Colpopexia al ligamento sacroespinoso con CapioTM; cirugía, resultados y evolución de pacientes / Sacroespinous ligament colpopexy with CapioTM; surgery patient outcomes and evolution

Introducción: El prolapso genital femenino altera significativamente la calidad de vida de la mujer. El prolapso apical es el segundo más frecuente después del defecto de pared anterior y la colposuspensión al ligamento sacroespinoso es una de las técnicas quirúrgicas descritas para su tratamiento. Objetivos: Determinar la factibilidad de la corrección del prolapso apical en pacientes sometidas a la colposuspensión al ligamento sacroespinoso, utilizando el dispositivo de captura de sutura CapioTM. Materiales y métodos: Análisis retrospectivo de pacientes intervenidas desde junio de 2015 a junio de 2016, en la unidad de piso pélvico del Hospital Luis Tisné Brousse, basándose principalmente en la evaluación del punto C del Prolpase Organ Pelvic Quatinfication (POP-Q). Resultados: Se intervinieron 15 pacientes, con edad promedio de 60,7 ± 6,8 años. Todas presentaron prolapso genital estadio III o IV. El seguimiento se realizó entre 3 y 13 meses después de la cirugía. Ninguna presentó complicaciones graves durante ni después de la cirugía y sólo una paciente recidivó. Conclusiones: La colposuspensión al ligamento sacroespinoso con CapioTM, es una técnica factible, segura y eficaz para el tratamiento del prolapso apical, sin embargo, es necesario mayor tiempo de seguimiento y estudios comparativos con otras técnicas de colposuspensión.

Introduction: Female genital prolapse significantly alter the quality of life of women. The apical prolapse is the second common defect after anterior wall and the colposuspension to sacrospinous ligament is one of the described surgical techniques for its treatment. Objective: To determine the feasibility of apical prolapse correction in patients undergoing sacrospinous colposuspension using the suture capture device CapioTM. Methods: Retrospective analysis of patients undergoing this surgery from June 2015 to June 2016, including an objective assessment focused mainly in the C point of Prolapse Organ Pelvic Quatinfication (POP-Q) and a subjective evaluation of the patient. Results: 15 patients, of which only 11 were able to complete follow-up, were included. The mean age of the patients at the time of surgery was 60.7 ± 6.8 years, and all were classified as prolapse stages III or IV. The evaluation was performed in average 6.75 ± 3.39 months after surgery, with a minimum of 3 and a maximum of 13 months. No patient had several complications during or after surgery and only one recurred. Conclusions: The colposuspension to sacrospinous ligament with CapioTM is a safe and effective alternative for the treatment of apical genital prolapse. However, a longer follow-up study is needed, in addition to comparative studies with other colposuspension techniques.

Prolapso uterino em gata - Relato de caso / Uterine prolapse in a cat - A case report / Prolapso uterino en gata ­ Relato de caso

O prolapso uterino em cadelas e gatas é uma emergência reprodutiva na qual ocorre eversão de um ou ambos os cornos uterinos através da vagina, durante ou após o parto. Tal patologia não é frequente em gatas, por isso o presente relato tem o objetivo de descrever um caso de prolapso uterino em uma gata atendida no Hospital Veterinário da Universidade Federal do Piauí. Na anamnese o proprietário se queixou de massa avermelhada na vulva após a expulsão de dois filhotes. Ao exame clínico, observou-se que a massa era o útero prolapsado. O animal foi encaminhado imediatamente ao centro cirúrgico para redução do útero prolapsado e realização de ovariosalpingohisterectomia (OSH). Após a OSH, o animal permaneceu internado durante 24 horas. Findo este período o animal teve alta e apresentou boa recuperação.

