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2.
Fisioter. Bras ; 22(5): 697-711, Nov 11, 2021.
Article in Portuguese | LILACS | ID: biblio-1353485

ABSTRACT

Prolapso de órgão pélvico (POP) consiste no deslizamento de órgãos pélvicos femininos através do introito vaginal, por falhas no sistema de suporte. Acredita-se que a etnia esteja diretamente associada ao aparecimento do POP. Objetivo: Revisar estudos publicados nos últimos 5 anos para verificar a relação entre etnia e a incidência de prolapso de órgãos pélvicos em mulheres de diversas raças. Métodos: Revisão integrativa de literatura efetuada através de uma busca em artigos científicos publicados em revistas impressas e eletrônicas no período compreendido entre os anos de 2015 e março de 2020, nas bases PubMed, Bireme e PEDro. Resultados: Foram incluídos 4 estudos segundo os critérios de elegibilidade. Foram identificados estudos sobre diferenças étnicas em POP ou períneo descendente. A população estudada foi de mulheres afrodescendentes, caucasianas e asiáticas. Na avaliação metodológica, apenas um estudo foi considerado moderado, enquanto os demais foram considerados fortes. Conclusão: A análise dos dados foi capaz de demonstrar diferenças em sintomas, nos perfis genético, metabólico e de composição das fibras musculares. Observou-se que mulheres afrodescendentes apresentam maior índice de prolapsos de parede anterior, as caucasianas de parede posterior e asiáticas apresentaram maior descida uterina e prolapsos de cúpula vaginal.


Subject(s)
Ethnicity , Pelvic Organ Prolapse , Women , Pelvic Floor
4.
Rev. bras. ginecol. obstet ; 43(7): 570-577, July 2021. tab, graf
Article in English | LILACS | ID: biblio-1347252

ABSTRACT

Abstract Sacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication.We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of imageguided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.


Resumo A colpopexia sacral é um dos procedimentos padrão para tratar o prolapso de órgãos pélvicos apical. Na maioria dos casos, uma tela sintética é usada para facilitar a colposuspensão. A espondilodiscite é uma complicação rara, mas potencialmente grave, que deve ser prontamente diagnosticada e tratada, apesar da falta de consenso no manejo dessa complicação. Relatamos um caso de espondilodiscite após histerectomia supracervical laparoscópica e colpopexia sacral tratada conservadoramente. Também apresentamos uma revisão da literatura sobre essa complicação rara. Uma abordagem conservadora sem remoção da tela pode ser possível em pacientes selecionadas (estáveis, sem lesões vaginais, exposição da tela ou comprometimento neurológico grave). Hemoculturas e cultura de biópsias guiadas por imagem devemser realizadas para direcionar a antibioticoterapia. O tratamento conservador versus o cirúrgico deve ser avaliado regularmente, dependendo da progressão clínica e analítica. Uma equipe multidisciplinar é de suma importância no acompanhamento desses pacientes.


Subject(s)
Humans , Female , Discitis/etiology , Uterine Prolapse/surgery , Laparoscopy , Gynecologic Surgical Procedures , Surgical Mesh/adverse effects , Pelvic Organ Prolapse/surgery , Conservative Treatment
7.
Int. braz. j. urol ; 47(1): 82-89, Jan.-Feb. 2021. tab
Article in English | LILACS | ID: biblio-1134308

