Urinary incontinence in female athletes with inadequate eating behavior: a case-control study.

INTRODUCTION AND HYPOTHESIS: Female athletes can develop symptoms of urinary incontinence (UI) as well as risk behaviors for eating disorders owing to the type of training and sports modality. Such symptoms are intensified by the demands for results and an idealized body composition. Our aim is to investigate the possible association between urinary incontinence and risk behaviors for eating disorders in female athletes. METHODS: A case-control study was conducted with 270 female athletes who answered the International Consultation on Incontinence Questionnaire (ICIQ-SF) and the Eating Attitudes Test (EAT-26). Different sports modalities and their respective impact levels were considered in the study. Female athletes were divided into two groups, i.e., athletes with UI (case group) and those without UI (control group). Multiple logistic regression was used to calculate associated factors. RESULTS: From all variables included in the study, only abnormal eating behavior was found to be associated with UI according to the multiple logistic regression test. Participants with UI were 2.15-fold more likely to have risk behaviors for eating disorders. CONCLUSIONS: Female athletes with UI were more likely to have risk behaviors for eating disorders. Multidisciplinary teams that provide care for these athletes should be attentive to symptoms that may not appear to be associated at first glance but may reflect a condition that needs to be treated.

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).

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).

The prevalence of fecal incontinence and associated risk factors in older adults participating in the SABE study.

AIMS: To assess the prevalence of fecal incontinence (FI) and associated factors in older adults. METHODS: The prevalence and factors associated with FI in older adults were studied by means the SABE study (Health, Well-being, and Aging). A group of 1,345 subjects were interviewed during the third wave of the SABE study performed in Sao Paulo, in 2010. The study included 64.3% females; the mean age of the participants was 70.4 years. The dependent variable was the positive answer for the question "In the last 12 months, have you ever lost control of bowel movements or stools?". Descriptive analysis and hierarchical logistic regression were performed. The independent variables were as follows: (a) demographics: gender, age and (b) clinical characteristics: self-reported chronic diseases, presence of cognitive and/or functional decline, depression and urinary incontinence symptoms, and nutritional status. RESULTS: The overall prevalence of FI was 11,7%, being 8.3% and 13.2% for males and females respectively. Among male subjects, the presence of malnutrition was associated with FI and thus presented a high relative risk index for its occurrence. Among female subjects, age group 70-74 years and some self-reported diseases or conditions such as mild depression, heart disease, urinary incontinence, and polypharmacy were associated with FI. For the first time in literature, polypharmacy appeared as an associated factor for FI for female older adults. CONCLUSIONS: The prevalence of FI in older adults was 11.7% and was mainly associated with advanced age and presence of heart disease, symptoms of depression, polypharmacy and urinary incontinence and malnutrition. Neurourol. Urodynam. 35:959-964, 2016. © 2015 Wiley Periodicals, Inc.

Cocaine abuse that presents with acute scrotal pain and mimics testicular torsion.

Report case (s) relevant aspects: Man, 27 years old, complaining of acute testicular pain by 2 hours in the remaining left testicle. Denies fever, lower urinary tract symptoms such as dysuria, urinary frequency, concommitant or prior urethral discharge to the painful condition. He underwent right orchiectomy 13 years ago by testicular torsion. He is a chronic user of cocaine for 15 years and during the last three days the drug use was continuous and intense. Proposed premise substantiating case (s) description: Initial diagnostic hypothesis: Syndromic: Acute Scrotum Syndrome (SEA) • Main Etiologic (testicular torsion) • Secondary Etiologic (acute orchiepididymitis) Briefly delineates what might it add? Lines of research That Could be Addressed: In this challenging clinical case we presented an alternative and new etiologic diangosis for the acute scrotum which the main etiologic factor remains testicular torsion. This new diangosis is acute testicular ischemia as a complication of cocaine abuse.

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.

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.

Association between urinary incontinence in elderly patients and caregiver burden in the city of Sao Paulo/Brazil: Health, Wellbeing, and Ageing Study.

