¿Es la colpopexia sacroespinosa útil para tratar el prolapso de cúpula vaginal a largo plazo? / Is sacrospinous colpopexy useful for treating long-term vaginal vault prolapse?

Objetivo: evaluar los resultados quirúrgicos de pacientes con prolapso de cúpula vaginal operadas mediante técnica de Richter (colpofijación al ligamento sacroespinoso). El objetivo principal del estudio fue valorar los resultados a largo plazo de la intervención mediante parámetros subjetivos y objetivos (grado de satisfacción de las pacientes y ausencia de prolapso de cúpula en la revisión postoperatoria, respectivamente). Material y métodos: estudio descriptivo mediante revisión retrospectiva de 46 pacientes intervenidas mediante técnica de Richter en nuestro hospital. Realización de anamnesis y exploración física. Revisión bibliográfica de los tratamientos del prolapso de cúpula. Resultados: los resultados obtenidos del control postoperatorio a largo plazo (hasta 18 años de seguimiento) son ausencia de prolapso de cúpula en el 91,17% con muy pocas complicaciones, cistocele en el 19,35% y rectocele en el 3,22%. El grado de satisfacción subjetivo, valorado mediante anamnesis, fue del 100% (curación 85,29% y mejoría 14,71%). Conclusión: la técnica de Richter parece tener buenos resultados subjetiva y objetivamente (resultados clínicamente relevantes), por lo que puede considerarse una técnica eficiente en nuestro medio (AU)

Objective: To evaluate the surgical results of patients with vaginal vault prolapse who underwent Richter’s procedure (vaginal sacrospinous colpopexy). The main purpose of this study was to evaluate the success of the surgery, both subjectively (patient satisfaction) and objectively (absence of vault prolapse in long-term postsurgical follow-up). Material and methods: A descriptive study was conducted through a retrospective review of the medical records of 46 patients who underwent Richter surgery in our hospital, followed by medical history and physical examination. A literature review was conducted of procedures for vault prolapse. Results: The results observed in the long-term postsurgical follow-up (up to 18 years of follow-up) were as follows: no vaginal vault prolapse in 91.17% and few complications, cystocele in 9.35% and rectocele in 3.22%. The degree of subjective satisfaction evaluated through the medical history was 100% (cure in 85.29% and improvement in 14.71%). Conclusion: The Richter procedure seems to produce excellent subjective and objective (clinically relevant) results and can therefore be considered an efficient technique in our environment (AU)

Vesicouterine fistula: teaching video on diagnosis and surgical treatment.

INTRODUCTION: A 42-year-old woman presented with urinary incontinence 9 years after the last of four vaginal deliveries. She had also had one Caesarean section. Immediately after the last delivery, she presented with haematuria, which resolved within a few hours, but the drain remained prophylactically for 7 days. Nine years later, she was referred to a specialist hospital. METHOD: The patient presented with continuous urinary incontinence, and physical examination revealed a loss of urine from the vagina, the latter confirmed by a methylene blue test showing loss of urine from the uterine cervix. Other diagnostic techniques used were cystography, cystoscopy and uro-CT. Based on a literature review of the management options for such patients and the relevant clinical details of our patient, a decision was made to perform a total abdominal hysterectomy and fistula repair. RESULTS AND DISCUSSION: Six months following surgery, the results were entirely satisfactory, with full urinary continence and significant improvement in the patient's quality of life. A discussion about controversial approaches to diagnosis and management is included.