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Purpose: This study was undertaken to evaluate the use of pubovaginal sling for the treatment of female stress urinary incontinence in patients with intrinsic sphincteric deficiency and patients with urethral hypermobility.Materials and Methods: Sixty-two patients aging 22 to 73 years-old (mean = 49.6) with a median parity of 4.1 (range 0 -14) who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence from August/1999 to August/2002 were prospectively analyzed. Objective pre and postoperative urodynamic evaluation was performed in all cases. The patients were divided into 2 groups: thirty-nine patients (62.9%) with urethral hypermobility (Valsalva leak point pressure equal or superior to 60 cm of H 2 O) and twenty-three patients (37.1%) with intrinsic sphincteric insufficiency (Valsalva leak point pressure below 60 cm of H 2 O).Results: The average follow-up period was 24.8 months, ranging from 3 to 38 months. Three patients (4.8%) had detrusor overactivity before the operation, and 36 patients (58.1%) had voiding dysfunction before surgery. The postoperative objective cure rate was 88.7% for stress urinary incontinence. The study also showed that 32.2% of the patients had voiding dysfunction and 11.3% had detrusor overactivity. The mean hospital stay was 3.1 days (range 2 -4). No difference in the above parameters was noticed between patients with intrinsic sphincteric deficiency and those with urethral hypermobility.Conclusion: Construction of a pubovaginal sling is an effective technique for the relief of severe stress urinary incontinence, for both patients with urethral hipermobility and with intrinsic sphincteric deficiency, having a cure rate of 88.7%. The high frequency of postoperative voiding urgency was not related to the detrusor overactivity as evaluated by urodynamic studies.

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Objective: This study was undertaken to evaluate factors influencing the operative time and early complications of vaginal hysterectomy of a nonprolapsed uterus.Methods: This was a prospective, observational study, including 128 patients (mean age, 45.7 years) undergoing vaginal hysterectomy for benign conditions, except uterine prolapse. Main outcome measures were operative time, intraoperative complications (bleeding or lacerations), and conversion to laparotomy.Results: The median operative time was 60 minutes (range, 25-180 minutes) and the mean hospital stay was 36 hours (range, 24 -240 hours). A multivariate logistic regression showed that the operative time was significantly influenced by uterine weight (P <0.001) and adnexectomy (P ‫؍‬ 0.045). There were 10 (6.3%) intraoperative complications, of which 6 (4.7%) were with excessive bleeding, 3 (2.3%) bladder lacerations, and 1 (0.8%) rectal laceration. Two patients underwent conversion to laparotomy for nonfeasibility of the vaginal route and both had a uterine weight higher than 400 g. After multivariate analysis, only uterine weight influenced the occurrence of intraoperative complications (P ‫؍‬ 0.002).Conclusion: The uterine weight is an independent predictor of operative time and perioperative complications of vaginal hysterectomy for benign conditions in patients with a nonprolapsed uterus.

Objective Gonadotropin-releasing hormone analogues (GnRH-a) have been used preoperatively before hysteroscopic myomectomy to decrease the size and vascularization of the myomas, but evidence to support this practice is weak. Our objective was to analyze the use of GnRH-a in the reduction of submucous fibroid as a facilitator for surgical hysteroscopy from published clinical trials. Data sources Studies from electronic databases (Pubmed, Scielo, EMBASE, Scopus, PROSPERO), published between 1980 and December 2018. The keywords used were fibroid, GnRH analogue, submucous, histeroscopy, histeroscopic resection and their correspondents in Portuguese. Study selection The inclusion criteria were controlled trials that evaluated the GnRH-a treatment before hysteroscopic resection of submucous myomas. Four clinical trials were included in the meta-analysis. Data collection Two review authors extracted the data without modification of the original data, using the agreed form. We resolved discrepancies through discussion or, if required, we consulted a third person. Data synthesis The present meta-analysis included a total of 213 women and showed no statistically significant differences in the use of GnRH-a compared with the control group for complete resection of submucous myoma (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.80–1.11); operative time (mean difference [MD]: - 3.81; 95%CI : - 3.81–2.13); fluid absorption (MD: - 65.90; 95%CI: - 9.75–2.13); or complications (RR 0.92; 95%CI: 0.18–4.82). Conclusion The present review did not support the routine preoperative use of GnRH-a prior to hysteroscopic myomectomy. However, it is not possible to determine its inferiority when compared with the other methods due to the heterogeneity of existing studies and the small sample size.

