Predictive Factors of Male Sexual Dysfunction After Traumatic Spinal Cord Injury.

STUDY DESIGN: Observational study (Ethics Committee Number 973.648). OBJECTIVE: Evaluating the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction. SUMMARY OF BACKGROUND DATA: Besides the motor and sensory loss, sexual function changes after spinal cord injury, ranging from decreased sexual desire to erectile disorders, orgasm, and ejaculation. METHODS: Performed with 45 men, with traumatic spinal cord injury and sexually active. Sexual function was assessed by the International Index of Erectile Function and the level and degree of injury were determined following guidelines of International Standards for Neurological and Functional Examination Classification of Spinal Cord Injury. Bi and multivariate analysis was applied, with a 0.05 significance level. RESULTS: Forty-five subjects with mean injury time of 7.5 years (CI 5.2-9.9) were evaluated. Having a fixed partner is a protective factor (OR: 0.25; 95% CI: 0.07-0.92) of erectile dysfunction. Sexual desire is associated with the fixed partner (OR: 0.12; 95% CI: 0.02-0.66), masturbation (OR: 0.13; 95% CI: 0.02-0.62), and sexual intercourse in the last month (OR: 0.13; 95% IC: 0.01-0.92). Ejaculation (OR: 0.01; 95% CI: 0.00-0.15) and erectile dysfunction (OR: 15.7; 95% CI: 1.38-178.58) are associated with orgasm. Psychogenic erection (OR: 0.07; 95% CI: 0.01-0.69), monthly frequency of sexual intercourse (OR: 11.3; 95% CI: 2.0-62.8), and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1-44.8) are associated with satisfaction. CONCLUSION: Fixed partner, ejaculation, masturbation are protective factors for sexual dysfunction. Erectile dysfunction, orgasmic, and infrequent sex dysfunction are predictors of sexual dysfunction. LEVEL OF EVIDENCE: 3.

Validation of the urgency questionnaire in Portuguese: A new instrument to assess overactive bladder syndrome

ABSTRACT Purpose Overactive Bladder (OAB) is a clinical condition characterized by symptoms reported by patients. Therefore, measurement instruments based on reported information are important for understanding its impact and treatment benefits. The aim of this study was to translate, culturally adapt and validate the Urgency Questionnaire (UQ) in Portuguese. Materials and Methods Initially, the UQ was translated and culturally adapted to Portuguese. Sixty-three volunteers were enrolled in the study and were interviewed for responding the Portuguese version of the UQ and the validated Portuguese version of the Overactive Bladder Questionnaire short-form (OABq-SF), used as the gold standard measurement for the validation process. Psychometric properties such as criterion validity, stability, and reliability were tested. Results Forty-six subjects were included in the symptomatic group (presence of "urgency"), and seventeen were included in the asymptomatic group (control group). There was difference between symptomatic and asymptomatic subjects on all of the subscales (p≤0.001). The UQ subscales correlated with the OABq-SF subscales (p≤0.01), except the subscale "time to control urgency" and the item "impact" from the visual analog scales (VAS). However, these scales correlated with the OABq-SF - Symptom Bother Scale. The UQ subscales demonstrated stability over time (p<0.05), but the subscale "fear of incontinence" and the item "severity" of the VAS did not. All of the UQ subscales showed internal consistencies that were considered to be good or excellent. Conclusion The Portuguese version of the UQ proved to be a valid tool for the evaluation of OAB in individuals whose native language is Portuguese.

Validation of the urgency questionnaire in Portuguese: A new instrument to assess overactive bladder syndrome.

