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1.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 49(3): 100752, Jul - Sep 2022. ilus, graf
Article in Spanish | IBECS | ID: ibc-205912

ABSTRACT

La pandemia por la COVID-19 generó un cambio de forma brusca en la práctica asistencial habitual de nuestra unidad de uroginecología, y a raíz de esta situación se ideó un nuevo modelo asistencial para adaptarnos a la nueva etapa epidemiológica. Se acordó, como eje central del nuevo modelo, la disminución de la presencialidad hospitalaria, ofreciendo la misma calidad asistencial mediante la introducción de la telemedicina.Para conseguir tal fin, se elaboró un modelo con tres tipos de visitas nuevas: primera visita médica telemática, visitas de seguimiento de tratamientos conservadores y farmacológicos telemáticas, y creación de visita pack (pack STUI, el pack posparto y el pack postalta) que incluye visitas y pruebas diagnósticas uroginecológicas que se realizan todas el mismo día.El pack STUI va dirigido a todas las pacientes con síntomas del tracto urinario inferior, asociados o no a prolapso de órganos pélvicos. Consta de dos visitas (enfermería y médica), y dos pruebas diagnósticas avanzadas (urodinamia y ecografía de suelo pélvico).El pack posparto va dirigido a mujeres con síntomas de incontinencia urinaria, incontinencia anal, prolapso y/o alteraciones de la sexualidad tras el parto. También incluye mujeres asintomáticas con antecedente de trauma perineal obstétrico. Consta de una visita médica, una ecografía de suelo pélvico y una visita por la fisioterapeuta.El pack postalta se realiza al mes de la cirugía e incluye dos pruebas (ecografía de suelo pélvico y flujometría) y una visita médica.Los tratamientos de fisioterapia y otras visitas que por motivos médicos lo requirieran, han mantenido su presencialidad.(AU)


The COVID-19 pandemic caused a sudden change in the usual care practice of our urogynaecology unit. Therefore, we designed a new healthcare model to adapt our practice to the epidemiological situation. The central axis of the new model was reduced hospital attendance, offering the same healthcare quality through the introduction of telemedicine.To achieve this aim, we made the following changes: a first telematic medical visit was the first step, telematic monitoring visits for conservative and pharmacological treatments and pack visit. We created the following packs: LUTS, postpartum and post-discharge pack. All packs included visits and diagnostic tests performed on the same day.The LUTS pack is indicated in patients with lower urinary tract symptoms, associated or not with pelvic organ prolapse. It includes two visits (nursing and medical) and two tests (urodynamics and pelvic floor ultrasound).The postpartum pack is indicated in women with symptoms of urinary incontinence, anal incontinence, pelvic organ prolapse and sexual disfunctions after delivery, as well as asymptomatic patients with a history of obstetric perineal trauma. It includes a medical visit, a pelvic floor ultrasound and a visit with the physiotherapist.The post-discharge pack is scheduled a month after the surgery and includes two tests (pelvic floor ultrasound and uroflowmetry) and a medical visit.Some face-to-face visits were maintained, as were physiotherapy treatments and other visits following medical criteria.(AU)


Subject(s)
Humans , Female , Remote Consultation , Telemedicine , Pandemics , Betacoronavirus , Coronavirus Infections , Severe acute respiratory syndrome-related coronavirus , Pelvic Floor , Patient Care , Gynecology , Obstetrics
2.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 49(2): 1-7, Abril - Junio, 2022. ilus
Article in Spanish | IBECS | ID: ibc-203198

ABSTRACT

Las disfunciones miccionales más frecuentes son la incontinencia urinaria de esfuerzo (IUE), la incontinencia urinaria de urgencia y la dificultad miccional. Son un problema de salud que afecta a la calidad de vida y, a pesar de su alta prevalencia, su etiopatología y fisiopatología sigue sin estar bien establecida. La ecografía de suelo pélvico (ESP) tiene un papel importante para ayudarnos a comprender conceptos de la fisiopatología de estas disfunciones y el manejo clínico de la paciente.La ESP nos permite evaluar la movilidad uretral, la longitud de la uretra y la presencia de embudización del cuello vesical, todos ellos parámetros importantes a considerar, especialmente en aquellas pacientes que se someterán a una cirugía correctora de la IUE. Mediante la ESP evaluamos de forma rutinaria las paredes vesicales y la morfología uretral con el fin de descartar una enfermedad orgánica asociada. La ESP también nos permite evaluar el residuo posmiccional, importante en todas las pacientes con disfunciones miccionales. Finalmente, la ESP es de gran utilidad en la evaluación de las pacientes con antecedente de cirugía antiinconinencia con una banda suburetral libre de tensión (BSLT), permitiendo valorar los parámetros estáticos y dinámicos de la BSLT (en Valsalva), que se correlacionan con la sintomatología descrita por las pacientes.La ESP es una prueba subespecializada que se debe realizar por personal entrenado, y que cada vez va adquiriendo más protagonismo en las unidades de uroginecología. Se espera en un futuro disponer de una terminología estandarizada y de una aplicabilidad más extendida.


