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- ItemSomente MetadadadosEstudo comparativo do assoalho pélvico avaliado pela ultrassonografia tridimensional e epi-no de gemeligestas e gestação única(Universidade Federal de São Paulo (UNIFESP), 2013-10-30) Kubotani, Juliana Sayuri [UNIFESP]; Elito Junior, Julio Elito Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Comparar o assoalho pélvico de gemeligesta com gestação única. Métodos: Estudo prospectivo do tipo caso controle com adultas, nulíparas, sendo 20 gemeligestas e 23 gestação única. Avaliamos no terceiro trimestre, em posição ginecológica sendo realizada a ultrassonografia tridimensional e depois introduzido o balão do Epi-no® na vagina e inflado até o limite máximo de desconforto, retirado inflado e mensurado seu perímetro. Utilizamos os testes t de Student e Mann-Whitney para comparar os grupos; e o Coeficiente de Person para correlacionar a extensibilidade perineal com a morfologia e os dados antropométricos. Consideramos significância quando p<0,05. Resultados: A média da área do hiato na gestação única em repouso, Valsalva e contração foi de 14,58; 16,95 e 11,72cm2 e nas gemeligestas 16,02; 18,61 e 12,63cm2, repectivamente. A média das medidas ântero-posterior em repouso, Valsalva e contração na gestação única foi de 5,32; 5,66 e 4,50cm e nas gemeligestas de 5,29; 5,80 e 4,61. A média das medidas látero-lateral em repouso, Valsalva e contração na gestação única foi de 3,85; 4,12 e 3,58 e nas gemeligestas 4,26; 4,26 e 3,82, somente obtendo significância em repouso (p<0,01) e contração (p=0,04). Não houve diferença na extensibilidade perineal entre os grupos avaliada pelo Epi-no®. Obteve-se correlação positiva entre o Epi-no® e as medidas em Valsalva e a circunferência abdominal. Conclusão: O assoalho pélvico das gemeligestas sofre mais alterações, evidenciadas pelo aumento das medidas látero-lateral em repouso e contração. Quanto maior a extensibilidade verificada pelo Epi-no®, maiores foram as medidas avaliadas pela Ultrassonografia em Valsalva e maior foi a circunferência abdominal.
- ItemAcesso aberto (Open Access)Estudo comparativo dos tratamentos fisioterapêuticos e psicológicos em pacientes atendidas no setor de sexualidade feminina - Projeto Afrodite da Disciplina de Ginecologia endocrinológica da Universidade Federal de São Paulo(Universidade Federal de São Paulo (UNIFESP), 2013-04-24) Alcides, Maria Angelica [UNIFESP]; Silva, Ivaldo da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objetive: To evaluate and compare the proposed physiotherapeutic and psychotherapeutic interventions in patients with the diagnosis of vaginismus. Methods: We evaluated and compared in a descriptive study with 24 women, two groups: physiotherapy treatment (G1) and psychological treatment and physiotherapy (G2). Both groups underwent screening and were assessed through evaluation form by the multidisciplinary team (Doctors, Psychologists, Physiotherapists) sector of female sexuality Unifesp. To evaluate the physical therapy evaluation was performed bodily and physical assessment of pelvic floor muscle using palpation method and perineal body (subjective) so we could see any changes involuntary spastic contraction. We evaluated the physical and functional integrity of the pelvic floor in order to assess possible changes in muscle through digital examination and/or bidigital (objective evaluation). Were also collected during the evaluation questionnaires Sexual Quality of Life ? Female Sexual Quotient and Inventory and Beck ? BDI (psychological evaluation) for both the G1 Group as well as for the Group G2. Only underwent the treatment, patients with diagnosis of vaginismus. After signing the consent form, the same was referred for treatment with physical therapy and psychology individualized treatments. The number of sessions for therapy (physiotherapy and psychological) were 10 initial sessions the treatment may be extended for 10 more sessions if the multidisciplinary team thought very necessary. The treatment group G1 and G2 were started by working sex education (through the mirror technique and illustrative booklet (anatomy of the internal and external genitalia). Treatment Group G1 was accomplished through relaxation techniques and perineal body, respiratory training, normalization of body tone and perineal massage performed with and desensitization and perineal body and application of specific exercises (body awareness ? and acceptance verbalization through visualization and perineal body in the mirror) (mirror technique ? visualization body) and (autofocus ? visual and tactile perception of the body in the mirror). Results: The study included 15 patients in Group G1 and 9 patients in Group G2. With respect to gynecological assessment, initially seventeen (70.83%) failed to perform evaluation at the end of treatment the twenty-for (100.0%) have done it. In assessing physiotherapy, seven (46.67%) and nine in Group G1 (100.0%) in Group G2 conducted subjective evaluation and eight (53.33%) underwent objective evaluation the end of treatment the twenty-four (100.0%) of the patients began to perform objective evaluation. There was also improvement in relation to the scores of QSF (Female Sexual Quotient) and BDI (Beck Inventory of Psychological Assessment) and regarding the Partial and Total Penetration. Conclusions: physiotherapy should be an integral part of the multidisciplinary team treating sexual dysfunctions, we conclude also that the resources physiotherapeutic help produce physical changes in the body and perineal muscle, central nervous system, altering the mechanism of pain through the reeducation sensory motor.
