[Clinical and urodynamic experience with intravesical hyaluronic acid in painful bladder syndrome associated with interstitial cystitis]. / Experiencia clínica y urodinámica con ácido hialurónico intravesical en el síndrome de vejiga dolorosa asociado a cistitis intersticial.

INTRODUCTION: few studies have been carried out on therapeutic options in patients with painful bladder syndrome associated with interstitial cystitis. The aim is to verify the safety and effectiveness of treatment with sodium hyaluronate through intravesical instillation in patients with painful bladder syndrome. MATERIALS AND METHODS: a series of 18 female patients is presented, with a mean age of 51 years and prior diagnosis of painful bladder syndrome, who were treated by means of the weekly infusion of an intravesical solution of 40mg of sodium hyaluronate in sterile solution, over a period of eight weeks. The patients were examined clinically and urodynamically prior to their inclusion in the study and eight months after the instillations had concluded. RESULTS: there was a statistically significant improvement in the urodynamic parameters and in the symptoms measured quantitatively by means of the questionnaire "Pelvic Pain and Urgency/Frequency" between the baseline situation and after the vesical instillation of sodium hyaluronate in patients with painful bladder syndrome. There was no toxicity arising from the treatment, given that no adverse effects were recorded in relation to it. CONCLUSION: the clinical use of intravesical hyaluronic acid in patients with painful bladder syndrome possibly associated with interstitial cystitis has been demonstrated. The clinical improvement is also associated both with increased bladder capacity and improved bladder sensitivity. Tolerance was excellent. Clinical tests that more profoundly evaluate the therapeutic potential of this drug in this type of patients are required.

Experiencia clínica y urodinámica con ácido hialurónico intravesical en el síndrome de vejiga dolorosa asociado a cistitis intersticial / Clinical and urodynamic experience with intravesical hyaluronic acid in painful bladder syndrome associated with interstitial cystitis

Introducción: las opciones terapéuticas en las pacientes con vejiga dolorosa asociada a cistitis intersticial están poco estudiadas. Se pretende verificar la seguridad y eficacia del tratamiento con hialuronato de sodio a través de instilación intravesical en pacientes portadoras de síndrome de vejiga dolorosa. Material y métodos: se presenta una serie de 18 pacientes femeninas, con edad media de 51 años y diagnóstico previo de síndrome de vejiga dolorosa, que fueron tratadas mediante la infusión de una solución intravesical semanal de 40mg de hialuronato de sodio en solución estéril, durante 8 semanas. Las pacientes fueron evaluadas clínica y urodinámicamente antes de su inclusión en el estudio y 8 meses después de haber finalizado las instilaciones. Resultados: se observó una mejora estadísticamente significativa en los parámetros urodinámicos y en la sintomatología medida cuantitativamente mediante el cuestionario Pelvic Pain and Urgency/Frequency entre la situación basal y después de la instilación vesical de hialuronato de sodio en paciente con síndrome de vejiga dolorosa. La toxicidad derivada del tratamiento fue nula, puesto que no se registró efecto adverso relacionado con el tratamiento. Conclusión: se demuestra la utilidad clínica del ácido hialurónico intravesical en pacientes con síndrome de vejiga dolorosa posiblemente asociado a cistitis intersticial. La mejoría clínica se asocia también con aumento de la capacidad y mejora de la sensibilidad vesical. La tolerancia fue excelente. Se necesitan ensayos clínicos que evalúen en profundidad el potencial terapéutico de este fármaco en este tipo de pacientes (AU)

Introduction: few studies have been carried out on therapeutic options in patients with painful bladder syndrome associated with interstitial cystitis. The aim is to verify the safety and effectiveness of treatment with sodium hyaluronate through intravesical instillation in patients with painful bladder syndrome. Materials and methods: a series of 18 female patients is presented, with a mean age of 51 years and prior diagnosis of painful bladder syndrome, who were treated by means of the weekly infusion of an intravesical solution of 40mg of sodium hyaluronate in sterile solution, over a period of eight weeks. The patients were examined clinically and urodynamically prior to their inclusion in the study and eight months after the instillations had concluded. Results: there was a statistically significant improvement in the urodynamic parameters and in the symptoms measured quantitatively by means of the questionnaire “Pelvic Pain and Urgency/Frequency” between the baseline situation and after the vesical instillation of sodium hyaluronate in patients with painful bladder syndrome. There was no toxicity arising from the treatment, given that no adverse effects were recorded in relation to it. Conclusion: the clinical use of intravesical hyaluronic acid in patients with painful bladder syndrome possibly associated with interstitial cystitis has been demonstrated. The clinical improvement is also associated both with increased bladder capacity and improved bladder sensitivity. Tolerance was excellent. Clinical tests that more profoundly evaluate the therapeutic potential of this drug in this type of patients are required (AU)

[Nocturia is not associated with falls among the elderly: a population study in the city of São Paulo]. / La nicturia no se asocia con las caídas del anciano: un estudio de población en la ciudad de São Paulo.

INTRODUCTION: the present study aims to evaluate the association between nocturia and falls in a group of community-living elderly men in the city of São Paulo (Brazil). MATERIAL AND METHODS: under the coordination of the Pan American Health Organization and World Health Organization, a multicenter study named Health, Welfare and Aging (SABE Study) is being conducted to evaluate the living and health conditions of older people in Latin America and Caribbean. In Brazil, this study is evaluating the elderly population (60 years or more) in São Paulo since 2000. The presence of nocturia was taken as the response "yes" to the question "Do you need to void three times or more at night?" .The presence of falls was also taken as the response "yes" to the question "Did you have any fall during the last 12 months?" The intergroup analysis used was the logistic regression. RESULTS: total of 865 men was interviewed, mean age 68 years. It was observed high prevalence of nocturia and falls in all groups, with higher prevalence of both in the eldest group (p<0.001), however, the association of nocturia and falls was not statistically significant in any of the groups (p=0.45). CONCLUSION: this is one of the pioneering studies that assess only the male population, showing that nocturia was not significantly associated with falls. Nocturia and falls are highly prevalent conditions in the elderly, but no association was found between both, so that these variables may be correlated to age and other clinical conditions.

