Search

RESUMEN Objetivos . Correlacionar la ecografía prequirúrgica de las masas anexiales aplicando los criterios IOTA y el diagnóstico anatomopatológico tras intervención quirúrgica. Valorar la utilidad de los marcadores tumorales bioquímicos. Método . Estudio observacional prospectivo en 102 pacientes con diagnóstico ecográfico de tumoración anexial, intervenidas quirúrgicamente entre enero 2017 y febrero 2020. El análisis estadístico se realizó con SPSS 17.0. Las variables categóricas se analizaron mediante pruebas de Fisher y chi-cuadrado, las variables cuantitativas mediante prueba t-student. La concordancia entre la valoración de la ecografía transvaginal mediante criterios IOTA y el resultado anatomopatológico, se estudió con el coeficiente de contingencia y el índice kappa. Resultados . Según criterios IOTA, se clasificó como benignas a 48% de las tumoraciones, como malignas 24,5%, y 27,5% resultaron no clasificables. La anatomía patológica confirmó que 68,1% de las benignas y 72,8% de las malignas fueron correctamente filiadas por la ecografía. La concordancia entre la ecografía transvaginal prequirúrgica y la anatomía patológica fue significativa, con coeficiente de contingencia 0,58, índice kappa 0,47, p

Background Sacrococcygeal teratoma is one of the most frequently prenatally diagnosed neoplasias. Obstetric ultrasound has a role in the diagnosis and management of these tumors during pregnancy. In this report, we describe a multidisciplinary approach in a case of a patient with sacrococcygeal teratomas and preterm delivery, as well as postnatal outcomes. Case presentation A 26-year-old Caucasian woman at 20.3 weeks of gestation with a normal gestational course and no relevant medical or surgical history was referred to our institution with a sacrococcygeal mass diagnosis. Magnetic resonance imaging confirmed the diagnosis of sacrococcygeal teratoma type I according to the Altman classification. Follow-up with ultrasound showed an increase in the size of the mass up to 190 × 150 mm, high Doppler flow, and severe polyhydramnios. At 35.1 weeks of gestation, the patient had premature rupture of membranes, and an emergency cesarean section was performed due to recurrent late decelerations detected by fetal heart rate monitoring. Afterward, surgery was performed successfully at 36 hours of life. Posterior controls revealed normal and healthy child growth. Conclusions This case report demonstrates the importance of a multidisciplinary approach to offer the best neonatal outcomes by performing early surgery, as well as the need for follow-up by ultrasound in order to minimize complications by assessing mass growth, Doppler flow, and amniotic fluid.

Introduction: Urinary incontinence affects over 200 million people worldwide [1]. Tension free vaginal tape is the standard surgical treatment for stress urinary incontinence. De novo urge urinary incontinence is a long-term complication of this treatment with a significant impact in the quality of life of these patients. Objective: The major aim of this study is to assess the correlation between perineal ultrasonography findings and the incidence of de novo urge urinary incontinence. Material and Methods: A prospective observational study was designed. Patients with stress urinary incontinence diagnosed by clinical and urodynamic findings submitted to a tension-free vaginal tape surgery were included. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and introital perineal ultrasound were performed before surgical intervention (I-STOP&copy). Clinical and ultrasound re-evaluation were executed six months after surgery. Stress urinary incontinence was defined according to the ICS-IUGA. Data were recorded using a Microsoft Access database and statistical analysis using SAS&copy. Results: Bladder thickness equal to or below 6 mm has a low positive predictive value (PPV, 0.55), but a negative predictive power (NPP) of 0.72. Following surgery, a slight increase in postvoid residue is observed. Considering demographic data, an increase of 5 points in body mass index (BMI) resulted in an odds ratio (OR) of 1.74 of presenting de novo urge urinary in continence. Conclusions: In patients submitted to a tension-free vaginal tape surgery, high BMI seems to be associated with a higher rate of de novo urge urinary incontinence. Preoperative bladder wall thickness below 6 mm seems predict absence of this complication.

