Efeito do tônus do corpo perineal nas disfunçõessexuais em mulheres jovens nulíparas / Effect of perineal body tone on sexual dysfunctionsin young nulliparous women

Objetivo: avaliar o tônus do corpo perineal em mulheres jovens nulíparas e correlacionar com as funções sexuais e a presença de disfunção sexual. Método: foi realizado um estudo descritivo, observacional, transversal utilizando uma amostra de conveniência incluindo mulheres adultas jovens nulíparas. A avaliação das participantes consistiu na aplicação dos questionários socioclínico, Pelvic Organ Prolaps / Urinary Incontinence Sexual Questionnaire (PISQ-12), Female Sexual Function Index (FSFI) e exame físico do tônus do corpo perineal. Os dados foram analisados pelo programa Statistical Package for the Social Sciences (SPSS®), versão 23, adotando um nível de significância de 5%. Resultados: participaram 77 mulheres jovens nulíparas (21,68 ± 2,94 anos), destas 77, 92% apresentavam vida sexual ativa e 66,03% tônus normal do corpo perineal. Dentre as alterações tônicas, o aumento do tônus predominou (33,76%). Houve alta prevalência de disfunção sexual (87,01%) pelo FSFI (23,38 ± 7,21) com maior queixa de dispareunia. Mulheres com tônus aumentado apresentaram maior disfunção sexual em relação a desejo e estímulo subjetivo (p=0,04), à excitação (p=0,01), satisfação (p=0,04) e dor ou a desconforto (p=0,03). Houve correlação inversa entre a presença de aumento do tônus e os domínios FSFI desejo e estímulo subjetivo (R= - 0,56) e excitação (R= - 0,34) e correlação direta para dor ou desconforto (R= 0,30). Conclusão: o aumento do tônus do corpo perineal piora a função sexual de mulheres jovens nulíparas.

Sexual Function Index (FSFI) and physical examination of the tone of the perineal body. The data were analyzed using the Statistical Package for the Social Sciences (SPSS®), version 23, adopting a significance level of 5%. Results: 77 young nulliparous women (21.68 ± 2.94 years) participated, of which 77, 92% had an active sexual life and 66.03% had normal tone of the perineal body. Among the tonic changes, increased tone predominated (33.76%). There was a high prevalence of sexual dysfunction (87.01%) according to the FSFI (23.38 ± 7.21) with greater complaints of dyspareunia. Women with increased tone had greater sexual dysfunction in relation to desire and subjective stimulation (p=0.04), excitement (p=0.01), satisfaction (p=0.04) and pain or discomfort (p=0.03). There was an inverse correlation between the presence of increased tone and the FSFI domains desire and subjective stimulus (R= - 0.56) and excitement (R= - 0.34) and a direct correlation for pain or discomfort (R= 0.30). Conclusion: increased perineal body tone worsens sexual function in young nulliparous women.

The effect of intraspinal blocking analgesia on delivery quality and puerperal pelvic floor function of primipara / 中国医师进修杂志

Objective:To explore the effects of intraspinal blocking analgesia on the delivery quality and puerperal pelvic floor function of primiparas.Methods:A total of 99 primiparas who delivered in the Second People′s Hospital of Wuhu City from January 2021 to April 2022 were enrolled in this study, 54 patients received intraspinal blocking analgesia (study group) and 45 patients received conventional treatment, without intraspinal blocking analgesia (control group). The delivery quality between the two groups was compared, and the pelvic floor function was evaluated and compared by pelvic floor rehabilitation therapy instrument and pelvic floor ultrasound at 6-8 weeks after delivery.Results:Vaginal delivery were successful in both groups. The total labor duration in the study group was longer than that in the control group: (8.03 ± 2.94) h vs. (6.89 ± 3.49) h, there was statistical difference ( P<0.05). The maximum value of pelvic floor rapid contraction stage, rising time and average value of continuous contraction stage in the study group were higher than those in the control group: (32.85 ± 10.13) μV vs. (14.73 ± 3.25) μV, (0.28 ± 0.06) s vs. (0.22 ± 0.05) s, (30.26 ± 5.24) μV vs. (16.74 ± 4.00) μV, there were statistical differences ( P<0.05). There were no statistical differences in other indicators such as the pre-resting stage, rapid contraction phase recovery time and post-resting stage between the two groups ( P>0.05). The rate of pelvic floor class Ⅰ and class Ⅱ muscle abnormalities at 6-8 weeks after delivery in the study group were lower than those in the control group, but there were no statistical differences ( P>0.05). The maximum Valsalva state hiatus area of levator ani muscle, maximum Valsalva state bladder posterior urethral angle, hiatus area of levator ani muscle at rest state and bladder neck degree in the study group were smaller than those in the control group: (19.09 ± 4.82) cm 2 vs. (23.00 ± 5.34) cm 2, (138.59 ± 23.14)° vs. (148.47 ± 20.38)°, (9.96 ± 2.63) cm 2 vs. (11.60 ± 2.75) cm 2, (20.13 ± 4.37) mm vs. (28.05 ± 6.52) mm, there were statistical differences ( P<0.05). Conclusions:Although intraspinal block analgesia can prolong the total labor time of primipara, but it can reduce the damage of pelvic floor function, possibly by increasing systolic period to protect pelvic floor muscles.

Botulinum-toxin-A injection following conservative management in patients with dyssynergic defaecation only improves symptoms in the short term: a retrospective study

Objective: Dyssynergic defaecation (DD) is an important cause of chronic constipation. In patients where conservative treatments fail, injections of botulinum toxin A (BTX-A) into the puborectalis and anal sphincter muscles can be effective. Complications of this procedure are reported to be rare and generally mild. This study aimed to identify the complication rates and short- to medium-term success rates of BTX-A injections as a treatment for DD. Methods: A retrospective review was conducted on patients diagnosed with DD who had undergone BTX-A injections at a functional colorectal unit. Patient demographics, manometric assessment, conservative management, and injection technique were collected through a chart review. Subjective patient reports and comparison of pre- and postprocedure symptom scores were used to determine efficacy. Results: The 21 patients included (24 procedures, with 3 patients receiving BTX-A on two separate occasions) all received stool modification and dietary advice, and 20 patients underwent pelvic floor physiotherapy, averaging 8 sessions. The injections were universally applied under general anesthetic, primarily targeting the anal sphincter and/or puborectalis muscles. There were 6 reports of faecal urge/incontinence, with all but one being resolved within weeks. The BTX-A injection was subjectively reported as beneficial in 19 cases, averaging 4.7 months (range 1-32) of improvement. Only 2 were sustained beyond 12 months. Despite overall improvements in symptom scores from pre- to postprocedure, none were statistically significant. Conclusion: Following a course of conservative management, the BTX-A injection appears to be a safe treatment for DD, but only has short term efficacy. (AU)

