Mid- to Long-Term Magnetic Resonance Imaging Results of Two Prolapse Surgeries for Apical Defect: A Secondary Analysis of a Randomized Controlled Trial.

OBJECTIVE: Magnetic resonance imaging (MRI) has been considered another tool for use during the pre- and postoperative periods of the management of pelvic-organ prolapse (POP). However, there is little consensus regarding its practical use for POP and the association between MRI lines of reference and physical examination. We aimed to evaluate the mid- to long-term results of two surgical techniques for apical prolapse. METHODS: In total, 40 women with apical POP randomized from 2014 to 2016 underwent abdominal sacrocolpopexy (ASC group; n = 20) or bilateral vaginal sacrospinous fixation with an anterior mesh (VSF-AM group; n = 20). A physical examination using the POP Quantification System (POP-Q) for staging (objective cure) and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: subjective cure), were applied and analyzed before and one year after surgery respectively. All MRI variables (pubococcigeous line [PCL], bladder base [BB], anorectal junction [ARJ], and the estimated levator ani subtended volume [eLASV]) were investigated one year after surgery. Significance was established at p < 0.05. RESULTS: After a mean 27-month follow-up, according to the MRI criteria, 60% of the women were cured in the VSF-AM group versus 45% in ASC group (p = 0.52). The POP-Q and objective cure rates by MRI were correlated in the anterior vaginal wall (p = 0.007), but no correlation was found with the subjective cure. The eLASV was larger among the patients with surgical failure, and a cutoff of ≥ 33.5 mm3 was associated with postoperative failure (area under the receiver operating characteristic curve [ROC]: 0.813; p = 0.002). CONCLUSION: Both surgeries for prolapse were similar regarding the objective variables (POP-Q measurements and MRI cure rates). Larger eLASV areas were associated with surgical failure.

OBJETIVO: A ressonância magnética (RM) tem sido considerada uma outra ferramenta para uso pré e pós-operatório em casos de prolapso de órgãos pélvicos. Contudo, pouco consenso existe sobre a sua prática para prolapso e a associação entre as linhas de referência da RM e o exame físico. Nós objetivamos avaliar resultados de médio a longo prazo de duas técnicas cirúrgicas para prolapso apical. MéTODOS: Um total de 40 mulheres com prolapso apical foram submetidas entre 2014 a 2016 a sacrocolpopexia abdominal (grupo SCA; n = 20) ou fixação bilateral vaginal no ligamento sacroespinhoso com tela anterior (grupo FVLS-TA; n = 20). Os exames físicos com estadiamento usando o Pelvic Organ Prolapse Quantification System (POP-Q: cura objetiva), e o International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS: cura subjetiva) foram analisados antes e depois de um ano da cirurgia, respectivamente. O exame de RM (linha pubococcígea [LPC], base vesical [BV], junção anorretal [JAR] e o volume subtendido estimado do levantador do ânus [VSELA]) foi realizado um ano antes da cirurgia. Estabeleceu-se o nível de significância em 5%. RESULTADOS: Depois de uma média de 27 meses de seguimento, de acordo com a RM, 60% das mulheres foram curadas no grupo FVLS-TA versus 45% no grupo SCA (p = 0.52). As curas objetivas associadas ao POP-Q e à RM foram correlacionadas na parede vaginal anterior (p = 0.007), mas nenhuma correlação foi encontrada com a cura subjetiva. O VSELA foi maior entre as pacientes com fracasso da cirurgia, e um ponto de corte de ≥ 33.5 mm3 esteve associado ao fracasso da cirurgia (area sob a curva característica de operação do receptor [COR]: 0.813; p = 0.002). CONCLUSãO: Ambas as cirurgias para o prolapso foram similares nas curas objetivas tanto pelo POP-Q quanto pela RM. Áreas maiores de VSELA estiveram associadas com o fracasso das cirurgias.

Quality of life and vaginal symptoms of postmenopausal women using pessary for pelvic organ prolapse: a prospective study.