ABSTRACT

ABSTRACT Purpose: We aimed to determine pre-operative and post-operative sexual function scores of patients who underwent four-arm polypropylene mesh implantation surgery to treat urinary incontinence and pelvic organ prolapse. Materials and Methods: A prospective study from January 2011 to November 2015 including patients (n: 72) submitted to surgical mesh implantation (four-arm anterior mesh implant (Betamix POP4®, Betatech Medical, Turkey) questioned the patients with Female Sexual Function Index evaluation form. The questionnaire was applied to all patients at pre-operative, post-operative 3rd month and post-operative 1st year periods. Results: The mean age of the patients was 47.2±7.1 years. The mean Body Mass Index (kg/m2) was 28.7±3.7. The average of incontinence duration (year) was 4.6±2.6 and the average for operation time (min) was 35.7±2.1. After the urinary incontinence and pelvic organ prolapse surgery, it was observed that incontinence complaints of patients reduced. Furthermore, there was a positive change in quality of life and sexual function of patients at the post-operative period. There was a statistically significant increase according to Female Sexual Function Index score among all three periods (16%, 86% and 100% respectively, p=0.001) and improvement of sexual functions was observed. Conclusions: Transvaginal mesh use in the surgical treatment of pelvic organ prolapse improves quality of life. However, risk factors such as transvaginal mesh usage indication, surgical technique and experience of the surgeon, suitability of the material, the current health status of the patient and postoperative personal care of the patient may affect the success of operations.


Subject(s)
Animals , Female , Adult , Urinary Incontinence , Pelvic Organ Prolapse/surgery , Quality of Life , Surgical Mesh/adverse effects , Turkey , Prospective Studies , Surveys and Questionnaires , Treatment Outcome , Middle Aged
8.
Rev. bras. ginecol. obstet ; 43(1): 46-53, Jan. 2021. tab, graf
Article in English | LILACS | ID: biblio-1156084

ABSTRACT

Abstract Objective Magnetic resonance imaging (MRI) has been considered another tool for use during the pre- and postoperative periods of the management of pelvic-organ prolapse (POP). However, there is little consensus regarding its practical use for POP and the association betweenMRI lines of reference and physical examination.We aimedto evaluate the mid- to long-term results of two surgical techniques for apical prolapse. Methods In total, 40 women with apical POP randomized from 2014 to 2016 underwent abdominal sacrocolpopexy (ASC group; n = 20) or bilateral vaginal sacrospinous fixation with an anterior mesh (VSF-AM group; n = 20). A physical examination using the POP Quantification System (POP-Q) for staging (objective cure) and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: subjective cure), were applied and analyzed before and one year after surgery respectively. All MRI variables (pubococcigeous line [PCL], bladder base [BB], anorectal junction [ARJ], and the estimated levator ani subtended volume [eLASV]) were investigated one year after surgery. Significance was established at p < 0.05. Results After a mean 27-month follow-up, according to the MRI criteria, 60% of the women were cured in the VSF-AM group versus 45% in ASC group (p= 0.52). The POP-Q and objective cure rates by MRI were correlated in the anterior vaginal wall (p= 0.007), but no correlationwas foundwith the subjective cure. The eLASVwas largeramongthe patients with surgical failure, and a cutoff of ≥ 33.5mm3 was associated with postoperative failure (area under the receiver operating characteristic curve [ROC]: 0.813; p= 0.002). Conclusion Both surgeries for prolapse were similar regarding theobjective variables (POP-Q measurements and MRI cure rates). Larger eLASV areas were associated with surgical failure.


