Urinary incontinence, overactive bladder, and quality of life in women submitted to total hip replacement.

INTRODUCTION AND HYPOTHESIS: Hip osteoarthritis (OA) compromises functioning. Total hip replacement (THR) is the indicated treatment and may improve urinary incontinence (UI) and symptoms of overactive bladder (OAB). OBJECTIVES: Assess UI, OAB symptoms, and quality of life (QoL) impact in preoperative and postoperative periods of women submitted to THR and investigate associated factors. METHODS: A prospective cohort was conducted with 183 women submitted to THR. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB) and SF-12 questionnaires were administered pre- and 3 and 6 months after surgery. RESULTS: Significant improvements were found in UI and QoL 3- and 6-month postoperatively in the overall sample and in the subgroup with preoperative UI. The multivariate regression revealed that the preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI 6-month postoperatively. The factors the best predicted the occurrence of UI 6-month following THR were the preoperative ICIQ-OAB scores and preoperative UI. Each unit of increase in the ICIQ-OAB increases the chances of UI by 26.9% and preoperative UI increases the chances of postoperative UI by 18.7-fold. A weak but significant negative correlation was found between the ICIQ-SF score and the SF-12 score. CONCLUSION: Significant improvements in UI, OAB and QoL were found at 3- and 6-month postoperatively. Preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI at 6 months after surgery. We found significant association between urinary symptoms and THR, but this association is partially explained by current literature.

Fecal incontinence: incidence and risk factors from the SABE (Health, Wellbeing and Aging) study.

INTRODUCTION AND HYPOTHESIS: This study aimed to estimate the incidence of fecal incontinence (FI) and identify risk factors in a cohort of older individuals. METHODS: In 2006, individuals aged ≥ 60 years were selected from the SABE study. The dependent variable was FI in 2010. FI was assessed using the question: "In the last 12 months, have you ever lost control of bowel movements or stools?" Incidence was measured in units of per 1000 person-years. Multivariate analysis was used to assess risk factors for FI. RESULTS: This study was the first to examine the incidence of FI in older Brazilian individuals. In total, 1413 individuals were included; mean age was 74.5 years, and 864 (61.8%) participants were women. FI prevalence rates were 4.7% for men and 7.3% for women. Incidence rate of FI was 16.3 and 22.2 per 1000 person-years for men and women, respectively. The risk of FI was greater among women aged ≥ 75 years, with severe symptoms of depression, cancer (other than skin) and chronic obstructive pulmonary disease (COPD). In men, the risk of FI was greater among those with poor literacy (up to 3 years of schooling), an Instrumental Activities of Daily Living (IADL) category of 1-4 and those who self-reported "bad/very bad" health status. CONCLUSIONS: The FI incidence rate was high. The identified risk factors were age ≥ 75 years, with severe symptoms of depression, cancer and COPD (women); having up to 8 years of schooling; IADL category of 1-4 and self-reported health status (men).

Pooled incidence of continuation and pregnancy rates of four contraceptive methods in young women: a meta-analysis.

BACKGROUND: Continuation rates of contraceptive methods in young women vary among studies, and there is scarce data regarding the pregnancy rate in this population. METHODS: Four independently systematic searches were performed in PUBMED, EMBASE, LILACS, and Cochrane databases from inception until January 2021 for oral contraceptive pill (OCP), copper IUD, levonorgestrel intrauterine system (LNG-IUS), and subdermal implant. Inclusion criteria were observational or RCT studies that reported continuation for at least 12 months and/or pregnancy rate of these contraceptives methods in girls aged 22 years old or younger. Two authors extracted data from the study design and the outcomes. Pooled proportions of each method were applied using the inverse variance in all calculations with LOGIT transformation, using the random-effects model. Cochrane collaboration tool and New Castle-Ottawa were used to assess the quality and bias of all included studies. GRADE criteria evaluated the quality of evidence. RESULTS: Continuation rate for OCP was 51% (95%CI 34%-68%), while for cooper IUD was 77% (95%CI 74%-80%), LNG-IUS 84% (95%CI 80%-87%), and implant 85% (95%CI 81%-88%). The pooled estimated pregnancy rate for OCP was 11% (95%CI 6%-20%), while for cooper IUD was 5% (95%CI 3%-7%), LNG-IUS 1.6% (95%CI 1.2%-2.3%), and implant 1.8% (95%CI 0.4%-8.4%). CONCLUSION: Long-acting contraceptive methods presented higher continuation rates and lower pregnancy rates when compared to OCPs.

