[Bladder drainage in patients undergoing the Pereyra surgical procedure]. / Drenaje vesical en pacientes sometidas a operación Pereyra.

Postoperative acute urinary retention was evaluated in the patients who underwent Pereyra procedure. Comparison of suprapubic and urethral catheterization. Between January 1994 and July 1995, fifty two patients with urinary stress incontinence underwent Pereyra procedure, 31 female patient with suprapubic drainage (cistofix Ch 15) and 17 urethral catherization with a latex foley catheter. Sponatneous micturition and urinary retention was evaluated until the catheter was removed. Mean age was 43.8 years (32 a 66), the duration of suprapubic vesical drainage with suprapubic catheter were 3 days in 58.6% of the patients, and more than 3 days in 41.29%. Recatheterizacion in the patients with urethral drainage was more frequent. Urinary retention after 7 days was present in 23.99% with suprapubic vesical drainage and 28.5% with urethral catheter. Recatheterization is more frequent in patients with urethral catheter.

[Genitourinary fistulae at the National Institute of Perinatology]. / Fístulas genitourinarias en el Instituto Nacional de Perinatología.

Evaluation of the characteristics of urogenital fistula with a retrospective study at the clinic of Urology Ginecologica in the Instituto Nacional de Perinatologia between March 1992 to June 1995, information of the location, etiopathogenesis of the disease, urinary tract infection and surgical treatment were obtained form de patients records in the clinic. The etiophatogenesis of the disease was surgical gynecological procedures in 51.1%, and obstetric cause 48.5%; the location were 14 (66.6%) vesicovaginal, 5 (23.5% 0 ureterovaginal and 2 (urethrovaginal). The abdominal approach were in 8 patients and vaginal route in 9, no surgical treatment were 2. Successfully repair fistula were in 80.9%. Urinary tract infections before treatment agreed on the obstetric etiology was 47.6%, and for surgical gynecological procedures 52.2%. There is an increase in the incident of obstetric vesicovaginal fistula, we believe it depends on the patients that we have in de Instituto Nacional de Perinatologia, most of them are obstetric patients.

[Value of the Q-tip test in patients with urinary incontinence]. / Valor de la Prueba del Hisopo en pacientes con incontinencia urinaria.

We evaluated the accuracy of the Q-tip test to measure uretrhovesical junction mobility in patient's histories of urinary incontinence, and pelvic relaxation. A retrospective study of 183 files of patients with urinary incontinence and anterior vaginal wall relaxation in the Instituto Nacional de Perinatología (INPer) between march 1994 and may 1995. All patients underwent a systematic diagnosis evaluation with detailed history and physical examination including Q-test, neurology examination, urinary, urine culture, uretrhoscopy and urodinamic studies. We correlated Q-tip test pelvic relaxation to measure urethrovesical junction mobility. They were placed in three groups. Group I formed by stres incontinence, group II formed by mixed incontinence and group III formed by recurrent incontinence. Mean age 46.3 years (29-72), almost all the patients were multiparas, menopausal status in 72, with hormonal treatment 48. Q-tip test was not different between the groups. Group I had cystocele II with hipermobility statistically significant difference, the same in group II. No differences were found in the group III. We concluded that urethral position and mobility as measure by the Q-tip test are related to defects in interior vaginal support, but not to specific urologic diagnosis.

[Urologic lesions in gynecologic and uro-gynecologic surgery. Two years of hospital experience]. / Lesiones urológicas en la cirugía ginecológica y uroginecológica. Dos años de experiencia institucional.

We are reporting the most frequent urologic injuries of the gynecologic and urogynecologic surgeries at the National Institute of Perinatology in Mexico City. From the period of March 1993 to February 1995. There were performed 3,452 surgeries. Of this, 2,971 were gynecologic and 481 urogynecologic cases. We found 20 patients with injury to the inferior urinary tract. The most frequent type of injury found was by puncture and blunt, in eight cases respectively and cutting in four. The transoperatory diagnostic of injury was performed in 17 patients and in three few days after. The late complications of the injury was urethral vaginal fistula in two, one vesicovaginal communication and one ureterovaginal, one stone formation and one transurethral catheter retention. The more affected organ was the bladder in 18 cases, urether and urethra. The injury to the inferior urinary tract represents 4.15% of the urogynecologic surgical complications, and 0.67% of the gynecological ones. The main aspect in the prognosis of the injury to the inferior urinary tract, is the early diagnostic during the surgical procedures.

[Urethral leiomyoma during pregnancy. Report of a case and review of the literature]. / Leiomioma de la uretra durante el embarazo. Informe de un caso y revisión de la literatura.