Uterine prolapse in dogs and cats is a reproductive emergency in which there is the protrusion of one or both uterine horns through the vagina during or after delivery. This condition is not common in cats, so this report aims to describe a case of uterine prolapse in a cat treated at the Veterinary Hospital of the Federal University of Piaui. Upon anamnesis, the owner complained of a reddish mass in the vulva after the expelling of two kittens. Clinical examination revealed that the mass was the prolapsed uterus. The animal was immediately sent to the operating room for reduction of the prolapsed uterus and an ovariosalpingohisterectomy (OSH) was performed. After OSH, the animal remained hospitalized for 24 hours. After this period, the animal was discharged and recovered well.

El prolapso uterino en perras y gatas es una emergencia reproductiva en la cual ocurre eversión de uno o ambos los cuernos uterinos a través de la vagina, durante o después del parto. Tal patología no es común en gatas, este informe tiene como objetivo describir un caso de prolapso uterino en una gata tratada en el Hospital Veterinario de la Universidad Federal de Piauí. En la anamnesis el propietario se quejó de una masa rojiza en la vulva después de la expulsión de dos gatitos. El examen clínico reveló que la masa era el prolapso de útero. El animal fue enviado de inmediato al centro quirúrgico para reducción del prolapso de útero y realización de ovariosalpinghisterectomía (OSH). Después de realizada la OSH, el animal permaneció hospitalizado durante 24 horas. Después de este período, el animal fue dado de alta y se recuperó bien.

Evaluación de calidad de vida pre y posquirúrgica en pacientes con prolapso de compartimiento anterior y posterior / Evaluation of the quality of life outcomes for women with genital tract prolapses

Objetivos: Demostrar la utilidad de un inventario sobe calidad de vida para evaluar síntomas pre y postquirúrgicos en pacientes con prolapso anteior y posterior. Pacientes y métodos: Estudio retrospectivo, longitudinal, comparativo. Enero 2009-diciembre 2010. Se incluyeron 26 ptes, prom: 63 años con prolapso ant (EIII) y post (EII). Tratamiento: colporrafia anterior con malla subvesical y colpoperineorrafia. Evaluación de síntomas genitales, miccionales y defecatorios pre y postquirúrgicos con "Inventario de molestias por trastornos del piso pélvico" de Barber. Se utilizá Prueba Mc Nemar para variables cualitativas. Nivel de significación estadístico p=0.05. Resultados: Síntomas vaginales: preQ en el 100 por ciento. Los más frecuentes: pesadez y bulto vaginal que se redujeron en el postQ a 7 por ciento (p=0,000). Síntomas miccionales: preQ en el 84 por ciento. Los más frecuentes: a) sensación de vaciamiento incompleto de vejiga 77 por ciento que se redujo al 9 por ciento en postQ (P=0,001) y b) Aumento de la frecuencia miccional 68 por ciento que se redujo al 45 por ciento (p=0,063) Sintomas defecatorios preQ 46 por ciento. Los más frecuentes: a) necesidad de aumentar esfuerzo defecatorio 58 por ciento se redujo al 41 por ciento en postQ (P=0500) y b) maniiobras para completar la defecación 33 por ciento que desapareció en postQ (p=0.12). Conclusiones: mediante la utilización del Inventario se pudo comprobar que los resultados fueron estadísticamente significativos para los síntomas vaginales y para los miccionales de vaciado incompleto. El resto de los síntomas a pesar de no ser significativos evidenciaron mejoría en el postoperatorio.

Women with pelvic floor disorders show a negative impact on their quality of life questionnaires. The aim of the present report, was to demonstrate the usefulness of a quality of life questionnaire, to evaluate both pre and postsurgical outcomes in patients with anterior or posterior prolapses. Conclusion: the employement of an Inventary could arrive to the demonstration that the results were statistically significative for the vaginal symptons and for the micturation of incomplete emptiness. The rest of the symptons, despite that they were not significatives, showed improvement during the outcomes.