Current evidence of contraceptive uptake, pregnancy and continuation rates in young women: a systematic review and Meta-analysis.

OBJECTIVE: Half of all pregnancies worldwide are unintended, and the rate is even higher in women aged ≤25 years. We sought to identify which method of contraception was the most effective option to prevent unintended pregnancy in young women and adolescents. METHODS: Systematic searches, without language restrictions, were carried out of the PubMed, Embase, Lilacs and Cochrane databases from inception to July 2020. Abstracts and full-text articles of observational studies and randomised controlled trials comparing the use of multiple methods of long-acting reversible contraception (LARC) and short-acting reversible contraception (SARC) in young women and adolescents were screened and reviewed. Risk ratios (RRs) and mean differences with their 95% confidence interval (CI) were derived using a random-effects meta-analytical model. Meta-analyses provided pooled estimates for adverse events, continuation rates and efficacy of LARC methods in young women and adolescents. Nine of the 25 included studies compared LARC with SARC, and 16 compared LARC methods only. RESULTS: At 12 months, young women had better adherence with LARC compared with SARC (n = 1606; RR 1.60; 95% CI 1.21, 2.12; I 2 = 88%), which suggests a better unintended pregnancy prevention outcome for young women. However, more young women chose SARC (n = 2835; RR 0.37; 95% CI 0.17, 0.80; I 2 = 99%). Pregnancy during LARC use was rare. CONCLUSION: LARC methods are the most efficacious in preventing pregnancy, and women should be informed of this if pregnancy prevention is their priority. The evidence, however, is of low quality. PROSPERO REGISTRATION NUMBER: CRD42017055452.

A populational-based survey on the prevalence, incidence, and risk factors of urinary incontinence in older adults-results from the "SABE STUDY".

AIMS: To estimate the prevalence and incidence of urinary incontinence (UI) and identify the associated risk factors in a cohort of elderly individuals in Brazil. METHODS: In 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. RESULTS: This 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 (×1000 person-years) for men and women, respectively. CONCLUSIONS: The 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).

Pregnancy and herbal medicines: An unnecessary risk for women's health-A narrative review.

The indiscriminate use of herbal medicines to prevent or to heal diseases or even the use for questionable purposes such as weight loss has received both interest and scrutiny from the scientific community and general public alike. An increasing number of women put their own and the unborn child's health at risk due to a lack of knowledge about the phytochemical properties and adequate use of herbal medicine (phytomedicines or herbal supplements) and lack of communication with their healthcare provider. The purpose of this narrative review was to summarize the use of herbal medicines during pregnancy and their potential toxic effects to highlight the importance of caution when prescribing herbal medicines or supplements for women, because, in addition to suffering interactions and a great amount of information obtained in preclinical predictive studies, assessment of nephrotoxicity, neurotoxicity, hepatotoxicity, genotoxicity, and teratogenicity of traditional medicinal herbs still remains scarce in the clinical setting.

Outpatient biofeedback in addition to home pelvic floor muscle training for stress urinary incontinence: a randomized controlled trial.

AIMS: To 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). METHODS: 72 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 <2 g 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. RESULTS: It 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). CONCLUSIONS: Adjunct BF did not increase the frequency of home exercises performed by SUI patients.

Effectiveness of adding voluntary pelvic floor muscle contraction to a Pilates exercise program: an assessor-masked randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to evaluate the effectiveness of adding voluntary pelvic floor muscle contraction (PFMC) to a Pilates exercise program in sedentary nulliparous women. METHODS: Fifty-seven healthy nulliparous and physically inactive women were randomized to a Pilates exercise program (PEP) with or without PFMC. Forty-eight women concluded this study (24 participants for each group). Each woman was evaluated before and after the PEP, by a physiotherapist and an urogynecologist (UG). Neither of the professionals was revealed to them. This physiotherapist measured their pelvic floor muscle strength by using both a perineometer (Peritron) and vaginal palpation (Oxford Scale). The UG, who performed 3D perineal ultrasound examinations, collected their data and evaluated the results for pubovisceral muscle thickness and the levator hiatus area (LA). Both professionals were blinded to the group allocation. The protocol for both groups consisted of 24 bi-weekly 1-h individual sessions of Pilates exercises, developed by another physiotherapist who specializes in PFM rehabilitation and the Pilates technique. RESULTS: The PEP+ PFMC group showed significantly greater strength improvements than the PEP group when comparing the Oxford scale, vaginal pressure and pubovisceral muscle thickness during contraction measurements at baseline and post-treatment. CONCLUSIONS: Our findings suggest that adding a voluntary PFMC to a Pilates exercise program is more effective than Pilates alone in improving PFM strength in sedentary nulliparous women.

