Descripción demográfica, bioquímica y sintomática según los estadios reproductivos STRAW+10 en mujeres mexicanas en la peri y posmenopausia / Demographic, biochemical and symptomatic description according to STRAW + 10 reproductive stages in Mexican women in peri and postmenopause

Resumen OBJETIVO: Categorizar el perfil demográfico, bioquímico y sintomático de la población mexicana atendida en el Instituto Nacional de Perinatología para describir su comportamiento en los estadios del envejecimiento reproductivo. MATERIALES Y MÉTODOS: Estudio transversal y descriptivo efectuado entre junio y diciembre de 2018 en pacientes de la Clínica de peri y posmenopausia del Instituto Nacional de Perinatología. Criterios de inclusión: mujeres mayores de 41 años con diagnóstico de peri y posmenopausia, clasificadas según STRAW+10 en tres categorías: Categoría 1 (-2 a -1), Categoría 2 (+1A a +1C) y Categoría 3 (+2). Para el análisis estadístico se obtuvieron medidas de tendencia central, χ2 y ANOVA para el análisis inferencial. RESULTADOS: Se estudiaron 741 pacientes peri y posmenopáusicas, con edad promedio a la menopausia de 50.08 años. El promedio de edad poblacional fue de 57.11 años, con un índice de masa corporal promedio de 27.92, con 56.2% de la población en límites de obesidad. La comorbilidad más frecuente fue la hipertensión arterial y el síntoma más reportado, los bochornos, más prevalentes durante la transición a la menopausia. CONCLUSIONES: El sistema STRAW+10 es una manera clínica y objetiva de estadificar a las pacientes en transición a la menopausia. Es importante emprender más estudios poblacionales en mujeres para describir el comportamiento del envejecimiento reproductivo en México.

Abstract OBJECTIVE: Categorize the demographic, biochemical and symptomatic profile of the Mexican population served at the Instituto Nacional de Perinatología to describe their behavior in the stages of reproductive aging. MATERIALS AND METHODS: The following is an observational, descriptive, cross sectional study women from the Peri- and Postmenopause clinic at the National Institute of Perinatology in Mexico that enrolled 741 women over 41 years of age with a diagnosis of menopause according to the STRAW+10 criteria and classified in three categories: Category 1 (-2 to -1), Category 2 (+1A to +1C), and Category 3 (+2). The statistical analysis was performed by measure of central tendency, χ2 and ANOVA for the inferential analysis. RESULTS: In our population of 741 women, the average age at menopause was 50.08 years, while the population's age average was 57.11 years. Average body mass index was 27.92 kg/m2, with 56.2% of the population within obesity range. The most prevalent comorbidity was arterial hypertension and the most frequent symptom was hot flushes. Hot flushes were most prevalent during the transition to menopause. CONCLUSIONS: The STRAW+10 is an objective way to clinically classify patients in transition to menopause. There is an important need for more population-based studies in women to describe the reproductive ageing behavior in Mexico.

[Posterior tibial nerve stimulation for pelvic floor dysfunction. Review]. / Estimulación del nervio tibial posterior como tratamiento de la disfunción del piso pélvico. Revisión de la bibliografia.

Pelvic floor dysfunction is a highly prevalent functional pathology that affects women and can present with different clinical symptoms that include urinary urgency with or without incontinence, diurnal and nocturnal frequency, urinary retention, fecal incontinence, obstructive defecation, sexual dysfunction and pelvic pain. Lately, concern arised as to offer patients an advanced therapy within an integral approach. This interest was first focused in sacral nerve root modulation, a key element for pelvic function. Neuromodulation is considered a normal characteristic of the nervous system that regulates or modifies the electric impulses that come from different nervous body tissues. Neuromodulation is carried out through sacral neurostimulation (SNS), posterior tibial nerve stimulation (PNTS), which are reversible non destructive therapies used for peripheric stimulation of nerves, ganglia, spinal medula and brain. Even though there is evidence of efficacy for sacral nerve stimulation at short, medium and long-term, there are two main concerns within this approach: invasivity and high cost. It seems posterior nerve tibial stimulation has the same neuromodulatory effect as the one obtained by sacral nerve stimulation through a less invasive route and lower cost.

