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1.
Int Braz J Urol ; 45(5): 989-998, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626522

RESUMO

OBJECTIVE: To evaluate the subjective and objective outcomes of MacroplastiqueR (MPQ) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: Following Institutional Review Board (IRB) approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection and had 6 months minimum follow-up were reviewed from a prospectively maintained database. Patients were divided into 3 groups: Naive (Group I), Prior Anti-Incontinence Surgery (Group II), and combined Prior Bulking Agent and Anti-Incontinence Surgery (Group III). Data collected included SUI self-report, Urogenital Distress Inventory (UDI-6) Question 3, and VAS Quality of Life (QoL) Questionnaire scores at baseline and in follow-up. Three-dimensional ultrasound (3DUS) evaluated volume/confi guration of MPQ. Success was defi ned after the last MPQ injection as a UDI-6 Question 3 score of 0 (dry) or 1, and no reoperation for SUI. RESULTS: From 2011-2017, 106 of 142 women met study criteria. At a median follow-up of 20 months (mean=26 months; range: 6-71), success rate was 41% for Group I, 40% for Group II, and 65% for Group III (p = 0.22). QoL scores were signifi cantly improved over baseline in all groups. There was no signifi cant difference in clinical outcome between the asymmetrical and symmetrical group on 3DUS. The completely dry rate was highest in Group III at 29%, compared to 4% for Group I and 15% for Group II (p = 0.05). CONCLUSION: MacroplastiqueR improved subjective and objective outcome measures for SUI secondary to ISD as both a primary and secondary treatment option in women.


Assuntos
Dimetilpolisiloxanos/uso terapêutico , Doenças Uretrais/complicações , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colágeno/uso terapêutico , Feminino , Humanos , Injeções , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Reoperação , Reprodutibilidade dos Testes , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
2.
Zhonghua Yi Xue Za Zhi ; 99(32): 2511-2515, 2019 Aug 27.
Artigo em Chinês | MEDLINE | ID: mdl-31484278

RESUMO

Objective: To analyze the clinical characteristics and treatment of female stress urinary incontinence (SUI) combined with bladder neck obstruction (BNO). Methods: The clinical data of 17 cases of female SUI patients with BNO, who was admitted to the Urology department, Beijing Chaoyang hospital from November 2011 to April 2018, were retrospectively analyzed. The mean age was (60.3±2.6) years old and the mean body mass index was (23.8±0.5) kg/m(2). All patients had the first stage bladder neck incision with the second stage suprapubic urethral support sling. The clinical characteristics, curative effects and outcomes were analyzed. Results: The maximum flow rate was increased significantly after the bladder neck incision compared with preoperative [(9.3±0.5) vs (25.6±0.8) ml/s, P<0.001]. The postvoid residual urine volume and PdetQmax were decreased significantly than that preoperative [(167.5±4.4) vs (4.1±0.5) ml, P<0.001; (49.4±1.3) vs (24.9±0.7) cmH(2)O, P<0.001]. The incontinence questionnaire-short form score was significantly lower after the second stage suprapubic urethral support sling [(2.4±0.4) vs (14.9±0.3), P<0.001]. The number of subjective and objective case of suprapubic urethral support sling was 13, and the treatment effect of other patients was improved. The hospitalization and operation time of the bladder neck incision and the suprapubic urethral support sling were short. All patients had no intraoperative complications, two cases had dysuria and one case had groin pain after the suprapubic urethral support sling operation. Conclusions: The patients of female SUI combined with BNO are most elderly and obese population. The effectiveness and safety of the first stage bladder neck incision and the second stage suprapubic urethral support sling are high, and the surgeries can effectively relieve the obstruction and improve the quality of patients' life.


