RESUMEN
OBJECTIVE: Mid-urethral slings (MUS) become a standard, minimally invasive surgery to treat urinary stress incontinence. Our aim is to investigate the contribution of preoperative urodynamics to mid-urethral slings success and determine predictors for choosing mid-urethral sling route. METHODS: Women with stress urinary incontinence and who desired surgical correction of their incontinence were included in the study. The selection of the procedure was according to an algorithm used in an institution. Urodynamic and baseline factors that may be associated with surgery failure were analyzed. RESULTS: A total of 159 patients in the tension free transvaginal tape (TVT) group and 83 patients in the transobturator tape (TOT) group were included in the present study. Urodynamic findings of subjects who were considered MUS failure were not significantly different from those women who were continent after 1 year of surgery. Detrusor overactivity was present on urodynamics in 23 of 37 women (62.2%) with MUS failure, 81 of 205 women (39.7%) with no stress test positivity with the cough stress test (P < 0.05). A vaginal hysterectomy had been performed on 13 of 37 (35.1%) subjects with MUS failure 1 year after operation, and 20 of 205 subjects (9.8%) in the stress urinary incontinence (SUI) continent group (P < 0.001). CONCLUSIONS: Preoperative detrusor overactivity (DO) was the only urodynamic finding that negatively affected the success of surgery in both TOT and TVT groups. Our study demonstrated an increased risk of surgery failure for those who underwent a concurrent hysterectomy for pelvic organ prolapse.
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Cabestrillo Suburetral , Incontinencia Urinaria de Esfuerzo/cirugía , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Falla de Prótesis , Medición de Riesgo , Insuficiencia del Tratamiento , Incontinencia Urinaria de Esfuerzo/fisiopatología , Urodinámica/fisiologíaRESUMEN
OBJECTIVE: The aim of this study is to investigate the association of sexual functions with levator hiatus biometry measurements and levator ani muscle defect. METHODS: In 62 heterosexual, sexually active premenopausal women without pelvic floor disorders or urinary incontinence, 3-dimensional transperineal ultrasound imaging was used. Two 3-dimensional volumes were recorded, one at rest and one on Valsalva maneuver. Levator biometry measurements and levator defect were evaluated in an axial plane. Sexual function was assessed by a validated questionnaire, Female Sexual Function Index (FSFI). The primary outcome measure was correlation of sexual functions with the levator hiatus area, transverse and anteroposterior diameters, levator ani muscle thickness, vaginal length, and changes in measurements with Valsalva and levator defect. RESULTS: Forty-two women (67.7%) had low total FSFI scores (<26.55). Levator defect rates were similar in female sexual dysfunction (7/42, 16.7%) and women without female sexual dysfunction (5/20, 25%). The FSFI was negatively and weakly correlated with Δhiatal anteroposterior diameter (r = -0.33, P < 0.009) in the study population. There was a weak and inverse correlation between Δhiatal anteroposterior diameter and arousal (r = -0.35, P < 0.002), desire (r = -0.38, P < 0.001), and orgasm (r = -0.33, P < 0.007). Pain and lubrication did not correlate with any measurement. CONCLUSIONS: Hiatal area and diameters at rest are not related to sexual functions. Changes in anteroposterior diameter of the levator hiatus during Valsalva, which may be a sign of pelvic floor laxity or levator muscle weakness, are weakly associated with sexual functions, particularly desire, arousal, and orgasm domains.
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Imagenología Tridimensional , Diafragma Pélvico/diagnóstico por imagen , Disfunciones Sexuales Fisiológicas/diagnóstico , Disfunciones Sexuales Fisiológicas/etiología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Contracción Muscular , Orgasmo/fisiología , Diafragma Pélvico/patología , Estudios Prospectivos , Disfunciones Sexuales Fisiológicas/fisiopatología , Parejas Sexuales , Encuestas y Cuestionarios , Turquía , Ultrasonografía/métodos , Maniobra de Valsalva/fisiologíaRESUMEN
The diagnosis of premature ovarian failure is traumatic to women, with loss of gonadal functions having been associated with distress and anxiety. The aim of this study is to evaluate the sexual function and distress of women with premature ovarian failure before the diagnosis. Women with premature ovarian failure and age-matched controls were evaluated through the Female Sexual Function Index and the Female Sexual Distress Scale-Revised, and their androgen levels were compared. The major finding of this study is the lack of difference between sexual function in women who are unaware that they have premature ovarian failure and age-matched women with normal gonadal function.
