The treatment currently employed for endometriosis is essentially surgical. In the light of recent advances in surgical techniques, it is likely to remain the treatment of choice for some years to come.
No, the menopause is determined by a reduction in the hormonal secretion of the ovaries. If there is no ovarian pathology, the ovaries remain intact during hysterectomy, and since they have not been removed they continue to produce hormones. Menstruation disappears, but the patient who still has ovaries will not experience the symptoms that often accompany the menopause.
This is when, during the course of a surgical intervention, the ovaries are removed before the beginning of the menopause. This will indeed involve hormonal changes. It is as if the body undergoes a sudden menopausal change rather than a gradual process over several years, which is what occurs normally.
With the appropriate surgical techniques there is no modification of the structures comprising the ligaments, muscles and fascia, which are those responsible for keeping the pelvic organs in place (bladder, uterus, rectum, intestines). Furthermore, if any structural defects are found in this area, specific surgical techniques are employed together with the hysterectomy or with the uterus removal in order to correct problems involving the pelvic support system.
Surgical treatment is normally required for stress urinary incontinence associated with physical exercise, coughing, sneezing, laughing or effort. The remaining types of incontinence are usually treated with medication.
This depends on the type of hysterectomy and the procedure employed. Whether total or supracervical, hysterectomy by laparoscopy requires a general anaesthetic, but is not always necessary for vaginal hysterectomy.
Rarely. At present, 90% of all hysterectomies are performed by laparoscopy or transvaginally, and there are surgical teams fully prepared for obtaining good results with these techniques.
Yes, tightness can be restored. Surgical techniques for vaginal rejuvenation using laser reduce the diameter of the vagina and improve the quality of intercourse.
The uterine cervix is not always removed. The upper part of the uterus is removed in a supracervical hysterectomy, while the cervix is left intact. The uterine cervix forms part of the support for the ligaments of the pelvis, and therefore it is better to leave it intact whenever possible.
Current laparoscopic techniques using minimally invasive surgery allow exeresis of myomas while maintaing the uterus intact, as well as providing quick post-operative recovery and a speedy return to normal everyday activity.
Colposcopy is the examination of the uterine cervix through a magnifying lens by means of a colposcope, which is usually equipped with a surgical light and graduated lenses that can be adapted to a camera, a video device and a monitor for the recording or viewing of enlarged images of the examined area.
No preparation is required, although the patient is recommended to take the examination when she is not menstruating. The patient reclines in the gynecological position and the vagina is opened with a speculum to facilitate examination of the uterine cervix.
Once the uterine cervix is exposed, it is viewed directly through the colposcope according to the enlarged image required. Any vaginal fluid can be absorbed with a gauze or swab and is later cleaned with diluted acetic acid, which in addition to effectively cleaning away the fluid and cellular material also highlights any cells of the uterine cervix that may present abnormalities.
Once these areas have been identified, the uterine cervix can be stained with a lugol solution known as Schiller's test, which is rich in iodine. Under the effects of female hormones, the normal uterine cervix cells contain glucogen, which stains with iodine. Thus its dark brown colour cannot be seen in a woman who still has periods, except for those areas where there are epithelial lesions. The examination lasts from 4 to 10 minutes and requires a careful exploration of each of the areas of the uterine cervix.
The examination can be performed on any women undergoing a gynecological check-up for the first time. It can also be carried out on those women whose cervical cytology reveals any change in the cells of the uterine cervix.
It is not necessary to repeat the colposcopy every year that the patient has a gynecological check-up, although it should be performed during examinations for any untreated or suspected lesion.
Involuntary urine loss is never considered normal. There are various risk factors associated with stress urinary incontinence (SUI). Careful epidemiological trials have shown that middle-aged women are at greater risk from stress urinary incontinence (SUI). Symptoms fluctuate with time, but when lower urinary tract (LUT) anomalies persist, they require the appropriate study and treatment.
Age-associated changes in the bladder and structures of the pelvic floor contribute to the worsening of stress urinary incontinence (SUI). Furthermore, the menopause and lack of esterogen, together with other medical problems associated with aging, such as diabetes and dementia, can also cause stress urinary incontinence (SUI).
This consists of the involuntary loss of urine due to effort, exercise, sneezing or coughing. Incontinence occurs when pressure inside the urethra is greater than that in the bladder. The underlying cause may reside in the hypermobility of the neck of the bladder and the urethra because it lacks extrinsic support (vagina and pelvic floor). Stress urinary incontinence (SUI) may also be due to an intrinsic defect of the urethral sphincter as a result of neuromuscular problems.
Some research has shown that there is a correlation between excess weight, body mass index and stress urinary incontinence (SUI). The excess weight of an obese patient is transmitted to the structure of the pelvic floor, which becomes distended. The muscles and conjunctive tissue become weakened. As as result, the neck of the bladder or the urethra undergo hypermobility, which leads to urine loss during intrabdominal pressure increase.
It is very important to be careful about what one eats and drinks. An excessive intake of liquids is to be avoided, since it only aggravates the symptoms. However, a radical reduction of liquid intake is not recommended either, because the bladder is sensitive to low volumes of liquid. It is advisable to drink between 1.5 to 2 litres a day. Constipation also predisposes to stress urinary incontinence (SUI) and should therefore be avoided. A healthy, well-balanced diet and sometimes the ingestion of laxatives can assist in curing constipation.
The prevalence of stress urinary incontinence (SUI) is greater in young female athletes than in those women who do normal physical exercise. Physical activities that raise abdominal pressure may lead to episodes of stress urinary incontinence (SUI). Nevertheless, some physical exercise is necessary for general health and therefore stress urinary incontinence should not restrict all physical activity.
No direct correlation between smoking and urinary incontinence (UI) has been clearly established. Nevertheless, smoking involves a high risk of pulmonary and cardiovascular diseases, which irreversibly increase abdominal pressure, and in turn raise the risk of urinary incontinence (UI) symptoms.
Most of the causes of stress urinary incontinence (SUI) are not related to genetic predisposition, except for muscular dystrophy, which is rare. However, some predispositional or decompensating factors (such as obesity, diabetes mellitus, dementia) may tend to run in the family, and thus various members of the same family may suffer from stress urinary incontinence (SUI).
This is very common in pregnant women due to the growth of the uterus and the size it may reach, with the subsequent pressure on the bladder. Stress urinary incontinence (SUI) often recedes after pregnancy, but may persist after childbirth and at some times later. Childbirth involves considerable exertion of the pelvic floor and the lower urinary tract, and any damage to these structures can cause stress urinary incontinence (SUI).
It strengthens the muscles of the pelvic floor and increases support to the urethra and vesical wall, which can help to avoid stress urinary incontinence (SUI), although this still remains to be demonstrated.
The guidelines for pelvic floor muscle training (PFMT) should be adapted to each patient in accordance with the condition of her muscles. The main drawback is that the patient frequently starts off by doing the exercises regularly and then gradually becomes less disciplined. For this reason, pelvic floor muscle training (PFMT) should be kept up regularly for an indefinite period of time.
Research into the causes of stress urinary incontinence (SUI) still needs to be done. In many cases we have conservative measures for treating stress urinary incontinence (SUI) before considering surgery. Conservative treatment is based on modifications to lifestyle habits. Furthermore, pharmacotherapy may be tried before recourse to surgery.