Assuntos
Slings Suburetrais , Obstrução do Colo da Bexiga Urinária , Incontinência Urinária por Estresse , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Obstrução do Colo da Bexiga Urinária/complicações , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/terapia , Procedimentos Cirúrgicos Urológicos
3.
Medicine (Baltimore) ; 98(35): e16907, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464923

RESUMO

This study was to investigate the incidence and the risk factors of postpartum stress urinary incontinence (SUI), and the effect of comprehensive care and rehabilitation program (CCRP) on preventing postpartum SUI.In stage I, 479 puerperae were recruited within 1 week postpartum, then the postpartum SUI incidence at 8th week and its risk factors were investigated. In stage II, 240 vaginal delivery puerperae were enrolled within 1 week postpartum and randomly assigned to CCRP group or control group as 1:1 ratio. The postpartum SUI incidence and pelvic floor muscle function indexes were evaluated at 8th week.In stage I, the postpartum SUI incidence was 25.7%, and SUI puerperae presented with higher body mass index (BMI), vaginal delivery rate, newborn weight, and larger newborn head diameter compared with non-SUI puerperae. Besides, the vaginal delivery, the elevated age and BMI were independent risk factors for postpartum SUI. In stage II, the postpartum SUI incidence in CCRP group was decreased compared with control group, and the vaginal resting pressure, vaginal squeezing pressure, and vaginal contraction duration were increased in CCRP group compared to control group at 8th week postpartum.The incidence of postpartum SUI is 25.7%, and the vaginal delivery, increased age, and BMI are independent risk factors for postpartum SUI. More importantly, CCRP strengthens pelvic floor muscle functions and decreases postpartum SUI incidence in puerperae.


Assuntos
Assistência Integral à Saúde/métodos , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/reabilitação , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/reabilitação , Adulto , Índice de Massa Corporal , Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Feminino , Educação em Saúde/métodos , Humanos , Incidência , Idade Materna , Diafragma da Pelve/fisiopatologia , Período Pós-Parto , Gravidez , Distribuição Aleatória , Incontinência Urinária por Estresse/etiologia
4.
Ceska Gynekol ; 84(1): 73-76, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213062

RESUMO

OBJECTIVE: An overview of urinary incontinence issues during pregnancy. DESIGN: A review article. SETTING: Department of Gynekology and Obstetrics, University Hospital Ostrava. CONCLUSION: Mechanisms leading to stress incontinence are multifactorial. Pregnancy and childbirth can lead to injuries or drowsiness of the pelvic floor muscles. The age of the firstborn and BMI in the pelvic floor disorders is similar to that of the end of pregnancy.


Assuntos
Diafragma da Pelve/lesões , Períneo/lesões , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária/etiologia , Feminino , Humanos , Parto , Distúrbios do Assoalho Pélvico/etiologia , Gravidez , Complicações na Gravidez , Incontinência Urinária/prevenção & controle , Incontinência Urinária por Estresse/prevenção & controle , Ganho de Peso/fisiologia
5.
Urologe A ; 58(6): 640-650, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31089755

RESUMO

The differentiated surgical treatment of male urinary incontinence is a very interesting and sometimes also emotional topic, in which evidence is increasingly maturing. Nowadays, the most common surgical procedures are fixed sling and adjustable incontinence systems as well as the artificial urinary sphincter. The evidence for the procedures varies and there is currently a lack of prospective, comparative studies. The challenging question is: Which operation is the best for which patient? The following article is intended to give an overview of the surgical options and a constructive attempt to differentiate the indication.


Assuntos
Próteses e Implantes , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Intenção , Masculino , Complicações Pós-Operatórias/cirurgia , Prostatectomia , Resultado do Tratamento , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos
6.
Trials ; 20(1): 237, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023381

