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INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is caused by an imbalance in the stability of the pelvic organs, resulting in loss of support. The most common types of POP, anterior and apical, are associated with lower urinary tract symptoms (LUTS) such as bladder outlet obstruction and detrusor overactivity (DO). Vaginal surgery may improve LUTS and overall urinary symptoms. We assessed urodynamic (UD) parameters and urinary symptoms before and after vaginal surgery for POP correction. METHODS: A prospective cohort of 59 women with symptomatic anterior and/or apical POP associated with urinary symptoms and with indications for vaginal surgery were included. POP surgeries included anterior colporrhaphy and vaginal hysterectomy with culdoplasty (VH) and with/without concomitant posterior colporrhaphy and mid-urethral sling (MUS). All participants underwent UD evaluation and answered urinary symptom questionnaires pre- and 3 months post-surgery. RESULTS: Anterior colporrhaphy was performed in all patients: 45.7% with associated VH and 54.2% with concomitant MUS. Preoperative ICIQ-OAB score >8 points was significantly associated with DO (p<0.02) and decreased after surgery (9±4.3 to 3.2±3.0, p<0.001). All other questionnaires demonstrated improvements in urinary symptoms. Stress urinary incontinence rate decreased from 59.6% to 21% (p<0.001). Post-void residual (PVR) volume and Valsalva maneuver also decreased (p<0.001). CONCLUSIONS: Pelvic organ prolapse surgery reduced the prevalence of urgency symptoms, and all questionnaires on urinary symptoms showed clinically significant improvement. Vaginal surgery for POP, even combined with MUS, significantly reduced PVR volume and improved urgency symptoms.

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Resumen Objetivo: Determinar la frecuencia e intensidad del síndrome genitourinario de la menopausia en las mujeres atendidas en la consulta de climaterio y menopausia del Policlínico Universitario "Dr. Cosme Ordoñez Carceller. Materiales y métodos: Investigación tipo observacional, descriptiva y transversal, realizada en el período comprendido entre enero 2018 y diciembre de 2022. El universo de trabajo quedó constituido por 2962 mujeres de edad mediana del policlínico universitario Dr. Cosme Ordoñez Carceller. La muestra fue de 353 mujeres seleccionada mediante un muestreo estratificado simple. Para la recogida de los datos se empleó un modelo de Historia Clínica, de la cual se extrajeron los aspectos referidos a los datos sociodemográficos, la edad de inicio de los síntomas climatéricos y de la menopausia, las alteraciones genitourinarias y su intensidad en relación a la etapa del síndrome climatérico. Resultados: La edad promedio de las mujeres estudiadas fue de 49,4 +/- 5,18 años. La mayor cantidad de ellas se encontraban en la perimenopausia (60,1%), mientras que el porcentaje en las posmenopáusicas alcanzaba el 39,9%. La edad promedio de inicio de los síntomas fue de 45,8 +/- 6,2 años, la mayor frecuencia ocurrió entre los 45 y 49 años (61,5%). La edad promedio de aparición de la menopausia de 48,4+/- 3,7 años, lo que representa que más de dos tercios (81,6%) de las mujeres tuvieron su última menstruación por encima de los 45 años. Las alteraciones genitourinarias predominaron en la perimenopausia y la intensidad leve. Conclusiones: El síndrome genitourinario de la menopausia constituye un grupo de manifestaciones clínicas frecuentes en la mujer en etapa climatérica y afecta a más de dos tercios de las mujeres del policlínico, aparecen con mayor periodicidad entre los 45 y 49 años, en la perimenopausia y con intensidad leve.

Abstract Objective: To determine the frequency and intensity of genitourinary syndrome of menopause in womens treated in the climacteric and menopause consultation of the University Polyclinic 'Dr. Cosme Ordonez Carceller. Methods: Observational, descriptive and cross-sectional research, carried out in the period between January 2018 and December 2022. The universe of work was made up of 2962 middle-aged women from the Dr. Cosme Ordoñez Carceller university polyclinic. The sample consisted of 353 women selected by simple stratified sampling. For data collection, a Clinical History model was used, from which aspects related to sociodemographic data were extracted, the age of onset of climacteric symptoms and menopause, genitourinary disorders and their intensity in relation to the stage of climacteric syndrome. Results: The average age of the women studied was 49.4 +/- 5.18 years. The largest number of them were in perimenopause (60.1%), while the percentage in postmenopausal women reached 39.9%. The mean age of onset of symptoms was 45.8 +/- 6.2 years, the highest frequency occurring between 45 and 49 years (61.5%). The average age of onset of menopause of 48.4+/- 3.7 years, which represents that more than two thirds (81.6%) of the women had their last menstruation over 45 years of age. Genitourinary alterations predominated in perimenopause and mild intensity Conclusions: The genitourinary syndrome of menopause constitutes a group of frequent clinical manifestations in women in the climacteric stage and affect more than two thirds of the women al the policlinic, appearing more frequently between the ages of 45 and 49, in perimenopause and with mild intensity.