[Urinary ascites following open myomectomy]. / Ascitis urinaria después de una miomectomía abierta.

OBJECTIVE: A case of urinary ascites following a bladder injury during laparoscopic myomectomy, and its resolution. CLINICAL CASE: 42-year-old woman referred for urologic consultation for acute urinary retention 11 days after myomectomy. RESULTS: Ultrasound showed abdominal ascites. Cystoscopy gave evidence of one-centimeter bladder dome injury. During retrograde cystography contrast material leaked out through the bladder. CONCLUSION: Early treatment with drainage of urinary ascites and bladder injury surgical repair had excellent results.

[Prevalence of urinary incontinence in pregnant women with prenatal care at the National Institute of Perinatology Isidro Espinosa de los Reyes]. / Prevalencia de incontinencia urinaria en mujeres embarazadas con atención prenatal en el Institute Nacional de Perinatología Isidro Espinosa de los Reyes.

BACKGROUND: Urinary incontinence during pregnancy is relatively frequent and is seen in some cases as a normal event. Several authors estimate a prevalence of urinary incontinence during pregnancy of 58.1%. OBJECTIVE: To determine the prevalence of urinary incontinence in women at the National Institute of Perinatology Isidro Espinosa de los Reyes from March to May 2008. We also assessed the type, severity and frequency of involuntary loss of urine. PATIENTS AND METHODS: longitudinal study to determine the prevalence of urinary incontinence before and during pregnancy, by quarter, type, frequency and severity. RESULTS: The prevalence of urinary incontinence during pregnancy was 58.2% and before pregnancy was 34.7%. The odds ratio for the association of multiparity and incontinence before pregnancy was 1.7 (95% CI 1.2-2.5) and 2.0 (95% CI 1.4-2.9) to manifest during pregnancy. Patients under 26 years have an odds ratio for urinary incontinence of 0.67 (95% CI 0.4-0.9). CONCLUSION: The prevalence of urinary incontinence increases during pregnancy, multiparity is a risk factor for urinary incontinence and age under 26 is a protective factor.

[Results and complications following the placement of the transobturator tension free tape for the treatment of stress urinary incontinence]. / Resultados y complicaciones posteriores a la colocación de la cinta transobturadora libre de tensión en el tratamiento de pacientes con incontinencia urinaria de esfuerzo.

OBJECTIVE: Evaluate the complications and short term sucess rate of the transobturator tape for the treatment of stress urinary incontinence. MATERIAL AND METHODS: It is a retrospective study of the transobturator tapes perform in 2005 and 2006. All the procedures were done with epidural anesthesia. The success rate, the immediate, short-term and long term complications were recorded at the first, second and third year. RESULTS: 28 women were included in the study, 54% of them with stress urinary incontinence. 25% were solely transobturator procedures. mong the complications were 2 vesical puntures, 1 periurethral fascia trauma and 5 urinary retention during the first 24 hours. In the 1 and 2 year follow-up were 2 cases of overactive detrusor. Objective sucess was 90% and subjective sucess was 92%. CONCLUSIONS: Transobturator tape is a highly successful and a low morbility procedure.

[Suburethral cyst. A case report]. / Quiste suburetral. Reporte de un caso.

Suburethral cysts are rare, are formed from remnants of embryonic or blockage of the paraurethral glands, whose location in more than 85% of cases are found in the proximal two thirds and posterior and lateral to the urethra. The diagnosis is clinical and radiological studies are needed to demonstrate the absence of communication with the urethra. Once the diagnosis of suburethral cyst, surgery is the treatment of choice. Before its resection, the presence of a urethral diverticulum. Urethral injury is the most common surgical risk, as noted during surgery must be repaired immediately. So far it has not been reported urethra-vaginal fistula as a complication after repair. The present patient had a cyst in the distal third of Suburethral 4 x 2 cm, a 6-month follow-up remained asymptomatic, with no postoperative complication. The pathology reported wall 3 x 2.2 cm with a thickness of 0.3 cm, greyish, irregular, soft consistency. Microscopically identified transitional epithelium and foci of squamous metaplasia and focal chronic inflammation. According to the histopathological report, the transitional epithelium indicates the cyst Skene.

Giant intravesical calculus during pregnancy.