Resumo Objetivo A ressonância magnética (RM) tem sido considerada uma outra ferramenta para uso pré e pós-operatório em casos de prolapso de órgãos pélvicos. Contudo, pouco consenso existe sobre a sua prática para prolapso e a associação entre as linhas de referência da RM e o exame físico. Nós objetivamos avaliar resultados de médio a longo prazo de duas técnicas cirúrgicas para prolapso apical. Métodos Um total de 40mulheres com prolapso apical foramsubmetidas entre 2014 a 2016 a sacrocolpopexia abdominal (grupo SCA; n = 20) ou fixação bilateral vaginal no ligamento sacroespinhoso com tela anterior (grupo FVLS-TA; n = 20). Os exames físicos comestadiamento usando o Pelvic Organ Prolapse Quantification System (POP-Q: cura objetiva), e o International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: cura subjetiva) foram analisados antes e depois de um ano da cirurgia, respectivamente. O exame de RM (linha pubococcígea [LPC], base vesical [BV], junção anorretal [JAR] e o volume subtendido estimado do levantador do ânus [VSELA]) foi realizado um ano antes da cirurgia. Estabeleceu-se o nível de significância em 5%. Resultados Depois de uma média de 27 meses de seguimento, de acordo com a RM, 60% das mulheres foram curadas no grupo FVLS-TA versus 45% no grupo SCA (p = 0.52). As curas objetivas associadas ao POP-Q e à RM foram correlacionadas na parede vaginal anterior (p = 0.007), mas nenhuma correlação foi encontrada com a cura subjetiva. O VSELA foi maior entre as pacientes com fracasso da cirurgia, e um ponto de corte de ≥ 33.5mm3 esteve associado ao fracasso da cirurgia (area sob a curva característica de operação do receptor [COR]: 0.813; p = 0.002). Conclusão Ambas as cirurgias para o prolapso foram similares nas curas objetivas tanto pelo POP-Q quanto pela RM. Áreas maiores de VSELA estiveramassociadas como fracasso das cirurgias.


Subject(s)
Humans , Female , Aged , Pelvic Organ Prolapse/diagnostic imaging , Postoperative Complications , Gynecologic Surgical Procedures , Magnetic Resonance Spectroscopy , Randomized Controlled Trials as Topic , Surveys and Questionnaires , ROC Curve , Treatment Outcome , Pelvic Organ Prolapse/surgery , Middle Aged
9.
Chinese Medical Journal ; (24): 200-205, 2021.
Article in English | WPRIM | ID: wpr-878027

ABSTRACT

BACKGROUND@#It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.@*METHODS@#A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided).@*RESULTS@#The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107).@*CONCLUSIONS@#The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.@*TRIAL REGISTRATION NUMBER@#NCT03620565, https://register.clinicaltrials.gov.


Subject(s)
China , Female , Gynecologic Surgical Procedures/adverse effects , Humans , Pelvic Floor/surgery , Pelvic Organ Prolapse/surgery , Surgical Mesh/adverse effects , Treatment Outcome , Vagina
10.
Article in Chinese | WPRIM | ID: wpr-921556

ABSTRACT

Objective To observe the patients after transvaginal mesh(TVM)implantation surgery by using transperineal ultrasound(TPUS),compare the diagnosis of pelvic organ prolapse(POP)by TPUS and clinical examination[according to the Pelvic Organ Prolapse Quantification(POP-Q)system published by the International Continence Society],and to explore the role of ultrasound in postoperative evaluation as well as the high-risk factors of post-surgery POP recurrence. Methods This is a retrospective study based on the POP-Q records and TPUS data sets of patients within 6 months after TVM surgery during September 2013 and November 2019.The diagnostic results of TPUS and POP-Q were compared.The incidences of hiatal ballooning and levator avulsion were separately compared between the TPUS group and the control group. Results A total of 147 patients were enrolled.The Kappa values between TPUS and POP-Q in the diagnosis of anterior and posterior compartment POP were 0.268(


Subject(s)
Humans , Pelvic Floor/diagnostic imaging , Pelvic Organ Prolapse/diagnostic imaging , Retrospective Studies , Surgical Mesh/adverse effects , Ultrasonography
11.
J. coloproctol. (Rio J., Impr.) ; 40(4): 345-351, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1143172

ABSTRACT

ABSTRACT Introduction: Currently, problems such as constipation due to outlet obstruction, rectal/vaginal prolapse and fecal and urinary incontinence have become increasingly more frequent because of the population aging process, with great impact on the quality of life. Objective: To describe a technique for surgical repair of middle/posterior pelvic floor compartments and extra-mucosal rectal wall treatment by transperineal and vaginal approach, using native tissues and present the results in twenty patients submitted to this surgical technique. Method: Patients with symptoms secondary to middle/posterior pelvic floor descent and anatomical changes confirmed by proctological exam and pelvic MRI defecography. Results were evaluated through the Agachan constipation score, using pre- and post-operative questionnaires. Results: Immediate repair of rectocele and musculature, with prompt improvement of constipation, sustained by 42 months. There were no severe complications in the postoperative period. Conclusion: This is an effective technique, with adequate anatomic repair, improvement of constipation scores and with low risk.


