Navegando por Palavras-chave "pelvic floor"

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    Analysis of type I collagen in the parametrium of women with and without uterine prolapse, according to hormonal status
    (Springer, 2003-11-01) Barbiero, E. C.; Sartori, MGF; Girao, MJBC; Baracat, E. C.; Lima, G. R. de; Universidade Federal de São Paulo (UNIFESP)
    The content and quality of type I collagen in the parametrium of women with and without uterine prolapse was evaluated. Forty-four consecutive patients were selected and divided into two groups: A, 21 women without uterine prolapse, and B, 23 with uterine prolapse. Patients in group A had uterine leiomyoma and were submitted to abdominal hysterectomy; in those from group B, vaginal hysterectomy was performed for correction of the uterine prolapse. During surgery, fragments of the parametrium were removed and processed for immunohistochemical analysis using polyclonal antibodies for type I collagen. A system of computerized digital imaging analysis was used for the quantification of collagen fibers. There was no difference between collagen content in patients either with or without prolapse, nor between pre- and postmenopausal women with prolapse. A modification of the quality of the collagen fiber was observed, it being longer and more compact in the group without uterine prolapse. in contrast, in the group with prolapse, the fibers were shorter and thinner and areas with large spaces between fibers were found at several, points of the parametrium. the conclusion was that patients with uterine prolapse have the same type I collagen content as those without, but the quality of the fiber is modified. the hormonal status also did not affect collagen content.
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    Assessment of pelvic floor of women runners by three-dimensional ultrasonography and surface electromyography. A pilot study.
    (Soc Romana Ultrasonografe Medicina Biologie-srumb, 2014-03-01) Araujo Junior, Edward [UNIFESP]; Katalin Jarmy-Di Bella, Zsuzsanna Ilona [UNIFESP]; Zanetti, Míriam Raquel Diniz [UNIFESP]; Araujo, Maita Poli [UNIFESP]; Petricelli, Carla Dellabarba [UNIFESP]; Martins, Wellington de Paula [UNIFESP]; Alexandre, Sandra Maria [UNIFESP]; Nakamura, Mary Uchiyama [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Aim: To evaluate female runners' pelvic floor muscles using three-dimensional ultrasonography (3DUS) and surface electromyography (SEMG). Material and methods: A cross-sectional study was conducted on 24 female runners. SEMG was performed using surface electrodes inserted in the vagina. 3DUS was performed using perineal convex transducer. SEMG was evaluated at rest and with maximum voluntary contraction (MVC) and slow contraction. Levator ani muscle thickness, levator hiatus area and the angle between the levator muscles at rest and with MVC and Valsalva were evaluated using 3DUS. The women were divided into two groups (women running <= 25 km/week; women running > 25 km/week). Means, standard deviations and non-paired t tests were used for both groups. Results: Among the 24 women, 11 ran <= 25 km/week (16.91 +/- 4.13 km/week) and 13 ran > 25 km/week (40.77 +/- 1.15 km/week). The mean SEMG at rest and with MVC and slow contraction were 16.25, 65.86 and 71.41 mV, respectively. For the levator hiatus area at rest and with MVC and Valsalva, the means were 12.54, 10.06 and 16.57 cm2, respectively. Correlations between 3DUS and SEMG showed significant differences in SEMG at rest and levator thickness with Valsalva (r = 0.46; p = 0.04). Conclusions: 3DUS and SEMG are two feasible methods for evaluating female runners' pelvic floor. Correlations between 3DUS and SEMG showed significant differences in SEMG at rest and levator thickness with Valsalva.
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    Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse?
    (Wiley-Blackwell, 2012-01-01) Magalhaes Resende, Ana Paula [UNIFESP]; Stuepp, Liliana; Bernardes, Bruno Teixeira; Oliveira, Emerson; Castro, Rodrigo Aquino; Batista Castello Girao, Manoel Joao; Ferreira Sartori, Marair Gracio; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Uberlândia (UFU)
    Aims the aim of the study was to compare the effect of hypopressive exercises including pelvic floor muscle contraction, pelvic floor muscle training (PFMT) alone and control on pelvic floor muscle function in women with pelvic organ prolapse (POP). Methods: Fifty-eight women with a mean age of 55.4 (+/-9.8) years old with stage II POP were randomly assigned to participate in the PFMT group, the hypopressive exercises associated with PFMT (HE + PFMT) group or the control group. Each treatment group underwent a 3-month course of treatment. the three groups received lifestyle advice regarding weight loss, constipation, coughing, and the avoidance of heavy lifting. Participants were evaluated before and after the treatment. Maximal voluntary contraction (MVC) and endurance were assessed using the Modified Oxford grading system. To evaluate muscle activation, surface electromyography (SEMG) was used. Results: the two treatment group significantly increase pelvic floor muscle function as measured by MVC (P < 0.001) using the Modified Oxford grading system, as well as muscle activation (P < 0.001), measured by SEMG. the PFMT group was superior regarding endurance (P = 0.007). Both groups were superior to the control group regarding MVC, endurance and muscle activation. Conclusion: Adding hypopressive exercises to PFMT does not improve PFM function. Both treatment groups performed better than the control group. Neurourol. Urodynam. 31:121-125, 2012. (C) 2011 Wiley Periodicals, Inc.
