Pelvic floor physical therapy and mindfulness: approaches for chronic pelvic pain in women-a systematic review and meta-analysis.

PURPOSE: Chronic pelvic pain (CPP) in women is a complex syndrome and symptoms are associated with sexual dysfunction, musculoskeletal and myofascial disorders, and comorbid psychiatric disorders. Its widespread prevalence results in substantial expense due to therapy and lost productivity, and it is perhaps one of the most urgent and neglected medical needs. This systematic review and meta-analysis aimed to estimate the role of mindfulness and pelvic floor physical therapy (PFPT) in the treatment or management of women with CPP. METHODS: This systematic review (CRD42020204987) searched for relevant publications between January 2000 and November 2020 on MEDLINE/PubMed, Web of Science, One File GALE, and Technology Research databases using the following search terms: chronic pelvic pain, pelvic floor physical therapy/physiotherapy, mindfulness, and their variants. Risk of bias and quality of evidence were evaluated. RESULTS: Seven clinical trials (n = 279) were included in the review, and five in the meta-analysis (n = 225). For the pain outcome and its catastrophizing, there was a statistical difference for the Pain Catastrophizing Scale after treatment and during follow-up with mindfulness and PFPT (MD = - 3.82 [- 6.97, - 0.68], p = 0.01, and MD = - 4.49 [- 7.61, - 1.37], p = 0.00, respectively). Sexual function, assessed by the female sexual function index, differed significantly during follow-up between PFPT and mindfulness (MD = - 0.72 [- 1.38, - 0.05], p = 0.03). CONCLUSION: The small number of studies applying both PFPT and mindfulness to CPP suggests that a multidisciplinary approach is required to treat women with CPP, and further studies involving these therapeutic techniques throughout the CPP cycle are needed.

An ideal e-health system for pelvic floor muscle training adherence: Systematic review.

BACKGROUND: Nowadays, Pelvic Floor Muscle Training (PFMT) is a first line, level 1 evidence-based treatment for urinary incontinence (UI), but adherence to PFMT is often problematic. Today, there are several mobile applications (mApps) for PFMT, but many lack specific strategies for enhancing adherence. AIMS: To review available mApps for improvement of adherence to PFMT, and to introduce a new App so called iPelvis. METHODS: Review study all available mApps for PFMT and relevant literature regarding adherence by electronic search through the databases Pubmed, Embase, CINAHL, LILACS, PEDro, and Scielo. Based on these results, development of a mApp, called "iPelvis" for Apple™ and Android™ systems, implementing relevant strategies to improve adherence. RESULTS: Based on the current adherence literature we were able to identify 12 variables helping to create the optimal mApp for PFMT. None of the identified 61 mApps found for Android™ and 16 for Apple™ has all these 12 variables. iPelvis mApp and websites were constructed taking into consideration those 12 variables and its construct is now being subject to ongoing validation studies. CONCLUSION: MApps for PFMT are an essential part of first-line, efficient interventions of UI and have potentials to improve adherence, in case these respect the principles of PFMT, motor learning and adherence to PFMT. iPelvis has been constructed respecting all essential variables related to adherence to PFMT and may enhance the effects of UI treatment.

Auditory Nerve Recovery Function in Cochlear Implant Surgery with Local Anesthesia and Sedation versus General Anesthesia.

OBJECTIVE: To analyze auditory nerve recovery function (REC), comparing the results after local anesthesia and sedation with those after general anesthesia. METHODS: This was a prospective, cross-sectional and descriptive study in a tertiary referral center hospital. We included all patients (37 ears) who underwent surgery for cochlear implant under either general anesthesia or local anesthesia and sedation during 3 years. REC was measured according to the function of 3 components, 'T0', 'A' and 'tau', and was taken for 3 cochlear electrodes (apical, medial and basal). RESULTS: There were no significant differences in 'tau' and in the current level used, but there were significant differences in the parameters 'T0' apical and 'A' basal. CONCLUSIONS: There were no significant differences in REC between the 2 types of anesthesia, except for the parameters 'T0' apical and 'A' basal.

Oxidative Damage in the Aging Heart: an Experimental Rat Model.

INTRODUCTION: Several theories have been proposed to explain the cause of 'aging'; however, the factors that affect this complex process are still poorly understood. Of these theories, the accumulation of oxidative damage over time is among the most accepted. Particularly, the heart is one of the most affected organs by oxidative stress. The current study, therefore, aimed to investigate oxidative stress markers in myocardial tissue of rats at different ages. METHODS: Seventy-two rats were distributed into 6 groups of 12 animals each and maintained for 3, 6, 9, 12, 18 and 24 months. After euthanasia, the heart was removed and the levels of non-protein thiols, lipid peroxidation, and protein carbonylation, as well as superoxide dismutase and catalase activities were determined. RESULTS: Superoxide dismutase, catalase activity and lipid peroxidation were reduced in the older groups of animals, when compared with the younger group. However, protein carbonylation showed an increase in the 12-month group followed by a decrease in the older groups. In addition, the levels of non-protein thiols were increased in the 12-month group and not detected in the older groups. CONCLUSION: Our data showed that oxidative stress is not associated with aging in the heart. However, an increase in non-protein thiols may be an important factor that compensates for the decrease of superoxide dismutase and catalase activity in the oldest rats, to maintain appropriate antioxidant defenses against oxidative insults.

Endoscopic stented ureterocystostomy.