Prolapso genital: alteraciones del colágeno como factor etiológico / Genital prolapse: alterations of collagen as an etiological factor

The etiological search of pelvic organ prolapse has led to the study of connective tissue that surrounds it directly, called endopelvic fascia. So there have been several studies looking for changes in the main types of collagen existing in this area, trying to describe the changes that they would experience in order to facilitate the prolapse. It has been postulated mainly a decrease in collagen content, thereby reducing the tensile strength of the suspension elements of the pelvic organs and thus descent occurring. However, the literature has been discordant, and published numerous studies that show an increase of collagen in this area, which could be due to a state of pelvic floor repair in patients with various recognized risk factors. Most publications have different biases that preclude a completely valid conclusion. Because of this, still is not clear what changes would experience at the histological level the endopelvic fascia and there is no consensus among different centers. Here is a review of existing literature on this subject with emphasis on different molecular and histological findings of each study and their biases.

Prolapso genital e reabilitação do assoalho pélvico / Pelvic floor rehabilitation and genital prolapse

O prolapso genital é condição comum e importante indicação de cirurgia ginecológica nos dias atuais. A quantificação do prolapso é realizada por meio do POP-Q, uma classificação internacionalmente reconhecida e preconizada pela Sociedade Internacional de Continência (ICS). O suporte dos órgãos pélvicos se dá por um sistema de suspensão, constituído de ligamentos, e outro de sustentação, constituído por fáscias e músculos, especialmente o levantador do ânus, que deve estar íntegro para que possa manter perfeito suporte dos órgãos e o hiato genital fechado. A fraqueza ou defeitos nesse músculo podem levar ao aparecimento de prolapso genital. O tratamento conservador tem ganhado espaço, especialmente em estágios menos avançados do prolapso. Consiste em mudanças nos hábitos de vida diária, tais como redução de peso, diminuição das atividades que aumentam a pressão abdominal, tratamento da constipação intestinal, e intervenções físicas, como o fortalecimento da musculatura do assoalho pélvico. Este estudo constitui um levantamento das evidências científicas acerca do tratamento conservador do prolapso genital, visando proporcionar uma visão mais atual do problema

The pelvic organ prolapse is a common condition and the main cause of gynecologic surgery nowadays. The quantification of genital prolapse is performed by means of POP-Q, an international classification recognized and indicated by the International Continence Society (ICS). The support of the pelvic organs relies on a suspension system, made of ligaments, and a sustentation system, made of fascies or muscles, especially the levator ani, that should be intact in order to give a perfect support for the organs and for close genital gap. The weakness or damages in this muscle can cause genital prolapse. The nonsurgical treatment has been used more frequently, especially in early stages of the prolapse. It consists of changing daily habits, such as reducing weight, decreasing activities that raise abdominal pressure, treating intestinal constipation, and other physical interventions, such as the strengthening of the pelvic floor musculature. This study is a bibliographic evidence-based research about the conservative treatment of the genital prolapse

Histerocele total complicado con miasis a propósito de un caso / Histerocele myiasis complicated by a total of one case

Miasis es la infestación de órganos o tejidos por larvas de moscas. La infestación con larvas de mosca produce diversas manifestaciones según el sitio afectado y puede incluso, causar la muerte. No es una enfermedad común en humanos pero se observa con alguna regularidad en países neotropicales. Afecta con mayor frecuencia las áreas expuestas de la piel y se presenta raramente en ojos, nariz, senos paranasales, tracto urogenital o recto; en estos casos la infestación se asocia con traumas previos o secresiones purulentas que atraen a las moscas adultas. Se presenta el caso de una paciente femenina de 65 años de edad, con prolapso total del útero (histerocele grado IV) complicado con miasis específica por Cochliomya hominivorax.

Avaliação dos glicosaminoglicanos do tecido periuretral de pacientes com e sem prolapso genital / Evaluation of glycosaminoglycans of periurethral tissue in patients with and without pelvic organ prolapse