RESUMO Introdução: Problemas como constipação intestinal por obstrução de saída, prolapsos retal/vaginal e incontinências fecal e urinária são cada vez mais frequentes pelo envelhecimento populacional, com grande impacto na qualidade de vida. Objetivo: Descrever técnica para correção do compartimento médio/posterior do assoalho pélvico e tratamento extramucoso da parede retal, por vias perineal e vaginal, utilizando tecidos nativos. Apresentar os resultados da cirurgia em 20 pacientes submetidas à técnica. Método: Pacientes com sintomas secundários ao descenso de assoalho pélvico médio/posterior, submetidas à propedêutica - exame proctológico e defecografia por RNM de pelve que confirmaram as alterações anatômicas. A avaliação dos resultados foi feita com questionários no pré e pós-operatório, com a utilização do escore de Agachan para constipação intestinal. Resultado: Correção imediata da retocele e da musculatura, com melhora imediata da constipação intestinal, sustentada ao longo de 42 meses. Sem complicações graves no pós-operatório. Conclusão: Técnica eficaz, com correção anatômica adequada, associada a melhora significativa dos escores de constipação e de baixo risco.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Pelvic Floor/abnormalities , Pelvic Organ Prolapse/surgery , Pelvic Floor Disorders/surgery
12.
Fisioter. Bras ; 21(4): 388-395, Ago 08, 2020.
Article in Portuguese | LILACS | ID: biblio-1283407

ABSTRACT

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 Floor
13.
Rev. chil. obstet. ginecol. (En línea) ; 85(3): 270-274, jun. 2020. tab
Article in Spanish | LILACS | ID: biblio-1126162

ABSTRACT

INTRODUCCIÓN: El prolapso de órganos pélvicos es infrecuente durante el embarazo y se asocia principalmente a mujeres multíparas. Dado que la población gestante no es la ideal para manejo quirúrgico, los pesarios son útiles para controlar los síntomas con pocos efectos adversos y contraindicaciones. Por su baja incidencia, la información reportada en la literatura se deriva de reportes de caso y las recomendaciones se extrapolan de pacientes no embarazadas. METODOLOGÍA: Revisión de la literatura y exposición de casos. Resultados: Se exponen cuatro casos de gestantes con prolapso de órganos pélvicos manejadas exitosamente con pesarios hasta el final de la gestación sin presentar complicaciones serias. CONCLUSIONES: Los pesarios son un método seguro y eficaz para el manejo de síntomas de prolapsos de órganos pélvicos durante el embarazo.


INTRODUCTION: Pelvic organ prolapse is rare during pregnancy and is associated to women with multiple vaginal child births. Pregnant women are not ideal candidates for surgical management of prolapse, making pessaries useful for symptom control with few adverse effects. Due to its low incidence, information reported in literature is derived from case reports and recommendations are extrapolated from non-pregnant patients. METHODOLOGY: Literature review and presentation of cases. RESULTS: Four cases of pregnant women with pelvic organ prolapse successfully managed with pessaries until the end of pregnancy without presenting serious complications are described. Conclusions: Pessaries are a safe and effective way to treat symptoms of pelvic organ prolapse during pregnancy.


