Hemorragia postoperatoria en histerectomía por patología benigna: Estudio unicéntrico / Postsurgical bleeding in hysterectomy due to benign pathoogy unicentric experience

Introducción: la histerectomía es la intervención quirúrgica más frecuente en el ámbito de la ginecología. Si bien se trata de un procedimiento de bajo riesgo, las infecciones y la hemorragia post-operatoria son sus principales complicaciones. Nuestro objetivo ha sido evaluar la hemorragia post-operatoria en nuestro medio durante la realización de histerectomías por patología benigna. Material y métodos: durante 2 años se ha realizado una recogida prospectiva de todos los casos de histerectomía realizados en contexto de patología benigna en único centro. Realizamos un estudio descriptivo de las características de los pacientes y un análisis univariado de la hemorragia post-operatoria significativa (pérdida de hemoglobina mayor a 2g/dl). Resultados: de un total de 256 histerectomías; 125 (48.8%) han sido totales y 131 (51.2%) subtotales. La edad media de los pacientes era de 49.1 ± 8,7 años y la tasa de hemorragia significativa ha sido del 62.5% (n=160). El único predictor de hemorragia significativa ha sido la cirugía abierta (95 vs 87.5%, p=0,05), sin diferencias significativas en el tipo de histerectomía, la realización de anexectomía concomitante o en el tiempo de cirugía. La necesidad de transfusión ha sido mayor (4.4 vs 0%, p=0.048) pero no la necesidad de reintervención (3.8 vs 5.2%, p=0.752). No se han producido exitus. Conclusión: La hemorragia significativa definida por la pérdida de 2 g/dl de hemoglobina es una complicación frecuente de la histerectomía por patología benigna, siendo uno de sus predictores la vía quirúrgica abierta

Introduction: the hysterectomy is the most frequent surgical procedure in gynecology. It is a low risk procedure, but infections and post-operative bleeding are their main complications. Our aim has been to evaluate the post-operative bleeding in our environment in the context of hysterectomies due to benign pathology. Material and methods: during 2 years we have been prospectively recruiting all of the hysterectomies performed in our centre due to benign pathology. We did a descriptive study of the main features of these patients and a univariate analysis of significant post-operative bleeding (lost of hemoglobin more than 2 g/dl). Results: among 256 hysterectomies, 125 (48.8%) have been total hysterectomies and 131(51.2%) subtotal hysterectomies. Mean age of patients was 49.1 ± 8,7 years old and the rate of significant post-operative bleeding was 62.5% (n=160). The unique predictor of significant bleeding was the open operative surgical procedure (95 vs 87.5%, p=0,05), without significant differences among the type of hysterectomy, the concomitant annexectomy or the surgery duration. Need of transfusion was greater (4.4 vs 0%, p=0.048) but not the need of new intervention (3.8 vs 5.2%, p=0.752). There were no deaths. Conclusion: significant postoperative bleeding defined by the lost of haemoglobin greater than 2g/dl is a frequent complication of hysterectomy in the context of benign pathology, being the open operative surgical procedure one of its predictors

Tratamiento de la incontinencia urinaria de esfuerzo femenina mediante cintillas suburetrales: estudio retrospectivo comparativo observacional de 2 técnicas quirúrgicas / Treatment of Female Stress Urinary Incontinence Using Suburethral Slings: Comparative, Retrospective, Observational Study of Two Surgical Techniques

Objetivo: El tratamiento de la incontinencia urinaria femenina ha sufrido una revolución en los últimos años por la aparición en el mercado de las cintillas suburetrales. El objetivo de este estudio es comparar 2 técnicas quirúrgicas para el tratamiento de la incontinencia urinaria de esfuerzo: Monarc™ (cintilla suburetral transobturadora) y MiniArc® (mini-cintilla suburetral de incisión única). Material y métodos: Estudio retrospectivo observacional comparativo desde enero de 2005 hasta diciembre de 2011 con 317 mujeres diagnosticadas de incontinencia urinaria de esfuerzo. Doscientas catorce fueron tratadas con la cintilla suburetral transobturadora Monarc™ y 103 con la mini-cintilla MiniArc®. Los resultados han sido tratados con el programa informático SPSS v 15 y el nivel de significación estadística ha sido p ≤ 0,005. Resultados: Los 2 grupos de pacientes son homogéneos en cuanto a la edad, el número de partos, la presencia de incontinencia urinaria de urgencia o histerectomía previa. Diferencias significativas en estancia hospitalaria, tiempo quirúrgico y complicaciones precoces a favor del Miniarc®, pero no en las tardías donde no hay diferencias significativas globales. El 84% de las pacientes tratadas con la cintilla transobturadora Monarc™ están curadas frente al 72% en las que colocamos un MiniArc® con diferencia significativa. Conclusión: Debemos realizar un mayor número de estudios de alta calidad de carácter prospectivo y aleatorizados, con mayor número de pacientes y tiempo de seguimiento para confirmar o rechazar la diferencia que hemos encontrado en la tasa de éxito a favor de cintilla suburetral transobturador Monarc™ (AU)

Objective: The treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc® (single-incision suburethral mini-sling). Material and methods: Comparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc® mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P ≤ 0.005. Results: The two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc®, technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc®, a difference that was statistically significant. Conclusion: We need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling (AU)

Treatment of female stress urinary incontinence using suburethral slings: comparative, retrospective, observational study of two surgical techniques.

OBJECTIVE: The treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc(®) (single-incision suburethral mini-sling). MATERIAL AND METHODS: Comparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc(®) mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P≤.005. RESULTS: The two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc(®), technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc(®), a difference that was statistically significant. CONCLUSION: We need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling.

Diagnóstico de rabdomioma fetal ecográfico / Ultrasonographic diagnosis of fetal rhabdomyoma

El rabdomioma es una tumoración rara detectada, en la mayor parte de las ocasiones, por ecografía y representa aproximadamente un 1% del total de las anomalías cardíacas halladas intraútero. La evolución intrauterina y su repercusión hemodinámica dependen del crecimiento del tumor. Grandes masas pueden ser causa de obstrucciones y posteriormente de hidropesía y taquiarritmias. A estas complicaciones se añade su asociación a la esclerosis tuberosa, la cual ocupa un lugar importante en el consejo prenatal a los padres, ya que su herencia es autosómica dominante. La frecuencia de la asociación es del 50-70% en las distintas series (AU)

Rhabdomyoma is a rare tumor usually detected by ultrasonography. This neoplasm represents approximately 1% of all intrauterine cardiac abnormalities. Development inside the uterus and the hemodynamic repercussions of this entity depend on tumoral growth. Large masses can cause obstructions and subsequently hydrops and tachyarrhythmias. In addition to these complications, rhabdomyoma is associated with tuberous sclerosis, which occupies an importance place in prenatal counseling since inheritance is autosomal dominant. The frequency of this association is between 50% and 70% in distinct series (AU)