RESUMO

BACKGROUND: Stress urinary incontinence (SUI) is highly prevalent during pregnancy and after delivery. It is often associated with a failing pelvic floor, sphincteric and/or supportive system. Pelvic-floor-muscle training (PFMT) peri-partum has been proven effective for up to 1 year post-partum; however, its long-term effects are unknown. Group PFMT, given by a physiotherapist, has been proven to be as equally effective as individual therapy. Motherfit is a group-PFMT therapy with an emphasis on pelvic floor exercises, adherence and general fitness. Care-as-usual (CAU), if guideline driven, should, as first treatment option, consist of PFMT. Cost-effective strategies are of relevance, given the rise of health care costs. Motherfit group therapy has the potential to be cost-effective in women with urinary incontinence. Therefore, the objectives of the two current studies are: (1) to investigate whether intensive, supervised, pre-partum (MOTHERFIT1) or post-partum (MOTHERFIT2) pelvic-floor-muscle group therapy reduces 18-month post-partum severity of SUI compared to CAU and (2) whether MOTHERFIT1 OR MOTHERFIT 2 is more (cost-)effective compared to CAU. METHODS: Two multi-centred, randomised controlled trials (MOTHERFIT1, n = 150, MOTHERFIT2, n = 90) will be performed. Participants will be recruited by their midwife or gynaecologist during their routine check. Participants with SUI will receive either motherfit group therapy or CAU. Motherfit group therapy consists of eight group sessions of 60 min each, instructed and supervised by a registered pelvic physiotherapist. Motherfit group therapy includes instructions on pelvic floor anatomy and how to contract, relax and train the pelvic-floor muscles correctly and is combined with general physical exercises. Adherence during and after motherfit will be stimulated by reinforcement techniques and a mobile app. The primary outcome measure is the absence of self-reported SUI based on the severity sum score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) at 18 months post-partum. Secondary outcomes evaluate quality of life, subjective improvement and health care costs. DISCUSSION: The motherfit studies are, to our knowledge, the first studies that evaluate both long-term results and health care costs compared to CAU in pregnant and post-partum women with SUI. If motherfit is shown to be (cost-)effective, implementation in peri-partum care should be considered. TRIAL REGISTRATION: Netherlands Trial Register, ID: NL5816 . Registered on 18 July 2016.


Assuntos
Terapia por Exercício/métodos , Grupo Associado , Diafragma da Pelve/fisiopatologia , Assistência Perinatal/métodos , Complicações na Gravidez/prevenção & controle , Incontinência Urinária por Estresse/prevenção & controle , Feminino , Humanos , Estudos Multicêntricos como Assunto , Países Baixos , Período Pós-Parto , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Fatores de Proteção , Psicoterapia de Grupo , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/fisiopatologia
7.
Curr Urol Rep ; 20(5): 23, 2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-30929095

RESUMO

PURPOSE OF REVIEW: The purpose of this paper is to review (1) the epidemiology and pathophysiology of pelvic organ prolapse (POP) and occult stress urinary incontinence (SUI), (2) examine the data on combined operative management of POP and occult SUI, (3) discuss the approaches to clinical decision making, and (4) present future therapies. RECENT FINDINGS: Prospective data on many approaches to concomitant treatment of prolapse and occult stress urinary incontinence, such as minimally invasive sacrocolpopexy and midurethral sling, or older approaches that have regained favor among patients and clinicians wishing to avoid synthetic mesh, such as native tissue prolapse repair and pubovaginal sling, are limited. Safe durable treatments with absorbable graft materials that promote a beneficial host response are intriguing but may be far from clinical implementation. Stem cell therapy for the treatment of stress urinary incontinence has demonstrated benefit in phase I/II trials but has not been studied in the setting of concomitant treatment of occult SUI with POP surgery and remains in the preclinical phase for the treatment of POP. A personalized approach to concomitant SUI surgery that incorporates individual risk assessment as well as informed patient preferences likely optimizes the risk/benefit ratio and patient satisfaction. Novel therapies, including graft materials and cellular therapies that stimulate a regenerative response, may improve or maintain continence outcomes while mitigating risk and alter the approach to both POP and SUI surgery.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária por Estresse/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/epidemiologia , Prolapso de Órgão Pélvico/fisiopatologia , Estudos Prospectivos , Medição de Risco , Slings Suburetrais , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia
8.
Oxid Med Cell Longev ; 2019: 2039856, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30962861