Subject(s)
Humans , Female , Pregnancy , Adult , Pessaries , Pelvic Organ Prolapse/therapy
14.
Rev. cient. Esc. Univ. Cienc. Salud ; 7(1): 5-12, ene.-jun. 2020. tab.
Article in Spanish | LILACS | ID: biblio-1179048

ABSTRACT

Las disfunciones del piso pélvico tienen unaelevada incidencia en la población femenina,dentrodeestassedestacanlospro-lapsos uterinos, de la cúpula vaginal, entero-cele, cistóceles, retóceles, la incontinencia uri-nariaylafecal.Seestimaquedel3%al6%de la población femenina desarrollará alguna de estas disfunciones en algún momento de sus vidas. Objetivo: Determinar los conocimientos y cuidados que tienen las mujeres en etapa reproductiva y no reproductiva para prevenir prolapsos de órganos pélvicos en el Centro de Salud Miguel Paz Barahona (CSMPB) de San Pedro Sula en el primer semestre del año 2018. Pacientes y métodos: Estudio cuantita-tivo, transversal, descriptivo, instrumento tipo cuestionario aplicado a mujeres en etapa re-productivaynoreproductivaenelCSMPB,du-rante el primer semestre del año 2018. Pobla-ción 1766, muestra probabilística 316mujeres. Resultados: El 55% de la población tenían en-tre20-35añosdeedad,58%norealizabaejer-cicio físico, más de 90% desconocían sobre el prolapso de órganos pélvicos y sus cuidados, 19.2%presentósignosysíntomasdeprolapso de órganos pélvicos. Conclusión: Los resul-tados señalan que la mayoría mujeres tienen poco conocimiento sobre el prolapso de órga-nospélvicosyunporcentajepresentósintoma-tología, por lo tanto, no realizan cuidados para prevenir algún tipo de prolapso en el trascurso de suvida...(AU)


Subject(s)
Humans , Female , Adult , Uterine Prolapse/complications , Pelvic Organ Prolapse/diagnosis , Women's Health Services , Pelvic Floor
16.
Rev. med. Risaralda ; 26(1): 38-46, ene.-jun. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1127002

ABSTRACT

Resumen Introducción: El problema que se presenta en la atención de salud en los hospitales públicos es la alta cantidad de pacientes, generando un sostenido crecimiento en las listas de espera y provocando un aumento del tiempo de espera, generando un impacto negativo en los usuarios. Objetivo: Mejorar el proceso clínico de atención del prolapso de órganos pélvicos de un hospital público chileno. Metodología: Se identifican nudos críticos mediante diagramas de flujo, realizando un diagnóstico del proceso desde el ingreso del paciente hasta su alta del hospital. Resultados: Se identifican cada uno de los puntos críticos y se proponen soluciones para agilizar el proceso y con ello mejorar la atención a las usuarias, lo que en definitiva llevó a una disminución del tiempo de espera y, lo más relevante, a una disminución en la cantidad de personas en la lista de espera.


Abstract Introduction: The high number of patients is a common issue in public hospitals that causes a negative impact on the users due to the increment in the waiting lists and in the waiting time to be treated. Objective: To improve the clinical process for caring pelvic organ prolapse in a chilean public hospital. Methodology: The methodology was focused on identifying critical knots using flowcharts and diagnosing the patient's process from their admission until their discharge from the hospital. Results: Some solutions were proposed for each critical point identified so as to accelerate the process, thus improving users' health caring. As a result, the high number of people in the waiting lists and the waiting time decreased substantially.


Subject(s)
Humans , Prolapse , Time , Delivery of Health Care , Pelvic Organ Prolapse , Patient Discharge , Chile , Waiting Lists , Diagnosis , Hospitals
17.
Int. braz. j. urol ; 46(1): 5-14, Jan.-Feb. 2020. graf
Article in English | LILACS | ID: biblio-1056367