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Coito/psicología , Satisfacción Personal , Insuficiencia Ovárica Primaria/psicología , Disfunciones Sexuales Psicológicas/psicología , Adulto , Nivel de Alerta , Femenino , Humanos , Orgasmo , Insuficiencia Ovárica Primaria/complicaciones , Disfunciones Sexuales Psicológicas/etiología , Encuestas y Cuestionarios , Salud de la MujerRESUMEN
AIMS: The aim of this study was to assess medium-term outcomes of the single anterior vaginal wall incision technique with concomitant mid-urethral sling (MUS) procedure. METHODS: Patients suffering from stress urinary incontinence and who desired surgical correction for their incontinence were divided into two groups according to MUS surgery alone or MUS surgery with anterior vaginal wall surgery. Concomitant surgery was performed via single large anterior vaginal wall incision. Primary outcome was treatment success 12 months after surgery. Urodynamic and baseline factors that may be associated with surgery failure were analyzed. RESULTS: Single incision anterior colporrhaphy with MUS was performed in 180 patients, 62 patients underwent only MUS procedure. Success rate was 87.1% in sling surgery alone and 83.9% in single incision concomitant surgery group (P = 0.5). Detrusor overactivity (DO) was present on UDS in 23 of 37 women (62.2%) with MUS failure, 81 of 205 women (39.7%) with no stress test positivity with the cough stress test (P < 0.05). Total continence rate in patients who underwent vaginal hysterectomy was 60.6% (P < 0.001). CONCLUSION: Concurrent cystocele repair with MUS operations through a single anterior wall incision is a safe and effective method for SUI. This study demonstrated an increased risk of surgery failure for those who underwent a concurrent hysterectomy for pelvic organ prolapse. Neurourol. Urodynam. 35:995-999, 2016. © 2015 Wiley Periodicals, Inc.
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Procedimientos Quirúrgicos Ginecológicos/métodos , Cabestrillo Suburetral , Incontinencia Urinaria de Esfuerzo/cirugía , Vagina/cirugía , Adulto , Anciano , Cistocele/cirugía , Femenino , Humanos , Histerectomía/estadística & datos numéricos , Persona de Mediana Edad , Prolapso de Órgano Pélvico/cirugía , Calidad de Vida , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/cirugía , Incontinencia Urinaria de Esfuerzo/psicología , UrodinámicaRESUMEN
OBJECTIVE: To compare perinatal, neonatal outcome and congenital anomalies of multiple gestations conceived by means of assisted reproductive techniques with spontaneously conceived multiples before the limitation of number of embryo transfer. METHODS: Cases consisted of assisted reproductive technique (ART) multifetal gestations and control group comprised of spontaneously conceived multifetal gestations delivered in the same time period. Outcomes were perinatal, neonatal outcome, long-term outcomes and congenital anomalies of multiple gestations. There were 270 multifetal pregnancies for analysis, of which 137 were achieved by ART and 133 were spontaneous in this prospective study. RESULTS: Incidences of preeclampsia, gestational diabetes, deep vein thrombosis, thrombocytopenia, intrahepatic cholestasis and preterm premature rupture of membranes were similar in ART and spontaneous groups. There was no difference in fetal malformation rates between ART and control group, but higher rates of central nervous system malformation were observed (4 (1.5%) in control, 0 in ART group, p = 0.04) in spontaneous group. No difference was seen in the perinatal mortality. CONCLUSIONS: Neonatal and maternal outcomes are comparable between ART and spontaneous multifetal gestations. Congenital fetal malformation rates between ART and spontaneous multifetal pregnancies were similar except central nervous system malformation that was more likely in spontaneously conceived ones.