Efeitos do modelo de enfermagem de Newman na qualidade de vida e recuperação muscular do assoalho pélvico em pacientes com disfunção do assoalho pélvico pós-parto / Efectos del modelo de enfermería de Newman en la calidad de vida y recuperación muscular del suelo pélvico en pacientes con disfunción del suelo pélvico posparto / Effects of the Newman nursing model on quality of life and pelvic floor muscle recovery in patients with postpartum pelvic floor dysfunction

Resumo Objetivo Avaliar os efeitos do modelo de enfermagem de Newman na qualidade de vida e recuperação muscular do assoalho pélvico em pacientes com disfunção do assoalho pélvico pós-parto. Métodos Oitenta e oito pacientes com disfunção do assoalho pélvico pós-parto tratadas de janeiro a abril de 2023 foram divididas em grupo Observação e Controle (n=44) por meio de tabela de números aleatórios. O grupo Controle recebeu enfermagem de rotina e o grupo Observação recebeu cuidados de enfermagem de Newman. A qualidade de vida foi avaliada pelo Short Form-36 Health Status Questionnaire. A função do assoalho pélvico foi avaliada por meio do Pelvic Floor Impact Questionnaire-7 (PFIQ7) e da Pelvic Organ Prolapse Quantification (POPQ). Resultados Após a intervenção, as pontuações de aspectos físico, emocional, capacidade funcional, social e motor do grupo Observação foram superiores às do grupo Controle (P<0,05). As pontuações da Escala de Autoavaliação de Ansiedade e da Escala de Autoavaliação de Depressão do grupo Observação foram inferiores às do grupo Controle. O nível de conhecimento sobre a doença foi maior no grupo Observação do que no grupo Controle (P<0,05). O grupo Observação apresentou maior força das fibras musculares tipo I e II, e menores graus de fadiga das fibras musculares tipo I e II do que o grupo Controle (P<0,05). As pontuações PEIQ7 e POPQ do grupo Observação foram inferiores às do grupo Controle (P<0,05). Conclusão O modelo de enfermagem de Newman ajuda a melhorar a função do assoalho pélvico, a qualidade de vida e o conhecimento sobre a doença, além de aliviar a ansiedade, a depressão e outras emoções adversas.

Resumen Objetivo Evaluar los efectos del modelo de enfermería de Newman en la calidad de vida y recuperación muscular del suelo pélvico en pacientes con disfunción del suelo pélvico posparto. Métodos Un grupo de 88 pacientes con disfunción del suelo pélvico posparto, tratadas de enero a abril de 2023, fue dividido en dos grupos, uno de observación y otro de control (n=44) mediante una tabla de número aleatorios. El grupo de control recibió cuidados de enfermería de rutina y el grupo de observación recibió cuidados de enfermería de Newman. Se utilizó el Short Form-36 Health Status Questionnaire para evaluar la calidad de vida. La función del suelo pélvico se evaluó mediante el Pelvic Floor Impact Questionnaire-7 (PFIQ7) y la Pelvic Organ Prolapse Quantification (POPQ). Resultados Después de la intervención, el puntaje de los aspectos físico, emocional, social, motor y de la capacidad funcional del grupo de observación fue más alto que el del grupo de control (P<0,05). El puntaje de la Escala de Autoevaluación de Ansiedad y de la Escala de Autoevaluación de Depresión del grupo de observación fue más bajo que el del grupo de control. El nivel de conocimiento sobre la enfermedad fue mayor en el grupo de observación que en el grupo de control (P<0,05). El grupo de observación presentó mayor fuerza de las fibras musculares tipo I y II y un nivel menor de fatiga de las fibras musculares tipo I y II que el grupo de control (P<0,05). El puntaje de PEIQ7 y POPQ del grupo de observación fue más bajo que el del grupo de control (P<0,05). Conclusión El modelo de enfermería de Newman ayuda a mejorar la función del suelo pélvico, la calidad de vida y el conocimiento sobre la enfermedad, además de calmar la ansiedad, la depresión y otras emociones adversas.

Abstract Objective We aimed to evaluate the effects of the Newman nursing model on the quality of life and pelvic floor muscle recovery in patients with postpartum pelvic floor dysfunction. Methods Eighty-eight patients with postpartum pelvic floor dysfunction treated from January to April 2023 were divided into observation and control groups (n=44) using a random number table. The control group was given routine nursing, based on which the observation group was given Newman nursing. The quality of life was assessed by the Short Form-36 Health Status Questionnaire. The pelvic floor function was evaluated using the Pelvic Floor Impact Questionnaire-7 (PEIQ7) and Pelvic Organ Prolapse Quantification (POPQ). Results After intervention, the scores of role physical, language communication, physical functioning, social functioning and motor functioning of the observation group were higher than those of the control group (P<0.05). The Self-rating Anxiety Scale and Self-rating Depression Scale scores of the observation group were lower than those of the control group. The awareness rate of disease knowledge of the observation group was higher than that of the control group (P<0.05). The observation group had higher class I and class II muscle fiber potentials, whereas lower class I and class II muscle fiber fatigue degrees than those of the control group (P<0.05). The PEIQ7 and POPQ scores of the observation group were lower than those of the control group (P<0.05). Conclusion Newman nursing helps improve the pelvic floor function, quality of life and awareness of the disease knowledge, and relieve anxiety, depression and other adverse emotions.

Prevalence and factors associated with the perception of perineal laceration: a cross-sectional study with data from the Nascer no Brasil Survey, 2011 and 2012 / Prevalencia y factores asociados a la percepción de laceración perineal: estudio transversal con datos de la Encuesta Nascer no Brasil, 2011 y 2012 / Prevalência e fatores associados à percepção da laceração perineal: estudo transversal com dados do Inquérito Nascer no Brasil, 2011 e 2012

Abstract Objective: To describe the prevalence of perineal laceration, based on the self-reported perception of postpartum women, and to analyze factors associated with its occurrence in Brazil. Methods: This was a cross-sectional study conducted with 23,894 postpartum women, excluding twin pregnancies, cesarean sections, and births with episiotomies, between 2011 and 2012. Prevalence ratios (PR) and 95% confidence intervals (95%CI) of association between the event and maternal, fetus/newborn, obstetric and clinical management characteristics were estimated in hierarchical Poisson regression models. Results: Out of 4,606 postpartum women, 49.5% (95%CI 46.1;42.9) self-reported perineal laceration. Being an adolescent (PR = 1.12; 95%CI 1.02;1.25), primipara (PR = 1.47; 95%CI 1.33;1.63), having had excessive gestational weight gain (PR = 1.17; 95%CI 1.07;1.29) and having undergone the Kristeller maneuver (PR = 1.18; 95%CI 1.08;1.29) increased the proportion of the outcome. Conclusion: The results found call for prenatal care and adjustments to childbirth care so as to be in accordance with current recommendations.