La nicturia no se asocia con las caídas del anciano: un estudio de población en la ciudad de São Paulo / Nocturia is not associated with falls among the elderly: a population study in the city of São Paulo

Introducción: el propósito de este estudio es evaluar la relación entre nictura y caídas en un grupo de hombres ancianos que viven en comunidad en la ciudad de São Paulo (Brasil). Materiales y métodos: bajo la coordinación de la Organización Panamericana de Salud y la Organización Mundial de la Salud, un estudio multicéntrico denominado Salud, Bienestar y Envejecimiento (Estudio SABE) se está llevando a cabo para evaluar las condiciones de vida y salud de los ancianos en América Latina y el Caribe. En Brasil este estudio evalúa la población anciana (60 años o más) en São Paulo desde 2000. La presencia de nicturia se tomó como la respuesta “sí” a la pregunta “¿Necesita orinar tres veces o más por la noche?” La presencia de caídas también se tomó como la respuesta “sí” a la pregunta “¿Ha sufrido una caída en los últimos 12 meses?” Se aplicó la regresión logística para el análisis intergrupal. Resultados: se entrevistó a un total de 865 hombres con una edad media de 68 años. Se identificó una alta prevalencia de nicturia y caídas en todos los grupos, con una mayor prevalencia de ambas en el grupo de los más mayores (p<0,001); sin embargo, la asociación de nicturia y caídas no fue estadísticamente significativa en ninguno de los grupos (p=0,45). Conclusión: éste es uno de los estudios pioneros que solamente evalúa la población masculina, demostrando que la nicturia no está asociada con caídas de manera significativa. La nicturia y las caídas son condiciones altamente prevalentes en los ancianos, pero no se encontró ninguna relación entre ambas, por lo tanto estas variables se podrían correlacionar con la edad y otras condiciones clínicas (AU)

Introduction: the present study aims to evaluate the association between nocturia and falls in a group of community-living elderly men in the city of São Paulo (Brazil). Material and methods: under the coordination of the Pan American Health Organization and World Health Organization, a multicenter study named Health, Welfare and Aging (SABE Study) is being conducted to evaluate the living and health conditions of older people in Latin America and Caribbean. In Brazil, this study is evaluating the elderly population (60 years or more) in São Paulo since 2000. The presence of nocturia was taken as the response “yes” to the question “Do you need to void three times or more at night?” .The presence of falls was also taken as the response “yes” to the question “Did you have any fall during the last 12 months?” The intergroup analysis used was the logistic regression. Results: total of 865 men was interviewed, mean age 68 years. It was observed high prevalence of nocturia and falls in all groups, with higher prevalence of both in the eldest group (p<0.001), however, the association of nocturia and falls was not statistically significant in any of the groups (p=0.45). Conclusion: this is one of the pioneering studies that assess only the male population, showing that nocturia was not significantly associated with falls. Nocturia and falls are highly prevalent conditions in the elderly, but no association was found between both, so that these variables may be correlated to age and other clinical conditions (AU)

[Behavioral group-based therapy improves quality of life in men recovering from radical prostatectomy]. / Terapia grupal de comportamiento mejora la calidad de vida en hombres post prostatectomía radical.

BACKGROUND: This study evaluated the efficacy of 24-week, group-based, behavioral therapy in improving quality of life (QoL) among men treated for localized prostate carcinoma (PC) by means of radical prostatectomy (RP) who presented treatment-related dysfunctions: urinary incontinence (UI) and erectile dysfunction (ED). PATIENTS AND METHODS: Thirty men were assigned to 24-week behavioral group therapy. The intervention was designed to improve QoL by helping participants to identify and effectively manage stressful experiences. It focused on treatment-related sequelae from PC. Differences in variables were compared between the beginning and end of the study by means of Student's t test for paired samples. Multiple analysis was carried out by stepwise multiple linear regression following bivariate Pearson's correlation analysis. This was achieved for all predictors (i.e. general health perception, ED and UI impact) and relevant covariates (i.e. age, work/retirement status, alcohol addiction, attitude towards cancer and surgery, sexual satisfaction, and future plans). RESULTS: In all patients the time elapsed from surgery to attending the behavioral group therapy exceeded 24 months. There was no significant correlation between this time and the predictor variables. General health perception scores decreased by the end of the study (p = 0.000), as did the UI impact score (p = 0.023), thus denoting improvement in both factors. The difference in UI impact scores correlated negatively and significantly with both age (p = 0.04) and work/retirement (p = 0.05). Multiple stepwise regression showed that age was the most important variable (r2 = 26.0%). Considering age and work/retirement simultaneously, there was an increase of 10.3% (r2 = 36.3%). ED increased by the end of the study (p = 0.000), and the difference between the ED scores correlated positively and significantly with sexual satisfaction alone (p = 0.029), which signifies that previous sexual satisfaction had a positive influence over erectile dysfunction (r2 = 15.8%). CONCLUSION: 24-week behavioral group therapy was effective in improving the perceived QoL among men treated for PC. There were changes associated with the therapy, particularly the improvement in UI and ED.