ABSTRACT

ABSTRACT The exact prevalence of pelvic organ prolapse is difficult to establish. The anatomical changes do not always consist with the severity or the symptoms associated with prolapse. There are many risk factors associated with pelvic organ prolapse and this review aims to identify the epidemiology and pathophysiology while looking at the known risk factors for pelvic organ prolapse. PubMed search involved a number of terms including: epidemiology, risk factors, reoccurrence indicators, management and evaluation. Several risk factors have been associated with pelvic organ prolapse, all contribute to weakening of the pelvic floor connective tissue/collagen, allowing the pelvic organs to prolapse through the vaginal walls. Among the risk factors are genetic background, childbirth and mode of delivery, previous hysterectomy, menopausal state and the ratio between Estrogen receptors. The "Integral theory" of Petros and the "Levels of Support" model of Delancey enable us to locate the defect, diagnose and treat pelvic organ prolapse. The currently available demographic data is not reliable enough to properly estimate the true extent of pelvic organ prolapse in the population. However, standardization of the diagnosis and treatment may significantly improve our ability to estimate the true incidence and prevalence of this condition in the coming years.


Subject(s)
Humans , Female , Pelvic Organ Prolapse/etiology , Pelvic Organ Prolapse/physiopathology , Parity , Menopause/physiology , Risk Factors , Collagen/physiology , Pelvic Floor/physiopathology , Pelvic Organ Prolapse/therapy , Obesity/complications , Obesity/physiopathology
18.
Rev Assoc Med Bras (1992) ; 66(5): 680-686, 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136268

ABSTRACT

SUMMARY OBJECTIVE Pelvic organ prolapse (POP) is a very frequent situation in our population that may lead to a significant decrease in patients' quality of life. Currently, we are looking for predictive factors for the development of POPs; thus, this study seeks to evaluate whether the Fibulin 5 polymorphism (FBLN5) is associated with the occurrence of POP. METHODS This is a cohort study with postmenopausal women who were divided into groups by POP stage: POP stages 0 and I (control group) and POP stages III and IV (case group). Subsequently, analyses of genetic polymorphisms of FBLN5 were performed using the Restriction Fragment Length Polymorphism (RFLP) technique. RESULTS A total of 292 women were included in the study. Pregnancy, parity and vaginal delivery in the patients, as well as in data described in the literature, were related to the occurrence of POP in the univariate analysis. However, after binary logistic regression, home birth and age remained independent risk factors for POP. We found no association between the FBLN5 polymorphism and the occurrence of POP (p = 0.371). CONCLUSION There was no association between the FBLN5 polymorphism and the occurrence of POP in Brazilian women.


RESUMO OBJETIVOS O prolapso de órgãos pélvicos (POP) é uma situação muito frequente em nossa população que pode levar a uma diminuição significativa da qualidade de vida dos pacientes. Atualmente, buscam-se fatores preditivos para o desenvolvimento de POPs e, assim, este estudo correlaciona um polimorfismo de Fibulina 5 (FBLN5) com a ocorrência da doença. MÉTODOS Estudo de coorte com mulheres na pós-menopausa, divididas por grupos pelos estádios 0 e I do POP (grupo controle) e POP III e IV (grupo caso). Posteriormente, análises do polimorfismo genético de FBLN5 foram realizadas utilizando a técnica de Polimorfismo de Comprimento de Fragmentos de Restrição (RFLP). RESULTADOS Um total de 292 mulheres foi incluído no estudo. Gestação, paridade e parto vaginal, como bem descritos na literatura, foram relacionados à ocorrência de POPs na análise univariada. No entanto, após a regressão logística binária, o parto domiciliar e a idade permaneceram como fatores de risco independentes para os POPs. Não encontramos associação deste polimorfismo FBLN5 com a ocorrência de POP (p=0,371). CONCLUSÃO Não houve associação deste polimorfismo FBLN5 com a ocorrência de POPs em mulheres brasileiras.


