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Int. braz. j. urol ; 48(1): 198-199, Jan.-Feb. 2022.
Article in English | LILACS | ID: biblio-1356291


ABSTRACT Introduction: The transverse vaginal septum (TVS) with congenital urethra-vaginal fistula (CUVF) is a rare anomaly of the mullerian duct (1, 2). Incomplete channelling of the vaginal plate, or an abnormality in the fusion of the vaginal component of mullerian duct with the urogenital sinus results in TVS (1, 3, 4). High CUVF occurs due to the persistent communication between the urogenital sinus and utero-vaginal primordium at the tubercle sinus, whereas low CUVF is due to excessive apoptosis of the vaginal plate during channelling (5). The principles of management of CUVF with TVS include: 1) TVS resection, 2) Create a neovagina. We present a case of CUVF with TVS managed by robotic assistance. Material and methods: A 24-year-old female, married for 3 years, presented with cyclical hematuria since menarche, dyspareunia and primary infertility. Examination revealed blind ending vagina 4cm from the introitus. Magnetic resonance imaging revealed a fistulous communication between urethra and vagina, and TVS. Cystourethroscopy confirmed a proximal urethra-vaginal fistula. Urethroscopy guided puncture of the TVS was performed, tract dilated and a catheter was placed across it. Robotic assisted transvaginal approach was planned. Air docking of robot was performed. Traction on the catheter was given to identify the incised edges of the septum. Vaginal flaps were raised laterally, fistulous tract was excised. Proximal vagina mucosa was identified and vaginoplasty was performed. Result: Patient's postoperative recovery was uneventful. Urethral catheter was removed after 5 days. She had normal voiding and menstruation. Vaginoscopy performed at 1st month follow-up, revealed an adequate vaginal lumen. Vaginal moulds were advised for 6 weeks during the night, following which she resumed her sexual activity. She conceived 6 months post-surgery, and delivered a child by caesarean section. Conclusion: We successfully managed this case by resection of septum, neovagina creation and thereby achieving normal menstruation and conception. The advantages of robotic approach were magnification, precision and manoeuvrability in a limited space, avoiding a vaginal release incision.

Humans , Male , Female , Vaginal Diseases , Vaginal Fistula/surgery , Robotic Surgical Procedures , Urethra/surgery , Urethra/diagnostic imaging , Vagina/surgery
Int. braz. j. urol ; 47(4): 861-867, Jul.-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1286762


ABSTRACT Introduction: 46,XX Congenital adrenal hyperplasia (CAH) remains the first cause of genital virilization and current surgical techniques aim to restore female aspect of genitalia while preserving dorsal neurovascular bundle but not at the expense of not preserving erectile tissue. We aim to report our experience with a new surgical technique for clitoroplasty, completely preserving corporeal bodies, neurovascular bundles without dismembering the clitoris, in four patients with over a year follow up. Materials and Methods: After IRB approval four patients with 46,XX CAH and Prader 5 and 3 external genitalia, underwent feminizing genitoplasty. Complete preservation of erectile tissue was accomplished without a need to dissect dorsal neurovascular bundle. Glans size allowed no need for glanular reduction and there was no need to dismember the corporeal bodies. Results: Four patients 12 to 24-months-old underwent complete corporeal preservation clitoroplasty (CCPC), mean age was 18.5 months, mean follow up was 10.25 months. Vaginoplasty was performed in all patients with partial urogenital mobilization (PUM) and Urogenital Sinus flap (UF), only one severely virilized patient required a parasagittal pre-rectal approach to mobilize the vagina. We had no complications until last follow up. Conclusion: To our knowledge, we are introducing the concept of CCPC without the need of disassembling the corporeal bodies, neurovascular bundle and glans. It stands as a new alternative for feminizing genitoplasty with complete preservation of erectile tissue and no dissection of neurovascular bundle. Although there is still lacking long-term follow-up, it represents a new step in conservative reconfiguration of the external virilized female genitalia.

Humans , Male , Female , Infant , Child, Preschool , Adolescent , Adrenal Hyperplasia, Congenital/surgery , Reconstructive Surgical Procedures , Surgical Flaps , Vagina/surgery , Clitoris/surgery , Genitalia, Female/surgery
Int. braz. j. urol ; 47(2): 263-273, Mar.-Apr. 2021. graf
Article in English | LILACS | ID: biblio-1154477


ABSTRACT Vaginoplasty is a commonly performed surgery for the transfeminine patient. In this review, we discuss how to achieve satisfactory surgical outcomes, and highlight solutions to common complications involved with the surgery, including: wound separation, vaginal stenosis, hematoma, and rectovaginal fistula. Pre-operative evaluation and standard technique are outlined. Goal outcomes regarding aesthetics, creation of a neocavity, urethral management, labial appearance, vaginal packing and clitoral sizing are all described. Peritoneal vaginoplasty technique and visceral interposition technique are detailed as alternatives to the penile inversion technique in case they are needed to be used. Post-operative patient satisfaction, patient care plans, and solutions to common complications are reviewed.

