Complicaciones del uso del pesario con soporte y sin soporte en el prolapso genital completo
PDF

Palabras clave

Peasrios
Indicaciones
Tratamientos Conservadores del Organo
Polapso de organo Pélvico
Prolapso Uterino

Cómo citar

Espitia De La Hoz, F. J. (2015). Complicaciones del uso del pesario con soporte y sin soporte en el prolapso genital completo. Médicas UIS, 28(3), 309–315. https://doi.org/10.18273/revmed.v28n3-2015005

Resumen

RESUMEN
Introducción: La prevalencia del prolapso genital se ha incrementado; a menudo cursa de forma asintomática, se suele presentar con síntomas de un “bulto” vaginal. Las opciones de tratamiento incluyen ejercicios del suelo pélvico, manejo expectante, el uso de dispositivos mecánicos y corrección quirúrgica. Objetivo: Evaluar las complicaciones inmediatas y tardías del uso del pesario sin soporte y con soporte, en el manejo conservador del prolapso genital completo. Materiales y métodos: Estudio descriptivo, observacional, transversal y comparativo. Se revisaron 108 historias clínicas de las pacientes atendidas por prolapso genital completo y se evaluaron a las que se les manejó de forma conservadora con pesarios con soporte (Grupo A: 9) y sin soporte (Grupo B: 18). Los dos grupos se compararon tomando en cuenta el aumento de secreción vaginal, aparición de erosión y úlceras vaginales, impactación, fístulas, atipias citológicas, incarceración, hidronefrosis, infección vaginal y complicaciones intestinales. Resultados: Se analizaron 27 pacientes en total, 9 manejadas con pesarios con soporte y 18 con pesarios sin soporte. Hubo diferencia significativa en cuanto al aumento de secreción vaginal con menor secreción en uso del pesarios sin soporte (p =0,045). Se encontró diferencia en la aparición de erosión y úlceras vaginales (p < 0,05). Conclusiones: Hay diferencia significativa en cuanto al aumento de la secreción vaginal y la aparición de erosión y úlceras vaginales en el uso de pesarios sin soporte en comparación con el uso de pesarios con soporte. MÉD UIS. 2015;28(3):309-15.

Palabras clave: Pesarios. Indicaciones. Tratamientos Conservadores del Órgano. Prolapso de Órgano Pélvico. Prolapso Uterino.

ABSTRACT
Introduction: The prevalence of genital prolapse has increased; often it is asymptomatic, usually presents with symptoms of a vaginal “bulge”. Treatment options include pelvic floor exercises, expectant management, the use of mechanical devices and surgical correction.
Objectives: Evaluate the immediate and late complications of the use of pessary without support and with support in the conservative management of the entire genital prolapse. Materials and Methods: Descriptive, observational, transversal and comparative study. 108 medical records of patients treated by complete genital prolapse were reviewed and evaluated which were managed conservatively with pessaries supported (Group A: 9) and unsupported (Group B: 18). The two groups are compared taking into account the increased vaginal discharge, vaginal appearance of erosion and ulcers, impaction, fistulas, cytologic atypia, incarceration, hydronephrosis, vaginal infection and intestinal complications. Results: 27 patients were analyzed in total, 9 handled pessaries supported and 18 unsupported pessaries. There was significant difference in terms of vaginal discharge increasment with less secretion in unsupported use of pessaries (p = 0.045). A difference was found in the occurrence of erosion and vaginal ulcers (p < 0.05 ). Conclusions: There is a significant difference in terms of vaginal discharge increasment and occurrence of erosion and ulcers vaginal pessaries using unsupported compared with using supported pessaries. MÉD UIS. 2015;28(3):309-15.

https://doi.org/10.18273/revmed.v28n3-2015005
PDF

Referencias

ACOG practice bulletin. Pelvic organ prolapse. Obsstet Gynecol 2007;110(3):717-29.

Nygaard I, Bradley C, Brandt D; Women`s Health Initiative.Pelvic organ prolapse in older women: Prevalence and risk factors. Obstet Gynecol. 2004;104:489-97.

Echavarría LG. Fijación sacroespinosa en el manejo del prolapsode cúpula vaginal y hernia pélvica: diez años de experiencia(1992-2002). Rev Colomb Obstet Ginecol 2004;55:30-4.

