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1.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(3): 111-117, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-191033

RESUMO

La actual pandemia ocasionada por el SARS-coronavirus tipo 2 ha generado, en pocas semanas, cambios importantes en el funcionamiento del sistema sanitario y la forma en cómo se realiza la atención a las pacientes. La patología uroginecológica afecta a la calidad de vida, pero sin riesgo vital en la mayoría de casos, por lo que suele ser demorable. Además, afecta a un alto porcentaje de mujeres > 65 años (población de riesgo ante la infección por COVID-19). En este manuscrito se resume la evidencia que existe sobre la efectividad de la telemedicina aplicada en las disfunciones de suelo pélvico, así como recomendaciones de las sociedades científicas uroginecológicas durante el estado de alarma. Describimos el abordaje de las disfunciones de suelo pélvico durante la pandemia por COVID-19 y una propuesta de cómo organizar las agendas para el diagnóstico (visitas y pruebas diagnósticas) y tratamiento (conservador, farmacológico y la cirugía) en el período interpandemia y en el futuro


The current SARS-coronavirus type 2 pandemic caused, in few weeks, important changes in the health system organization and in the way we attend the patients. Urogynaecological diseases affect quality of life, but without life risk in most cases, so it is possible to delay. Moreover, urogynaecological diseases affect mostly women over 65 years old (a high risk population for contracting COVID-19). In this manuscript we summarise the current evidence about telemedicine efectivity to manage to pelvic floor dysfunctions and, in addition, the recommendations of Urogynaecological scientific societies during state of alarm. We describe the management of the different pelvic floor dysfunctions during COVID-19 pandemic and a proposal to organize the urogynaecological services to diagnose (visits and diagnostic investigations) and to treat (conservative, pharmacological or surgery) in the interpandemic period and in the future


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Telemedicina , Distúrbios do Assoalho Pélvico/patologia , Distúrbios do Assoalho Pélvico/terapia , Sociedades Médicas/normas , Espanha/epidemiologia , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia , Infecções Urinárias/terapia , Prolapso
2.
PLoS One ; 15(8): e0237518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810136

RESUMO

The study assessed the prevalence and determinants of non-fistulous urinary incontinence among gynaecologic care seekers as well as its interference with everyday life activities of affected women. A cross-sectional study involving 400 women was conducted in a tertiary facility in Ghana. Urinary incontinence was assessed using the International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) which has not been validated locally. The questionnaire was administered mostly in the Asante Twi language with translation done at the time of the interview. The data was analysed for proportions and associations between selected variables. The prevalence of urinary incontinence was 12%, the common types being urgency (33.3%), stress (22.9%), and mixed (20.8%). Age ≥60 years compared to 18-39 years (OR 3.66 95%CI 1.48-9.00 P = 0.005), and a history of chronic cough (OR 3.80 95% CI 1.36-10.58 P = 0.01) were associated with urinary incontinence. Women with education beyond the basic level were 72% less likely to experience urinary incontinence (OR 0.28 95%CI 0.08-0.96 P = 0.04). Urinary incontinence interferes with everyday life activities of most affected women. Non-fistulous urinary incontinence is relatively common among gynaecologic care seekers yet very few women were referred with such a diagnosis. Advocacy measures aimed at urging affected women to report the condition and educating the general population on potential causes, prevention and treatment are needed.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Gana/epidemiologia , Ginecologia/estatística & dados numéricos , Hospitais de Ensino , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários , Incontinência Urinária/diagnóstico , Adulto Jovem
4.
Urologe A ; 59(8): 963-972, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32691107