OBJECTIVE: The use of pessary is an option for the conservative treatment of pelvic organ prolapse (POP). However, here are few studies assess the quality of life (QoL) after inserting the pessary for POP. We have hypothesized that the use of pessary would modify QoL in women with POP. METHODS: A prospective, observational study was performed that included 19 women with advanced POP. Pessary was introduced, and the SF-36 (general quality of life) and ICIQ-VS (vaginal symptoms and quality of life subdomain) questionnaires were applied before the introduction and after six months. A single question about the satisfaction regarding the use of the device was presented (subjective impression). RESULTS: The mean age of the women included was 76 years. Most of them were non-caucasian (52.6%), with no prior pelvic surgery (57.5%), with urinary symptoms (78.9%). A third of the patients reported sexual activity. After treatment, 22.2% of them presented vaginal infection, and 27.7% increased vaginal discharge. Urinary symptoms remained unaltered. Women reported 100% satisfaction after using the pessary (77.7% partial improvement; 22.3% total improvement). SF-36 had significant improvement in three specific domains: general state of health (p=0.090), vitality (p=0.0497) and social aspects (p=0.007). ICIQ-VS presented a reduction in the vaginal symptoms (p < 0.0001) and an improvement in QoL (P < 0.0001). CONCLUSION: The use of pessary for six months improved the QoL and reduced vaginal symptoms for women with advanced POP.

Quality of life and vaginal symptoms of postmenopausal women using pessary for pelvic organ prolapse: a prospective study

SUMMARY OBJECTIVE: The use of pessary is an option for the conservative treatment of pelvic organ prolapse (POP). However, here are few studies assess the quality of life (QoL) after inserting the pessary for POP. We have hypothesized that the use of pessary would modify QoL in women with POP. METHODS: A prospective, observational study was performed that included 19 women with advanced POP. Pessary was introduced, and the SF-36 (general quality of life) and ICIQ-VS (vaginal symptoms and quality of life subdomain) questionnaires were applied before the introduction and after six months. A single question about the satisfaction regarding the use of the device was presented (subjective impression). RESULTS: The mean age of the women included was 76 years. Most of them were non-caucasian (52.6%), with no prior pelvic surgery (57.5%), with urinary symptoms (78.9%). A third of the patients reported sexual activity. After treatment, 22.2% of them presented vaginal infection, and 27.7% increased vaginal discharge. Urinary symptoms remained unaltered. Women reported 100% satisfaction after using the pessary (77.7% partial improvement; 22.3% total improvement). SF-36 had significant improvement in three specific domains: general state of health (p=0.090), vitality (p=0.0497) and social aspects (p=0.007). ICIQ-VS presented a reduction in the vaginal symptoms (p < 0.0001) and an improvement in QoL (P < 0.0001). CONCLUSION: The use of pessary for six months improved the QoL and reduced vaginal symptoms for women with advanced POP.

RESUMO OBJETIVO: O pessário é uma opção para o tratamento conservador do prolapso genital. MÉTODOS: Um estudo prospectivo e observacional foi realizado com 19 mulheres com prolapso genital avançado. A avaliação da qualidade de vida e dos sintomas vaginais foi mensurada pelos questionários SF-36 e ICIQ-VS antes e seis meses depois da colocação do pessário. Uma pergunta simples sobre satisfação do uso do dispositivo foi também feita (impressão subjetiva). RESULTADOS: A idade média das mulheres foi de 76 anos. A maioria era parda/negra (52,6%), sem cirurgias pélvicas (57,5%), com sintomas urinários (78,9%). Um terço das pacientes relatou atividade sexual. Depois do tratamento, 22,2% apresentaram infecção vaginal e 27,7% fluxo vaginal aumentado. Não houve alteração da prevalência dos sintomas urinários. As mulheres relataram 100% de satisfação (77,7% melhora parcial e 22,3% melhora completa) depois do uso do pessário. Houve melhora em três domínios do SF-36: saúde em geral (p=0,090), vitalidade (p=0,0497) e aspectos sociais (p=0,007). O ICIQ-VS apresentou redução nos sintomas vaginais (p<0,0001) e melhora da qualidade de vida (p<0,0001). CONCLUSÕES: O uso do pessário por seis meses em mulheres com prolapso genital melhorou a qualidade de vida e reduziu os sintomas vaginais.

Can the Pessary Use Modify the Vaginal Microbiological Flora? A Cross-sectional Study.

