An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction.

INTRODUCTION: The terminology for anorectal dysfunction in women has long been in need of a specific clinically-based Consensus Report. METHODS: This Report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted on Committee by experts in their fields to form a Joint IUGA/ICS Working Group on Female Anorectal Terminology. Appropriate core clinical categories and sub classifications were developed to give an alphanumeric coding to each definition. An extensive process of twenty rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS: A Terminology Report for anorectal dysfunction, encompassing over 130 separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific anorectal investigations and imaging (ultrasound, radiology and MRI) has been included whilst appropriate figures have been included to supplement and help clarify the text. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION: A consensus-based Terminology Report for female anorectal dysfunction terminology has been produced aimed at being a significant aid to clinical practice and a stimulus for research. Neurourol. Urodynam. 36:10-34, 2017. © 2016 Wiley Periodicals, Inc., and The International Urogynecological Association

Tasa de éxito subjetivo y objetivo en pacientes operados con cinta suburetral transobturatriz: ocho años de seguimiento

Indexación: Scopus; Scielo.Antecedentes: La Incontinencia Urinaria de Esfuerzo (IOE) representa el 50% de las incontinencias urinarias en la mujer, produciendo un gran impacto en su calidad de vida. Actualmente el TOT es una de las técnicas quirúrgicas más utilizadas para su tratamiento. Objetivos: Determinar la tasa de éxito objetiva y subjetiva de las pacientes operadas por IOE e incontinencia de orina mixta (IOM) mediante TOT, y determinar la tasa de complicaciones perioperatorias. Métodos: Se realizó un estudio retrospectivo de cohorte de 8 años de seguimiento, en el que se evaluó mediante anamnesis, examen físico y protocolos quirúrgicos la tasa de éxito objetivo y subjetivo del TOT. Resultados: La tasa de éxito objetivo y subjetivo fue 92% y 76% respectivamente. El 8,3% de las pacientes presentó alguna complicación y la tasa de exposición de malla fue de 1,2%. Conclusiones: El TOT es una excelente alternativa para el tratamiento de la IOE en el Hospital de Quilpué.http://ref.scielo.org/6tnxn

Desconforto do assoalho pélvico e via de parto em mulheres no puerpério remoto

TCC(graduação) - Universidade Federal de Santa Catarina. Araranguá. Fisioterapia.Introdução: Os desconfortos do assoalho pélvico (DAP) tem inúmeros fatores de risco associados ao seu desenvolvimento, incluindo gravidez e via de parto. Objetivo: Analisar a presença de DAP em primíparas no puerpério remoto conforme a via de parto. Métodos: Estudo transversal, cuja amostra foi composta por mulheres primíparas residentes no sul de Santa Catarina, Brasil, com idade igual ou superior à 18 anos que estivessem no puerpério remoto. As participantes preencheram uma ficha de caracterização da amostra e o Pelvic Floor Distress Inventory (PFDI-20) para avaliar a presença de sintomas de DAP. Esses dados foram coletados por meio de um sitio eletrônico e foram analisados de forma descritiva e inferencial, com nível de significância de 5%. Resultados: Participaram do estudo 242 mulheres, sendo 64,9% puérperas de parto cesáreo e 35,1% puérperas de parto vaginal. Quanto às características da amostra, as puérperas de parto cesáreo possuíam uma maior tendência ao sobrepeso do que puérperas de parto vaginal. Observou-se que 87,2% das mulheres possuem algum DAP, havendo diferença significativa apenas nos sintomas urinários, em que, 60% das puérperas de parto vaginal apresentaram algum tipo desse sintoma. Os sintomas de prolapso de órgão pélvico (8,2%); incontinência urinária de urgência (25,9%); incontinência urinária de esforço (28,8%) e perda de urina em pequenas quantidades (34,1%) foram maiores entre as puérperas de parto vaginal. Conclusão: Somente as puérperas de parto vaginal tiveram associação com sintomas de DAP

Sviluppo di una nuova procedura per la riparazione complessa dei difetti avanzati del pavimento pelvico con assistenza robotica