RESUMO

Idiopathic overactive bladder (OAB) is defined as a symptom complex characterized by urinary urgency with or without urinary incontinence, nycturia and increased frequency of micturition without the presence of an infection or other pathological conditions, especially a neurological disease. It is a diagnosis by exclusion. If conservative treatment with behavioral therapy and pelvic floor muscle training alone is not successful, pharmaceutical treatment is recommended according to the OAB staged treatment. For treatment refractory OAB, intravesical injection of onabotulinum toxin A is recommended according to the current guidelines (recommendation level A). The approved dose is 100 U botulinum toxin and is transurethrally injected into the detrusor muscle. The treatment effect lasts on average for 6-9 months and injections can be repeated without limitations. Due to the low rate of complications, the good success rate and the low invasiveness, botulinum toxin offers a good treatment option for treatment refractory OAB.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Incontinência Urinária/tratamento farmacológico , Transtornos Urinários/tratamento farmacológico , Administração Intravesical , Toxinas Botulínicas Tipo A/administração & dosagem , Humanos , Injeções , Fármacos Neuromusculares/administração & dosagem , Resultado do Tratamento , Bexiga Urinária Hiperativa/diagnóstico , Incontinência Urinária/diagnóstico , Transtornos Urinários/diagnóstico
5.
Ceska Gynekol ; 85(2): 94-102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32527102

RESUMO

BACKGROUND: Examination of pelvic floor muscle function is very important before starting exercises in patients with urine leakage and other pelvic floor dysfunctions. Perineometer and palpation examination is currently being used. A new trend in physiotherapy is the ultrasound examination of pelvic floor muscles. The examination can be performed by abdominal approach or perineal approach. We evaluate 2D and 3/4D images of pelvic floor muscles. METHODS: The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). OAB-q - overactive bladder questionnaire - short form. The Urinary Incontinence Quality of Life scale (I-QoL) - self-assessment scale for assessing the quality of life of patients with urinary incontinence. Adjusted Oxford scale to assess pelvic floor muscle strength. PERFECT scheme by Laycock and Jerwood. Pelvic floor examination by perineometer (Peritron-Ontario, L4V, Canada). Pelvic floor examination by 2D and 3/4D ultrasound examination (Volunson-i BT 11 Console, VCI volume contrast imaging software, (GE Healthcare Austria GmbH & Co OG, Zipf, Austria, RAB4-8-RS 3D/4D 4-8 MHz probe). High intensity exercise of pelvic floor muscles with stabilization elements. CONCLUSION: The effect of pelvic floor muscle training was objectively proved by the above mentioned objectivization methods with subjective improvement of quality of life. There was also a significant effect of education in USG exercise.


Assuntos
Terapia por Exercício/métodos , Diafragma da Pelve/fisiologia , Incontinência Urinária por Estresse/reabilitação , Incontinência Urinária/reabilitação , Feminino , Humanos , Diafragma da Pelve/diagnóstico por imagem , Qualidade de Vida , Ultrassonografia , Incontinência Urinária/diagnóstico , Incontinência Urinária/psicologia , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/psicologia
6.
Eur Urol Focus ; 6(5): 1049-1057, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32540267

RESUMO

CONTEXT: Coronavirus disease 19 (COVID-19) has changed standard urology practice around the world. The situation is affecting not only uro-oncological patients but also patients with benign and disabling conditions who are suffering delays in medical attention that impact their quality of life. OBJECTIVE: To propose, based on expert advice and current evidence where available, a strategy to reorganize female and functional urological (FFU) activity (diagnosis and treatment). EVIDENCE ACQUISITION: The present document is based on a narrative review of the limited data available in the urological literature on SARS-Cov-2 and the experience of FFU experts from several countries around the world. EVIDENCE SYNTHESIS: In all the treatment schemes proposed in the literature on the COVID-19 pandemic, FFU surgery is not adequately covered and usually grouped into the category that is not urgent or can be delayed, but in a sustained pandemic scenario there are cases that cannot be delayed that should be considered for surgery as a priority. The aim of this document is to provide a detailed management plan for noninvasive and invasive FFU consultations, investigations, and operations. A classification of FFU surgical activity by indication and urgency is proposed, as well as recommendations adopted from the literature for good surgical practice and by surgical approach in FFU in the COVID-19 era. CONCLUSIONS: Functional, benign, and pelvic floor conditions have often been considered suitable for delay in challenging times. The long-term implications of this reduction in functional urology clinical activity are currently unknown. This document will help functional urology departments to reorganize their activity to best serve their patients. PATIENT SUMMARY: Many patients will suffer delays in urology treatment because of COVID-19, with consequent impairment of their physical and psychological health and deterioration of their quality of life. Efforts should be made to minimize the burden for this patient group, without endangering patients and health care workers.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Telemedicina , Doenças Urológicas/diagnóstico , Doenças Urológicas/terapia , Urologia/métodos , Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Cistite Intersticial/diagnóstico , Cistite Intersticial/terapia , Gerenciamento Clínico , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia , Retenção Urinária/diagnóstico , Retenção Urinária/terapia , Infecções Urinárias/diagnóstico , Infecções Urinárias/terapia , Procedimentos Cirúrgicos Urológicos , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/terapia
7.
J Urol ; 204(5): 1003-1011, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32469267