PURPOSE: Overactive Bladder (OAB) is a clinical condition characterized by symptoms reported by patients. Therefore, measurement instruments based on reported information are important for understanding its impact and treatment benefits. The aim of this study was to translate, culturally adapt and validate the Urgency Questionnaire (UQ) in Portuguese. MATERIALS AND METHODS: Initially, the UQ was translated and culturally adapted to Portuguese. Sixty-three volunteers were enrolled in the study and were interviewed for responding the Portuguese version of the UQ and the validated Portuguese version of the Overactive Bladder Questionnaire short-form (OABq-SF), used as the gold standard measurement for the validation process. Psychometric properties such as criterion validity, stability, and reliability were tested. RESULTS: Forty-six subjects were included in the symptomatic group (presence of "urgency"), and seventeen were included in the asymptomatic group (control group). There was difference between symptomatic and asymptomatic subjects on all of the subscales (p≤0.001). The UQ subscales correlated with the OABq-SF subscales (p≤0.01), except the subscale "time to control urgency" and the item "impact" from the visual analog scales (VAS). However, these scales correlated with the OABq-SF - Symptom Bother Scale. The UQ subscales demonstrated stability over time (p<0.05), but the subscale "fear of incontinence" and the item "severity" of the VAS did not. All of the UQ subscales showed internal consistencies that were considered to be good or excellent. CONCLUSION: The Portuguese version of the UQ proved to be a valid tool for the evaluation of OAB in individuals whose native language is Portuguese.

Native vaginal tissue repair for genital prolapse surgical treatment: a minimum of 30 months of results.

OBJECTIVE: The aim of this study was to assess the impact of using native vaginal tissue repair as a surgical treatment for pelvic organ prolapse (POP) on quality of life using validated questionnaires. STUDY DESIGN: Fifty-one women underwent surgical POP repair. All of the women were evaluated by physical examination using the POP-Q, ICIQ-VS and P-QoL questionnaires prior to surgery as well as six and at least 30 months after surgery. RESULTS: Fifty-one patients returned for assessment at least 30 months after surgery (median 36 months, range 30-50 months). There was significant improvement in most points - Aa, Ba, C, Bp, Ap, and hg - and at the stage of prolapse. There were statistically significant improvements in bulge symptoms after surgery (p<0.001), and significant differences were also seen regarding questions related to urinary and bowel symptoms. Indeed, most quality of life questionnaire domains showed significant differences before and after surgery. CONCLUSION: Native vaginal tissue repair improved POP-related symptoms and quality of life after 30-50 months of assessment.

Fascial surgical repair for vaginal prolapse: effect on quality of life and related symptoms.

OBJECTIVE: The aim of this study was to evaluate the impact of surgical treatment for pelvic organ prolapse (POP) on quality of life and on bladder, vaginal and bowel symptoms using validated questionnaires such as the prolapse quality of life questionnaire (P-QoL). STUDY DESIGN: Sixty-five women underwent surgical POP repair. All were evaluated by physical examination and by the use of ICIQ-VS and P-QoL questionnaires before surgery as well as three and six months after surgery. RESULTS: The preoperative scores of all domains on the ICIQ-VS and P-QoL questionnaires and the scores obtained from quantification of the urinary, sexual and bowel symptoms were higher than those at three and six months after surgery (p<0.0001). There was no significant difference in the domain scores for the ICIQ-VS and P-QoL questionnaires at three and at six months after surgery (p>0.05). The preoperative staging was higher than that at three and six months after surgery (p<0.001), and there was no difference in staging between the two postoperative time points (p>0.05). CONCLUSIONS: Surgery with fascial repair for the treatment of pelvic organ prolapse improved health-related quality of life, as assessed by the P-QoL and ICIQ-VS, as well as urinary, vaginal and intestinal symptoms.

Urethral sensory threshold and urethro-anal reflex latency in continent women.

AIMS OF STUDY: The sensory evaluation of the lower urinary tract is summarized in the bladder proprioceptive sensitivity during cystometry. Experimental studies suggest that abnormalities of the urethral innervation and micturition reflex can be related to the presence of continence disturbances. This study aimed to measure the urethral sensory threshold and the urethro-anal reflex latency in healthy volunteers, establishing reading criteria, comparing the results and technique used with the literature and verifying the effect of physiological factors. MATERIALS AND METHODS: Thirty healthy female volunteers were studied. They had an absence of genital or urinary complaints and had undergone no previous pelvic or vaginal procedures. The measurement of the urethral sensory threshold and urethro-anal reflex latency were performed as described. RESULTS: The determination of the urethral sensory threshold and urethro-anal reflex latency were obtained in 96.6% of the volunteers. The electrophysiological parameters did not correlate with age, parity or number of vaginal deliveries. There was a positive association of the urethral sensory threshold with height. Technical aspects were considered and compared with those in the literature as well as the advantages and limitations of the method. CONCLUSIONS: The measurement of the urethral sensory threshold and urethro-anal reflex latency presented consistent recordings. The urethral sensory threshold should be analyzed carefully in individuals with height above the population average. Subsequent observations are necessary to clarify their function in patients with continence disturbances and to measure the urethral function, but these values can be used as normal parameters for comparison.

