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Vesicovaginal fistula is an abnormal communication between the bladder and vagina and represents the most frequent type of fistula in the urinary tract. The most common cause in Brazil is iatrogenic fistula, secondary to histerectomia. Classically these women present continuous urinary leakage from the vagina and absence of micturition, with strong negative impact on their quality of life. We present a case of totally continent vesicovaginal fistula, with a follow-up of 11 years with no complications.

Revisión de literatura cuyo objetivo fue identificar las asociaciones entre la incontinencia urinaria en las mujeres y los aspectos raciales. Se utilizaron las bases de datos MEDLINE y LILACS para investigar los artículos publicados en los años 2003 a 2010. Se analizaron 30 publicaciones que indicaron diferentes relaciones entre la incontinencia y la raza. La prevalencia de la incontinencia fue mayor entre las mujeres blancas. La incontinencia urinaria de esfuerzo fue más frecuente entre blancas y de urgencia entre negras. Blancas y asiáticas tenían pérdida urinaria en menor cantidad en comparación con las negras e hispanas. El impacto en la calidad de vida está más relacionada con la severidad de la pérdida de orina y otros factores, y no específicamente a la cuestión de la racial. Blancas tuvieron un mejor conocimiento acerca de la incontinencia y con mayor frecuencia fueron sometidos a tratamiento quirúrgico por la incontinencia urinaria de esfuerzo. Las blancas y latinas tienen mayor riesgo de incontinencia cuando comparadas con las negras y asiáticas. Se resalta la necesidad de estudios brasileños para que los datos puedan ser adecuados a nuestra realidad.

Purpose: The objective of this study was to analyze the influence of a retraining urogynecology program in women with the diagnosis of stress urinary incontinence, compared to the amount of urine leakage, strength of the pelvic floor muscles and subjective perception of improvement. Methodology: This case study with multiple subjects, constituted a sample group of 14 women, who underwent a retraining urogynecology program (Manual Reeducation, Electrical Stimulation and Biofeedback), twice a week for a total of twenty sessions, lasting three months. Before and after the program, perineometry was performed to assess the strength of maximum voluntary contraction of the pelvic muscles, and pad-test to quantify urinary leakage. The final questionnaire allowed to assess the subjective perception of improvement. Results: After implementation of the program in the sample group, a total of 14 women with a mean age of 51,6 years (sd = 5,43), was obtained a significantly increased by 26,95% of maximum voluntary contraction of the pelvic floor muscles (3,1cmH2O, p=0,004), significantly reduced the amount of urinary leakage of 60,81% (Pad Test/1 Hour – 4,5 grams, p=0,008) and 92,9% of women feel improved, almost healed or healed. The correlation between the increase of maximum voluntary contraction and decrease the quantity of urine leakage was not statistically significant (r = -0,378, p= 0,183). Conclusion: After the application of the retraining urogynecology program, women with stress urinary incontinence of the sample group presented statistically significant improvements on the maximal voluntary contraction force of the pelvic floor muscles, in the amount of urinary leakage and the subjective perception of improvement.