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    Correlation between maximum voluntary contraction and endurance measured by digital palpation and manometry: An observational study
    (Assoc Medica Brasileira, 2016) Fitz, Fatima Fani [UNIFESP]; Stupp, Liliana [UNIFESP]; Costa, Thais Fonseca [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Castro, Rodrigo Aquino [UNIFESP]
    Introduction: Digital palpation and manometry are methods that can provide information regarding maximum voluntary contraction (MVC) and endurance of the pelvic floor muscles (PFM), and a strong correlation between these variables can be expected. Objective: To investigate the correlation between MVC and endurance, measured by digital palpation and manometry. Method: Forty-two women, with mean age of 58.1 years (+/- 10.2), and predominant symptoms of stress urinary incontinence (SUI), were included. Examination was firstly conducted by digital palpation and subsequently using a Peritron manometer. MVC was measured using a 0-5 score, based on the Oxford Grading Scale. Endurance was assessed based on the PERFECT scheme. Results: We found a significant positive correlation between the MVC measured by digital palpation and the peak manometric pressure (r= 0.579, p< 0.001), and between the measurements of the endurance by Peritron manometer and the PERFECT assessment scheme (r= 0.559, p< 0.001). Conclusion: Our results revealed a positive and significant correlation between the capacity and maintenance of PFM contraction using digital and manometer evaluations in women with predominant symptoms of SUI.
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    Eletromiografia de superfície para avaliação dos músculos do assoalho pélvico feminino: revisão de literatura
    (Universidade de São Paulo, 2011-09-01) Resende, Ana Paula Magalhães; Nakamura, Mary Uchiyama [UNIFESP]; Ferreira, Elizabeth Alves Gonçalves [UNIFESP]; Petricelli, Carla Dellabarba [UNIFESP]; Alexandre, Sandra Maria [UNIFESP]; Zanetti, Míriam Raquel Diniz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Uni Anchieta; Universitário FIEO
    Surface electromyography has clinical and research importance for the physiotherapist. Although capturing electrical activity promoted by recruitment of motor units, there is a good correlation between the number of activated units and muscle strength. This is one of the methods of higher specificity in pelvic floor evaluation, although the lack of consensus regarding its application. The aim of this literature review was to cluster information regarding to the use of surface electromyography in the evaluation of pelvic floor. Papers were searched in Medline, Pubmed Lilacs, SciELO and Cochrane Library. Were selected papers which methods used surface electromyography to evaluate the pelvic floor. Although its methodology still lacks standardization, is an instrument that should be considered in scientific research in our country because it seems to have good reproducibility and reliability. Women with pelvic floor disorders have changes in the activation time of the pelvic floor muscles (PFM) and abdominal muscles. With respect to pregnancy and postpartum, there is a lack of evidence on possible changes in electrical activation of PFM in these periods.
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    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.
