Uroginecología

Uroginecología

Jun 21, 2017, 12:37 PM
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    Sobre la Unidad

    Una mejor calidad de vida para la mujer

    La Unidad de Piso Pélvico está orientada a la prevención, diagnóstico y tratamiento de diversas patologías que afectan al área pélvica. Ésta está compuesta por un conjunto de estructuras óseas, ligamentosas y musculares responsables de la continencia de los órganos de la pelvis (vejiga, uretra, intestino delgado, recto, útero y vagina).

    Las enfermedades  y defectos de los que se hace cargo esta subespecialidad son:

    • Incontinencia urinaria.
    • Prolapso genital.
    • Incontinencia anal.
    • Dolor pelviano crónico.
    • Cistitis crónica.

    El equipo multidisciplinario de Clínica Santa María está compuesto por médicos de amplia experiencia en esta área de la medicina:

    • Ginecólogos.
    • Urólogos.
    • Cirujanos coloproctólogos.
    • Kinesiólogos.
    • Psicólogos.
    • Urodinamistas.

    Problemas comunes de la mujerproblemas_tipicos

    En la mayoría de los casos, la incontinencia urinaria y el prolapso genital son trastornos con alta incidencia en la población femenina post menopáusica.
    Actualmente, gracias a los adelantos de la medicina estas patologías son posibles de solucionar.

    Incontinencia urinaria: es la pérdida involuntaria de orina, situación que puede ocasionar un trastorno en el diario vivir. Esta enfermedad se puede presentar en la forma de escape de orina relacionado al esfuerzo (al toser, estornudar, reírse, levantar pesos, etc.) o en la forma de “urgencia”, es decir, pacientes que presentan el deseo súbito e imperioso de orinar al punto de no alcanzar a llegar a un baño.

    Prolapso genital: es la alteración del soporte del piso pélvico causado por distintos motivos, como  traumatismos en el parto, embarazos múltiples o partos dificultosos, cirugías de pelvis, obesidad, constipación crónica, debilitamientos de los tejidos de la vagina por motivos hereditarios o por la llegada de la menopausia, entre otros.

    Los principales síntomas de este mal son la sensación de peso o plenitud pelviana, sensación de dolor o tirón en el abdomen bajo, ingle y espalda baja, salida o palpación de una masa por la vagina, pérdida de orina o problemas de tránsito intestinal, ya sea constipación o incontinencia de gases y/o fecal. 

    Incontinencia Urinaria

    La incontinencia urinaria es la pérdida involuntaria de orina. Afecta hasta el 30% de las mujeres –con una mayor prevalencia sobre los 40 años–, que ven comprometida su calidad de vida. Se puede presentar de dos formas:

    Incontinencia de esfuerzo

    Se refiere al escape de orina al toser, estornudar, reírse o levantar pesos. Afecta principalmente a mujeres, ya que por lo general se debe al debilitamiento del piso pélvico, conjunto de músculos y ligamentos que sostienen en la posición adecuada a la vejiga, uretra, útero, vagina y recto, para su normal funcionamiento. Este tipo de incontinencia puede presentarse aislado o en combinación con otras afecciones del piso pelviano como el prolapso del útero, vejiga o recto.

    Causas

    • Estar en etapa postmenopáusica. Los tejidos pierden la tonicidad y elasticidad normales debido a la falta de hormonas.

    • Haber tenido partos vaginales múltiples (especialmente si se usaron fórceps).

    • Haber sido sometida a cirugías de la pelvis o parte inferior del abdomen.

    • Tener obesidad y/o tabaquismo.

    Incontinencia de urgencia 

    Diagnóstico

    Se realiza mediante una entrevista a la paciente, examen físico, ecotomografía, exámenes de orina y eventuales estudios urodinámicos para conocer la función y estado tanto de la vejiga como del tracto urinario.

    Tratamientos

    Depende del tipo de incontinencia que se diagnostique. Puede ser farmacológico (vía oral o intravesical), quirúrgico o una combinación de ambos. Además, estos tratamientos se pueden complementar con cambios de hábitos alimenticios y ejercicios de Kegel, que ayudan a fortalecer los músculos pélvicos.

    Cirugía

    El procedimiento para el tratamiento de la incontinencia de esfuerzo (Sling sub-uretral), consiste en una cinta de material sintético que se instala por vía transvaginal libre de tensión bajo la uretra media. Ésta funciona como un reemplazo a los soportes dañados que causan la pérdida de orina involuntaria.

    El proceso tiene una corta duración, se utiliza anestesia regional y, al ser mínimamente invasivo, permite una rápida recuperación, por lo que en la mayoría de los casos la paciente vuelve a su casa en 24 horas. Esta técnica quirúrgica ofrece sobre el 90% de probabilidades de éxito.

     

    Terapia de neuromodulación central

    Las mujeres con incontinencia urinaria de urgencia, pueden ser candidatas a un tratamiento a largo plazo con la nueva tecnología InterStim®. Este pequeño dispositivo proporciona impulsos eléctricos suaves que ayudan a restablecer la actividad nerviosa normal, lo cual le permite a la paciente orinar normalmente.

    Esta terapia, aprobada por la FDA, debe ser utilizada después de haber probado otros tratamientos sin obtener resultados positivos o si se presenta intolerancia a ellos.

    El sistema InterStim® incluye un:

    • Neuroestimulador implantable, similar a un marcapasos implantado debajo de la piel.
    • Electrodo (cable fino), que envía los impulsos eléctricos suaves a los nervios que controlan la vejiga.
    • Programador inalámbrico, que le permite ajustar el nivel de la estimulación.

    El procedimiento para implantar el electrodo y dispositivo (“marcapasos”) es ambulatorio y mínimamente invasivo. El neuroestimulador se coloca en la parte superior del glúteo justo por debajo de la piel de la paciente y se le entrega un controlador inalámbrico para detener, iniciar y ajustar su tratamiento fácilmente.

    La Unidad de Piso Pélvico de Clínica Santa María está conformada por ginecólogos y urólogos especializados quienes entregan un tratamiento integral para el prolapso e incontinencia urinaria.

    Diagnóstico y tratamiento

    El diagnóstico  de estas enfermedades se realiza mediante una entrevista al paciente y un examen físico, lo que generalmente da una idea bastante clara respecto a la magnitud y repercusión del problema. Lo habitual es que se afine el diagnóstico con algunos métodos de imágenes como la ecotomografía, exámenes de orina y la urodinamia (procedimiento sencillo e indoloro).

    Puede ser farmacológico, kinesiológico, quirúrgico o una combinación de éstos.

    En la actualidad, las técnicas quirúrgicas tienen excelente rendimiento, requieren de incisiones mínimas, periodos postoperatorios cortos y resultados inmediatos, con una rápida reincorporación a las actividades habituales de las pacientes.

    En el caso de la incontinencia urinaria lo más utilizado es la cirugía tiposling o malla, que consiste en una cinta que suspende la vejiga y que ofrece un 95% de probabilidades de éxito.

    Ubicación

    Centro Médico Pediátrico:
    Avenida Santa María 0506, piso 3° y 4°, Providencia.

    Teléfono
    +56 2 2913 0000