- ItemSomente MetadadadosIncidência de bacteriúria, sintomática e assintomática, após o estudo urodinâmico (eud), com ou sem antibioticoprofilaxia, em mulheres com incontinência urinária(Universidade Federal de São Paulo (UNIFESP), 2014-05-31) Hirakauva, Elizabeth Yukie [UNIFESP]; Jarmy, Zsuzsanna Ilona Katalin de Jarmy [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To determine the effects of pelvic floor muscle training (TMAP) in combination with biofeedback (BF) for the treatment of Dysfunctions of the female pelvic floor. Methods: Systematic review with Meta-analysis. Search strategy: The searched databases were: MEDLINE (1966- March / 2011), LILACS (1993-March / 2011), PUBMED (1974-March / 2011), PEDro (1985-March / 2011). The tests in English were considered eligible. Selection criteria: Randomized and controlled clinical trials, in which the BF was used as an adjunct to TMAP in the treatment of Female pelvic floor muscles (MAP), such as urinary dysfunctions, Anorectal and sexual. Exclusion criteria: trials in which training of MAP was combined with BF for learning muscle contraction Pelvic floor; In which the BF was used in combination with another therapy; Trials in which BF was used only as an evaluation of MAP; and Trials involving men and women in which demographic and The results were not reported separately. Data collection: extraction And quality assessment was done independently for two years. Investigators according to predetermined criteria and the results Were compared to determine the degree of agreement. The quality Methodology was evaluated by the PEDro scale. For the meta-analysis Continuous measures of outcome were extracted using a fixed-effect model And / or random. The results were presented in weighted averages. Results: Collectively, a total of 22 studies were included. Just us Trials that dealt with urinary disorders, it was possible to have a Studies. Comparing TMAP with BF and TMAP without BF was not found Statistical significance in the results that assessed the function of MAPs in short and Medium term: mean 9.89 (95% confidence interval -5.05, 24.83) and 15.03 (95% Confidence interval -9.71. 39.78), respectively. Conclusion: TMAP with BF does not seem to offer additional benefits in the treatment of Women.
- ItemAcesso aberto (Open Access)Qual o índice de massa corporal de mulheres com disfunções dos músculos do assoalho pélvico que procuram tratamento fisioterapêutico?(Universidade de São Paulo, 2012-12-01) Fitz, Fátima Faní [UNIFESP]; Costa, Thaís Fonseca [UNIFESP]; Feitosa, Suellen Maurin [UNIFESP]; Yuaso, Denise Rodrigues [UNIFESP]; Alves, Gabriel Andrade [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Overweight and obesity are reported as important risk factors for developing of female pelvic floor (PF) dysfunction. Thus, the objective was to verify the body mass index (BMI) of women with PF dysfunctions who sought physiotherapy treatment, and comparing it with national statistics. This is an observational study. There were evaluated the records of women with PF dysfunctions served by the Physiotherapy Service from 2004 to 2010, and included all women with the presence of any symptom of PF dysfunction. It was calculated the BMI of 312 women with PF dysfunction. The BMI mean was 28.1 kg/m². Approximately 70% of these women were overweight or obese, a value higher than the national rate of 59%. The pathophysiological basis of the relationship between obesity and PF dysfunction is the correlation between BMI and intra-abdominal pressure. The identification of overweight and obesity should be part of the rehabilitation programs of the PF, since the reduction in body weight can contribute by reducing the severity of the disorder. With the present study it was observed that women seeking physiotherapy treatment for PF dysfunction have higher rates of obesity than the national female population.