Resumen Objetivo: Describir la prevalencia de laceración perineal, a partir de la percepción autoinformada de puérperas, y analizar los factores asociados a su aparición en Brasil. Métodos: Estudio transversal entre 2011 y 2012, con 23.894 puérperas, excluyendo embarazos gemelares, cesáreas y partos con episiotomías. Se estimaron razones de prevalencia (RP) e intervalos de confianza del 95% (IC95%) de la asociación entre el evento y las características maternas, feto/recién nacido, obstétricas y de manejo clínico en modelos de regresión jerárquica de Poisson. Resultados: Entre 4.606 mujeres en posparto, el 49,5%(IC95%:46,1;42,9) informó laceración perineal. Ser adolescente (RP = 1,12; IC95% 1,02;1,25), primipara (RP = 1,47; IC95% 1,33;1,63), haber tenido aumento excesivo de peso gestacional (RP = 1,17; IC95% 1,07;1,29) y haber sido sometido a la maniobra de Kristeller (RP = 1,18; IC95% 1,08;1,29) aumentó la proporción de resultados. Conclusión: Los resultados encontrados requieren atención prenatal y ajustes en la atención del parto de acuerdo con las recomendaciones actuales.

Resumo Objetivo: Descrever a prevalência da laceração perineal segundo a percepção autorrelatada da puérpera, e analisar os fatores associados à sua ocorrência no Brasil. Métodos: Estudo transversal conduzido em 23.894 puérperas, excluindo-se gestações gemelares, cesarianas e partos com episiotomias entre 2011 e 2012. Razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) da associação entre o evento e as características maternas, feto/recém-nato, obstétricas e manejo clínico foram estimadas em modelos de regressão de Poisson hierarquizados. Resultados: Entre 4.606 puérperas, 49,5% (IC95% 46,1;42,9) autorrelataram laceração perineal. Ser adolescente (RP = 1,12; IC95% 1,02;1,25), primípara (RP = 1,47; IC95% 1,33;1,63), ter tido ganho de peso gestacional excessivo (RP = 1,17; IC95% 1,07;1,29) e ter sido submetida à manobra de Kristeller (RP = 1,18; IC95% 1,08;1,29) elevaram a proporção do desfecho. Conclusão: Os resultados encontrados demandam atenção pré-natal e adequações na assistência ao parto conforme recomendações vigentes.

Adherencias del capuchón del clítoris al glande: una condición poco estudiada y poco examinada / Clitoral hood adhesions to the glans penis: an understudied and under-examined condition

INTRODUCCIÓN: El clítoris es una de las estructuras vulvares menos examinadas, pese a su relevancia en la vida sexual y sus importantes relaciones anatómicas. Las adherencias del capuchón del clítoris han sido descritas y clasificadas según la exposición del glande, siendo relacionadas con trastornos del deseo sexual. La inervación del clítoris depende de raíces de S3-S4, siendo posible que síntomas frecuentes del piso pélvico tengan relación con esta condición. Realizamos un análisis retrospectivo de pacientes de policlínico de piso pélvico entre noviembre de 2021 y abril de 2022. Se incluyeron 100 pacientes con adherencias al ingreso. RESULTADOS: Promedio de edad 45,8 ± 15,5 años. Las adherencias fueron el 19% leves, el 62% moderadas y el 18% graves. Los principales síntomas eran mal vaciado vesical (38%), dolor (28%), disfunción sexual (39%) y síntomas irritativos vesicales (43%); solo una paciente fue asintomática. El área visible promedio del clítoris era de 20,7 ± 13,7 mm2. CONCLUSIONES: Las adherencias del capuchón del clítoris son un hallazgo común, muchas veces no diagnosticadas, por lo que su evaluación debe ser parte de la exploración física. Pueden asociarse a sintomatología de piso pélvico.

INTRODUCTION: The clitoris is one of the least examined vulvar structures despite its relevance in sexual life and important anatomical relationships. Clitoral hood adhesions have been described in the literature, classified based on glans exposure, and related to sexual desire disorders. The innervation of the clitoris depends on the roots of S3-S4, and frequent pelvic floor symptoms may be associated with this condition. We retrospectively analyzed the clinical record of patients admitted to a pelvic floor clinic between November 2021 and April 2022. One hundred patients with adhesions at the time of admission were registered. RESULTS: Average 45.8 ± 15.5 years. Clitoral hood adhesions were mild (19%), moderated (62%), or severe (18%). The main symptoms were voiding dysfunction symptoms (38%), pain (28%), sexual dysfunction (39%), and irritative bladder symptoms (43%); only one patient was asymptomatic. The visible area of the clitoris was 20.7 ± 13.7 mm2. CONCLUSIONS: Adhesions of the clitoral hood are often undiagnosed, and its analysis should be part of the physical exam. Clitoral hood adhesions could be associated with pelvic floor symptoms.

Functional outcomes and satisfaction rates of sacral nerve stimulation in the treatment of one and multiples pelvic floor dysfunctions

Objective: Few studies have addressed the use of sacral nerve stimulation (SNS) in the treatment of patients with multiple pelvic floor dysfunctions (PFD). So, we evaluated the functional outcomes and level of satisfaction with SNS in selected patients with one or multiples PFD. Methods: A prospective database was used to collect information on eligible patients treated for PFD with SNS, and severity of symptoms was assessed with scores and satisfaction rates by visual analogue scale (VAS) at baseline and by the end of follow-up. Results: We recruited 70 patients, 98.6% of whom responded positively during the evaluation period (Global Response Assessment ≥ 50% for at least one type of PFD), resulting in the implantation of a permanent SNS device. Additionally, 49 of the patients (71%) had a single PFD (fecal incontinence [FI] = 38; constipation/obstructed defecation syndrome [C/ODS] = 11), while 20 (29%) had more than one PFD (double incontinence/n = 12; double incontinence + C/ODS/n = 8). All scores improved significantly between baseline (pre-SNS) and the end of follow-up (post-SNS), as did VAS in all groups (single and multiple PFD). The pre-SNS scores were higher in patients with a single PFD, including FI (Cleveland clinic Florida incontinence score [CCF-FI]) and C/ODS (Cleveland clinic constipation score [C-CCF] and the Renzi ODS score). The pre-SNS impact of VAS scores was similar in all groups (single and multiple PFD), but the VAS (post-SNS) was significantly lower (better response) for FI alone compared with multiple PFD. Conclusion: The SNS technique is an effective and safe option for patients with one or more PFD refractory to conservative measures. Response was positive for at least two PFD, based on reduced correspondent scores and satisfaction rate. (AU)

