Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Urinary incontinence"

Navegando por Palavras-chave "Urinary incontinence"

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Autologous transplantation of adult adipose derived stem cells into rabbit urethral wall
(Springer, 2010-06-01) Almeida, Fernando Goncalves [UNIFESP]; Dantas Nobre, Yuri Tulio [UNIFESP]; Leite, Katia R.; Bruschini, Homero; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
A study was carried out to evaluate the feasibility of autologous adipose derived stem cells (ADSC) transplantation into female rabbits' urethra walls as an alternative to intrinsic urethral regeneration.Inguinal fat pad of 12 New Zealand adult female rabbits were harvested and processed to obtain stromal vascular fraction (SVF). the SVF were platted to isolate ADSC. Before urethral injection, cells were labeled with DiI marker. the urethra wall was injected with 1 x 10(7) autologous cells or saline (sham). the urethra was harvested at 2, 4, and 8 weeks to identify DiI-labeled cells.At 2 and 4 weeks, the ADSCs create a nodule localized in the urethral sub-mucosa. At 8 weeks, the ADSCs spread and integrated with the urethra wall from the initial injection site.This is the first study to demonstrate a successful autologous ADSCs transplantation. It confirms that ADSCs can survive and integrate within the urethral wall.
Acesso aberto (Open Access)
Avaliação de incontinência anal e urinária em mulheres atletas
(Universidade Federal de São Paulo (UNIFESP), 2019-09-26) Gomes, Natalia Tavares [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objective:The aims wasto determinethe role of high-level sport practice on anal incontinence (AI) and urinary incontinence (UI) in a young nullliparous female.Settings/Patients: case- control study that included 136 women (85 athletes and 51 sedentary) invited to respond questions extracted from validated questionnaires specific to anal incontinence and urinary incontinence. Results: The groups were homogeneous as to age and educational level. The prevalence of anal incontinence was statistically higher in the athletesgroup than in the sedentary group (68,2% versus 13,7%, p<0,001). Between the athletes with AI, 96,5% were classified as anal incontinence (OR=13,03, p<0,001), involuntary loss of gas was more frequent symptom reported. The UI risk was higher in female athletes than control group (34,1% versus 5,9%, p<0,001). Conclusion: The study evidenced a strong correlation between the high- level sport and risk for AI and UI.
Acesso aberto (Open Access)
Avaliação molecular e imunohistoquímica da uretra de ratas após trauma induzido e terapia intravenosa com células-tronco derivadas de músculo
(Universidade Federal de São Paulo (UNIFESP), 2017-02-22) Bilhar, Andreisa Paiva Monteiro [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Bortolini, Maria Augusta Tezelli [UNIFESP]; http://lattes.cnpq.br/1150368284144393; http://lattes.cnpq.br/6590913930590292; http://lattes.cnpq.br/8795441347109037; Universidade Federal de São Paulo (UNIFESP)
Objective: To identify the migration to the urethra of muscle derived stem cells (MDSCs) after intravenous (IV) injection in rats submitted to pelvic floor trauma due to vaginal distension (DV) and to analyze the effects of MDSC in the urethra of rats after seven and thirty days of the trauma in regards to: (1) mRNA expression of collagens, vascular endothelial growth factor (VEGF), nerve growth factor (NGF), Ki67 cell proliferation marker, and the expression of genes related to smooth and striated muscle apparatus; (2) expression of smooth and striated muscle proteins. Methods: MDSCs expressing green fluorescent protein (GFP) were injected into the tail vein of the rats at day three after DV. The urethras of five groups were analyzed: Control, Trauma 7 days (animals submitted to DV, sacrificed 7 days), MDSC 7 days (animals submitted to DV receiving IV therapy with MDSC, sacrificed 7 days), Trauma 30 days (animals submitted to DV, sacrificed at 30 days), MDSC 30 days (animals submitted to DV receiving IV therapy with MDSC, sacrificed at 30 days). Location of GFP cells was verified at 2 hours and 7 days after IV injection. RT-qPCR was used for gene expression and immunohistochemistry for protein identification and quantification. Results: MDSCs were early identified in the urethra, but only deformed cells after 7 days. After seven days of trauma, the MYH11 gene was overexpressed in the Trauma group in relation to Control (p=0.01). Expression of the mKi67 gene was increased in the MDSC group relative to Trauma (p=0.03) and Control (p=0.02). Expression of the COL1A1 and COL3A1 genes increased in the MDSC group relative to the Control (p=0.001 and p=0.002). The gene expression of NGF was decreased in the MDSC group in relation to Trauma (p=0.001) and there was no difference in expression of the MYH2, Desmin and VEGF gene. In the same period, immunohistochemical expression of MHY11, MYH2 and Desmin was increased in the MDSC group in relation to Trauma (p=0.01, p=0.005 and p=0.02) and decreased in the Trauma group in relation to the Control (p =0.01, p=0.008 and p=0.03). After 30 days of trauma, MYH11 and MYH2 gene expression was increased in the Trauma group compared to Control (p=0.03 and p=0.04). Expression of the mKi67 gene was increased in the MDSC group relative to Trauma (p=0.02) and Control (p=0.01). Expression of the COL1A1 gene increased in the MDSC group compared to the Control (p=0.008) and Trauma (p=0.03) and COL3A1 gene expression increased in the MDSC group compared to Control (p=0.03). However, the gene expression of NGF was decreased in the MDSC group in relation to Trauma (p=0.002) and there was no difference in the gene expression of Desmin and VEGF. In the same period, immunohistochemical expression of MYH11, MYH2 and Desmin was increased in the MDSC group in relation to Trauma (p=0.01, p=0.002 and p=0.01) and MYH2 gene expression decreased in the Trauma group compared to Control (p=0.04). Conclusion: MDSCs migrated early to the traumatized urethra, but did not integrate into the tissue. IV administration of MDSC alters the expression of genes related to cell proliferation, neural growth factor and extracellular matrix and the expression of smooth and striated muscle proteins in traumatized rat urethra.