IntroduçãoDesde o início do século passado, os procedimentos do tipo sling têm sido descritos no tratamento da incontinência urinária de esforço (IUE), sendo utilizada grande variedade de materiais, como: músculo piramidal, fáscia lata, músculo grácil e bulbocavernoso Apesar das várias modificações técnicas, a cirurgia de sling consiste na utilização de uma faixa posicionada inferiormente à uretra ou colo vesical e fixada superiormente na parede abdominal. Apresenta taxas de cura objetiva de 61 a 100% e de cura subjetiva de 73 a 93% no tratamento da IUE feminina 1 . As altas taxas de sucesso do sling suburetral no tratamento da IUE, associadas aos novos conceitos na fisiopatologia da IUE e ao desenvolvimento de técnicas menos invasivas com material sintético, têm ocasionado um ressurgimento do interesse pelo sling no tratamento da IUE feminina.A utilização de tecido não autólogo no sling pubovaginal tem como vantagens a diminuição do tempo operatório, a possibilidade de utilização de anestesia local, além de menor tempo de internação e convalescência das pacientes 1,3 . Dessa forma, existe grande interesse por materiais

Leiomyomas are a major source of morbidity and decrease in quality of life for women of reproductive age. Goserelin is a Gonadotrophin-releasing hormone agonist (GnRHa) which treats leiomyomas inducing a hypogonadotropic state. Adverse effects includes hot flushes and vaginal dryness. When choosing a treatment, its capability to improve the patient’s quality of life must be taken in consideration. The objective of this retrospective case series was to study the impact of Goserelin in the quality of life of women with leiomyomas and abnormal uterine bleeding refractory to hormonal contraceptives. In this study, twenty-three women with abnormal uterine bleeding due to leiomyoma who were treated with Goserelin at two tertiary public teaching hospitals from Brazil answered the UFS-QoL regarding their leiomyoma symptoms before and after using Goserelin and other questions regarding their experience with Goserelin. It is observed that the Symptom severity scale and the Health-related quality of life scale in all its 6 domains had an improvement in quality of live after the use of Goserelin. The UFS-QoL has 37 questions and there was an improvement in quality of life in all 37 questions. Most participants experienced hot flushes (78.2%). Amenorrhea was achieved in 82.9% of the participants. Fifteen (68.1%) participants experienced vaginal dryness. Therefore Goserelin is effective to improve quality of life of women with abnormal uterine bleeding due to leiomyomas, although, hot flushes and vaginal dryness are common adverse effects.

IntroduçãoA técnica de histerectomia vaginal, descrita por Heaney 1934, apresenta algumas vantagens em relação à via abdominal. A via vaginal proporciona uma menor manipulação de alças intestinais, um pós-operatório menos doloroso, além de um menor tempo de internação e convalescência. Outra vantagem é a possibilidade de correção pela mesma via das distopias genitais associadas . O tratamento deve ser individualizado, podendo ser realizado por via vaginal, abdominal ou laparoscópica.Relatamos o caso de uma paciente que apresentou essa complicação rara após histerectomia vaginal, cujo diagnóstico e tratamento adequados possibilitaram a completa remissão dos sintomas. Relato do casoPaciente com 47 anos, G5P3A2, e antecedentes de três cesarianas prévias e sem doenças associadas. No primeiro atendimento apresentava queixa de sangramento uterino anormal e anemia sem melhora com tratamento hormonal e suplementação de ferro. O exame clínico evidenciava um útero não prolapsado e aumentado de volume, além de uma boa mobilidade uterina, amplitude vaginal e arco púbico adequados. A ultra-sonografia mostrava útero miomatoso com volume estimado de 220 cm 3 , sem alterações nos anexos ou endométrio.