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- ItemAcesso aberto (Open Access)Clinical and urodynamic evaluation in women with stress urinary incontinence treated by periurethral collagen injection(Sociedade Brasileira de Urologia, 2007-10-01) Martins, Sérgio Brasileiro [UNIFESP]; Oliveira, Emerson [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Lima, Geraldo Rodrigues de [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the success of treatment with periurethral collagen injections in patients suffering from stress urinary incontinence (SUI) with bladder neck hypermobility and intrinsic sphincter deficiency MATERIALS AND METHODS: Forty women suffering from (SUI) were selected and divided into GI (consisting of 13 women with SUI and bladder neck hypermobility) and GII (consisting of 27 women with SUI and intrinsic sphincter deficiency). Periurethral collagen was injected followed by a subjective evaluation (the need for urinary protectors) and an objective evaluation through urodynamic study before and after the treatment RESULTS: It was noticed that after 9 months there was a decrease in the need of urinary protectors in the two groups. It was observed through the urodynamic study that either cure or improvement was achieved in 46% in GI and 40.7% in GII. There was a significant increase in the leak pressure in GII. Moreover, there was a decrease in the volume of urine leak in the two groups, being the results in GII statistically significant CONCLUSIONS: It was concluded that the periurethral collagen injection is useful for the treatment of the SUI. The results in hypermobility are similar to those in intrinsic sphincter deficiency. In fact, it is a very simple out patient's procedure, with little side effects.
- ItemSomente MetadadadosConservative Treatment of Stress Urinary Incontinence: A Systematic Review with Meta-analysis of Randomized Controlled Trials(Federacao Brasileira Soc Ginecologia & Obstetricia-Febrasgo, 2016) Moroni, Rafael Mendes; Magnani, Pedro Sergio; Haddad, Jorge Milhem; Castro, Rodrigo de Aquino [UNIFESP]; Brito, Luiz Gustavo OliveiraWe performed a systematic review and meta-analysis of randomized controlled trials that studied the conservative management of stress urinary incontinence (SUI). There were 1058 results after the initial searches, from which 37 studies were eligible according to previously determined inclusion criteria. For the primary outcomes, pelvic floor muscle training (PFMT) was more efficacious than no treatment in improving incontinence-specific quality of life (QoL) scales (SMD = -1.24SDs; CI 95% = -1.77 to -0.71SDs). However, its effect on pad tests was imprecise. Combining biofeedback with PFMT had an uncertain effect on QoL (MD = -4.4 points; CI 95% = -16.69 to 7.89 points), but better results on the pad test, although with elevated heterogeneity (MD = 0.9g; 95% CI = 0.71 to 1,10g); group PFMT was not less efficacious than individual treatment, and home PFMT was not consistently worse than supervised PFMT. Both intravaginal and superficial electrical stimulation (IES and SES) were better than no treatment for QoL and pad test. Vaginal cones had mixed results. The association of IES with PFMT may improve the efficacy of the latter for QoL and pad test, but the results of individual studies were not consistent. Thus, there is evidence of the use of PFMT on the treatment of SUI, with and without biofeedback.
- ItemAcesso aberto (Open Access)Conservative Treatment of Stress Urinary Incontinence: A Systematic Review with Meta-analysis of Randomized Controlled Trials(Federacao Brasileira Soc Ginecologia & Obstetricia-Febrasgo, 2016) Moroni, Rafael Mendes; Magnani, Pedro Sergio; Haddad, Jorge Milhem; Castro, Rodrigo de Aquino [UNIFESP]; Brito, Luiz Gustavo OliveiraWe performed a systematic review and meta-analysis of randomized controlled trials that studied the conservative management of stress urinary incontinence (SUI). There were 1058 results after the initial searches, from which 37 studies were eligible according to previously determined inclusion criteria. For the primary outcomes, pelvic floor muscle training (PFMT) was more efficacious than no treatment in improving incontinence-specific quality of life (QoL) scales (SMD = -1.24SDs; CI 95% = -1.77 to -0.71SDs). However, its effect on pad tests was imprecise. Combining biofeedback with PFMT had an uncertain effect on QoL (MD = -4.4 points; CI 95% = -16.69 to 7.89 points), but better results on the pad test, although with elevated heterogeneity (MD = 0.9g; 95% CI = 0.71 to 1,10g); group PFMT was not less efficacious than individual treatment, and home PFMT was not consistently worse than supervised PFMT. Both intravaginal and superficial electrical stimulation (IES and SES) were better than no treatment for QoL and pad test. Vaginal cones had mixed results. The association of IES with PFMT may improve the efficacy of the latter for QoL and pad test, but the results of individual studies were not consistent. Thus, there is evidence of the use of PFMT on the treatment of SUI, with and without biofeedback.