Acesso aberto (Open Access)
Avaliação ultra-sonográfica e urodinâmica em pacientes com incontinência urinária
(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 1999-01-01) Sartori, Marair Gracio Ferreira [UNIFESP]; Bergamo, Carlos Alberto Salles [UNIFESP]; Martins, Sérgio Brasileiro [UNIFESP]; Takano, Cláudia [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Lima, Geraldo Rodrigues De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Purpose: to evaluate the agreement between the urodynamic and ultrasonography diagnoses of urinary incontinence, as well as to correlate the variables of both examinations. Methodology: three hundred eighty-one patients with urine loss were selected, from the Sectior of Urogynecology and Vaginal Surgery of the Division of Gynecology, Escola Paulista de Medicina - Federal University of São Paulo. All of them were submitted to urodynamic study, according to the standardization of the International Society of Continence, and to ultrasonography of the bladder neck, with a 6 MHz trasvaginal transducer. We analyzed the maximum closing urethral pressure (MCUP) and the etiological diagnosis of the urine loss. In the ultrasonography, the position of the bladder neck was evaluated in relation to the inferior border of the pubic symphysis, and its mobility as well as the diameter of the urethra and bladder neck. The women were categoriaed according to the urodynamic study in to stress urinary incontinence, detrusor instability and mixed urinary incontinence. Results: 1) the bladder neck, at rest was most frequently above the inferior border of the pubic symphysis and, during effort, below or at the height of the bony reference, in the three groups; 2) the mobility of the bladder neck was similar in the groups; 3) there was no significant correlation between MCUP and the diameter of the urethra and of the bladder neck. Conclusion: we deem that ultrasonography of the bladder neck is always a complement to the clinical evaluation and the urodymanic study.
Somente Metadadados
Biofeedback for the treatment of female pelvic floor muscle dysfunction: a systematic review and meta-analysis
(Springer, 2012-11-01) Fitz, Fatima Fani [UNIFESP]; Magalhaes Resende, Ana Paula [UNIFESP]; Stuepp, Liliana [UNIFESP]; Ferreira Sartori, Marair Gracio [UNIFESP]; Batista Castello Girao, Manoel Joao [UNIFESP]; Castro, Rodrigo Aquino [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Biofeedback (BF) has been widely used in the treatment of pelvic floor dysfunctions, mainly by promoting patient learning about muscle contraction with no side effects. However, its effectiveness remains poorly understood with some studies suggesting that BF offers no advantage over the isolated pelvic floor muscle training (PFMT). the main objective of this study was to systematically review available randomized controlled trials assessing the effectiveness of BF in female pelvic floor dysfunction treatment. Trials were electronically searched and rated for quality by use of the PEDro scale (values of 0-10). Randomized controlled trials assessing the training of pelvic floor muscle (PFM) using BF in women with PFM dysfunction were selected. Outcomes were converted to a scale ranging from 0 to 100. Trials were pooled with software used to prepare and update Cochrane reviews. Results are presented as weighted mean differences with 95 % confidence intervals (CI). Twenty-two trials with 1,469 patients that analyzed BF in the treatment of urinary, anorectal, and/or sexual dysfunctions were included. PFMT alone led to a superior but not significant difference in the function of PFM when compared to PFMT with BF, by using vaginal measurement in the short and intermediate term: 9.89 (95 % CI -5.05 to 24.83) and 15.03 (95 % CI -9.71 to 39.78), respectively. We found a few and nonhomogeneous studies addressing anorectal and sexual function, which do not provide the cure rate calculations. Limitations of this review are the low quality and heterogeneity of the studies, involving the usage of distinct protocols of interventions, and various and different outcome measures. the results of this systematic review suggest that PFMT with BF is not more effective than other conservative treatments for female PFM dysfunction.