OBJETIVOS: Caracterizar e quantificar os subtipos de glicosaminoglicanos sulfatados (GAGs) existentes no tecido peri-uretral de pacientes com e sem prolapso genital. METODOS: Foram incluídas 35 pacientes que se submeteram a cirurgia vaginal para correção de distopias genitais e/ou incontinência urinária de esforço ou por outra condição benigna. As pacientes foram avaliadas por anamnese padronizada, exame físico e urodinâmico e agrupadas segundo a existência do prolapso genital. Durante o procedimento cirúrgico, amostras de aproximadamente 1,0 x 1,0 cm do tecido periuretral foram retiradas para avaliação. Os GAGs foram extraídos do tecido por proteólise e precipitação por ácido tricloroacético e caracterizados por eletroforese em gel de agarose. A quantificação foi feita por meio de densitometria a 525 nm do gel corado com azul de toluidina. Compararam-se os dados pela análise de variância (ANOVA). RESULTADOS: Nos grupos estudados, houve maior predomínio de dermatam sulfato (DS), em torno de 85 por cento do total de GAGs, seguido do condroitim sulfato (CS) e do heparam sulfato (HS). Observou-se aumento significativo dos GAGs totais, do DS e do HS em mulheres com prolapso genital. Não se observou diferença significante com relação ao CS. CONCLUSÃO: Este estudo demonstrou diferenças na matriz extracelular do tecido periuretral com aumento de GAGs totais, DS e HS nas mulheres com prolapso genital.

OBJECTIVE: To characterize and quantify periurethral tissue sulphated glycosaminoglycans (GAGs) in women with and without pelvic organ prolapse. STUDY DESIGN: Periurethral tissue was obtained from 35 women who underwent surgery for pelvic organ prolapse, for stress urinary incontinence, or for other gynecological benign conditions. Patients were submitted to a clinical history, physical and urodynamic examination and were divided in two groups according to genital prolapse. The standard biopsy with 1.0 x 1.0 cm was taken from periurethral tissue during surgery and assessed by biochemical methods. The GAGs were obtained by proteolysis and precipitated by trichloroacetic acid. The relative concentration of sulfated GAGs was determined by densitometry of toluidine blue stained gel using a spectrophotometer with a 525 nm wavelength. Data were compared using analysis of variance (ANOVA). RESULTS: In the two groups dermatan sulphate (DS) was the predominant glycosaminoglycan (85 percent), followed by chondroitin sulphate (CS) and heparan sulphate (HS). Women with pelvic organ prolapse had significantly more total GAGs, DS and HS. Differences in CS were not observed. CONCLUSIONS: This study showed altered biochemical characteristics in the extracellular matrix of periurethral tissue and also accumulation of GAGs, DS and CS, in women with pelvic organ prolapse.

Cura de prolapso de cúpula vaginal según técnica quirúrgica del Doctor Alfredo Halabí / Cure for vaginal vault prolapse surgical technique according to Dr. Alfredo Halabí

Dar a conocer los resultados obtenidos en la fijación de cúpula vaginal utilizando la técnica quirúrgica del Dr. Alfredo Halabí realizada en la Policlínica Metropolitana de Caracas y en el Hospital "Luis Salazar Domínguez" IVSS, Guarenas. El presente estudio fue realizado en 45 pacientes con edades comprendidas entre 43 y 78 años, con prolapso de cúpula vaginal, las cuales fueron sometidas a cirugía con la técnica del Dr. Halabí. De las 45 pacientes, los resultados obtenidos fueron satisfactorios y hasta la presente fecha, no se ha detectado ninguna recurrencia del prolapso de cúpula vaginal. Se puede concluir la eficacia de la técnica quirúrgica Dr. Halabí, para corregir el prolapso de la cúpula vaginal, la cual es una alternativa eficiente, segura y de procedimiento sencillo para el manejo de las pacientes con esta patología.

Histopathological analysis of hysterectomy specimens.

