[Posterior genital prolapse following the Burch method of colposuspension]. / Prolapso genital posterior a colposuspensión de Burch.

The aim of this paper was to know the prevalence of genital prolapse after the Burch procedure. Also to intend knowing if the associate surgery for vaginal relaxation used in our Urogynecologic Service is working well. Seventy four patients with more than six months after the Burch procedure were addressed from October 1995 to January 1996. Special attention was put to detect pelvis floor defects in specific vaginal sites (urethra, bladder, vaginal ápex, cul de sac and distal posterior wall). The prevalence of urethrocele was 2.7%, cystocele 50.6%, almost of all were mild. None severe cystocele was detected. Cervical prolapse was present in 21.3%, vault prolapse in 9.3% and enterocele 41.9%. The posterior colporraphy seems to be useful to prevent the vault prolapse and the enterocele. On the contrary the Moschowitz procedure seems not to be useful in this aspect. In order to diminish the prevalence of genital prolapse posterior to Burch procedure it would be better to improve the preoperative vaginal examination in order to do segmentary prolapse diagnosis and also to stablish an individualized surgical treatment of them.

Prolapso genital posterior a colposuspensión de Burch / Genital prolapse after the Burch procedure

Los objetivos del estudio fueron: conocer la prevalencia de prolapso genital posterior al procedimiento de Burch. Evaluar resultados de la cirugía efectuada en asociación con procedimiento de colposuspensión con el propósito de corregir el prolapso existente o prevenir el prolapso postoperatorio. Estudio clínico retrospectivo, longitudinal. Se exploraron 74 pacientes que con diagnóstico de incontinencia genuina de esfuerzo habían sido tratadas quirúrgicamente con el procedimiento de Burch en el Servicio de Urología Ginecológica del Hospital de Gineco-Obstetricia del C.M.N.O. del IMSS en Guadalajara. Control postoperatorio mínimo de seis meses. Método estadístico utilizado: frecuencias simples, porcentajes y prueba de Chi-cuadrada. La incidencia de prolapso genital postoperatorio en pared anterior de vagina, ápex y pared posterior, fue: Uretrocele 2.7 por ciento, cistocele 51.3 por ciento, ápex 17.9 por ciento en pacientes histerectomizadas; rectocele 45.9 por ciento. La mayoría de los casos fueron de grado leve, sin embargo siete pacientes (9.5 por ciento) requirieron de cirugía complementaria por el prolapso mismo. La colporrafia posterior parece ser útil para evitar el enterocele; no así el cierre de Douglas con la técnica de Moschowitz. Al evaluar con criterio estricto cada uno de los segmentos de vagina, se pudo apreciar una alta incidencia de prolapso genital posterior al procedimiento de Burch. Si bien la gran mayoría de los casos fueron prolapsos leves y asintomáticos, es aconsejable estudiar preoperatoriamente a la paciente con gran cuidado, a fin de establecer una estrategia de manejo individualizado con resultados más eficientes

[Suprapubic urinary drainage after surgical correction of stress urinary incontinence using Pereyra's technique]. / Drenaje urinario suprapúbico posterior a cirugía correctiva de incontinencia urinaria de esfuerzo con la técnica de Pereyra.

One hundred patients with diagnoses of stress urinary incontinence underwent Pereyra's revised procedure and suprapubic bladder drainage. Postoperative urinary infection was 12%. The urinary infection rate and the length of suprapubic bladder drainage had an excellent relationship (r = 0.9484). Postoperative normal bladder functions recovery was 7.8 days in average. Length of hospitalization was 5.5 days. All these values were significantly reduced respectively urethral drainage (P < 0.01 for urinary infection; P < 0.05 for bladder function recovery and P < 0.001 for hospitalization rate). We did not have any type of serious complications. We conclude that suprapubic is a simple and safe bladder drainage method that offers also economical advantages.

[Value of cystoscopy in the study of the urogynecological patient]. / Valor de la cistoscopia en el estudio de la paciente uroginecológica.

The results of 350 cystoscopic studies, are presented. In 85.7%, urinary incontinence was present, and in 72% one or more of the following symptoms were present: urgency, dysuria, urinary frequency, vesical tenesmus and nycturia. The following were analyzed: age, parity, uroculture and its relation to cystoscopic findings. Most of the patients (64.5%) were 40 to 60 years old, 54% had seven or more deliveries. Most frequent diagnoses were: urethritis alone or with trigonitis (66.8%) and urethral stenosis (meatus) in 31.4%. Uroculture was done in 96% and it was positive in 20% and negative 76%. In 88% of the patients with a negative uroculture, there were other lesions shown by urethrocytoscopy. From 300 patients with urinary incontinence, only in 155 it was confirmed objectively.