Introduction Vaginal pessary is used as a conservative treatment for pelvic organ prolapse (POP). Some studies have shown that common complaints of its use may include vaginal discomfort and increased vaginal discharge. Scant information is available about the microflora status after using this device. Objective To determine if the usage of vaginal pessary can interfere with the vaginal environment. Methods A cross-sectional study was performed from March of 2014 to July of 2015 including 90 women with POP. The study group was composed of 45 women users of vaginal pessary and 45 nom-users. All enrolled women answered a standardized questionnaire and were subjected to a gynecological exam to collect vaginal samples for microbiological evaluation under optic microscopy. Clinical and microbiological data were compared between study and control groups. Results Vaginal discharge was confirmed in 84% of the study group versus 62.2% in the control group (p < 0.01); itching was reported in 20 and 2.2%, respectively (p < .05); genital ulcers were only found in the pessary group (20%). There was no difference with regard to the type of vaginal flora. Bacterial vaginosis was prevalent in the study group (31.1% study group versus 22.2% control group), (p =.34). Conclusion Women using vaginal pessaries for POP treatment presented more vaginal discharge, itching and genital ulcers than non-users.

Can the Pessary Use Modify the Vaginal Microbiological Flora? A Cross-sectional Study / O uso de pessário vaginal pode alterar a flora microbiológica? Um estudo transversal

Abstract Introduction Vaginal pessary is used as a conservative treatment for pelvic organ prolapse (POP). Some studies have shown that common complaints of its use may include vaginal discomfort and increased vaginal discharge. Scant information is available about the microflora status after using this device. Objective To determine if the usage of vaginal pessary can interfere with the vaginal environment. Methods A cross-sectional study was performed from March of 2014 to July of 2015 including 90 women with POP. The study group was composed of 45 women users of vaginal pessary and 45 nom-users. All enrolled women answered a standardized questionnaire and were subjected to a gynecological exam to collect vaginal samples for microbiological evaluation under optic microscopy. Clinical and microbiological data were compared between study and control groups. Results Vaginal discharge was confirmed in 84% of the study group versus 62.2% in the control group (p< 0.01); itching was reported in 20 and 2.2%, respectively (p< .05); genital ulcers were only found in the pessary group (20%). There was no difference with regard to the type of vaginal flora. Bacterial vaginosis was prevalent in the study group (31.1% study group versus 22.2% control group), (p=.34). Conclusion Women using vaginal pessaries for POP treatment presented more vaginal discharge, itching and genital ulcers than non-users.

Resumo Introdução O pessário vaginal é utilizado como tratamento conservador para o prolapso de órgãos pélvicos (POP). Alguns estudos demonstraram que as queixas mais comuns do seu uso são o desconforto vaginal e um aumento do fluxo vaginal. As informações são escassas a respeito do que ocorre com a microflora vaginal após o uso do pessário. Objetivo Determinar se o uso do pessário pode interferir com o ambiente vaginal. Métodos Um estudo transversal realizado de março de 2014 a julho de 2015 com 90 mulheres com POP; metade delas usaram pessário e a outra metade permaneceu como grupo controle. Todas preencheram um questionário e realizaram exame ginecológico para coleta de amostras vaginais para análise microbiológica. Dados clínicos e microbiológicos foram comparados entre os grupos de estudo e de controle. Resultados O fluxo vaginal foi confirmado em 84% das mulheres do grupo de estudo versus 62,2% do grupo de controle (p< 0,01); prurido foi encontrado em 20 e 2,2%, respectivamente (p< 0,05). As úlceras genitais foram somente encontradas no grupo pessário (20%). Não houve diferenças com relação ao tipo de flora vaginal. A vaginose bacteriana fora encontrada em 31,1% das mulheres do grupo de estudo versus 22,2% do grupo de controle (p= 0,34). Conclusão Mulheres usando pessários vaginais para tratamento do POP apresentaram maior fluxo vaginal, prurido e úlcera genital do que as não usuárias do dispositivo.

Eficácia e segurança da colpopexia sacroespinhal vaginal e da sacrocolpopexia abdominal para tratamento do prolapso uterino: um estudo randomizado / Eficacy and safety of vaginal sacrospinous colpopexy and abdominal sacrocolpopexy for uterine prolapse treatmente: a radomized study

