Prolapso genital: etiopatogenia, diagnóstico y tratamiento / Genital prolapse: etiopathogenesis, diagnosis and treatment

Vaginal prolapse is a very common disorder in the general female population. Because it is so common and often asymptomatically, there is no exact definition of this condition. Additionally its exact prevalence is not known. There are multiple risk factors that cause vaginal prolapse, for example age and vaginal deliveries are the most common, and nevertheless it is considered a multifactorial process. From the surgical point of view the most accepted theory for its production is site-specific tears that would generate the prolapse as they occur. Its diagnosis is clinical and is currently classified into four stages according to the degree of descent that exists with respect to the hymen. There are many different types of treatment, and the most used are pessaries, physiotherapy and surgery. The following is a review that covers various relevant aspects of the vaginal prolapse, his confrontation and treatment.

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.

Suspensión transvaginal alta a ligamentos uterosacros para el tratamiento de defectos apicales (stalus): descripción de la técnica y resultados anatómicos a mediano plazo / High uterosacral vaginal vault suspension for the treatment of apical prolapse: anatomical outcomes

Objetivos: Describir una técnica quirúrgica, novedosa en el medio nacional, de abordaje vaginal, para el tratamiento del prolapso apical: la suspensión transvaginal alta a ligamentos úterosacros (STALUS). Método: Estudio descriptivo longitudinal, de 57 pacientes con defectos apicales, a los cuales se les realizó esa técnica entre Diciembre de 2002 y Octubre 2005. Se realizó estadística descriptiva y test t (2 muestras) para análisis de pronóstico anatómico (POP-Q). Para análisis de potenciales factores pronósticos se utilizó ANOVA, regresión lineal y logística. Resultados: El tiempo operatorio promedio fue de 151 minutos. El resultado anatómico (POP-Q), pre y postoperatorio, resultó favorable y estadísticamente significativo, en los nueve puntos evaluados, 49 de las 54 pacientes fueron seguidas en promedio durante 15 meses. En el compartimiento apical (punto C) obtuvimos curación del 89 por ciento y no hubo fracasos. En la pared anterior, 22 por ciento de las pacientes recidivaron. En cuanto a las complicaciones, se produjo una fístula ureterovaginal. Conclusiones: Tomando las precauciones necesarias, es una técnica segura y reproducible, con buenas tasa de curación. Asegurar la indemnidad del uréter, siempre será una obligación. La recidiva en pared anterior, aunque sea asintomática, resulta ser extremadamente alta, lo que nos obliga a pensar en nuevas técnicas de abordaje de este compartimiento.

Objective: To describe a novel surgery technique in the national ground, of vaginal approach for the treatment of apical prolapse: the transvaginal high suspension to the uterosacral ligaments (STALUS). Method: It is a longitudinal descriptive study that included 57 patients with apical support defects, in which this technique was performed between December 2002 and October 2005. Descriptive statistics and t test were per-formed for the anatomical outcome (POP-Q). For the potential prognosis factors, ANOVA, lineal regression and logistic, were used. Results: The average surgery time was 151 minutes. The anatomical result (POP-Q), before and after surgery, was favourable and significant in the nine points evaluated. 49 of 54 patients were followed for 15 months in average. In the apical compartment (C point) we got an 89 percent of cure and there were no failure. In the anterior wall, instead, 22 percent of our patients recurred. About complications, there was an ureterovaginal fistula. Conclusions: If all precautions are taking, there is a secure and reproducible technique, with good cure rate. To secure the ureter it is always an obligation. The recurrence in the anterior wall, even been asymptomatic, is too high, that make us think in new techniques in order to manage this compartment.