Terapia grupal de comportamiento mejora la calidad de vida en hombres post prostatectomía radical / Behavioural group-based therapy improves quality of life in men recovering from radical prostatectomy

Antecedentes: Este estudio valoró la eficacia de la terapia de comportamiento en grupo para mejorar la calidad de vida, durante 24 semanas, entre hombres que han sido tratados de cáncer de próstata localizado por medio de prostatectomía radical y presentan disfunciones relacionadas con el tratamiento: incontinencia urinaria y disfunción eréctil. Pacientes y Métodos: Se asignaron 30 hombres a un grupo de terapia de comportamiento durante 24 semanas. Esta participación se diseñó para mejorar la calidad de vida ayudando a los participantes a identificar y controlar de forma efectiva las experiencias traumáticas. Se centró en las secuelas relacionadas con el tratamiento de prostatectomía radical. Las diferencias en las variables se compararon al principio y al final del estudio por medio de la prueba t de Student para muestras pareadas. Se llevaron a cabo múltiples análisis por etapas de regresión lineal múltiple siguiendo el análisis de correlación bivariante de Pearson. Esto se logró con todas las predicciones (es decir la percepción de salud general, e impacto en la disfunción eréctil e incontinencia urinaria)y las covariables importantes (es decir la edad, la situación trabajo/jubilación, la adicción al alcohol, la actitud hacia el cáncer y la cirugía, la satisfacción sexual, y los planes futuros. Resultados: En todos los pacientes el tiempo transcurrido desde la cirugía a la asistencia al grupo de terapia del comportamiento superó los 24 meses. No hubo correlación significativa entre este momento y ninguna de las variables. Las puntuaciones de la percepción general de salud disminuyeron en el final del estudio (p=0,000), al igual que la puntuación de la incontinencia urinaria (p=0,023), lo que indica mejoría en ambos factores. La diferencia en las puntuaciones de la incontinencia urinaria se correlaciona significativamente y negativamente con la edad (p=0,04) y el trabajo/jubilación (p=0,05). Las múltiples etapas de regresión mostraron que la edad es la variable más importante (r2=26,0%). Teniendo en cuenta la edad y el trabajo/jubilación al mismo tiempo, hubo un aumento del 10,3% (r2 = 36,3%). La disfunción eréctil aumentó en el final del estudio (p=0,000), y la diferencia entre las puntuaciones de la disfunción eréctil se correlacionaron positiva y significativamente solamente con la satisfacción sexual (p=0,029), lo que significa que la satisfacción sexual anterior tuvo una influencia positiva sobre la disfunción eréctil (r2 = 15,8%). Conclusión: La terapia de comportamiento en grupo de 24 semanas fue eficaz para mejorar la percepción de calidad de vida, entre los hombres tratados con prostatectomía radical. Hubo cambios asociados con la terapia, especialmente la mejoría en la incontinencia urinaria y la disfunción eréctil (AU)

Background: This study evaluated the efficacy of 24-week, group-based, behavioral therapy in improving quality of life (QoL) among men treated for localized prostate carcinoma (PC) by means of radical prostatectomy (RP) who presented treatment-related dysfunctions: urinary incontinence (UI) and erectile dysfunction (ED). Patients and methods: Thirty men were assigned to 24-week behavioral group therapy. The intervention was designed to improve QoLby helping participants to identify and effectively manage stressful experiences. It focused on treatment-related sequelae from PC. Differences in variables were compared between the beginning and end of the study by means of Student’s t test for paired samples. Multiple analysis was carried out by stepwise multiple linear regression following bivariate Pearson’s correlation analysis. This was achieved for all predictors (i.e. general health perception, ED and UI impact) and relevant covariates (i.e. age, work/retirement status, alcohol addiction, attitude towards cancer and surgery, sexual satisfaction, and future plans).Results: In all patients the time elapsed from surgery to attending the behavioral group therapy exceeded 24 months. There was no significant correlation between this time and the predictor variables. General health perception scores decreased by the end of the study (p=0.000), as did the UI impact score (p=0.023), thus denoting improvement in both factors. The difference in UI impact scores correlated negatively and significantly with both age (p=0.04) and work/retirement (p=0.05). Multiple stepwise regression showed that age was the most important variable (r2=26.0%). Considering age and work/retirement simultaneously, there was an increase of 10.3% (r2=36.3%). ED increased by the end of the study (p=0.000), and the difference between the ED scores correlated positively and significantly with sexual satisfaction alone (p=0.029), which signifies that previous sexual satisfaction had a positive influence over erectile dysfunction (r2=15.8%). Conclusion: 24-week behavioral group therapy was effective in improving the perceived QoL among men treated for PC. There were changes associated with the therapy, particularly the improvement in UI and ED (AU)

[Urodynamic studies about the use of the valsalva maneuver in the urination of men with inguinal hernias above the age of fifty]. / Estudios urodinámicos sobre la utilización de la Maniobra de Valsalva en la micción de los hombres con hernia inguinal superior a los 50 años.

OBJECTIVE: To verify if the Valsalva Maneuver during urination in patients with inguinal hernias is associated with specific urodynamic findings. METHOD: Men, of over 50 years of age, who had inguinal hernias and visited a general surgery unit between May 2003 and November 2005, underwent an urodynamic study. They were mainly evaluated according to average urethral resistance (URA), the detrusal isometric contractibility (Pw) and urinal residue. The patients were divided into two groups: in the first group the Valsalva maneuver was not used during urination (Group I) while in the second group the Valsalva maneuver was employed (Group II). Initially, the data was expressed using the averages of the analysed parameters; they were then dichotomised according to the reference values. In order to carry out the statistical analysis, the qui quadrant and non conditional logistic regression were used. RESULTS: One hundred patients took part in the research with an average age of 64.2 years of age (SD of +/- 9.7 years). Group I was made up of 52 patients and Group II of 48 patients. The averages of the urodynamic parameters were compared between the two groups. It was found that the Group that carried out the Valsalva maneuver while urinating showed a damaged detrusal contractibility (p < 0.01) and an increased urinal residue (p < 0.02). When using logistic regression in order to express the odds ratios. The OR value was found to be 2.57 (IC 95%: 1.09-6.06) in the detrusal hypocontractibility group. CONCLUSION: The Valsalva Maneuver during urination is associated with the presence of detrusal hypocontractibility in patients affected by inguinal hernia.

