Objectives: To evaluate the urodynamic changes when a severe cystocele is correct by a vaginal valve to identify occult urinary incontinence. Method: Prospective study in 70 women at the Urogynecology and Vaginal Surgery Unit, in Clínica Las Condes. Inclusion Criteria: Symptomatic cystocele degree III or IV. Exclusion criteria: antecedent of incontinence and/o genital prolapse surgery; presence of urinary incontinence symptoms. In all patients the urethra retroresistance pressure was measured by a non-multichannel urodynamic test with and without cystocele reduction by a vaginal Bresky valve. Additionally a cystometry was realized. Results: In all patients the URP was normal when the severe cystocele was not reduced. When the severe cystocele was reduced in 50 (71.4%) women the URP was altered. The cystometry identify asymptomatic overactive detrusor in 8 women. Occult urinary incontinence in the 50 women was: Type I in 1, type II in 27, type III in 1, type II+III in 21. Conclusion: When a severe cystocele is reduced by a vaginal valve, urodynamic changes can be detected and women with occult urinary incontinence may be identified. These women may express symptoms of urinary incontinence when a prolapse surgery is realized.

Objetivo: Evaluar los cambios urodinámicos al corregir el cistocele severo mediante una valva vaginal, para identificar incontinencia de orina oculta. Método: Estudio prospectivo de 70 mujeres ingresadas a la Unidad de Uroginecología y Cirugía Vaginal de Clínica Las Condes. Criterio de inclusión: Cistocele grado III o IV sintomático. Criterio de exclusión: antecedente de cirugía por incontinencia de orina y/o prolapso genital; presencia de incontinencia de orina clínica. A todas se les realizó medición de la presión de retroresistencia uretral, mediante urodinamia monocanal sin y con reducción del cistocele severo, por medio del reposicionamiento mecánico de la vejiga por una valva vaginal de Bresky. Además se realizó medición complementaria de cistometría. Resultado: Sin corrección del cistocele severo la presión de retro-resistencia uretral fue normal en las 70 pacientes. Al reducir el cistocele severo en 50 (71,4%) mujeres, se encontró alteración de la presión de retroresistencia uretral. La cistometría identificó detrusor hiperactivo asintomático en 8 mujeres. La incontinencia de orina oculta en las 50 mujeres fue: Tipo I en 1, tipo II en 27, tipo III en 1, tipo II+III en 21. Conclusión: Al realizar corrección del cistocele severo mediante valva vaginal, se pueden detectar cambios urodinámicos, que permiten identificar mujeres con incontinencia de orina oculta, que potencialmente pueden expresarla al realizar una restauración quirúrgica del prolapso.

Objectives: To review the effectiveness and security of the TVT-Secur system in the surgical treatment of stress urinary incontinence (SUI). Methods: Prospective analysis of 110 patients undergoing SUI surgical treatment in the Urogynecology and Vaginal Surgery Unit of Clínica Las Condes, between January 2007 and May 2008. The patients must have stress urinary incontinence over one year or more. They must not have history of a previous surgery for urinary incontinence or prolapse. They must not have mixed urinary incontinence or urge incontinence, only SUI demonstrated by clinical symptoms and non-multichannel urodynamic study. Results: Mean surgical time was 8 minutes (6 to 16 mi-nutes). The observational period was between 2 months (4 cases) and 19 months, mean 8 months. During the intraoperative time 2 cases of bladder perforation were registered. In the immediate postoperative time 2 cases of obstruction were observed. In 97 (88,2%) of the 110 patients some concomitant gynecological surgery was performed. In 105 (95,5%) of the 110 cases cure of the SUI was registered. In 4 (3,6%) cases improvement was observed and 1 (0,9%) case was a failure. In 2 (1,8%) patients de novo urge incontinence was registered. Conclusions: The TVT-Secur system corresponds to a third generation tape effective and safe in the surgical treatment of stress urinary incontinence. This technique has potential advantages when compared with the preceding operations. Only the long time follow-up and incorporation of new patients will allow to determine the permanence of these good results in the time.

Objetivo: Revisar la eficacia y seguridad del sistema TVT-Secur en el tratamiento quirúrgico de la incontinencia de orina de esfuerzo. Método: Análisis prospectivo de 110 mujeres ingresadas a la Unidad de Uroginecología y Cirugía Vaginal, de Clínica Las Condes, para corrección de la incontinencia de orina de esfuerzo, entre enero del 2007 y mayo del 2008. Debían tener incontinencia de orina por al menos un año y de carácter permanente. No debían tener antecedente de alguna cirugía para corrección de la incontinencia de orina de esfuerzo ni prolapso genital. No debían tener incontinencia mixta, ni urgeincontinencia, sólo incontinencia de orina de esfuerzo clínica y objetivada por urodinamia monocanal. Resultado: El tiempo operatorio del TVT-Secur fluctuó entre 6 y 16 minutos, media de 8 minutos. Se completó un período de observación entre 2 meses (4 casos) y 19 meses, con una media de 8 meses. Durante el período intraoperatorio se registraron 2 casos de perforación vesical. En el postoperatorio se reajustaron 2 cintas por subobstrucción, detectadas por síntomas y residuos post-miccionales vesicales altos. En 97 (88,2%) de las 110 pacientes se realizó concomitantemente alguna cirugía ginecológica. En 105 (95,5%) de los 110 casos se registró cura de la IOE, que se mantuvo durante el período de observación. En 4 (3,6%) casos se observó mejoría y en 1 (0,9%) falla. En 2 (1,8%) se registró la aparición de urgencia miccional de novo. Conclusiones: El TVT-Secur corresponde a una cinta de tercera generación, eficaz y segura en el tratamiento quirúrgico de la incontinencia de orina de esfuerzo. Se trata de una técnica con potenciales ventajas al compararla con las cirugías antecesoras. La mantención de los buenos resultados en el tiempo, deberá evaluarse con el seguimiento e incorporación de nuevas pacientes a través de los años a este protocolo de trabajo.

OBJECTIVE: The present work describes our experience in surgical correction of stress urinary incontinence, comparing both the TVT and the TVT-O techniques. METHOD: Between October 2001 and March 2004, 76 patients underwent the TVT procedure. Between January 2004 and January 2005, 98 surgical corrections of urinary incontinence were carried out using the TVT-O technique. RESULTS: Median operative time was 28 minutes for TVT and 7 minutes for TVT-O. Intraoperative complications for TVT occurred in 4 patients (6.6%): urinary bladder perforation in 3 patients (5%, p = 0.0228) and parietal peritoneum perforation in 1 case (1.6%). No intraoperative complications took place during TVT-O. Immediate postoperative complications: transient urinary retention in TVT, 2 cases (2.6%) and overcorrection in TVT-O (1%) which was readjusted within 24 hours. There were no late complications after TVT. There were 2 cases (2.04%) with late complications in TVT-O. TVT and TVT-O resulted in correction of incontinence in 100% of the patients. CONCLUSION: TVT and TVT-O are two effective techniques for the correction of stress urinary incontinence. TVT-O would seem to be a technique much easier to perform resulting in less intraoperative complications.

OBJECTIVES: To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transvaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% of patients, with a pursuit between 1 and 8 months. DISCUSSION: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.