RESUMO

Apoptosis and oxidative damage are involved in the pathogenesis and progression of stress urinary incontinence (SUI). Our previous results indicate that cell apoptosis and oxidative damage increase in a mouse model of mechanical injury-induced SUI and in fibroblasts treated with excessive mechanical strain. Nuclear factor erythroid-2-related factor 2 (Nrf2) is a well-characterized global antioxidant gene inducer that can reduce oxidative damage and apoptosis. Therefore, we predicted that Nrf2 may have a protective role in mechanical trauma-induced SUI. To test this hypothesis, a mouse model of vaginal distension- (VD-) induced SUI was established. Leak point pressure (LPP); levels of apoptosis, apoptosis-related proteins, and peroxidation products; and the activities of antioxidative proteins in the anterior vaginal wall were measured in wild-type (Nfe2l2+/+) C57BL/6 mice and Nrf2-knockout mice (Nfe2l2-/-). The results showed that Nrf2 knockout aggravated VD-induced reduction in LPP, increase in cell apoptosis and peroxidation product levels, decrease in antioxidative protein activities, and alterations in apoptosis-related protein levels in the vaginal walls of mice. To further confirm the role of Nrf2 in mechanical trauma-induced apoptosis and SUI, VD was performed on mice overexpressing Nrf2 via in vivo transfection of LV-Nfe2l2. The results showed that Nrf2 overexpression significantly alleviated VD-induced abnormalities in the anterior vaginal wall. Taken together, our data suggested that Nrf2 is a potential protective factor in mechanical trauma-induced apoptosis in a mouse model of SUI. Antioxidative therapy may be a promising treatment for mechanical trauma-related SUI.


Assuntos
Fator 2 Relacionado a NF-E2/uso terapêutico , Incontinência Urinária por Estresse/tratamento farmacológico , Incontinência Urinária por Estresse/etiologia , Vagina/lesões , Animais , Apoptose , Modelos Animais de Doenças , Feminino , Camundongos , Camundongos Endogâmicos C57BL , Fator 2 Relacionado a NF-E2/farmacologia , Estresse Oxidativo , Transfecção , Incontinência Urinária por Estresse/patologia
9.
Rom J Intern Med ; 57(3): 220-232, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30990789

RESUMO

A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.


Assuntos
Prostatismo/terapia , Bexiga Urinária Hiperativa/terapia , Transtornos Urinários/diagnóstico , Transtornos Urinários/terapia , Cistite Intersticial/diagnóstico , Cistite Intersticial/etiologia , Cistite Intersticial/terapia , Feminino , Humanos , Masculino , Prostatismo/diagnóstico , Prostatismo/etiologia , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/etiologia , Bexiga Inativa/diagnóstico , Bexiga Inativa/etiologia , Bexiga Inativa/terapia , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/terapia , Transtornos Urinários/etiologia
10.
Andrologia ; 51(7): e13295, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30995702

RESUMO

Artificial urinary sphincter (AUS) implantation is the gold standard treatment in total stress urinary incontinence (SIU). Our aim is to evaluate the effect of AUS implantation on erectile function and sexual satisfaction (SS). Fourteen patients aged 58-73 years (mean: 66.92 ± 4.51 years) who underwent AUS implantation by a perineal approach between May 2015 and April 2018 were included in our study. Patients with neurogenic disease or very low or no erectile function and those who underwent non-nerve-sparing radical prostatectomy were excluded. Erectile function and intercourse satisfaction were evaluated pre-operatively and post-operatively at 6-month follow-up using international index of erectile function (IIEF) questionnaires. After AUS implantation; eight patients were totally dry, four achieved social continence (less than one pad/day), and two still had SUI (two or more pads/day). Mean pre- and post-operative IIEF values of the patients were 16.14 ± 3.18 and 17.42 ± 4.43 respectively. Mean pre- and post-operative SS values were 8.57 ± 1.78 and 8.71 ± 2.19 respectively. There was no statistically significant difference between pre- and post-operative IIEF-5 and intercourse satisfaction scores (p > 0.05). Although we did not see a significant effect of AUS implantation in our study, in SIU patients, coital incontinence or unpleasant odour during intercourse can lead to sexual avoidance and reduced SS, and AUS implantation may improve SS.


Assuntos
Orgasmo/fisiologia , Ereção Peniana/fisiologia , Implantação de Prótese , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Idoso , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Prostatectomia/efeitos adversos , Resultado do Tratamento , Incontinência Urinária por Estresse/etiologia
11.
Medicine (Baltimore) ; 98(14): e15063, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946355

RESUMO

Vaginal pessary treatment for pelvic organ prolapse (POP) is relatively safe and cost-effective. Since long-term use is an important key to keep the benefit of pessary treatment, we would like to investigate the factors which might affect the compliance of vaginal pessaries. In this retrospective study, 65 women were included, and we found poor compliance in women with severe stress urinary incontinence (SUI) after reduction (1-hour pad test >10 gm vs ≦10 gm, 57.1% vs. 84.3%, P = .027). Besides, women younger than 60 years-old also had poor compliance (age ≦60-year-old vs >60-year-old, 58.3% vs 83.0%, P = .04). Other factors such as POP stage, history of hysterectomy, and types of pessaries, did not show significant influence on the long-term compliance in this study. Therefore, to evaluate the severity of SUI after reduction before providing pessary treatment is important to predict long-term compliance. Meanwhile, long-term pessary treatment seems to be more acceptable to elderly patients.