Correlation analysis between the structural changes of the anterior chamber and pelvic floor dysfunction observed by transperineal pelvic floor ultrasound after natural childbirth / 中国医师进修杂志

Objective:To investigate the correlation between the structural changes of the anterior chamber and pelvic floor dysfunction (PFD) observed by transperineal pelvic floor ultrasound after natural childbirth.Methods:Eight hundred patients underwent transperineal pelvic floor four-dimensional ultrasonography after natural childbirth in Hunan Provincial Hospital of Traditional Chinese Medicine from January to December 2021 were enrolled. Among them, 320 cases with PFD were selected as the research group, and 480 cases without PFD were selected as the control group. The anterior chamber structure parameters were compared between the two groups at rest and during the maximal Valsalva maneuver, and the value of the anterior chamber structure parameters in diagnosing PFD after natural childbirth was analyzed. The structural parameters of the anterior chamber in patients with different degrees of pelvic organ prolapse and different degrees of stress urinary incontinence at rest and during the maximum Valsalva maneuver were compared, and the correlation between the structural parameters of the anterior chamber and pelvic floor function were analyzed.Results:The position of the bladder neck in the research group was lower than that in the control group at rest: (22.67 ± 4.02) mm vs. (25.53 ± 4.07) mm, the posterior angle of the bladder and the movement of the bladder neck and the angle of urethral rotation during the maximal Valsalva maneuver were larger than those in the control group :(134.26 ± 21.54)° vs. (115.31 ± 17.82)°, (30.27 ± 8.41) mm vs. (21.94 ± 7.69) mm, (45.29 ± 12.74)° vs. (33.26 ± 11.52)°, there were statistical differences ( P<0.05). The area under the curve (AUC) of bladder neck position at rest, bladder posterior angle and maximum Valsalva maneuver, bladder neck movement and urethral rotation angle for the diagnosis of PFD after natural childbirth were 0.731 (95% CI 0.699-0.761), 0.783 (95% CI 0.753-0.811), 0.737 (95% CI 0.705-0.767), 0.774 (95% CI 0.743-0.803), the AUC of the combined diagnosis of each index was the largest, which was 0.893 (95% CI 0.870-0.914). In the research group, the position of the bladder neck in the resting state gradually decreased with the degree of pelvic organ prolapse ( P<0.05). In the research group, the position of the bladder neck in the resting state gradually decreased with the increase of the degree of stress urinary incontinence ( P<0.05). The position of the bladder neck in the resting state was negatively correlated with the degree of pelvic organ prolapse and stress urinary incontinence ( r = - 0.574, - 0.569, P<0.05). Mobility and urethral rotation angle were positively correlated with pelvic organ prolapse and stress urinary incontinence ( r = 0.531, 0.537, 0.498, 0.512, 0.511 and 0.537, P<0.05). Conclusions:Transperineal pelvic floor four-dimensional ultrasonography has important reference value in the diagnosis of PFD by observing the structural changes of the anterior chamber after natural childbirth, and the ultrasonic parameters of the structural changes of the anterior chamber are closely related to the degree of pelvic organ prolapse and stress urinary incontinence, which is helpful to assess the degree of impairment of pelvic floor function in patients.

Application of electrical stimulation, biofeedback, and radiofrequency therapy in combination for the treatment of pelvic floor dysfunction / 中国基层医药

Objective:To investigate the clinical efficacy of electrical stimulation, biofeedback, and radiofrequency therapy in combination for the treatment of pelvic floor dysfunction.Methods:A total of 144 patients with pelvic floor dysfunction who received treatment in Lianyungang Maternal and Child Health Hospital from June 2020 to June 2022 were included in this prospective randomized controlled study. They were randomly assigned to undergo electrical stimulation combined with biofeedback (electrical stimulation group, n = 48), treatment with a novel radiofrequency technique (radiofrequency therapy group, n = 48), or electrical stimulation, biofeedback, and treatment with a novel radiofrequency technique (combined group, n = 48). Pelvic floor dysfunction, stress urinary incontinence, and pelvic floor myofascial pain were compared among the three groups. Pelvic organ prolapse quantification was compared among the three groups before and after treatment. Quality of life was evaluated. Results:The effective rates of treatment against pelvic floor dysfunction, stress urinary incontinence, and pelvic floor myofascial pain in the combined group were 95.83% (46/48), 97.92% (47/48), and 93.75% (45/48), respectively, which were significantly higher than 79.17% (38/48), 79.17% (38/48), 77.08% (37/48) in the radiofrequency group, and 75.00% (36/48), 77.08% (37/48), 72.92% (35/48) in the electrical stimulation group ( χ2 = 8.40, 9.77, 7.66, all P < 0.05). After treatment, the severity of pelvic organ prolapse in the combined group was significantly milder than that in the novel radiofrequency technique group and electrical stimulation group (both P < 0.05). The scores of the pelvic floor dysfunction questionnaire and urinary incontinence questionnaire in the combined group were significantly lower than those in the radiofrequency therapy group and the electrical stimulation group (both P < 0.05). Conclusion:Electrical stimulation, biofeedback, and radiofrequency therapy in combination can greatly strengthen the muscle strength of the pelvic floor, relieve urinary incontinence, reduce pelvic floor myofascial pain, and improve the quality of life of patients with pelvic floor dysfunction.

Efficacy of Sacrospinous Fixation or Uterosacral Ligament Suspension for Pelvic Organ Prolapse in Stages III and IV: Randomized Clinical Trial / Eficácia da fixação sacroespinhal ou da suspensão do ligamento útero-sacro no prolapso de órgãos pélvicos nos estágios III e IV: Ensaio clínico randomizado

Abstract 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 (NCT 01347021), 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.

Resumo 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 (NCT 01347021), 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.

