ABSTRACT
El leiomioma parauretral es una patología poco frecuente, se trata de un tumor mesenquimatoso no dependiente de uretra y que ocasiona sintomatología uroginecológica en la paciente. Su manejo es principalmente quirúrgico. No se reportan casos de malignización, recidiva, ni metástasis y su diagnóstico diferencial se debe realizar con todas las patologías de masas uretrales y para-uretrales. El presente caso describe la presencia de este tumor en una mujer post-menopaúsica de 60 años, que además de presentar incontinencia urinaria mixta, refería signos obstructivos urinarios, fue diagnosticada y manejada de manera quirúrgica: Resección de tumor y posterior ubicación de cinta suburetral.
The paraurethral leiomyoma is a rare pathology, it is a mesenchymal tumor not dependent of the urethra which causes urogynecological symptoms in the patient. Its management is mainly surgical. No cases of malignancy, recurrence or metastasis are reported and its differential diagnosis must be performed with all pathologies of urethral and para-urethral masses. The present case describes the presence of this tumor in a 60-year-old post-menopausal woman who, in addition to presenting mixed urinary incontinence, referred obstructive urinary signs, was diagnosed and managed surgically: tumor resection and subsequent placement of suburethral tape.
Subject(s)
Humans , Diagnostic Techniques, Obstetrical and Gynecological , Leiomyoma/diagnostic imaging , Urinary Incontinence/drug therapy , Magnetic Resonance SpectroscopyABSTRACT
Objective To compare urodynamic studies (UDS) and perineal sonography for assessing mixed urinary incontinence (MUI) in women. Methods A total of 118 adult females with MUI and 30 controls were enrolled from September, 2010 to December, 2017. Their baseline clinical characteristics were recorded. The MUI patients were divided into stress-predomi-nant (S-MUI, n=51), urge-predominant (U-MUI, n=34) and equal predominance (E-MUI, n=33) according to King's Health Questionnaire. Both UDS and perineal sonography were performed in all the subjects. Tolerability of the two methods was compared. Results For sonography parameters, compared with the controls, S-MUI patients had greater dynamic posterior urethral angle, dynamic angle of urethral inclination, dynamic pubo-urethral distance and descent of bladder neck (P<0.001), U-MUI patients had greater detrusor thickness (P<0.05), and E-MUI patients had greater descent of blad- der neck (P<0.05). For UDS parameters, compared with the controls, S-MUI patients had lower Pure.clos.max and functional urethral length; U-MUI patients had lower Qmax, smaller bladder volume, higher Pdet.open, high-er Pdet.Qmax and higher incidence of detrusor overactivity; and E-MUI patients had higher Pdet.Qmax and low-er Pure.clos.max (P<0.05). All UDS and sonography parameters differed significantly between S-MUI and U-MUI patients. The descent of the bladder neck, dynamic angle of urethral inclination, and dynamic puboure-thral distance were negatively correlated with detrusor pressure at maximal flow and functional urethral length, while detrusor wall thickness was positively correlated with detrusor pressure at maximal flow and functional urethral length. Perineal ultrasound was better tolerated than UDS in 82.3% patients. Conclusion Perineal sonography parameters show good correlation with UDS parameters. Ultrasonography is better tol-erated than UDS and provides additional morphologic data. Perineal sonography could facilitate to diagnose U-MUI.