Acesso aberto (Open Access)
Comparison of vaginal wall sling and modified vaginal wall sling for stress urinary incontinence
(Associação Paulista de Medicina - APM, 2000-05-04) Bezerra, Carlos Alberto; Sadi, Marcus Vinicius [UNIFESP]; Faculty of Medicine of the ABC Foundation, São Paulo Urology Division; Universidade Federal de São Paulo (UNIFESP)
CONTEXT: There are several controversies about which is the best form of surgical treatment for stress urinary incontinence in women. The vaginal wall sling in its original and modified form were presented by Raz as new options for treatment of these conditions, but there is a lack of comparative clinical trials using both techniques. OBJECTIVE: To compare the effectiveness of the original and the modified vaginal wall sling. DESIGN: A comparative, prospective, non-randomized clinical trial. SETTING: Public and private health care units (Urology Division, Faculty of Medicine of the ABC Foundation, and Universidade Federal de São Paulo (UNIFESP) / Escola Paulista de Medicina). PARTICIPANTS: Twenty patients with anatomical and intrinsic sphincter deficiency stress urinary incontinence were surgically treated for evaluating the initial results of the vaginal wall sling, from February 5, 1994, to June 27, 1996. INTERVENTIONS: The patients were divided into two groups. Group A (n = 10) were treated with the original vaginal wall sling. Group B (n = 10) were treated with the modified vaginal wall sling. Both groups were statistically similar according to clinical and urodynamic parameters. MAIN MEASUREMENTS: Cure and complication rates. RESULTS: Follow-up ranged from 19 to 43 months (median = 28) for group A. The overall cure rate was 70%. Fifty per cent of the patients had urinary retention of 7 to 35 days. There were no major complications. Follow-up ranged from 14 to 26 months (median = 18) for Group B. The cure rate was 80%. Two patients had urinary retention of 7 and 55 days. There were no major complications. CONCLUSIONS: The vaginal wall sling is as effective as the modified vaginal wall sling but has a higher rate of urinary retention.
Acesso aberto (Open Access)
Correção da Incontinência Urinária de Esforço com Sling: Resultados Iniciais
(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2000-06-01) Martins, José Antônio M. [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Lima, Geraldo R. de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Purpose: to analyze the surgical results after slings with vaginal wall, performed by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM, for the treatment of incontinent women with hypermobility of the bladder neck, who show great risk of surgery failure with other techniques or in those with intrinsic sphincteric deficiency (ISD) and, also, surgery recurrence. Methods: we studied 21 patients submitted to surgery in order to correct urinary incontinence by the vaginal wall sling technique, in the period from December 1997 to February 1999, with postoperative follow-up which varied between 1 and 14 months (average 8.2). The mean age of patients was 56 years (39 to 77 years), 15 (71.4%) were in menopause and 6 (28.6%) in menacme. All patients were evaluated before the surgery through medical interview, physical examination, ultrasound and urodynamic study, the grade of urinary loss being high in 66.7% and moderate in 33.3% of the patients. All patients showed hypermobility of the bladder neck (more than 10 mm) and 12 patients had previous surgery to correct the urinary incontinence. Regarding the urodinamic study, the patients manifested urinary loss with maximum pressure of urethral closure (MPUC) varying from 20 to 124 cmH2O (average 55.2) and Valsalva leak point pressure (VLPP) varying from 18 to 128 cmH2O (average 60.3). The indications of surgery were: ISD (11 patients -- 52.4%), obesity (5 patients -- 23.8%), ISD and obesity (2 patients -- 9.5%), surgery recurrence (2 patients -- 9.5) and ISD and first grade womb prolapse (1 patient -- 4.8%). Results: as complications, 6 patients (28.6%) showed temporary urinary retention after surgery, 1 patient (4.8%) infection in the urinary tract, 1 patient (4.8%) presence of polypropylene suture in the vagina, 1 patient (4.8%) infection of the surgery wound, 4 patients (19%) developed urgency/incontinence, 1 (4.8%) urgency and 1 (4.8%) difficulty in urinating (high postvoiding residue). The grade of the patients' satisfaction was satisfactory, with 15 patients (71.4%) referring cure, 3 patients (14.3%) improvement, in 2 patients (9.5%) the urinary loss remained unchanged and in 1 patient (4.8%) the urinary loss got worse. Conclusions: the vaginal wall sling surgery is efficient for the treatment of specific cases of stress urinary incontinence, emphasizing intrinsic urethral sphincteric incompetence, surgery recurrence and predisposing factors to failure of other techniques.