Assessment of pelvic floor muscles in women with deep endometriosis.

PURPOSE: To assess function and prevalence of spasms and trigger points of the pelvic floor muscles in women with deep endometriosis. METHODS: One hundred and four (104) patients were assessed. Group 1 (G1) was composed of 52 subjects diagnosed with deep endometriosis proven by magnetic resonance imaging (MRI); Group 2 (G2) was composed of 52 women with no signs of endometriosis. Subjects from both G1 and G2 were seen at the Division of Pelvic Pain and Endometriosis and at Center for Prevention of Sexually Transmitted Diseases, both at Federal University of São Paulo (UNIFESP), respectively. A full physical therapy evaluation was carried out, including medical history, presence of dyspareunia and physical examination, which included detailed evaluation of pelvic floor muscles and occurrence of muscle spasm, trigger point and muscle function. RESULTS: The average age of the subjects in the study group was 36.4 and 30.9 years in the control group (p = 0.002). A greater prevalence of deep dyspareunia was found in the subjects in the endometriosis group when compared to the control group (p = 0.010). Women in G1 had higher prevalence of muscle spasms. In this group, 53.9 % had spasms-compared to only 17.3 % of women in G2 (p < 0.001). On the other hand, no significant difference between the groups (p = 0.153) was found while searching for the presence of trigger points. CONCLUSION: Women with deep endometriosis have increased prevalence of pelvic floor muscle spasms when compared to the control group.

A prospective, randomized, controlled trial of the treatment of anterior vaginal wall prolapse: medium term followup.

PURPOSE: We compared the efficacy and safety of anterior colporrhaphy with transvaginal polypropylene mesh insertion for anterior vaginal wall prolapse at medium term followup. MATERIALS AND METHODS: In this prospective, randomized, controlled trial 100 women with stage II or greater anterior vaginal wall prolapse assessed by POP-Q were randomized to anterior colporrhaphy (controls) or mesh insertion. Anatomical outcomes were assessed by POP-Q measurement and prolapse stage. Subjective outcomes and quality of life impact were evaluated by ICIQ questionnaires. We evaluated the procedure safety profile according to intraoperative complication rates throughout followup. RESULTS: In the mesh and control groups 42 and 50 women completed the 24-month followup. Point Ba did not significantly differ between the groups at baseline but at 24-month followup it had significantly improved in the mesh group compared to controls. However, no difference was found between the groups when considering 2 cure criteria on prolapse stage and subjective parameters. Asymptomatic mesh exposure developed on the anterior vaginal wall prolapse in 7 patients (16.4%) in the mesh group. Minor mesh related complications consisted of mesh exposure, prepubic ecchymosis and groin pain, of which most were treated conservatively. Urinary retention was treated surgically. CONCLUSIONS: Nazca TC™ and anterior colporrhaphy provided good overall anatomical outcomes during a minimum 24-month followup. Vaginal and urinary symptoms, and quality of life improved postoperatively in each group. From the patient perspective Nazca TC did not show superior overall outcomes compared to anterior colporrhaphy performed with or without a retropubic sling.

Oestrogen receptor alpha expression in neovaginal tissue of women following modified Abbé-McIndoe technique and in premenopausal women.

The aim of the study was to compare the expression of oestrogen receptor alpha (ERα) in neovaginal tissue of patients with vaginal agenesis following neovaginoplasty using regenerated, oxidised cellulose in premenopausal women. A prospective, observational case-control study was performed on eight patients with vaginal agenesis following modified Abbé-McIndoe neovaginoplasty and 10 control premenopausal women following benign gynaecologic surgery. 6F11 monoclonal antibody was used to determine ERα expression in the vaginal mucosa. Quantitative and qualitative evaluations were performed, respectively, in vaginal epithelium and stroma. The thickness of the vaginal epithelium was determined as the vertical distance between the basal layer cells and the apical surface of the superficial layer. The percentage of ERα-expressing cells was higher in the control group, except in the superficial zone of the epithelium. In the stromal tissue, ERα was detected in only one patient from the neovagina group compared with nine women in the control group. The neovagina group had a statistically thinner epithelium. Our study suggests that women with vaginal agenesis following modified Abbé-McIndoe neovaginoplasty using regenerated oxidised, cellulose experience relatively local hypo-oestrogenism in the first year after surgery, with repercussion in vaginal trophism.