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    Evaluation of pelvic floor muscle strength and its correlation with sexual function in primigravid and non-pregnant women: A cross-sectional study
    (Wiley, 2018) Santos, Marilia Duarte; Palmezoni, Vanessa Pinho; Torelli, Luiza [UNIFESP]; Pereira Baldon, Vanessa Santos; Ferreira Sartori, Marair Gracio[UNIFESP]; Magalhaes Resende, Ana Paula
    AimsWe aimed to compare pelvic floor muscle (PFM) strength and sexual function in primigravid and non-pregnant women and compare PFM strength between those who exhibited and did not exhibit sexual dysfunction. MethodsA cross-sectional observational study was conducted. The sample consisted of 154 women, including 76 primigravid and 78 non-pregnant women. The inclusion criteria were as follows: non-pregnant nulliparous women or primigravid women who were pregnant with a single foetus at least 14 weeks of gestational age and reported having sexual intercourse at least once during the last 4 weeks. The exclusion criteria were as follows: inability to contract the PFMs and prior urogynaecologic surgery. PFM strength was assessed via vaginal palpation (using the Modified Oxford Scale) and vaginal squeeze pressure (using the Peritron manometer). Sexual function was assessedusing the Female Sexual Function Index (FSFI) questionnaire. Sexual dysfunction was identified based on low FSFI scores.The data were analyzed using the Mann-Whiney and Spearman correlation tests. ResultsTo discussion, primigravid women had lower FSFI scores and lower PFM strength than non-pregnant women. Women with sexual dysfunction had lower PFM strength than women without sexual dysfunction, as indicated by vaginal palpation (scores of 2 out of 5 and 4 out of 5, respectively
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    Impacto do treinamento dos músculos do assoalho pélvico na qualidade de vida em mulheres com incontinência urinária
    (Associação Médica Brasileira, 2012-04-01) Fitz, Fátima Faní [UNIFESP]; Costa, Thaís Fonseca [UNIFESP]; Yamamoto, Deborah Mari [UNIFESP]; Resende, Ana Paula Magalhães [UNIFESP]; Stüpp, Liliana [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To evaluate the impact of pelvic floor muscle (PFM) training on the quality of life (QOL) in women with stress urinary incontinence (SUI). METHODS: Prospective clinical trial with 36 women with a diagnosis of SUI confirmed by urodynamic study. Women with neuromuscular diseases, using hormone replacement therapy, and with prolapse stage III and IV were not included. The exercise protocol for the PFM consisted of slow contractions (tonic fibers), followed by rapid contractions (phasic fibers) practiced in the supine, sitting, and standing positions, three times a week for a period of three months. We evaluated the impact of PFM on QOL using the King's Health Questionnaire (KHQ), a voiding diary, and digital palpation to assess the function of the PFMs during the initial evaluation and after three months of treatment. The result was described as means and standard deviations. We used the Wilcoxon test for comparison of the KHQ scores for paired samples, and the significance level was set at 0.05. RESULTS: There was a significant decrease in the mean scores of the domains assessed by the KHQ regarding the perception of health, impact of the incontinence, limitations of daily activities, physical limitations, social limitations, personal relationships, emotions, sleep/disposition, and measures of severity. In agreement with these results, significant decrease in nocturnal urinary frequency and urinary incontinence, as well as significant increase in muscle strength and endurance were observed. CONCLUSION: PFM training resulted in significant improvement in the QOL of women with SUI.
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    Incidência 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.
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    Outpatient biofeedback in addition to home pelvic floor muscle training for stress urinary incontinence: a randomized controlled trial
    (Wiley, 2017) Fitz, Fatima Fani [UNIFESP]; Stupp, Liliana [UNIFESP]; da Costa, Thais Fonseca [UNIFESP]; Tezelli Bortolini, Maria Augusta [UNIFESP]; Batista Castello Girao, Manoel Joao [UNIFESP]; Castro, Rodrigo Aquino [UNIFESP]
    AIMSTo test if biofeedback (BF) added to pelvic floor muscle training (PFMT) increases the frequency of home exercises performed by women with stress urinary incontinence (SUI). METHODS72 incontinent women were randomized to BF (outpatient BF+home PFMT) or PFMT (outpatient PFMT+home PFMT) groups. Assessments: baseline, after 3 months of supervised treatment, at 9-month follow-up (after six additional months of home PFMT only). Primary outcome: frequency of monthly exercises sets performed (exercise diary) after 3-month treatment. Secondary outcomes: adherence, urinary symptoms, severity and cure of SUI (pad test<2g leakage), muscle function, quality of life, and subject cure (satisfaction report with no desire for different treatment) at the two time-points. Statistical analyses: ANOVA and Student's t-test with 5% cut-off for significance. RESULTSIt was observed similar frequency of monthly home exercises sets performed by BF (67.9 out of 82) and PFMT (68.2 out of 82) groups at 3 months. Secondarily, equal satisfaction, but superior objective cure of SUI for BF group after 3-month treatment (P=0.018; OR: 3.15 [95% CI: 1.20-8.25]). At 9-month follow-up, the adherence to home exercises was similar (around 50%) and significantly dropped in both groups compared to the 3-month results (around 85%). No difference was detected in the objective and subjective cure of SUI between the groups after 9 months. Both therapies similarly improved the muscle function and quality of life during the study (P<0.005). CONCLUSIONSAdjunct BF did not increase the frequency of home exercises performed by SUI patients.