Subject(s)
Humans , Female , Pregnancy , Quality of Life , Extracellular Matrix Proteins/genetics , Pelvic Organ Prolapse , Polymorphism, Genetic , Brazil , Calcium-Binding Proteins/genetics , Cohort Studies
19.
São Paulo; s.n; 2020. 37 p.
Monography in Portuguese | LILACS, SMS-SP, CACHOEIRINHA-Producao, SMS-SP | ID: biblio-1252845

ABSTRACT

Introdução: O prolapso de órgão pélvico é uma condição com alta prevalência em mulheres de meia idade e com aumento gradativo da incidência conforme o envelhecimento populacional e aumento da expectativa de vida. 21,3% das mulheres irão apresentar incontinência urinária de esforço associado ao prolapso uterino. Objetivo: Avaliar a incidência de incontinência urinária DE NOVO nas pacientes submetidas a correção cirúrgica via vaginal de prolapso de órgão pélvico no Hospital Maternidade Escola Vila Nova Cachoeirinha. Métodos: Estudo Prospectivo com seguimento de 86 pacientes portadoras de prolapso de órgão pélvico em estadios III e IV submetidas a tratamento cirúrgico com uso de tela vaginal. As pacientes continentes na avaliação pré-operatória foram tratadas apenas para correção do prolapso com uso de duas telas comerciais. As pacientes com perda urinária aos esforços foram tratadas com sling de uretra média concomitante com à correção do prolapso. O seguimento foi realizado com 14 dias, 30 dias, 3 e 12 meses. A avaliação feita relaciona idade, medidas de quantificação do POP através do POP-Q, sintomas urinários e questionários de qualidade de vida relacionados a perda urinária e sintomas vaginais. Resultados:Das 86 pacientes abordadas, 56 eram continentes do pré operatório, dessas, 20,68% desenvolveram IUDN de esforço, com 66 % sendo submetidas a nova cirurgia para inserção de SLING transobturatório. No pós operatório foi encontrado redução significativa das queixas urinárias com p < 0,05, exceto para noctúria além de melhora na qualidade de vida em relação aos sintomas urinários e sintomas vaginais devido a presença de prolapso. Conclusão: No presente estudo foi observado, a partir dos dados estatísticos, que a incidência de incontinência urinária de novo em pacientes submetidas a correção cirúrgica via vaginal com tela devido a prolapso em estádio avançado foi de 20,68%.


Subject(s)
Humans , Female , Middle Aged , Pelvic Organ Prolapse , Quality of Life , Urinary Incontinence , Uterine Prolapse
20.
Article in English | WPRIM | ID: wpr-827364

ABSTRACT

OBJECTIVES@#To assess short-term functional outcomes achieved by robot-assisted sacrocolpopexy for pelvic organ prolapse.@*METHODS@#We retrospectively collected clinical and operative data for female patients who underwent either pure laparoscopic sacrocolpopexy (a control group, =20) or robot-assisted laparoscopic sacrocolpopexy (a study group, =20) between December 2017 and December 2018. The clinical indicators included age, gestational age, parity, the stage of pelvic organ prolapse. Perioperative data included operative time and total blood loss. Post-operative outcomes included hospital stay, the time of detaining urethral catheterization, and the restart of anal exhaust after surgery. At the same time, complications and quality of life were observed till 6 months after the surgery.@*RESULTS@#There were no definitely differences in the perioperative data between the 2 groups. It is worth mentioning that robot-assisted laparoscopic sacrocolpopexy was superior in strict operative time. With a follow-up of 6 months, the study group's anatomic repair rate was 100% (20/20), while the control group was 95% (19/20). Pelvic Floor Distress Inventory-short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-short Form 7 (PFIQ-7) were used to evaluate patients' quality of life. There was no significant difference in the scores between the study group and the control group before and 6 months after surgery. Only the data of the PFDI-20 questionnaires at 1 month after operation were statistically significant, and in the control group was larger than that in the study group, showing that robotic surgery can recover faster than laparoscopy, and the quality of life can be improved quickly.@*CONCLUSIONS@#Robot-assisted laparoscopic sacrocolpopexy is a safe and reliable technique, faster than laparoscopy in recovery and has a short-term effect.


Subject(s)
Female , Humans , Laparoscopy , Pelvic Organ Prolapse , Quality of Life , Retrospective Studies , Robotics , Treatment Outcome
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