Estudios urodinámicos sobre la utilización de la Maniobra de Valsalva en la micción de los hombres con hernia inguinal superior a los 50 años / Urodynamic studies about the use of the Valsalva maneuver in the urination of men with inguinal hernias above the age of fifty

Objetivo: Verificar si la presencia de la Maniobra de Valsalva durante la micción en pacientes portadores de hernia inguinal está asociada a hallazgos urodinámicos específicos. Método: hombres portadores de hernia inguinal, con edad igual o superior a los 50 años, que comparecieron al ambulatorio de cirugía general en el período de mayo del 2003 a noviembre de 2005, fueron sometidos al estudio urodinamico. evaluándose principalmente la resistencia uretral media (URA), la contractilidad isométrica detrusora (Pw) y el resíduo miccional. Los pacientes fueron divididos en un grupo sin utilización de la maniobra de Valsalva durante la micción (grupo I) y otro con presencia de la maniobra (grupo II). Inicialmente, los datos se expesaron a través de los promedios de los parametros analizados; después fueron dicotomizados conforme los valores de referencia; y, para el análisis estadístico, se empleó el test del chi cuadrado y regresión logística no condicional. Resultado: Participaron 100 pacientes, con promedio de edad de 64,2 años (DP de +-9,7 años). El grupo I fue compuesto por 52 pacientes y el grupo II, por 48 pacientes. Los promedios de los parametros urodinámicos fueron comparados entre los dos grupos. Se constató que el grupo que realizaba Maniobra de Valsalva durante la micción presentaba una contractilidad detrusora comprometida (p<0,01) y un residuo miccional aumentado (p<0,02). Al utilizarse la regresión logística para expresar las razones de odds, se encontró OR de 2,57 (IC 95%: 1,09-6,06) en grupo de hipocontractilidad detrusora. Conclusión: la maniobra de Valsalva durante la micción se asocia con la presencia de hipocontractilidad detrusora en portadores de hernia inguinal

Objective: To verify if the Valsalva Maneuver during urination in patients with inguinal hernias is associated with specific urodynamic findings. Method: Men, of over 50 years of age, who had inguinal hernias and visited a general surgery unit between May 2003 and November 2005, underwent an urodynamic study. They were mainly evaluated according to average urethral resistance (URA), the detrusal isometric contractibility (Pw) and urinal residue. The patients were divided into two groups: in the first group the Valsalva maneuver was not used during urination (Group I) while in the second group the Valsalva maneuver was employed (Group II). Initially, the data was expressed using the averages of the analysed parameters; they were then dichotomised according to the reference values. In order to carry out the statistical analysis, the qui quadrant and non conditional logistic regression were used. Results: One hundred patients took part in the research with an average age of 64.2 years of age (SD of ± 9.7 years). Group I was made up of 52 patients and Group II of 48 patients. The averages of the urodynamic parameters were compared between the two groups. It was found that the Group that carried out the Valsalva maneuver while urinating showed a damaged detrusal contractibility (p<0.01) and an increased urinal residue (p<0.02). When using logistic regression in order to express the odds ratios. The OR value was found to be 2.57 (IC 95%: 1.09-6.06) in the detrusal hypocontractibility group. Conclusion: The Valsalva Maneuver during urination is associated with the presence of detrusal hypocontractibility in patients affected by inguinal hernia

[Three dimensional anatomy and virtual surgery for transobturator approach]. / Anatomía tridimensional y cirugía virtual para procedimientos transobturatrizes.

INTRODUCTION: Stress Urinary Incontinence (SUI) may be managed by transobturator approach. We developed a three-dimensional model, for understanding the surgical anatomy and manual training as well, in order to reduce the learning curve for pelvic surgeries. OBJECTIVE: To demonstrate in synthetic models, the anatomical basis for the management of SUI and cystocele. METHOD: The anatomical model includes: pelvic bones, the main layers of the pelvic muscles, ligaments and fascias. The surgical devices were transobturator needles, synthetic slings and meshes for anterior vaginal wall repair. The workshop was carried out with an anatomical overview and hands-on training in this tridimentional models and finally surgery in animals. At the end, a questionnaire was applied to verify the impact of this tool in the learning process and trainee satisfaction. RESULTS: As far as the anatomical concept, 90% (n=72) of the participants classified this model as very good and 10% (n=8) as good. As a tool for understanding the tridimentional pelvic floor anatomy applied to transobturator procedures there were 100% of approval. CONCLUSIONS: This synthetic model allows for understanding the pelvic floor tridimentional anatomy and surgical procedures as well. Further skill is got in the animal model reducing the learning curve for transobturator procedures.