Bump RC, mattiasson a, Bo K, Brubaker LP, DeLancey JO,Klarskov P et al. The standardization of terminology of femalepelvic organ prolapse and pelvic floor dysfunction. am J Obstet Gynecol 1996;175:10-7.

Espitia De La Hoz FJ. Factores de riesgo asociados con prolapsogenital femenino: estudio de asos y controles. Rev Urol Colomb. 2015;24(1):12-8.

Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernanA. Pelvic organ prolapse in the Women’s Health Initiative: Gravityand gravidity. Am J Obstet Gynecol. 2002;186:1160-6.

Clark AL, Gregory R, Smith VJ, Edwards R. Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 2003; 189: 1261-7.

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501-6.

Samuellson E C, Victor FT A, Tibblin G, Svardsudd K F. Signsof genital prolapsed in a Swedish population of women 20 to 59years of age and possible related factors. Am J Obstet Gynecol. 1999;180:229-305.

Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet 2007; 369: 1027-38.

Maher C, Feiner B, Baessler K, Schmid C. Surgical managementof pelvic organ prolapse in women. Cochrane Database Syst Rev.2013 (4):CD004014.

Elneil S. Complex pelvic floor failure and associated problems.Best Pract Res Clin Gastroenterol. 2009;23:555-73.

Bump RC, Norton PA: Datos epidemiológicos y evolución naturalde la disfunción del piso pelviano. Obstet Ginecol, 1998; 4:681.

Swift S. Current opinion on the classification and definition of genital tract prolapse. Curr Opin Obstet Gynecol 2002; 14: 503-7.

Mant J, Painter R, Vessey M. Epidemiology of genital prolapse:observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol 1997; 104: 579-85.

Klein MC, Gauthier RJ, Robbins JM, Kaczorowski J, Jorgensen SH,Franco ED, y cols. Relationship of episiotomy to perineal trauma and morbidity, sexual disfunction and pelvic floor relaxation. Am J Obstet Gynecol 1994; 171 (3): 591-9.

Bump RC, McClish DK. Cigarette smoking and urinary incontinence in woman. Am J Obstet Gynecol 1992; 167(5):1213-8.

Carley ME, Schaffer JI. Urinary incontinence and pelvic organ prolapse in women with marfan or Ehlers Danlos syndrome. Am J Obstet Gynecol 2000;182:1021-3.

Bradley C, Zimmerman M, Wang Q, et al. Vaginal descent and pelvic floor symptoms in postmenopausal women. A longitudinal study. Obstet Gynecol 2008; 111(5): 1148-53.

Kahn M, Breitkopf C, Valley M, et al. Pelvic organ support study (POSST) and bowel symptoms: straining at stool is associated with perineal and anterior vaginal descent in a general gynecology population. Am J Obstet Gynecol 2005; 192: 1516-22.

Baden WF, Walker T. Fundamentals, symptoms and classification. In: Baden WF, Walker T, editors. Surgical repair of vaginal defects. Philadelphia (PA): JB Lippincott; 1992.p 14.

Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic oragn prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175: 10-7.

Bernard T. Haylen & Dirk de Ridder, Robert M. Freeman, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010; 21: 5–26.

Vierhout ME, Stoutjesdijk J, Spruijt J. A comparison of preoperative and intraoperative evaluation of patients undergoing pelvic reconstructive surgery for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System. Int Urogynecol JPelvic Floor Dysfunct 2006; 17:46.

Peschers UM, Schaes GN, DeLancey JO, Schuessler B. Levator ani function before and after Childbirth. Br J Obstet Gynecol 1997; 104(9): 1004-8.

Diwan A, Rardin CR, Coolí N. Uterine preservation during surgery for uterovaginal prolapse: a review. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15(4): 286-92.

Christopher Maher , Kaven Baessler , Cathryn MA Glazener, Elisabeth J Adams , Suzanne Hagen. Surgical management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, Issue 2, 2009.

Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2007;(3): CD004014.

Trowbridge Er, fenner DE. Conservative management of pelvicorgan prolapse. Clin Obstet Gynecol 2005;48:668-81.

Oliver R, Thakar R, Sultan AH. The history and usage of the vaginal pessary: a review. Eur J Obstet Gynecol Reprod Biol. 2011;156:125-30.

