RESUMO
OBJECTIVE: To evaluate long-term (5-10 years) outcomes of Minimally Invasive Surgical (MIS) kit insertion with Prolift® (non-absorbable) mesh compared to the use of Prolift M® (partially absorbable), for anterior vaginal wall prolapse repair. STUDY DESIGN: In this retrospective study we compared women undergoing MIS kit Prolift ® insertion (n=90) vs. Prolift M® insertion (n=79) for anterior vaginal wall prolapse repair between 2006 and 2012 at our Institution. A number of 169 women fulfilled the inclusion criteria and were included in the study. RESULTS: During the study period 128 women (76%) completed full follow-up; of them 58 (73%) following MIS kit Prolift® insertion, and 70 (88%) following MIS kit ProliftM® insertion. There was no signifi cant difference between the Prolift® and Prolift M® regarding parity (3.04 vs. 2.88, p=0.506), presence of hypertension (24.1% vs. 39.1%, p=0.088), diabetes mellitus (3.4% vs. 11.6%, p=0.109), or urinary stress incontinence (39.7% vs. 47.1%, p=0.475). All participants had been diagnosed with POP grade 3 or 4 before the procedure. No significant complications during the procedure or postoperative period were identified in the study groups. The follow-up period was at least five years in duration for both groups. Both groups were comparable according to questionnaires focused on function and satisfaction. CONCLUSION: Patients undergoing MIS kit Prolift® and Prolift M® insertion for anterior vaginal wall prolapse repair had comparable early and late postoperative outcomes. No differences in patient's function and satisfaction between the two groups were identified. According to our fi ndings, there is no superiority to either of the two studied mesh devices.
Assuntos
Implantes Absorvíveis , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Implantes Absorvíveis/efeitos adversos , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Diafragma da Pelve , Complicações Pós-Operatórias , Estudos Retrospectivos , Estatísticas não Paramétricas , Telas Cirúrgicas/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento , Prolapso Uterino/complicações , Prolapso Uterino/fisiopatologiaRESUMO
ABSTRACT Objective: To evaluate long-term (5-10 years) outcomes of Minimally Invasive Surgical (MIS) kit insertion with Prolift® (non-absorbable) mesh compared to the use of Prolift M® (partially absorbable), for anterior vaginal wall prolapse repair. Study design: In this retrospective study we compared women undergoing MIS kit Prolift® insertion (n=90) vs. Prolift M® insertion (n=79) for anterior vaginal wall prolapse repair between 2006 and 2012 at our Institution. A number of 169 women fulfilled the inclusion criteria and were included in the study. Results: During the study period 128 women (76%) completed full follow-up; of them 58 (73%) following MIS kit Prolift® insertion, and 70 (88%) following MIS kit ProliftM® insertion. There was no significant difference between the Prolift® and Prolift M® regarding parity (3.04 vs. 2.88, p=0.506), presence of hypertension (24.1% vs. 39.1%, p=0.088), diabetes mellitus (3.4% vs. 11.6%, p=0.109), or urinary stress incontinence (39.7% vs. 47.1%, p=0.475). All participants had been diagnosed with POP grade 3 or 4 before the procedure. No significant complications during the procedure or postoperative period were identified in the study groups. The follow-up period was at least five years in duration for both groups. Both groups were comparable according to questionnaires focused on function and satisfaction. Conclusion: Patients undergoing MIS kit Prolift® and Prolift M® insertion for anterior vaginal wall prolapse repair had comparable early and late postoperative outcomes. No differences in patient's function and satisfaction between the two groups were identified. According to our findings, there is no superiority to either of the two studied mesh devices.