BACKGROUND AND PURPOSE: Fibrotic or neoplastic obstruction of the terminal ureter and ureterovesical junction can preclude internal drainage with a Double-J catheter. Some minimally invasive alternatives are described in the literature to avoid a percutaneous nephrostomy. We present a pure endourologic technique. PATIENTS AND METHODS: In six patients with an obstructed upper urinary tract, after the introduction of iodine contrast, the ureter was punctured with a needle to introduce a guidewire in the urinary tract under cystoscopic and fluoroscopic control. The alternative path between the bladder and ureter was then dilated up 10F to facilitate the Double-J catheter introduction. RESULTS: All six patients had their obstructed urinary tract drained with a Double-J catheter inserted above the level of obstruction. No complication was verified. CONCLUSION: Internal urinary tract drainage with a Double-J catheter was accomplished using endourologic principles in six patients, avoiding a percutaneous nephrostomy or other more invasive procedures.

Estrogen replacement avoids the decrease of bladder innervations in ovariectomized adult virgin rats: in vivo stereological study.

INTRODUCTION AND HYPOTHESIS: The authors quantified the nerve fibers in the bladder wall of ovariectomized rats with and without estradiol replacement. METHODS: This study was conducted on 40 Wistar rats (3 months old). Group 1: remained intact; Group 2: underwent bilateral ovariectomy, and after 30 days was started on subcutaneous sesame oil replacement (0.2 ml per day) for 90 days; Group 3: sham-operated, and after 30 days was started on subcutaneous sesame oil replacement (0.2 ml per day) for 90 days; Group 4: bilateral ovariectomy, and after 30 days was started on subcutaneous injection of 17ß-estradiol (10 µg/kg body weight) for 90 days. S-100 was used to stain nerves myelinized fibers on paraffin rat bladder sections. The G-50 grid system was used to quantitatively analyze the fibers. CONCLUSION: Long-term estrogen deprivation caused significant changes in bladder innervations, which can be characterized by a decreased number of nerve fibers by 65% (p < 0.001).

Impact of the structure of polypropylene meshes in local tissue reaction: in vivo stereological study.

Polypropylene slings are monofilament and multifilament meshes. Their features can impact clinical outcomes. We analyzed tissue reaction, inflammation, and the density of collagen fibers elicited by polypropylene meshes in the subcutaneous tissue of female rats. Thirty female Wistar rats underwent the implantation of 8x4-mm polypropylene meshes (two monofilamentar and two multifilamentar). The rats were killed at 7, 60, and 120 days after implant. Stereology was used to analyze the collagen fiber density. Acute inflammation was more intense in the early post-implant period (p=0.006), except for intravaginal slingplasty (p=0.342). Lymphoplasmocytic reaction was more intense in multifilament samples, even after 60 days (p<0.001) and 120 days (p=0.001). The stereological analysis showed significant differences between mono- and multifilament meshes, considering that monofilament meshes induced more collagen deposition and a greater density of collagen fibers (p<0.001). Multifilament meshes produced a more granulomatous reaction. The collagen fiber density was greater in monofilament meshes, which induced more favorable biocompatibility assessed objectively.

Role of 17 beta-estradiol on type IV collagen fibers volumetric density in the basement membrane of bladder wall.

The authors quantified the type IV collagen fibers volumetric density in the basement membrane of bladder wall of ovariectomized rats with and without estradiol replacement. This study was conducted on 40 Wistar rats (3 months old) randomly divided in 4 groups: group 1, remained intact (control); group 2, submitted to bilateral oophorectomy and daily replacement 4 weeks later of 17 beta-estradiol for 12 weeks; group 3, sham operated and daily replacement 4 weeks later of sesame oil for 12 weeks; and group 4, submitted to bilateral oophorectomy and killed after 12 weeks. It was used in immunohistochemistry evaluation using type IV collagen polyclonal antibody to stain the fibers on paraffin rat bladder sections. The M-42 stereological grid system was used to analyze the fibers. Ovariectomy had an increase effect on the volumetric density of the type IV collagen fibers in the basement membrane of rat bladder wall. Estradiol replacement in castrated animals demonstrated a significative difference in the stereological parameters when compared to the castrated group without hormonal replacement. Surgical castration performed on rats induced an increasing volumetric density of type IV collagen fibers in the basement membrane of rats bladder wall and the estradiol treatment had a significant effect in keeping a low volumetric density of type IV collagen fibers in the basement membrane of rats bladder wall.

Massive prolapse of the urethral mucosa following periurethral injection of calcium hydroxylapatite for stress urinary incontinence.

The injection of bulking agents into the urethral submucosa is designed to create artificial urethral cushions that can improve urethral coaptation and hence restore continence. Ideally, a urethral bulking agent should be non-immunogenic and biocompatible, leading to minimal inflammatory and fibrotic response. The authors present a case report of a granulomatous reaction leading to urethral prolapse, 3 months after the transurethral injection of calcium hydroxylapatite. To our knowledge, this is the first granulomatous reaction described after calcium hydroxylapatite injection.

Safyre: a readjustable minimally invasive sling for female urinary stress incontinence.

INTRODUCTION: SAFYRE is a readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). It is as a pubovaginal sling placed in the medial third of the urethra. The initial experience is described. MATERIALS AND METHODS: Forty-five patients (mean age = 59 years) underwent a SAFYRE implant to treat SUI. Physical examination and urodynamic study were performed before surgery. All patients presented symptoms of SUI and 20% also reported mild urgency. Approximately 60% of this group had a previously failed anti-incontinence procedure. Urethral hypermobility was diagnosed in 40% of the patients and intrinsic sphincter deficiency (ISD) in 60% of the cases. RESULTS: The average follow up period was 10 months. The mean operative time was 20 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 11% of the implants, bladder perforation occurred. During the postoperative period, 9 patients (20%) developed transient urgency symptoms. During the initial follow up period, 90% were found to be continent, 3% reported an improvement and 7% were unchanged. CONCLUSION: SAFYRE is a safe and quick procedure that allows postoperative readjustment. This technique may be an attractive alternative in the management of SUI, should the good result obtained so far prove to be long lasting.