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El prolapso de órganos pélvicos es una condición patológica que impacta negativamente en la calidad de vida de la mujer. Ocurre cuando los músculos, los ligamentos y las fascias del suelo pélvico se estiran y se debilitan, dejando de proporcionar un sostén adecuado, pudiendo descender y salir al exterior (1). La prevalencia está estimada de un 43% a un 76% de la población femenina general, siendo la etiología compleja y multifactorial (2). El pesario es un dispositivo que se instala en la vagina para proveer soporte a los órganos pélvicos. La importancia de su utilización reside en mejorar significativamente la calidad de vida de la paciente y evitar una intervención quirúrgica. El tratamiento es mínimamente invasivo, de bajo coste, seguro y efectivo. Se recomienda cuando la cirugía representa un riesgo mayor a los beneficios (3)

Pelvic organ prolapse is a pathological condition that negatively affects women's quality life. It occurs when the muscles ligaments and tissues supporting the pelvic organs become weak or loose. Then, the pelvic organs can droop down and bulge out of the vagina. The prevalence in women is estimated to be between 43 and 76%, etiology is complex and multifactorial. A pessary is a device inserted into the vagina to support areas that are affected by pelvic organ prolapse. The potential benefit that derives form pessary use is the significant improvement in the patient's quality of life. Thus, pessary treatment allows surgery to be avoided. It is minimally invasive, inexpensive, safe and effective treatment. It is therefore recommended when surgery may pose greater risk than benefit

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PURPOSE: To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS: One hundred eighteen subjects were randomly selected to receive pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS: In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment. CONCLUSION: Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.

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PURPOSE: To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS: One hundred eighteen subjects were randomly selected to recieve pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS: In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58 percent, 55 percent, and 54 percent of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21 percent patients were satisfied with the treatment. CONCLUSION: Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.

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Although surgery is commonly performed to alleviate or cure stress incontinence, there are non-surgical options that might well be explored and tried before a woman undergoes surgery, for which many are poor candidates. The least drastic treatments are behavioral therapies, chiefly pelvic floor muscle training (Kegel exercises), alone or with biofeedback. This method is effective but has the drawback of poor patient compliance. Another therapy, almost noninvasive, is electrical stimulation via needle or surface electrodes of the pudendal nerve and the pelvic plexus in order to treat detrusor instability. Some studies show good results for many patients; and there is no need for long-term compliance. Medical management has included hormone replacement therapy and alpha-adrenergic agonists, but questionable results and intolerable risks have shifted this mode to serotonin-norepinephrine reuptake inhibitors, which have CNS action. Finally, there are urethral occlusive devices, which have poor acceptance owing to side effects and difficulty of use, and vaginal pessaries, theoretically attractive but inexplicably poor performers in the marketplace.

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A number of vaginal and urethral devices have recently been introduced for the treatment of female urinary stress incontinence. Nine recent studies of these were scrutinized. The median corrected subjective cured/improved rate was 63% for the vaginal and 43% for the urethral devices. The latter group have a high percentage of side-effects with related drop-outs. Urinary tract infection and migration of the device into the bladder are particularly worrying. The vaginal devices currently available compete favourably with other non-surgical forms of therapy for stress incontinence in terms of efficacy and safety.

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BACKGROUND: To develop a new disposable vaginal device for use during the daytime, and test its efficacy and short-term safety in the treatment of stress incontinence. METHODS: The intravaginal support device was designed from polyurethane, a foam product with documented high tissue compatibility. It was tested in 26 women with the symptom of stress incontinence. Before and after one month's use of the device, a 24-hour home pad weighing test, uroflowmetry, postvoid residual urine and a 3-days voiding diary were made. A questionnaire about the subjective effect and adverse events was filled in. In vitro and in vivo microbiology testing were performed. RESULTS: Four women discontinued the treatment because of discomfort or difficulties in using the device. Out of 22 women who completed the study nine (41%) were subjectively cured of incontinence, ten (45%) improved while three (14%) claimed unchanged incontinence. With the device in place all had decreased leakage at the 24-hour pad weighing test and unchanged urodynamic tests. The subjective complaints were few, and no vaginal or urinary infections were found. All women whose condition both subjectively and objectively improved, (19/22) wanted to continue treatment with the device. CONCLUSIONS: The new disposable vaginal device is effective in alleviating the symptoms of stress incontinence. It is well accepted and safe.

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Genuine stress urinary incontinence can be treated by surgical or nonsurgical methods. Conservative treatments include pelvic muscle exercises, hormonal and nonhormonal pharmacologic therapy, and functional electrical stimulation with vaginal or anal electrodes. All of these methods improve or cure stress incontinence in a significant proportion of selected women, with less cost and morbidity. Patients with genuine stress incontinence generally should have a trial of conservative therapy before corrective surgery is offered. Behavioral and pharmacologic methods, alone and in combination, are used for women with detrusor instability. Behavioral regimens, including bladder retraining and biofeedback, are particularly effective for urge and stress incontinence, but are dependent on compliance and motivation of both patient and caregiver. Drug therapy is effective, but with potential morbidity. As with genuine stress incontinence, surgical methods should only be employed for patients with detrusor instability who do not respond to nonsurgical treatment.

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Vaginal pessaries are useful for treating uterine prolapse when surgical intervention is not a safe option. This article covers recommendations for selection, insertion and care of the appliance. Careful follow-up is necessary to minimize possible complications, which can include infection, ulceration of the mucosa, incarceration of the pessary, and an increased incidence of vaginal and cervical malignancy. Disagreement within the literature about the proper schedule for follow-up, and inadequate documentation of the risks of pessary usage underscore the need for clinical research in this area.

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This study represents the first of its kind in Kuwait. Two preparations of prostaglandin E2 (PGE2) have been compared as agents for induction of labor. In a randomized controlled study of 200 women of low parity and unfavorable cervical induction features induction of labor by means of a single vaginal tablets of PGE2 was compared with locally prepared PGE2 vaginal pessaries. The gradual increase of uterine contractions and the establishment of labor in a similar way to that observed during spontaneous labor was more apparent after PGE2 tablets. Labor induction was successful in 80% of patients in PGE2 tablet group compared with 59% in PGE2 pessaries group. The incidence of cesarean section was equal in both groups (4%), but none was performed due to uterine hyperactivity. The data presented indicate that the PGE2 vaginal tablet is safe and effective in induction of labor in healthy women at term.

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