Management of stress urinary incontinence with surface electromyography-assisted biofeedback in women of reproductive age.

BACKGROUND AND PURPOSE: Although surgery has been widely accepted as the treatment of choice for stress urinary incontinence (SUI), there has recently been an increased interest in the conservative management of this condition. The aims of this study were to test the ability of a biofeedback-assisted pelvic-floor muscle exercise (PFME) program to affect symptoms of SUI in premenopausal women and to evaluate a training program that might lead to successful outcomes in a relatively limited number of sessions. SUBJECTS: Twenty-six women with SUI were treated with PFME with surface electromyography (sEMG)-assisted biofeedback. All participants were of reproductive age and were treated individually for 12 sessions. METHODS: results were evaluated with a 7-day voiding diary, a 1-hour pad test, pelvic-floor muscle strength measurements, sEMG amplitudes, a leakage index, and a quality-of-life questionnaire. These variables were compared before and after the intervention. RESULTS: The frequency of urine loss, the occurrence of nocturia, and the number of pads required decreased significantly after the intervention. Objective cure was found in 61.5% of women. There was a significant improvement in the quality of life, in pelvic-floor muscle strength, and in the sEMG amplitudes of all contractions throughout the intervention. DISCUSSION AND CONCLUSION: A relatively short-term intervention of PFME with sEMG-assisted biofeedback appeared to be helpful in relieving symptoms of SUI in premenopausal women and represents a reasonable conservative management option.

Ligadura tubária: estudo de duas vias (abdominal e vaginal) / Tubal ligation: study of vaginal and abdominal routes

A laqueadura tubária é bastante difundida como método anticoncepcional. Existe uma tendência de realizar-se este procedimento durante a operaçao cesariana, com aumento do risco de complicaçoes, tanto para a gestante como para o recém-nascido. Este trabalho, realizado no Departamento de Tocoginecologia do Centro de Atençao Integral à Saúde da Mulher-Unicamp, revisou 340 casos de laqueadura fora do ciclo gravídico-puerperal ocorridos no período de novembro de 1989 a julho de 1991. Foram comparadas as vias vaginal e abdominal quanto à idade, paridade, indicaçao de laqueadura, antecedentes cirúrgicos, operaçoes concomitantes, tempo da cirurgia e da internaçao e complicaçoes no intra e pós-operatório imediato. A via vaginal mostrou-se mais vantajosa quando analisados o tempo cirúrgico e o de internaçao. Os autores concluem que se deve dar preferência à via vaginal quando nao houver contra-indicaçao e quando for necessária a realizaçao de outra cirurgia vaginal concomitante.