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INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is a defect of the female pelvic floor. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), and obstructive symptoms may occur in these patients. The objective of surgical treatment is to restore the anatomy and function of the pelvic floor; however, it may prompt urinary symptoms not present previously. We performed a systematic review and meta-analysis to determine urodynamic changes in patients undergoing surgical correction for POP. METHODS: PubMed and Cochrane databases were searched for studies that contained data from urodynamic evaluation before and after vaginal surgery for POP. The main urodynamic data collected were free uroflowmetry (maximum flow [Qmax], voided volume, and post-void residual volume [PVR]), cystometry (bladder capacity, presence of detrusor overactivity [DO], SUI or UUI, and Valsalva leak point pressure), and pressure × flow study (detrusor pressure at maximum flow [PdetQmax], Qmax, and PVR). RESULTS: A total of 22 studies were included (1,549 women). Patients had a significantly higher prevalence of DO before surgery (OR = 1.56; 95% CI = 1.06-2.29), and surgeries without sling placement demonstrated a tendency to ameliorate DO. Patients who did not receive a sling were more incontinent after surgery. Bladder-emptying parameters improved after surgery, with higher PdetQmax before surgery (IV = 3.23; 95% CI = 0.45-1.18). Patients who did not receive MUS presented a lower Qmax (IV = -3.19; 95%CI = -4.09 to -2.30) and a higher PVR (IV = 27.89; 95%CI = 15.68-40.1) before surgery. CONCLUSION: Correction surgery for POP yields better urodynamic emptying parameters, with a reduction in the prevalence of DO. In contrast, sling placement enhances obstructive parameters.

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POP affected 40% of participants in the WHI trial. Risk factors include parity, vaginal delivery, large babies, advancing age, obesity, hysterectomy and lifting. Data suggest African-American women have a lower prevalence of symptomatic POP than other racial groups. Literature review did not show a study of risk factors and symptoms in a black population. Cross-sectional study of women with POP attending urogynaecology clinic at the UHWI from May to October 2013, using an interviewer administered questionnaire was performed and analysed using SPSS version 19 program (SPSS Inc., Chicago, IL). One hundred and eight participants were included: 94.7% postmenopausal (mean 65.08 years) and 94.5% parous (mean 4). Risk factors included obesity (mean BMI 28.82 kg/m2), hysterectomy (28.7%), heavy lifting (51.9%) and chronic cough (13.9%). Symptoms included stress incontinence (40.7%), stranguria (16.7%), faecal incontinence (13.9%), constipation (31.5%), coital urinary and faecal incontinence (6.3%, 12.6%). We concluded risk factors for POP in this population correlates with other studies. Stress urinary incontinence and constipation most frequently reported symptoms in this population.Impact StatementWhat is already known on this subject? Pelvic organ prolapse (POP) is a common condition with multifactorial aetiology. As seen in systematic reviews (Vergeldt TFM, Weemhoff M, IntHout J, Kluivers KB. 2015. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. International Urogynecology Journal 26(11):1559-1573). Study shows white women appeared to have more overall symptoms both from prolapse, as well as urinary symptoms, as compared with black women (Ford AT, Eto CU, Smith M, Northington GM. 2019. Racial differences in pelvic organ prolapse symptoms among women undergoing pelvic reconstructive surgery for prolapse. Female Pelvic Medicine & Reconstructive Surgery 25:130-133).What do the results of this study add? The result highlights the fact that Black women are exposed to similar risk factors and have similar symptoms to other racial groups for POP.What are the implications of these findings for clinical practice and/or further research? These findings can be used to educate women with risk factors about the possibility of developing symptomatic POP. Further research is needed to ascertain the prevalence of POP and to assess knowledge and attitude in this population as we hypothesise that there is generalised assumption in that being black is protective from POP.