The aim of this study was to transculturally adapt the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR) into Spanish and to validate the new version. We carried out a two-stage observational cross-sectional study: translation and back-translation, followed by a validation stage in which the final version was administered to 268 consecutive women (118 not sexually active [NSA] and 150 sexually active [SA]) older than 18 from an Urogynecology Unit. Besides PISQ-IR, women also completed the following questionnaires: Incontinence Severity Index (ISI); Female Sexual Function Index (FSFI); Pelvic Floor Distress Inventory (PFDI-20); and question #35 from the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ). Feasibility (percentage of valid cases), internal consistency (Cronbach’s alpha), and construct validity (structural, by factor analysis, and convergent validity by Spearman’s Rho) were evaluated. The sample was formed by 118 NSA and 150 SA women, with a mean age (SD) of 59.2 (11.5) years; mean body mass index (BMI) of 29.6 kg/m2 (5.6), and mean parity of 2.6 deliveries (1.2). PISQ-IR showed a high response rate (98.3% NSA and 94.7% SA), and elevated internal consistency (Cronbach’s alpha for NSA and SA of 0.79 and 0.91 respectively). Factor analysis confirmed the structure of the original questionnaire and the convergent validity showed moderate to strong correlation between PISQ-IR and the ISI, PFDI-20, and FSFI scores, in addition to item #35 of the EPIQ. The Spanish version of the PISQ-IR has adequate psychometric properties; therefore, it can be a useful tool for assessing sexual function in women with pelvic floor disorders.

The aims of this study are to study the surgical outcomes in patients with stress-predominant mixed urinary incontinence (MUI) treated with tension-free vaginal tape, and to evaluate the effect of concomitant anterior colpoplasty.A total of 134 women with MUI clinical and urodynamic were assessed at 6 months and annually (maximum 9 years) after surgery.As a whole, a complete healing of 49-51% at 3 years is observed, which hence could result in a tax drop of 36.8% at 5-9 years. Nevertheless, the rate of healing or improvement (subjective) is 73.7% at long term (5-9 years). There were no significant differences between the two techniques used: TVT vs TVT-Obturator. On the other hand, we have found significant differences between association of anterior colpoplasty and not (complete healing rate 34.6% vs 64.6%, p = 0.014), at 2 years of monitoring.MUI with cystocele presents better surgical results for two components of incontinence, with its physiopathogenic implications.

We report a case of genital donovanosis in a pregnant woman, whose diagnosis was difficult because of the low incidence of this disease in our country. Donovanosis or granuloma inguinale is a sexually transmitted infection that causes chronic genital painless ulceration. It is an endemic disease in tropical and subtropical countries. Due to the increase of immigration coming from these countries and sexual tourism in endemic countries, we are witnessing an increase in this infectious disease not very prevalent in our country until now.

After an ectopic pregnancy (EP) fertility decreases, mostly due to tubal factor. Hysterosalpingography (HSG) is the most cost-effective tool for tubal patency assessment.Objective. To evaluate the usefulness of a HSG after a medical treatment for an EP, in order to counsel women on the most appropriate way to conceive future pregnancies.Methods. Between 1998 and 2008, 144 patients were submitted to medical treatment for an EP and performed HSG 3 months after the event.Results. 72.2% of normal HSG, 18.8% with unilateral obstruction, 6.3% tubal patency with defect, and 2.8% bilateral obstruction.Conclusion. Routine HSG following medical treatment for an EP does not seem necessary, as it does not change the initial management in 97.2% of the cases, but might be considered in selected risk cases, permitting timely referral of patients to in vitro fertilization.

Objective: To determine the frequency of de novo urgency after tension-free vaginal tape (TVT) compared with the transobturator tape (TOT) procedure in women with stress urinary incontinence (SUI). Study design: Prospective study of all consecutive women with urodynamically confirmed SUI undergoing anti-incontinence surgery between January 2000 and January 2008. All procedures were performed by experienced urogynaecologists well trained in TVT and TOT surgery. Assessments were carried out at 1, 6, 12 and, 36 months after surgery. Results: The study population included 366 women (mean age 59.5 years), 243 in the TVT group and 123 in the TOT group. The groups were similar in terms of demographics, preoperative data, and cure rates. De novo urgency occurred in 13.4% of patients at 6 months after surgery, in 19.3% at 12 months, and in 22.1% at 36 months. De novo urgency was significantly more frequent in the TVT group than in the TOT group at 12 (22.2% vs 11.2%, P = 0.025), 24 (24.8% vs 12.3%, P = 0.033), and 36 (0% vs 24.7%, P = 0.034) months. Cure rates were similar in both groups. The final adjusted cure rate was 87.3% (319/366). Conclusion: Treatment of SUI using the TOT procedure was associated with a lower rate of de novo urgency.