We present a case of leiomyoma of the urethra diagnosed during pregnancy. The patient a 40 year old woman, gravida II, who presents a mass that depend of the proximal urethra, it was observed in the vaginal introitus, it's growth was progressive after 8th weeks of pregnancy. We realized local excision at 23rd weeks pregnancy. Histopathological examination reported leiomyoma of the urethra. The pregnancy was resolved through cesarean section by fetal indication. Actually the patient is free of symptoms.

[Modified sling operation: institutional experience]. / Operación de cabestrillo modificada: experiencia institucional.

We report the retrospective experience in the treatment of six patients with recurrent or severe stress urinary incontinence or low urethral pressure. They were treated with sling modified procedure with polytetrafluoroethylene (Gore-Tex); in the National Institute of Perinatology (INPer) at 1992-1994. The morbidity was highest, the patients in the post operatory present detrusor instability, voiding problems and tissue reaction to polytetrafluoroethylene. The patients are continent in the actuality. They were observed by 8-32 months. This surgery is easy to make and not required of more experience than the necessary for realizing the cysto-urethropexy with needle, but, the selections criteria must be carefully analyzed.

[Urinary retention secondary to surgical treatment of stress urinary incontinence]. / Retención urinaria secundaria al tratamiento quirúrgico de incontinencia urinaria de esfuerzo.

A retrospective, descriptive study at the National Institute of Perinatology (INPer), was carried out. 401 records of patients with stress urinary incontinence who underwent surgical treatment, were reviewed. The objective of this study was to know the urinary retention rate. Urinary retention was present in 103 of 401 patients (25.68%). In modified Pereyra's procedure it was present in 67 of 195 (34.35%); in modified Burch's procedure, in 25 of 131 (19.08%); in Kelly's procedure in 9 of 70 (12.85%) and in 2 of 5 patients with sling procedure with polytetrafluoroethylene (Goretex). The problem of urinary retention was observed more frequently in vaginal surgery (modified Pereyra procedure and/or sling procedure).

[Genuine stress urinary incontinence. An analysis of 2 surgical technics: Pereyra's and Burch's]. / Incontinencia urinaria genuina de esfuerzo. Análisis de dos técnicas quirúrgicas: Pereyra y Burch.

Two hundred and twenty-nine patients operated for genuine stress urinary incontinence by two surgical techniques, were studied. Risk factors were analyzed: age, gesta, para, and added gynecological pathology. They were placed in two groups. Group I formed by operated patients with Pereyra's technique (136), and Group II operated by Burch's technique (93). There were no differences as far as general characteristics of patients in both groups. More frequent added pathologies for Group I were pelvic statics changes, and for Group II, uterine myomatosis. Technically there were no advantages for one technique as compared with the other one, independently of indications for each one.

[Vaginal hysterectomy. The experience at the Instituto Nacional de Perinatología]. / Histerectomía vaginal. Experiencia en el Instituto Nacional de Perinatología.

In gynecologic surgery the most frequent procedure is hysterectomy. Some factors are determinant for the election of the kind of surgery to be done, it could be by abdominal or vaginal approach. These factors include the experience and ability of the surgeon as well as the indication for the operation. Two hundred and sixty six patients operated of vaginal hysterectomy at Instituto Nacional de Perinatología, from August 1986 to July 31 1992 were reviewed. Indications, complications and associated surgery to this procedures, were analyzed. The findings were compared with other authors.

[Urogenital fistula: our institutional experience]. / Fístula urogenital: experiencia institucional.

We are reporting the institutional experience of March 1992 to May 1993. Eleven patients were studied with a diagnostic of urogenital fistula, one of them was vesico-uterine, two uretero-vaginal and eight vesico-vaginal. Only to eight of the patients surgery correction was realized, one of them was aboarded by vaginal tract and seven by abdominal tract. Of the patients with abdominal aboarded, two cases were ureteroneocystostomies. The failure of the surgery was presented in two cases, both with abdominal aboarded. These data clears up that the urogenital fistula is a frequent complication in patients that are submitted to surgical gynecological procedures. The surgical success probably depends more of the surgical technique rather than aboarded tract.

[The correlation of the findings between the urological clinical history and urodynamic evaluation in urinary incontinence]. / Correlación de los hallazgos entre la historia clínica urológica y la evaluación urodinámica en incontinencia urinaria.

Patient's histories of urinary incontinence and results of several standard clinical tests, were correlated with final diagnosis obtained by multichannel urodynamic testing. One hundred and thirty one histories of women with urinary incontinence who were in the Urogynecology Clinics of the Instituto Nacional de Perinatología in the period from july to december 1992, were evaluated including dates of standardized questionnaire and structural clinical examination with the urodynamic testing to obtain a final diagnosis. Although the objective urinary loss and the cystocele II-III were significantly associated with genuine stress incontinence and mixed incontinence, in patients with detrusor instability did not. Women with complaints of urinary incontinence, especially those for whom surgery is contemplated, should undergo complete urodynamic evaluation.