- ItemSomente MetadadadosCorrelation between valsalva leak point pressure and maximal urethral closure pressure in women with stress urinary incontinence(Springer, 2004-06-01) Feldner, P. C.; Bezerra, LRPS; Castro, R. A. de; Sartori, MGF; Baracat, E. C.; Lima, G. R. de; Girao, MJBC; Universidade Federal de São Paulo (UNIFESP)This study analyzed the relationship between valsalva leak point pressure (VLPP) and maximal urethral closure pressure (MUCP) in women with stress urinary incontinence. One hundred sixty-one patients were selected with diagnosis of mixed or stress urinary incontinence. During urodynamics we measured VLPP and MUCP. Patients were gathered according to VLPP and analysis of variance (ANOVA) was performed. Pearson's correlation coefficient and linear regression were also utilized. the group with VLPP under 60 cm H2O had mean MUCP of 44.5 cm H(2)0; the group with VLPP between 60 and 90 cm H2O had mean MUCP of 54.3 cm H2O; and the group with VLPP over 90 cm H2O had mean MUCP of 60.1 cm H2O. We observed correlation between MUCP and VLPP when we used Pearson's correlation coefficient (r=0.22) and linear regression (p<0.05). There was weak correlation between MUCP and VLPP, and MUCP was significantly lower in patients with leak point pressure inferior to 60 cm H2O.
- ItemAcesso aberto (Open Access)Cross-cultural adaptation of the dysfunctional voiding score symptom (DVSS) questionnaire for Brazilian children(Sociedade Brasileira de Urologia, 2010-08-01) Calado, Adriano A. [UNIFESP]; Araujo, Eleazar M.; Barroso Junior, Ubirajara; Bastos Netto, Jose M.; Zerati Filho, Miguel; Macedo Junior, Antonio [UNIFESP]; Bagli, Darius; Farhat, Walid; Pernambuco State University Division of Pediatric Urology; Federal University of Bahia Division of Pediatric Urology; Federal University of Juiz de Fora Division of Pediatric Urology; Urology and Nephrology Institute Division of Pediatric Urology; Universidade Federal de São Paulo (UNIFESP); Hospital for Sick Children Division of Pediatric UrologyPURPOSE: To translate and culturally adapt the Dysfunctional Voiding Symptom Score (DVSS), questionnaire into Brazilian Portuguese. MATERIALS AND METHODS: The 10-item Dysfunctional Voiding Symptom Score (DVSS) was translated into Brazilian Portuguese according to a standard methodology: translation, synthesis, back-translation, Expert Committee, and pre-testing. After the translation process the final version was pre-tested and patient responses were analyzed to identify necessary modifications. Reliability was evaluated using the test-retest method, and internal consistency was assessed using Cronbach’s alpha. RESULTS: The Cronbach’s alpha coefficient was calculated in the test and retest phases. Internal consistency was found to be satisfactory, as confirmed by a Cronbach’s alpha coefficient of 0.76 for the test and 0.77 for the retest. A high degree of stability was found in the test/retest, with an intraclass correlation coefficient (ICC) of 0.960 (p < 0.001; 95% CI: 0.943-0.972). CONCLUSION: The cross-cultural adaptation process of the Dysfunctional Voiding Symptom Score questionnaire to be used on Brazilian children was successfully completed following internationally accepted methodologies.