Humans , Male , Female , Transsexualism , Sex Reassignment Surgery , Penis/surgery , Gynecologic Surgical Procedures , Vagina/surgery
Int. braz. j. urol ; 47(2): 287-294, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154463


ABSTRACT Purpose: Despite high success rates in the treatment of urinary incontinence, complications related to the use of polypropylene (PP) meshes are still a concern, especially in vaginal prolapses surgeries. The objective of this study was to assess the effect of autologous platelet-rich plasma (PRP) coating on the integration of PP meshes implanted in the vaginal submucosa of rabbits. Materials and Methods: Thirty adult New Zealand rabbits were randomly divided into two groups (n=15): PP, implanted with conventional PP meshes; and PRP, implanted with autologous PRP coated PP meshes. Animals in both groups (n=5) were euthanized at 7, 30 and 90 days postoperatively, the vaginas extracted and sent to immunohistochemical analysis for the assessment of the pro-inflammatory agent TNF-α, anti-inflammatory agents TGF-β and IL-13, collagen metabolism marker MMP-2, and angiogenesis marker CD-31. AxioVision™ image analysis was used for the calculation of the immunoreactive area and density. Statistical analysis was performed with ANOVA followed by Tukey test (p <0.05). Results: Animals in the PRP group showed significantly increased expression of the angiogenesis agent CD-31 at all experimental times when compared to the PP group (p <0.0001). However, no differences concerning the expression of the other markers were observed between the groups. Conclusion: The addition of autologous PRP gel to PP meshes can be simply and safely achieved and seems to have a positive effect on implantation site angiogenesis. Further investigations are required to ascertain PPR coated meshes clinical efficacy in prolapses and stress urinary incontinence surgeries.

Animals , Female , Polypropylenes , Platelet-Rich Plasma , Rabbits , Surgical Mesh , Vagina/surgery , Collagen
Rev. bras. ginecol. obstet ; 43(3): 178-184, Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1251297


Abstract Objective The present study aimed to explore the opinion and ethical consideration of vulvovaginal aesthetics procedures (VVAPs) among health professionals and medical students in Saudi Arabia. Methods This is a cross-sectional study performed between January 2020 and April 2020. Data was collected through electronic media, WhatsApp, and emails. The results were analyzed by applying the Students t-test, and correlations were considered significant if they presented a p-value<0.05. Results There is significant demand to educate doctors, health professionals, medical students, and gynecologists for the VVAPs to have a solid foundation, justified indications, and knowledge about various aesthetic options. Although female doctors, medical students, young doctors, and gynecologists have more knowledge about VVAPs, all health professionals ought to be aware of recent trends in vulvovaginal aesthetics (VVA). The present analysis determined that VVA should be under the domain of gynecologists, rather than under that of plastic surgeons, general surgeons, and cosmetologists. Themajority of the participants considered that vaginal rejuvenation, "G-spot" augmentation, clitoral surgery, and hymenoplasty are not justifiable on medical grounds. Conclusion The decision to opt for different techniques for vaginal tightening and revitalization should be taken very carefully, utilizing the shared decision-making approach. Ethical aspects and moral considerations are important key factors before embarking in the VVAPs purely for cosmetic reasons. Further research is required to determine the sexual, psychological, and body image outcomes for women who underwent elective VVAPs. Moreover, medical educators must consider VVAPs as part of the undergraduate and postgraduate medical curriculum.

Humans , Female , Adult , Young Adult , Students, Medical , Vagina/surgery , Vulva/surgery , Practice Patterns, Physicians' , Health Personnel , Rejuvenation , Saudi Arabia , Cross-Sectional Studies , Surveys and Questionnaires , Electronic Health Records , Gynecology , Middle Aged
Rev. chil. obstet. ginecol. (En línea) ; 85(4): 371-375, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138634


RESUMEN Las lesiones del tracto genital femenino tras relaciones sexuales son un problema frecuente en las urgencias de ginecología, pero poco estudiado salvo su aspecto médico-legal. Su incidencia es desconocida ya que muchas mujeres no llegan a consultar por miedo o pudor. El reconocimiento precoz de estas lesiones y su correcto tratamiento puede evitar la parición de secuelas que acompañarán a nuestra paciente durante el resto de su vida. Presentamos el caso de una paciente de 18 años con un desgarro perineal con mucosa vaginal íntegra tras su primera relación sexual.

ABSTRACT Injuries to the female genital tract after sexual intercourse are a frequent problem in gynecological emergencies, but little studied except for their medico-legal aspect. Its incidence is unknown since many women do not go to their specialist out of fear or embarrassment. Early recognition of these injuries and their correct treatment may prevent the appearance of sequelae that will accompany our patient for the rest of her life. We present the case of an 18-year-old patient with a perineal tear with intact vaginal mucosa after her first sexual intercourse.