Sexuality education in Brazilian medical schools.

INTRODUCTION: Sexuality education has been valued since the 1960s in medical schools worldwide. Although recent studies reaffirm the importance of incorporating sexuality into medical education, there are data gaps concerning how this happens in Brazil. AIM: To understand how Brazilian medical school professors teach sexuality in undergraduate courses. METHODS: An exploratory, cross-sectional descriptive study was conducted. A total of 207 professors from 110 Brazilian medical schools responded to an online semistructured questionnaire about the characteristics of the sexuality-related topics offered. MAIN OUTCOME MEASURES: The main variables assessed were contact hours devoted to sexuality, disciplines in which sexuality topics were taught, sexuality-related course titles, and sexuality-related topics addressed. Questionnaires were tabulated and analyzed using descriptive statistics for frequency distribution. RESULTS: The response rate to the questionnaire was 77.2%. Almost all professors (96.3%) addressed sexuality-related topics mainly in the third and fourth years as clinical disciplines, with a 6-hour load per discipline. Gynecology was the discipline in which sexuality-related topics were most often taught (51.5%), followed by urology (18%) and psychiatry (15%). Sexuality-related topics were addressed mainly in classes on sexually transmitted diseases and AIDS (62.4%) and on the anatomy and physiology of the reproductive system (55.4%). About 25% of the professors reported teaching courses with a sexuality-related title. There was emphasis on the impact of diseases and sexual habits (87.9%) and sexual dysfunction (75.9%). Less than 50% of professors addressed nonnormative sexuality or social aspects of sexuality. CONCLUSIONS: The teaching of sexuality in Brazilian medical schools occurred in a nonstandardized and fragmented fashion across several disciplines. The topic was incorporated with an organic and pathological bias, with a weak emphasis on the social aspects of sexuality and the variety of human sexual behaviors. The results point to the need for change in the provision of sexuality education in Brazilian medical schools.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I.

OBJECTIVE: To compare the use of polypropylene mesh (PM) and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP) using objective and subjective tests and evaluation of quality of life (QoL). MATERIALS AND METHODS: One hundred women were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a PM implant and the control group (n = 55) was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System) and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire - Vaginal Symptoms). Complications related to the use of PM or not were also described. RESULTS: There was a significant difference between all POP-Q measures of pre- and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. CONCLUSION: The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part II.

OBJECTIVE: To compare the effects of two surgical procedures for the correction of anterior vaginal wall prolapse (AVWP) on the lower urinary tract symptoms (LUTS) using symptom questionnaires and quality of life (QoL). MATERIALS AND METHODS: One hundred women with Pelvic Organ Prolapse Quantification stage (POP-Q) ≥ 2 were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a polypropylene mesh (PM) implant and the control group (n = 55) was submitted to anterior colporraphy with or without synthetic sling. Postoperatory follow-up was done after 12 months. The primary objective was to compare the effect of the surgeries on LUTS using the final scores of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Overactive Bladder Questionnaire (OAB-V8), as well as the analysis of the incapacitating urinary symptoms and ″de novo″ urinary symptoms after 12 months of surgery in both groups. RESULTS: Although there was a different number of women in each group, randomization was adequate, resulted in homogeneous groups that could be compared regarding socio demographic, clinical and gynecological (POP-Q) variables. Patients of both groups showed improvements regarding LUTS and QoL, whether using polypropylene mesh or not, based on the final scores of the ICIQ-UI SF and OAB-V8 questionnaires after 12-month follow-up. There were few incapacitating and ″de novo ″ urinary symptoms, without any significant statistical difference between both groups after 12 months of surgery. CONCLUSION: There was a general improvement of LUTS and QoL in both groups after 12-month follow-up. However, there was no significant difference of LUTS, as well as the more incapacitating and ″de novo ″ urinary symptoms between both groups after 12 months of surgery.

Efficacy of Sacrospinous Fixation or Uterosacral Ligament Suspension for Pelvic Organ Prolapse in Stages III and IV: Randomized Clinical Trial.