Histerectomía vaginal: experiencia en el Instituto Nacional de Perinatología / Vaginal histerectomy: experience at Instituto Nacional de Perinatologia

La histerectomía es la cirugía ginecológica que con mayor frecuencia se realiza. El que se lleve a cabo por vía abdominal o vaginal, depende de algunos factores, tales como la experiencia y habilidad del cirujano, la indicación de la misma y la presencia de alteraciones que podrían dificultar el abordaje. En este trabajo se lleva a cabo la revisión de 266 casos de histerectomía vaginal en el Instituto Nacional de perinatología realizadas en el periodo comprendido del 1o. de agosto de 1986 al 31 de julio de 1992. Se analizan factores tales como indicaciones, complicaciones y cirugías asociadas entre otros, mismos que son comparados con resultados de otros autores

[Heterotopic pregnancy in intrauterine insemination. Presentation of a case]. / Embarazo heterotópico con inseminación intrauterina. Presentación de un caso.

The heterotopic (ectopic and orthotopic simultaneous) pregnancy shows a frequency of 1 to 15,000 to 1 to 30,000 gestations. The clinical diagnosis is difficult due to the lack of precise indicators, as to diagnose an intrauterine pregnancy eliminates the possibility of ectopic pregnancy. The methods of Assisted Reproduction seem to be factors that have influenced on the increment of this type of gestations. A case of a 32 year patient with primary sterility by pelvic adhesions process, that was surgically treated, as there was no pregnancy after surgery, she was given intrauterine insemination with her husband's semen (IU) pregnancy was obtained, determined at 15 days of menstrual lack by presence of subunit B of HCG in serum and vaginal ultrasound that confirmed gestational sac. One month after she presented at Urgencies with an acute abdominal condition; laparotomy was done and salpingectomy was carried out for ruptured tubal pregnancy confirmed by histopathology. The evolution on intrauterine pregnancy was normal culminating with cesarean section at week 35 by inminence of eclampsia/Mother and child in good conditions.

[Unexplained sterility. Treatment with superovulation and intrauterine insemination]. / Esterilidad inexplicable. Tratamiento con superovulación e inseminación intrauterina.

Fifty couples with unexplainable sterility, were selected for study. They were treated following a uniform treatment protocol, consisting in inducin superovulation by human menopausic gonadotropins hormones, followed by intrauterine insemination with husband's fresh semen. One hundred and thirty six cycles of treatment, were obtained; 15 pregnancies were achieved, corresponding to 30% of the total of couples, and to 11% of amount of treatment cycles. These figures were similar to other author's, and similar to the ones obtained by intrauterine gametes transference. It is concluded that this a new alternative of treatment that may be used before IGT, or in places where there is not such methodology.

[Abdominal myomectomy and subsequent fertility]. / Miomectomía abdominal y fertilidad subsecuente.

45 cases of myomectomy in infertile patients were analyzed. The study of the couples problem did not report another cause of the infertility. The number and localization of the tumors did not alter the prognostic of the fertility. We had 23 pregnancies (51%), all this surgeries must be made by strictly microchirurgical technique, so the rates of success will be improved.

[Premature membrane rupture in preterm pregnancies. The timing for pregnancy termination]. / Ruptura prematura de membranas en embarazos de pretérmino. Momento de interrupción del embarazo.

A total of 82 patients with 28 to 36 weeks of pregnancy, with a average of 61 hours after premature rupture of membranes, were studied. The greatest frequency was seen from 30 to 33 weeks (57%). Phosphatidylglycerol determination in the first sample was positive in 64% of the patients. The conservative management is adequate only up to 32 weeks; thereafter, and with phosphatidyiglycerol present, pregnancy interruption, after an adequate materno-fetal evaluation, will mean a better prognosis for mother and child.

[Laparoscopic recovery of spermatozoa in the peritoneal fluid: its correlation with the Sims-Hühner test]. / Recuperación laparoscópica de espermatozoides en líquido peritoneal: correlación con la prueba de Sims-Hühner.

Paradoxical are the results relative to conception following a positive or negative Sims-Hühner test (SH). For that reason we decided to look for the presence of sperm in peritoneal fluid of five patients with good and five with poor or negative SH. In three of five patients with a positive SH and in four of five with a poor SH sperm was found in the aspirate. The results illustrate the limitations of this long-accepted test in the prognosis of infertile couples.