Stress urinary incontinence (SUI), urge urinary incontinence, and voiding dysfunction are the most frequent urinary dysfunctions. These dysfunctions affect the patient's quality of life and despite their high prevalence, their aetiopathology and pathophysiology are still not well established. Pelvic floor ultrasound (PFUS) helps us to understand the pathophysiology of these dysfunctions and the clinical evaluation and treatment of patients.PFUS allows us to assess urethral mobility, urethral length, and bladder neck funnelling, all of which are important parameters to be considered in patients undergoing SUI surgery. The evaluation of bladder walls and urethral morphology could be routinely performed by PFUS to assess other pathologies. PFUS also allows us to evaluate the post void residual volume which is especially important in patients with voiding dysfunction. Finally, PFUS is useful in the assessment of the mid urethral slings used for the surgical treatment of SUI. We can evaluate the static and dynamic (with Valsalva) parameters which correlate with the patient's symptoms.PFUS should be performed by trained professionals, and it is expected that in the near future its use will be more extended.


Subject(s)
Humans , Female , Health Sciences , Ultrasonography , Pelvic Floor , Urination , Urinary Incontinence , Urology , Gynecology , Female Urogenital Diseases , Urinary Incontinence, Stress
3.
Clin Invest Ginecol Obstet ; 49(3): 100752, 2022.
Article in Spanish | MEDLINE | ID: mdl-35185235

ABSTRACT

The COVID-19 pandemic caused a sudden change in the usual care practice of our urogynaecology unit. Therefore, we designed a new healthcare model to adapt our practice to the epidemiological situation. The central axis of the new model was reduced hospital attendance, offering the same healthcare quality through the introduction of telemedicine.To achieve this aim, we made the following changes: a first telematic medical visit was the first step, telematic monitoring visits for conservative and pharmacological treatments and pack visit. We created the following packs: LUTS, postpartum and post-discharge pack. All packs included visits and diagnostic tests performed on the same day.The LUTS pack is indicated in patients with lower urinary tract symptoms, associated or not with pelvic organ prolapse. It includes two visits (nursing and medical) and two tests (urodynamics and pelvic floor ultrasound).The postpartum pack is indicated in women with symptoms of urinary incontinence, anal incontinence, pelvic organ prolapse and sexual disfunctions after delivery, as well as asymptomatic patients with a history of obstetric perineal trauma. It includes a medical visit, a pelvic floor ultrasound and a visit with the physiotherapist.The post-discharge pack is scheduled a month after the surgery and includes two tests (pelvic floor ultrasound and uroflowmetry) and a medical visit.Some face-to-face visits were maintained, as were physiotherapy treatments and other visits following medical criteria.

4.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(3): 111-117, jul.-sept. 2020. tab
Article in Spanish | IBECS | ID: ibc-191033

ABSTRACT

La actual pandemia ocasionada por el SARS-coronavirus tipo 2 ha generado, en pocas semanas, cambios importantes en el funcionamiento del sistema sanitario y la forma en cómo se realiza la atención a las pacientes. La patología uroginecológica afecta a la calidad de vida, pero sin riesgo vital en la mayoría de casos, por lo que suele ser demorable. Además, afecta a un alto porcentaje de mujeres > 65 años (población de riesgo ante la infección por COVID-19). En este manuscrito se resume la evidencia que existe sobre la efectividad de la telemedicina aplicada en las disfunciones de suelo pélvico, así como recomendaciones de las sociedades científicas uroginecológicas durante el estado de alarma. Describimos el abordaje de las disfunciones de suelo pélvico durante la pandemia por COVID-19 y una propuesta de cómo organizar las agendas para el diagnóstico (visitas y pruebas diagnósticas) y tratamiento (conservador, farmacológico y la cirugía) en el período interpandemia y en el futuro


The current SARS-coronavirus type 2 pandemic caused, in few weeks, important changes in the health system organization and in the way we attend the patients. Urogynaecological diseases affect quality of life, but without life risk in most cases, so it is possible to delay. Moreover, urogynaecological diseases affect mostly women over 65 years old (a high risk population for contracting COVID-19). In this manuscript we summarise the current evidence about telemedicine efectivity to manage to pelvic floor dysfunctions and, in addition, the recommendations of Urogynaecological scientific societies during state of alarm. We describe the management of the different pelvic floor dysfunctions during COVID-19 pandemic and a proposal to organize the urogynaecological services to diagnose (visits and diagnostic investigations) and to treat (conservative, pharmacological or surgery) in the interpandemic period and in the future


Subject(s)
Humans , Female , Middle Aged , Pandemics/prevention & control , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Telemedicine , Pelvic Floor Disorders/pathology , Pelvic Floor Disorders/therapy , Societies, Medical/standards , Spain/epidemiology , Urinary Incontinence/diagnosis , Urinary Incontinence/therapy , Urinary Tract Infections/therapy , Prolapse
5.
Clin Invest Ginecol Obstet ; 47(3): 111-117, 2020.
Article in Spanish | MEDLINE | ID: mdl-32834308

ABSTRACT

The current SARS-coronavirus type 2 pandemic caused, in few weeks, important changes in the health system organization and in the way we attend the patients. Urogynaecological diseases affect quality of life, but without life risk in most cases, so it is possible to delay. Moreover, urogynaecological diseases affect mostly women over 65 years old (a high risk population for contracting COVID-19). In this manuscript we summarise the current evidence about telemedicine efectivity to manage to pelvic floor dysfunctions and, in addition, the recommendations of Urogynaecological scientific societies during state of alarm. We describe the management of the different pelvic floor dysfunctions during COVID-19 pandemic and a proposal to organize the urogynaecological services to diagnose (visits and diagnostic investigations) and to treat (conservative, pharmacological or surgery) in the interpandemic period and in the future.

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