AIM: Some elderly patients with incontinence require the care of third parties, known as caregivers. Such care can occur on a daily basis leaving little opportunity for the caregiver to take care of himself/herself. The aims are to assess the association between urinary incontinence in elderly patients and caregiver burden and identify independent factors for caregiver's burden in the city of Sao Paulo, Brazil. METHODS: The Pan-American Health Organization and World Health Organization coordinated a multicenter study named Health, Wellbeing and Aging (SABE Study) in elderly people living in seven countries of Latin America and the Caribbean. In Brazil, the study population carried out in São Paulo in the year 2000 and reassessed in 2006 (COHORT A). Urinary incontinence was assessed by ICIQ-SF and caregiver burden by means of Zarit Burden Scale. RESULTS: A total of 327 patients with caregivers were included in the study. The general prevalence of urinary incontinence was 25.8%, higher among the women. There was a significant positive association between caregiver burden and incontinent patients, demonstrating that urinary incontinence in elderly patients produced greater caregiver burden. In the present study, the variables with significant correlations were assessed using the multivariate logistic regression model. Category 2 of the ICIQ-SF (incontinent patients) increased the chances of caregiver burden 1.96-fold in comparison to Category 1 (continent patients). Likewise, the category of impaired cognition increased the chances of caregiver burden 2.34-fold. CONCLUSIONS: Urinary incontinence and cognitive impairment in elderly patients were associated to an increase in caregiver burden.

Factors Associated with Sexual Activity for Women with Pelvic Floor Dysfunction - A Cross-Sectional Study.

OBJECTIVE: To examine women with pelvic floor dysfunction (PFDs) and identify factors associated with sexual activity (SA) status that impacts quality of life (QoL). METHODS: We conducted a cross-sectional study that included women > 18 years old who presented with at least one PFD symptom (urinary incontinence [UI] and/or pelvic organ prolapse [POP]), in outpatient clinics specializing in urogynecology and PFD in Fortaleza, state of Ceará, Brazil, using a service evaluation form and QoL questionnaires. RESULTS: The analysis of 659 women with PFD included 286 SA (43.4%) women and 373 non-sexually active (NSA) (56.6%) women, with a mean age of 54.7 (±12) years old. The results revealed that age (odds ratio [OR] = 1.07, 95% confidence interval [CI] 1.03-1.12) and post-menopausal status (OR = 2.28, 95% CI 1.08-4.8) were negatively associated with SA. Being married (OR = 0.43, 95% CI 0.21-0.88) was associated with SA. Pelvic organ prolapse (OR = 1.16, 95% CI 0.81-1.68) and UI (OR = 0.17, 95% CI 0.08-0.36) did not prevent SA. SF-36 Health Survey results indicated that only the domain functional capacity was significantly worse in NSA women (p = 0.012). Two King's Health Questionnaire domains in NSA women, impact of UI (p = 0.005) and personal relationships (p < 0.001), were significantly associated factors. Data from the Prolapse Quality-of-life Questionnaire indicated that NSA women exhibited compromised QoL. CONCLUSION: Postmenopausal status and age negatively affected SA. Being married facilitated SA. Presence of POP and UI did not affect SA. However, NSA women with POP exhibited compromised QoL.

OBJETIVO: Examinar mulheres com disfunções do assoalho pélvico (DAP) e identificar fatores associados ao status de atividade sexual (AS) e impacto na qualidade de vida (QV). MéTODOS: Realizamos um estudo transversal, no qual participaram mulheres > 18 anos, que apresentaram pelo menos um sintoma de DAP (incontinência urinária [UI] e/ou prolapso de órgão pélvico [POP]), em ambulatórios especializados em uroginecologia e DAP em Fortaleza, CE, Brasil, utilizando um formulário de avaliação de serviço e questionários de QV. RESULTADOS: A análise de 659 mulheres com DAP incluiu 286 mulheres sexualmente ativas (SA) (43,4%) e 373 mulheres não sexualmente ativas (NSA) (56,6%), com idade média de 54,7 (±12) anos. Os resultados revelaram que idade (odds ratio [OR] = 1,07; intervalo de confiança [IC] 95%: 1,03­1,12) e status pós-menopausa (OR = 2,28; IC 95% 1,08­4,8) foram negativamente associados à atividade sexual. O casamento (OR = 0,43; IC 95% 0,21­0,88) foi associado à AS. Por outro lado, POP (OR = 1,16; IC 95% 0,81­1,68) e IU (OR = 0,17; IC 95% 0,08­0,36) não impediram a AS. Os resultados do SF-36 Health Survey indicaram que apenas a capacidade funcional do domínio (p = 0,012) foi significativamente pior em mulheres NSA. Dois domínios King's Health Questionnaire (KHQ, na sigla em inglês) em mulheres NSA, impacto da IU (p = 0,005) e relacionamento pessoal (p < 0,001), foram fatores significativamente associados. Os dados do Prolapse Quality-of-life Questionnaire (P-QoL, na sigla em inglês) indicaram que as mulheres NSA apresentavam QV comprometida. CONCLUSãO: O status pós-menopausa e a idade afetaram negativamente a AS, enquanto o casamento facilitou a AS. A presença de POP e IU não afetou a AS. No entanto, as mulheres NSA com POP apresentaram QV comprometida.