EFETIVIDADE DO APLICATIVO IPELVIS® NA REABILITAÇÃO DE PACIENTES COM INCONTINÊNCIA URINÁRIA: UM ENSAIO-CLÍNICO ALEATORIZADO / EFFECTIVENESS OF THE IPELVIS® APPLICATION IN THE REHABILITATION OF PATIENTS WITH URINARY INCONTINENCE: A RANDOMIZED CLINICAL TRIAL

Objetivo: Verificar a efetividade do aplicativo Ipelvis® na reabilitação de pacientes com incontinência urinária comparada com a fisioterapia pélvica convencional e domiciliar. Metodologia: Trata-se de um ensaio-clínico aleatorizado realizado 20 mulheres que apresentavam sintomas de incontinência urinária. Foram utilizados os instrumentos para avaliar antes e após a intervenção: The 3 Incontinence Questions, International Consultation on Incontinence Questionnaire ­ Short Form e Qualidade de vida medida pelo King's Health Questionnaire. As participantes foram divididas aleatoriamente em grupos e receberam orientações de tratamento domiciliar por três meses, com o Grupo 1 utilizando o aplicativo como tratamento domiciliar e o Grupo 2, utilizou uma folha convencional com exercícios terapêuticos. Os dados foram analisados por meio da estatística descritiva. Resultados: Após intervenção, 85% das pacientes não apresentaram nenhum sintoma de incontinência, 10% apresentaram Incontinência urinária de esforço, 5% de Incontinência urinária de urgência e nenhuma paciente apresentou Incontinência urinária de mista, evidenciando a melhora do quadro das pacientes com incontinência urinária posteriormente à realização dos exercícios terapêuticos de assoalho pélvico em ambos os grupos. Conclusão: Os exercícios terapêuticos de assoalho pélvico foram eficazes para pacientes com incontinência urinária em ambos os grupos, mas os resultados foram mais eficazes no método de tratamento digital, por meio do aplicativo Ipelvis® quando comparado com o método tradicional por meio da folha.

Objective: To verify the effectiveness of the Ipelvis® application in the rehabilitation of patients with urinary incontinence compared to conventional and home pelvic physiotherapy. Methodology: This is a randomized clinical trial carried out with 20 women who had symptoms of urinary incontinence. The following instruments were used to assess before and after the intervention: The 3 Incontinence Questions, International Consultation on Incontinence Questionnaire ­ Short Form and Quality of life measured by the King's Health Questionnaire. Participants were randomly divided into groups and received home treatment guidelines for three months, with Group 1 using the app as home treatment and Group 2 using a conventional sheet with therapeutic exercises. Data were analyzed using descriptive statistics. Results: After the intervention, 85% of the patients had no symptoms of incontinence, 10% had stress urinary incontinence, 5% had urge urinary incontinence and no patient had mixed urinary incontinence, showing the improvement in the condition of patients with urinary incontinence. after performing therapeutic pelvic floor exercises in both groups. Conclusion: Therapeutic pelvic floor exercises were effective for patients with urinary incontinence in both groups, but the results were more effective in the digital treatment method, through the Ipelvis® application, when compared to the traditional method through the sheet.

Assessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review / Avaliação das desordens do assoalho pélvico decorrentes do diabetes gestacional usando a ultrassonografia tridimensional: Uma revisão narrativa

Abstract Gestational diabetes mellitus (GDM)is an entity with evolving conceptual nuances that deserve full consideration. Gestational diabetes leads to complications and adverse effects on the mother's and infants' health during and after pregnancy. Women also have a higher prevalence of urinary incontinence (UI) related to the hyperglycemic status during pregnancy. However, the exact pathophysiological mechanism is still uncertain. We conducted a narrative review discussing the impact of GDM on the women's pelvic floor and performed image assessment using three-dimensional ultrasonography to evaluate and predict future UI.

Resumo O diabetes gestacional (DG)é uma entidade com nuances conceituais em evolução que merecem total consideração. O DG leva a complicações e efeitos adversos na saúde da mãe e do bebê durante e após a gravidez. As mulheres também apresentam maior prevalência de incontinência urinária (IU) relacionada ao estado hiperglicêmico durante a gravidez. No entanto, o mecanismo fisiopatológico exato ainda é incerto. Realizamos uma revisão narrativa discutindo o impacto do DG no assoalho pélvico das mulheres e utilizamos o exame de ultrassonografia tridimensional para avaliar e predizer a ocorrência de IU.

Efectividad de la Terapia Física en la Disfunción Eréctil Posterior a Prostatectomía Radical: Scoping Review / Effectiveness of Physical Therapy in Erectile Dysfunction Following Radical Prostatectomy: Scoping Review

Introducción. El cáncer de próstata es una patología con alta prevalencia, la prostatectomía radical es la técnica quirúrgica utilizada y la disfunción eréctil es una de las secuelas más frecuentes de ésta. En la actualidad existen diferentes intervenciones en el manejo de la disfunción eréctil. La literatura refiere como tratamiento de primera línea el uso de inhibidores de la fosfodiesterasa-5, también se describe que el uso de terapia física podría potenciar la mejora de la disfunción eréctil en conjunto con el tratamiento farmacológico. Objetivo. Identificar y describir la evidencia científica disponible referente a la efectividad de la terapia física en pacientes con disfunción eréctil posterior a una prostatectomía. Métodos. Se realizó una búsqueda en Pubmed, LILACS, Cochrane Library, de artículos publicados entre el 2012 y 2022. Se seleccionaron los relacionados con los efectos de la terapia física en la disfunción eréctil posterior a prostatectomía Resultados: En esta revisión se incluyeron 9 estudios. La mayoría demostró mejoras en la disfunción eréctil con la aplicación de la terapia de ondas de choque extracorpóreas de baja intensidad y entrenamiento muscular de piso pélvico, combinada con el tratamiento farmacológico. Conclusión. Debido a la alta prevalencia de la disfunción eréctil posterior a prostatectomía radical y a la escasa evidencia existente, se sugieren más investigaciones en el área, con diseños metodológicamente rigurosos, que incluyan un mayor tamaño de muestra y profundicen en la creación protocolos de rehabilitación y su posterior seguimiento.

Background. Prostate cancer is a pathology with high prevalence, radical prostatectomy is the surgical technique used and erectile dysfunction is one of the most frequent sequelae of this. Currently there are different interventions in the management of erectile dysfunction. The literature refers as first line treatment the use of phosphodiesterase-5 inhibitors, it is also described that the use of physical therapy could enhance the improvement of erectile dysfunction in conjunction with pharmacological treatment. Objective. To identify and describe the available scientific evidence regarding the effectiveness of physical therapy in patients with erectile dysfunction following prostatectomy. Methods. A search was performed in Pubmed, LILACS, Cochrane Library, of articles published between 2012 and 2022. Those related to the effects of physical therapy on post-prostatectomy erectile dysfunction were selected Results. 9 studies were included in this review. Most demonstrated improvements in erectile dysfunction with the application of low-intensity extracorporeal shock wave therapy and pelvic floor muscle training combined with pharmacological treatment. Conclusion. Due to the high prevalence of erectile dysfunction after radical prostatectomy and the scarce existing evidence, more research is suggested in this area, with methodologically rigorous designs, including a larger sample size and deepening in the creation of rehabilitation protocols and their subsequent follow-up.