Assuntos
Cooperação do Paciente/estatística & dados numéricos , Prolapso de Órgão Pélvico/terapia , Pessários/efeitos adversos , Incontinência Urinária por Estresse/etiologia , Distribuição por Idade , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/complicações , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo
12.
Obstet Gynecol ; 133(4): 683-690, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870279

RESUMO

OBJECTIVE: To validate a previously developed prediction model for de novo stress urinary incontinence (SUI) after undergoing vaginal surgery for pelvic organ prolapse (POP). METHODS: Model performance was determined using a cohort of women who participated in two, 14-center randomized trials in the Netherlands that evaluated whether postoperative SUI 1 year after surgery was reduced with or without concomitant midurethral sling at the time of surgery for symptomatic women who had at least stage 2 POP. Age, number of previous vaginal births, urine leakage associated with urgency, history of diabetes, body mass index, preoperative stress test result, and placement of a midurethral sling were used to calculate the predicted probability of an individual developing de novo SUI. Predicted probabilities were compared with outcomes and quantitated using the concordance index and calibration curves. Model accuracy was compared with and without the preoperative stress test, and net reclassification improvement was measured using probability cutoffs of 0.2, 0.3, and 0.4. RESULTS: Of 239 participants who did not report preoperative SUI and underwent surgery, 152 were eligible for analysis with complete baseline and outcome data. Model discrimination was acceptable and consistent with performance in the original development cohort when the preoperative stress test result was included (concordance index 0.63; 95% CI 0.52-0.74) and had lower discrimination than when the stress test variable was not included (concordance index 0.57; 95% CI 0.46-0.67, P=.048). The model that included the stress test variable was most accurate when predicted probabilities of de novo SUI were between 0 and 50%, and it correctly reclassified upward 5.9% (95% CI -14.8 to 26.8) of participants with de novo SUI and correctly reclassified downward 16.9% (95% CI 6.6-27.7) of participants without de novo SUI. CONCLUSION: On external validation, the model was predictive of de novo SUI after vaginal prolapse surgery and may facilitate decision making regarding concomitant sling placement. CLINICAL TRIAL REGISTRATION: Nederlands Trial Register, NTRR 1197 en 1070.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária por Estresse/diagnóstico , Procedimentos Cirúrgicos Urogenitais/efeitos adversos , Procedimentos Cirúrgicos Urogenitais/métodos , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Modelos Teóricos , Países Baixos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Probabilidade , Slings Suburetrais , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/etiologia , Urodinâmica
13.
Neurourol Urodyn ; 38(4): 1086-1092, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30843271

RESUMO

OBJECTIVE: To develop a prediction model for stress urinary incontinence (SUI) after vaginal prolapse repair (postoperative stress urinary incontinence [POSUI]) and assess the value of a preoperative stress test. PATIENTS AND METHODS: Secondary analysis of two trials in which women were randomised for prolapse repair with or without a midurethral sling (MUS). The trials included women with (CUPIDO-1, n = 134) and without (CUPIDO-2, n = 225) coexisting SUI. POSUI was defined as bothersome SUI one year after surgery and/or treatment of SUI in the first postoperative year. Logistic regression analysis was used to define a reference model, which was extended with the preoperative stress test. The stress test was performed with and without reduction of the prolapse. Missing values were imputed 20 times, with bootstrap resampling for internal validation of discriminatory ability. RESULTS: Three hundred fifty-six women could be included. POSUI occurred in 17% of the women (n = 61). The reference model included age (<55 years), point Ba of the pelvic organ prolapse quantification system (<-1), vaginal parity (≤3), subjective urinary incontinence, and MUS. The stress test had an odds ratio of 2.4 (95% confidence interval [CI], 1.2-4.6) in the extended model, which increased the optimism-corrected area under the receiver-operating curve from 0.74 to 0.76. The stress test was especially valuable in women with a 10% to 30% POSUI risk, where a stress test substantially impacted the POSUI risk. In more than 50% of the women, the stress test had no additional value in predicting POSUI. CONCLUSION: A preoperative stress test is not valuable for women at low risk of SUI after vaginal prolapse repair.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/etiologia , Vagina/cirurgia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Modelos Teóricos , Complicações Pós-Operatórias/etiologia , Prolapso Uterino/cirurgia
14.
Neurourol Urodyn ; 38(4): 1093-1099, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30843273