RESUMO

PURPOSE: We established severity banding ranges, bother assessment and key item content in principal patient reported outcomes measures in men seeking therapy for lower urinary tract symptoms. MATERIALS AND METHODS: Data for International Prostate Symptom Score (I-PSS) and International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) were derived from a study evaluating 820 men at 26 United Kingdom hospitals. ROC curves were used to establish severity bandings. RESULTS: Classification tree showed that thresholds between mild-moderate and moderate-severe severity bands were 15 and 27 for I-PSS, 16 and 26 for ICIQ-MLUTS/severity, and 22 and 81 for ICIQ-MLUTS/bother, respectively. Highest area under the ROC curve and lowest Akaike's information criteria of univariate logistic regression indicated that ICIQ-MLUTS/bother was more related to global quality of life than were I-PSS and ICIQ-MLUTS/severity. The symptoms affecting I-PSS-quality of life (QoL) were only fully identified by ICIQ-MLUTS, because 2 key symptoms (urinary incontinence and post-micturition dribble) are not measured by I-PSS. ICIQ-MLUTS demonstrated that bother of some lower urinary tract symptoms is disproportionate to severity, and that persisting high bother levels following surgery are more likely due to storage (18% to 25%) and post-voiding (18% to 28%) lower urinary tract symptoms than voiding lower urinary tract symptoms (5% to 13%). Symptom improvement after surgery was uncertain if baseline I-PSS-QoL score was less than 3. CONCLUSIONS: The severity threshold scores were measured for the 2 key lower urinary tract symptoms patient reported outcomes measures, and the results indicate suitable categories of symptom severity for use in men referred for urological care. The ICIQ-MLUTS measures all the lower urinary tract symptoms affecting quality of life and includes individual symptom bother scores.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Índice de Gravidade de Doença , Incontinência Urinária/diagnóstico , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Reino Unido , Incontinência Urinária/complicações , Incontinência Urinária/psicologia , Incontinência Urinária/terapia
8.
Ann Intern Med ; 172(3): ITC17-ITC32, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32016335

RESUMO

Urinary incontinence (UI) is common among women and contributes to decreased quality of life. Several effective treatment options are available for the most common types of UI (stress, urge, and mixed), including lifestyle and behavioral therapy, drug therapy, and minimally invasive procedures. Most women improve with treatment, and UI is not an inevitable part of aging. To maximize the opportunity for successful treatment, it is critical to align the treatment approach with patient goals and expectations for care, including an assessment of patient-driven priorities regarding potential adverse effects, costs, and expected benefit of different treatment approaches.


Assuntos
Incontinência Urinária , Envelhecimento/fisiologia , Feminino , Humanos , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Prognóstico , Qualidade de Vida , Fatores de Risco , Incontinência Urinária/diagnóstico , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/terapia
9.
BMC Urol ; 20(1): 8, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005113