Urolithiasis is commonly found during pregnancy; but the presence of a giant vesical calculus during pregnancy is a very rare entity, associated with several potential obstetric complications. A 25-year-old primigravida at 25 weeks of gestational age was referred to our tertiary care unit because she presented a giant hyperechoic intravesical mass and inability to pass urine with suprapubic pain since 2 days. An open cystolithotomy revealed a huge intravesical calculus. The patient continued with her pregnancy until full term without adverse perinatal outcomes.

[Ureteral injury at the National Institute of Perinatology]. / Lesiones ureterales atendidas en el Instituto Nacional de Perinatologia.

OBJECTIVES: To evaluate the incidence of ureteral injury at Instituto Nacional de Perinatologia and to know the variables associated to ureteral injury as a ginecoobstetric surgery complication, and to do a theme review. MATERIAL AND METHODS: We conducted a study including patients with ureteral injury from January 1st 1992 to July 1st 2005. Files were registered for age, parity, surgery associated to the injury, injury type, diagnostic time and methods, management type and evolution. The study was observational, transversal, and retrospective. We analyzed the results with descriptive statistics. RESULTS: We included 39,405 surgeries; a total of 32 injuries were identified, and in 41% the injured ureter was the left one, in 42% was the right one and both in 17%. We included patients from the Instituto and from another hospital. Mean age was 38.9 years, media 43 and mode 44 years. Principal surgery related was the gynecological histerectomy. Patients' evolution was satisfactory. The most frequent surgery to repair the ureter was the reimplantation, followed by the immediate reparation with simple stitches. CONCLUSIONS: The ureteral injury frequency was 0.04%, in relation principally with gynecological histerectomy. The most frequent injury type was the ligation in the distal third. In three cases there was a ureter-bladder fistula. The ureteral reimplantation was the most frequent surgical repair.

[Burch procedure: experience of 45 years of history]. / Operación de Burch: experiencia a 45 años de historia.

It has been 45 years since John C. Burch first described his "colposuspension of the Cooper's ligament" technique for the surgical management of stress urinary incontinence. Half a century later, his legacy remains alive. His technique, and its further modifications, still occupies a privileged place among the surgical options for the management of the stress urinary incontinence. Even now, Burch procedure is considered the gold standard with which all the other new techniques must be compared in order to measure their effectiveness. In the past few years, there have been important advances in the knowledge and standardization of the female urodynamics. This has increased the accuracy of the medical assessments to have a better selection for this surgical procedure. Then, with the technique focused on such cases, the results of the procedure have been optimized, considering that its complications are not serious and they are relatively infrequent. The success rates of this technique are up to approximately 90% in 5 to 10 years follow-ups and 69% in 10 to 20 years follow-ups. Therefore, it is believed that Burch's urethropexia continues contributing greatly to the management of the stress urinary incontinence. This revision includes 33 articles, all of them related with this matter from Ovid database.

[Vesicovaginal fistula. Experience at the Instituto Nacional de Perinatología]. / Fístula vesicovaginal. experiencia en el Instituto Nacional de Perinatologia.

BACKGROUND: The damage of the lower urinary tract is originated by complications of obstetric or gynecological surgery, which if not detected timely determines the formation of fistulas. OBJECTIVE: To analyze the experience in diagnosing and treating vesicovaginal fistulas attended at the gynecologic urology clinic of the Instituto Nacional de Perinatologia (INPer). MATERIAL AND METHOD: Retrospective study of 27 files of patients diagnosed with vesicovaginal fistula at the gynecologic urology clinic of the INPer from January 11 1992 trough December 31st 2005. The variables analyzed were age, parity, corporal mass index, surgical history, surgery performed to correct the fistula and postoperative evolution. Averages and standard deviation were calculated to describe data. RESULTS: Average age was 38.2 years. Abdominal hysterectomy (53.3%), followed by obstetric hysterectomy (33.3%), caused the most of complications. The most often used techniques to correct the fistula were Latzko operation, 19 patients (45.23%), and Sims' fistulectomy, 11 patients (26.19%). The most used drainage was Foley probes, with 9.1 days average of use. Urinary tract infection was the most common complication (6.7%). CONCLUSIONS. After our analysis, surgical treatment to patients with vesicovaginal fistula showed good results (71.4% of healing) with a minimum of complications (28.5% of recurrence).