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INTRODUCTION AND HYPOTHESIS: To evaluate the performance of mesh-augmented repair of anterior pelvic organ prolapse (POP) with or without apical vaginal wall involvement in women with recurrent or complex prolapse. METHODS: This multicenter cohort study included women undergoing surgery with Calistar S (Promedon, Argentina) for anterior POP between 2016 and 2018. The SCENIHR opinion was considered for patient selection, surgeon's experience and choice of implant. Patients were prospectively invited to assess effectiveness and safety by anamnesis, validated questionnaires and pelvic examination. A composite endpoint defined by POP-Q ≤ 1, absence of a vaginal bulge symptom and repeated surgery for POP was used to define treatment success. Descriptive statistics were applied. McNemar or Wilcoxon signed rank tests were used as paired samples tests. The significance level was set at 5%. RESULTS: A total of 107 non-fertile women with a mean age of 70.6 years were enrolled. Ninety-three (86.9%) women presented with recurrent prolapse. The mean follow-up time was 18.5 months. Treatment success was achieved in 76% of cases according the composite endpoint, with 98% reaching POP-Q ≤ 1 and a significant improvement in quality of life (p < 0.001). Mesh exposure occurred in six (5.6%) patients, although none required further surgery. Four (3.7%) patients reported dyspareunia, and a single (0.9%) patient displayed a prominence due to mesh folding. CONCLUSIONS: Mesh-augmented repair of anterior POP is effective and safe in women with recurrent or complex prolapse. Hence, in a select patient population, the benefits of mesh-augmented POP repair still outweigh the risks.

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PURPOSE: Bladder hernias are asymptomatic in most cases and are found incidentally during exploration for inguinal hernia repair. The treatment of inguinal bladder hernia is either reduction or resection of the herniated bladder, followed by herniorrhaphy. We present a case series with preoperative diagnoses, along with their surgical outcomes. METHODS: We retrospectively reviewed the medical records from a single institution over a 5-year period (2012-2017) of five patients with diagnosis of large bladder inguinal hernia. Demographics, clinical status, medical history, anatomical structure of the hernia, and surgical outcomes were all analyzed. RESULTS: Patients' median age was 51 years (range 45-81 years). The median size of the hernial sac was 13 cm (range 8-20 cm). The diagnosis was made with computed tomography in three patients and with ultrasonography and cystography in two patients. Median length of hospital stay was 2 days (range 1-6 days), and median length of follow-up was 28 months (range 18-72 months). All patients continue to be alive and well, without hernia recurrence. The five cases are described separately along with their surgical managements. CONCLUSION: The main objectives in treatment of inguinal bladder hernia are to preserve the voiding function and to avoid bladder injuries in a tension-free hernia repair. To our knowledge, this is the first series of cases in which all inguinal bladder hernias were diagnosed preoperatively.

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PURPOSE: To evaluate the safety and efficacy of a surgical polypropylene mesh for correction of anterior vaginal prolapse, with or without apical defects, by providing simultaneous reinforcement at the anterior and apical aspects of the vagina with a single-incision approach. METHODS: This was a prospective, multicenter, single-arm study involving women with baseline stage ≥2 anterior and/or apical vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system. The primary endpoint was defined as achievement of POP-Q stage ≤1 status. Additionally, patient-reported outcomes were assessed using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). The device under evaluation was Calistar A, which is fixed posteriorly to the sacrospinous ligaments with a novel tissue-anchoring system (TAS) and anteriorly to the obturator internus muscles. Postoperative follow-ups were scheduled at 7 days and at 6, 12, and 24 months. RESULTS: Ninety-seven women were treated and assessed for the primary outcome. They were followed for up to 2 years (n=43), with a median of 12 months. Objective cure was achieved in 86 of the 97 patients (88.7%) (P<0.0005). The mean reduction in the ICIQ-VS scores was in the range of 70%-90% for every time point (P<0.05). No bleeding or surgical revision was reported. Mesh exposure occurred in 7 patients (7.2%), urinary retention in 5 (5.2%), de novo dyspareunia in 3 (3.1%), and urinary tract infections in 7 (7.2%). CONCLUSION: This midterm follow-up showed that apical and anterior vaginal reinforcement with a polypropylene implant fixed with a TAS provided good anatomical correction, with no major complications.