This was a retrospective study carried out on all hysterectomy specimens sent to Department of Pathology of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 1st September 2005 to 28th February 2006, to study the histopathological findings of these specimens. All informations used in the study were obtained from the records of Department of Pathology of the hospital. Out of 221 hysterectomy specimens received during the study period, 139 (62.9%) were total abdominal and 82 (37.1%) were vaginal hysterectomy specimens. Mean age of the patient was 53.4 years for vaginal hysterectomy group where as it was 37.6 years for total abdominal hysterectomy with unilateral salpingo-oophorectomy and 46.3 years for total abdominal hysterectomy with bilateral salpingo-oophorectomy group. Uterine prolapse was commonest indication of hysterectomy overall (37.1%) and accounted for 98.8% of vaginal hysterectomies. Other common indications of hysterectomy were uterine fibroid (24.9%), ovarian tumor (14.9%) and dysfunctional uterine bleeding (7.7%). Leimyoma was the most common pathology found in uterine corpus (27.1%). Chronic cervicitis in cervix, functional cysts in ovaries and paratubal cysts in fallopian tubes were most common histological findings. Ovarian neoplasms accounted for 18.3% of ovarian pathology. 38% specimens were unremarkable histopathologically. In Tribhuvan University Teaching Hospital, abdominal hysterectomies are more common than vaginal hysterectomies. Most vaginal hysterectomies are done for uterine prolapse and patients are older than those undergoing abdominal hysterectomies. Most abdominal hysterectomies are performed for uterine leiomyomas. Hysterectomy specimens may be unremarkable histopathologically, most of which are vaginal hysterectomies done for uterine prolapse.

Histopathological analysis of hysterectomy specimens.

The objective of this study was to explore the histopathological findings and the rate of removal of ovaries in hysterectomy specimens. This study took into account 328 hysterectomy specimens examined in the Department of Pathology, Mymensingh Medical College and in one private Pathology Laboratory in Mymensingh town from March to August, 2005. Formalin fixed paraffin embedded tissue sections stained with haematoxylin and eosin were examined under light microscope. Patients' age, parts of uterus examined and their histopathological findings were retrieved from laboratory records. The common histopathological findings were: chronic cervicitis (87.80%), leiomyoma (17.07%), uterine prolapse (16.72%), adenomyosis (3.96), non-specific endometritis (3.35%), squamous cell carcinoma of cervix (2.44%), endometrial polyp (2.44%), serous cystadenoma of ovary (2.44%) and endometrial hyperplasia (1.83%). Some of the specimens show more than one lesions in the body of uterus, of which coexistence of adenomyosis and leiomyoma was the most common. Neoplastic lesions in cervix were 4.27%, in body 16.92% and in ovaries 5.06%. Malignant neoplasms were found in cervix 71.43%, in uterine corpus 3.03% and in ovaries 25%. Ovaries of both sides were removed in 48.17% of total cases. Their median age was 45 years, lowest age 23 years and maximum age was 82. The rate of removal of both ovaries was found to be increasing with the increase of age. Only one case was found to be subtotal hysterectomy and others were total hysterectomy. The present study revealed that the most common histopathological cause of hysterectomy is chronic cervicitis. Most common neoplastic cause of hysterectomy is leiomyoma. The rationalities and the possible after effect of hysterectomy in sexual functions and other physiological impairment should be followed up.

The Relationship between Maximal Urethral Closure Pressure and Functional Urethral Length in Anterior Vaginal Wall Prolapse Patients According to Stage and Age

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n=13), 50s (n=53), 60s (n=54), and 70 and over (n=16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n=35), stage III (n=76), and stage IV (n=25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.

Melanosis of uterine cervix: a report of two cases.

Uterine prolapse is a common gynecological problem which is associated with complications like keratinisation, thickening and ulceration of cervical mucosal epithelium. Two cases of second degree uterine prolapse are being reported here showing heavy melanotic pigmentation of the basal layers of ectocervical epithelium. It appears to be a metaplastic change in response to local trauma or chronic irritation.