[Urolithiasis and pregnancy]. / Urolitiasis y embarazo.

Urolithiasis disease during pregnancy fortunately is a relatively rare disease; nevertheless many times it complicates the diagnosis and treatment. This paper reviews the safety and efficacy of both and their relationships with mother and fetus and proposes different options for the urologist, gynecologist, and urogynecologist for the attention of pregnant women with suspicion of urolithiasis. The ultrasound seems to be the first-choice method during the pregnancy; it is available in many health centers and does not require too much experience for its interpretation. Intravenous urography, simple X-ray and magnetic resonance image with its limitations aid support to our clinical suspicion; additionally the uretheroscopy is the diagnostic and therapeutic method and can be used safely during the pregnancy; thus first-choice study is the ultrasound with changes in vascular resistance rates. Once diagnosis is established, conservative treatment is applied because the majority of patients has spontaneous elimination of stones (70 to 80%). Surgical intervention can be an option and when is needed, placement of an uretheral catheter JJ, percutaneous nephrostomy and uretheroscopy may be an option to definitive treatment.

[Long holder: hidden forked thorn wound level in patients with diagnosis of overactive bladder. Pilot study]. / Localización de lesión de espina bífida oculta y diagnóstico de vejiga hiperactiva: estudio piloto.

BACKGROUND: Anatomical alterations in bony structures, as the sacrum, can be related with defects in nervous supply to pelvic viscera and low urinary tract. OBJECTIVE: To relate location of damages at spina bifida occult with diagnosis of overactive bladder. MATERIAL AND METHODS: Cross sectional study between December 2005 and March 2006 in 31 patients with diagnose of overactive bladder. All of them with complete medical history, uroneurologic physical exam, multichannel urodynamic study, urethrocystoscopy, urine culture, bladder voiding, life quality questionnaire, and antero subsequent, sacred lateral and lumbar column x-ray. Statistical analysis was done through distribution frequencies graphics and averages comparison. RESULTS: Age average was 47 years, 20 to 69 years; gestations average was four and childbirth average was three by patient. Highest percentage of dysraphia was located between S2 to S5 in 29 patients (94%), and between L5 to S5 in 2 patients (6%). Other findings were: scoliosis in 20 patients (64.5%), asymmetry of hip in 9 patients (29%), and lordosis in 7 patients (22.5%); spondilolistesis, lumbarization of S1 and sacralization of L5 were found each one in a patient (22.5%). CONCLUSIONS: In 94% of patients, presence of spina bifida occult between S2 to S4 correlates with the diagnosis of overactive bladder. Another type of alteration, as lordosis and scoliosis, are findings in a high percentage of patients and can be related to symptoms of overactive bladder.

Características clínicas de la mujer con prolapso genital / Clinical features of genital prolapse

Se determinaron las características clínicas de las pacientes con prolapso genital total. Se realizó un estudio retrospectivo desde enero de 1990 hasta junio de 1995, en donde se incluyeron las pacientes que como único criterio de inclusión tuvieran diagnósticos de prolapso genital total primario (prolapso de útero en el cual el cérvix precede la inversión de la mucosa vaginal). Hubo 15 pacientes con este diagnóstico, de las cuales se determinó edad, paridad, estado hormonal, ocupación, sintomatología e índice de masa corporal, así como resultados de la pieza quirúrgica para ser evaluados. La edad promedio fue de 60 años, la paridad promedio mayor a tres, 80 por ciento fue prosmenopáusica, el índice de masa corporal, fue de 23.5 en promedio, la ocupación de todas las pacientes fue el hogar, el síntoma que se presentó en 100 por ciento de los casos fue la sensación de cuerpo extraño en vagina, el tratamiento quirúrgico de las pacientes fue histerectomía vaginal, y los resultados de patología informaron datos de inflamación crónica por exposición del útero, el peso de las piezas quirúrgicas (útero) estuvo dentro de la normalidad en 80 por ciento. Los factores asociados con la paridad y envegecimiento tienen una correlación importante en este proceso

Drenaje vesical en pacientes sometidas a operación Pereyra / Vesical drainage in patients who underwent Pereyra's operation