Assuntos
Humanos , Feminino , Idoso , Telas Cirúrgicas/efeitos adversos , Prolapso Uterino/cirurgia , Implantes Absorvíveis/efeitos adversos , Complicações Pós-Operatórias , Inquéritos e Questionários , Estudos Retrospectivos , Seguimentos , Prolapso Uterino/complicações , Prolapso Uterino/fisiopatologia , Resultado do Tratamento , Satisfação do Paciente , Diafragma da Pelve , Estatísticas não Paramétricas , Pessoa de Meia-IdadeRESUMO
INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the correlations between the POP-Q Bp point and the perineal body (Pb) and genital hiatus (Gh) measurements and constipation, anal incontinence, severity of symptoms and quality of life. METHODS: The patients were distributed into two groups according to the posterior vaginal wall Bp point: one group with Bp ≤-1 (without posterior vaginal wall prolapse, control group) and the other group with Bp ≥0 (with posterior vaginal wall prolapse, case group). Demographic data, defecatory dysfunction and SF-36 scores were compared between the groups. Correlations between severity of posterior prolapse (Bp, Gh, Pb and Gh + Pb) and severity of bowel symptoms were also calculated. RESULTS: A total of 613 women were evaluated, of whom 174 were included, 69 (39.7%) in the control group and 105 (60.3%) in the case group. The groups were similar in terms of anal incontinence, fecal urgency and/or constipation. There was no correlation between the severity of constipation and anal incontinence according to the Wexner score, and the severity of posterior vaginal wall prolapse measured in terms of point Bp. There were, however, statistically significant differences in Pb, Gh and Gh + Pb between the groups. The Pb and Gh + Pb measurements were positively correlated with symptoms of constipation, as well as with the scores of some SF-36 domains, but were not correlated with anal incontinence. CONCLUSIONS: These results suggest that the severity of posterior vaginal wall prolapse is not correlated with constipation or anal incontinence, but Pb and Gh + Pb measurements are correlated with constipation and SF-36 scores.
Assuntos
Constipação Intestinal/fisiopatologia , Incontinência Fecal/fisiopatologia , Distúrbios do Assoalho Pélvico/fisiopatologia , Índice de Gravidade de Doença , Adulto , Constipação Intestinal/etiologia , Constipação Intestinal/patologia , Incontinência Fecal/etiologia , Incontinência Fecal/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve/patologia , Diafragma da Pelve/fisiopatologia , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/patologia , Períneo/patologia , Qualidade de Vida , Prolapso Uterino/complicações , Prolapso Uterino/patologia , Prolapso Uterino/fisiopatologia , Vagina/patologia , Vagina/fisiopatologiaRESUMO
Uterine prolapse associated with pregnancy is rare today. The case of a 34-year-old woman whose pregnancy ended at 39 weeks and analyzed with those reported in the literature is presented.
Assuntos
Complicações na Gravidez/fisiopatologia , Prolapso Uterino/etiologia , Adulto , Feminino , Humanos , Gravidez , Resultado da Gravidez , Prolapso Uterino/fisiopatologiaRESUMO
BACKGROUND/AIMS: To compare biomechanical properties of vaginal tissues between women with and without pelvic organ prolapse (POP) and investigate factors that may influence these properties. METHODS: Forty patients submitted to POP surgery and 15 non-POP cadavers were evaluated. The tissue was excised from anterior and posterior middle third vagina. The biomechanical properties considered were stiffness (E) and maximum stress (S), and they were evaluated by means of uniaxial tension tests. RESULTS: POP patients were associated with higher values of E (13.1 ± 0.8 vs. 9.5 ± 0.7 MPa; p < 0.001) and S (5.3 ± 0.5 vs. 3.2 ± 0.9 MPa; p < 0.001) in the anterior vaginal wall compared to the posterior wall. In contrast, non-POP women presented lower values of E (6.9 ± 1.1 vs. 10.5 ± 1.0 MPa; p = 0.01) and S (2.6 ± 0.4 vs. 3.5 ± 0.4 MPa; p = 0.043) in the anterior wall. The occurrence of POP was the only independent predictor of higher values of E and S in anterior vaginal samples (p = 0.003 and p = 0.008, respectively). Women with severe anterior vaginal prolapse presented higher levels of E and S in the anterior sample compared to those with lower POP stages (p = 0.001 and p = 0.01; respectively). CONCLUSION: Women with POP present significant changes of biomechanical properties in the vagina.