OBJECTIVE: To evaluate the efficacy and outcomes of the surgical treatment for pelvic organ prolapse (POP) in stages III and IV by sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) by comparing anatomical and subjective cure rates and quality-of-life parameters (through the version validated for the Portuguese language of the Prolapse Quality of Life [P-QoL] questionnaire) under two definitions: genital prolapse Ba, Bp, and C < -1 (stage I) and Ba, Bp, and C ≤ 0 (stage II). MATERIALS AND METHODS: After we obtained approval from the Ethics Committee (under CAAE 0833/06) and registered the study in ClinicalTrials.gov (NCT01347021), 51 patients were randomized into two groups: the USLS group (N = 26) and the SSLF group (N = 25), with follow-up 6 and 12 months after the procedures. RESULTS: There was a significant improvement in the P-QoL score and anatomical measurements of all compartments in both groups after 12 months (p < 0.001). The anatomical cure rates in the USLS and SSLF groups, considering stage 1, were of 34.6% and 40% (anterior) respectively; of 100% both for groups (apical); and of 73.1% and 92% (posterior) respectively. The rates of adverse outcomes were of 42% (N = 11) and 36% (N = 11) for the USLS and SSLF groups respectively (p = 0.654), and those outcomes were excessive bleeding, bladder perforation (intraoperative) or gluteal pain, and urinary infection (postoperative), among others, without differences between the groups. CONCLUSION: High cure rates in all compartments were observed according to the anatomical criterion (stage I), without differences in P-QoL scores and complications either with USLS or SSLF for the surgical treatment of accentuated POP.

OBJETIVO: Avaliar a eficácia e os resultados do tratamento cirúrgico para prolapso de órgãos pélvicos (POP) nos estágios III e IV, por meio da técnica de fixação do ligamento sacroespinal (FLSE) ou suspensão do ligamento útero-sacro (SLUS), ao comparar os índices de cura anatômicos, subjetivos, e os parâmetros de qualidade de vida (por meio do questionário Prolapse Quality of Life [P-QoL] validado para a língua portuguesa) sob duas definições: prolapso genital Ba, Bp e C < −1 (estágio I) e Ba, Bp e C ≤ 0 (estágio II). MATERIAIS E MéTODOS: Após aprovação do Comitê de Ética (CAAE 0833/06) e registro no ClinicalTrials.gov (NCT01347021), 51 pacientes foram randomizadas em dois grupos: grupo SLUS (N = 26) e (2) grupo FLSE (N = 25), com seguimento de 6 e 12 meses. RESULTADOS: Houve melhora significativa nas pontuações no P-QoL e nas medidas anatômicas de todos os compartimentos em ambos os grupos após 12 meses (p < 0,001). As taxas de cura anatômica nos grupos SLUS e FLSE , considerando o estágio 1, foram de 34,6% e 40% (anterior), respectivamente; de 100% em ambos os grupos (apical); e de 73,1% e 92% (posterior), respectivamente. As taxas de resultados adversos foram de 42% (N = 11) e 36% (N = 11), respectivamente, nos grupos SLUS e FLSE (p = 0,654), e elas foram sangramento excessivo, perfuração da bexiga (intraoperatória) ou dor glútea, e infecção urinária (pós-operatória), entre outras, sem diferenças entre os grupos. CONCLUSãO: Altas taxas de cura em todos os compartimentos foram observadas segundo critério anatômico (estágio I), sem diferença quanto às pontuações no P-QoL e às complicações tanto com SLUS quanto com FLSE para o tratamento cirúrgico de POP acentuado.

Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse?

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.

Biofeedback for the treatment of female pelvic floor muscle dysfunction: a systematic review and meta-analysis.

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.

Role of estrogen receptor alpha on vaginal epithelialization of patients with Mayer-Rokitansky-Kuster-Hauser syndrome submitted to neovaginoplasty using oxidized regenerated cellulose.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to evaluate the expression of estrogen receptor alpha (ERα) on the neovaginal tissue of patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome submitted to modified Abbé-McIndoe neovaginoplasty using oxidized regenerated cellulose. METHODS: The current study involved eight subjects with MRKH syndrome. Serial samples of the neovagina were obtained after the surgery and immunohistochemical detection of ERα was performed using antibody NCL-L-ER-6F11. RESULTS: The operation was performed successfully in all subjects without complications. A total of 22 samples of neovaginal tissue were analyzed. The expression of ERα was detected only 6 months after the surgery, when the neovagina acquired characteristics of normal vagina. CONCLUSION: In our study, the expression of ERα occurred when complete epithelialization of vaginal tissue was observed. Other mechanisms may be involved in the formation of vaginal epithelium in patients with MRKH syndrome.