No mesh versus mesh in the treatment of anterior vaginal wall prolapse: prospective, randomised, controlled trial, long-term follow-up.

OBJECTIVES: To compare the efficacy and safety of anterior colporrhaphy (AC) versus transvaginal polypropylene mesh (PM) for the treatment of anterior vaginal wall prolapse (AVWP) at long-term follow-up. METHODS: Prospective and randomized controlled trial, 100 women with AVWP stage ≥ II assessed by the Pelvic Organ Prolapse Quantification System (POP-Q) underwent AC (control group) or PM insertion (mesh group). At baseline and at 60-month follow-up, safety profile, anatomical outcomes by POP-Q measurements and staging, subjective outcomes and quality of life (QoL) impact by ICIQ (SF and VV) and OAB-V8 questionnaires were assessed RESULTS: 76 women completed the study, 43 in Control versus 33 in Mesh group. Significant improvements were observed in all variables between the 2 times in each group (p < 0.0001), without differences between groups. Objective cure (POP-Q Ba ≤ - 2 and Ba ≤ - 1) occurred in 22 and 36 (51.2 and 83.7%) versus 23 and 31 (69.7 and 93.9%), p = 0.10 and 0.29; and subjective cure (VSS, no vaginal symptom) in 21 (48.8%) versus 17 (51.5%), p = 0.82, respectively, at 60-month follow-up. When adjusted for the other variables, Mesh group showed worse QoL impact due to subjective vaginal symptoms (odds ratio 3.99, CI 95% 1.13; 14.13). AVW asymptomatic mesh exposure occurred in 2 patients (6.06%) in the Mesh group. CONCLUSIONS: AC and PM provided good overall objective and subjective outcomes for a minimum 60-month follow-up. Vaginal and urinary symptoms improved post-operatively in both groups. Mesh group experienced four times more negative impact on QoL compared to Control at 60-month follow-up.

Macroplastique implantation system for female stress urinary incontinence: long-term follow-up.

PURPOSE: To evaluate the 60-month outcome of the Macroplastique Implantation System (MIS) for the treatment of female stress urinary incontinence (SUI) caused by intrinsic sphincter deficiency evaluated by objective and subjective measures, including Quality of Life (QoL) impact. PATIENTS AND METHODS: Twenty-one women, mean age 47.4 years, with urodynamically diagnosed intrinsic sphincter deficiency were enrolled. They were assessed preoperatively by physical examination, QoL (King's Health Questionnaire), Stamey grading of incontinence, pad usage, 1-hour pad-weight test, and urodynamic testing. Patients underwent periurethral injection of MIS under local anesthesia. After 24-month follow-up, six patients were discharged from the group, and the remaining 15 patients were reassessed by means of objective and subjective parameters at 6, 12, 24, and 60 months after last treatment. RESULTS: Patients' QoL improved in all domains throughout the study. The overall subjective success rate was 80%. At 60 months, pad usage was reduced from a mean of 3.5/day to 0.9/day, and the 1-hour pad weight decreased from 53.8 to 5.9 g. Valsalva leak-point pressure testing demonstrated a 73.3% rate of cure/improvement. There was no significant statistical difference assessed by Stamey grading and objective cure at 6, 12, 24, and 60 months of follow-up. The data showed a stable overall outcome from 6 to 60 months. CONCLUSION: The MIS produced promising long-term subjective and objective outcomes, as well as long-lasting improvements in QoL. It should be considered a good option for certain cases of female SUI.