- ItemAcesso aberto (Open Access)Development of a rabbit's urethral sphincter deficiency animal model for anatomical-functional evaluation(Sociedade Brasileira de Urologia, 2012-02-01) Skaff, M. [UNIFESP]; Pinto, E.r.s. [UNIFESP]; Leite, Kátia Ramos Moreira [UNIFESP]; Almeida, F.g. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The aim of the study was to develop a new durable animal model (using rabbits) for anatomical-functional evaluation of urethral sphincter deficiency. MATERIALS AND METHODS: A total of 40 New Zealand male rabbits, weighting 2.500 kg to 3.100 kg, were evaluated to develop an incontinent animal model. Thirty-two animals underwent urethrolysis and 8 animals received sham operation. Before and at 2, 4, 8 and 12 weeks after urethrolysis or sham operation, it was performed cystometry and leak point pressure (LPP) evaluation with different bladder distension volumes (10, 20, 30 mL). In each time point, 10 animals (8 from the study group and 2 from the sham group) were sacrificed to harvest the bladder and urethra. The samples were evaluated by H&E and Masson's Trichrome to determine urethral morphology and collagen/smooth muscle density. RESULTS: Twelve weeks after urethrolysis, it was observed a significant decrease in LPP regardless the bladder volume (from 33.7 ± 6.6 to 12.8 ± 2.2 cmH2O). The histological analysis evidenced a decrease of 22% in smooth muscle density with a proportional increase in the collagen, vessels and elastin density (p < 0.01). CONCLUSIONS: Transabdominal urethrolysis develops urethral sphincter insufficiency in rabbits, with significant decrease in LPP associated with decrease of smooth muscle fibers and increase of collagen density. This animal model can be used to test autologous cell therapy for stress urinary incontinence treatment.
- ItemSomente MetadadadosDoes valsalva leak point pressure predict outcome after the distal urethral polypropylene sling? Role of urodynamics in the sling era(Lippincott Williams & Wilkins, 2004-07-01) Rodriguez, Larissa V.; Almeida, Fernando Gonçalves de [UNIFESP]; Dorey, Frederick; Raz, Shlomo; Univ Calif Los Angeles; Universidade Federal de São Paulo (UNIFESP)Purpose: Recently sling procedures have been shown to be effective in the treatment of all types of incontinence. in this study we evaluated the role of preoperative Valsalva leak point pressure (VLPP) in predicting the outcome of sling surgery.Materials and Methods: We prospectively evaluated 174 consecutive patients who underwent a distal polypropylene sling procedure for the treatment of stress urinary incontinence (SUI). Using SEAPI scores patients were divided by VLPP into group 1-60 patients who did not leak on urodynamics, group 2-27 patients with VLPP greater than 80 cm H2O, group 3-71 patients with VLPP 30 to 80 cm H2O and group 4-16 patients with VLPP less than 30 cm H2O. Surgical outcomes were determined by symptom, bother and quality of life questionnaires filled out by patients. the physicians were blinded to patient response.Results: Mean followup was 14.7 months (range 12 to 30) and mean patient age was 62 years (range 32 to 88). the groups were well matched before surgery with respect to age, number of previous surgeries, and severity of SUI symptoms and urge incontinence. the percentage of patients who were cured or improved was similar among groups. After surgery there was no statistical difference among patient mean self-reported symptoms of or bother from SUI or urge incontinence.Conclusions: the distal urethral polypropylene sling provides similar symptom improvement in all patients regardless of preoperative VLPP. VLPP is helpful in the diagnosis of SUI but appears to be of minimal benefit in predicting the outcome of the distal urethral polypropylene sling procedure.
- ItemAcesso aberto (Open Access)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 FIEOSurface 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.
- ItemSomente MetadadadosIncidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence(Federacao Brasileira Soc Ginecologia & Obstetricia-Febrasgo, 2017) Hirakauva, Elizabeth Yukie [UNIFESP]; Homem de Mello Bianchi-Ferraro, Ana Maria [UNIFESP]; Monteiro Zucchi, Eliana Viana [UNIFESP]; Kajikawa, Marcio Massashi [UNIFESP]; Batista Castello Girao, Manoel Joao [UNIFESP]; Ferreira Sartori, Marair Gracio [UNIFESP]; Katalin de Jarmy-Di Bella, Zsuzsanna Ilona [UNIFESP]Introduction The presence of bacteria in urine is called bacteriuria, which may be symptomatic or asymptomatic. The manipulation of the urinary tract during urodynamic study (UDS), which is an invasive procedure, can result in urinary tract infection (UTI). Studies on the use of prophylactic antibiotics for UDSs are contradictory. Some investigators concluded that they were valuable and others did not. The objective of this study is to evaluate the efficacy of antibiotic prophylaxis before UDS. This is a placebo-control randomized double-blind study. Methods Two-hundred and seventeen women affected by urinary incontinence were eligible for this study. All patients had presented negative urine culture previous to the UDS. They were randomized in four groups: group A received placebo, group B received 500 mg of levofloxacin, group C received 80 mg trimethoprim and 400 mg sulfamethoxazole and group D received 100 mg of nitrofurantoin. A urine culture was performed 14 days after the UDS. Results We observed asymptomatic bacteriuria after the UDS in five patients in group A, one in group B, one in group C and one in group D. Only one patient on group A had symptomatic bacteriuria. We didn't observe statistical difference between the groups. When we recategorized the patients in two groups, the incidence of bacteriuria was significantly higher in the placebo group compared with the antibiotic group. Conclusion The conclusion is that antibiotic prophylaxis before the UDS did not reduce the incidence of UTI in women within the target population.