RESUMO

BACKGROUND: Post-operative urinary incontinence is a significant concern for patients choosing to undergo a radical prostatectomy (RP) for treatment of prostate cancer. The aim of our study was to determine the effect of pre-operative MUL on 12 month continence outcomes in men having robot-assisted laparoscopic prostatectomy (RALP). METHODS: We use the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC) database, to identify 602 patients who had undergone RALP by a high volume surgeon. Only patients who received an assessment and education by a specialist pelvic floor physiotherapist, had completed EPIC questionnaires before treatment and did not have radiotherapy treatment within 12 months of surgery were included. MUL measurements were taken from pre-operative magnetic resonance imaging (MRI) scans. The short-form version of the Expanded Prostate Cancer Index Composite (EPIC-26) was used to measure continence outcomes. Continence was defined as 100/100 in the EPIC-26 Urinary Continence domain score. RESULTS: The observed median MUL in this study was 14.6 mm. There was no association between MUL and baseline continence. MUL was associated with continence at 12 months post RALP (OR 1.13, 95% CI 1.03-1.21, p = 0.0098). In men who were continent before surgery, MUL was associated with return to continence at 12 months after RALP (OR 1.15, 1.05-1.28, p = 0.006). MUL was also associated with change in continence after surgery (ß = 1.22, p = 0.002). CONCLUSIONS: MUL had no effect on baseline continence but had a positive and significant association with continence outcomes over 12 months post RALP.


Assuntos
Complicações Pós-Operatórias/diagnóstico , Prostatectomia/tendências , Procedimentos Cirúrgicos Robóticos/tendências , Uretra/anatomia & histologia , Incontinência Urinária/diagnóstico , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Complicações Pós-Operatórias/etiologia , Prostatectomia/efeitos adversos , Recuperação de Função Fisiológica/fisiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Austrália do Sul , Resultado do Tratamento , Incontinência Urinária/etiologia
10.
Rev. Rol enferm ; 43(1,supl): 395-404, ene. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-193334

RESUMO

Introduction: Urinary incontinence is a major health problem resulting in physical, psychological and social changes with economic repercussions on the health system. Is a multifactorial condition associated with age-related changes and disorders of the genitourinary system, which corroborates the fact that it is the most often recurring geriatric syndrome. Aims: To identify non-pharmacological interventions for adults with urinary incontinence and to identify tools for urinary incontinence diagnosis in adults. Method: An integrative review study design was completed. Two electronic databases was search (MEDLINE and Web of Science). Three independent reviewers searched databases according to a predetermine inclusion and exclusion criteria. Results: Twelve articles were included in the review. Eleven articles mentioned non-pharmacological interventions, such as physical therapies, lifestyle strategies, behavioural therapies and alternative conservative management options. These interventions should be targeted and individualized to the type of incontinence to result in health gains for the population. One article mentioned an assessment tool for urinary incontinence - The Gaudenz-Fragebogen tool. The evaluation tools can help to systematize the diagnostic activity and consequently improve the clinical practice in the field of urinary incontinence. Conclusion: In care conception, nurses should target their interventions to personal data to address individual symptoms and use assessment tools that can help in the differential diagnosis of UI. Then, to advancing the quality and rigor of nursing care, we advocate that providing nurses with skills in attaining a differential diagnosis of UI presents an added value to the improvement of quality of care in a multidisciplinary context


No disponible


Assuntos
Humanos , Incontinência Urinária/diagnóstico , Diagnóstico de Enfermagem/métodos , Incontinência Urinária/enfermagem , Cuidados de Enfermagem/métodos , Avaliação de Eficácia-Efetividade de Intervenções , Assistência Integral à Saúde/métodos , Diagnóstico Diferencial , Qualidade da Assistência à Saúde
11.
BMC Urol ; 20(1): 1, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31941470

RESUMO

BACKGROUND: Urinary incontinence (UI) is highly prevalent and affects the lives of many men and women. We aimed to conduct a qualitative evidence synthesis (QES) to explore the experience of living with UI and to develop a conceptual model that can help us to understand this experience, and the potential barriers to appropriate healthcare. METHODS: We used the methods of meta-ethnography developed by Noblit and Hare and recently refined for larger studies. Meta-ethnography involves identifying concepts from the studies and abstracting these concepts into a line of argument. We searched for studies that explored the experience of adults with UI. We used the GRADE-CERQual framework to assess confidence in review findings. RESULTS: We screened 2307 titles, 429 abstracts, 107 full texts and included 41 studies (36 unique samples) in the synthesis. We organised the concepts into 26 conceptual categories, which we further abstracted into 6 themes: (1) Am I ill or is this normal? (2) It effects who I am and how I feel; (3) I feel stigmatised, ashamed and guilty; (4) talking can be difficult but it can help; (5) keeping incontinence under control; (6) have I got to the point that I need help? Our model conceptualises living with UI as navigating antagonists: Is UI normal or am I ill? Do I need help or am I managing? Do I keep UI to myself (and manage alone) or do I tell other people (and get the support that I need)? Do I use control strategies that focus on concealing (avoid risky situations, wear pads) versus, I use strategies that focus on improving the bodily function to improve continence. Our model highlights the experience of stigma, shame and guilt which exert a pull towards concealment. CONCLUSIONS: The culture of secrecy and profound sense of shame is barrier to seeking help. An environment which reduces the shame and stigma of UI may help people to switch the focus to strategies that will improve continence, rather than conceal incontinence.