Assuntos
Elasticidade/fisiologia , Estresse Mecânico , Prolapso Uterino/fisiopatologia , Vagina/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Paridade , Prolapso de Órgão Pélvico/etiologia , Prolapso de Órgão Pélvico/fisiopatologia , Estudos Prospectivos , Prolapso Uterino/etiologia , Adulto JovemRESUMO
Objetivo: comparar la función sexual (FS) de mujeres con prolapso genital (PG) antes y después de su reparación quirúrgica. Métodos: investigación de tipo comparativa y aplicada, con diseño cuasi experimental, prospectivo y de campo, donde se evaluó la FS de mujeres con diagnóstico de PG antes y después del tratamiento quirúrgico con técnicas convencionales, mediante el Cuestionario Sexual para Prolapso genital e Incontinencia Urinaria versión corta (PISQ-12). Resultados: al comparar la FS antes y después de la cirugía reparadora del PG, se determinó que tanto la puntuación total del PISQ-12 (15,90 +/- 6,51 vs. 32,17 +/- 3,62) como las puntuaciones de las dimensiones respuesta sexual (5,87 +/- 2,80 vs. 10,97 +/- 2,80) y limitaciones sexuales femeninas (4,88 +/- 3,90 vs. 16,77 +/- 3,00) fueron significativamente más altas luego de la intervención quirúrgica (p<0,001), a excepción del indicador intensidad del orgasmo (0,80 +/- 0,71 vs. 0,87+/- 0,73; p= 0,722) y la dimensión limitaciones sexuales de la pareja (4,37 +/- 2,14 vs. 3,56 +/- 2,70; p=0,815) donde sus puntuaciones antes y después del tratamiento quirúrgico no fueron estadísticamente significativas (p>0,05). Conclusiones: Lls mujeres con PG presentan una pobre FS, la cirugía reparadora del PG por técnicas convencionales mejoró significativamente la FS de las pacientes con disfunción del piso pélvico, permitiéndoles obtener a estas mujeres una vida sexual más placentera, con mejoría de su calidad de vida.
Objective: to compare sexual function (SF) of women with genital prolapse (GP) before and after surgical repair. Methods: this is a comparative and applied research with quasi-experimental, prospective and field design, which evaluated the SF of women diagnosed with PG before and after surgical treatment with conventional techniques, by the short version of the Prolapse and Incontinence Sexual Questionnaire (PISQ-12). Results: when comparing the SF before and after surgical repair of GP, it was determined that both the total score of PIQS-12 (15.90 +/- 6.51 vs. 32.17 +/- 3.62) and the scores of the dimensions: sexual response (5.87 +/- 2.80 vs. 10.97 +/- 2.80) and female sexual limitations (4.88 +/- 3.90 vs. 16.77 +/- 3.00) were significantly higher after surgery (p<0.001), except the indicator: orgasm intensity (0.80 +/- 0.71 vs. 0.87 +/- 0.73, p = 0.722) and the dimension partner's sexual limitations (4.37 +/- 2,14 vs. 3.56 +/- 2.70, p=0.815) where their scores before and after surgery showed no statistically significant differences (p>0.05). Conclusions: women with GP exhibit a poor SF, surgical repair of GP by conventional techniques significantly improves the SF of patients with pelvic floor dysfunction, allowing these women get sexual life more pleasant, which will impact on improving their quality of life.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Comportamento Sexual , Prolapso Uterino/cirurgia , Qualidade de Vida , Inquéritos e Questionários , Estudos Prospectivos , Período Pós-Operatório , Prolapso Uterino/fisiopatologia , Prolapso Uterino/psicologia , Recuperação de Função Fisiológica , Resultado do TratamentoRESUMO
The decline in sex hormone levels that accompanies the menopause has substantial effects on the tissues of the urogenital system, leading to atrophic changes. These changes can have negative effects on sexual and urinary function. The authors evaluate the repercussion of hypoestrogenism and sexual steroids on some elements of the pelvic floor and lower urinary tract. They summarize their research work and review significant published papers. They emphasize the changes in urinary mucosae, periurethral vessels, muscular layer, connective tissue, gene expression, autonomic nervous system receptors, as well as the main clinical aspects involved.