- ItemSomente MetadadadosThe influence of bladder neck mucosal eversion and early urinary extravasation on patient outcome after radical retropubic prostatectomy: a prospective controlled trial(Blackwell Publishing Ltd, 2005-04-01) Srougi, Miguel [UNIFESP]; Paranhos, Mario [UNIFESP]; Leite, Kátia Ramos Moreira [UNIFESP]; Dall'Oglio, Marcos Francisco [UNIFESP]; Nesrallah, Luciano João [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)To evaluate the role of bladder neck (BN) mucosal eversion during retropubic radical prostatectomy (RRP) on the rate of BN sclerosis and urinary incontinence, with the hypothesis that BN mucosal eversion is not essential to improve the clinical outcome after RRP.One hundred patients with stage T1c-T2c prostate cancer had RRP by the same surgeon and were randomly divided in two equal groups; one had a vesico-urethral anastomosis with and one with no BN mucosal eversion. the patients were assessed by retrograde cysto-urethrography 4 days after surgery to evaluate the presence of urinary leakage. the occurrence of BN sclerosis and the rate of urinary incontinence (more than one pad/day) was assessed by double-blind interviews at 2 days, 2 months and 6 months after catheter removal, and the incidence of BN sclerosis was also assessed after 12 months.In the groups with or with no BN mucosal eversion, 48 and 47 patients, respectively, fulfilled the selection criteria. Urinary leakage after vesico-urethral anastomosis was more common after mucosal eversion (33% vs 21%), but not significantly (P = 0.251). BN sclerosis occurred in only one patient, with no mucosal eversion. the rate of urinary continence was similar in both groups at 2 days (69% vs 68%, respectively), 2 months (90% vs 87%) and 6 months (92% vs 92%) after surgery. Urinary extravasation at 4 days after surgery was followed by same rate of BN sclerosis and urinary continence as in patients with no urinary extravasation.BN mucosal eversion before vesico-urethral anastomosis during RRP is not essential to reduce the frequency of BN sclerosis or urinary incontinence. Early radiological urinary extravasation at the vesico-urethral anastomosis did not increase the risk of BN sclerosis or urinary incontinence.
- ItemSomente MetadadadosIntravesical resiniferatoxin for the treatment of women with idiopathic detrusor overactivity and urgency incontinence: A single dose, 4 weeks, double-blind, randomized, placebo controlled trial(Wiley-Blackwell, 2007-01-01) Rios, Luis Augusto Seabra [UNIFESP]; Panhoca, Renato; Mattos, Dernerval; Srougi, Miguel [UNIFESP]; Bruschini, Hornero [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Serv Publ Estadual São PauloAims: To assess the hypothesis that resiniferatoxin (RTX) can be useful in women with urgency incontinence and idiopathic detrusor overactivity (IDO), we conducted a prospective, double-blind, randomized, placebo-controlled, parallel trial comparing the effects of RTX and placebo. Materials and Methods: Fifty-eight patients were randomly assigned to receive a single intravesical dose of 100 ml of either RTX 50 nM or placebo. Safety and efficacy were evaluated over 4 weeks. the primary efficacy endpoints were voiding symptoms evaluated through the voiding diary. Secondary efficacy endpoint was urodynamic response. Quality of life was measured by the Kings' Health Questionnaire Results: Although improving trends were seen in both groups after the instillations, no statistically significant differences were found between the groups in any of the clinical or urodynamic parameters. RTX instillations were well tolerated with few and self-limited side-effects. Conclusion: A single 50 nM intravesical dose of RTX was not better than placebo for the treatment of women with IDO and urgency incontinence.