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Anomalías Congénitas/epidemiología , Transferencia de Embrión , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Embarazo Múltiple/estadística & datos numéricos , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Adolescente , Adulto , Anomalías Congénitas/etiología , Femenino , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Masculino , Embarazo , Complicaciones del Embarazo/etiología , Estudios Prospectivos , Técnicas Reproductivas Asistidas/efectos adversos , Adulto JovenRESUMEN
INTRODUCTION: Female sexual dysfunction (FSD) is a common problem that may be encountered in the interruption of normal sexual functioning in the sexual response cycle. Women with a pelvic floor disorder who scored low on the Female Sexual Function Index (FSFI) showed an improvement in their sexual life following treatment by vaginal electrical stimulation (VES). AIM: The aim of this trial was to evaluate the effectiveness of VES in women with FSD without a predominant pelvic floor disorder or urinary incontinence. METHODS: Forty-two women with FSD were randomly allocated to VES and placebo groups. Pelvic floor muscle (PFM) assessment and the FSFI questionnaire were performed at baseline and after the completion of sessions. VES treatment was administered using a vaginal probe. The probe was inserted, and a medium-frequency (50 Hz) alternating current was administered for a duty cycle of 5 seconds on followed by a 5-second rest. MAIN OUTCOMES MEASURES: Primary outcome measure was the improvement in FSFI score. PFM assessments were performed according to the PERFECT scheme. RESULTS: Total FSFI scores improved significantly in both the VES group and the control group. Results show that in the VES group, there was an improvement in total score and FSFI domains that improved including arousal, desire, orgasm, and satisfaction. Similarly, control group domains that improved were desire, arousal, and orgasm. But there was no significant increase in satisfaction scores in the placebo group. No significant changes in pain or lubrication domains were seen in either group. Power, endurance, fast contractions, and repetitions were significantly improved in the VES group. CONCLUSIONS: The lack of significant differences between the placebo and VES groups, except the satisfaction domain, puts into question the effectiveness of electrical stimulation as a monotherapy in treating primary FSD without pelvic floor disorder.
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Estimulación Eléctrica , Músculo Liso/fisiopatología , Diafragma Pélvico/fisiopatología , Disfunciones Sexuales Fisiológicas/terapia , Vagina/fisiopatología , Administración Intravaginal , Adulto , Nivel de Alerta , Estimulación Eléctrica/instrumentación , Femenino , Humanos , Músculo Liso/inervación , Orgasmo , Diafragma Pélvico/inervación , Satisfacción Personal , Estudios Prospectivos , Calidad de Vida , Conducta Sexual , Disfunciones Sexuales Fisiológicas/fisiopatología , Encuestas y Cuestionarios , Resultado del Tratamiento , Turquía/epidemiología , Vagina/inervaciónRESUMEN
AIMS: Hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, in its complete form, is associated with increased risk of maternal mortality and increased rate of serious obstetric complications, such as acute renal failure, hepatic failure, abruptio placentae, pulmonary edema, sepsis, hemorrhage and disseminated intravascular coagulopathy. To compare maternal and perinatal outcomes, we investigated the subsequent pregnancy outcomes and long-term complications of women with partial HELLP (pHELLP) and complete HELLP (cHELLP) syndromes. MATERIAL AND METHODS: In this retrospective study, patients complicated with HELLP between the years 2002 and 2007 were analyzed. cHELLP syndrome was defined by the presence of all of the three laboratory criteria according to the Tennessee Classification System. pHELLP syndrome was defined by the presence of one or two features of HELLP, but not the complete form. RESULTS: Sixty-four patients had cHELLP syndrome and 67 had pHELLP syndrome. Maternal complications and neonatal outcomes of the indexed pregnancies were similar. The rate of blood product transfusion was significantly higher in the cHELLP group (P<0.0001). Twenty-eight patients within the cHELLP group and 26 within the pHELLP group had subsequent pregnancies with a mean interpregnancy interval of 2.9 ± 1.5 years and 2.4 ± 1.1 years, respectively. Elective termination of pregnancy (dilatation and curettage) was more frequent in the cHELLP group. Pre-eclampsia recurrence was higher in the pHELLP group than in the cHELLP group (7.1% vs 34.6%). CONCLUSIONS: Partial and complete HELLP syndrome are not distinct groups based on neonatal, long-term and subsequent pregnancy outcomes. They probably represent a continuum in the natural evolution of the same disease.