4555 records were reviewed from 1998 to 2008 and 430 with pelvic floor disorders were selected. Associated factors such as age, pregnancy, dystocia, episiotomy, fetal weight, body mass, stress urinary incontinence, recurrent lower urinary tract infections, thyroid disorders, diabetes, uterine fibromatosis, menopause, previous gynecologic interventions, constipation, hard work, chronic cough and use of belts were evaluated. Types and degrees of prolapse, treatments and complications were classified. Instituto Médico Quirúrgico Ribas. Los Teques, Estado Miranda, Venezuela. Average age 47.72 ± 11.88 years. 9.4 percent dysfunction incidence; in 72 percent was medical finding, 73.2 percent referred stress urinary incontinence, 18 percent urinary tract infections, average parity 3.86 ± 2.59, 21.4 percent dystocia and 48.8 percent episiotomy. Prolapse diagnosis 97.4 percent, grade II 73.3 percent more frequent. Among the factors were: high body mass, uterine fibromatosis, constipation, and previous interventions. Non surgical treatment was indicated in 67.3 percent, 8 percent vaginal surgery and abdominal 11 percent. The incidence of dysfunction is low, the grade II cystocele is the more common and is associated with stress urinary incontinence, urinary tract infections, age group between 40 and 50 years, multiparity, higher body mass index, constipation, uterine fibromatosis and previous pelvic interventions. The most accepted treatment is the muscular rehabilitation
Subject(s)
Humans , Pelvic Floor/pathology , Urinary Incontinence, Stress/ethnology , Uterine Prolapse/complications , Uterine Prolapse/diagnosis , Uterine Prolapse/etiology , Constipation/etiology , Fibroma/ethnology , Urinary Tract Infections/ethnologyABSTRACT
To evaluate the efficacy of hochuekkito on genital prolapse, 37 patients with genital prolapse or descending organs were studied. Hochuekkito (7.5g/day) was administered to all patients without confirming their Sho. Change of subjective symptoms, consequence of disease, relation between efficacy and grade of prolapse, and adverse effects were evaluated. The mean age of patients was 68.7 years. The mean number of parities was 2.5. No patient was nulliparious, or had over 5 parities. Total efficacy rate for subjective symptoms was 48.9%. The treatment was also effective for those who had suffered from vaginal prolapse after total hysterectomy. At endpoint, six of 37 patients continued taking hochuekkito. Six of 37 patients stopped taking Kampo after all their symptoms had disappeared. Ten of 37 patients received surgery. Nine of 37 patients were set with ring pessaries. Five of 37 patients discontinued their drugs beyond endpoint of their own accord. Adverse events were observed in only one patient. Hochuekkito was considered a useful Kampo drug for those who are suffering from genital prolapse, and do not want to be set with ring pessaries or receive surgery.
Subject(s)
Medicine, Kampo , GenitaliaABSTRACT
OBJETIVO: Evaluar la factibilidad, seguridad y eficacia de la corrección quirúrgica del prolapso genital, con sistema Gynecare Prolift. MÉTODO: Durante junio y agosto del 2006, se realizó corrección de prolapso genital anterior y/o posterior en tres pacientes de la Unidad de Uroginecología y Cirugía Vaginal de Clínica Las Condes. Correspondían a prolapsos grado 2 y 4. RESULTADOS: Se logró una corrección exitosa en los tres casos, no hubo complicaciones intraoperatorias, ni en el postoperatorio inmediato o tardío. El tiempo operatorio fue de 55 y 60 minutos para los dos casos de corrección posterior y de 90 minutos para el de anterior y posterior. La escala visual análoga del dolor a las 12, 24 y 48 horas, fue de puntuación 3. Todas expresaron su entera satisfacción frente a los resultados logrados. CONCLUSIONES: La corrección quirúrgica del prolapso genital con sistema Gynecare Prolift, es factible, seguro y eficaz. Sólo el seguimiento a largo plazo permitirá objetivar la permanencia de estos excelentes resultados.
OBJECTIVE: To evaluate the feasibility, efficacy and safety of the genital prolapse surgery correction with Gynecare Prolift System. METHOD: Between June and August 2006, 3 cases of anterior and/or posterior genital prolapse with this new technique were performed, in patients of Urogynecology and Vaginal Surgery Unit of Las Condes Clinic. The prolapse degree was 2 and 4. RESULTS: The correction was obtained in all cases. Intraoperative, immediate and remote postoperative period not registered any complication. The operating time was 55 and 60 minutes for the posterior correction and 90 minutes for anterior and posterior correction. The pain visual analogue scale at 12, 24 and 48 hours was 3. All patients expressed total satisfaction with the surgical results. CONCLUSIONS: The surgical correction of the genital prolapse with system Gynecare Prolift is feasible, safe and effective. Only the long term following will allow observing the permanence of these excellent results.
Subject(s)
Humans , Middle Aged , Aged , Gynecologic Surgical Procedures/instrumentation , Surgical Mesh , Uterine Prolapse/surgery , Treatment Outcome , Patient Satisfaction , Operative TimeABSTRACT
Neonatal genital prolapse is very rare and is usually associated with meningomyelocele or other anomalies of the central nervous system. Synonyms of genital prolapse are sacropubic hernia, pelvic relaxation, and pelvic organ prolapse. There are two types of genital prolapse including vaginal prolapse and uterovaginal prolapse. We experienced a case of uterovaginal prolapse in a 30 day-old premature infant, which was resolved with hypertonic saline pack on the 78th day of life. We report a case with the review of the literatures.