Three-dimensional Printer Molds for Vaginal Agenesis: An Individualized Approach as Conservative Treatment.

OBJECTIVE: The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with vaginal agenesis (VA). METHODS: A total of 16 patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, total androgen insensitivity syndrome, and cervicovaginal agenesis) from the Federal University of São Paulo were selected. Device production was performed in a 3D printer, and the polymeric filament of the lactic polyacid (PLA) was used as raw material. A personalized treatment was proposed and developed for each patient. RESULTS: There were 14 patients who reached a final vaginal length of 6 cm or more. The initial total vaginal length (TVL) mean (SD) was 1.81(1.05) and the final TVL mean (SD) was 6.37 (0.94); the difference, analyzed as 95% confidence interval (95% CI) was 4.56 (5.27-3.84) and the effect size (95% CI) was 4.58 (2.88-6.28). CONCLUSION: The 3D printing molds for vaginal dilation were successful in 87.5% of the patients. They did not present any major adverse effects and offered an economical, accessible, and reproducible strategy for the treatment of VA.

OBJETIVO: O objetivo deste estudo foi avaliar o uso de moldes dilatadores vaginais, confeccionados com impressão tridimensional (3D), para tratamento conservador através da dilatação vaginal em pacientes com agenesia vaginal (AV). MéTODOS: Foram selecionadas 16 pacientes com diagnóstico de AV (síndrome de Mayer-Rokitansky-Küster-Hauser, síndrome de insensibilidade androgênica total e agenesia cervicovaginal), da Universidade Federal de São Paulo. A produção dos dispositivos foi realizada em uma impressora 3D e, como matéria-prima, foi utilizado o filamento polimérico do poliácido lático (PLA). Um tratamento personalizado foi proposto e desenvolvido para cada paciente. RESULTADOS: Quatorze pacientes atingiram um comprimento vaginal final (CVF) de 6 cm ou mais. A média inicial do CVF (DP) foi de 1,81 (1,05) e a média final do CVF (DP) 6,37 (0,94); a diferença (IC 95%) foi de 4,56 (5,27­3,84) e o tamanho do efeito (IC 95%) foi de 4,58 (2,88­6,28). CONCLUSãO: Os moldes de impressão 3D para dilatação vaginal obtiveram sucesso em 87,5% das pacientes. Como impacto secundário, não apresentaram efeitos adversos importantes e ofereceram uma estratégia econômica, acessível e reprodutível para o tratamento da AV.

Metabolomic Profiling of Peripheral Plasma by GC-MS and Correlation With Size of Uterine Leiomyomas.

Background: Uterine leiomyomas are benign monoclonal tumors originating from the myometrium. Little information exists concerning metabolomics and the presence of leiomyomas. Objective: The present study evaluated circulating metabolites in the plasma and their correlation with the presence and size of leiomyomas. Study Design: Cross-sectional observational study, including women divided into 3 groups: 37 with leiomyomas and uterus >500 cm3, 17 with leiomyomas and uterus ≤150 cm3, and 21 leiomyoma-free. Patients underwent peripheral blood collection using untargeted metabolic assessment by gas chromatography coupled to mass spectrometer. Results: There was no statistical difference between patients' anthropometric and demographic features and laboratory tests. Statistical differences in uterus volume (P < 0.0001) were found. Forty-six metabolites were identified (35% amino acids and derivatives, 22% fatty acids, and 18% carbohydrates). Statistically significant metabolic distinction (P < 0.05, false discovery rate< 0.05) was observed for 14 metabolites. Most amino acids (L-isoleucine, L-valine, and pyroglutamic acid) were significantly reduced in plasma levels of patients with large leiomyomas. The only exception was L-glutamine, with a significant increase. Fatty acids (arachidonic acid, alfa-tocopherol, palmitic acid, and stearic acid) were similarly reduced in large leiomyomas patients, except for alpha-linolenic acid, which increased. For carbohydrates (myo-inositol, D-threitol, and D-ribose), there was a decrease in the plasma of patients with leiomyomas. Conclusion: There are different plasma metabolites levels of amino acids, fatty acids, and carbohydrates among patients with leiomyomas, most of them reduced, but some significantly increased in large leiomyomas, compared to leiomyoma-free patients.