Tratamiento del síndrome genitourinario de la menopausia mediante láser fraccionado CO2: una opción terapéutica emergente / Treatment of genitourinary syndrome of menopause by CO2 fractional laser: an emerging therapeutic option

Estudios recientes han demostrado que el láser fraccionado es una opción terapéutica no hormonal efectiva, sencilla, bien tolerada y sin efectos adversos, para el tratamiento del Síndrome Genitourinario de la Menopausia. La reacción térmica originada produce la restauración del epitelio vaginal, un proceso de neocolagénesis y una mayor vascularización que favorece la llegada de nutrientes, reestableciéndose la estructura de la mucosa, su grosor y trofismo funcional, mejorando por tanto la sintomatología. No obstante, se precisan estudios a largo plazo, controlados, frente a estrógenos locales y otros tratamientos no hormonales para validar la duración de los efectos y la seguridad de las sucesivas aplicaciones. El objetivo de este trabajo es revisar la evidencia relacionada con esta terapia emergente.

Recent reported studies have demonstrated that non-invasive fractional laser is a valid, safe, effective and well tolerated therapeutic option, without adverse events to treat the Menopause Genitourinary Syndrome. The heat shock effect induces the increase of vaginal epithelium thickness, the new glycogen content and the vascular changes, improving the vaginal epithelium structure, functionality and menopausal symptoms. Nevertheless, duration of treatment effects and safety of repeated session are not clear enough. Further controlled long-term follow-up research on laser versus local estrogens and other non-hormonal therapies are needed. The objective of this paper is to review the scientific evidence related to this emergent treatment.

Management of total urinary incontinence in females a two years experience

A prospective study of 7 cases in Urology Department at Sir Ganga Ram Hospital Lahore was carried out from September 1994 to September 1996. All patients presented with urinary incontinence [100%]. One patient [14.3%] was having associated pain Left Lumber Region and one [14.3%] pain Left Iliac fossa. The age varied from 14 to 40 years, with mean age of 28 years. Six patients [85.7%] were having ureterovaginal fistulae and one [14.3%] a vesicovaginal fistula. One [14.3%] of the ureterovaginal fistulae was result of a congenital opening of one of the double ureters in the vagina. One [14.3%] resulted from involvement of ureter in a growth. Four [57.1%] of the ureterovaginal fistulae and one [14.3%] vesicovaginal Fistula were result of some obstetrical surgery. In all the cases of the ureterovaginal fistulae, the ureters were implanted in urinary bladder with D.J. Stent, while vesicovaginal fistula was repaired with delayed absorbable vicryl 2/0. The results were 100%

On proper drainage by split drains in genito-urology surgery

A thorough statistical analysis of the results of drainage types and drain properties adopted in 3327 cases of genitourology operated upon in 5 years showed the following : 1. Due to rich vascularity of the genito urinary organs, the usual urine collection drainage has become a must. 2. Drain by plastic or silicon coated corrugated sheet or multiparous tubes gave better results 3. The suitable breadth of the sheet drain is of 3 corrugations while the optimum size of the tube or catheter is Fr 16 or 14. 4 Multiple tubular sheet silicon coated may not sensibly be the best drain, as pores are narrow. Besides, this was not available in this work. 5. Gauze drain is not suitable in urological drain as harbours infection due to presence of urine, thus should be avoided. 6. As regards the site of drain fixation, the split one i.e. from a stab incision about 1 inch from the wound incision is superior to the traditional drain from the wound incision itself. Moreover, the interior end of the drain should be located in the most dependent part of the depth of the operation. 7. The surface length of the drain should be neither too long to hinder dressing nor too short to retract inside the wound edges; 3 cm are satisfactory. 8. Consistency of the drain not to be too soft as it may impede drainage when compressed by oedema of the healing wound as well as it would be liable to cut off on removal. On the other hand, the hard drains are painful to the healing sensitive tissues of the operation on movement 9. Mulitplicity of individual drains may be helpful and necessary. However, it is contraindicated to use the drain by cleavage of its interior segment. 10. Drainage efficiency implies insinuating the drain into the most independent part of the operative wound to avoid blood and/ or urine collection. 11. Removal of the drain is to be experienced gently, if it resists extraction no force is exerted and is left for extra time till any probable unnoticeable catgut stitch hitching it, is absorbed. 12. The most suitable period of drainage is for 6 days. However, when intestine is involved as a step of operation, peritoneal drainage may be exceptional as long as 12 to 15 days. 13. The mean hospital stay is shortest in the second group of drainage [6 days period] with consequently less hospital running expenses, besides a more satisfaction to both the patient and the surgeon