RESUMO

AIMS: Radical prostatectomy may cause stress urinary incontinence (SUI). We compared continent and incontinent men after radical prostatectomy, in regard to the change of the temporal pattern of pelvic floor activation during cough. METHODS: Twenty-two patients were included in this prospective, multicentric study. All patients gave their informed consent. Simultaneous recordings of electromyographic activity of external anal sphincter (EAS EMG) and external intercostal muscle (EIC EMG) during cough were performed with a pair of pregelled surface electrodes. Cough effort caused an involuntary pelvic contraction. Intercostal muscles recording was chosen because they are one of the muscular components of cough initiation with diaphragm muscle. Twenty-four-hour pad-weighing test was used to quantify urinary incontinence. The primary endpoint was the latency between the onset of EIC EMG and EAS EMG (RT3), during a cough effort. We also measured the contraction time, the maximum EAS EMG activity, and the area under the curve. RESULTS: All the patients were analyzed: 12 continent and 10 with SUI. The median age was 66 years old. Both groups were similar except in term of follow-up. Median latency was increased by -1.7 ms (-47.9; +34.2) to 55.8 ms (+47.5; +80) in patients with SUI (P = 0.0033; Table 2). The duration of the contraction, the maximum EAS EMG activity and the area under the curve were not different. CONCLUSIONS: The latency between the onset of EIC EMG and EAS EMG is increased in patients with SUI after radical prostatectomy. It may be one of the reasons for SUI in these patients.


Assuntos
Contração Muscular/fisiologia , Diafragma da Pelve/fisiopatologia , Prostatectomia/métodos , Incontinência Urinária por Estresse/etiologia , Idoso , Canal Anal/fisiopatologia , Tosse , Eletromiografia , Humanos , Músculos Intercostais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prostatectomia/efeitos adversos , Incontinência Urinária por Estresse/fisiopatologia
15.
Int Urol Nephrol ; 51(4): 609-615, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30798475

RESUMO

PURPOSE: Urinary incontinence (UI) is one of the most bothersome surgical side effects after robot-assisted radical prostatectomy (RARP). Alteration of both smooth and striate urethral sphincter occurs after RARP. Since the contraction of perineal muscles is involved in the complex mechanism of urinary continence, the uroflow stop test (UST) seems to predict early continence recovery after RARP. The UST was added of perineal surface electromyography (EMG) evaluation to evaluate the latency time (LT) between muscular contraction and the complete stop of urine flow. Our aim was to present UST-EMG as a new tool in the investigation of UI, implying pelvic floor integrity, and to evaluate whether an early return (≤ 3 months) to preoperative LT could be associated with early recovery of UC (≤ 3 months). METHODS: After prospectively enrolling 137 patients who underwent RARP with a minimum follow-up of 6 months, we identified two groups: Group 1 (93 patients) with early (≤ 3 months) pre-surgical LT recovery and Group 2 (44 patients) with late > 3 months or not able to reach pre-surgical LT recovery. RESULTS: Between the two groups, there were significant differences in terms of different surgical technique (nerve-sparing versus non-nerve-sparing) and pads use at 3 and 6 months after RARP (p < 0.05). No differences were recorded neither in postoperative maximum flow-rate, nor in postoperative symptoms score. CONCLUSIONS: UST with EMG can be considered as a noninvasive, reproducible and easily performable tool. LT is applicable in the clinical evaluation to predict urinary continence recovery after RARP.