Il pavimento pelvico femminile è un’ unità funzionale complessa con molteplici funzioni che vanno oltre il semplice supporto degli organi pelvici. La disfunzione del pavimento pelvico generalmente coinvolgono la minzione, la defecazione e l’ attività sessuale peggiorando notevolmente la qualità di vita della donna. Il pavimento pelvico femminile è sottoposto a numerosi cambiamenti adattativi in relazione ai differenti momenti della vita e alle modificazioni endocrine della donna. La maggior parte delle manifestazioni cliniche di queste modificazioni nella donna, compaiono dopo la menopausa e durante l’ invecchiamento. Si stima che circa l’ 11% delle donne con prolasso degli organi pelvici (POP) o incontinenza urinaria necessitano, nel corso della vita, di una correzione chirurgica. Lo scopo di questo studio è quello di descrivere una nuova tecnica chirurgica di sospensione laterale per la riparazione del prolasso avanzato degli organi pelvici, con assistenza robotica, utilizzando una mesh e conservando l’ utero. Verrà valutata la praticabilità, l’ efficacia e l’ outcome a breve termine di questa nuova procedura. Abbiamo analizzato una serie di 20 pazienti con prolasso del compartimento anteriore e apicale di alto grado (grado III e IV), di età media 65 anni (range 48-75) che sono state sottoposte a questo nuovo tipo di intervento dal mese di settembre 2014 ai primi mesi del 2015. L’ utero e la vescica sono stati sospesi alla parete addominale seguendo il principio della riparazione “tension -free”, applicando una mesh (Ti-Loop del Prof. JB Dubuisson) parzialmente riassorbibile in sede extraperitoneale, con tecnica laparoscopica robot-assistita, con conseguente ricostituzione di un supporto anatomico. Gli outcome di interesse includono: tempi operatori, perdite ematiche, giorni di ricovero e regressione del prolasso. Il follow-up è stato descritto ad 1 e 6 mesi. Il successo chirurgico è stato definito in termini di praticabilità dell’ intervento e miglioramento significativo del prolasso di alto grado con bassa incidenza di complicanze post-operatorie. La procedura robotica è stata completata con successo in tutte le pazienti. L’ outcome operatorio è risultato caratterizzato da breve ricovero ospedaliero e perdite ematiche, dolore postoperatorio e complicanze quasi assenti. Il follow-up a breve termine ha mostrato che questa nuova tecnica robotica di sospensione laterale con mesh per il trattamento dei prolassi complessi è sicura, ben tollerata ed efficace così da proporsi come una efficace alternativa ai canonici approcci addominale, vaginale o laparoscopico. Attualmente è plausibile pensare che la tecnica robotica possa diventare in futuro la metodica superiore di approccio per il trattamento del prolasso complesso, di alto grado, degli organi pelvici

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I

Objective To compare the use of polypropylene mesh (PM) and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP) using objective and subjective tests and evaluation of quality of life (QoL). Materials and Methods One hundred women were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a PM implant and the control group (n = 55) was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System) and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire - Vaginal Symptoms). Complications related to the use of PM or not were also described. Results There was a significant difference between all POP-Q measures of pre- and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. Conclusion The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups.Federal University of Sao Carlos Department of MedicineHealth Secretary of Jau Ambulatory of UrogynecologyFederal University of São Paulo Department of Urogynecology and Pelvic Surgery, Department of GynecologyUNIFESP, Department of Urogynecology and Pelvic Surgery, Department of GynecologySciEL

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction

There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report.This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper.A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible.A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research

