Relevancia clínica del estudio urodinámico en el tratamiento de la incontinencia urinaria oculta asociada al prolapso de órganos pélvicos

espanolEl objetivo general del presente estudio es evaluar la utilidad de la realizacion del estudio urodinamico como parte del protocolo preoperatorio del prolapso de organos pelvicos (POP). La inclusion de la urodinamia en el estudio del POP quirurgico es controvertida, y aunque la Sociedad Internacional de Continencia (ICS, por sus siglas en ingles) la recomienda, su valor diagnostico no esta completamente establecido 1 . Sin embargo, cuando se vaya a realizar un abordaje quirurgico conjunto del prolapso y la incontinencia, permitira definir no solo a las pacientes con incontinencia urinaria de esfuerzo, sino tambien a aquellas con incontinencia urinaria oculta ademas de la urgencia de novo , presente en algunos casos antes de los procedimientos quirurgicos y no consecuencia de estos. Material y metodos: Estudio de una cohorte retrospectiva de mujeres diagnosticadas de prolapso de organos pelvicos quirurgico. Independientemente de que en su historia clinica refiriesen sintomatologia de incontinencia urinaria de esfuerzo o no, se les realizo un estudio urodinamico con reduccion del prolapso mediante especulo desechable. Resultados: Se recogieron datos de un total de 94 mujeres, diagnosticandose 50 con incontinencia urinaria de esfuerzo y 7 con hiperactividad del detrusor (VH); 37 mujeres presentaban una urodinamia normal. La incontinencia urinaria de esfuerzo oculta se diagnostico en 26 mujeres (27,7%), asociando en todas ellas a la cirugia del prolapso una tecnica de correccion de incontinencia; tras la cirugia conjunta de ambos procesos solo 2 pacientes (7,7%) presentaron urgencia de novo. Conclusiones: La incontinencia urinaria de esfuerzo oculta con frecuencia se convierte en sintomatica despues de la correccion del prolapso. En el presente estudio, al realizar una urodinamia preoperatoriamente, a 26 (27,7%) de las 94 pacientes se las diagnostico de incontinencia urinaria oculta. A todas ellas se les corrigio la incontinencia en el mismo acto quirurgico que el del prolapso, y al haberse diagnosticado tratado preoperatoriamente las vejigas hiperactivas, solo hubo 2 casos de urgencia de novo posquirurgicas. Por tanto, si se van a corregir la incontinencia y el prolapso a la vez, el estudio urodinamico con reduccion de prolapso preoperatorio permite una mejor seleccion de las pacientes, con lo que disminuyen los efectos adversos asociados a la cirugia. EnglishClinical relevance of the urodynamic study during treatment of occult urinary incontinence associated with prolapse of pelvic organs The general aim of this study is to evaluate the usefulness of performing the urodynamic study as part of the pre-operative protocol for pelvic organ prolapse (POP). The inclusion of urodynamics in the surgical POP study is moot and although the International Continence Society (ICS) recommends this, its diagnostic value is not fully elucidated 1 . However, when combined prolapse and incontinence surgery is to be performed, this enables defining not only patients with stress urinary incontinence, but also those with occult urinary incontinence in addition to de novo emergency, present in some cases before surgery and not a consequence of them. Material and methods: Retrospective cohort study of women diagnosed with surgical prolapse of pelvic organs regardless of whether or not their clinical history refers symptoms of stress urinary incontinence. An urodynamic study with reduction of the prolapse by means of disposable speculum was performed on them.Material and methods: Retrospective cohort study of women diagnosed with surgical prolapse of pelvic organs regardless of whether or not their clinical history refers symptoms of stress urinary incontinence. An urodynamic study with reduction of the prolapse by means of disposable speculum was performed on them. Results: A total of 94 women were collated; 50 women were diagnosed with stress urinary incontinence, seven with overactive bladder (OAB) and 37 presented normal urodynamics. Occult stress urinary incontinence was diagnosed in 26 women (27.7%); all of them had an incontinence correction technique associated with the prolapse surgery. After combined surgery for both processes, only two patients (7.7%) presented de novo emergency. Conclusions: Occult stress urinary incontinence commonly presents symptoms after the prolapse is corrected. In this study, when performing urodynamics pre-operatively, 26 women (27.7%) of the 94 patients were diagnosed with occult urinary incontinence. All of them had the incontinence corrected during the same surgery as the prolapse, and because the hyperactive bladders were diagnosed and treated pre-operatively there were only two cases of postoperative de novo emergencies. Therefore, if the incontinence and prolapse are to be corrected at the same time, the urodynamic study with reduction of pre-operative prolapse enables a better selection of patients by reducing the adverse effects of surgery in this way. .