Assuntos
Diafragma da Pelve/fisiopatologia , Prostatectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Uretra/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Absorventes Higiênicos , Idoso , Eletromiografia , Humanos , Pessoa de Meia-Idade , Contração Muscular , Períneo , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Prostatectomia/métodos , Recuperação de Função Fisiológica , Fatores de Tempo , Incontinência Urinária por Estresse/etiologia , Urodinâmica
16.
Int Urogynecol J ; 30(4): 589-594, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30710159

RESUMO

INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the functional outcomes and urodynamic findings after laparoscopic sacrocolpopexy (LSC) in patients with stages II-IV pelvic organ prolapse (POP). METHODS: In this single-center prospective study, we evaluated 63 women (mean age 62.5 ± 7.5 years) women with symptomatic and advanced POP (stage II-IV) who underwent LSC without concomitant anti-incontinence surgery. The preoperative evaluation incuded history, clinical examination, and urodynamic testing. Women were followed up at 1, 3, 6, and 12 months after surgery and then annually using history, examination, and uroflowmetry. At 6 months, we performed urodynamic testing. To evaluate urinary symptoms, we used the Urogenital Distress Inventory (UDI)-6 questionnaire before and 6 months after surgery. RESULTS: Median follow- up was 22 months (range 8-48). After surgery, maximum flow (Qmax) significantly improved compared with baseline (14.17 ± 2.3 vs 27 ± 8.4 ml/s; p = 0.02), and the percentage of patients with elevated postvoid residual (PVR) significantly decreased (33.3% vs 11.1%; p = 0.001). Detrusor overactivity and bladder outlet obstruction disappeared in 73.6% and 85.7% of patients, respectively, while detrusor underactivity persisted in 66.6% of women. Twenty women (31.7%) reported stress urinary incontinence (SUI) before surgery (14 clinically evident and 6 as occult form), which persisted in only 7/20 (11%) patients following LSC, with no de novo cases. The most common preoperative symptoms were voiding symptoms, present in 42/63 (66.6%) patients, which resolved in 36 (85.7%). The overactive bladder syndrome disappeared in 60% of women, with no de novo cases. Results were reflected by a significant decrease in UDI-6 score from a median of 16 (0-45) at baseline to 5.5 (0-17) at the final follow-up (p = 0.001). The domain on storage symptoms (median 3 vs 1) and voiding symptoms (median 3 vs 1) of UDI-6 showed an improvement after surgery (p = 0.001). CONCLUSIONS: The urodynamic finding showed that LSC in women with advanced POP provides good functional outcomes.


Assuntos
Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/cirurgia , Doenças da Bexiga Urinária/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Urodinâmica , Vagina/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Laparoscopia , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Sacro/cirurgia , Inquéritos e Questionários , Doenças da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Inativa/etiologia , Bexiga Inativa/fisiopatologia , Incontinência Urinária por Estresse/etiologia
17.
Int Braz J Urol ; 45(2): 354-360, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735337

RESUMO

OBJECTIVE: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery. MATERIALS AND METHODS: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to preoperative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent. RESULTS: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm. CONCLUSIONS: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.


Assuntos
Esfíncter Esofágico Inferior/fisiologia , Prostatectomia/efeitos adversos , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/etiologia , Esfíncter Urinário Artificial/efeitos adversos , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Incontinência Urinária por Estresse/cirurgia
18.
Physiotherapy ; 105(3): 338-345, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30630622

RESUMO

BACKGROUND: Stress urinary incontinence is common in men after prostate cancer surgery. Rehabilitative interventions incorporate pelvic floor muscle training, biofeedback, electrical stimulation, lifestyle changes, or a combination of these strategies. However, little is known about the physiological impact of whole-body vibration for stress urinary incontinence after radical prostatectomy. OBJECTIVE: To investigate the effect of whole-body vibration training on stress urinary incontinence after prostate cancer surgery. DESIGN: Randomised controlled trial. SETTING: Tertiary university hospitals. PARTICIPANTS: Sixty-one patients with mild stress urinary incontinence after radical prostatectomy. INTERVENTION: Group 1 included 30 patients who performed pelvic floor muscle training and whole-body vibration training with a frequency and amplitude of 20Hz/2mm for the first two sessions and 40Hz/4mm for the rest of the intervention. Group 2 included 31 patients who performed pelvic floor muscle training alone. The intervention in both groups was conducted three times per week for 4 weeks. MAIN OUTCOMES: Incontinence Visual Analogue Scale (I-VAS) score, International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score and 24-hour pad test result. RESULTS: I-VAS score, ICIQ-UI-SF score and 24-hour pad test result showed significant within-group differences at each assessment with the exception of the baseline and post-intervention I-VAS score in Group 2. For example, Group 1 I-VAS score had a median difference of 3.9cm [95% confidence interval (CI) -4.0 to -3.8] from baseline to first follow-up, and a median difference of -2.0cm (95% CI -2.2 to -1.8) at 4-week follow-up. Comparisons between the groups demonstrated significant differences in favour of Group 1 after 4 weeks of intervention and at follow-up for all measured parameters. CONCLUSION: Whole-body vibration training is an effective modality for treating patients with stress urinary incontinence after prostatectomy. TRIAL REGISTRATION: Clinicaltrial.gov (NCT03325660).