Acesso aberto (Open Access)
Diagnóstico clínico e subsidiário da incontinência urinária
(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2006-01-01) Feldner Junior, Paulo Cezar [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Lima, Geraldo Rodrigues de [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Female lower urinary tract symptoms are nonspecific and a clinical evaluation is required to establish the correct diagnosis. Such evaluation should consist of a structured micturition history or questionnaire, physical examination, micturition diary, pad test, and urodynamic evaluation. Urodynamic investigation was developed as an extension of patient history and physical examination in order to reveal the etiology of the patient's complaints. The goal of the present article is to review clinical and subsidiary diagnosis of urinary incontinence.
Acesso aberto (Open Access)
Efeito do treinamento resistido sobre o ganho de força muscular e a diminuição da perda de urina em mulheres com incontinência urinária de esforço
(Universidade Federal de São Paulo (UNIFESP), 2011-02-22) Martines, Guilherme Augusto [UNIFESP]; Dambros, Miriam [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Introduction: Urinary Incontinence (IU) is defined by the International Continence Society as “complaint of any involuntary loss of urine”. It has a high prevalence and principally affecting women. The factors that trigger off IU are multiple and the symptoms favour the socially isolated, lost independence, anxiety and consequently there is a diminishing of the quality of life. Objective: To assess the effects of a protocol of force training, composed of 5 specific exercises for the inferior members under the complaint of IU. Material and Methods: In a sample composed of 30 women between 50 and 70 years old, from the city of Jaú-SP, it utilized a clinic test called “self controlled” characterized by two phases: the first phase was characterized as the sample forming, part of the control group and the second phase when the sample became to be classified as being the intervention group. Each phase had a period of duration of 12 weeks. During the period of intervention the women exercised themselves twice a week. It utilized a specific chart of 1-RM (Baechle) for individualization of training weights (70% of 1-RM), as well as anamnese. “Pad Test” – a specific test to quantify the loss of urine, as well as “ICIQ-SF” – a standard questionnaire that assess the quality of life of the suffers of IU. Results: At the end of the study, it was observed that there was a significant statistical increase of muscular force in the inferior members, and consequently a reduction of the loss of urine, as shown by the “Pad Test” in the intervention group, compared to the control group. The score of the ICIQ-SF also showed a significant statistical reduction in the intervention group, over the control group, suggesting an improvement of the clinical symptoms of the illness, as well as an improvement in the quality of life of the women, whom participated in the sample. Conclusion: The protocol of the force training caused a significant increase of muscular force of the inferior members, as well as a reduction in the quantify of lost urine.
Acesso aberto (Open Access)
Efeitos da Corticosteroidoterapia na Uretra e na Bexiga de Ratas Castradas antes e durante Reposição Estrogênica
(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2000-12-01) Santos Junior, João Batista dos [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Simões, Manuel de Jesus [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Lima, Geraldo Rodrigues de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Purpose: the effects of corticosteroids on the female urinary tract are not well understood, specially in climacteric women with or without estrogen replacement therapy. We studied the effects of corticosteroids on the blood vessels and epithelium of the bladder and urethra of female rats. Method: fifty-four female rats were used, divided into five groups. Group I - ten castrated female rats; Group II - eleven castrated female rats which receivedintraperitoneally 15 mg/kg weight prednisolone, for 26 days; Group III - twelve castrated female rats which received the same amount of corticosteroid, during the same time, and subcutaneously 10 mg/kg 17 beta-estradiol, in the last five days before they were sacrificed; Group IV - eleven castrated rats which received placebo for 26 days; and Group V - no castrated female rats which received the same dose of corticosteroid during the same time as in Group II. Results: we observed an average of 1.8 vessels in the bladder of the castrated group which received corticosteroid, a similar number to that of those which received corticosteroid and estrogen, compared with 0.8 vessel in the placebo group. Regarding the urethra, 0.7 vessel was observed in the group which received corticosteroid, as compared with 0.9 vessel in the group treated with corticosteroid associated with estrogen and 0.4 in the placebo group. Regarding the mucous membrane, the vesical epithelium thickness of 14.1 mm in the placebo group increased to 20.6 mm in that with corticosteroid and to 22.6 mm in that with corticosteroid plus estrogen. The urethral epithelium thickness of 12.4 mm in the placebo group increased to 15.1 mm in the group with corticosteroid and to 16.7 mm in that with corticosteroid plus estrogen. Conclusion: corticosteroids significantly increased the vascularization and the thickness of the vesical and urethral epithelia of castrated female rats.