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    Pelvic Floor 3D Ultrasound of Women with a TVT, TVT-O, or TVT-S for Stress Urinary Incontinence at the Three-year Follow-up
    (Federacao Brasileira Soc Ginecologia & Obstetricia-Febrasgo, 2017) Rodrigues, Claudinei A. [UNIFESP]; Bianchi-Ferraro, Ana Maria H. M. [UNIFESP]; Monteiro Zucchi, Eliana Viana [UNIFESP]; Sartori, Marair G. F. [UNIFESP]; Girao, Manoel J. B. C. [UNIFESP]; Jarmy-Di Bella, Zsuzsanna I. K. [UNIFESP]
    Objective Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of mid-urethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results. Methods A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVT-O), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student t-test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons. Results Differences among the groups were found in the mean angle of the tape arms (TVT = 119.94 degrees, TVT-O = 141.93 degrees, TVT-S = 121.06 degrees p < 0.001) and in the distance between the bladder neck and the tape at rest (TVT = 1.65 cm, TVT-O = 1.93 cm, TVT-S = 1.95 cm p = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8% p = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4% p = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVT-S = 89.2% p = 0.001), with a more distal location associated with obesity (distal: 66.7% obese mid-urethra: 34% obese p = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT-S = 21.6% p = 0.630). Conclusions The angle formed by the arms of the sling tape was more obtuse for the transobturator slings compared with the angles for the retropubic or single-incision slings. Retropubic slings were more frequently located in the mid-urethra compared with the other slings, regardless of obesity. However, the analyzed sonographic measures did not correlate with the urinary symptoms three years after the surgery.
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    Pelvic floor muscle training for overactive bladder symptoms - A prospective study
    (Assoc Medica Brasileira, 2017) Fitz, Fatima [UNIFESP]; Sartori, Marair [UNIFESP]; Girao, Manoel Joao [UNIFESP]; Castro, Rodrigo [UNIFESP]
    Introduction: Pelvic floor muscle training (PFMT) involves the contraction of the puborectal, anal sphincter and external urethral muscles, inhibiting the detrusor contraction, what justify its use in the treatment of overactive bladder (OAB) symptoms. Objective: To verify the effects of isolated PFMT on the symptoms of OAB. Method: Prospective clinical trial with 27 women with mixed urinary incontinence (MUI), with predominance of OAB symptoms and loss >= 2 g in the pad test. It was evaluated: pelvic floor muscles (PFMs) function (digital palpation and manometry)
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    Pudendal nerve latency time in normal women via intravaginal stimulation
    (Sociedade Brasileira de Urologia, 2006-12-01) Cavalcanti, Geraldo A. [UNIFESP]; Manzano, Gilberto Mastrocola [UNIFESP]; Giuliano, Lydia M. [UNIFESP]; Nobrega, João Antonio [UNIFESP]; Srougi, Miguel [UNIFESP]; Bruschini, Homero [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION & OBJECTIVES: Studies of motor conduction for the efferent functional assessment of the pudendal nerve in women with pelvic dysfunctions have been conducted through researching distal motor latency times. The transrectal approach has been the classic approach for this electrophysiological examination. The objective of the present study is to verify the viability of the transvaginal approach in performing the exam, to establish normal values for this method and to analyze the influence of age, stature and parity in the latency value of normal women. MATERIALS AND METHODS: A total of 23 volunteers without genitourinary pathologies participated in this study. In each, pudendal motor latency was investigated through the transvaginal approach, which was chosen due to patient s higher tolerance levels. RESULTS: The motor response represented by registering the M-wave was obtained in all volunteers on the right side (100%) and in 13 volunteers on the left side (56.5%). The mean motor latency obtained in the right and left was respectively: 1.99 ± 0.41 and 1.92 ± 0.48 milliseconds (ms). There was no difference between the sides (p = 0.66). Latency did not correlate with age, stature or obstetric history. The results obtained in the present study were in agreement with those found by other researchers using the transrectal approach. CONCLUSION: The vaginal approach represents an alternative for pudendal nerve distal motor latency time, with similar results to those achieved through the transrectal approach. Normative values obtained herein might serve as a comparative basis for subsequent physiopathological studies.
