[Vaginal repair of vesico-vaginal fistula: Experience at a tertiary care center in Venezuela.] / Reparación vía vaginal de la fístula vesico-vaginal (FVV): experiencia en un centro de atención terciaria en Venezuela.

Vesico-vaginal fistula (VVF) is a pathology with serious social repercussions; its resolution can be achieved through multiple surgical, abdominal or vaginal techniques, the choice of which will generally depend on the characteristics of the fistula and the experience of the surgeon.OBJETIVE: We describe our experience with vaginal approach to treat VVF using different flap interpositions. METHODS: A retrospective review of the charts of VVF patients attended at University Hospital of Caracas (UHC) during the 2009 - 2016 period was undertaken. The follow up period ranged from 3 months to 7 years, with an average of 2 years and 6 months. RESULTS: Of a total of 22 cases of VVF, most had a single orifice, retrotrigonal position, with an average diameter of 9.5 mm. A peritoneal flap was used in 77.27 % of the cases, Martius flap in 13.63 %, and omentum and vaginal mucosa each in 4.54 % of the cases. Success rate was 90.91%. Failure occurred in 2 cases (9.09%), due to relapse of the pathology. Morbidity rate was 13.64%, mainly due to urinary tract infections. CONCLUSION: The vaginal technique for the treatment of VVF is safe and effective with low recurrence rate and complications.

La FVV es una patología con graves repercusiones sociales, cuya resolución se puede realizar a través de múltiples técnicas quirúrgicas, abdominales o vaginales, cuya elección generalmente dependerá de las características de la fístula y la experiencia del cirujano. OBJETIVO: Describir nuestra experiencia en el tratamiento de la FVV mediante cirugía por abordaje vaginal usando diferentes colgajos de interposición. MÉTODOS: Se realizó una revisión retrospectiva y descriptiva de las pacientes operadas de FVV en el periodo comprendido entre 2009 y 2016 en el Hospital Universitario de Caracas (HUC). El período de seguimiento osciló entre 3 meses a 7 años, con un promedio de 2 años y 6 meses. RESULTADOS: De un total de 22 casos operados de FVV, la mayoría tenían un orificio único, de posición retrotrigonal y con un diámetro promedio de 9,5 mm. El tipo de colgajo más frecuentemente utilizado fue peritoneal en el 77,27% de los casos, seguido por colgajo de Martius en el 13,63%, y epiplón y mucosa vaginal con 4,54% cada uno. La tasa de éxito global fue de 90,91%. El fracaso se presentó en 2 casos (9,09%), dado por recidiva de la patología. La morbilidad estuvo en un 13,64%, dada en gran parte por infecciones urinarias. CONCLUSIÓN: La técnica vaginal para cura de FVV es segura y efectiva con baja tasa de recidiva y complicaciones.

Overactive bladder - 18 years - Part I.

Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals - including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Overactive bladder - 18 years - Part II.

Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Overactive bladder - 18 years - Part II

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Overactive bladder - 18 years - Part I

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.