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BACKGROUND: The aim of this study was to evaluate the role of dynamic translabial ultrasound (TLUS) in the assessment of pelvic floor dysfunction and compare the results with echodefecography (EDF) combined with the endovaginal approach. METHODS: Consecutive female patients with pelvic floor dysfunction were eligible. Each patient was assessed with EDF combined with the endovaginal approach and TLUS. The diagnostic accuracy of the TLUS was evaluated using the results of EDF as the standard for comparison. RESULTS: A total of 42 women were included. Four sphincter defects were identified with both techniques, and EDF clearly showed if the defect was partial or total and additionally identified the pubovisceral muscle defect. There was substantial concordance regarding normal relaxation and anismus. Perfect concordance was found with rectocele and cystocele. The rectocele depth was measured with TLUS and quantified according to the EDF classification. Fair concordance was found for intussusception. There was no correlation between the displacement of the puborectal muscle at maximum straining on EDF with the displacement of the anorectal junction (ARJ), compared at rest with maximal straining on TLUS to determine perineal descent (PD). The mean ARJ displacement was similar in patients with normal and those with excessive PD on TLUS. CONCLUSIONS: Both modalities can be used as a method to assess pelvic floor dysfunction. The EDF using 3D anorectal and endovaginal approaches showed advantages in identification of the anal sphincters and pubodefects (partial or total). There was good correlation between the two techniques, and a TLUS rectocele classification based on size that corresponds to the established classification using EDF was established.

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Abstract Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6- 8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used,with or without the use of vaginalmeshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: 'anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)' in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score (> 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07-1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72-82,25]), longer surgery time (MD = 15,08 [0,48-29,67]), but less prolapse recurrence (OR = 0,22 [01,3-0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.

Resumo Introdução Prolapso de órgãos pélvicos é problema de saúde públicas, sendo o mais comumo anterior. Para tratamento são utilizadas cirurgias, comou semtelas. O uso de telas é para diminuir recidivas, mas não h á consenso. Métodos Foi realizada revisão da literatura e metanálise, sobre uso de telas na correção do prolapso anterior. Base de dados foi PUBMED , com termos (MESH): "Anterior Pelvic Organ OR Cystocele AND Surgery AND (Mesh or Colporrhaphy)". Critérios de exclusão foram: seguimento menor que 1 ano, telas biológicas ou absorvíveis. Resultados: foram avaliados 115 artigos. Após revisão dos títulos, 70 estudos foram descartados e 18 após leitura de resumos. Após critérios de Jadad (>2), 12 estudos foram incluídos. Análise estatística foi razão de risco ou diferença entre médias dos grupos, e as análises com grande heterogeneidade foram avaliadas através de análise de efeito aleatório. Resultados Cura objetiva foi superior no grupo com tela - OR 1,28 (1,07-1,53, p 1 0,00001), maior perda sanguínea - diferença média (MD) 45,98 (9,72-82,25, p = 0,01), tempo cirúrgico mais longo - MD 15,08 (0,48-29,67, p = 0,04), porém menor recorrência - OR 0,22 (0,13-0,38, p = 0,00001), não apresentando maior resolução dos sintomas - OR 1,93 (0,83-4,51, p = 0,15). Dispareunia e taxa de reoperação também não foram diferentes entre grupos. Qualidade de vida não apresentou diferença. Conclusões Cirurgia com tela para prolapso vaginal anterior apresenta melhor taxa de cura anatômica e menor recorrência, sem diferenças cura subjetiva, reoperação e qualidade de vida. Há maior tempo cirúrgico e perda sanguínea. Uso de telas deve ser individualizado.

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Introducción: la zona crítica de sostén apical de la fascia vesicovaginal es el anillo pericervical, el cual no existe en el caso de mujeres histerctomizadas. Por lo tanto, el análisis y el desarrollo de posibilidades terapéuticas para el cistocele con menores recidivas posteriores es un tema crítico en la cirugía uroginecológica. Objetivo: presentar una nueva técnica quirúrgica para el tratamiento del colpocele anterior. Material y método: se presentan los primeros diez casos de pacientes operadas con una nueva técnica quirúrgica en el tratamiento por vía vaginal del colpocele anterior. La técnica denominada CATO (C-colposuspensión, A-anterior, TO-transobturatriz) se basa en la reparación del defecto del colpocele anterior (sea este central, medial o pericervical) mediante tejido propio, el cual se fija a una neoestructura dada por el emplazamiento de una cinta de malla de prolene por vía obturatriz posterior. Resultados: no se registraron complicaciones intraoperatorias; hubo un hematoma vesicovaginal posoperatorio inmediato. En cuanto a los resultados funcionales, no se registraron disfunciones vesicales. En el seguimiento se destaca que todas las pacientes presentan puntos Aa y Ba normales. No se registran complicaciones de la malla utilizada. La técnica resulta segura, respeta la anatomía funcional y es reproducible para el ginecólogo vaginalista entrenado y con conocimiento del abordaje transobturatriz posterior. El seguimiento a largo plazo demostrará si esta nueva técnica desarrollada por nuestro equipo tiene un lugar que ocupar en el arsenal quirúrgico del tratamiento de la patología del piso pélvico.(AU)