Humans , Female , Adolescent , Vagina/injuries , Wounds, Penetrating/etiology , Coitus , Vagina/surgery , Vaginal Diseases/surgery , Vaginal Diseases/etiology , Wounds, Penetrating/surgery , Wounds, Penetrating/diagnosis , Risk Factors , Lacerations , Mucous Membrane/surgery , Mucous Membrane/injuries
Int. braz. j. urol ; 45(5): 999-1007, Sept.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040065


ABSTRACT Objective To compare the intermediate-term follow-up results of laparoscopic pectopexy and vaginal sacrospinous fixation procedures. Materials and Methods Forty-three women who had vaginal sacrospinous fixations(SSF) using Dr. Aksakal's Desta suture carrier and 36 women who had laparoscopic pectopexies were re-examined 7 to 43 months after surgery. The PISQ-12 and P-QOL questionnaires were answered by all of the women. Results The apical descensus relapse rates did not differ between the groups (14% in the SSF vs. 11.1% in the pectopexy group). The de novo cystocele rates were higher in the SSF group (25.6% in the SSF vs. 8.3% in the pectopexy group). There were no significant differences in the de novo rectocele numbers between the groups. The treatment satisfaction rates were high in both groups (93% in the SSF vs. 91.7% in the pectopexy group), which was not statistically significant. Moreover, the postoperative de novo urge and stress urinary incontinence rates did not differ; however, the postoperative sexual function scores (PISQ-12) (36.86±3.15 in the SSF group vs. 38.21±5.69 in the pectopexy group) were better in the pectopexy group. The general P-QOL scores were not significantly different between the surgery groups. Conclusion The vaginal sacrospinous fixation maintains its value in prolapse surgery with the increasing importance of native tissue repair. The new laparoscopic pectopexy technique has comparable positive follow-up results with the conventional sacrospinous fixation procedure.

Humans , Female , Aged , Vagina/surgery , Laparoscopy/methods , Pelvic Organ Prolapse/surgery , Quality of Life , Surveys and Questionnaires , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Patient Satisfaction , Middle Aged
Rev. chil. obstet. ginecol. (En línea) ; 84(3): 236-244, jun. 2019. tab, graf, ilus
Article in Spanish | LILACS | ID: biblio-1020642


RESUMEN INTRODUCCIÓN: La ausencia congénita de vagina es una condición poco común, algunas causas son el síndrome de Mayer-Rokitansky-Kuster-Hauser y la insensibilidad periférica a los andrógenos. Múltiples técnicas quirúrgicas y no quirúrgicas se han descrito para el manejo de esta condición, siendo el objetivo principal la creación de un canal vaginal de diámetro y longitud adecuada que permitan restaurar la función coital. El objetivo de este estudio es detallar la experiencia del procedimiento de neovagina con la técnica quirúrgica de McIndoe en pacientes con Mayer-Rokitansky-Kuster-Hauser realizados en la Unidad de Uroginecología de la Clínica Universitaria Bolivariana. METODOLOGÍA: Reporte de 5 casos de pacientes con agenesia de vagina secundarios al síndrome de Mayer-Rokitansky-Kuster-Hauser, a las cuales se les realizó neovagina con la técnica de McIndoe con algunas modificaciones en el molde para el implante de piel. RESULTADOS: Se incluyeron cinco pacientes con diagnóstico de Mayer-Rokitansky-Kuster-Hauser, todas tenían desarrollo de características sexuales secundarias, perfil hormonal normal, y un cariotipo XX. Se utilizó la técnica quirúrgica de McIndoe para la realización de la neovagina sin complicaciones intraoperatorias asociadas y con adecuada evolución posoperatoria, con una longitud vaginal entre 7-9 cm y 3 pacientes con vida sexual activa. El tiempo de estancia hospitalaria fue 7 a 9 días. CONCLUSIÓN: La técnica quirúrgica de McIndoe es una opción para restaurar la función sexual en mujeres con agenesia vaginal con resultados favorables. El tiempo para decidir su realización es electivo, sin embargo, se debe contar con madurez física y emocional para ser llevado a cabo. Las pacientes de nuestro reporte tenían una edad promedio de 18 años.

SUMMARY INTRODUCTION: The congenital absence of the vagina is an uncommon condition, some causes are the Mayer-Rokitansky-Küster-Hauser syndrome and peripheral insensitivity to androgens. Multiple surgical and non-surgical techniques have been described for the management of this condition, being the main objective the creation of a vaginal canal of adequate diameter and length to restore coital function. The objective of this study is to detail the experience of the neovagina procedure with the McIndoe surgical technique performed in patients with Mayer-Rokitansky-Küster-Hauser syndrome at the Clinica Universitaria Bolivariana. METHODOLOGY: Report of five cases of patients with vaginal agenesis secondary to the Mayer-Rokitansky-Kuster-Hauser syndrome, who underwent neovagina with the McIndoe technique and some modifications in the mold for the skin implant. RESULTS: Five patients with diagnosis of Mayer-Rokitansky-Kuster-Hauser were included, all had development of secondary sexual characteristics, normal hormonal profile, and a XX karyotype. The McIndoe surgical technique was used to perform the neovagina without associated intraoperative complications and with adequate postoperative evolution, with a vaginal length between 7-9 cm and three patients with active sexual life. The length of hospital stay was 7 to 9 days. CONCLUSION: The McIndoe surgical technique is an option to restore sexual function in women with vaginal agenesis with favorable results. The time to decide its realization is elective, however, they must have the physical and emotional maturity to be carried out. The patients in our report have an average age of 18 years.