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    Pudendal somatosensory evoked potentials in normal women
    (Sociedade Brasileira de Urologia, 2007-12-01) Cavalcanti, Geraldo A. [UNIFESP]; Bruschini, Homero [UNIFESP]; Manzano, Gilberto Mastrocola [UNIFESP]; Nunes, Karlo Faria [UNIFESP]; Giuliano, Lydia M. [UNIFESP]; Nobrega, Joao Antonio [UNIFESP]; Srougi, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    OBJECTIVE: Somatosensory evoked potential (SSEP) is an electrophysiological test used to evaluate sensory innervations in peripheral and central neuropathies. Pudendal SSEP has been studied in dysfunctions related to the lower urinary tract and pelvic floor. Although some authors have already described technical details pertaining to the method, the standardization and the influence of physiological variables in normative values have not yet been established, especially for women. The aim of the study was to describe normal values of the pudendal SSEP and to compare technical details with those described by other authors. MATERIALS AND METHODS: The clitoral sensory threshold and pudendal SSEP latency was accomplished in 38 normal volunteers. The results obtained from stimulation performed on each side of the clitoris were compared to ages, body mass index (BMI) and number of pregnancies. RESULTS: The values of clitoral sensory threshold and P1 latency with clitoral left stimulation were respectively, 3.64 ± 1.01 mA and 37.68 ± 2.60 ms. Results obtained with clitoral right stimulation were 3.84 ± 1.53 mA and 37.42 ± 3.12 ms, respectively. There were no correlations between clitoral sensory threshold and P1 latency with age, BMI or height of the volunteers. A significant difference was found in P1 latency between nulliparous women and volunteers who had been previously submitted to cesarean section. CONCLUSIONS: The SSEP latency represents an accessible and reproducible method to investigate the afferent pathways from the genitourinary tract. These results could be used as normative values in studies involving genitourinary neuropathies in order to better clarify voiding and sexual dysfunctions in females.
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    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.
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    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.
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    Ultrasonographic and Doppler velocimetric evaluation of the levator ani muscle in premenopausal women with and without urinary stress incontinence
    (Elsevier B.V., 2007-08-01) Oliveira, Emerson; Castro, Rodrigo A.; Takano, Cldudia C.; Bezerra, Leonardo R. P. S.; Sartori, Marair G. F.; Lima, Geraldo R.; Baracat, Edmund C.; Girao, Manoel J. B. C.; Universidade Federal de São Paulo (UNIFESP)
    Objectives: the objective was to evaluate the cross-sectional area (CSA) and the Doppler velocimetric parameters of the levator am muscle vessels in premenopausal women with and without urinary stress incontinence.Study design: Sixty-three premenopausal women constituted three groups: GI (nulliparous), GII (continent multiparous), and Gill (incontinent multiparous). the patients had undergone transperineal ultrasound in which the CSA was measured and Doppler velocimetry was performed. the examination was repeated by a second observer using the same procedure.Results: There was a statistically significant correlation between the measurements of the observers I and II regarding all the parameters studied, except for the A/B ratio in Gill. the CSA was significantly greater in GI and GII than in Gill. As far as Doppler velocimetry is concerned there were no differences in the Doppler velocimetric indices among the three groups. Concerning the absent end diastolic shift, it was observed that there was a significantly greater incidence of such findings in GI + GII (continent women) towards GIII (incontinent women).Conclusions: the CSA evaluation and the Doppler velocimetry of the levator ani muscle vessels were highly reproducible. the CSA was higher in continent women and the frequency of the absent end diastolic shift was higher in incontinent women. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
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    Ultrassonografia 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.
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    Urethral sensory threshold and urethro-anal reflex latency in continent women
    (Springer, 2007-12-01) Cavalcanti, Geraldo de Aguiar; Bruschini, Homero; Manzano, Gilberto M.; Giuliano, Lydia P.; Nobrega, Joao Antonio M.; Srougi, Miguel; Universidade Federal de São Paulo (UNIFESP)
    Aims the sensory evaluation of the lower urinary tract is summarized in the bladder proprioceptive sensitivity during cystometry. Experimental studies suggest that abnormalities of the urethral innervation and micturition reflex can be related to the presence of continence disturbances. This study aimed to measure the urethral sensory threshold and the urethro-anal reflex latency in healthy volunteers, establishing reading criteria, comparing the results and technique used with the literature and verifying the effect of physiological factors.Materials and methods Thirty healthy female volunteers were studied. They had an absence of genital or urinary complaints and had undergone no previous pelvic or vaginal procedures. the measurement of the urethral sensory threshold and urethro-anal reflex latency were performed as described.Results the determination of the urethral sensory threshold and urethro-anal reflex latency were obtained in 96.6% of the volunteers. the electrophysiological parameters did not correlate with age, parity or number of vaginal deliveries. There was a positive association of the urethral sensory threshold with height. Technical aspects were considered and compared with those in the literature as well as the advantages and limitations of the method.Conclusions the measurement of the urethral sensory threshold and urethro-anal reflex latency presented consistent recordings. the urethral sensory threshold should be analyzed carefully in individuals with height above the population average. Subsequent observations are necessary to clarify their function in patients with continence disturbances and to measure the urethral function, but these values can be used as normal parameters for comparison.