Anatomía tridimensional y cirugía virtual para procedimientos transobturatrizes / Three dimensional anatomy and virtual surgery for transobturator approach

Introducción: La Incontinencia Urinaria de Esfuerzo (IUE) se maneja quirúrgicamente diferente siguiendo la Teoría Integral de la Continencia razón por la cual es importante el conocimiento de las estructuras anatómicas. Desarrollamos un modelo tridimensional basado en la anatomía de la pelvis para el entrenamiento manual de la cirugía y así disminuir la curva de aprendizaje de urólogos y ginecólogos. Objetivo: Demostrar en modelos sintéticos, las bases anatómicas del manejo transobturatriz en la IUE, cistoceles y en IUE recidivante post tratamiento quirúrgico. Metodología: El modelo anatómico incluye: huesos pélvicos, las principales capas de los músculos pélvicos, ligamentos y fascias. Los dispositivos quirúrgicos son agujas transobturatrizes en forma de “C” y helicoidales; un sling reajustable de acceso universal y una malla especial autofijable y el sling crossover. Fue realizado un entrenamiento con clases teóricas y prácticas. Las clases prácticas fueron realizadas con las pelvis y los dispositivos de la cirugía transobturatriz. A continuación fueran realizadas cirugías transobturatrizes en ovejas. Al final, se aplicó un cuestionario para verificar el impacto de esta herramienta en la curva de aprendizaje del acceso transobturatriz. Resultados: Con respecto al concepto anatómico, el 90% (n=72) de los participantes, clasificó el modelo como muy bueno y 10% (n=8) como bueno. Como herramienta para el aprendizaje de los procedimientos transobturatrizes, el 100% aprobó tanto el material escrito como el modelo anatómico tridimensional. Conclusiones: Este modelo sintético permite entender y poner en práctica las diversas técnicas quirúrgicas, substituyendo los modelos animales, las reconstrucciones tridimensionales computarizadas y las imágenes bidimensionales, contribuyendo así de forma significativa en la curva de aprendizaje

Introduction: Stress Urinary Incontinence (SUI) may be managed by transobturator approach. We developed a threedimensional model, for understanding the surgical anatomy and manual training as well, in order to reduce the learning curve for pelvic surgeries. Objective: To demonstrate in synthetic models, the anatomical basis for the management of SUI and cystocele. Method: The anatomical model includes: pelvic bones, the main layers of the pelvic muscles, ligaments and fascias. The surgical devices were transobturator needles, synthetic slings and meshes for anterior vaginal wall repair. The workshop was carried out with an anatomical overview and hands-on training in this tridimentional models and finally surgery in animals. At the end, a questionnaire was applied to verify the impact of this tool in the learning process and trainee satisfaction. Results: As far as the anatomical concept, 90% (n=72) of the participants classified this model as very good and 10% (n=8) as good. As a tool for understanding the tridimentional pelvic floor anatomy applied to transobturator procedures there were 100% of approval. Conclusions: This synthetic model allows for understanding the pelvic floor tridimentional anatomy and surgical procedures as well. Further skill is got in the animal model reducing the learning curve for transobturator procedures

[Female sexual function before and after treatment of urinary incontinence]. / Evaluación de la función sexual femenina antes y después de un procedimiento para la corrección de la incontinencia urinaria de esfuerzo.

The prevalence of urinary incontinence is around 20% of healthy middle-aged women. Incontinence causes a negative impact on the quality of life and sexuality. From August 2002 to January 2004, 30 patients (mean age 43 years) with stress urinary incontinence (59%), overactive bladder (15%) and mixed incontinence (26%) answered the ICIQ-SF(International Consultation on Incontinence Questionnarie-Short Form) and FSFI (Female Sexual Function Index) questionnaires before and after treatment for urinary incontinence. The follow-up ranged from 12 to 53 months. Mean ICIQ score was 17 and 7 before and after treatment respectivelly (p<0,001). Overactive bladder showed the worst scores in all domains. The patients who underwent surgery increased their scores of desire (p=0,02), satisfaction (p=0,05) and total score (p=0,02). Thirteen patients which ICIQ was zero increased: desire (p<0,01), satisfaction (p=0,05) and total score (p=0,01). Urinary incontinence significantly affects the quality of life. Therefore sexual evaluation in incontinence patients is recommended.

Evaluación de la función sexual femenina antes y después de un procedimiento para la correlación de la incontinencia urinaria de esfuerzo / Female sexual function before and after treatment of urinary incontinence

La incontinencia urinaria afecta a cerca del 20% de las mujeres en edad reproductiva y afecta negativamente la calidad de vida y la sexualidad. Entre agosto de 2002 y enero 2004, 30 pacientes portadoras de incontinencia urinaria (IU), respondieron los cuestionarios ICIQ-SF (Internacional Consultation on Incontinente Questionaire- Short Form) y FSFI (Female Sexual Function Index) antes y después del tratamiento. La edad media fue de 43 años (31 a 51 años), con un tiempo de inicio de los síntomas urinarios que varió entre 12 a 53 meses. Participaron pacientes con incontinencia urinaria de esfuerzo (59%), vejiga hiperactiva idiopática (15%) e incontinencia urinaria mixta (26%). Se utilizó el test de Wilcoxon para datos pareados para la evaluación estadística. Los valores de p≤0,05 indicaron diferencias significativas de la respuesta sexual (RS) antes y después del tratamiento de la incontinencia urinaria (IU). El objetivo fue evaluar la respuesta sexual y la calidad de vida de las pacientes con incontinencia urinaria antes y después del tratamiento. La muestra final contó con 27 pacientes. La media del score de ICIQ-SF pasó de 17 a 7 después del tratamiento (p0,01), satisfacción (p=0,05) y puntaje total (p=0,01). Se recomienda la evaluación de la respuesta sexual en pacientes con incontinencia urinaria, porque esta condición causa un impacto negativo en la calidad de vida (QoL)

The prevalence of urinary incontinence is around 20% of healthy middle-aged women. Incontinence causes a negative impact on the quality of life and sexuality. From August 2002 to January 2004, 30 patients (mean age 43 years) with stress urinary incontinence (59%), overactive bladder (15%) and mixed incontinence (26%) answered the ICIQ-SF(International Consultation on Incontinence Questionnarie-Short Form) and FSFI (Female Sexual Function Index) questionnaires before and after treatment for urinary incontinence. The follow - up ranged from 12 to 53 months. Mean ICIQ score was 17 and 7 before and after treatment respectivelly (p<0,001). Overactive bladder showed the worst scores in all domains. The patients who underwent surgery increased their scores of desire (p=0,02), satisfaction (p=0,05) and total score (p=0,02). Thirteen patients which ICIQ was zero increased: desire (p<0,01), satisfaction (p=0,05) and total score (p=0,01). Urinary incontinence significantly affects the quality of life. Therefore sexual evaluation in incontinence patients is recommended

[Correlation between urogenital prolapse and detrusor overactivity]. / Correlación entre los prolapsos urogenitales y la presencia de detrusor hiperactivo.