Humans , Female , Adolescent , Adult , Congenital Abnormalities/surgery , Congenital Abnormalities/diagnosis , Congenital Abnormalities/genetics , Vagina/surgery , Gynecologic Surgical Procedures , Vagina/abnormalities , Surgically-Created Structures , 46, XX Disorders of Sex Development/surgery , Mullerian Ducts/abnormalities
Int. braz. j. urol ; 44(5): 1036-1041, Sept.-Oct. 2018. graf
Article in English | LILACS | ID: biblio-975641


ABSTRACT Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome. This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula. In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.

Humans , Female , Adult , Vagina/surgery , Cystectomy/adverse effects , Vaginal Fistula/surgery , Urinary Reservoirs, Continent , Urinary Bladder Neoplasms/surgery , Vaginal Fistula/etiology , Treatment Outcome
Rev. bras. ginecol. obstet ; 40(10): 642-646, Oct. 2018. graf
Article in English | LILACS | ID: biblio-977780


Abstract Transverse vaginal septum is a rare female genital tract anomaly, and little is described about its surgical treatment. We report the case of a patient who wished to preserve hymenal integrity due to social and cultural beliefs. We performed a vaginoscopic resection of the septum under laparoscopic view, followed by the introduction of a Foley catheter in the vagina, thus preserving the hymen. After 12 months of follow-up, no septal closure was present, and the menstrual flow was effective. Vaginoscopic hysteroscopy is an effectivemethod of vaginal septum resection, even in cases in which hymenal integrity must be preserved due to social and cultural beliefs.

Resumo Septo vaginal transverso é uma anomalia rara do trato genital feminino, e pouco é descrito sobre o tratamento cirúrgico. Relatamos o caso de uma paciente que desejava preservar a integridade do hímen devido a crenças sociais e culturais. Realizamos ressecção vaginoscópica do septo sob visão laparoscópica, seguida da introdução de um cateter de Foley na vagina, preservando assim o hímen. Após 12 meses de acompanhamento, não havia fechamento do septo, e o fluxo menstrual era eficaz. A histeroscopia vaginoscópica é um método eficaz de ressecção dos septos vaginais, incluindo os casosemque a integridade do hímen deve ser mantida devido a crenças sociais e culturais.

Humans , Female , Adolescent , Vagina/abnormalities , Vagina/surgery , Hysteroscopy/methods , Organ Sparing Treatments/methods , Hymen
Rev. méd. Urug ; 34(2): 87-101, jun. 2018.
Article in Spanish | LILACS | ID: biblio-914529


El desarrollo de la cirugía vaginal y de las diferentes técnicas terapéuticas de las patologías del piso pélvico femenino en la realidad de la ginecotocología de Uruguay ha presentado un importante desarrollo en los últimos 20 años. El objetivo es presentar la forma de abordaje diagnóstico y los fundamentos y arsenal quirúrgico de la Unidad de Patología de Piso Pélvico de la Clínica Ginecotocológica A, en base a la teoría integral. Se realiza una descripción evolutiva de las diferentes técnicas quirúrgicas implementadas y desarrolladas en nuestro medio, así como la fundamentación anátomo-funcional de las mismas. Como conclusión del análisis evolutivo es fundamental conceptualizar que las alteraciones funcionales y anatómicas de los órganos pélvicos femeninos forman parte de una unidad y no de la suma de compartimentos estancos, celdas o sectores. En este sentido, desarrollar estrategias terapéuticas quirúrgicas cada vez menos invasivas, con correcciones sitio específico, aparece como la perspectiva estratégica por sobre las correcciones estereotipadas.(AU)

Vaginal surgery and the different therapeutic techniques to treat pelvic floor disorders in the context of Gynecotocology in Uruguay have dramatically developed in the last 20 years. The study aims to present the different diagnostic approaches, the principles and the surgical possibilities at the Pelvic Floor Pathology Department of Gynecotocology Clinic "A", based on the comprehensive theory. It comprises a description of the evolution of the different surgical techniques implemented and developed in our country, as well as the anatomic and functional grounds that support them. In order to come up with a conclusion on the analysis of this evolution it is of the essence to conceptualize that the functional and anatomic alterations of the female pelvic organs are all part of a whole, rather than the addition of different domains, cells or sectors. In that sense, developing surgical strategies that are gradually less invasive and include specific-site correction seems to be the best the strategic perspective over stereotype corrections.(AU)