Acesso aberto (Open Access)
The effect of pelvic floor muscle training in urinary incontinent elderly women: a sistematic review
(Pontifícia Universidade Católica do Paraná, 2014-12-01) Jácomo, Raquel Henriques; Fitz, Fátima Fani; Alves, Aline Teixeira; Fernandes, Isabella Silveira; Teixeira, Fellipe Amatuzzi; Sousa, João Batista De; Universidade de Brasília; Universidade Federal de São Paulo (UNIFESP); Faculdade de Ciências Médicas de Minas Gerais
Introduction The International Continence Society (ICS) determines that the pelvic floor muscles training (PFMT) is the first-choice treatment of urinary symptoms in women. Objective The aim of this study was to systematize randomized controlled clinical trials that address the effects of PFMT in the treatment of urinary symptoms in older women using objective outcome measures. Method Systematic review search was performed eletronic the following databases: Medline, Pubmed, Lilacs, PEDro and manual research conducted in the references of the studies. Were considered eligible women aged over 60 years who performed PFMT in isolation, without the involvement of another technique. The PFMT performed in clinic or at home, with or without the supervision of a therapist and with or without the use of biofeedback as an adjunct. Considered as outcome measures urodynamic studies, voiding diary that assesses daytime urinary frequency, nocturnal urinary frequency, urinary incontinence and exchange absorbent, and, finally, the absorbent test that quantifies loss urinary grams. The assessment of methodological quality of the studies was conducted by PEDro scale. Results Three studies were reviewed in full. Only one trial was rated high methodological quality. There was significant improvement in urinary symptoms after treatment proposed in the three selected studies. Conclusion Considering the studies available so far are weak the evidence for the use of PFMT in the treatment of urinary symptoms in elderly women.
Somente Metadadados
Electrophysiological evaluation of the pudendal nerve and urethral innervation in female stress urinary incontinence
(Springer, 2013-05-01) Cavalcanti, Geraldo de Aguiar [UNIFESP]; Manzano, Gilberto Mastrocola [UNIFESP]; Nunes, Karlo Faria [UNIFESP]; Pereira Giuliano, Lydia Maria [UNIFESP]; Menezes, Tatiane Almeida de; Bruschini, Homero [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Pernambuco (UFPE); Universidade de São Paulo (USP)
Although still a matter of debate, stress urinary incontinence (SUI) may be accompanied by damage to urethral and pelvic floor innervations, thus promoting dysfunctions of the urethral support and sphincteric closure mechanisms. the aim of this study was to analyze the pelvic floor and urethral innervations through pelvic electrophysiological tests to identify whether neurological alterations interfere with urinary continence and urethral functional activity.This prospective study included 52 women, 33 with clinically and urodynamically proven SUI and 19 continent volunteers matched for age, height, parity, and number of vaginal deliveries by the propensity score method. the patients were divided according to the severity of urinary loss evaluated by measuring abdominal leak point pressure (ALPP). Pudendal nerve terminal motor latency (PNTML), pudendal somatosensory evoked potential (SSEP) latencies, urethral and clitoral sensory thresholds, and urethroanal reflex latency were tested.SUI and control subjects did not differ in PNTML, SSEP latency, and clitoral sensory thresholds. However, reduced responsiveness to urethral electrosensitivity and prolonged urethroanal reflex latency were detected in most incontinent patients. in addition, urethral electrosensitivity was altered in suspected intrinsic sphincteric dysfunction.Urethral afferent pathways can be altered in women with SUI and may play an important role in evoking intrinsic sphincteric dysfunction.