PURPOSE: To evaluate the urodynamic characteristics of a series of women with stress urinary incontinence presenting various rates of vaginal prolapse. METHODS: 92 female patients were included in this study, mean age was 48 years (range 29-75). All patients underwent urogynecologic physical examination (vaginal prolapse was graded) and complete urodynamic study in order to detect the presence of detrusor overactivity. Urodynamic terminology and measurements comply with the ICS (International Continence Society) standards. Statistical significance was established below 0.05. RESULTS: 65 women (70.6%) presented anterior vaginal prolapse and 31 (33.6%) posterior vaginal prolapse. Involuntary contractions of the detrusor muscle appeared in 13 patients (20%) who had an anterior vaginal prolapse and 6 women (19.3%) who had a posterior vaginal prolapse. The existence of involuntary contractions was not associated with the diagnosis of vaginal prolapse. CONCLUSION: Our study did not show any correlation between existence of vaginal prolapse and detrusor overactivity.

Correlación entre los prolapsos urogenitales y la presencia de detrusor hiperactivo / correlation between urogenital prolapse and detrusor overactivity

Objetivo: Evaluar la relación entre el prolapso urogenital y la presencia de hiperactividad del detrusor en mujeres con incontinencia urinaria de esfuerzo. Materiales y Métodos: Se evaluaron en forma prospectiva, desde enero 1999 a septiembre 2001, en el ambulatorio de Uroginecología de la Universidad Estatal de Campinas (UNICAMP), 92 mujeres con diagnóstico clínico de incontinencia urinaria de esfuerzo que fueron sometidas a estudio urodinámico. La edad varió entre 29 y 75 años, con una media de 48 ± 10 años. Se analizó la relación entre la presencia de prolapsos urogenitales, sus diferentes grados, y la ocurrencia de hiperactividad del detrusor. Resultados: De acuerdo con el examen clínico y el estudio urodinámico se observaron los siguientes resultados: prolapso anterior en 65 (70,6 %) de las mujeres y prolapso posterior en 31 (33,6 %). La hiperactividad del detrusor estaba presente en 13 de los prolapsos anteriores (20 %) y 6 de los prolapsos posteriores(19,3%). No se observó diferencia significativa en ninguno de los prolapsos examinados en relación a la presencia de hiperactividad del detrusor: anterior (p=0,1639) y posterior (p=0,1849). Conclusión: Los prolapsos urogenitales, en sus diferentes grados, no se relacionan con la incidencia de hiperactividad del detrusor en mujeres con incontinencia urinaria de esfuerzo (AU)

Purpose: To evaluate the urodynamic characteristics of a series of women with stress urinary incontinence presenting various rates of vaginal prolapse. Methods: 92 female patients were included in this study, mean age was 48 years (range 29-75). All patients underwent urogynecologic physical examination (vaginal prolapse was graded) and complete urodynamic study in order to detect the presence of detrusor overactivity. Urodynamic terminology and measurements comply with the ICS (International Continence Society) standards. Statistical significance was established below 0.05. Results: 65 women (70.6%) presented anterior vaginal prolapse and 31 (33.6%) posterior vaginal prolapse. Involuntary contractions of the detrusor muscle appeared in 13 patients (20%) who had an anterior vaginal prolapse and 6 women (19.3%) who had a posterior vaginal prolapse. The existence of involuntary contractions was not associated with the diagnosis of vaginal prolapse. Conclusion: Our study did not show any correlation between existence of vaginal prolapse and detrusor overactivity (AU)

[Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery]. / Uretrolisis transvaginal tras cirugía correctora de la incontinencia urinaria de esfuerzo.

PURPOSE: To analyse the success of transvaginal urethrolysis in resolving voiding dysfunction in patients following an anti-incontinence procedure. MATERIALS AND METHODS: A retrospective chart review was performed on 20 patients who had undergone transvaginal urethrolysis for urethral obstruction following an anti-incontinence procedure. Preoperatively, a history was taken, pelvic examination and urodynamic were done. Mean patient age was 48 years, and the median time between the anti-incontinence procedure and the urethrolysis was nine months. Four patients had urinary retention and had irritative voiding symptoms. Previous surgery included pubovaginal sling in eleven patients, retropubic urethropexy in three and bladder neck suspension in six cases. Mean length of follow up after urethrolysis was 14 months. The urodynamic study demonstrated voiding flow rate of 9.9 ml/s and detrusor pressures at maximum flow of 48cmH20. RESULTS: Of the 20 patients 14 (70%) had relief of symptoms after a single urethrolysis, while two patients underwent a second transvaginal urethrolysis, with placement of a Martius flap between the urethra and the symphysis. There was no correlation between preoperative parameters examined and the outcome from urethrolysis. CONCLUSION: Our data support transvaginal urethrolysis for the treatment of urethral obstruction after anti-incontinence surgery. It is effective and minimally invasive technique with good results that should be considered if voiding dysfunction does not resolve spontaneously.

[Transobturator correction of cystocele]. / Corrección transobturatoria de los cistoceles.

