A história da classificação do prolapso genital / The history of genital prolapse classification

A avaliação do prolapso genital constitui uma etapa importante do exame ginecológico, devendo, sempre que possível, ser classificados os graus de prolapso por meio de métodos padronizados. Embora a afecção não possa ser considerada fatal, ela pode determinar sequelas importantes para a saúde da mulher, comprometendo a sua qualidade de vida. Como o prolapso genital só se torna sintomático quando o segmento prolapsado ultrapassa o introito vaginal, torna-se necessário o diagnóstico precoce com o objetivo de prevenir o estágio final da doença. A história da classificação do prolapso genital nos mostra o esforço dos pesquisadores para adquirir uma linguagem comum que permita a comunicação mais precisa da posição anatômica dos órgãos pélvicos.

The assessment of genital prolapse is a major phase of the gynecological exam and, whenever is possible, the degree of prolapse should be identified by means of standard methods. Although the disease should is not considered fatal, it can bring significant sequelae to women's health and determine negative impacts on quality of life. As the genital prolapse only becomes symptomatic when the segment exceeds the vaginal introitus, it is necessary to perform the early diagnosis in order to prevent the final stage of the disease. The history of classification of genital prolapse shows us the effort of researchers to acquire a common language that allows more precise communication on the anatomical position of the pelvic organs.

Uso del sistema POPQ para la clasificación de los prolapsos: Hospital Parroquial de San Bernardo / Use of the POPQ system for prolapses classification: Hospital Parroquial de San Bernardo

El sistema de Pelvic Organ Prolapse Quantification (POPQ) ha demostrado ser útil, fácil de aprender, rápido de realizar y con una buena confiabilidad intra e interobservador. Quisimos comenzar a aplicar este tipo de clasificación y compararla con la clasificación clásica de Baden y Walker descrita en la ficha clínica. Para esto se realizó un estudio observacional de 41 pacientes en que se comparó el sistema tradicional consignado en la ficha, con la medición de nueve puntos que utiliza el sistema POPQ. En 17 por ciento de los casos ambos sistemas coincidieron en el diagnóstico del descenso de todos los elementos del prolapso: pared anterior, posterior y cuello uterino. El sistema POPQ permite un diagnóstico acabado del estado y magnitud del descenso de los órganos pelvianos.

The Pelvic Organ Prolapse Quantification (POPQ) System has proved to be a good method for describing and quantifying pelvic organ prolapse. The objective of this observational study was to compare the classification consigned in the clinical records (Baden and Walker classification) with the new POPQ system. In the first 41 cases we proceed to evaluate our patients by mean of the POPQ system. In only 17 percent of the cases the two systems agreed in the diagnosis of the anterior, posterior and cervix descents. POPQ system allows an acute diagnosis of the state and magnitude of the descent of pelvic organs.

Prevalence of genital prolapse in Thai menopausal women (using new standardization classification).

BACKGROUND: There is an increasing number of menopausal women in Thailand (estimation of 5 million women). There is no published data on the prevalence of genital prolapse among Thai menopausal woman. So the authors created this hospital based study to identify the magnitude of this problem in Thai menopausal women. OBJECTIVE: To study the prevalence and symptoms of genital prolapse in Thai menopausal women attending the menopausal clinic in King Chulalongkorn Memorial Hospital. STUDY DESIGN: Descriptive study (Cross-sectional study). MATERIAL AND METHOD: Two hundred and fifteen Thai menopausal women attending the menopause clinic at King Chulalongkorn Memorial Hospital from the 1st of January to the 28th of February 2004 were recruited. Urinary symptoms history taking and pelvic examination were done. The severity of any prolapse was classified using International Continence Society classification. RESULTS: Prevalance of Thai menopausal women having any type of genital prolapse was 43.3%. Anterior vaginal wall prolapse and superior vaginal prolapse were the two highest prevalences of genital prolapse (29.3% and 14.9%). The prevalence of genital prolapse increased by the menopausal age. The two leading symptoms were stress incontinence and vaginal outlet relaxation (89.3% and 51.6%). CONCLUSION: From the present study, the authors found the prevalence of any genital prolapse (43.3%) and stress incontinence(89.3%) among Thai women attending menopausal clinic in King Chulalongkorn Memorial Hospital. The authors strongly recommend pelvic examination and urinary-symptoms history taking to evaluate the severity of genital prolapse.

Tratamiento del muñon vaginal en la técnica de la histerectomía abdominal / Treatment of vaginal stump in abdominal hysterectomy

La histerectomía abdominal es la intervención quirúrgica que se practica con mayor frecuencia. En diversas series publicadas se estima que la mortalidad es de 0.1% pero la morbilidad puede variar del 25 al 50% En la técnica de la histerectomía se han señalado 4 pasos básicos que si no se omiten, permiten ejecutar una técnica correcta que asegura un post-operatorio favorable.Ellos son: Prevención de la hemorragia, Prevención de la infección, Evitar heridas a órganos vecinos y Reconstruir correctamente la Fascia Endopélvica. En este trabajo se insiste en que en la extirpación del cuello uterino y en el correcto manejo del muñón vaginal radica el éxito de la operación.