Fernando RJ, Thakar R, Sultan, et al. Effect of vaginal pessaries on symptoms associated with organ prolapse. Obstet Gynecol 2006; 108(1):93-9.

Hanson LA, Schultz JA, Flood CG, et al. Vaginal pessaries in managing women with pelvis organ prolapse and urinary incontinente: patient characteristics and factors

contributing to su cess. Int Urogynecol J Pelvic Floor Dysfunct 2006;17(2):155-9.

Young JB, Selby PL, Peacock M, Brownjohn AM: Uterine prolapse and urinary tract obstruction. Br Med J 1984; 289: 41-2.

Atnip S, O’Dell K. Vaginal support pessaries: indications for use and fitting strategies. Urol Nurs 2012;32:114-24.

Lazarou K, Wang A, LaCombe J, et al. Pessary use in advanced pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2006;17(2): 160-4.

Gregoir W, Schulman CC, Chantrie M: Ureteric obstruction associated with uterine prolapse. Eur Urol 1976; 2: 29-33.

Gleason JL, et al. (2012). Pelvic organ prolapse. In JS Berek, ed., Berek and Novak’s Gynecology, 15th ed., pp. 906–939. Philadelphia: Lippincott Williams and Wilkins.

Bai SW, Yoon BS, Kwon JY, et al. Survey of the characteristics and satisfaction degree of the patients using a pessary. Int Urogynecol J Pelvic Floor Dysfunct 2005;16(3):182-6.

Alexander JL, Rustom R, Bone JM: Acute renal failure from complete uterine prolapse: role of polycystic kidney disease. Clin Nephrol 60: 143-145, 2003.

Lamers BH, Broekman BM, Milani AL. Pessary treatment for pelvic organprolapse and health-related quality of life: a review. Int Urogynecol J 2011;22:637-44.

Bash K. Review of vaginal pessaries. Obstet Gynecol Surv 2000;55:455-60.

Guidelines for the use of support pessaries in the management of pelvic organ prolapse. Adelaide: International Centre for Allied Health Evidence; 2012.

Brincat C, Kenton K, Pat Fitzgerald M, Brubaker L. Sexual Activity predicts continued pessary use. Am J Obstet Gynecol 2004;191(1):198-200.

Matsubara S, Ohki Y. Can a ring pessary have a lasting effect to reverse uterine prolapse even alter its renoval? J Obstet Gynecol Res. 2010;36:459-61.

Hagen S, Stark D, Maher C, Adams E. Conservative management of pelvic organ prolapsed in women. Cochrane Database Syst Rev 2006 Oct 18; (4): CD003882.

Clemons JL, Aguilar VC, Tillinghast TA, et al. Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol 2004; 190(4):1025-9.

Rousseau J, Fenton J, Mathieu G, Taleb M. Les cancers vaginaux primitives de lˇıadulte. A propos de 72 cas traités à la Fondation Curie de 1956 à 1968. Bull Cancer. 1977;64:429-42.

Picurelli L, Lopez-Olmos J, Sendra A, Tramoyeres A. Fistula vesicovaginal por cuerpo extra˜no en vagina. Actas Urol Esp. 1997;21:511-2.

Powers K, Grigorescu B, Lazarou G, Greston WM, Weber Th. Neglected pessary causing a rectovaginal fistula. A case report. J.Reprod Med. 2008;53:235-7.

Stephan WB, Zaaijhan J, du T. Retention of a vaginal ring pessary in a postmenopausal patient. SAMJ. 2007;97:552.

Atnip ShD. Uso de pesarios y tratamiento del prolapso de los órganos pélvicos, en Clínicas Obstétricas y Ginecológicas de Norteamérica. En: Schaffer JI, editor. Medicina pélvica y Cirugía reconstructiva en la mujer, 36. Saunders, 2010: Elsevier Masson;2009. p. 541-63.

Hughes D, Schaffer JI. Prolapso de órganos pélvicos. Tratamientono quirúrgico. En: WILLIAMS Ginecología, de Schorge, Schaffer, Halverson, Hoffman, Bradchaw y Cunningham. 1a ed. 2009, cap 24, p. 545-9.

Descargas

Los datos de descargas todavía no están disponibles.