O desenvolvimento da cirurgia vaginal e das diferentes técnicas terapêuticas das patologias do assoalho pélvico feminino mostrou um avanço importante nos últimos 20 anos na tocoginecologia do Uruguai. O objetivo é apresentar a forma de abordagem diagnóstica e os fundamentos e o arsenal cirúrgico da Unidad de Patología de Piso Pélvico da Clínica Ginecotocológica A, baseado na teoria integral. Faz-se uma descrição evolutiva das diferentes técnicas cirúrgicas desenvolvidas e implementadas no nosso meio, assim como a fundamentação anatomofuncional das mesmas. Como conclusão da análise evolutiva é fundamental incorporar o conceito de que as alterações funcionais e anatómicas dos órgãos pélvicos femininos formam parte de uma unidade e não da soma de compartimentos estanques. Nesse sentido, o desenvolvimento de estratégias terapêuticas cirúrgicas cada vez menos invasivas, com correções específicas para um ponto específico, aparece como a perspectiva estratégica sobre as correções estereotipadas.(AU)

Surgical Procedures, Operative , Vagina/surgery , Pelvic Floor/pathology
Rev. chil. obstet. ginecol. (En línea) ; 83(3): 219-227, jun. 2018. tab
Article in Spanish | LILACS | ID: biblio-959509


RESUMEN El prolapso de órganos pélvicos es definido como el descenso de la pared anterior y /o posterior de la vagina y/ o la cúpula o útero a través de la vagina. Esta patología se ha visto asociada a disfunción urinaria, alteración de la defecación y disfunción sexual. El prolapso sintomático de órganos pélvicos es una condición que afecta negativamente la calidad de vida de las mujeres, encontrando una prevalencia de 3-6%. La cirugía obliterativa de vagina, tiene un menor tiempo quirúrgico, las tasas de morbilidad y pérdida de sangre son más bajas, la recuperación es más rápida, y el éxito anatómico mayor. Las pacientes que son ideales candidatas a la colpocleisis suelen presentar múltiples comorbilidades médicas que las descartan para llevar a una cirugía reconstructiva con una eficiencia de 90% en la literatura, refiriendo que mejora de la calidad de vida y la imagen corporal para la mayoría de pacientes. OBJETIVO: Realizar una revisión sobre el procedimiento de colpocleisis referente a los resultados anatómicos, resolución de los síntomas, satisfacción con los resultados quirúrgicos y la morbimortalidad asociada de pacientes que consultaron a una institución prestadora de salud privada de tercer nivel, ubicada en Medellín, (Colombia). METODOLOGÍA: Se realizó un estudio de cohorte retrospectivo en el cual se incluyen todas las pacientes con prolapso grado 3-4 a quienes se les haya realizado colpocleisis en el periodo de tiempo comprendido entre 2013 al 2016, en una institución prestadora de salud privada de III nivel en Medellín, Antioquia, que atiende régimen contributivo del sistema seguridad social en Colombia y pacientes particulares. Se usó la escala de cuantificación del Prolapso del Órgano Pélvico (POP-Q) para determinar los niveles de prolapso y que tipo de prolapso se identificaba antes y después de la cirugía. Se les solicitó a todas evaluación urodinámica multicanal preoperatoria con reducción del prolapso para evaluar incontinencia oculta o dificultades de micción. Y se realizó una evaluación subjetiva de la respuesta a la cirugía con la escala de Impresión Global de Mejora del paciente (PGI-I). RESULTADOS: Se realizó una recolección de datos entre enero de 2013 a diciembre de 2016. Fueron sometidas a colpocleisis 143 pacientes, 27 de ellas (18.8 %) tenían más de 80 años. 52 pacientes (36.3%) entre 60-70 años, 62 pacientes (43.3%) entre 70-80 años y 1 pacientes <60 años. La edad media del grupo de edad fue de 75 años, rango 58-94 años; el índice de masa corporal promedio fue de 27, la duración del seguimiento promedio fue 9 meses, y el número de partos vaginales 4. El 97.9% de las pacientes presentaban comorbilidades médicas. Hubo una tasa de curación de 97.9%. CONCLUSIÓN: El estudio de cohorte describe nuestra experiencia y agrega a los datos existentes que apoyan la viabilidad y seguridad de la colpocleisis. Encontramos alta eficacia de las cleisis en cuanto a la satisfacción de las pacientes, en mejoría de calidad de vida, independiente de la edad, con una baja tasa de complicaciones y fallas quirúrgicas. La colpocleisis es una buena opción de tratamiento para prolapso de órganos pélvicos estadio 3-4, en quienes no deseen conservar la función sexual, sin embargo este concepto debe ser individualizado para cada paciente.