Tratamiento del prolapso de cúpula vaginal con sacrocolpopexia

El prolapso de cúpula vaginal posthisterectomía es una entidad de díficil manejo quirúrgico; una de las técnicas más utilizadas es la fijación de la cúpula vaginal al sacro, la cual requiere hacer tunelización retroperitoneal con el riesgo de lesiones vasculares, por eso en la técnica que en este trabajo se describe se obvia la disección retroperitoneal extensa, recurriendo a un artificio realizado con el peritoneo. Material y Métodos: Se estudiaron 14 pacientes con prolapso de cúpula a quienes se les realizó sacrocolpopexia modificada sin tunelización retroperitoneal con dacrón de injerto vascular; se hizo seguimeinto al mes, tres meses, seis meses y luego anualmente. Resultados: La edad promedio de las pacientes fue de 56.5 años, el tiempo quirúrgico promedio fue de 32.5 minutos. No hubo complicaciones intra ni postoperatorias. La estancia hospitalaria fue en promedio de 4 días. Hasta el momento no ha habido recidiva con un seguimiento entre 6 meses y 6 años, habiendo completado el 71.42 por ciento de las pacientes un seguimiento de 4 años. Conclusiones: Esta técnica disminuye el riesgo de lesiones intraoperatorias al evitar la extensa disección retroperitoneal, sin incrementar costos, ni estancia hospitalaria, con baja posibilidad de recidivca por lo cual esta técnica puede incluirse dentro de los recursos quirúrgicos para el manejo de esta entidad

Prolapso de mucosa uretral em meninas / Urethral Mucosa Prolapse

Entre janeiro de 1985 e dezembro de 1993 foram tratadas seis meninas com prolapso de mucosa uretral através da exérese cirúrgica de prolapso e ampliaçäo do meato uretral externo. A patologia predominou em criança de pele negra e classe social baixa. Os principais sintomas e sinais foram sangramento vaginal e tumores a nível do meato uretral externo. Os resultados, com seguimento de um mês, três meses, nove meses, 12 meses e 24 meses foram excelentes

Histological study of the endometrium in menopausal women with breast carcinoma

The first reference concerning the multiple primary malignant neoplasms was made by Bilroth, 1880 and since then a large number of studies have been published. Furthermore, an increasing incidence of simultaneous cancers are currently observed (16,18). At the same time, several retrospective populational studies evidenced the association between breast and endometrium carcinoma. It is well known that both uterus and breast are hormone-dependent organs and are likely to be influenced by the same oncogenic stimulus, either of endocrine nature or dietary origin (2, 3, 14). The risk of developing endometrial carcinoma is higher in patients already affected by breast neoplasm and is much more evident in older women within the first five years following the diagnosis of breast tumor. Conversely, patients with endometrial carcinoma may present a second mammary neoplasm and the relative risk is around 2.0 (1, 17). Although the existence of a correlation between these two primary malignant neoplasms is clearly observed, the absence of systematic studies directed to the screening of endometrial cancer in women with breast carcinoma is surprising. This study deals with histological analysis of the endometrium of postmenopausal patients with breast cancer and aims to determine the possible changes that might have occurred in the onset of the disease

Achados colposcópicos, citológicos e histológicos em portadores de prolapso do útero de II§ e III§ graus / Colposcopic, cytologic and histologic findings in patients with uterine prolapse of second and third degree

Entre 1983 e 1985 foram estudadas na Clínica Ginecológica da Faculdade de Medicina da Universidade de Säo Paulo 199 pacientes com prolapso do útero de II§ (140 pacientes) e III§ (59 pacientes) graus. A média etária foi 56,7. Todas pacientes foram submetidas a tratamento cirurgico. O objetivo deste trabalho é estudar os aspectos colposcópicos, citológicos e histológicos e correlacionar os mesmos. os resultados demonstraram: colpocitologia oncótica classe I, II, III e 0 em 51 (25,6%), 129 (64,8%), 7(3,5%) e 12(6,9%) casos, respectivamente. Os principais achados colposcópicos foram: mucosa apegaminhada em 55(27,6%), zona de transformaçäo típica 38(19,1%) e úlcera de decúbito 27(13,6) casos. O estudo anatomopatológico do colo do útero na peça operatória revelou: cervite crônica em 195 (97,9%), polipo endocervical em dois (1,0%) e carcinoma "situ" en dois (1,0%). Concluem os autores da importância da propedêutica acurada nos casos de prolapso do úteo devido a possível associaçäo com o carcinoma do colo