Implantação de um serviço para pessoas com distúrbios do assoalho pélvico / Implementation of a service for people with pelvic floor disorders / Implementación de un servicio para personas con trastornos del suelo pélvico

Objetivo:objetivou-se descrever os procedimentos técnicos operacionais e dados clínicos relacionados à implantação de um programa de atenção à saúde das pessoas com distúrbios do assoalho pélvico em um serviço público de atenção secundária. Método: trata-se de um relato de experiência, baseado em vivências relacionadas à assistência acadêmico-profissional na implantação de serviço voltado aos distúrbios do assoalho pélvico na região do Cariri cearense, realizado de maio a julho de 2021. Resultados: para a implantação do serviço, adotaram-se as seguintes estratégias: rastreamento da rede de atenção à saúde da pessoa com distúrbios do assoalho pélvico; estruturação organizacional do serviço; captação de pessoas com disfunções pélvicas; início dos atendimentos; e seguimento terapêutico. Conclusão: face ao exposto, evidencia-se que o programa de atenção à saúde das pessoas com distúrbios do assoalho pélvico pôde ser implantado satisfatoriamente, tendo em vista a infraestrutura, ao expressivo quantitativo de atendimentos realizados e ao seguimento terapêutico alcançado. Assim, com este relato, espera-se contribuir para o desenvolvimento de novos serviços ambulatoriais voltados a essa área de atuação do enfermeiro estomaterapeuta e da equipe multidisciplinar.

Objective:the objective was to describe the technical operational procedures and clinical data related to the implementation of a health care program for people with pelvic floor disorders in a public secondary care service. Method: this is an experience report, based on experiences related to academic and professional assistance in the implementation of a service aimed at pelvic floor disorders in the Cariri region of Ceará, carried out from May to July 2021. Results: for the implementation of the service, the following strategies were adopted: tracking the health care network for people with pelvic floor disorders; organizational structuring of the service; capturing people with pelvic dysfunctions; start of care; and therapeutic follow-up. Conclusion: in view of the above, it is evident that the health care program for people with pelvic floor disorders could be implemented satisfactorily, considering the infrastructure, the significant amount of care provided and the therapeutic follow-up achieved. Thus, with this report, it is expected to contribute to the development of new outpatient services aimed at this area of work of the stomatherapist nurse and the multidisciplinary team.

Objetivo:El objetivo es describir los procedimientos técnicos operativos y datos clínicos relacionados a la implementación de un programa de atención a la salud de las personas con trastornos del suelo pélvico en un servicio público de atención secundaria. Método: se trata de un reporte de experiencia, basado en vivencias relacionadas a la asistencia académico-profesional en la implementación de servicio destinado a los trastornos del suelo pélvico en la región del Cariri cearense, realizado de mayo a julio de 2021. Resultados: para la implementación del servicio, se adoptaron las siguientes estrategias: rastreo de la red de atención a la salud de personas con trastornos del suelo pélvico; estructuración organizacional del servicio; captación de personas con disfunciones pélvicas; inicio de la atención; y seguimiento terapéutico. Conclusión: frente a lo expuesto, queda evidente que el programa de atención a la salud de las personas con trastornos del suelo pélvico puede ser implementado satisfactoriamente, teniendo en cuenta la infraestructura, el importante número de atenciones realizadas y al seguimiento terapéutico alcanzado. Así, con este informe, se espera contribuir al desarrollo de nuevos servicios ambulatorios destinados a esta área de trabajo del enfermero estomaterapeuta y del equipo multidisciplinario.

Pelvic floor muscle exercise for prevention of pelvic floor disorders at each life stage in women / 体力科学

Pelvic floor muscles play an important role in inner unit functioning related to excretion, reproduction, support of pelvic organs, posture, and respiration, while their weakening is a characteristic health problem for many women. The pelvic floor is closely related to women’s life events, and protection and strengthening of the pelvic floor in accordance with life stages will lead to the prevention of pelvic floor disorders (pelvic frailty). Pelvic floor muscle exercises may be the first choice for prevention, improvement, and/or conservative treatment of pelvic organ prolapse caused by weakening of pelvic floor muscle groups. Also, pelvic floor muscle exercises can be done on a daily and continuous basis as a fitness activity; but proper assessment and practice with appropriate methods are important. In addition, an integrated program that includes lifestyle modification can enhance its effectiveness. In order to realize the lifelong well-being of women, there is a need to further develop effective pelvic floor exercises in creating a more comprehensive prevention-care health system for society.

Prevalence and factors associated with pelvic floor dysfunction in university women: a cross-sectional study / Prevalência e fatores associados à disfunção do assoalho pélvico em mulheres universitárias: um estudo transversal

Abstract Introduction Urinary incontinence (UI), fecal inconti-nence (FI), and genito-pelvic pain or penetration disorder (GPPPD) are considered pelvic floor dysfunction (PFD), and are mainly characterized by poor functionality of the pelvic floor muscles. Despite the relevance of these dysfunctions in women's lives, the demand for care is low. Objective To analyze the prevalence of PFD, in university women, and factors associated with PFD. Methods This is a cross-sectional study conducted at São Paulo State University, Marília, SP, Brazil, with undergraduate and/or postgraduate women aged over 18 years. An online questionnaire containing 40 open and multiple-choice questions about PFD was developed by the authors and a Google form was disclosed via social media (Facebook, Instagram) to the participants. The questionnaire was applied between April and July 2020. Results A sample of 707 participants was included. The average age was 22.5 ± 21.0 years old. The most prevalent PFD was GPPPD, reported by 30.7% of women, followed by UI (16.8%) and FI (3.2%). PFD was significant less reported in the Midwest region compared to other regions (p = 0.015) and significantly more prevalent in women who attended public university (p = 0.038), in women with UI, FI, and GPPPD. The association-test showed that attending public university showed association to UI (p < 0.001), FI (p = 0.008) and GPPPD (p = 0.006). In addition, parity showed association with GPPD (p = 0.032) and to attend health courses with UI (p = 0.002). Conclusion PFD is prevalent among university women and GPPPD was the most recurrent, followed by UI and FI. GPPPD was associated with parity and attending a public university. UI was associated with attending public university and health courses. FI was associated with attending a public university.