- ItemAcesso aberto (Open Access)Magnetic resonance imaging urodynamics: technique development and preliminary results(Sociedade Brasileira de Urologia, 2006-06-01) Borghesi, Gustavo [UNIFESP]; Simonetti, Rogerio [UNIFESP]; Goldman, Suzan M. [UNIFESP]; Szejnfeld, Jacob [UNIFESP]; Srougi, Miguel [UNIFESP]; Ortiz, Valdemar [UNIFESP]; Bruschini, Homero [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: In this preliminary study we report the development of the video urodynamic technique using magnetic resonance imaging (MRI). MATERIALS AND METHODS: We studied 6 women with genuine stress urinary incontinence, diagnosed by history and physical examination. Urodynamic examination was performed on multichannel equipment with the patient in the supine position. Coughing and Valsalva maneuvers were performed at volumes of 150, 250 and 350 mL. Simultaneously, MRI was carried out by using 1.5 T GE Signa CV/i high-speed scanner with real time fluoroscopic imaging possibilities. Fluoroscopic imaging was accomplished in the corresponding planes with T2-weighted single shot fast spin echo sequences at a speed of about 1 frame per second. Both studies were recorded and synchronized, resulting in a single video urodynamic examination. RESULTS: Dynamic MRI with cine-loop reconstruction of 1 image per second demonstrated the movement of all compartment of the relaxed pelvis during straining with the concomitant registration of abdominal and intravesical pressures. In 5 patients, urinary leakage was demonstrated during straining and the Valsalva leak point pressure (VLPP) was determined as the vesical pressure at leak subtracted from baseline bladder pressure. Mean VLPP was 72.6 cm H2O (ranging from 43 to 122 cm H2O). CONCLUSIONS: The concept of MRI video urodynamics is feasible. In a clinical perspective, practical aspects represent a barrier to daily use and it should be recommended for research purposes.
- ItemSomente MetadadadosOrthotopic ileal neobladder: the influence of reservoir volume and configuration on urinary continence and emptying properties(Blackwell Publishing Ltd, 2004-02-01) Nesrallah, Luciano João [UNIFESP]; Srougi, Miguel [UNIFESP]; Dall'Oglio, Marcos Francisco [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVETo evaluate the influence of the volume and configuration of the neobladder on urinary continence and reservoir emptying in orthotopic urinary reservoirs using intestinal segments for bladder replacement after radical cystectomy.PATIENTS and METHODSFifty-nine patients who had had a radical cystectomy and urinary reconstruction with an orthotopic ileal neobladder were followed for greater than or equal to 1 year; 27 (group 1) had the ileal neobladder created with a shorter intestinal segment (40 cm) in an elongated shape ('J'), and 32 (group 2) had their reservoir made more spherical with a longer ileal loop (60-65 cm). the rates of urinary continence, enuresis, neobladder capacity and postvoid residual urine were evaluated first at 3-6 months and again 1 year after surgery in both groups.RESULTSAt 3-6 months after surgery urinary incontinence and enuresis were more common in group 1, but at 1 year had the same frequency in both groups, at respectively 11% and 44% in group 1, and 13% and 47% in group 2 (P > 0.05). the neobladder capacity and postvoid residual urine were significantly higher in group 2, at > 600 mL and > 100 mL, respectively, in 14% and 14% of the patients in group 1 and 57% and 52% of those in group 2 (P < 0.05). Urinary retention requiring intermittent catheterization did not occur in group 1 but did in 19% of group 2.CONCLUSIONThe orthotopic spherical ileal neobladder with a large initial volume is apparently not associated with better continence rates and is prone to developing progressive enlargement, which can lead to neobladder atony and progressive emptying failure, increasing the chance of complete urinary retention.
- ItemSomente MetadadadosOutpatient 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.
- ItemAcesso aberto (Open Access)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.
