TVT versus TVT-O for minimally invasive surgical correction of stress urinary incontinence

OBJECTIVE: The present work describes our experience in surgical correction of stress urinary incontinence, comparing both the TVT and the TVT-O techniques. METHOD: Between October 2001 and March 2004, 76 patients underwent the TVT procedure. Between January 2004 and January 2005, 98 surgical corrections of urinary incontinence were carried out using the TVT-O technique. RESULTS: Median operative time was 28 minutes for TVT and 7 minutes for TVT-O. Intraoperative complications for TVT occurred in 4 patients (6.6 percent): urinary bladder perforation in 3 patients (5 percent, p = 0.0228) and parietal peritoneum perforation in 1 case (1.6 percent). No intraoperative complications took place during TVT-O. Immediate postoperative complications: transient urinary retention in TVT, 2 cases (2.6 percent) and overcorrection in TVT-O (1 percent) which was readjusted within 24 hours. There were no late complications after TVT. There were 2 cases (2.04 percent) with late complications in TVT-O. TVT and TVT-O resulted in correction of incontinence in 100 percent of the patients. CONCLUSION: TVT and TVT-O are two effective techniques for the correction of stress urinary incontinence. TVT-O would seem to be a technique much easier to perform resulting in less intraoperative complications.

Tension free monofilament macropore polypropylene mesh (Gynemesh PS) in female genital prolapse repair

OBJECTIVES: To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transvaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100 percent of patients, with a pursuit between 1 and 8 months. DISCUSSION: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.

Macrosomía fetal: ¿riesgo perinatal? / Fetal macrosomia: perinatal risk?

El parto de un feto macrosómico lo expone teóricamente a un mayor riesgo de mortalidad y morbilidad secundaria a trauma obstétrico y asfixia intraparto. Esta potencial complicación implica que muchos de estos embarazos culminen en cesárea. La incidencia de trauma obstétrico se relaciona con el nivel de control del embarazo y de la atención del trabajo de parto por un equipo médico experto: este factor resulta más importante que la vía del parto en la prevención de trauma obstetrico. Se plantea conocer la frecuencia de macrosomía en Clínica Las Condes y su asociación con trauma obstétrico severo y conocer el porcentaje de cesáreas en macrosómicos y relacionarlo al número de cesáreas totales. Se realizó un estudio retrospectivo de base de datos de maternidad y neonatología de un período de 5 años. Se consignó el número de partos totales y su vía de parto. Se dividió el universo en dos grupos considerando el peso de nacimiento. El grupo I incluyó los nacidos con peso igual o mayor a 4.000 gramos y el grupo II incluyó a los de peso inferior a 4.000 gramos. Se definió trauma obstétrico severo como toda complicación grave atribuida al parto traumático con potencial riesgo vital y/o de secuelas posteriores de acuerdo a clasificación pediátrica. Se incluyó 6.969 partos, 474 correspondieron a RN de 4.000 gramos o más (7por ciento). El porcentaje total de cesáreas fue de 40.5 por ciento y de 31.9 por ciento en macrosómicos (p<0.01). De los 474 neonatos con peso al nacer igual o mayor a 4.000 gramos ninguno presentó trauma obstétrico severo a diferencia del grupo de menor peso que concentró los casos de trauma. El análisis de las variables permite concluir que en nuestro medio no se asocia trauma obstétrico a macrosomía y que esto no se debe a un aumento en la frecuencia de cesárea para resolver estos embarazos