Assuntos
Antropologia Cultural/métodos , Internacionalidade , Pesquisa Qualitativa , Vergonha , Incontinência Urinária/etnologia , Incontinência Urinária/terapia , Antropologia Cultural/normas , Feminino , Humanos , Masculino , Inquéritos e Questionários , Incontinência Urinária/diagnóstico
12.
J Urol ; 203(4): 786-791, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31642741

RESUMO

PURPOSE: Stress urinary incontinence following radical prostatectomy is common and potentially debilitating. Surgical therapy with a urethral sling or an artificial urinary sphincter is an effective option with high patient satisfaction in men in whom conservative measures fail to treat post-prostatectomy incontinence. We sought to characterize the contemporary utilization of surgical therapy of post-prostatectomy incontinence using an all payer database. MATERIALS AND METHODS: We used the Healthcare Cost and Utilization Project databases for Florida from 2006 to 2015 and identified men who underwent radical prostatectomy between 2006 and 2012 using ICD procedure codes. Patients were tracked longitudinally for placement of an ambulatory or inpatient urethral sling, or an artificial urinary sphincter between 2006 and 2015. Patient and clinical data were extracted and analyzed with descriptive statistics. A multivariable logistic regression model was constructed to determine risk adjusted predictors of subsequent incontinence surgery. RESULTS: During the study period 29,287 men underwent radical prostatectomy, of whom 1,068 (3.6%) were treated with subsequent incontinence surgery a median of 23.5 months after prostatectomy. On multivariate analysis risk factors for incontinence surgery included age groups 61 to 70 years (OR 1.25, p=0.008) and 71 to 80 years (OR 1.34, p=0.022), Medicare insurance (OR 1.33, p <0.005) and an increased Charlson Comorbidity Index (OR 1.13 per unit increase, p <0.005). CONCLUSIONS: Of patients who underwent radical prostatectomy 3.6% subsequently underwent stress urinary incontinence surgery. Post-prostatectomy incontinence surgery is likely under performed and delayed in performance based on the previously reported prevalence of severe post-prostatectomy incontinence and the natural history of symptoms. Efforts to increase prompt repair of refractory or severe incontinence can greatly improve patient quality of life after radical prostatectomy.


Assuntos
Complicações Pós-Operatórias/cirurgia , Prostatectomia/efeitos adversos , Slings Suburetrais/estatística & dados numéricos , Incontinência Urinária/cirurgia , Esfíncter Urinário Artificial/estatística & dados numéricos , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Florida , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Próstata/cirurgia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos , Incontinência Urinária/diagnóstico , Incontinência Urinária/etiologia
13.
J Vet Intern Med ; 34(1): 216-226, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31859391

RESUMO

BACKGROUND: In contrast to dogs, the causes and outcomes of urinary incontinence (UI) in cats are largely unknown. OBJECTIVES: To determine the causes, identify comorbid conditions, and assess outcomes of cats with micturition disorders presenting as UI. ANIMALS: Forty-five cats with UI. METHODS: Retrospective study. Medical records of cats presented from January 2006 to December 2017 were searched using 45 keywords related to UI. History, presenting complaint, and physical examination findings were used to confirm a diagnosis. Cases were categorized based on functional and anatomic localizations. RESULTS: Forty-five cats met inclusion criteria. Spinal cord disease was the most common cause of UI (n = 18), followed by urethral (n = 17), bladder (n = 9), and ureteral (n = 1) disorders. Proportions of voiding and storage phase disorders were similar (53% and 47%, respectively). However, voiding-phase disorders were observed more frequently in males and younger-aged cats (P < .03). Urinary tract infection was detected in 11 of 28 (39%) cats. Outcomes were available in 38/45 cases; 16 cats (42%) regained continence, 3 (8%) improved with treatment, and 19 (50%) remained incontinent or were euthanized. Multiple variable logistic regressions indicated that spinal cord disease was significantly more likely to be associated with poor outcomes compared to bladder or urethral disorders (P < .04). CONCLUSIONS AND CLINICAL IMPORTANCE: Urinary incontinence in cats was associated with a variety of congenital and acquired disorders that affected both phases of micturition with similar frequency. Incontinent cats with spinal cord disorders were common and warrant a more guarded prognosis than do cats with bladder or urethral disorders.