Resumo Introdução A incontinência urinária (IU), a incontinência fecal (IF) e a dor genitopélvica ou distúrbio de penetração (DGDP) são considerados disfunções do assoalho pélvico (DAP) e caracterizam-se principalmente pela má funcionalidade dos músculos do assoalho pélvico. Apesar da relevância dessas disfunções na vida das mulheres, a demanda por atendimento é baixa. Objetivo Analisar a prevalência das DAP em mulheres universitárias e fatores associados à DAP. Métodos Trata-se de um estudo transversal realizado na Universidade Estadual Paulista, Marília, SP, Brasil, com graduandas e/ou pós-graduandas maiores de 18 anos. Um questionário online contendo 40 questões abertas e de múltipla escolha sobre DAP foi desenvolvido pelos autores e um formulário do Google foi divulgado via mídia social (Facebook, Instagram) às participantes. O questionário foi aplicado entre abril e julho de 2020. Resultados Uma amostra de 707 participantes foi incluída. A média de idade foi de 22,5 ± 21 anos. A disfunção mais prevalente foi a DGDP, relatada por 30,7% das mulheres, seguida por IU (16,8%) e IF (3,2%). As características gerais não diferiram entre os grupos, mas no geral as disfunções foram significativamente menos relatadas na região Centro-Oeste em comparação com outras regiões (p = 0,015) e significativamente mais prevalente em mulheres que frequentaram universidade pública (p = 0,038) e em mulheres com IU, IF e DGDP. O teste de associação não demonstrou associação entre as disfunções e etnia, índice de massa corporal ou tipo de assistência à saúde. Além disso, frequentar universidade pública apresentou associação com IU (p < 0,001), IF (p= 0,008) e DGDP (p = 0,006). Além disso, a paridade mostrou-se associada à DGDP (p = 0,032) e frequentar cursos de saúde com IU (p = 0,002). Conclusão A disfunção do assoalho pélvico é prevalente entre as universitárias e a DGDP foi a mais recorrente, seguida de IU e IF. DGDP foi associado à paridade e a frequentar universidade pública. IU foi associada a frequentar universidade pública e a cursos da área da saúde. IF foi associada a frequentar universidade pública.

Knowledge of pelvic floor disorders in young women: a cross-sectional study / Conhecimento dos distúrbios do assoalho pélvico em mulheres jovens: um estudo transversal

Abstract Introduction: Young women's knowledge about pelvic floor function and dysfunction are poor. Objective: To identify the level of knowledge of young women about pelvic floor muscles (PFM) anatomy and function, pelvic floor muscle dysfunction (PFMD), pelvic organ prolapse (POP), and sexual dysfunction (SD). Methods: This is a cross-sectional study. Two hundred forty-two (242) young women from first to the third year of high school from ten public schools, in geographically disparate areas of a Brazilian county serving economic minority student populations, participated in the study. Data analysis was performed using SPSS 20.0 (SPSS Inc., Chicago, IL). The categorical data were expressed as absolute and relative frequency. Results: Only 28% of the young women knew PFM, and 26% answered to be able to contract these muscles. The prevalence of urinary incontinence was 16%, while 5% reported fecal incontinence. The previous knowledge about POP was similar between bladder and uterus prolapse, 34% and 40%, respectively. SD was known by 48% of the young women. Seventy-seven young women (31.8%) declared to have had sexual intercourse. Ten percent declared difficulties to allow vaginal penetration, and 48% of those who were able to have penetration declared that they experienced pain and discomfort. Conclusion: Young women have little knowledge about the PFM anatomy and function, PFMD, POP, and SD. In addition, they have complaints related to sexual practice, such as difficulty during vaginal penetration and pain.

Resumo Introdução: O conhecimento de mulheres jovens sobre a função e disfunção do assoalho pélvico é insuficiente. Objetivo: Identificar o nível de conhecimento de mulheres jovens sobre a anatomia e função dos músculos do assoalho pélvico (MAP), disfunção dos músculos do assoalho pélvico (DMAP), prolapso de órgãos pélvicos (POP) e disfunção sexual (DS). Métodos: Trata-se de um estudo transversal. Participaram dos estudo 242 mulheres jovens do primeiro ao terceiro ano do ensino médio de dez escolas públicas, em áreas geograficamente díspares de um município brasileiro que atende a populações de estudantes de minorias econômicas. A análise dos dados foi realizada usando SPSS 20.0 (SPSS Inc., Chicago, IL). Os dados categóricos foram expressos em frequência absoluta e relativa. Resultados: Apenas 28% das mulheres jovens conheciam os MAP e 26% responderam ser capazes de contrair esses músculos. A prevalência de incontinência urinária foi de 16%, enquanto 5% relataram incontinência fecal. O conhecimento prévio sobre POP foi semelhante entre o prolapso de bexiga e útero, 34% e 40%, respectivamente. De todas as mulheres jovens avaliadas, 48% tinham conhecimento sobre DS. Setenta e sete (31,8%) declararam ter vivenciado relação sexual, sendo que 10% destas declararam dificuldade para permitir a penetração vaginal e 48% das que conseguiam ter penetração declararam sentir dor e desconforto. Conclusão: Mulheres jovens apresentam pouco conhecimento sobre a anatomia e função dos MAP, sobre as DMAP, POP e sobre as DS. Além disso, apresentam queixas relacionadas à prática sexual, como dificuldade durante a penetração vaginal e dor.

Genital self-image, sexual function and pelvic floor discomfort in COVID-19 pandemic scenario / Autoimagem genital, função sexual e desconforto do assoalho pélvico no cenário pandêmico de COVID-19

Abstract Introduction: Sexual health is an important area of women's health, comprising aspects that can be affected by stressors, such as in the COVID-19 pandemic scenario. Objective: To investigate genital self-image, sexual function and pelvic floor discomfort in young female university students during the COVID-19 pandemic, comparing these factors with their sexual activity. Methods: This study is a quantitative and cross-sectional survey of young female university students during the COVID-19 pandemic period, carried out through an online form. To assess the variables, the Female Sexual Function Index, Pelvic Floor Distress Inventory, and Female Genital Self-Image Scale were used. Results: 182 women participated in the study, and the general mean age was 22.06 ± 2.75 years. Sexually active women (n = 128) had significantly better genital self-image compared to inactive women (22.87 ± 2.92 vs. 20.85 ± 4.41; p = 0.004). Likewise, better genital self-image was also observed in women without sexual dysfunction (23.36 ± 2.72 vs. 21.11 ± 2.96; p < 0.001) and in those who reported fewer symptoms of pelvic floor discomfort (p = 0.014). Conclusion: A positive genital self-image was associated with fewer sexual dysfunctions, better sexual function, and fewer symptoms of pelvic floor discomfort. Furthermore, sexual activity is associated with a better genital self-image.