Acesso aberto (Open Access)
Estudo prospectivo controlado comparando a resposta a aplicação intradetrusora de abobotulinumtoxina A (Dysport®) em relação à onabotulinumtoxina a (Botox®) em pacientes do sexo feminino com bexiga hiperativa refratária
(Universidade Federal de São Paulo (UNIFESP), 2017-10-31) Silva, Davidson Bezerra da [UNIFESP]; Almeida, Fernando Gonçalves de [UNIFESP] ; http://lattes.cnpq.br/9336208077764596; http://lattes.cnpq.br/5165375948476141; Universidade Federal de São Paulo (UNIFESP)
A incontinência urinária é uma condição clínica que afeta sobremaneira a qualidade de vida e autoestima dos pacientes [2]. Estima-se que, em mulheres acima de 40 anos, a taxa de prevalência da incontinência urinária varia de 30% a 60% [4]. A Síndrome da Bexiga Hiperativa é a segunda causa de incontinência urinária feminina e está diretamente relacionada ao aumento do número de quedas e fraturas [1,4,5]. Dentre as diversas opções terapêuticas para tratamento da Bexiga Hiperativa, os anticolinérgicos orais são os mais utilizados [15]. Entretanto, alguns pacientes apresentam condições clínicas que contraindicam o seu uso ou até mesmo possuem refratariedade a sua ação [15,16]. Além disso, estes medicamentos possuem uma taxa de adesão baixa, devido aos importantes efeitos colaterais que proporcionam [15,16]. Nestas situações, a aplicação intradetrusora de toxina botulínica do tipo A é uma opção minimamente invasiva e altamente eficaz [13,14]. No tratamento da Bexiga Hiperativa refratária, há dois tipos de toxina botulínica do tipo A mais utilizados: onabotulinumtoxina A (Botox®) e a abobotulinumtoxina A (Dysport®) [20]. O uso da onabotulinumtoxina A (Botox®) no tratamento de pacientes com Bexiga Hiperativa refratária idiopática e neurogênica já está bem estabelecido [36]. Há um consenso em relação às doses a serem administradas em cada uma das condições de Bexiga Hiperativa descritas, bem como a sua eficácia [36]. Entretanto, há poucos estudos que avaliam o uso da abobotulinumtoxina A (Dysport®) no tratamento da Bexiga Hiperativa [29]. Consequentemente, ainda não se estabeleceu uma dose que apresente alta efetividade e baixa toxicidade comparáveis às da onabotulinumtoxina A (Botox®). Este estudo é o primeiro estudo prospectivo controlado que compara a onabotulinumtoxina A (Botox®) à abobotulinumtoxina A (Dysport®) no tratamento de pacientes com Bexiga Hiperativa refratária e que busca através de questionários de sintomas e qualidade de vida, estudo urodinâmico e escala visual analógica, propor uma dose equivalência, além de comparar a efetividade das terapias. A partir dos dados obtidos através das avaliações pré e pós-aplicação intradetrusora de toxina botulínica do tipo A, a dose equivalência 1 : 2,5 (Onabotulinumtoxina A : Abobotulinumtoxina A) mostra eficácia clínica e urodinâmica semelhantes no tratamento de pacientes portadores de Bexiga Hiperativa refratária. Além disso, pode-se afirmar que Abobotulinumtoxina A (Dysport®) é uma alternativa segura e eficaz para tratamento destes pacientes.
Somente Metadadados
Female urinary incontinence: effective treatment strategies
(Informa Healthcare, 2015-04-01) Castro, Rodrigo de Aquino [UNIFESP]; Arruda, Raquel Martins [UNIFESP]; Bortolini, Maria Augusta Tezelli [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Urinary incontinence is a dysfunction that tremendously affects women's quality of life, involving social, emotional and economic aspects. Although various treatments for urinary incontinence have been described, it is important to know which of them are truly effective. This review seeks to determine the current available therapies for women with stress urinary incontinence and overactive bladder syndrome, based on the best scientific evidence.
Acesso aberto (Open Access)
Ferramenta para classificar os subtipos de incontinência urinária feminina baseada em questionários de sintomas urinários recomendados pela International Continence Society (ICS)
(Universidade Federal de São Paulo, 2024-11-13) Girotti, Marcia Eli [UNIFESP]; Almeida, Fernando Gonçalves de [UNIFESP]; http://lattes.cnpq.br/9336208077764596; http://lattes.cnpq.br/4684527524158764
Objetivo: Desenvolver uma ferramenta para classificar os subtipos mais frequentes de IU feminina, baseado em questionários de sintomas urinários recomendados pela International Continence Society (ICS). Métodos: este é um estudo observacional transversal descritivo, baseado em uma coleta de dados planejada e sistematizada. Foram incluídas no banco de dados (BD), 635 mulheres incontinentes com idade superior a 18 anos, encaminhadas das Unidades Básicas de Saúde, localizadas no estado de São Paulo. O atendimento especializado foi realizado no ambulatório de Disfunção Miccional Feminina da Disciplina de Urologia da UNIFESP. O diagnóstico clínico foi obtido através da avaliação do especialista, baseado na anamnese e no exame físico e, quando necessários, exames complementares. O diagnóstico de sintomas foi obtido pela combinação de respostas dos questionários: International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) e Overactive Bladder Validated 8-question (OAB-V8). Resultados: sequencialmente, foram incluídas no banco de dados 635 mulheres com incontinência, com idade média de 58 anos (±12,7) e IMC de 28,4 kg/m². Destas, 86% tinham filhos, 66% estavam na menopausa, 49% apresentavam hipertensão arterial sistêmica, 17% faziam uso de antidepressivos e 15% eram tabagistas. Entre as 467 pacientes com diagnóstico clínico, 181 (32%) apresentavam incontinência urinária de esforço (IUE), 219 (54%) incontinência urinária mista (IUM) e 67 (13%) incontinência urinaria de urgência (IUU). Um total de 590 mulheres foram capazes de preencher os questionários e tiveram seu diagnóstico baseado nestes instrumentos, 132 (23%) apresentavam IUE, 357(62%) IUM e 101 (15%) IUU. Segundo o coeficiente de Kappa ponderado, uma concordância moderada de 0,43, com intervalo de confiança de 95% [0,30; 0,55], foi encontrada entre o diagnóstico médico e o diagnóstico autorreferido pelas pacientes nos questionários. Na análise das discordâncias, das 229 pacientes que foram diagnosticadas com IUM nos questionários, 77 foram diagnosticadas pelo médico como portadoras de IUE, entretanto, 67% delas responderam que se incomodavam muito ou muitíssimo com os sintomas de urgência. A correlação moderada entre os dois diagnósticos avaliados neste estudo parece indicar que existe uma dificuldade, até mesmo entre os especialistas, em detectar sintomas de bexiga hiperativa. Conclusões: A correlação moderada entre os diagnósticos avaliados neste estudo parece indicar que o médico especialista durante sua avaliação clínica não percebe os sintomas de urgência e urge-incontinência referido pelas pacientes nos questionários. Este método diagnóstico possui potencial para ser utilizado como método reprodutível em estudos médicos e também para outros profissionais de saúde.