Resumo: INTRODUÇÃO: A correção do prolapso apical pela técnica de sacrocolpopexia abdominal (SCA) tem excelentes resultados, mas alta morbidade. A fixação sacroespinhal vaginal (FSV) tem boa eficácia, mas aumento de prolapsos de parede anterior. O uso de tela, pode diminuir esse prolapso. OBJETIVO: Avaliar eficácia e segurança da cirurgia do prolapso uterino comparando-se duas técnicas assim como a mudança da flora vaginal. MATERIAIS E MÉTODOS: Mulheres menopausadas, sem terapia hormonal ou cirurgia uroginecológica prévias, com prolapso uterino estágios 3 ou 4, avaliados pelo "Pelvic Organ Prolapse Quantification" (POP-Q), foram recrutadas para este estudo randomizado, aleatorizado. Foram excluídas mulheres com contraindicação clínica ou que não desejassem operar, com prolapso recidivado ou déficit cognitivo. Esta dissertação resultou em dois artigos: o primeiro analisou eficácia e segurança da cirurgia. As mulheres foram randomizadas em dois grupos: SCA e FSV com colocação de tela em parede vaginal anterior (FSV-TA). Foram avaliados: hemoglobina antes e após a cirurgia, complicações intraoperatórias e tardias, queixas urinárias e exame físico (antes e depois). Foram aplicados questionários validados: International Consultation on Incontinence Questionnaire ¿ Overactive bladder (ICIQ-OAB), International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) e International Consultation on Incontinence Questionnaire ¿ Vaginal Symptoms (ICIQ-VS). O segundo artigo foi uma análise da flora vaginal. Para análise estatística, foram utilizados qui-quadrado, teste exato de Fisher ou test t para variáveis contínuas. Para comparação de antes e após cirurgia, utilizamos teste Wilcoxon, Mann-Whitney e ANOVA para diferença das médias, nível de significância de 5%. RESULTADOS: No primeiro artigo foram incluídas 71 mulheres: 36 no grupo SCA e 35 no grupo FSV-TA. Não houve diferença nos dados sociodemográficos e variáveis clínicas (exceto para uma prevalência maior de prolapso apical estágio 4 no grupo FSV-TA). Não houve diferença nos escores pré operatórios dos questionários ICIQ-VS, ICIQ-SF e ICIQ-OAB. O tempo operatório foi maior no grupo SCA do que no grupo FSV-TA (129.1 vs 117.2, p = .0038). Retorno mais longo às atividades diárias foi observado no grupo abdominal (103,8 dias vs 57,6 dias; p <0,05). Os grupos tiveram melhora em todos os pontos do POP-Q (exceto o comprimento vaginal no grupo FSV-AM) e todos os escores dos questionários. Não foi observada diferença significativa nas complicações pós-operatórias. O segundo artigo incluiu 50 mulheres: grupo ASC (n=25) e grupo FSC-TA (n=25). Antes da cirurgia, dois terços das mulheres apresentaram flora de tipo 3, e metade delas não apresentou lactobacilos (52%). Sobre os critérios de Nugent, 48% apresentaram flora normal, 50% encontraram flora alterada e 2% com vaginose bacteriana. Comparando a flora antes e após a cirurgia, não houve diferença quanto ao tipo de flora (p = 1), número de lactobacilos (p = 0,9187), critérios de Nugent (p = 0,4235), inflamação (p = 0,1018) e vaginose bacteriana (p = 0,64). CONCLUSÃO: SCA e FSV-TA foram igualmente eficazes nas taxas de cura objetiva e subjetiva. O grupo vaginal apresentou menor tempo cirúrgico, tempo para retorno às atividades e maior exposição da tela. Concluímos que não houve mudança na flora vaginal de mulheres após a cirurgia, independentemente da via cirúrgica(AU)