Abstract Introduction: the critical area of apical support for the vesicovaginal fascia is the peri-cervical ring, which does not exist in women who have undergone hysterectomies. Thus, the analysis and development of new therapies for colpocele with smaller posterior relapse is critical for urogynecologic surgery. Objective: to present a new surgical technique for treatment of anterior colpocele Method: the study presents the first ten cases of women who were operated with a new surgical technique in treatment for anterior colpocele through the vagina. The technique under the name CATO (following the Spanish words: CATO (C-colposuspension, A-anterior, TO-transobturator) is based on repairing the anterior colpocele defect (central, medium or peri-cervical) using her own tissue, which is fixed to a new structure created by placing a mesh ribbon through a posterior transobturator. Results: no intraoperative complications were recorded; there was one case of immediate postoperative vesicovaginal hematoma. As to functional results, no vesical dysfunctions were recorded. Upon follow up, it is worth pointing out all patients show normal Aa and Bb stitches. Nos complications arose for the mesh used. The technique is safe, it respects functional anatomy and may be replicated by trained gynecologists who are familiar with the posterior transobturator approach. Long term follow up will reveal whether this new technique developed by our team may become part of the surgical toolkit for treating pelvic floor pathology.(AU)

Resumo Introdução: a zona crítica do suporte apical da fáscia vesicovaginal é o anel pericervical, que não existe nas mulheres histerectomizadas. Portanto, a análise e o desenvolvimento de possibilidades terapêuticas para o cistocele com menores recidivas posteriores é uma tema crítico na cirurgia uroginecológica. Objetivo: apresentar uma nova técnica cirúrgica para o tratamento do colpocele anterior. Material e método: apresentam-se os dez primeiros casos de pacientes operadas com uma nova técnica cirúrgica para tratamento por via vaginal da colpocele anterior. A técnica denominada CATO (Colpossuspensão, A-anterior, TO-transobturatoria) está baseada na reparação do defeito do colpocele anterior (seja central, medial ou pericervical) utilizando tecido próprio, que se fixa a uma neoestrutura dada pela colocação de uma tira de malla de prolene por via obturatriz posterior. Resultados: não foram registradas complicações intra-operatórias ou hematoma vesicovaginal pós-operatório imediato. Com relação aos resultados funcionais, não foram registradas disfunções vesicais. No seguimento se destaca que todas as pacientes apresentam pontos Aa e Ba normais. Não foram registradas complicações da malha utilizada. A técnica é segura, respeita a anatomia funcional e é reproduzível por ginecologista vaginalista treinado e com conhecimento da abordagem transobturatoria posterior. O seguimento em longo prazo demonstrará se esta nova técnica desenvolvida por nosso grupo de trabalho tem um lugar no arsenal cirúrgico no tratamento da patologia do piso pélvico.(AU)

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Introducción: la zona crítica de sostén apical de la fascia vesicovaginal es el anillo pericervical, el cual no existe en el caso de mujeres histerctomizadas. Por lo tanto, el análisis y el desarrollo de posibilidades terapéuticas para el cistocele con menores recidivas posteriores es un tema crítico en la cirugía uroginecológica. Objetivo: presentar una nueva técnica quirúrgica para el tratamiento del colpocele anterior. Material y método: se presentan los primeros diez casos de pacientes operadas con una nueva técnica quirúrgica en el tratamiento por vía vaginal del colpocele anterior. La técnica denominada CATO (C-colposuspensión, A-anterior, TO-transobturatriz) se basa en la reparación del defecto del colpocele anterior (sea este central, medial o pericervical) mediante tejido propio, el cual se fija a una neoestructura dada por el emplazamiento de una cinta de malla de prolene por vía obturatriz posterior. Resultados: no se registraron complicaciones intraoperatorias; hubo un hematoma vesicovaginal posoperatorio inmediato. En cuanto a los resultados funcionales, no se registraron disfunciones vesicales. En el seguimiento se destaca que todas las pacientes presentan puntos Aa y Ba normales. No se registran complicaciones de la malla utilizada. La técnica resulta segura, respeta la anatomía funcional y es reproducible para el ginecólogo vaginalista entrenado y con conocimiento del abordaje transobturatriz posterior. El seguimiento a largo plazo demostrará si esta nueva técnica desarrollada por nuestro equipo tiene un lugar que ocupar en el arsenal quirúrgico del tratamiento de la patología del piso pélvico.