Assuntos
Doenças do Gato/diagnóstico , Incontinência Urinária/veterinária , Doenças Urológicas/veterinária , Envelhecimento , Animais , Gatos , Feminino , Masculino , Estudos Retrospectivos , Incontinência Urinária/diagnóstico , Doenças Urológicas/diagnóstico
14.
Trials ; 20(1): 723, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31843002

RESUMO

BACKGROUND: Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CHs) and profoundly impacts on residents' dignity and quality of life. CHs predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe and low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in CHs is not known. The ELECTRIC trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in CH residents and investigate the associated costs and consequences. METHODS: This is a pragmatic, multicentre, placebo-controlled, randomised parallel-group trial comparing the effectiveness of TPTNS (target n = 250) with sham stimulation (target n = 250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff-reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-h Pad Weight Tests, post void residual urine (bladder scans), Patient Perception of Bladder Condition, Minnesota Toileting Skills Questionnaire and Dementia Quality of Life. Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors, and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers. DISCUSSION: TPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03248362. Registered on 14 August 2017. ISRCTN, ISRCTN98415244. Registered on 25 April 2018. https://www.isrctn.com/.


Assuntos
Instituição de Longa Permanência para Idosos , Casas de Saúde , Nervo Tibial , Estimulação Elétrica Nervosa Transcutânea , Incontinência Urinária/terapia , Análise Custo-Benefício , Custos de Cuidados de Saúde , Instituição de Longa Permanência para Idosos/economia , Humanos , Estudos Multicêntricos como Assunto , Casas de Saúde/economia , Ensaios Clínicos Pragmáticos como Assunto , Recuperação de Função Fisiológica , Fatores de Tempo , Estimulação Elétrica Nervosa Transcutânea/efeitos adversos , Estimulação Elétrica Nervosa Transcutânea/economia , Resultado do Tratamento , Reino Unido , Incontinência Urinária/diagnóstico , Incontinência Urinária/economia , Incontinência Urinária/fisiopatologia , Urodinâmica
16.
Medicine (Baltimore) ; 98(44): e17719, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689809

RESUMO

INTRODUCTION: Mixed urinary incontinence (MUI) is a coexistence of both urgency urinary incontinence and stress urinary incontinence. Medical, Epidemiologic, and Social aspects of Aging (MESA) questionnaire is a validated and commonly used tool to diagnose predominant components of it and assess the severity, which can offer help in clinic. However, MESA questionnaire is still not available in China. The aim of the study is to translate English MESA questionnaire into a Chinese version, adapt it in Chinese culture, and validate the measurement properties among female patients with MUI and urgency-predominant MUI. METHODS: MESA questionnaire will be translated and culturally adapted in China. The validation will be embedded in a multicentered randomized controlled trial targeted at women with urgency-predominant MUI. Apart from MESA questionnaire, 3 groups of patients are to receive clinical extended assessment, keep 3-day voiding diary, and complete International Consultation on Incontinence Questionnaire Short Form to evaluate the measurement properties of reliability and validity (internal consistence, test-retest reliability, construct validity, and responsiveness). DISCUSSION: If MESA questionnaire is of relatively high reliability and validity in diagnosing subtypes of MUI and assessing the severity, it can help to choose more appropriate therapy for patients and simplify the workload of clinicians. TRIAL REGISTRATION: ClinicalTrials.gov NCT03803878, January 11, 2019.