Factors associated with sexual activity for women with pelvic floor dysfunction - a cross-sectional study / Fatores associados à atividade sexual de mulheres com distúrbios do assoalho pélvico - um estudo transversal

Abstract Objective To examine women with pelvic floor dysfunction (PFDs) and identify factors associated with sexual activity (SA) status that impacts quality of life (QoL). Methods We conducted a cross-sectional study that includedwomen> 18 years old who presented with at least one PFD symptom (urinary incontinence [UI] and/or pelvic organ prolapse [POP]), in outpatient clinics specializing in urogynecology and PFD in Fortaleza, state of Ceará, Brazil, using a service evaluation form and QoL questionnaires. Results The analysis of 659 women with PFD included 286 SA (43.4%) women and 373 non-sexually active (NSA) (56.6%) women, with a mean age of 54.7 (±12) years old. The results revealed that age (odds ratio [OR]= 1.07, 95% confidence interval [CI] 1.03-1.12) and post-menopausal status (OR= 2.28, 95% CI 1.08-4.8) were negatively associated with SA. Being married (OR= 0.43, 95% CI 0.21-0.88) was associated with SA. Pelvic organ prolapse (OR= 1.16, 95% CI 0.81-1.68) and UI (OR= 0.17, 95% CI 0.08-0.36) did not prevent SA. SF-36 Health Survey results indicated that only the domain functional capacity was significantly worse in NSA women (p= 0.012). Two King's Health Questionnaire domains in NSA women, impact of UI (p= 0.005) and personal relationships (p< 0.001), were significantly associated factors. Data from the Prolapse Quality-of-life Questionnaire indicated that NSA women exhibited compromised QoL. Conclusion Postmenopausal status and age negatively affected SA. Being married facilitated SA. Presence of POP and UI did not affect SA. However, NSAwomen with POP exhibited compromised QoL.

Resumo Objetivo Examinar mulheres com disfunções do assoalho pélvico (DAP) e identificar fatores associados ao status de atividade sexual (AS) e impacto na qualidade de vida (QV). Métodos Realizamos um estudo transversal, no qual participaram mulheres > 18 anos, que apresentaram pelo menos um sintoma de DAP (incontinência urinária [UI] e/ou prolapso de órgão pélvico [POP]), em ambulatórios especializados em uroginecologia e DAP emFortaleza, CE, Brasil, utilizando um formulário de avaliação de serviço e questionários de QV. Resultados A análise de 659 mulheres comDAP incluiu 286 mulheres sexualmente ativas (SA) (43,4%) e 373 mulheres não sexualmente ativas (NSA) (56,6%), com idade média de 54,7 (±12) anos. Os resultados revelaram que idade (odds ratio [OR]= 1,07; intervalo de confiança [IC] 95%: 1,03-1,12) e status pós-menopausa (OR= 2,28; IC 95% 1,08-4,8) foram negativamente associados à atividade sexual. O casamento (OR= 0,43; IC 95% 0,21-0,88) foi associado à AS. Por outro lado, POP (OR= 1,16; IC 95% 0,81-1,68) e IU (OR= 0,17; IC 95% 0,08-0,36) não impediram a AS. Os resultados do SF-36 Health Survey indicaram que apenas a capacidade funcional do domínio (p = 0,012) foi significativamente pior em mulheres NSA. Dois domínios King's Health Questionnaire (KHQ, na sigla em inglês) em mulheres NSA, impacto da IU (p = 0,005) e relacionamento pessoal (p< 0,001), foram fatores significativamente associados. Os dados do Prolapse Qualityof- life Questionnaire (P-QoL, na sigla em inglês) indicaram que as mulheres NSA apresentavam QV comprometida. Conclusão O status pós-menopausa e a idade afetaram negativamente a AS, enquanto o casamento facilitou a AS. A presença de POP e IU não afetou a AS. No entanto, as mulheres NSA com POP apresentaram QV comprometida.

Treatment of intrinsic sphincter deficiency using the Macroplastique Implantation System: two-year follow-up.