Assuntos
Estrogênios/deficiência , Sistema Urinário/metabolismo , Urotélio/fisiologia , Envelhecimento/fisiologia , Animais , Atrofia , Colágeno/análise , Colágeno/efeitos dos fármacos , Ciclo-Oxigenase 1/genética , Terapia de Reposição de Estrogênios , Estrogênios/fisiologia , Estrogênios/uso terapêutico , Matriz Extracelular/metabolismo , Feminino , Expressão Gênica , Glicosaminoglicanos/metabolismo , Humanos , Ácido Hialurônico/metabolismo , Microcirculação/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Neovascularização Fisiológica/efeitos dos fármacos , Diafragma da Pelve/irrigação sanguínea , RNA Mensageiro/metabolismo , Receptores Muscarínicos/efeitos dos fármacos , Receptores Muscarínicos/fisiologia , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Incontinência Urinária/tratamento farmacológico , Incontinência Urinária/fisiopatologia , Sistema Urinário/irrigação sanguínea , Urotélio/efeitos dos fármacos , Prolapso Uterino/fisiopatologia , Vagina/metabolismo , Vagina/patologia , Fator A de Crescimento do Endotélio Vascular/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/genética , Fator A de Crescimento do Endotélio Vascular/metabolismo , Microglobulina beta-2/genéticaRESUMO
INTRODUCTION: Hypoestrogenism causes structural changes in the vaginal wall that can lead to sexual dysfunction. A reduction in vaginal wall thickness has been reported to occur after menopause, although without precise morphometry. AIM: To measure vaginal wall thickness in women with genital prolapse in normal and hypoestrogenic conditions and to correlate sexual dysfunction with vaginal wall thickness and estradiol levels. METHODS: Surgical vaginal specimens from 18 normoestrogenic and 13 postmenopausal women submitted to surgery for genital prolapse grades I and II were examined. Patients were evaluated for FSH, estradiol, prolactin, glycemia, and serum TSH levels. For histological analysis, samples were stained with Masson's trichrome and hematoxylin-eosin. Sexual function was assessed by the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). MAIN OUTCOME MEASURES: GRISS questionnaire, histological analysis, morphometric methods, Masson's trichrome. RESULTS: The vaginal wall was thicker in the postmenopausal than premenopausal group (2.72 +/- 0.72 mm and 2.16 +/- 0.43, P = 0.01, and 2.63 +/- 0.71 mm and 2.07 +/- 0.49 mm, P = 0.01, for the anterior and posterior walls, respectively). These thicknesses seem to be due to the muscular layer, which was also thicker in the postmenopausal group (1.54 +/- 0.44 and 1.09 +/- 0.3 mm, P = 0.02, and 1.45 +/- 0.47 and 1.07 +/- 0.44 mm, P = 0.03, for the anterior and posterior wall, respectively). The vaginal epithelium was thinner in the middle segment than in the proximal one in the posterior wall (0.17 +/- 0.07 mm, 0.15 +/- 0.05 mm, 0.24 +/- 0.09 mm, P = 0.02). There was no correlation between coital pain, vaginal wall thickness, and estradiol levels in either group. CONCLUSION: The vaginal wall is thicker after menopause in women with genital prolapse. In this study, vaginal thickness and estrogen levels were not related to sexual dysfunction.
Assuntos
Menopausa/fisiologia , Comportamento Sexual/fisiologia , Prolapso Uterino/fisiopatologia , Vagina/fisiopatologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Prolapso Uterino/complicações , Prolapso Uterino/etiologia , Vagina/patologiaRESUMO
El orígen del prolapso genital es multifactorial, actuando fundamentalmente en las estructuras del sostén pélvico. Las causas más frecuentes son la multiparidad, embarazos y partos con fetos macrosómicos, partos traumáticos, antecedente de cirugías previas del suelo pelviano y factores intrínsecos de la calidad de tejidos. Este daño tisular y en los ligamentos constituyen el orígen en la fisiopatología de la incontinencia urinaria, cistocele, rectocele e histerocele. Existen varias técnicas quirúrgicas para su reparación, sin embargo, los porcentajes de recidiva llegan hasta un 29 por ciento. Esto explica el por qué se está permanentemente investigando y realizando nuevos avances de refuerzo, como es el caso de la utilización de mallas protésicas, en que las estadísticas muestran un significativo beneficio y eficacia, que superan largamente a las otras técnicas cuando las indicaciones de uso son adecuadas. Al momento de elegir cuál utilizaremos, es importante el tamaño del poro y si es mono o multifilamento; ya que de estas características depende la potencial infección, biointegración y erosión de la vagina, como de órganos vecinos. La recidiva del cistocele reparado con malla polipropileno, macroporo monofilamento no supera el 3 por ciento, permitiendo asegurar que se trata de una técnica de mayor eficacia que las anteriores.
Assuntos
Humanos , Feminino , Telas Cirúrgicas/classificação , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Prolapso Uterino/fisiopatologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Fatores de Risco , Vagina/cirurgiaRESUMO
Our objective was to compare the amount of collagen in parametrium and vaginal apex between women with uterine prolapse at pre- and postmenopause, and in women without prolapse. The study included 22 premenopausal women without prolapse (group A), 10 premenopausal women with prolapse (group B), and 23 postmenopausal women with prolapse (group C) (total 55). Patients in group A underwent abdominal hysterectomy for uterine leiomyoma, and patients in groups B and C underwent vaginal hysterectomy. During the surgical procedure we obtained biopsies from the lateral parametrium and vaginal apex. The tissue was stained for histological analysis with picrosirius. We observed a lower amount of collagen in the parametrium of women with uterine prolapse, both in menacme and in postmenopause, than in the parametrium of women without prolapse. We observed no statistically significant difference in vaginal apex between the groups.