Assuntos
Inquéritos e Questionários/normas , Incontinência Urinária/diagnóstico , Idoso , Envelhecimento/psicologia , Grupo com Ancestrais do Continente Asiático/psicologia , China , Feminino , Humanos , Idioma , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Projetos de Pesquisa , Índice de Gravidade de Doença , Traduções , Incontinência Urinária/psicologia , Estudos de Validação como Assunto
17.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 598-603, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642242

RESUMO

OBJECTIVE: To investigate the incidence of early postpartum urinary incontinence in parturients from Chengdu, and to find out the high-risk factors for reference for clinical diagnosis and treatment. METHODS: A total of 9 918 parturient women who gave delivery at the West China Second University Hospital of Sichuan University from January 2014 to January 2018 were enrolled and reviewed 6 weeks after delivery. The prevalence of urinary incontinence at 6 weeks postpartum was investigated by questionnaire. χ2 test and multivariate logistic regression analysis were used to analyze the risk factors affecting the prevalence. RESULTS: 9 550 parturient women were actually investigated. The prevalence of urinary incontinence was 15.53% (1 483/9 550) at 6 weeks postpartum in Chengdu, among which stress urinary incontinence was the most common (73.03%, 1 083/1 483). Univariate analysis showed that age, pelvic surgery history, prenatal body mass index (BMI), urinary incontinence during pregnancy, neonatal body mass, the number of parturition, delivery mode, lateral perineal incision, perineal laceration and prolonged second stage of labor were all correlated with the occurrence of urinary incontinence at 6 weeks postpartum (P < 0.05). Multivariate logistic regression analysis showed that cesarean section can reduce the risk of urinary incontinence compared with vaginal delivery 〔odds ratio (OR)=0.373, P < 0.001〕. Age≥35 yr. (OR=1.803, P=0.001), pelvic surgery history (OR=1.260, P=0.003), BMI≥28 kg/m2 during pregnancy (OR=1.694, P=0.025), urinary incontinence during pregnancy (OR=2.605, P < 0.001), neonatal body mass ≥4 kg (OR=2.307, P=0.040), multipara (OR=1.284, P=0.023) and perineal laceration (OR=1.372, P=0.035) were independent risk factors for urinary incontinence at 6 weeks postpartum. CONCLUSIONS: Urinary incontinence at 6 weeks postpartum is not rare in Chengdu, and stress urinary incontinence is more frequent. Eutocia, elderly parturient, multipara, pelvic surgery history, prenatal obesity, urinary incontinence during pregnancy, large neonatal body mass and perineal laceration are the main risk factors for urinary incontinence at 6 weeks postpartum.


Assuntos
Período Pós-Parto , Incontinência Urinária/diagnóstico , Cesárea , China/epidemiologia , Feminino , Humanos , Gravidez , Fatores de Risco , Incontinência Urinária/epidemiologia
18.
Obstet Gynecol ; 134(5): e126-e142, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31651832

RESUMO

Pelvic organ prolapse (POP) is a common, benign condition in women. For many women it can cause vaginal bulge and pressure, voiding dysfunction, defecatory dysfunction, and sexual dysfunction, which may adversely affect quality of life. Women in the United States have a 13% lifetime risk of undergoing surgery for POP (). Although POP can occur in younger women, the peak incidence of POP symptoms is in women aged 70-79 years (). Given the aging population in the United States, it is anticipated that by 2050 the number of women experiencing POP will increase by approximately 50% (). The purpose of this joint document of the American College of Obstetricians and Gynecologists and the American Urogynecologic Society is to review information on the current understanding of POP in women and to outline guidelines for diagnosis and management that are consistent with the best available scientific evidence.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Prolapso de Órgão Pélvico , Pessários , Qualidade de Vida , Disfunções Sexuais Fisiológicas , Incontinência Urinária , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Procedimentos Cirúrgicos em Ginecologia/métodos , Exame Ginecológico/métodos , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/classificação , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/terapia , Pessários/efeitos adversos , Pessários/classificação , Medição de Risco/métodos , Índice de Gravidade de Doença , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Avaliação de Sintomas/métodos , Resultado do Tratamento , Incontinência Urinária/diagnóstico , Incontinência Urinária/etiologia
19.
Ren Fail ; 41(1): 937-945, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31599184