OBJECTIVE: We present our initial experience with the Perigee system for anterior vaginal wall prolapses repair. MATERIAL AND METHOD: 15 patients with anterior vaginal wall prolapse (mean age: 62 years old) underwent implanted with Perigee system which is composed by a mesh for correcting central defect and four self-attached horns for correcting lateral defect. The implanted procedure consist of four steps: 1) lateral vaginal wall dissection as far as isquiopubic branch; 2) performance of two upper marks at genitofemoral fold and two lower marks at 2 cm laterally and 3 cm lower; 3) insertion of the upper needles parallel to the isquiopubic branch and connection with the mesh's "arms" plus insertion of the lower needles vertically and connection with mesh's "legs"; 4) to adjust the mesh free tension. The system POP-Q was used as an objective measure of correction rate. RESULTS: Preoperatively, the point Aa was 0.09. After 6 weeks and three months postoperatively was -3.00 and -2.73 respectively. Preoperatively, the point Ba was 1.73. After 6 weeks and three months postoperatively was -2.82 and -2.82 respectively. No major complications were presented. No vascular damage or significant bleeding was observed. CONCLUSION: The transobturator correction of cystocele is an attractive alternative. The initial good outcome may be expected to be long lasting.

Uretrolisis transvaginal tras cirugía correctora de la incontinencia urinaria de esfuerzo / Transvaginal urethrolysis for urethral obstruction after anti-incontince surgery

Objetivos: Analizar los resultados de la uretrolisis transvaginal como medida terapéutica para la disfunción miccional, en pacientes sometidas previamente a cirugía anti-incontinencia. Materiales y Métodos: Fue realizado un estudio retrospectivo, en 20 pacientes quienes fueron sometidas auretrolisis por obstrucción uretral secundaria a una cirugía anti-incontinencia. Preoperatoriamente fueron realizados historia, examen físico y estudio urodinámico. La edad media de las pacientes fue 48 años. El tiempo de evolución entre la cirugía y la uretrolisis, varió de 3 meses a 8 años. Cuatro pacientes presentaron retención urinaria y las demás referían síntomas irritativos. Las cirugías previas incluían: sling pubo vaginal en 11pacientes, uretropexia retropúbica en 3 y suspensión del cuello vesical con aguja en 6. El seguimiento posterior a la realización de la uretrolisis fue de 14 meses. La evaluación urodinámica demostró un flujo urinario promedio de 9,9 ml/s y presión detrusora media en el flujo máximo de 48 cmH2O. Resultados: Aproximadamente 70% de las pacientes presentaron mejoría subjetiva total de los síntomas. Dos pacientes presentaron falla del método y fueron sometidas a nueva uretrolisis con interposición de flap de Martius. No hubo correlación entre los parámetros clínicos y urodinámicos encontrados en el pre operatorio y los resultados posteriores a la uretrolisis. Conclusión: Tratamos de demostrar que la uretrolisis posterior a cirugía anti-incontinencia es un procedimiento efectivo, mínimamente invasivo que permite resultados satisfactorios para el tratamiento de la disfunción miccional que no se resuelve espontáneamente (AU)

Purpose: To analyse the success of transvaginal urethrolysis in resolving voiding dysfunction in patients following an anti-incontinence procedure. Materials and Methods: A retrospective chart review was performed on 20 patients who had undergone transvaginal urethrolysis for urethral obstruction following an anti-incontinence procedure. Preoperatively, a history was taken, pelvic examination and urodynamic were done. Mean patient age was 48 years, and the median time between the anti-incontinence procedure and the urethrolysis was nine months. Four patients had urinary retention and had irritative voiding symptoms. Previous surgery included pubovaginal sling in eleven patients, retropubic urethropexy in three and bladder neck suspension in six cases. Mean length of follow up after urethrolysis was 14 months. The urodynamic study demonstrated voiding flow rate of 9,9ml/s and detrusor pressuresat maximum flow of 48 cmH2O.Results: Of the 20 patients 14 (70%) had relief of symptoms after a single urethrolysis, while two patients underwent a second transvaginal urethrolysis, with placement of a Martius flap between the urethra and the symphysis. There was no correlation between preoperative parameters examined and the outcome from urethrolysis. Conclusion: Our data support transvaginal urethrolysis for the treatment of urethral obstruction after anti-incontinence surgery. It is effective and minimally invasive technique with good results that should be considered if voiding dysfunction does not resolve spontaneously (AU)

Corrección transobturatoria de los cistoceles / Transobturator correction of cystocele

Objetivo: Presentar nuestra experiencia inicial con el sistema Perigee para la corrección de prolapsos de pared anterior vaginal. Material y método: 15 pacientes con prolapso de la pared anterior de la vagina (edad media: 62 años) fueron intervenidas con el sistema Perigee compuesto de una tela para la corrección del defecto central y cuatro astas autofijables para la corrección del defecto lateral. La técnica de implante consta de cuatro pasos: 1) disección lateral vaginal hasta rama isquiopúbica; 2) realización de dos marcas superiores en el pliegue genito-femoral y dos inferiores a 2 cm lateralmente y 3 cm inferiormente en relación a las primeras; 3) introducción agujas superiores paralelas a la rama isquiopúbica y conexión con los “brazos” del injerto e introducción de agujas inferiores verticalmente con conexión a las “piernas” del injerto; 4) ajuste sin tensión de la malla. La tasa de curación fue medida objetivamente utilizando el sistema POP-Q. Resultados: El punto Aa preoperatorio paso de 0.09 a -3.00 a las 6 semanas del postoperatorio y se mantuvo en -2.73 a los tres meses. El punto Ba preoperatorio era de 1.73 y paso a -2.82 a las 6 semanas y se mantuvo en -2.82 a los 3 meses. Las complicaciones no fueron significativas. No se produjeron daños vasculares ni sangrados significativos. Conclusiones: La corrección transobturadora de los cistoceles es una opción atrayente. Los buenos resultados iniciales prometen ser duraderos