Abstract Introduction: the critical area of apical support for the vesicovaginal fascia is the peri-cervical ring, which does not exist in women who have undergone hysterectomies. Thus, the analysis and development of new therapies for colpocele with smaller posterior relapse is critical for urogynecologic surgery. Objective: to present a new surgical technique for treatment of anterior colpocele Method: the study presents the first ten cases of women who were operated with a new surgical technique in treatment for anterior colpocele through the vagina. The technique under the name CATO (following the Spanish words: CATO (C-colposuspension, A-anterior, TO-transobturator) is based on repairing the anterior colpocele defect (central, medium or peri-cervical) using her own tissue, which is fixed to a new structure created by placing a mesh ribbon through a posterior transobturator. Results: no intraoperative complications were recorded; there was one case of immediate postoperative vesicovaginal hematoma. As to functional results, no vesical dysfunctions were recorded. Upon follow up, it is worth pointing out all patients show normal Aa and Bb stitches. Nos complications arose for the mesh used. The technique is safe, it respects functional anatomy and may be replicated by trained gynecologists who are familiar with the posterior transobturator approach. Long term follow up will reveal whether this new technique developed by our team may become part of the surgical toolkit for treating pelvic floor pathology.

Resumo Introdução: a zona crítica do suporte apical da fáscia vesicovaginal é o anel pericervical, que não existe nas mulheres histerectomizadas. Portanto, a análise e o desenvolvimento de possibilidades terapêuticas para o cistocele com menores recidivas posteriores é uma tema crítico na cirurgia uroginecológica. Objetivo: apresentar uma nova técnica cirúrgica para o tratamento do colpocele anterior. Material e método: apresentam-se os dez primeiros casos de pacientes operadas com uma nova técnica cirúrgica para tratamento por via vaginal da colpocele anterior. A técnica denominada CATO (Colpossuspensão, A-anterior, TO-transobturatoria) está baseada na reparação do defeito do colpocele anterior (seja central, medial ou pericervical) utilizando tecido próprio, que se fixa a uma neoestrutura dada pela colocação de uma tira de malla de prolene por via obturatriz posterior. Resultados: não foram registradas complicações intra-operatórias ou hematoma vesicovaginal pós-operatório imediato. Com relação aos resultados funcionais, não foram registradas disfunções vesicais. No seguimento se destaca que todas as pacientes apresentam pontos Aa e Ba normais. Não foram registradas complicações da malha utilizada. A técnica é segura, respeita a anatomia funcional e é reproduzível por ginecologista vaginalista treinado e com conhecimento da abordagem transobturatoria posterior. O seguimento em longo prazo demonstrará se esta nova técnica desenvolvida por nosso grupo de trabalho tem um lugar no arsenal cirúrgico no tratamento da patologia do piso pélvico.

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Introduction and Hypothesis To our knowledge a study regarding the efficacy of Pelvisoft® Biomesh for cystocele repair has not previously been reported in the literature. The aim of our study was to assess the long-term efficacy, subjective outcomes and complications in the use of a non-synthetic porcine skin mesh graft (Pelvisoft® Biomesh) associated with transvaginal anterior colporrhaphy in the treatment of cystocele prolapse. Materials and Methods A retrospective study was performed at a single centre. Thirty-three women aged 35-77 years underwent cystocele repair using Pelvisoft® graft between December 2005 and June 2009. Twenty-nine women who underwent transvaginal cystocele repair with Pelvisoft® Biomesh for over a 2 years period were assessed. Four patients were lost to follow-up. Cystocele repair was performed via the vaginal route using Pelvisoft®Biomesh implant by inserting it in the anterior vaginal wall. The median follow-up time was 54.0 months. The rate of recurrence was 17.3%. A total of 6.9% of patients presented early mesh exposure treated by conservative treatment. The mean PFDI-20 score was 72.2. Among sexually active women, the mean PISQ 12 was 33.9 but 56.2% had dyspareunia. After surgery, 6 patients had de novo intercourse. Our results show that the use of Pelvisoft® biomaterial associated with anterior colporrhaphy for cystocele repair appears to be safe with acceptable failure and complication rates at long term. Nevertheless, an adverse impact on sexual function was reported by the majority of patients. .