PURPOSE: To evaluate the 24-month outcome of the Macroplastique Implantation System (MIS) for the treatment of stress urinary incontinence (SUI) using objective and subjective measures, including quality-of-life (QoL) impact. PATIENTS AND METHODS: Twenty-one consecutive women with a mean age of 47.4 years and a mean body mass index 26.16 kg/m(2) having urodynamically diagnosed intrinsic sphincter deficiency (ISD) were enrolled. Patients were assessed preoperatively and postoperatively by physical examination, Stamey grading of incontinence, pad usage, pad weight test, and urodynamic measurements. Quality of life was assessed by the King's Health Questionnaire. Patients underwent transurethral injection of the MIS under local anesthesia on an outpatient basis. The mean volume injected was 6.3 mL. The data presented are based on 24-month followup from the last injection, and the patients were considered their own controls. RESULTS: Patient QoL improved in all domains. Ten patients (47%) considered themselves cured; three (14.3%) thought they were improved, and eight (38.1%) believed the procedure had failed. According to the subjective surgeon Stamey grading, 8 patients (38.1%) were considered cured, 5 (23.8%) improved, and 8 (38.1%) failed. Daily pad usage was reduced from a mean of 4.38 to 1.47. According to the pad weight test, 12 patients (57.1%) were dry and two (9.5%) improved, while in 7 (33.3%), MIS failed. Urodynamic testing demonstrated 10 patients (50%) dry and 5 (25%) improved. CONCLUSION: The MIS proved to have an outcome acceptable to patients and surgeons at 24-month followup. The procedure can be performed easily under local anesthesia.

[Validation of the Portuguese version of the King's Health Questionnaire for urinary incontinent women]. / Validação do "King's Health Questionnaire" para o português em mulheres com incontinência urinária.

OBJECTIVE: To translate into Portuguese and evaluate the condition-specific quality of life King's Health Questionnaire (KHQ) for female urinary incontinence. METHODS: Two Brazilian translators, aware of the aim of the project, prepared two versions of the KHQ into Portuguese, which were back-translated into English by two other English translators. The differences were harmonized and pre-tested in a pilot study. The final version of the KHQ and the "Short-Form Health Survey" (SF-36), which has already been translated and validated into Portuguese were simultaneously administered to 156 and 119 women respectively. KHQ's psychometric properties such as reliability (internal consistency and retest) and construct validity were tested. A retest was performed within 2 weeks from the start date. RESULTS: The cultural adjustment process resulted in no changes in the KHQ Portuguese version, although for low schooling patients the questionnaire had to be read by the researcher during face-to-face interview. For all other patients, the KHQ was self-administered. KHQ's standardized Cronbach's alpha was 0.87 and when assessed by domains ranged from 0.49 to 0.92. Reliability measured by intraclass correlation (ICC) was considered moderate to strong for all domains and the severity measure scale ranged from 0.53 to 0.81. Pearson's correlation coefficient between KHQ and SF-36 was considered weak to moderate in the majority of the related domains, ranging from -0.27 to -0.53. CONCLUSIONS: The KHQ Portuguese version was translated and adjusted for Brazilian women with urinary incontinence complaints. It represents an important tool for the assessment of incontinent women in clinical trials.

[Validation of the "International Consultation on Incontinence Questionnaire -- Short Form" (ICIQ-SF) for Portuguese]. / Validação para o português do "International Consultation on Incontinence Questionnaire -- Short Form" (ICIQ-SF).

