Sexual function after energy-based treatments of women with urinary incontinence. A systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) affects approximately 50% of adult women worldwide and is associated with declining sexual function (SF). Energy-based devices emerged as a minimally invasive alternative treatment. Nevertheless, their effect on sexuality is uncertain. We hypothesize that the UI energy treatment can lead to sexual function improvement. METHODS: A search was performed in PubMed, Cochrane Library, Web of Science, Embase, and Scopus for randomized clinical trials (RCTs) and nonrandomized studies of intervention, which treated incontinent women using energy, with UI and sexual function (SF) as outcomes. Severe comorbidities, pelvic organ prolapse (POP)> grade 2, and use of medication to treat UI or that affects SF were excluded. Quality assessment and meta-analysis were performed. RESULTS: From 322 articles, 11 RCTs were included for qualitative analysis. UI symptoms improved in all studies. Regarding SF, RCT with premenopausal women showed improvement in SF in the Er:Yag group (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 and Female Sexual Function Index). A prospective study showed improvement in SF independent of the grade of SUI. RF showed benefits for SF but was not superior to pelvic floor muscle training. One nonrandomized study of intervention with a High-Intensity Focused Electromagnetic Field showed significant improvement of SF in the Golombok Rust Inventory of Sexual Satisfaction total score, a decline in pain and dissatisfaction domains. Meta-analysis with 4 RCTs and 2 nonrandomized studies found no difference between groups (0.26 (95% CI -0.67 to 1.20, and -0.74 (95% CI -3.78 to 2.30) respectively). CONCLUSIONS: This meta-analysis did not confirm that energy equipment improved the SF of women with UI.

Contribuição da tomografia helicoidal no estadiamento pré-operatório do carcinoma gástrico / Contribution of abdominal helical tomography in the preoperative staging of gastric carcinoma

Objetivo: Analisar a sensibilidade da tomografia helicoidal abdominal na detecção do comprometimento linfonodal e de metástases hepáticas e peritoneais no estadiamento pré-operatório do carcinoma gástrico. Método: Foram estudados retrospectivamente 52 doentes operados por carcinoma gástrico e estadiados por tomografia helicoidal abdominal com contraste oral e intravenoso. Os resultados baseados nos laudos correspondentes foram correlacionados com os achados intraoperatórios e exame anatomopatológico dos espécimes cirúrgicos. Resultados: A neoplasia gástrica localizou-se na região do antropilórica em 38 (73,1%) doentes, na cárdia em 8 (15,4%) e no corpo e fundo em 6 (11,5%). A tomografia helicoidal abdominal detectou lesão gástrica em 25 (48,1%) doentes, metástases hepáticas em 6 (11,5%), acometimento de linfonodos em 5 (9,6%), ascite em 4 (7,7%) e comprometimento no fígado, baço e pâncreas em 1 (1,9%). Na laparotomia, constataram-se metástases hepáticas em 6 (11,5%) doentes e ascite em 12 (23,1%). Nos doentes submetidos à ressecção com intenção curativa da neoplasia, foram identificados pela tomografia helicoidal abdominal pré-operatória 27 (67,5%) linfonodos sugestivos de comprometimento. O exame anatomopatológico mostrou 16 (40,0%) doentes com linfonodos infiltrados pelo carcinoma gástrico. A sensibilidade do exame de tomografia helicoidal abdominal na identificação pré-operatória da lesão gástrica foi 48,1%, para linfonodos acometidos foi de 18,5% e para metástases hepáticas a sensibilidade foi 100,0%. Treze (25%) doentes apresentaram metástases peritoneais não reveladas pela tomografia helicoidal. Conclusões: O exame de tomografia computadorizada helicoidal abdominal no pré-operatório do carcinoma gástrico apresentou sensibilidade elevada na detecção de metástases hepáticas, sensibilidade baixa na detecção do comprometimento linfonodal pela neoplasia e não foi capaz de identificar metástases peritoneais.

Objective: To analyze the sensitivity of preoperative abdominal helical tomography of gastric carcinoma in detecting lymph node compromise and hepatic and peritoneal metastases. Method: We examined retrospectively 52 patients with gastric carcinoma who had undergone surgery. Patients were staged in according to the findings using abdominal helical tomography with oral and intravenous contrast. Results of pre-operative abdominal tomography correlated with intra-operative findings and anatomopathological results. Results: Gastric neoplasia was located in the antropyloric region in 38 patients (73.1%), in the cardia region in 8 (15.4%), and in the body and fundus in 6 (11.5%). Abdominal tomography detected gastric lesions in 25 patients (48.1%), revealed hepatic metastases in 6 (11.5%), lymph node invasion in 5 (9.6%), ascitis in 4 (7.7%), and neoplastic infiltration in the liver, spleen, and pancreas in 1 (1.9%). Laparotomy detected hepatic metastases in 6 (11.5%) patients and ascitis in 12 (23.1%). Among the patients submitted to curative resection, 27 (67.5%) were identified as having lymph nodes compromised on preoperative abdominal tomography. Anatomopathological examination of the operative specimen showed that 16 patients (40.0%) had lymph nodes invaded by carcinoma. The sensitivity of pre-operative abdominal tomography exams in identifying gastric lesion was 48.1, 18.5% for invaded lymph nodes, and 100.0% for hepatic metastases. Although 13 (25%) patients presented peritoneal metastases intra-operatively, the abdominal tomography exams did not reveal such lesions. Conclusions: Exams of the gastric carcinoma presented high sensitivity in detecting hepatic metastases, low sensitivity in detecting lymph node invasion by neoplasia, and inability to identify peritoneal metastases.