ABSTRACT Pelvic organ prolapse is defined as the descent of the anterior and / or posterior wall of the vagina and / or the dome or uterus through the vagina. This pathology has been associated with urinary dysfunction, altered defecation and sexual dysfunction. Symptomatic prolapse of pelvic organs is a condition that negatively affects the quality of life of women, finding a prevalence of lifetime prevalence is 3-6%. Obliterative vaginal surgery, has a shorter surgical time, morbidity and blood loss rates are lower, recovery is faster, and anatomic success greater. Patients who are ideal candidates for colpocleisis usually present multiple medical comorbidities that discard them to lead to reconstructive surgery. With an efficiency of 90% in the literature, indicating that improvement of the quality of life and body image for the majority of patients. OBJECTIVE: To perform a review of the colpocleisis procedure regarding anatomical results, resolution of symptoms, satisfaction with surgical results and associated morbidity and mortality of patients who consulted a third-level private health care institution located in Medellín, (Colombia). METHODOLOGY: A retrospective cohort study was carried out in which all patients with grade III-IV prolapse who underwent colpocleisis were included in the period from 2013 to 2016, in a private health institution of III level in Medellín, Antioquia, that attends contributory regime of the social security system in Colombia and private patients. The Pelvic Organ Prolapse (POP-Q) scale was used to determine prolapse levels and what type of prolapse was identified before and after surgery. All preoperative multichannel urodynamic evaluations with prolapse reduction were requested to evaluate occult incontinence or micturition difficulties. And a subjective evaluation of the response to surgery was performed with the Global Impression of Patient Improvement (PGI-I) scale. RESULTS: Data were collected between January 2013 and December 2016. Thirty-three patients were submitted to colpocleisis, 27 of which 18.8 (%) were older than 80 years. 52 (36.3%) patients between 60-70 years, 62 (43.3%) between 70-80 years and <60 years 1 patient. The mean age of the age group was 75 years, range 58-94 years; the mean body mass index was 27, the average follow-up duration was 9 months, and the number of vaginal deliveries was 4. (97.9%) of the patients had medical comorbidities. With a cure rate of 97.9%. CONCLUSION: The cohort study describes our experience and adds to existing data that support the viability and safety of colpocleisis. We found high efficacy of cleisis in terms of patient satisfaction, improvement in quality of life, independent of age, with a low rate of complications and surgical failures. Colpocleisis is a good treatment option for prolapse of pelvic organs stage III-IV, in those who do not wish to preserve sexual functionality, however this concept must be individualized for each patient.

Humans , Female , Aged , Aged, 80 and over , Gynecologic Surgical Procedures , Vagina/surgery , Pelvic Organ Prolapse/surgery , Retrospective Studies , Cohort Studies , Treatment Outcome
Rev. chil. obstet. ginecol. (En línea) ; 82(6): 595-602, Dec. 2017. graf
Article in English | LILACS | ID: biblio-899949


RESUMEN Antecedentes: El síndrome de hemivagina obstruida, útero didlefo y anomalía renal ipsilateral (OVHIRA) es una malformación mülleriana infrecuente. Objetivo: Se presenta un caso con una complicación no antes descrita y se hace una revisión de la literatura hasta la fecha. Caso clínico: Mujer de 12 años de edad con antecedentes de diagnóstico de útero bicorne y agenesia renal derecha en la infancia. Veintidós meses post menarquia consulta por algia pelviana y dismenorrea premenstrual. Ecografía revela hematómetra en cuerpo uterino izquierdo, de 142 x 69 x 61 mm. Resonancia nuclear magnética (RNM) describe además un hematocolpos de 7 x 10 cm y un tabique vaginal transverso de hemivagina izquierda. Se diagnostica OHVIRA y se planifica cirugía para resecar el tabique. Días antes del la cirugía, la paciente tiene episodio de metrorragia. Ecográficamente se constata una disminución considerable del volumen de hematómetra. En la cirugía se pesquisa fístula uterina que comunica útero obstruido izquierdo con útero no obstruido derecho por donde había drenado espontáneamente la hematómetra. Al resecar el tabique vaginal izquierdo se termina de drenar hematómetra y hematocolpos. Al alta, paciente se maneja con dilatación vaginal progresiva por seis meses para evitar la estenosis del tabique. Conclusión: Se presenta una complicación no descrita, fístula útero uterina, de una malformación mülleriana infrecuente (OVHIRA). El proceso diagnóstico meticuloso, la cirugía bien planificada y la dilatación vaginal prolongada permitieron tener éxito en su manejo.

ABSTRACT Background: Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome (OHVIRA) is an uncommon Müllerian anomaly. Objective: A case is described and the main complications related to the syndrome are reviewed. Case report: Female, 12 years old, with a medical history of a bicornuate uterus and right renal agenesis diagnosed at birth. Twenty-two months post menarche she seeks medical attention due to pelvic pain, menometrorrhagia and premenstrual dysmenorrhea. An ultrasound revealed a hematometra, of 142 x 69 x 61 mm, in the left uterus. Magnetic resonance imaging also described a 7 x 10 cm hematocolpos and a transverse vaginal septum of the left hemivagina. OHVIRA is diagnosed and surgery is planned to resect the septum. Two days before the surgery, the patient has an episode of abundant metrorrhagia. Ultrasonographically a considerable decrease in the volume of the hematometra is observed. In surgery, a uterine fistula is discovered which communicates the left obstructed uterus with the right unobstructed uterus, where the hematometra had been partially drained. During the procedure, the left vaginal septum is resected, which completes the drainage of the hematometra and hematocolpos. At discharge, the patient undergoes progressive vaginal dilation for six months to avoid stenosis of the septum. Conclusion: An utero-uterine fistula has not been previously described as a complication of OHVIRA. The meticulous diagnostic process, the well planned surgery and the prolonged vaginal dilation allowed for a successful management.