Acesso aberto (Open Access)
Fisioterapia para consciência perineal: uma comparação entre as cinesioterapias com toque digital e com auxílio do biofeedback
(Pontifícia Universidade Católica do Paraná, 2012-09-01) Pinheiro, Brenda de Figueiredo; Franco, Gisela Rosa; Feitosa, Suellen Maurin; Yuaso, Denise Rodrigues; Castro, Rodrigo de Aquino [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
INTRODUCTION: A significant number of women (around 30 to 50%) are unable to contract correctly their pelvic floor muscles when given a command. OBJECTIVE: This study's objective was to compare pelvic floor muscle training with digital palpation to pelvic floor muscle training with biofeedback for perineal consciousness of women with stress urinary incontinence. METHOD: It was conducted a randomized clinical trial, comprising two groups, each of them formed by five interventional women with stress urinary incontinence and without perineal consciousness. RESULTS: Initially, the biofeedback group was formed by six women and the pelvic floor muscle training group was formed by five women, but one patient was excluded from the biofeedback group during the research. It was observed that there was a statistically significant improvement in both groups for the Power, Endurance, Fast and knowledge of the perineal region, but there was no significant difference between the two groups, i.e., both treatments are equally effective. CONCLUSION: Given the results, we conclude that both pelvic floor training with digital palpation and with biofeedback are excellent treatment options to gain perineal awareness.
Somente Metadadados
Fuzzy cognitive map in differential diagnosis of alterations in urinary elimination: A nursing approach
(Elsevier B.V., 2013-03-01) Baena de Moraes Lopes, Maria Helena; Siqueira Ortega, Neli Regina; Panse Silveira, Paulo Sergio; Massad, Eduardo; Higa, Rosangela; Marin, Heimar de Fatima [UNIFESP]; Universidade Estadual de Campinas (UNICAMP); Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
Purpose: To develop a decision support system to discriminate the diagnoses of alterations in urinary elimination, according to the nursing terminology of NANDA International (NANDA-I).Methods: A fuzzy cognitive map (FCM) was structured considering six possible diagnoses: stress urinary incontinence, reflex urinary incontinence, urge urinary incontinence, functional urinary incontinence, total urinary incontinence and urinary retention; and 39 signals associated with them. the model was implemented in Microsoft Visual C++(R) Edition 2005 and applied in 195 real cases. Its performance was evaluated through the agreement test, comparing its results with the diagnoses determined by three experts (nurses). the sensitivity and specificity of the model were calculated considering the expert's opinion as a gold standard. in order to compute the Kappa's values we considered two situations, since more than one diagnosis was possible: the overestimation of the accordance in which the case was considered as concordant when at least one diagnoses was equal; and the underestimation of the accordance, in which the case was considered as discordant when at least one diagnosis was different.Results: the overestimation of the accordance showed an excellent agreement (kappa = 0.92, p < 0.0001); and the underestimation provided a moderate agreement (kappa = 0.42, p < 0.0001). in general the FCM model showed high sensitivity and specificity, of 0.95 and 0.92, respectively, but provided a low specificity value in determining the diagnosis of urge urinary incontinence (0.43) and a low sensitivity value to total urinary incontinence (0.42).Conclusions: the decision support system developed presented a good performance compared to other types of expert systems for differential diagnosis of alterations in urinary elimination. Since there are few similar studies in the literature, we are convinced of the importance of investing in this kind of modeling, both from the theoretical and from the health applied points of view.Limitations: in spite of the good results, the FCM should be improved to identify the diagnoses of urge urinary incontinence and total urinary incontinence. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
Somente Metadadados
Impact of HTLV-I in quality of life and urogynecologic parameters of women with urinary incontinence
(Elsevier B.V., 2009-12-01) Costa Diniz, Monica Suzana [UNIFESP]; Feldner, Paulo Cezar [UNIFESP]; Castro, Rodrigo Aquino [UNIFESP]; Ferreira Sartori, Marair Gracio [UNIFESP]; Batista Castello Girao, Manoel Joao [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Pernambuco (UFPE)