- ItemAcesso aberto (Open Access)Reflexo pudendo-anal em mulheres normais(Academia Brasileira de Neurologia - ABNEURO, 2004-09-01) Cavalcanti, Geraldo De Aguiar [UNIFESP]; Manzano, Gilberto Mastrocola [UNIFESP]; Bruschini, Homero [UNIFESP]; Giuliano, Lydia Maria [UNIFESP]; Srougi, Miguel [UNIFESP]; Nóbrega, João Antônio Maciel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The pudendo-anal reflex was studied in a sample of 31 normal women. Responses were obtained after bilateral independent stimulation of the clitoris, with surface recordings from both sides of the external anal sphincter. Reponses were elicited with double-pulses of 0,2 ms duration with a interstimulus interval of 5 ms, frequency of stimulation was lower than 0,5 Hz. A minimal of four responses were recorded after supramaximal stimulation. In one volunteer no response was recorded after unilateral stimulation. Latencies of the responses from the right and left sides of the anal sfincter after right and left stimulation were 36.35±6.37, 36.28±6.23, 35.88±4.68, 36.44±4.45ms, respectively. No relation was detected between latencies and age, body mass index and parity (considering either total parity or vaginal delivery only). In 12% of the recordings uncertainty was introduced in the latency measurements related to a poor signal-noise ratio.
- ItemSomente MetadadadosUltrassonografia tridimensional do assoalho pélvico após 3 anos de correção de incontinência urinária de esforço por sling retropúbico, transobturador ou incisão única(Universidade Federal de São Paulo (UNIFESP), 2015-09-30) Rodrigues, Claudinei Alves [UNIFESP]; Jarmy, Zsuzsanna Ilona Katalin de Jarmy [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: To compare the USG 3D positioning the sling band in the mid-urethra in different insertion techniques, correlating sonographic findings with the late postoperative clinical outcomes. METHODS: We evaluated 105 women after retropubic sling (TVT; n: 26), single-incision sling (TVT-O, n: 42) and the single incision sling (TVT-S; n: 37). Clinical and sonographic evaluations were carried out between the 36th 40 months after surgery. ultrasound examinations (USG) were performed with volumetric transducer placed on the perineum in sagittal middle position. Volumes were obtained at rest, in Valsalvam maneuver and perineal contraction and posteriormemte, analyzed off-line by two different blind observers on the procedure performed and about the state of urinary continence of the patient, the multiplanar mode OminiView for 3D USG pelvic floor. The statistical analysis was performed by Student t test, chi-square, ANOVA and Tukey. p value <0.05 was considered significant. RESULTS: the average angle between the range of arms 119.94 * on TVT, TVT-O in 141,93º and 121,06º the TVT-S, p <0.001, the distance between the bladder neck and the band the TVT was 1.65 cm in the TVT-O was 1.93 cm and the TVT-S was 1.95 cm (p = 0.01) .The slings were visualized in the mid-urethra in 87.5% of cases ( TVT = 100%, TVT-O = 73.8% and TVT-S: 89.2%) p <0.001. The objective of the sample cure was 83.8% (88.5% = TVT, TVT-O = 85.7% and TVT-S: 78.4%) and p = emergency 0,514.Sintomas were found in 23, 8% of the cases (TVT = 30.8%, TVT-O = 21.6% and TVT-S: 21.6%) and p = 0,630.Houve positive correlation between the displacement of the home range for hiring and symptoms of urgency (p = 0.029), but there is no difference when comparing sonographic measurements with objective or subjective cure rates. CONCLUSIONS: The angle between the arms band was more obtuse in transobturator sling in the retropubic or single incision. Slings retropubic were found more often in the middle urethra when compared to non-urgent, 3 years after surgery.