Humans , Female , Child , Urogenital Abnormalities/diagnosis , Hematocolpos , Hematometra , Urogenital Abnormalities/surgery , Uterus/abnormalities , Uterus/diagnostic imaging , Vagina/abnormalities , Vagina/surgery , Kidney/abnormalities
Rev. chil. obstet. ginecol. (En línea) ; 82(5): 480-490, Nov. 2017. tab, graf
Article in English | LILACS | ID: biblio-899934


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.

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 Time
Int. braz. j. urol ; 43(4): 746-752, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-892861


ABSTRACT Purpose The polypropylene mesh (PPM) is used in many surgical interventions because of its good incorporation and accessibility. However, potential mesh-related complications are common. Platelet-rich plasma (PRP) improves the healing of wounds and is inexpensive. Thus, the purpose of this study was to analyze the effect of the PRP-gel coating of a PPM on inflammation, production of collagen, and smooth muscle in the rabbit vagina. Materials and Methods The intervention consisted of a 1.5cm incision and divulsion of the vaginal mucosa for the implantation of a PRP-coated PPM. The PRP-coated mesh was implanted in 15 rabbits, and in the second group, the same implant was used without the PRP coating. In the sham group, the intervention consisted of the incision, divulsion, and suture. The rabbits were euthanized at 7, 30 and 90 days, and full-thickness sagittal sections of the posterior vaginal wall and rectum were scored. The inflammatory infiltrate was evaluated using hematoxylin and eosin staining. The Sirius Red stain was used to examine deposition of collagen I and III, and Masson's trichrome staining was used to visualize the smooth muscle. Results The group with PRP-coated meshes had a lower inflammatory infiltrate count at 30 days. Deposition of collagen III increased with the use of PRP-coating at 90 days. Conclusions The area of inflammatory infiltrate was significantly increased in the group without the PRP-coated mesh at 30 days but not in the group with the PRP-coated mesh, indicating a less intense inflammatory response. In addition, a significant increase in collagen III occurred at 90 days.

Animals , Female , Polypropylenes , Surgical Mesh/adverse effects , Vagina/surgery , Platelet-Rich Plasma , Postoperative Complications , Rabbits , Vagina/pathology , Wound Healing , Collagen/metabolism
Rev. bras. ginecol. obstet ; 39(8): 415-423, Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-898891


Abstract Objective To assess themedical doctors andmedical students' opinion regarding the evidence and ethical background of the performance of vulvovaginal aesthetic procedures (VVAPs). Methods Cross-sectional online survey among 664 Portuguese medical doctors and students. Results Most participants considered that there is never or there rarely is amedical reason to perform: vulvar whitening (85.9% [502/584]); hymenoplasty (72.0% [437/607]); mons pubis liposuction (71.6% [426/595]); "G-spot" augmentation (71.0% [409/576]); labia majora augmentation (66.3% [390/588]); labia minora augmentation (58.3% [326/559]); or laser vaginal tightening (52.3%[313/599]).Gynecologists and specialistsweremore likely to consider that there are no medical reasons to performVVAPs; the opposite was true for plastic surgeons and students/residents. Hymenoplasty raised ethical doubts in 51.1% (283/554) of the participants. Plastic surgeons and students/residents were less likely to raise ethical objections, while the opposite was true for gynecologists and specialists. Most considered that VVAPs could contribute to an improvement in self-esteem(92.3% [613/664]); sexual function (78.5% [521/664]); vaginal atrophy (69.9% [464/664]); quality of life (66.3% [440/664]); and sexual pain (61.4% [408/664]). Conclusions While medical doctors and students acknowledge the lack of evidence and scientific support for the performance of VVAPs, most do not raise ethical objections about them, especially if they are students or plastic surgeons, or if they have had or have considered having plastic surgery.