ABSTRACT
Resumen OBJETIVO Evaluar el éxito subjetivo y analizar las complicaciones de la aplicación de la cinta transobturadora en el tratamiento de pacientes con incontinencia urinaria de esfuerzo. MATERIALES Y MÉTODOS Estudio de cohorte simple, retrospectivo, al que se incluyeron pacientes a quienes entre los años 2008-2016 se les colocó una cinta transobturadora. Se consideró éxito subjetivo cuando la paciente negó la pérdida de orina por interrogatorio; se registraron las complicaciones intra y posoperatorias. Se realizó estadística descriptiva (SPSS 24.0.), χ2 para variables cualitativas y t de Student para cuantitativas; para determinar los factores de riesgo se obtuvieron la razón de momios y el IC95%. RESULTADOS Se incluyeron 292 pacientes con edad promedio de 51 ± 10 años, 48.6% (n = 141) con diagnóstico de incontinencia urinaria de esfuerzo, 47.2% (n = 139) con incontinencia urinaria mixta, 3.4% (n = 10) con alto riesgo de incontinencia urinaria de novo posterior a la cirugía de prolapso pélvico, 0.68% (n = 2) con incontinencia urinaria oculta. A 214 (73.2%) pacientes se les realizó cirugía concomitante por prolapso de órganos pélvicos. La tasa de curación subjetiva de incontinencia urinaria de esfuerzo fue de 95%; las complicaciones transquirúrgicas fueron: lesión vesical (n = 3) y lesión uretral (n = 1) e inmediatas: retención urinaria 11.3% (n = 33). Las pacientes con falla quirúrgica eran de mayor edad y paridad que las que tuvieron éxito subjetivo (4 ± 2.4 vs 2.72 ± 1.9, p = 0.045 y 56.44 ± 11.6 vs 51.29 ± 9.8, p = 0.007, respectivamente). CONCLUSIONES En el tratamiento de la incontinencia urinaria de esfuerzo la colocación de una cinta transobturadora tiene altas tasas de curación subjetiva y bajos índices de complicaciones. La edad y la paridad son factores asociados con la falla del tratamiento quirúrgico.
Abstract OBJECTIVE To evaluate the subjective success and analyze the complications of transobturator tape application in the treatment of stress urinary incontinence. MATERIAL AND METHODS Retrospective single cohort study. Patients who were placed to transobturator tape application from 2008-2016 were included. Subjective success of Stress Urinary Incontinence was defined when the patient denied urine loss by questioning, intra and postoperative complications were recorded. With the SPSS 24.0 program was done descriptive statistics, χ2 for qualitative variables and t student for quantitative. Odds Ratio and Confidence Intervals of 95% (95% CI) to determine the risk factors. RESULTS 292 patients, average age of 51 ± 10 years, 48.6% (n = 141) with a diagnosis of SUI, 47.2% (n = 139) mixed urinary incontinence, 3.4% (n = 10) with high risk of de novo urinary incontinence after pelvic prolapse surgery, 0.68% (n = 2) with occult urinary incontinence. To 214 (73.2%) concomitant surgery for pelvic organ prolapse was performed. The subjective cure rate of stress urinary incontinence was 95%, the trans-surgical complications: bladder injury (n = 3) and urethral injury (n = 1) and immediate complications: urinary retention in 11.3% (n = 33). Patients with surgical failure was increased age and parity than patients with subjective success (4 ± 2.4 vs 2.72 ± 1.9, p = 0.045 and 56.44 ± 11.6 vs 51.29 ± 9.8, p = 0.007, respectively). CONCLUSIONS Transobturator tape application placement has high subjective cure rates for the treatment of stress urinary incontinence and low complication rates.
ABSTRACT
PURPOSE: The purpose of this study was to analyze the relationship between lower urinary tract symptoms and urodynamic parameters to investigate the characteristics of mixed urinary incontinence (MUI) and stress urinary incontinence (SUI). METHODS: The subjects were 318 women with MUI and 128 women with SUI. Data were collected retrospectively from electronic medical records including Bristol Female Lower Urinary Tract Symptoms-Scored Form (BFLUTS-SF), Incontinence Quality of Life Instrument (I-QOL), voiding diaries, and urodynamic parameters. RESULTS: Compared with the SUI group, the MUI group was older and showed lower I-QOL and more severe urinary tract symptoms. The MUI group had more urinary frequency, more nocturia, and a higher urgency score than the SUI group. In the correlation analysis, the greatest difference between the two groups was that urgency was associated with Qmax, maximal cystometric capacity, and detrusor condition over activity only in the MUI group (r=−.175, p=.004; r=−.281, p<.001; r=.232, p<.001, respectively). CONCLUSION: As a result of this study, we propose that a customized management program that emphasizes the control of pelvic floor for the MUI group, and one that effectively strengthens the weak pelvic floor for the SUI group.