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Objetivo: describir la frecuencia de éxito, recidivas y complicaciones, en mujeres con prolapso genital del compartimiento anterior a quienes se les realizó intervención quirúrgica usando malla multianclaje macroporosa monofilamento. Metodología: estudio observacional de una cohorte de 71 mujeres con prolapso del compartimiento anterior e intervenidas en la Clínica Universitaria Bolivariana y a quienes se les realizó corrección quirúrgica con malla multianclaje durante el periodo de 2008-2011. Se realizaron dos evaluaciones postquirúrgicas cuantificando el prolapso por medio de la clasificación internacional POP-Q (Pelvic Organ Prolapse Quantification System) a los seis meses y al año de la cirugía. Resultados: se encontró mejoría del prolapso genital pasando del grado POP-Q III y IV prequirírgico al grado I postquirúrgico en 90,5 % de las pacientes; se encontró 2,9 % de recaída del prolapso grado IV. Nueve pacientes presentaron complicaciones tempranas. Se observó un porcentaje de recidiva de prolapso del compartimiento anterior a los seis meses del 4,2 % y de 9,9% al año de evaluación. Conclusión: encontramos disminución en el porcentaje de recidivas del prolapso de compartimento anterior en las pacientes a quienes se les corrigió con malla multianclaje. Se requieren estudios posteriores con diseños más exigentes. Por ahora podemos sugerir que hay una tendencia a un mejor resultado con el uso de la malla multianclaje para la corrección del prolapso del compartimiento anterior.

ABSTRACT Objective: to describe the success rate, complications and recurrences in women with genital prolapse of the anterior compartment who underwent surgery using macroporous monofilament mesh multianchorage. Methods: observational study of a cohort of 71 women with anterior compartment prolapse who were seized in the Clinica Universitaria Bolivariana and who underwent surgical repair with mesh multianchorage during the period 2008- 2011. Two postoperative assessments were performed by quantifying prolapse by the POP-Q International Classification (Pelvic Organ Prolapse Quantification System) at six months and one year after surgery. Results: an improvement was found genital prolapse POP-Q passing grade III and grade IV preoperative to grade I postoperative in 90.5% of patients; 2.9% of grade IV prolapse relapse was found. Nine patients had early complications. A recurrence rate of prolapse prior to six months of 4.2% and 9.9% to year evaluation was observed. Conclusions: We found decrease in the recurrence rate of anterior compartment prolapse in patients who were corrected mesh multianchorage. Subsequent studies are needed with better designs. Nowadays we can suggest that there is a trend to a better outcome with the use of mesh multianchorage correction of anterior compartment prolapse.

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Introduction and Hypothesis We evaluated the anatomical success and complications of Perigee® with porcine dermis Graft in the repair of anterior vaginal wall prolapse (AVWP) Materials and Methods After Institutional Review Board (IRB) approval, the charts of all patients who underwent AVWP repair using the Perigee/InteXen® kit from July 2005 to July 2009 were reviewed. Patients who had less than 6-month follow-up were excluded. Preoperative data including patient age, previous AVWP repairs, hysterectomy status, preoperative dyspareunia and pertinent physical findings were collected and recorded. Postoperative success was defined as anatomical stage 0 or I using the Pelvic Organ Prolapse Quantification (POP-Q) scoring system. Graft related complications were also recorded. Results Out of 89 patients, 69 completed at least 6-month follow-up. Median follow-up was 13 (6-48) months. Seventeen patients (25%) had previous AVWP repair and 32 (46%) had previous hysterectomy. Preoperatively, AVWP stage II was found in 9 (13%), stage III in 27 (39%) and stage IV in 33 (48%) patients. Anatomic success was found in 48 (69%) patients, with 23 (33%) having stage 0 and 25 (36%) stage I AVWP. Intraoperative complications included incidental cystotomy in one patient and bladder perforation in one. Postoperative complications included vaginal exposure and dyspareunia in one case, wound dehiscence in one and tenderness over the graft arm with dyspareunia in one. conclusions The use of porcine dermis in AVWP repair is safe with minimal graft related complications; however, anatomical success is lower than that reported with the use of synthetic grafts. .