- ItemAcesso aberto (Open Access)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)
- ItemSomente MetadadadosA populational-based survey on the prevalence, incidence, and risk factors of urinary incontinence in older adults-results from the "SABE STUDY"(Wiley, 2018) Nunes Tamanini, Jose Tadeu [UNIFESP]; Pallone, Leticia Valerio; Ferreira Sartori, Marair Gracio [UNIFESP]; Batista Castello Girao, Manoel Joao [UNIFESP]; Ferreira dos Santos, Jair Licio; de Oliveira Duarte, Yeda Aparecida; van Kerrebroeck, Philip E. V. A.AimsTo estimate the prevalence and incidence of urinary incontinence (UI) and identify the associated risk factors in a cohort of elderly individuals in Brazil. MethodsIn 2006, individuals aged 60 years were selected from the SABE Study (Health, Well-being, and Aging). The dependent variable was reported UI in 2009. UI was assessed using the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form (ICIQ-UI SF). Incidence was measured in units of 1000 person-years, and Cox regression was applied for data analysis. Multivariate analysis was used to assess risk factors for UI. Incidence risk ratio (IRR) was used for comparison. ResultsThis is the first study to examine the incidence of UI in Brazilian elderly individuals. In total, 1413 individuals were included; the mean age was 74.5 years, and 864 (61.8%) participants were female. The risk of UI was greater among women with cancer (other than skin) and among those with diabetes. In men, the risk of UI was greater for those in Instrumental Activities of Daily Living (IADL) category 5-8 and those who self-reported a fair health status. The prevalence of UI was 14.2% and 28.2% for men and women, respectively. The incidence rate of UI was 25.6 and 39.3 (x1000 person-years) for men and women, respectively. ConclusionsThe incidence rate of UI among older adults in the Brazilian community was high for elderly individuals. The identified risk factors were diabetes and IADL category 5-8 (women) as well as cancer (other than skin) and self-reported health status (male).
- ItemSomente MetadadadosPower Doppler of the urethra in continent or incontinent, pre- and postmenopausal women(Springer, 2000-06-01) Jarmy-Di Bella, ZIK; Girao, MJBC; Sartori, MFG; Di Bella, V; Lederman, H. M.; Baracat, E. C.; Lima, G. R.; Universidade Federal de São Paulo (UNIFESP)Urethral pressure should exceed bladder pressure, both at rest and on stress, for urinary continence to occur. A decrease in urethral pressure is a major factor explaining the pathogenesis of urinary incontinence. A number of elements, such as smooth and striated periurethral muscles, and connective, vascular and elastic tissues, contribute to urethral pressure. the periurethral vessels are influenced by hormonal changes during the menstrual cycle, during pregnancy and postmenopause. We studied the periurethral vessels in 97 women, 57 of whom were incontinent and 40 continent, using power color Doppler velocimetry. the number of periurethral vessels, systolic peak, minimum diastolic values, pulsatility and resistance indexes, as well as systolic-diastolic ratio, were assessed. Statistically significant differences were found between incontinent women in the premenopausal period and those in the postmenopausal period, regarding the number of periurethral vessels, systolic peak, minimum diastolic values, pulsatility and resistance indexes.
- ItemSomente MetadadadosProspective randomized comparison of oxybutynin, functional electrostimulation, and pelvic floor training for treatment of detrusor overactivity in women(Springer, 2008-08-01) Arruda, Raquel M. [UNIFESP]; Castro, Rodrigo A. [UNIFESP]; Sousa, Gabriela C. [UNIFESP]; Sartori, Marair G. F. [UNIFESP]; Baracat, Edmund C. [UNIFESP]; Girao, Manoel J. B. C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The purpose of this study is to compare the effectiveness of oxybutynin, functional electrostimulation (FES), and pelvic floor training (PFT) for treatment of women with detrusor overactivity. Sixty-four subjects were randomized to oxybutynin (n = 22), FES (n = 21), or PFT (n = 21). Women were evaluated before and after completion of 12 weeks of treatment by subjective response, voiding diary, and urodynamic test. There was subjective symptomatic improvement in 77% of the women treated with oxybutynin, 52% with FES, and 76% with PFT. Urgency resolved in 64% of women treated with oxybutynin, 52% with FES, and in 57% with PFT. Urodynamic evaluation was normal in 36% treated with oxybutynin, 57% with FES, and 52% with PFT. Maximum detrusor involuntary contraction pressure decreased in all groups (p < 0.05). All treatments were equally effective. Subjective reduction of urge-incontinence episodes was associated with symptomatic improvement.
- ItemAcesso aberto (Open Access)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.