RESUMO
PURPOSE: The Burch procedure is used in conjunction with a modified pubovesical sling to produce a potentially more durable incontinence operation. This augmented incontinence procedure is recommended for use in patients at particularly high risk of recurrence of incontinence or in patients with intrinsic sphincter deficiency who have concomitant cystocoele (paravaginal defect). MATERIALS AND METHODS: A prospective study was initiated to demonstrate the efficacy of this combined operative procedure that incorporates two established operative techniques. RESULTS: Ten of 13 patients in whom this operation was performed are completely continent. They have neither stress nor urgency incontinence. They have all resumed active lifestyles. Three patients experienced postoperative problems. They had complex presentations and/or required multiple operative procedures. Two women continue to have mild urge incontinence postoperatively. One of these women has occasional urinary retention. The third woman who had a large cystocele, intrinsic sphincter deficiency, and rectal prolapse has functional obstruction postoperatively. CONCLUSION: Support and stability are developed at the urethrovesical angle by means of a combined operative procedure.
Assuntos
Ligamentos/cirurgia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Feminino , Seguimentos , Humanos , Masculino , Satisfação do Paciente , Estudos Prospectivos , Técnicas de Sutura , Resultado do Tratamento , Bexiga Urinária/cirurgia , Esfíncter Urinário ArtificialRESUMO
Vaginal delivery is reviewed from a urogynecologic perspective. The birthing process is recognized to be clearly traumatic to the pelvic floor. Directed study is suggested as a means by which predisposing factors for injury may be identified. Ultimately we may be better able to select the optimal mode of delivery for all women.
Assuntos
Parto Obstétrico , Complicações do Trabalho de Parto , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Complicações do Trabalho de Parto/fisiopatologia , Complicações do Trabalho de Parto/prevenção & controle , Complicações do Trabalho de Parto/terapia , GravidezRESUMO
Pregnancies complicated by severe thoracolumbar scoliosis may be affected by obstetric and cardiovascular complications. This case report of a pregnant woman with severe thoracolumbar scoliosis includes extensive documentation of complications by pulmonary function studies and peripartum arterial blood gas analysis. The differences between the physiologic changes of normal pregnancies and those of pregnancies with scoliosis are described.
