Perineal abscess three years after a transobturator sling.

OBJECTIVE: This study aimed to report a unique perineal abscess after placement of a transobturator sling, involving the thighs and obturator regions bilaterally without involving mesh exposure. CASE REPORT: A 66-year-old woman treated for stress urinary incontinence with a transobturator sling developed a late bilateral obturator infection 30 months after surgery. This complication appeared 6 months after chemotherapy for breast cancer. Sling removal through vaginal and bilateral inguinal incisions was performed. The patient evolved well, without recurrence of the infection or incontinence. DISCUSSION: This case presents a unique scenario of muscle and skin infection after sling placement without any mesh exposure or vaginal involvement. The occurrence of the infection only after chemotherapy may indicate that immunosuppression had participation on its development. Care should be taken when exposing this mesh in contaminated perineal areas.

Comparison of the efficacy and safety of surgical procedures utilizing autologous fascial and transobturator slings in patients with stress urinary incontinence.

OBJECTIVE: To evaluate whether the conventional autologous fascial (AF) sling is superior or equal to the readjustable transobturator (TOT) sling in efficacy and safety in women with stress urinary incontinence (SUI). STUDY DESIGN: This was a retrospective study comprised of a sample of 463 patients from 2003 to 2009. A total of 203 women received TOT slings for urodynamically confirmed SUI, and 260 patients received AF slings. We analyzed the subjective success rate (cure and/or improvement) after 12 and 24 months of surgery as well as any immediate and late surgical complications. RESULTS: Both groups were statistically similar with regard to age, parity, body mass index, number of previous gynecological surgeries, and antiincontinence therapies. After 12 months patients with the TOT sling had a higher subjective percentage efficacy rate when compared to those with the AF sling (94% vs. 88%, p < 0.05); however, after 24 months this percentage was no longer statistically significant (88.7% vs. 84.6%, p = 0.20). The TOT sling presented fewer postoperative complication rates (14.1% vs. 25.6%, p < 0.05), similar intraoperative complication rates (1.15% vs. 2.3%, p = 0.22) and a shorter mean operative time (23 vs. 112 minutes, p < 0.05) than the AF sling. CONCLUSION: Both techniques had similar subjective efficacy rates, but the TOT sling demonstrated fewer postoperative surgical complications than the AF sling.

Sexuality during the climacteric period.

BACKGROUND: Cultural, social, physiological and psychological factors may alter the course of sexual function in climacteric women. OBJECTIVE: The objective of the present literature review is to survey the prevalence of sexual dysfunctions in the climacteric and to establish the association between the organic and psychic changes that occur during this phase and sexual dysfunction. We also discuss potential treatments. METHODS: We evaluated the data available in PubMed (1982-2008). For each original article, two reviewers analyzed the data independently and considered a study to be of high quality if it had all three of the following characteristics: prospective design, valid data and adequate sample size. Both reviewers extracted data from each of the 99 studies selected: 34 cross-sectional studies, 25 cohort studies, 9 trials, 31 reviews related to sexuality in pre- and post-menopausal women. RESULTS: Sexual dysfunction among climacteric women is widespread and is associated with bio-psychosocial factors. However, there is not enough evidence to correlate sexual dysfunction with a decrease in estrogen levels and biological aging. A strong association exists between climacteric genital symptoms and coital pain. There is, however, sufficient evidence demonstrating the benefits of local estrogen therapy for patients with genital symptoms. CONCLUSION: A significant decline in sexual function occurs in climacteric women, although it is still unclear whether this is associated with the known decrease in estrogen levels or with aging, or both. Relational factors may interfere with sexual function during this phase. The climacteric genital symptoms improve with estrogen replacement therapy, and positively influence sexual function. Further studies are needed to establish the actual impact of the decrease in estrogen levels and of aging on the sex life of climacteric women.

Avaliaçäo multidisciplinar da osteoporose / Multidisciplinary evaluation of osteoporosis

A osteoporose é uma doença esquelética sistêmica, caracterizada pela perda de massa óssea e deterioraçao da microarquitetura do tecido ósseo, com conseqüente aumento de sua fragilidade. Nas mulheres menopausadas em especial, torna-se importante pelo risco de fratura óssea atraumática, responsável pelo aumento sobremaneira da morbidade desta doença. Discute-se vantagens e desvantagens de métodos diagnósticos clínicos, bioquímicos e radiológicos conhecidos, a fim de selecionar os mais sensíveis e específicos, servindo assim para identificaçao de mulheres com maior risco para o desenvolvimento da osteoporose. Finaliza-se com uma análise crítica da abordagem atual da osteoporose com os métodos atualmente disponíveis.

Efeitos Vasculares do estradiol e da progesterona: ionoforese de drogas vasoativas / Vascular effects of estradiol and progesterone: Ionophorese of vasodilator drugs

RETROSPECTIVA: A terapia de reposiçao estrogênica (TRH) está associada a uma reduçao em cerca de 50 por cento nos eventos cardiovasculares. Embora o efeito do estrogênio no perfil lipídico seja um dos potenciais mecanismos, estas mudanças lipídicas parecem insuficientes para justificar completamente o grau clínico de benefícios atribuídos à estrogenioterapia. OBJETIVO: Pelo fato de ser um dos efeitos benéficos do estrogênio uma modulaçao na funçao vasomotora, investigamos os efeitos de níveis fisiológicos de estrogênio na resposta vascular de mulheres com deficiência de estrogênio. CASUISTICA E MÉTODOS: Foram avaliadas neste estudo 26 mulheres sadias, com deficiência estrogênica. O fluxo de sangue na microvascularizaçao periférica foi avaliado usando a Dopplerfluxometria laser (DFL). Foi avaliada a resposta vascular da acetilcolina (ACh)- um agonista dependente do endotélio e do nitroprussiato de sódio (NaNP)- um vasodilatador independente, utilizando a técnica de ionoforese na pele das pacientes. Três avaliaçoes foram realizadas: 1-basal, ausência de qualquer terapia de reposiçao hormonal; 2-após E2, após 14 dias de administraçao de estradiol; 3-após E2/P, após 12 dias de administraçao de estradiol e progesterona. RESULTADOS: Os dados sao mostrados como média e desvio padrao referentes ao ângulo de inclinaçao da curva do fluxo de sangue em resposta à ACh e ao NaNP. Houve uma atenuaçao do ângulo de inclinaçao da curva da resposta vasodilatadora pela ACh após 14 dias de E2 (0.27+0.15 volts/min vs.0.096+0.08 volts/min; p<0.05) e após 12 dias de E2/P (0.27+0.15 volts/min; vs 0.11+0.09;P<0.05). Em relaçao ao NaNP, o ângulo de inclinaçao da curva após 14 dias de E2 variou de 0,12+0.08 volts/min vs 0.092+0.07 volts/ min; (NS) e após 12 dias de E2/P de 0,12+0,08 volts/min vs 0,09+0,05 (NS). CONCLUSOES: A administraçao do E2 modulou significativamente a resposta vaso dilatador para ACh (endotélio dependente) mas nao para a NaNP (endotélio independente). Estes resultados sugerem que a açao do E2 pode se fazer a nével de célula endotelial e nao no músculo liso vascular. A administraçao concomitante de P (E2/P) por um período de 12 dias reverteu a açao moduladora do E2, mas as mudanças no fluxo sangüíneo foram mais evidentes quando o E2 foi administrado sozinho. Assim, o E2 pode ser um participante sobre o tônus vascular da microcirculaçao.