gineco
ro
tehnici chirurgicale
Uroginecologie - tehnici chirurgicale
Up-to-date surgical guidelines for the treatment
of urinary incontinence and urogenital prolapse
G. Bumbu
1
, D. Riva
2
, A. Hofstetter
3
, C. Bumbu
4
, M. Berechet
5
1. Şef Clinică Urologie - Spitalul Clinic Judeţean Oradea, preşedinte Societatea
Română de Uroginecologie, vicepreşedinte - Asociaţia Română de Urologie,
România
2. Responsabile della U.O. di Ostetricia e Ginecologia dell’Ospedale S. Anna di
Como, Presodio di Cantù, Italia; Presidente - Associazione Italiana di Urologia
Ginecologica e del Pavimento Pelvico
3. Urologische Klinik der Universität München - Groβhadern, Deutschland
4. Clinica de Chirurgie, Cluj-Napoca, România
5. Clinica de Urologie - Spitalul Clinic Judeţean Oradea, România
In every day practice we meet patients often present different pelvic showed that up to 11,1% of the 80 year-
patients that require our help regarding floor disorders that complicate our old women may have an intervention for
various urinary disorders. Very therapeutic indications. Even if urogenital prolapse and incontinence
often, after completing urological symptoms like increased frequency, and up to 29% have re-interventions [1].
specific examinations, we took into urgency, nocturia, affect the lifestyle of In the United States of America, one
consideration cystitis or pseudo-cystitis these patients’, we followed the literature out of nine female patients requires
supported by an extra-bladder affection. protocol concerning the stress urinary anatomical pelvic disorder surgery and
We are referring to those patients that incontinence as a major symptom. The one out of four requires re-intervention,
follow the gynecologist-urologist circuit urinary incontinence combined with each year up to 15 - 20 billion dollars
often finished to the neurologists’ or urogenital prolapse represents a major being spent for this problem [2]. Based
even psychiatrists’. Also these female health problem. Olsen and the coworkers on these studies, Oradea urology clinic
conducted a screening in order to find
these medical conditions; our results
showed a higher prevalence (23%): from
327 female patients, 262 had urinary
disorders (increased frequency, urgency,
nocturia) often combined, 180th with
stress urinary incontinence and 70th
with pelvic floor disorders (cystocel,
rectocel, cystorectocel, vault prolapse,
uterine prolapse) also in various
associations.
According to Papa Petros’ integral
theory, all those urinary symptoms result
from an early urinary reflex activated
due to a lax vagina which doesn’t allow
the support of the bladder during filling.
It is well-known that the vagina does
not have its own strength due to its
structure, therefore being necessary
to sustain it with support elements:
pubouretheral ligaments, tendinous
arch of endopelvic fascia, uterosacral
and cardinal ligaments, together with
tendinous center. According to this
theory, the opening and closing of the
Figure 1. Central cystocel
bladder neck result from the action of
pag. 48 Vol. 4, Nr. 1 /februarie 2008
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