Subject(s)
Female , Humans , Electronic Health Records , Lower Urinary Tract Symptoms , Nocturia , Pelvic Floor , Quality of Life , Retrospective Studies , Urinary Incontinence , Urinary Tract , UrodynamicsABSTRACT
Maobushisaishinto was given to 10 elderly female patients with stress urinary incontinence (SUI) for 4 weeks. Five patients showed SUI improvement with its herbs. The mean age for the effective group was higher than that for the non-effective group (73.2 vs 50.2 yrs old ; p = 0.08). In former group, 2 cases demonstrated a remarkable effect ; one with the number of pads used decreasing from 8 to 2 and the other decreasing from 4 to 1.<br>Because of the possibilities of urethral pressure elevation with ma huang (the mao component) and improvement of detrusor overactivity with Fu zi (the bushi component), maobushisaishinto may be applicable for the aged female suffering from SUI.
ABSTRACT
Recently, QOL has become an important consideration when giving medical treatment. The development of treatments for urinary incontinence, a condition which greatly affects QOL, however, has been late in coming, because there are few critical symptoms. We experienced three cases of urinary incontinence successfully treated with ryokyojutsukanto. Case 1 was a 63-year-old woman. She had developed stress urinary incontinence (SUI) from about 30 years of age. As she came to be aware of lumbago and numbness of legs, she sought Kampo treatment. Tokishakuyakusangoninjinto was ineffective, but her all symptoms were improved with ryokyojutsukanto. Case 2 was a 46-year-old woman. She had become aware of incontinence after delivery of her first child (at 27 years of age), and she received Kampo treatment for lumbago and her incontinence. Tokishakuyakusankabushi was slightly effective for her lumbago, but ineffective for her incontinence. These symptoms were improved after a change to ryokyojutsukanto. Case 3 was a 70-year-old woman. She developed a bladder/bowel disturbance, and mixed urinary incontinence (MUI) caused by conus syndrome with a compression fracture of Th12 vertebral body. With ryokyojutsukanto, her fecal incontinence disappeared, and her lumbago and urinary incontinence showed a tendency toward improvement.
Subject(s)
Urinary Incontinence , Low Back PainABSTRACT
PUPPOSE: We wanted to investigate outcomes after midurethral sling(MUS) operations for treating women with mixed urinary incontinence(MUI) and we wanted to identify the factors for achieving a favorable outcome. MATERIALS AND METHODS: The retrospective data was collected for 279 women with MUI and who underwent a MUS operation with at least 2 years follow up. The following measures were recorded before MUS: a disease-specific validated questionnaire, 1-hour pad tests, standardized stress tests and urodynamic study. The patients were divided as followed; a predominance of bothering symptoms(stress-predominance, urgency-predominance) and the presence of detrusor overactivity(DO). The patients with DO were further classified into the high detrusor pressure (HPDO) group and the low pressure(LPDO) group with a reference level of 15cmH2O of maximum detusor pressure at which involuntary contraction occurred during filling cystometry. The patient's postoperative global impression of improvement, the Bristol Female Lower Urinary Tract Symptom(BFLUTS) score, improvement of stress incontinence(SUI) and urgency were analyzed. RESULTS: The overall success rate of SUI was 96.4%. The predominance of bothering symptoms or the presence of DO did not influence the over all SUI success rate. In a subgroup of women with DO, those women with LPDO showed a significantly higher SUI cure rate than those with HPDO. Urge incontinence resolved in 176(63.1%) and it improved in 60(21.5%), while it was aggravated or it persisted in 43(15.4%). Women with stress- predominant MUI, DO and LPDO experienced better resolution of urgency incontinence, an improved quality of life(QoL) and a higher global impression of improvement. CONCLUSIONS: Our results suggest that women with stress-predominant MUI and without DO or with LPDO are more likely to be cured of their urge urinary incontinence after a MUS operation for treating mixed urinary incontinence.