Resumo Introdução: A saúde sexual é uma área importante da saúde da mulher, compreendendo aspectos que podem ser afetados por estressores, como no cenário de pandemia da COVID-19. Objetivo: Investigar a autoimagem genital, função sexual e desconforto do assoalho pélvico em jovens universitárias durante a pandemia de COVID-19, comparando esses fatores com sua atividade sexual. Métodos: Este estudo é uma pesquisa quantitativa e transversal com jovens universitárias durante o período da pandemia de COVID-19, realizada por meio de formulário online. Para avaliar as variáveis, foram utilizados o Índice de Função Sexual Feminina, Inventário de Desconforto do Assoalho Pélvico e Escala de Autoimagem Genital Feminina. Resultados: Participaram do estudo 182 mulheres, com média de idade de 22,06 ± 2,75 anos. Mulheres sexualmente ativas (n = 128) apresentaram autoimagem genital significativamente melhor em comparação às mulheres inativas (22,87 ± 2,92 vs. 20,85 ± 4,41; p = 0,004). Da mesma forma, melhor autoimagem genital também foi observada em mulheres sem disfunção sexual (23,36 ± 2,72 vs. 21,11 ± 2,96; p < 0,001) e naquelas que relataram menos sintomas de desconforto do assoalho pélvico (p = 0,014). Conclusão: Uma autoimagem genital positiva foi associada a menos disfunções sexuais, melhor função sexual e menos sintomas de desconforto do assoalho pélvico. Além disso, a atividade sexual está associada a uma melhor autoimagem genital.

Effectiveness of systemic acupuncture in the control of urinary incontinence following radical prostatectomy: a randomized clinical trial / Efectividad de la acupuntura sistémica en el control de la incontinencia urinaria post-prostatectomía radical: ensayo clínico randomizado / Efetividade da acupuntura sistêmica no controle da incontinência urinária pós-prostatectomia radical: ensaio clínico randomizado

ABSTRACT Objective: To evaluate the effectiveness of acupuncture associated with pelvic floor muscle training for the control of urinary incontinence following radical prostatectomy. Method: Open-label, parallel randomized clinical trial. The intervention group (n = 33) underwent eight sessions of systemic acupuncture associated with pelvic floor muscle training and the control group (n = 31) performed only pelvic floor muscle training. The outcome variable was urinary incontinence assessed by the Pad Test and Daily Pad Used, before treatment (T0), after four weeks (T1) and after eight weeks of treatment (T2). Data analysis was performed using a longitudinal model of Generalized Estimating Equations, significance level of 0.05. Results: The control group showed greater urinary loss compared to the intervention group at T1 (p = 0.006) and at T2 (p < 0.001). Both groups showed improvement in the level of urinary incontinence over time, but the improvement was greater in the intervention group (p < 0.001). Conclusion: Acupuncture associated with pelvic floor muscle training was effective in reducing urinary incontinence in prostatectomized men. Brazilian Registry of Clinical Trials:RBR-3jm5y2

RESUMEN Objetivo: evaluar la efectividad de la acupuntura asociada al entrenamiento muscular de piso pélvico para el control de la incontinencia urinaria post-prostatectomía radical. Método: ensayo clínico aleatorizado paralelo, del tipo abierto. El grupo intervención (n = 33) fue sometido a ocho sesiones de acupuntura sistémica asociada al entrenamiento muscular de piso pélvico y el grupo control (n = 31) solamente al entrenamiento muscular de piso pélvico. La variable desfecho fue incontinencia urinaria evaluada por el Pad Test y Daily Pad Used, antes del tratamiento (T0), después de cuatro semanas (T1) y después de ocho semanas de tratamiento (T2). El análisis de datos fue realizado por modelo longitudinal de Ecuaciones de Estimaciones Generalizadas, nivel de significancia de 0,05. Resultados: el grupo control presentó mayor pérdida urinaria en comparación al grupo intervención en T1 (p = 0,006) y en T2 (p < 0,001). Ambos grupos presentaron mejor nivel de incontinencia urinaria a lo largo del tiempo, sin embargo la mejora fue mayor en el grupo intervención (p < 0,001). Conclusión: la acupuntura asociada al entrenamiento muscular de piso pélvico fue efectiva para la reducción de la incontinencia urinaria en hombres prostatectomizados. Registro Brasileño de Ensayos Clínicos:RBR-3jm5y2

RESUMO Objetivo: Avaliar a efetividade da acupuntura associada ao treinamento muscular do assoalho pélvico para o controle da incontinência urinária pós-prostatectomia radical. Método: Ensaio clínico aleatorizado paralelo, do tipo aberto. O grupo intervenção (n = 33) foi submetido a oito sessões de acupuntura sistêmica associada ao treinamento muscular do assoalho pélvico e o grupo controle (n = 31) somente ao treinamento muscular do assoalho pélvico. A variável desfecho foi incontinência urinária avaliada pelo Pad Test e Daily Pad Used, antes do tratamento (T0), após quatro semanas (T1) e após oito semanas de tratamento (T2).A análise de dados foi realizada por modelo longitudinal de Equações de Estimações Generalizadas, nível de significância de 0,05. Resultados: O grupo controle apresentou maior perda urinária em comparação ao grupo intervenção em T1 (p = 0,006) e em T2 (p < 0,001). Ambos os grupos apresentaram melhora no nível de incontinência urinária ao longo do tempo, porém a melhora foi maior no grupo intervenção (p < 0,001). Conclusão A acupuntura associada ao treinamento muscular do assoalho pélvico foi efetiva para a redução da incontinência urinária em homens prostatectomizados. Registro Brasileiro de Ensaios Clínicos:RBR-3jm5y2

Manejo quirúrgico de la hernia perineal primaria / Surgical management of primary perineal hernia

Las hernias perineales presentan una incidencia variable entre el 0,3-6 %. El abordaje quirúrgico se puede realizar por vía perineal o por vía laparoscópica. Se presentan las imágenes de una paciente con una hernia perineal adquirida primaria, tratada exitosamente mediante un abordaje mixto.

Perineal hernias present a variable incidence between 0.3-6%. The surgical approach can be performed perineally or laparoscopically. Images of a patient with a primary acquired perineal hernia, successfully treated using a mixed approach, are presented.