Assuntos
Terapia por Exercício , Diafragma da Pelve/fisiopatologia , Complicações Pós-Operatórias/terapia , Prostatectomia , Neoplasias da Próstata/cirurgia , Incontinência Urinária por Estresse/terapia , Vibração , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Inquéritos e Questionários , Incontinência Urinária por Estresse/etiologia
19.
Prog Urol ; 29(4): 209-215, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30683548

RESUMO

INTRODUCTION: The purpose of this article is to summarise the data available in literature on Lower Urinary Tract Symptoms [lower urinary tract symptoms (LUTS)] after female genital mutilation (MSF). METHODS: Our review identified 177 publications, 14 of which were included in the article. RESULTS: With regard to short-term complications, the prevalence of Acute Urinary Retention (RAU) after MSF is estimated between 3% and 12%. With respect to long-term complications, the data is discordant on repeat urinary tract infections (IUR) after MSF with an estimated prevalence between 9% and 39%. The prevalence of LUTS is significantly increased among women having suffered MSF. For example, mixed urinary incontinence is significantly higher in the MSF group with OR 5.17 CI 95% (2.34-12.97). And the more important the MSF is, the higher the LUTS prevalence is. Medical and surgical treatments are empirical and not evaluated. CONCLUSION: Further studies are needed to better characterize and evaluate the prevalence of LUTS after MSF as well as the interest and efficiency of different therapeutics.


Assuntos
Circuncisão Feminina/efeitos adversos , Sintomas do Trato Urinário Inferior/etiologia , Feminino , Humanos , Sintomas do Trato Urinário Inferior/epidemiologia , Prevalência , Fatores de Risco , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária de Urgência/epidemiologia , Incontinência Urinária de Urgência/etiologia , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
20.
Prog Urol ; 29(2): 101-107, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30661941

RESUMO

OBJECTIVE: Assess the early morbidity after HOLEP, the urinary incontinence in particular, and specify its different types, evolution, and predictive factors. PATIENTS AND METHODS: We conducted an observational, analytical, retrospective, monocentric study including all patients undergoing surgery for benign prostatic hypertrophy (HBP) by HoLEP between November 2015 and January 2017. The data were collected pre-, per- and postoperatively. The follow-up was for 6 months. RESULTS: One hundred and seventy one patients were included. 23 patients (14.6%) had a complication according to Clavien-Dindo classification [4]: 19 (83%) Clavien 2, 1 (4%) Clavien 3b et 3 (13%) Clavien 4. At one month of the surgery, 64 (42.7%) patients had urinary incontinence of which 55 (86.1%) presented pure stress urinary incontinence. 18 (32.7%) were still incontinent at 6 months of the surgery. The delivered amount of energy during the surgery and the preoperative IIEF5 score were statistically significantly associated with the occurrence rate of stress urinary incontinence. There was no correlation between the surgeon's learning curve and the occurrence of incontinence. CONCLUSION: The occurrence rate of urinary incontinence post HoLEP might be related to the adopted surgical technique ; It is crucial to keep the patient well informed of the risk of this complication postoperatively. LEVEL OF EVIDENCE: 4.


Assuntos
Lasers de Estado Sólido/uso terapêutico , Hiperplasia Prostática/cirurgia , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária/etiologia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Incidência , Lasers de Estado Sólido/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Incontinência Urinária/epidemiologia , Incontinência Urinária por Estresse/epidemiologia
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