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O prolapso genital constitui afecção de grande importância social e econômica dada sua prevalência estimada em até 40% das mulheres, cujo aumento gradual coincide com o envelhecimento populacional. Estima-se que 30% das pacientes submetidas ao tratamento cirúrgico já foram operadas previamente pelo mesmo motivo. Fatos como esses e outras situações conflitantes, como a escolha entre tratamento conservador ou cirúrgico, a melhor técnica operatória para tratar as alterações anatômicas e funcionais do assoalho pélvico e o uso ou não de uma grande complexidade de materiais sintéticos e biológicos, têm sido objeto de constante investigação. O presente estudo teve por objetivo realizar uma revisão sistemática da literatura em relação ao manejo das pacientes portadoras de prolapso genital, considerando as evidências atuais referentes à utilização dos pessários vaginais, ao papel da fisioterapia, à melhor abordagem cirúrgica, às indicações do uso de telas e a concomitância, na vigência do prolapso, do tratamento cirúrgico da incontinência urinária

The pelvic organ prolapse is an important social and economic problem with the estimated prevalence at up to 40% of women, increasing with the aging population. It is estimated that 30% of patients undergoing surgical treatment, have been operated previously for the same reason. Facts such as these and other situations of conflict as the choice between conservative or surgical treatment, the best surgical technique to treat the anatomical and functional changes of the pelvic floor and use or not of a great complexity of biological and synthetic materials, have been under constant investigation. This study aims to realize a systematical review regarding the management of patients with genital prolapse, considering the current evidence regarding the use of vaginal pessaries, the role of physiotherapy, the best surgical approach, the indications for the meshes use and the concomitant surgical treatment of urinary incontinence, in the presence of prolapse

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Objetivo: Describir la técnica quirúrgica y los resultados de la cura simultánea del cistocele e incontinencia urinariade esfuerzo (IUE) utilizando una monoprótesis de polipropileno monofilamento macroporosa, basado en el "Nazca TC POP Repair System". Material y Métodos: Estudio retrospectivo, descriptivo de tipo serie de casos. Se recolectaron los datos de 69 pacientes intervenidas en dos centros, uno público y otro privado, entre mayo 2007 y abril 2008 en Lima-Perú. Se recopilaron los datos de 56 pacientes hasta los tres meses post cirugía. Resultados: Las complicaciones más importantes fueron extrusión de malla en 4/69 (6%), recidiva del prolapso en 1/56 (2%), persistencia de la IUE 1/56 (2%, retención urinaria 11/69 (16%), infección urinaria en 16/69 (23%), infección de la cúpula en 9/69 (13%) y hematoma en 3/69 (4%). La curación del cistocele según el POP-Q a los tres meses fue de 53/56 (95%) y la satisfacción de las pacientes fue 96,42%. La cura subjetiva de la IUE fue: curada 48/56 (85,1%), mejorada 7/56 (12,5%) y no curada en 1/56 (1,78%). Conclusiones: El uso de esta monoprótesis puede significar un procedimiento seguro y eficaz para la corrección quirúrgica del cistocele y la IUE.

Objectives: To describe the technique for the simultaneous cure of cystocele and the stress urinary incontinence (SUI) using, polypropylene mesh, based on the "Nazca TC POP Repair System". Materials and methods: Retrospective, descriptive study, case series type. We included 69 patients, operated in two centres, a public and a private one, between May 2007 and April 2008 in Lima - Perú. We compiled the data of 56 patients until three months post surgery. Results: The most important complications were: mesh erosion 4/69 (5.7%), prolapse relapse 1/56 (1.7%), SUI persistence 1/56 (1.7%), urinary retention 11/69 (15.9%). We also had urinary tract infection 16/69 (23.18%), vaginal cupula infection 9/69 (13.04%) and hematoma 3/69 (4.34%). The cure rate with POP-Q system scores three months after surgery was 53/56 (94.64%) for cystocele and the patient satisfaction was 54/56 (96.42%). For SUI, the subjective efficacy for cure was 48/56 (85.71%), improvement in 7/56 (12.5%) and failure in 1/56 (1.78%). Conclusions: The use of monoprothesis can be an effective and sure procedure to repair the prolapse of anterior vaginal wall and SUI.

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