Complicaciones del tratamiento de incontinencia urinaria y prolapso de la pelvis

ResumenEste artículo tiene como objetivo proporcionar una visión general de las complicaciones asociadas al tratamiento quirúrgico por incontinencia urinaria y prolapso pélvico relacionado con el uso de mallas quirúrgicas. Asimismo, otro de sus objetivos es revisar la nueva clasificación de complicaciones relacionadas con la inserción de prótesis o injertos en la cirugía de piso pélvico femenino otorgada por la Asociación Uroginecológica Internacional (IUGA, por su sigla en inglés) / Sociedad de Continencia Internacional (ICS, por su sigla en inglés) y por las recientes notificaciones proporcionadas por la Administración de Medicamentos y Alimentación (FDA, por su sigla en inglés)

Recurrent urinary tract infections in healthy and nonpregnant women

AbstractRecurrent urinary tract infections (RUTI) are prevalent and pose significant clinical challenges. Although the term RUTI has long been vaguely defined, a consensus definition has emerged in recent years. The exact etiology behind RUTI remains under debate, with valid arguments for both ascending reinfections as well as persistent infection inside the bladder. These persistent infections exist in the form of quiescent intracellular reservoirs in the mouse model and may represent a novel concept to explain UTI recurrence in humans. Manageable risk factors such as behavioral patterns alongside nonmanageable risk factors including genetic susceptibility are growing fields of investigation. Acute UTI have been studied through two model bacterial strains: Escherichia coli UTI89 and CFT073. However, the clinical relevance to RUTI of these two strains has not been firmly established. Current treatment strategies for RUTI are limited and remain dominated by antibiotic usage despite variable efficacy. The majority of studies in humans have focused on younger groups of women with little information available about the postmenopausal population despite a heightened risk of RUTI in this age group

Missing Data Frequency and Correlates in Two Randomized Surgical Trials for Urinary Incontinence in Women

INTRODUCTION AND HYPOTHESIS: Missing data is frequently observed in clinical trials; high rates of missing data may jeopardize trial outcome validity. PURPOSE: We determined the rates of missing data over time, by type of data collected and compared demographic and clinical factors associated with missing data among women who participated in two large randomized clinical trials of surgery for stress urinary incontinence, the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) and the Trial of Midurethral Sling (TOMUS). METHODS: The proportions of subjects who attended and missed each follow-up visit were calculated. The chi-squared test, Fisher\u27s exact test and t test were used to compare women with and without missing data, as well as the completeness of the data for each component of the composite primary outcome. RESULTS: Data completeness for the primary outcome computation in the TOMUS trial (62.3%) was nearly double that in the SISTEr trial (35.7%). The follow-up visit attendance rate decreased over time. A higher proportion of subjects attended all follow-up visits in the TOMUS trial and overall there were fewer missing data for the period that included the primary outcome assessment at 12 months. The highest levels of complete data for the composite outcome variables were for the symptoms questionnaire (SISTEr 100 %, TOMUS 99.8%) and the urinary stress test (SISTEr 96.1%, TOMUS 96.7%). In both studies, the pad test was associated with the lowest levels of complete data (SISTEr 85.1%, TOMUS 88.3%) and approximately one in ten subjects had incomplete voiding diaries at the time of primary outcome assessment. Generally, in both studies, a higher proportion of younger subjects had missing data. This analysis lacked a patient perspective as to the reasons for missing data that could have provided additional information on subject burden, motivations for adherence and study design. In addition, we were unable to compare the effects of the different primary outcome assessment time-points in an identically designed trial. CONCLUSIONS: Missing visits and data increased with time. Questionnaire data and physical outcome data (urinary stress test) that could be assessed during a visit were least prone to missing data, whereas data for variables that required subject effort while away from the research team (pad test, voiding diary) were more likely to be missing. Older subjects were more likely to provide complete data

Recurrent urinary tract infection and estrogen shape the taxonomic ecology and function of the postmenopausal urogenital microbiome

Article describes how postmenopausal women are severely affected by recurrent urinary tract infection (rUTI). The authors perform shotgun metagenomics and advanced culture on urine from a controlled cohort of postmenopausal women to identify urogenital microbiome compositional and function changes linked to rUTI susceptibility

Complications of treatment of urinary incontinence and pelvic organ prolapse

This review aims to provide an overview of complications associated with surgical treatment for urinary incontinence and pelvic organ prolapse relating to synthetic mesh, as well as review the new International Urogynecologic Association (IUGA)/ International Continence Society (ICS) classification of complications for insertion of prosthesis or grafts in female pelvic floor surgery and the recent Food and Drug Administration (FDA) notifications