OBJECTIVE: To translate into and validate for Portuguese the "International Consultation on Incontinence Questionnaire -- Short Form" (ICIQ-SF), a condition-specific quality-of-life questionnaire for patients with urinary incontinence. METHODS: Two Brazilians independently translated the original ICIQ-SF into Portuguese. These two translations were harmonized, and then checked by independent back-translation by two native English speakers. The harmonized translation was pre-tested in a pilot study on 20 patients. The final version of the ICIQ-SF in Portuguese was applied to 123 consecutive patients aged 16 or over (29 males and 94 females) with a complaint of urinary incontinence, who had sought the Department of Urogynecology and Uroneurology of the School of Medical Sciences of Unicamp. The Portuguese version of the King's Health Questionnaire (KHQ) was also applied to the same group. The psychometric properties of the questionnaire, such as reliability and construct validity were assessed. RESULTS: The median age was 53 years (range: 16 to 86). The mean retest interval for the ICIQ-SF was 14.37 days (range: 6 to 41). No changes from the original format of the ICIQ-SF were observed at the end of the process of translation and cultural adaptation. The internal consistency was high (0.88), as measured by the Cronbach alpha coefficient. The test-retest value was considered moderate to strong, as measured by the weighted Kappa index (range: 0.72 to 0.75) and Pearson correlation coefficient (0.89). The correlation between the ICIQ-SF and KHQ was considered to be moderate to good for most items (range: 0.44 to 0.77). The evaluation of the construct and concurrent validity was also satisfactory and statistically significant. CONCLUSIONS: The "International Consultation on Incontinence Questionnaire" (ICIQ-SF) was successfully translated into Portuguese and validated for application to Brazilian female and male patients complaining of urinary incontinence, with satisfactory reliability and construct validity.

Cocaine abuse that presents with acute scrotal pain and mimics testicular torsion

ABSTRACT Report case (s) relevant aspects: Man, 27 years old, complaining of acute testicular pain by 2 hours in the remaining left testicle. Denies fever, lower urinary tract symptoms such as dysuria, urinary frequency, concommitant or prior urethral discharge to the painful condition. He underwent right orchiectomy 13 years ago by testicular torsion. He is a chronic user of cocaine for 15 years and during the last three days the drug use was continuous and intense. Proposed premise substantiating case (s) description: Initial diagnostic hypothesis: Syndromic: Acute Scrotum Syndrome (SEA) Main Etiologic (testicular torsion) Secondary Etiologic (acute orchiepididymitis) Briefly delineates what might it add? Lines of research That Could be Addressed: In this challenging clinical case we presented an alternative and new etiologic diangosis for the acute scrotum which the main etiologic factor remains testicular torsion. This new diangosis is acute testicular ischemia as a complication of cocaine abuse.

Validation of the Prolapse Quality-of-Life Questionnaire (P-QoL) in Portuguese version in Brazilian women.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to validate the Portuguese translated version of the Prolapse Quality-of-Life Questionnaire (P-QoL). METHODS: Ninety-eight women completed the P-QoL questionnaire translated into Portuguese at baseline and on the second visit, 2 weeks later. Clinical data and Pelvic Organ Prolapse Quantification Index (POP-Q) according to the International Continence Society were obtained. Psychometric properties of the questionnaire were assessed. RESULTS: Sixty-eight symptomatic and 30 asymptomatic women for POP symptoms were studied. Most patients presented POP-Q > 2. The P-QoL demonstrated good psychometric properties. The test-retest reliability confirmed a highly significant stability between the total scores for each domain (P < 0.0001). The construct validation distinguished differences in P-QoL questionnaire scores between symptomatic and asymptomatic women. CONCLUSION: The Portuguese version of the P-QoL questionnaire is a valid and reliable instrument to assess quality of life in Brazilian women with pelvic organ prolapse.

Analysis of the prevalence of and factors associated with urinary incontinence among elderly people in the Municipality of São Paulo, Brazil: SABE Study (Health, Wellbeing and Aging).

To investigate the prevalence of urinary incontinence among elderly people living in São Paulo, Brazil and their associated risk factors. The Pan-American Health Organization and World Health Organization coordinated a multicenter study named Health, Wellbeing and Aging (SABE Study) in elderly people (over 60 years old) living in seven countries in Latin America and the Caribbean. In Brazil, the study was carried out in São Paulo in the year 2000. The total Brazilian sample included 2,143 people. The prevalence of self reported urinary incontinence was 11.8% among men and 26.2% for women. It was verified that among those reporting urinary incontinence, 37% also reported stroke and 34% depression. It was found that the greater the dependence that the elderly people presented, the greater the prevalence of urinary incontinence. The associated factors found were depression (odds ratio = 2.49), female (2.42), advanced age (2.35), important functional limitation (2.01). Urinary incontinence is a highly prevalent symptom among the elderly population of the municipality of São Paulo, especially among women. The adoption of preventive measures can reduce the negative effects of urinary incontinence.