Objective: We present our initial experience with the Perigee system for anterior vaginal wall prolepses repair. Material and method: 15 patients with anterior vaginal wall prolapse (mean age: 62 years old) underwent implanted with Perigee system which is composed by a mesh for correcting central defect and four self-attached horns for correcting lateral defect. The implanted procedure consist of four steps: 1) lateral vaginal wall dissection as far as isquiopubic branch; 2) performance of two upper marks at genitofemoral foldy and two lower marks at 2 cm laterally and 3 cm lower; 3) insertion of the upper needles parallel to the isquiopubic branch and connection with the mesh’s “arms” plus insertion of the lower needles vertically and connection with mesh’s “legs”; 4) to adjust the mesh free tension. The system POP-Q was used as an objective measure of correction rate. Results: Preoperatively, the point Aa was 0.09. After 6 weeks and three months postoperatively was -3.00 and -2.73 respectively. Preoperatively, the point Ba was 1.73. After 6 weeks and three months postoperatively was -2.82 and -2.82 respectively. No major complications were presented. No vascular damage or significant bleeding was observed. Conclusion: The transobturator correction of cystocele is and attractive alternative. The initial good outcome may be expected to be long lasting

Safyre. Un nuevo concepto de cabestrillo ajustable mínimamente invasivo para la incontinencia urinaria por estrés femenina / Safyre. A new concept for adjustable minimally invasive sling for female urinary stress incontinence

INTRODUCCIÓN: SAFYRE es un nuevo cabestrillo (dispositivo de suspensión) reajustable y mínimamente invasivo para el tratamiento de la incontinencia urinaria por estrés (IUE). En los últimos años se ha intentado restaurar el lecho suburetral normal utilizando una técnica anatómica. Los autores comunican su experiencia con este dispositivo, que además de poseer la eficacia de los cabestrillos tiene capacidad de reajustación. MATERIALES y MÉTODOS: Un total de 100 pacientes consecutivas con diagnóstico de IUE desde el punto de vista clínico y urodinámico se sometieron al procedimiento de implantación del cabestrillo SAFYRE. Su rango de edad era de 40 a 71 años, con una edad media de 63 años. Previamente, 75 pacientes (75%) se habían sometido a procedimientos para la incontinencia que habían fracasado. Antes de la cirugía se realizaron una exploración física clínica, una prueba de estrés, un estudio urodinámico y un estudio sobre el uso de almohadillas. Todas las pacientes presentaban síntomas de IUE y el 30% también tenían tenesmo leve. RESULTADOS: El periodo de seguimiento medio fue de 14 meses (12 – 30 meses). El tiempo medio de la operación fue de 25 minutos. Durante el mismo procedimiento se reparó la distopia cuando se consideró necesario. La estancia hospitalaria media fue de 24 horas. En el 3% de los implantes se produjo perforación de la vejiga. Durante el periodo posoperatorio 26 pacientes presentaron síntomas de tenesmo. Durante ese periodo de seguimiento, el 92% presentaron continencia urinaria, el 3% mejoraron y el 5% no estuvieron satisfechas con el procedimiento. CONCLUSIÓN: SAFYRE es un procedimiento seguro y rápido que permite el reajuste posoperatorio. Esta técnica puede ser una alternativa atractiva si se demuestra que los buenos resultados obtenidos hasta ahora son de larga duración

INTRODUCTION: SAFYRE is a new readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). Attempts to restore the normal suburethral hammock using an anatomical approach have been made in recent years. The authors report their experience with this device, which associates the efficacy of slings with readjustability. MATERIAL AND METHODS: A total of 100 consecutive patients with clinical and urodynamic diagnosis of SUI underwent SAFYRE sling procedure. The age range was from 40 to 71, mean age 63 years. Seventy-five patients (75%) presented previous failed anti-incontinence procedures. Physical clinical examination, stress test, pad use and a urodynamic study were performed before the surgery. All the patients presented symptoms of SUI and 30 % also reported mild urgency. RESULTS: The average follow up period was 14 months (12 – 30 months). The mean operative time was of 25 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 3% of the implants, bladder perforation occurred. During the postoperative period, 26 patients developed urgency symptoms. During that follow up period, 92% were found to be continent, 3% reported an improvement and 5% were dissatisfied. CONCLUSION: SAFYRE is a safe and quick procedure that allows for postoperative readjustment. This technique may be an attractive alternative if the good result obtained so far proves to be long lasting

[SAFYRE. A new concept for adjustable minimally invasive sling for female urinary stress incontinence]. / SAFYRE. Un nuevo concepto de cabestrillo ajustable mínimamente invasivo para la incontinencia urinaria por estrés femenina.

INTRODUCTION: SAFYRE is a new readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). Attempts to restore the normal suburethral hammock using an anatomical approach have been made in recent years. The authors report their experience with this device, which associates the efficacy of slings with readjustability. MATERIAL AND METHODS: A total of 100 consecutive patients with clinical and urodynamic diagnosis of SUI underwent SAFYRE sling procedure. The age range was from 40 to 71, mean age 63 years. Seventy-five patients (75%) presented previous failed anti-incontinence procedures. Physical clinical examination, stress test, pad use and a urodynamic study were performed before the surgery. All the patients presented symptoms of SUI and 30% also reported mild urgency. RESULTS: The average follow up period was 14 months (12-30 months). The mean operative time was of 25 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 3% of the implants, bladder perforation occurred. During the postoperative period, 26 patients developed urgency symptoms. During that follow up period, 92% were found to be continent, 3% reported an improvement and 5% were dissatisfied. CONCLUSION: SAFYRE is a safe and quick procedure that allows for postoperative readjustment. This technique may be an attractive alternative if the good result obtained so far proves to be long lasting.