Abstract: INTRODUCTION: Correction of apical prolapse by the abdominal sacrocolpopexy (ASC) technique has excellent results, but high morbidity. Vaginal sacro-spinal fixation (SVF) has good efficacy but an increase in anterior wall prolapse. The use of the mesh may decrease this prolapse. OBJECTIVE: To evaluate the efficacy and safety of surgical correction of uterine prolapse by comparing two surgical techniques as well as changing the vaginal flora. MATERIALS AND METHODS: Menopausal women without prior hormone therapy or urogynecological surgery with prolapse classification by stage 3 or 4 by Pelvic Organ Prolapse Quantification (POP-Q) were recruited for this randomized, prospective study. Women with clinical contraindication or who did not wish to operate, with relapsed prolapse or cognitive deficit were excluded. This dissertation resulted in two articles: the first analyzed the efficacy and safety of surgical correction. The women were randomized into two groups: ASC and SVF with mesh placement on the anterior vaginal wall (SVF-AM). Hemoglobin before and after surgery, intraoperative and late complications, urinary complaints and physical examination (before and after) were evaluated. Validated questionnaires were applied (ICIQ-VS, ICIQ-SF and ICIQ-OAB). The second article was an analysis of the vaginal flora. For statistical analysis, chi-square, Fisher's exact test or t-test were used for continuous variables. For comparison before and after surgery, we used Wilcoxon, Mann-Whitney and ANOVA test for difference of means, significance level of 5%. RESULTS: In the first article, 71 women were included: 36 in the ASC group and 35 in the SVF-AM group. There was no difference in relation to sociodemographic data and clinical variables (except for a prevalence of upper stage 4 in the apical POP-Q classification in the SVF-AM group). POP-Q also did not differ as well as scores ICIQ-VS, ICIQ-SF and ICIQ-OAB. The operative time for ASC was higher than the SVF-AM group (129.1 vs 117.2, p = .0038). A longer return to daily activities was observed in the abdominal group (103.8 days vs 57.6 days, p <0.05). Both groups had improvement at all points of POP-Q (except vaginal length in the SVF-AM group) and all ICIQ scores. No significant difference was observed in postoperative complications. The second article included 50 women: ASC group (n = 25) and SVF-AM group (n = 25). Two thirds of the women presented type 3 flora, and half of them did not present lactobacilli (48.3%). Regarding Nugent criteria, 51.7% had normal flora, 46.6% found altered flora and 1.7% had bacterial vaginosis. There were no differences in the type of flora (p = 1), number of lactobacilli (p = 0.9187), Nugent criteria (p = 0,4235), inflammation (p = 0.1018) and bacterial vaginosis (p = 0.64) before and after surgery in both groups. CONCLUSION: ASC and SVF-AM were equally effective in objective and subjective cure rates in menopause women with advanced prolapse. The vaginal group presented shorter operation time, lower return to activities and greater exposure in the mesh. We conclude that there was no change in the vaginal flora of postmenopausal women after surgery with screen, independently of the surgical route(AU)

Mesh Surgery for Anterior Vaginal Wall Prolapse: A Meta-analysis.

Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6-8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: 'anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)' in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score (> 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07-1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72-82,25]), longer surgery time (MD = 15,08 [0,48-29,67]), but less prolapse recurrence (OR = 0,22 [01,3-0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.

Impact of Sacrospinous Colpopexy Associated with Anterior Colporrhaphy for the Treatment of Dome Prolapse on all Three Vaginal Compartments / Resultados da colpofixação sacroespinal associada a colporrafia anterior para o tratamento do prolapso de cúpula vaginal

Objective To evaluate the results of sacrospinous colpopexy surgery associated with anterior colporrhaphy for the treatment of women with post-hysterectomy vaginal vault prolapse. Methods This prospective study included 20women with vault prolapse, PelvicOrgan Prolapse Quantification System (POP-Q) stage≥2, treated between January 2003 and February 2006, and evaluated in a follow-up review (more than one year later). Genital prolapse was evaluated qualitatively in stages and quantitatively in centimeters. Prolapse stage < 2 was considered to be the cure criterion. Statistical analysis was performed using the Wilcoxon test (paired samples) to compare the points and stages of prolapse before and after surgery. Results Evaluation of the vaginal vault after one year revealed that 95% of subjects were in stage zero and that 5% were in stage 1. For cystocele, 50% were in stage 1, 10% were in stage 0 (cured) and 40% were in stage 2. For rectocele, three women were in stage 1 (15%), one was in stage 2 (5%) and 16 had no further prolapse. The most frequent complication was pain in the right buttock, with remission of symptoms in all three cases three months after surgery. Conclusions In this retrospective study, the surgical correction of vault prolapse using a sacrospinous ligament fixation technique associatedwith anterior colporrhaphy proved effective in resolving genital prolapse. Despite the low complication rates, there was a high rate of cystocele, which may be caused by posterior vaginal shifting due to either the technique or an overvaluation by the POP-Q system.