Objective: To assess the impact of urinary incontinence in quality of life, epidemiological data, symptoms, findings of gynecological/neurological examination and urodynamic of HTLV-I seropositive women compared with HTLV-I negative women.Study design: 43 incontinent women were divided in two groups: 24 serropositives and 19 seronegatives for HTLV-I. We used King's Health Questionnaire (KHQ), standardized recorded data and urodynamics. Data were compared using Mann-Whitney test or Chi-squared test.Results: Quality of life was significantly worse in seropositive incontinent women in the following parameters: general perception of health, impact of incontinence, limitation of daily life activities, social relations, sleep and disposition. Also, the following gynecological/neurological symptoms were more prevalent in seropositives: pain on vesical filling, dyspareunia, parestesis in inferior members, increased perineal sensitivity, pain in vaginal palpation, increased vaginal tonus, gait alteration, increased patellar reflex, Babinski reflex positive and increased tonus in inferior members.Conclusion: Poor quality of life and physical abnormalities were identified in incontinent HTLV-I seropositive women when compared with incontinent HTLV-I seronegative women. (C) 2009 Elsevier Ireland Ltd. All rights reserved.
Acesso aberto (Open Access)
Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence
(Associação Paulista de Medicina - APM, 2007-09-01) Zanetti, Míriam Raquel Diniz [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Rotta, Adriana Lyvio [UNIFESP]; Santos, Patrícia Diniz dos [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
CONTEXT AND OBJECTIVE: Urinary incontinence is a public health problem that affects more than 200 million people worldwide. Stress incontinence is the most prevalent type. Pelvic floor muscle exercises have been used for treating it, although there is no consensus regarding their application. The aim of this study was to compare the results from treating female stress urinary incontinence with pelvic floor muscle exercises with or without physiotherapist supervision. DESIGN AND SETTING: This was a randomized, prospective, controlled trial in the Urogynecology and Vaginal Surgery Sector, Universidade Federal de São Paulo (UNIFESP). METHODS: Forty-four women were randomized to be treated for stress urinary incontinence with pelvic floor exercises for three consecutive months, into two groups: one with and the other without physiotherapist supervision. They were evaluated before and after treatment using a quality-of-life questionnaire, pad test, micturition diary and subjective evaluation. Descriptive analysis was used to evaluate the population. The homogeneity of the two groups was evaluated using the Kruskal-Wallis and Chi-squared tests. The success of the two groups after treatment was evaluated using the Wilcoxon test. RESULTS: The supervised group showed statistically greater improvement in the pad test, micturition diary and quality of life than did the control group. In the subjective evaluation, only 23.8% of the control group patients were satised with their treatment. In the supervised group, 66.8% of patients did not want any other treatment. CONCLUSION: Supervised pelvic floor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises.
Acesso aberto (Open Access)
Impacto do estudo urodinâmico em mulheres com incontinência urinária
(Associação Médica Brasileira, 2007-04-01) Araujo, Maita Poli de [UNIFESP]; Oliveira, Emerson de [UNIFESP]; Queiroz, Gabriela Cabral [UNIFESP]; Pimentel, Silvia Helena Caires de Oliveira [UNIFESP]; Takano, Cláudia Cristina [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: The purpose was to evaluate tolerance of patients with urinary incontinence undergoing an urodynamic study. METHODS: Forty nine patients with lower urinary tract symptoms submitted to an urodynamic study were evaluated... Prior to and immediately after the procedure each patient completed a self-administered questionnaire about several emotional variables, including anxiety, pain and shame. Answers about pain were given on a visual analog scale. Mean values of continuous variables were compared using a paired t-test, whereas categorical variables were compared using the chi-square test. RESULTS: The mean age was 49.5 (23-84) years. Pain score pre-procedure was 4.29 ± 3 and after procedure was 2.7 ± 2.9 (p=0.001). CONCLUSION: The urodynamic study is well tolerated by female patients and a low morbidity was found. Previous orientation can decrease anxiety.

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