Resumo Objetivos Avaliar a opinião de médicos e estudantes de medicina relativamente à evidência e contexto ético para a realização de procedimentos estéticos vulvovaginais (PEVVs). Métodos Estudo transversal, consistindo de inquérito online a 664 médicos e estudantes de medicina portugueses. Resultados A maioria dos participantes considerou que nunca ou raramente há uma razão médica para a realização de: branqueamento vulvar (85,9% [502/584]); himenoplastia (72,0% [437/607]); lipoaspiração do mons pubis (71,6% [426/595]); aumento do "ponto G" (71,0% [409/576]); aumento dos grandes lábios (66,3% [390/588]); aumento dos pequenos lábios (58,3% [326/559]) ou aperto vaginal com laser (52,3% [313/599]). Ser ginecologista e especialista associou-se a maior probabilidade de considerar não haver razões médicas para a realização de PEVV; o oposto foi verdade para os cirurgiões plásticos e estudantes/internos. A himenoplastia levantou dúvidas em termos éticos em 51,1% (283/554) dos participantes. Cirurgiões plásticos e estudantes/internos relatarammenos dúvidas emtermos éticos; o oposto foi verdade para os ginecologistas ou especialistas. Amaioria considerou que os PEVVs podemcontribuir para uma melhoria na autoestima (92,3% [613/664]); função sexual (78,5% [521/664]); atrofia vaginal (69,9% [464/664]); qualidade de vida (66,3% [440/664]); e dor sexual (61,4% [408/664]). Conclusões Ainda que os médicos e estudantes de medicina reconheçam a falta de evidência e bases científicas para a realização de PEVVs, a maioria não levanta objecções em termos éticos, especialmente se forem estudantes, cirurgiões plásticos, ou se eles próprios tiverem sido submetidos a cirurgia plástica ou considerem vir a sê-lo.

Humans , Female , Adolescent , Adult , Aged , Young Adult , Physicians , Students, Medical , Vagina/surgery , Vulva/surgery , Attitude of Health Personnel , Reconstructive Surgical Procedures/methods , Portugal , Cross-Sectional Studies , Self Report , Middle Aged
Rev. bras. ginecol. obstet ; 39(7): 317-321, July 2017. tab
Article in English | LILACS | ID: biblio-898879


Abstract Purpose This study aimed to evaluate and validate the qualitative human chorionic gonadotropin β subunit (β-hCG) test of the vaginal fluid washings of pregnant women with premature rupture of fetal membranes (PROM). Methods Cross-sectional study of pregnant women between gestational weeks 24 and 39 who underwent consultations in one of our institutions. They were divided into two groups: group A (pregnant women clinically diagnosed with PROM) and group B (pregnant women without loss of amniotic liquid). The patients were subjected to a vaginal fluid washing with 3 mL of saline solution, which was aspirated subsequently with the same syringe. The solution was immediately sent to the laboratory to perform the vaginal β-hCG test with cut-off points of 10 mIU/mL (β-hCG-10) and/or 25 mIU/mL (β-hCG-25). Results The β-hCG-10 test of the vaginal secretion was performed in 128 cases. The chi-squared test with Yates' correction showed a statistically significant difference between the 2 groups (p = 0.0225). The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy parameters were 77.1%, 43.6%, 52.3%; 70.4%; and 58.6% respectively. The β-hCG-25 test of the vaginal washing was performed in 49 cases. The analysis by Fisher's exact test showed a statistically significant difference between the groups (p = 0.0175). The sensibility, specificity, PPV, NPV, and accuracy parameters were 44.4%, 87.1%, 66.6%; 72.9%; and 71.4% respectively. Conclusions The β-hCG-25 test showed better accuracy for the diagnosis of PROM, and can corroborate the early diagnosis of PROM because it is a simple and quick exam.

Resumo Objetivo Este estudo objetivou validar o exame qualitativo da subunidade β da gonadotrofina coriônica humana (β-hCG) em lavado vaginal de gestantes com ruptura prematura de membranas (RPM) fetais. Métodos Estudo transversal de gestantes com 24 a 39 semanas atendidas em um hospital de Maringá divididas em 2 grupos: grupo A (clinicamente diagnosticadas com RPM) e grupo B (gestantes sem perda de liquido amniótico). As pacientes foram submetidas a lavado vaginal com 3 mL de soro fisiológico, que logo em seguida foi aspirado de volta na mesma seringa e imediatamente enviado ao laboratório para a realização do exame de β-hCG vaginal com pontos de corte de 10 mIU/mL (β-hCG-10) e/ ou 25 mIU/mL (β-hCG-25). Resultados O teste de β-hCG-10 na secreção vaginal foi realizado em 128 casos, e o teste do qui-quadrado com correção de Yates mostrou diferença significante entre os dois grupos (p = 0,0225). Os parâmetros de sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia foram respectivamente 77,1%; 43,6%; 52,3%; 70,4%; e 58,6%. O teste de β-hCG-25 na secreção vaginal foi realizado em 49 casos, e a análise pelo teste exato de Fisher mostrou diferença significativa entre os grupos (p = 0,0175). Os parâmetros de sensibilidade, especificidade, VPP, VPN e acurácia foram respectivamente 44,4%; 87,1%; 66,6%; 72,9%; e 71,4%. Conclusões O β-hCG-25 apresentou melhor acurácia para o diagnóstico de RPM, e pode corroborar o diagnóstico precoce de RPM por se tratar de um exame simples e rápido.

Fetal Membranes, Premature Rupture/diagnosis , Chorionic Gonadotropin, beta Subunit, Human/analysis , Vagina/surgery , Cross-Sectional Studies , Prospective Studies , Early Diagnosis , Therapeutic Irrigation