Objetivo Avaliar os resultados da cirurgia de colpofixação sacroespinal associada a colporrafia anterior, para o tratamento de mulheres com prolapso de cúpula vaginal pós-histerectomia. Métodos Estudo prospectivo que incluiu 20 mulheres com prolapso de cúpula em estágio≥2 de acordo com o Sistema de Quantificação do Prolapso Genital (POP-Q) tratadas no período de janeiro de 2003 a fevereiro de 2006 e avaliadas emrevisão tardia (maior que um ano). O prolapso genital foi avaliado qualitativamente em estágios e, quantitativamente, emcentímetros. Como critério de cura, consideramos prolapso em estágio < 2. Para análise estatística, foi utilizado teste de Wilcoxon (amostras pareadas) para comparar os pontos e estágios dos prolapsos antes e depois da cirurgia. Resultados Na cúpula vaginal a avaliação após um ano mostrou 95% em estágio zero e 5% em estágio 1. Cistocele: 50% em estágio 1, 10% em estágio zero (curadas) e 40% emestágio 2. Retocele: trêsmulheres apresentavamestágio 1 (15%), uma emestágio 2 (5%) e dezesseis não apresentavam prolapso posterior. As complicações mais frequentes foramdor no glúteo direito com remissão do sintoma emtodos os três casos após três meses da cirurgia. Conclusões Neste estudo retrospectivo, a cirurgia de correção do prolapso de cúpula pela técnica de fixação no ligamento sacroespinal, associada à colporrafia anterior, se mostrou efetiva na resolução do prolapso genital com baixa taxa de complicações; porém com alta taxa de cistocele - o que pode ter sido decorrente do desvio vaginal posterior pela técnica, ou ainda uma supervalorização pelo sistema POP-Q.

[Correlation of the International Consultation on Incontinence Questionaire: Urinary Incontinence/Short Form to Urodynamic diagnosis in women with urinary incontinence]. / Associação entre o escore do International Consultation on Incontinence Questionaire: Urinary Incontinence/Short Form e a Avaliação Urodinâmica em mulheres com incontinência urinária.

PURPOSE: To evaluate the correlation between the International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form (ICIQ-UI/SF) and Urodynamic evaluation (UE) in women with urinary incontinence (UI). METHODS: Clinical data, UE and ICIQ-UI/SF scores for 358 patients from private health service were analyzed retrospectively . The correlation between ICIQ-UI/SF and urodynamic parameters was determined by Spearman's test. A ROC curve with the sensitivity and specificity of the ICIQ-UI/SF scores was utilized to establish the value of the questionnaire that would predict an altered urodynamic parameter. The χ(2) test or Fisher's exact test was used to calculate the p-value. The level of significance was 5% and the software used was SAS 9.2. RESULTS: Sixty-seven point three percent of the patients presented Stress UI (SUI) according to the UE (urodynamic SUI); those with SUI and Detrusor overactivity (DO) at UE represented 16.2% of the women (SUI+DO), and those with only DO at UE (DO) represented 7.3% of the women. Patients with normal UE represented 9.2% of the women. There was a significant association between ICIQ-UI/SF scores ≥14 and patients with urodynamic SUI, with or without DO. Patients with Valsava Leak Point Pressure (VLPP)≤90 cmH2O presented ICIQ-UI/SF≥15. Spearman's test showed a weak inverse correlation between ICIQ-UI/SF score and VLPP, although it did not show any correlation with maximum cystometric capacity or with bladder volume on first desire to void. CONCLUSION: There was an association between ICIQ-UI/SF score and patients with SUI, with or without DO, but no association between the score and patients with DO alone. The lower the VLPP value, the higher the ICIQ-UI/SF score. The ICIQ-UI/SF was not able to distinguish the different types of UI in the studied population.

Associação entre o escore do International Consultation on Incontinence Questionaire: Urinary Incontinence/Short Form e a Avaliação Urodinâmica em mulheres com incontinência urinária / Correlation of the International Consultation on Incontinence Questionaire: Urinary Incontinence/Short Form to Urodynamic diagnosis in women with urinary incontinence