МРТ-диагностика осложнений, связанных с мочеполовыми протезами

ПРОЛАПС ТАЗОВЫХ ОРГАНОВЦИСТОЦЕЛЕ /ХИРНЕДЕРЖАНИЕ МОЧИ СТРЕССОВОЕ /ХИРНЕДЕРЖАНИЕ МОЧИ НЕВРОГЕННОЕ /ХИРМОЧЕПОЛОВОЙ СИСТЕМЫ ХИРУРГИЧЕСКИЕ ОПЕРАЦИИУРОГЕНИТАЛЬНЫЕ ХИРУРГИЧЕСКИЕ ОПЕРАЦИИХИРУРГИЯ УРОГЕНИТАЛЬНАЯПРОТЕЗЫ И ИМПЛАНТАТЫ /ИСПМОЧЕВОЙ СФИНКТЕР ИСКУССТВЕННЫЙ /ИСПГЕНИТОУРИНАРНЫЙ СФИНКТЕР ИСКУССТВЕННЫЙ /ИСПСИНТЕТИЧЕСКИЕ ПРОТЕЗЫПОСЛЕОПЕРАЦИОННЫЕ ОСЛОЖНЕНИЯ /ДИАГНМАГНИТНОГО РЕЗОНАНСА ИЗОБРАЖЕНИЕМР-ТОМОГРАФИЯТОМОГРАФИЯ ПРОТОННАЯ СПИНОВАЯТОМОГРАФИЯ, ЯМРЯМР-ИЗОБРАЖЕНИЕЦель – провести анализ данных об информативности и целесообразности контрольных МРТ-исследований пациенткам, перенесшим операции по восстановлению положения тазовых органов. Материал и методы. Данные МРТ-обследований 29 пациенток, перенесших операции по восстановлению положения мочевого пузыря и уретры с использованием сетчатых протезов. Проведено обследование, включавшее гинекологический осмотр, анализы крови и мочи, урофлуометрию, МРТ таза, уретроцистоскопию. Результаты. У 11 (37,9%) из 29 пациенток в сроки от 1 до 2 лет после операций, корригировавших цистоцеле и стрессовое недержание мочи (СНМ) с использованием синтетических сетчатых протезов, с впервые возникшими жалобами на боли и рези при мочеиспускании, учащенное мочеиспускание, терминальную гематурию (до операции данных жалоб не было), на МР-томограммах зафиксированы характерные для осложнений признаки: выявлен субстрат, приводящий к развитию гиперактивности мочевого пузыря (ГМП), что послужило основанием для хирургического лечения. У остальных 18 (62,1%) пациенток также с признаками ГМП по данным МРТ признаков осложнений, связанных с мочеполовыми протезами, не получено. При оценке состояния и положения органов таза существенных отклонений от нормы не выявлено. Заключение. МРТ позволила документально подтвердить факт наличия осложнения и в 100% случаев определить его вид, что позволило в 37,9% случаев поменять тактику ведения пациенток с консервативного лечения на оперативное, а также выбрать адекватный хирургический метод коррекции развившегося осложнения.Objectives. To analyze the data on the information content and the feasibility of control MRT studies in female patients who have undergone surgery to restore the position of their pelvic organs. Material and methods. MRT data of 29 female patients who have undergone surgery for restoring the position of the bladder and urethra with the use of mesh prostheses served as the material for this study. The examination included a gynecological checkup, blood and urine tests, urofluometry, pelvic MRT, urethrocystoscopy. Results. In 11 (37.9%) of 29 female patients, in the time from 1 to 2 years after surgical interventions, correcting cystocele and stress incontinence (SI) by means of synthetic mesh prostheses, with the first complaints of pain and gripes during urination, frequent urination, terminal hematuria (before surgery there were no complaints of this kind), MRT tomograms showed signs characteristic of complications: a substrate was revealed that led to the development of hyperactivity of the bladder, which served as the basis for surgical treatment. The remaining 18 (62.1%) patients also with the signs of bladder hyperactivity according to MRT data showed no manifestations of complications associated with genitourinary prostheses; there were no significant deviations from the norm when assessing the condition and position of the pelvic organs. Conclusions. MRT made it possible to document the fact of the presence of complication and in 100% of cases to determine its type, which allowed in 37.9% of cases to change the method of management of patients from conservative treatment to the surgical one, as well as to choose an adequate surgical modality for correcting the developed complication

Variations in the reporting of outcomes used in systematic reviews of treatment effectiveness research in bladder pain syndrome

Abstract not availableSeema A. Tirlapur, Richeal Ni Riordain, Khalid S. Khan on behalf of the EBM-CONNECT Collaboratio