Assuntos
Colágeno/análise , Ligamentos/química , Prolapso Uterino/fisiopatologia , Vagina/química , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Prolapso Uterino/cirurgiaRESUMO
Raras se existentes, as análises estatísticas referentes as complicaçöes maiores e tardias das histerectomias totais - dispareunia, incontinência urinária, descenso da cúpula e prolapso vaginal - näo poderiam traduzir os resultados anatômo-topográficos - e por inferência funcionais e patológicos, ao par de uma concepçäo preditiva sobre a possível ocorrência destas patologias - que ocorrem ao nível da amputaçäo cérvico-vaginal e as conseqüentes repercussöes sobre as estruturas urogenitais remanescentes da regiäo. A cistografia fracionada demonstrou ser um método de imagem ideal para se estudar a altura do assoalho da bexiga e indiretamente da cúpula vaginal, a qualquer tempo ano pós-operatório da histerectomia, posto que ambas as estruturas permanecen em fixa continuidade. Ela reúne baixo custo, simplicidade, segurança, eficácia e fácil reprodutibilidade em centros médicos modestos. É efetiva e segura ferramenta para autocrítica dos procedimentos praticados pelos cirurgiöes e suas respectivas escolas, no particular. Para tanto foram estabelecidos três parâmetros - forma, posiçäo e altura - que interrelacionados sustentam o diagnóstico conclusivo. A fixaçäo da cúpula vaginal, nova variante técnica introduzida com o objetivo de fazer a profilaxia da ocorrência daquelas complicaçöes, realizada extra-peritonial e bilateralmente nos cotos intra-peritoniais dos ligamentos redondos, através dos espaços paramétricos e dos ligamentos largos abertos nos cursos da histerectomia, mantêm a mesma e o assoalho da bexiga - face a intrínseca continuidade de ambas - sempre elevados. Este procedimento é feito com a colocaçäo de um ponto em ambas extremidades laterais da cúpula vaginal, na altura do colo vesical e interessando os ligamentos cardial e útero-sacro, com um fio de lenta absorçäo medindo cinqüenta centímetros de comprimento. Subindo em seqüencia ele serve também para ligar a artéria uterina e ser fixado, finalmente, nos cotos dos ligamentos redondos. As análises estatísticas procedidas para a avaliaçäo de ambas as proposiçöes confirmam significativamente as afirmaçöes feitas de referência a cistografia fracionada e a técnica de fixaçäo da cúpula vaginal acima referidas.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Cistoscopia , Histerectomia Vaginal , Histerectomia/efeitos adversos , Complicações Pós-Operatórias , Bexiga Urinária , Útero/cirurgia , Vagina , Dispareunia/fisiopatologia , Incontinência Urinária/fisiopatologia , Prolapso Uterino/fisiopatologiaRESUMO
Clinical features of severe urogenital prolapse, were studied. Fifteen patients were included in a retrospective study between January 1990 and June 1995. The diagnosis of severe uterine prolapse (where the cervix precedes the inverted vaginal tube) was the sole inclusion criteria. Age, parity, hormonal stage, occupation, simptomatology, body mass index, and the results of histopathological examinations were evaluated. The mean age was 60 years, parity most frequently observed was more than three, 80% were postmenopausal, the body mass index was 23.5, all patients were housewifes, the symptomatology that was present in 100% of the patients was the sensation of an intravaginal foreign material. The surgical treatment performed was vaginal hysterectomy. The results of histopathological examinations were in the most inflammation. The parity and postclimaterium were the principal factors associated with the pathogenesis of uterine prolapse.
Assuntos
Prolapso Uterino , Idoso , Índice de Massa Corporal , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Tamanho do Órgão , Paridade , Pós-Menopausa , Estudos Retrospectivos , Prolapso Uterino/fisiopatologia , Prolapso Uterino/cirurgia , Útero/fisiopatologiaRESUMO
The objective of this work was to study two pudendal anal reflexes: Deep Pudendal Reflex (DPR) and classical Bulbocavernosus Reflex (BCR) in women with primary and recurrent genital prolapse to obtain support to the hypothesis of pelvic nerve damage in patients with pelvic floor disorders. 124 women were studied: 68 were normal; 38 with genital prolapse (GP); and 18 with recurrent GP. Clinical and electrophysiological studies were carried out. Delayed reflex responses were found in 44/56 of patients (79%). [27/38 in genital prolapse group (71%); 17/18 in recurrent GP group (94%)]. The evaluation of pelvic floor reflex responses are tests to be taken into account in the diagnosis and management of pelvic floor disorders.