RESUMO

The aim of this work was to evaluate the efficacy and safety of botulinum toxin A (BTX-A) treatment in patients with neurogenic detrusor overactivity. PUBMED, EMBASE, and Cochrane Library were identified on 13 May 2017 to identify relevant randomized controlled trials. All data obtained were analyzed using Stata 12.0. Five randomized controlled trials were included in this study. Compared to placebo, the BTX-A groups had significantly fewer urinary incontinence (UI) episodes per day and per week (BTX-A with 300 U for frequency of UI per day at week 2, mean difference (MD): -1.13, 95% confidence interval (CI): -1.89 to -0.37; 200 U; BTX-A with 300 U for frequency of UI per week at week 6, MD: -11.42, 95% CI: -13.91 to -8.93; BTX-A with 200 U for frequency of UI per week at week 6, MD: -10.72, 95% CI: -13.40 to -8.04), increased in maximum cystometric capacity at week 6 (BTX-A with 300 U, MD: 154.88, 95% CI: 133.92-175.84; BTX-A with 200 U, MD: 141.30, 95% CI: 121.28-161.33), decreased maximum detrusor pressure at week 6 (BTX-A with 300 U, MD: -31.72, 95% CI: -37.69 to -25.75; BTX-A with 200 U, MD: -33.47, 95% CI: -39.20 to -27.73). For adverse effects, BTX-A was often associated with more complications and urinary tract infections (BTX-A with 300 U: relative risk (RR):1.42, 95% CI: 1.15-1.76; BTX-A with 200 U: RR: 1.42, 95% CI: 1.11-1.82). This meta-analysis suggests that treatment with BTX-A is effective and safe for neurogenic detrusor overactivity, and recommends using BTX-A with 300 U or with 200 U, as suitable dosage.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Bexiga Urinaria Neurogênica/tratamento farmacológico , Bexiga Urinária Hiperativa/tratamento farmacológico , Incontinência Urinária/tratamento farmacológico , Infecções Urinárias/epidemiologia , Administração Intravesical , Toxinas Botulínicas Tipo A/efeitos adversos , Relação Dose-Resposta a Droga , Humanos , Injeções , Placebos/administração & dosagem , Placebos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Resultado do Tratamento , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária/diagnóstico , Incontinência Urinária/etiologia , Infecções Urinárias/induzido quimicamente
20.
Am Fam Physician ; 100(6): 339-348, 2019 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-31524367

RESUMO

Urinary incontinence is a common problem among women worldwide, resulting in a substantial economic burden and decreased quality of life. The Women's Preventive Services Initiative is the only major organization that recommends annual screening for urinary incontinence in all women despite low to insufficient evidence regarding effectiveness and accuracy of methods. No other major organization endorses screening. Initial evaluation should include determining whether incontinence is transient or chronic; the subtype of incontinence; and identifying any red flag findings that warrant subspecialist referral such as significant pelvic organ prolapse or suspected fistula. Helpful tools during initial evaluation include incontinence screening questionnaires, a three-day voiding diary, the cough stress test, and measurement of postvoid residual. Urinalysis should be ordered for all patients. A step-wise approach to treatment is directed at the urinary incontinence subtype, starting with conservative management, escalating to physical devices and medications, and ultimately referring for surgical intervention. Pelvic floor strengthening and lifestyle modifications, including appropriate fluid intake, smoking cessation, and weight loss, are first-line recommendations for all urinary incontinence subtypes. No medications are approved by the U.S. Food and Drug Administration for treatment of stress incontinence. Pharmacologic therapy for urge incontinence includes antimuscarinic medications and mirabegron. Patients with refractory symptoms should be referred for more invasive management such as mechanical devices, injections of bulking agents, onabotulinumtoxinA injections, neuromodulation, sling procedures, or urethropexy.


Assuntos
Incontinência Urinária , Feminino , Humanos , Guias de Prática Clínica como Assunto , Fatores de Risco , Inquéritos e Questionários , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia
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