Se evaluó el problema de retención urinaria en las pacientes sometidas a operación Pereyra con dos tipos de drenaje vesical. Se realizó un estudio prospectivo de enero de 1994 a julio de 1995 en el cual se incluyeron 52 pacientes sometidas operación Pereyra, las cuales se dividieron en dos grupos: Grupo I: a 31 pacientes se les aplicó drenaje suprapúbico con Cistofix Ch 15; Grupo II a 17 con sonda enduoretral (Foley 18 Fr) en pacientes sometidas a operación pereyra manejadas en el postoperatorio con drenaje suprapúbico (Cistofix Ch 15), con control de micción espontánea y orina residual hasta el retiro de la sonda, así como la toma de urocultivo preoperatorio. La edad promedio fue de 43.8 años (con un rango de 32 a 66 años). El drenaje vesical suprapúbico de 0 a tres días se presentó en 58.6 por ciento de las pacientes y más de tres días en 41.29 por ciento. La retención urinaria por más de siete días se presentó en 23.99 por ciento de las pacientes con drenaje suprapúbico y en 28.5 por ciento de las pacientes con sonda endouretral. El riesgo de recateterización fue significativamente mayor con el uso de sonda enduoretral

Valor de la prueba del hisopo en pacientes con incontinencia urinaria / Evaluation of Q-tip test in urinary incontinence patients

Se evaluó la utilidad de la prueba del hisopo en la movilidad de la unión uretrovesical. Se realizó un estudio retrospectivo en 183 expedientes de las pacientes que acudieron a la Clínica de Urología Ginecológica del Instituto Nacional de Perinatología, con diagnóstico de incontinencia urinaria, de marzo de 1994 a mayo de 1995. A todas la pacientes se les realizo historia clínica, examen físico que incluyó prueba del hisopo, prueba de la tos y examen neurológico, así como urocultivo, cistouretroscopia y estudio de urodinamia. Mediante la prueba del hisopo se evaluó el grado de descenso de la unión uretrovesical. Para el análisis se dividió en tres grupos de acuerdo al dignóstico: grupo I, incontinencia urinaria de esfuerzo; grupo II, incontinencia urinaria mixta y grupo III, incontinencia urinaria recurrente. El ánalisis estadístico se realizó, mediante la prueba de t de Student, análisis de varianza (ANOVA) y de correlación. La edad promedio fue de 46.3 años (29-72), la mayoría de las pacientes fueron multíparas, 72 menopáusicas, 48 con tratamiento hormonal sustitutivo. Con la prueba del hisopo no se encontro diferencia estadísticamente significativa entre los tres grupos de acuerdo al diagnóstico. Según el grado de cistocele, en el grupo I se encontró que las pacientes con cistocele II tuvieron un mayor desplazamiento, lo que fue estadísticamente significativo. En el grupo II de igual manera y para el grupo III no se encontró diferencia. La prueba del hisopo muestra la posición y movilidad de la uretra de acuerdo a los defectos anatómicos de la pared anterior de la vagina, pero no establece diagnósticos

Correlación de los hallazgos entre la historia clínica urológica y la evaluación urodinámica en incontinencia urinaria / Findings correlation between clinical history and urodynamic evaluation in urinary incontinence

Se trató de relacionar los datos de la historia clínica urológica con el diagnóstico final de urodinamia multicanal. Se realizó la revisión de 131 expedientes de los cuales se obtuvieron los datos del interrogatorio y la exploración uroginecológica, así como los informes de los estudios de urodinamia de las pacientes que acudiero a la clínica de Urología Ginecológica del INPer el lapso de julio a diciembre de 1992 con diagnóstico de incontinencia urinaria de esfuerzo. Mediante el estudio de urodinamia se pudo establecer el diagnóstico de incontinencia urinaria de genuina o de esfuerzo e incontinencia urinaria mixta, asociándose a la exploración del descanso vesical II-III y el dato objetivo de pérdida urinaria, datos que no se presentaron significativamente en las mujeres a las que se les diagnosticó inestabilidad de detrusor. Se requiere del estudio urodinámico como parte de la evaluación de las pacientes con incontinencia urinaria, sobre todo cuando son candidatas a tratamiento quirúrgico