Female pelvic floor myofascial syndrome and its relationship with lower urinary tract storage symptoms

Background: Pelvic floor myofascial syndrome is defined as non-articular skeletal muscle pain, characterized by the presence of trigger points. Present in 14-23% of patients with chronic pelvic pain. It has an impact on urinary function. The prevalence of lower urinary tract symptoms is 15-67%, with storage symptoms predominating in patients with PFMS. Objective was to determine the relationship between female pelvic floor myofascial syndrome and lower urinary tract storage symptoms.Methods: This was a retrospective, observational, descriptive, cross-sectional, homodemic and single-center study at University Hospital Doctor José Eleuterio González, Monterrey, Nuevo Leon, Mexico from period one from April 1st to June 30th, 2022. Type of non-probabilistic convenience sampling. Database in Excel 2016, Pearson's ?² statistical test in the SPSS V25® program.Results: 136 patients with PFMS and LUTS storage were evaluated. The most frequent age group was 46-55 years with 33.1% (N=45); the marital status was married with 74.3% (N=101). In relation to education 55.9% (N=76) with a bachelor's degree. The most frequent storage symptoms were nocturia 67.6% (N=92) p<0.05, frequency 60.3% (N=82) p=0.512, urgency 57.4% p<0.005.Conclusions: Knowing the correlation between PFMS and storage LUTS can guide specific pain treatment with review of urinary symptoms. In patients with nocturia, frequency, urgency, SUI and UUI, a physical examination should be performed and included trigger points in the pelvic floor. Nocturia is the most prevalent storage LUTS in PFMS.

Lower urinary tract symptoms secondary to a vaginal leiomioma the female prostate: case report

This is a case report of lower urinary tract symptoms secondary to a vaginal leiomioma “the female prostate”. A 45-year-old female patient with no significant personal history, sensation of a vaginal foreign body accompanied by lower urinary tract symptoms, on vaginal physical examination with a 7×7 cm deep tumor, increased consistency, not painful, without hemorrhage. Magnetic resonance imaging with hypointense T1 and T2 images, few linear hyperintense areas in T2, homogeneous postgadolinium enhancement 69×66×53 mm, solid tumor dependent on the vaginal vault. Tumor markers CA 19-9: 5.98 U/ml, CEA: 1.09 ng/ml and CA 125: 11.73 U/ml. Open surgery was performed in which a 8×6 cm tumor was found in the vaginal vault dependent on the posterior wall of the vagina. Histopathological report: conventional leiomyoma measuring 9×7.5 cm in long axes, without nuclear atypia. With resolution of symptoms in the lower urinary tract, with normal urinary frequency, without presence of urgency, without urinary incontinence or voiding symptoms. It is important to identify and diagnose lower urinary tract symptoms always, since they could be an initial manifestation of pelvic tumors in which the treatment approach should not be delayed.

Urethro-cutaneous fistula: a rare complication in anti-incontinence surgery with trans-obturator tapes sling

This case report presents a rare complication of tension-free mid-urethral tape surgery by the obturator approach (TOT) in the form of a urethro-cutaneous fistula. The patient underwent successful surgical repair, highlighting the importance of intraoperative cystoscopy to minimize surgical risks and complications. Tension-free mid-urethral tape surgery is a commonly performed procedure for the treatment of stress urinary incontinence (SUI). However, complications can occur, albeit rarely. In this case, a 52-year-old female patient developed a urethro-cutaneous fistula following TOT surgery. The fistula was identified by the presence of urine leakage at the right inguinal level, leading to significant distress and discomfort for the patient. Prompt diagnosis and appropriate management are crucial in such cases. The patient underwent surgical repair, which involved excision of the fistulous tract. The procedure was successful, resulting in complete resolution of the fistula and restoration of normal urinary function. In conclusion, this case report highlights the occurrence of a rare complication, namely a urethro-cutaneous fistula, following TOT surgery. The successful surgical repair emphasizes the importance of prompt diagnosis and appropriate management. Furthermore, the authors propose that an intraoperative cystoscopic evaluation be considered, even after a TOT procedure. Especially in cases that present risk factors or in hospital-school institutions. By implementing this practice, surgeons can enhance patient safety and improve surgical outcomes in anti-incontinence procedures.