Avaliação eletrofisiológica da inervação uretral e pudenda em mulheres com incontinência urinária de esforço e mista / Ecletrophysiological evaluation of the urethral and pudendal innervations in women with stress and mixed urinary incontinence

A incontinência urinária de esforço (IUE) feminina pode ser favorecida por lesões neurológicas do assoalho pélvico, causando disfunção das estruturas responsáveis pelo suporte uretral e mecanismo esfincteriano urinário. O objetivo deste estudo foi identificar disfunção eletrofisiológica uretral e pudenda em mulheres com IUE, bem como sua repercussão na gravidade da perda urinária, na quantificação da função uretral e na presença concomitante de hiperatividade detrusora. Pacientes com diagnóstico clínico e urodinâmico de IUE foram divididas em 2 grupos, pela intensidade da perda urinária e pela presença ou não de hiperatividade detrusora, e comparadas com grupo controle. Estes estudos foram controlados em relação à influência de características gerais das pacientes como idade, paridade, número de partos vaginais e altura. Foram pesquisados o tempo de latência motora distal e o potencial evocado somato-sensitivo do nervo pudendo, limiares sensitivos uretral e clitoriano e a latência do reflexo uretro anal. Foi detectado uma maior média da latência do reflexo uretro-anal no registro de pelo menos um dos lados pesquisados, entre os grupos incontinentes e o grupo controle. Não houve diferença entre os grupos com IUE. Os demais parâmetros eletrofisiológicos não detectaram diferenças. Esses resultados não se alteraram quando os grupos incontinentes foram divididos em portadoras de IUE pura e com hiperatividade detrusora concomitante. Em suma, foi identificada uma alteração na função eletrofisiológica da uretra nas pacientes com incontinência urinária aos esforços. A presença de hiperatividade detrusora não repercutiu nos resultados. O método utilizado não permitiu a quantificação deste problema nem a identificação da sua aplicabilidade clínica.

[Pudendo-anal reflex in normal women]. / Reflexo pudendo-anal em mulheres normais.

The pudendo-anal reflex was studied in a sample of 31 normal women. Responses were obtained after bilateral independent stimulation of the clitoris, with surface recordings from both sides of the external anal sphincter. Responses were elicited with double-pulses of 0.2 ms duration with a interstimulus interval of 5 ms, frequency of stimulation was lower than 0.5 Hz. A minimal of four responses were recorded after supramaximal stimulation. In one volunteer no response was recorded after unilateral stimulation. Latencies of the responses from the right and left sides of the anal sfincter after right and left stimulation were 36.35+/-6.37, 36.28+/-6.23, 35.88+/-4.68, 36.44+/-4.45 ms, respectively. No relation was detected between latencies and age, body mass index and parity (considering either total parity or vaginal delivery only). In 12% of the recordings uncertainty was introduced in the latency measurements related to a poor signal-noise ratio.

Reflexo pudendo-anal em mulheres normais / Pudendo-anal reflex in normal women

São descritas observações do registro do reflexo pudendo-anal em mulheres sem queixas de incontinência urinária. Foram estudadas 31 voluntárias adultas, com estimulação elétrica bilateral e independente do clitóris e registros de superfície em ambos os lados do músculo esfíncter externo do ânus (EEA). As respostas foram obtidas com pulsos duplos de 0,2 ms de duração e intervalos de 5 ms, aplicados a uma freqüência menor que 0,5 Hz. Foram medidas as latências iniciais das respostas. Não foram evidenciadas diferenças entre as respostas obtidas de cada lado do EEA e nem entre os lados, com relação aos estímulos. Uma das voluntárias não apresentou respostas após estimulação de um dos lados. Não foram observadas diferenças relacionadas a paridade total e nem com a presença de partos vaginais. A idade e o índice de massa corpórea não se correlacionaram com as respostas. Em 12 por cento das respostas, a medida das latências foi dificultada pela baixa relação sinal-ruído.