Chemoradiation for cervical cancer treatment portends high risk of pelvic floor dysfunction.

GOAL: To assess the impact of chemoradiation on pelvic floor (PF) muscle function after the treatment of cervical cancer (CC). METHODS: We performed a prospective cohort study of women between the ages of 20 and 70 years old who had a diagnosis of CC. Patients were treated with chemoradiation at the Barretos Cancer Hospital (BCH), between August 2016 and July 2017. We performed three evaluations at different time points after chemoradiation treatment to compare changes in muscle function. Pelvic floor muscle function was assessed through perineometry (PNM) and surface electromyography (EMG) at the following time points: Pretreatment Moment 1 (M1): evaluated before chemoradiation; Moment 2 (M2): at the first follow-up medical visit (usually 3 to 4 months after treatment); and Moment 3 (M3): at the second follow-up medical visit (usually after 6 to 9 months after treatment). Mean vaginal squeeze pressure levels were determined by PNM and muscle electromyographic activity by EMG and the results were evaluated by Generalized Linear Model comparisons. RESULTS: Forty-nine patients were evaluated at M1; 35 at M2; and 32 at M3, so that 32 patients had all three muscle evaluations performed. There was a statistically significant increase in the frequency of women with urgency urinary incontinence at the M2 evaluation time (41.9%), compared to pretreatment M1 (18.6%), p<0.001. The means of the vaginal squeeze pressures reduced through M1 to M3 in the phasic (M1: 17.7 mmHg; M3: 11.27mmHg) and tonic contractions (M1: 10.56 mmHg; M3: 7.52mmHg), p = 0.01 and p = 0.03 respectively. There was no difference in pelvic floor function in the three evaluations M1-M3, measured by EMG. The pelvic floor strength assessed by PMN and their interactions with anthropometric, parity and hormonal status variables, showed that a high body mass index (BMI) significantly influenced decreases in pelvic floor muscle function before and after treatment. CONCLUSION: These results show that chemoradiation causes reduction of muscle function of the pelvic floor, especially in the late phase after the end of treatment. Both the high BMI and urgent urinary incontinence symptoms were related to decreased muscle strength.

Pelvic floor muscle training and electrical stimulation as rehabilitation after radical prostatectomy: a randomized controlled trial.

[Purpose] To investigate the effect of electrical stimulation and pelvic floor muscle training on muscle strength, urinary incontinence and erectile function in men with prostate cancer treated by radical prostatectomy. [Subjects and Methods] One hundred twenty-three males were randomized into 3 groups 1 month after RP: (G1, n=40) control; (G2, n=41) guideline: patients were instructed to perform three types of home exercises to strengthen the pelvic floor and (G3, n=42) electrical stimulation: patients in this group were also instructed to perform exercises as group G2, and also received anal electro-stimulation therapy, twice a week for 7 weeks. The primary outcome assessment was based on the measurement of the recovery of pelvic floor muscle strength between groups. Secondary outcomes were: 1 hour Pad Test, ICIQ-SF, IIEF-5 and IPSS. Data were obtained preoperatively and at 1, 3 and 6 months after surgery. [Results] There was no significant difference in the demographic data among groups. Greater urinary leakage and pelvic floor muscle weakness in the first month compared to pre treatment improved after 3 and 6 months postoperative, without difference among groups. [Conclusion] The muscle strength recovery occurs independently of the therapy employed. Pelvic floor exercises or electrical stimulation also did not have an impact on the recovery of urinary continence and erectile function in our study.

Arm lymphoscintigraphy after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer.

PURPOSE: Compare the lymphatic flow in the arm after breast cancer surgery and axillary lymph node dissection (ALND) versus sentinel lymph node biopsy (SLNB) using lymphos-cintigraphy (LS). PATIENTS AND METHODS: A cross-sectional study with 39 women >18 years who underwent surgical treatment for unilateral breast cancer and manipulation of the axillary lymph node chain through either ALND or SLNB, with subsequent comparison of the lymphatic flow of the arm by LS. The variables analyzed were the area reached by the lymphatic flow in the upper limb and the sites and number of lymph nodes identified in the ALND or SLNB groups visualized in the three phases of LS acquisition (immediate dynamic and static images, delayed scan images). For all analyses, the level of significance was set at 5%. RESULTS: There was a significant difference between the ALND and SLNB groups, with predominant visualization of lymphatic flow and/or lymph nodes in the arm and axilla (P=0.01) and extra-axillary lymph nodes (P<0.01) in the ALND group. There was no significant difference in the total number of lymph nodes identified between the two groups. However, there was a significant difference in the distribution of lymph nodes in these groups. The cubital lymph node was more often visualized in the immediate dynamic images in the ALND group (P=0.004), while the axillary lymph nodes were more often identified in the delayed scan images of the SLNB group (P<0.01). The deltopectoral lymph node was only identified in the ALND group, but with no significant difference. CONCLUSION: The lymphatic flow from the axilla was redirected to alternative extra-axillary routes in the ALND group.

Results of preoperative electrical stimulation of pelvic floor muscles in the continence status following radical retropubic prostatectomy.

PURPOSE: To evaluate preoperative rectal electrical stimulation in the recovery of urinary continence in patients who undergo radical retropubic prostatectomy. MATERIALS AND METHODS: Patients were divided into 3 randomized groups: control, pelvic exercises, and electrical stimulation. A 1 hour pad-test, the ICIQ-SF, and the SF-36 were performed 1, 3, and 6 months after the surgical procedure. RESULTS: Of the 58 patients who were initially included in the study, 9 were excluded due to radiotherapy after surgical intervention, an indwelling urethral catheter for more than 30 days, high surgical risk, loss of follow-up, or incomplete participation in the study routines and spontaneous interruption. Forty-nine patients concluded the study (15 in the control group, 17 in the exercise group, and 17 in the electrical stimulation group). We did not observe any significant difference in the pad test (p > 0.05), the 8 domains of the SF-36, or ICIQ-SF score compared with control groups (control, exercise, and electrical stimulation). CONCLUSION: Preoperative rectal electrical stimulation has no impact on continence status in patients who undergo radical retropubic prostatectomy. There is no difference in the three above mentioned groups with regard to urinary leakage and quality of life.

Results of preoperative electrical stimulation of pelvic floor muscles in the continence status following radical retropubic prostatectomy

Purpose To evaluate preoperative rectal electrical stimulation in the recovery of urinary continence in patients who undergo radical retropubic prostatectomy. Materials and Methods Patients were divided into 3 randomized groups: control, pelvic exercises, and electrical stimulation. A 1 hour pad-test, the ICIQ-SF, and the SF-36 were performed 1, 3, and 6 months after the surgical procedure. Results Of the 58 patients who were initially included in the study, 9 were excluded due to radiotherapy after surgical intervention, an indwelling urethral catheter for more than 30 days, high surgical risk, loss of follow-up, or incomplete participation in the study routines and spontaneous interruption. Forty-nine patients concluded the study (15 in the control group, 17 in the exercise group, and 17 in the electrical stimulation group). We did not observe any significant difference in the pad test (p > 0.05), the 8 domains of the SF-36, or ICIQ-SF score compared with control groups (control, exercise, and electrical stimulation). Conclusion Preoperative rectal electrical stimulation has no impact on continence status in patients who undergo radical retropubic prostatectomy. There is no difference in the three above mentioned groups with regard to urinary leakage and quality of life. .