OBJETIVO: Avaliar a correlação entre o International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form (ICIQ-UI/SF) e a Avaliação Urodinâmica (AU) em mulheres com incontinência urinária (IU). MÉTODOS: Foram analisados retrospectivamente dados clínicos, AU e escore do ICIQ-UI/SF de 358 mulheres com IU atendidas em clínica privada. O teste de correlação entre ICIQ-UI/SF e os parâmetros urodinâmicos foi o teste de Spearman. Foi utilizada a curva ROC, com os valores de sensibilidade e especificidade dos escores do ICIQ-UI/SF apresentados pelas pacientes, para identificar o valor do questionário que determinasse a presença da alteração urodinâmica estudada. Para o cálculo do valor p foi utilizado o teste do c² ou exato de Fisher. O nível de significância foi de 5% e o software utilizado para análise foi o SAS versão 9.2. RESULTADOS: As pacientes com IU aos Esforços segundo a AU - IUE urodinâmica - representaram 67,3% do total; aquelas com IUE na AU e Hiperatividade Detrusora (HD) - IUM urodinâmica - 16,2%, e as pacientes com HD isolada - HD - 7,3% do total. As pacientes com AU normal representaram 9,2% do total da amostra. Houve associação significativa entre escore ³14 no ICIQ-UI/SF e as pacientes com IUE urodinâmica e IUM urodinâmica. Pacientes com Pressão de Perda ao Esforço (PPE) £90 cmH2O apresentaram escore ao ICIQ-UI/SF³15. O teste de Spearman mostrou correlação inversa fraca entre o escore e a PPE, porém não mostrou correlação entre esse escore e a Capacidade Cistométrica Máxima (CCM) ou com o volume vesical no primeiro desejo miccional. CONCLUSÃO: Houve associação entre o escore do ICIQ-UI/SF e IUE urodinâmica (isolada ou associada à HD); porém não houve associação com a HD isolada. Quanto menor o valor da PPE, maior o escore total do ICIQ-UI/SF. O ICIQ-UI/SF não foi capaz de discriminar o tipo de IU na população estudada.

PURPOSE: To evaluate the correlation between the International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form (ICIQ-UI/SF) and Urodynamic evaluation (UE) in women with urinary incontinence (UI). METHODS: Clinical data, UE and ICIQ-UI/SF scores for 358 patients from private health service were analyzed retrospectively . The correlation between ICIQ-UI/SF and urodynamic parameters was determined by Spearman's test. A ROC curve with the sensitivity and specificity of the ICIQ-UI/SF scores was utilized to establish the value of the questionnaire that would predict an altered urodynamic parameter. The c² test or Fisher's exact test was used to calculate the p-value. The level of significance was 5% and the software used was SAS 9.2. RESULTS: Sixty-seven point three percent of the patients presented Stress UI (SUI) according to the UE (urodynamic SUI); those with SUI and Detrusor overactivity (DO) at UE represented 16.2% of the women (SUI+DO), and those with only DO at UE (DO) represented 7.3% of the women. Patients with normal UE represented 9.2% of the women. There was a significant association between ICIQ-UI/SF scores ³14 and patients with urodynamic SUI, with or without DO. Patients with Valsava Leak Point Pressure (VLPP)£90 cmH2O presented ICIQ-UI/SF³15. Spearman's test showed a weak inverse correlation between ICIQ-UI/SF score and VLPP, although it did not show any correlation with maximum cystometric capacity or with bladder volume on first desire to void. CONCLUSION: There was an association between ICIQ-UI/SF score and patients with SUI, with or without DO, but no association between the score and patients with DO alone. The lower the VLPP value, the higher the ICIQ-UI/SF score. The ICIQ-UI/SF was not able to distinguish the different types of UI in the studied population.

Defeitos do compartimento vaginal posterior: fisiopatologia e tratamento da retocele / Defects of vaginal posterior compartment: pathophysiology and treatment of rectocele

A retocele é definida como uma herniação da parede anterior do reto e posterior da vagina em direção ao lúmen vaginal. A etiologia da retocele é variada, e como tal, o tratamento deve ser sítio específico. Apenas a miorrafia dos elevadores pode não resolver o problema e comprometer a evacuação, bem como dificultar o acesso ao sítio específico do defeito em futuras intervenções cirúrgicas. O uso de telas sintéticas, especialmente as de polipropileno, se mostra como um recurso valioso nas mulheres que apresentam o septo retovaginal muito atrófico ou com lesão extensa, que impossibilita sua reconstituição.

Aspectos atuais no tratamento do prolapso de cúpula vaginal / Current aspects of treatment of vaginal vault prolapse

O prolapso de cúpula vaginal é uma complicação tardia da histerectomia vaginal e sua incidência está estimada na faixa de 2-3,6/1.000 mulheres-ano a 15/1.000 mulheres-ano nas pacientes cuja indicação da histerectomia tenha sido o prolapso. Há várias técnicas cirúrgicas para o tratamento desta distopia com os mais variados índices de sucesso e complicações, porém as duas mais usadas são a colpopexia sacral (por via abdominal) e a colpopexia no ligamento sacro-espinhal (por via vaginal). Recentemente uma nova técnica veio se somar ao arsenal cirúrgico do tratamento do prolapso de cúpula vaginal com uma boa taxa de cura e baixa incidência de complicações: a slingoplastia intravaginal posterior (IVS Posterior)