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1.
JAMA ; 323(2): 149-163, 2020 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-31935027

RESUMO

Importance: Understanding adverse effects of contemporary treatment approaches for men with favorable-risk and unfavorable-risk localized prostate cancer could inform treatment selection. Objective: To compare functional outcomes associated with prostate cancer treatments over 5 years after treatment. Design, Setting, and Participants: Prospective, population-based cohort study of 1386 men with favorable-risk (clinical stage cT1 to cT2bN0M0, prostate-specific antigen [PSA] ≤20 ng/mL, and Grade Group 1-2) prostate cancer and 619 men with unfavorable-risk (clinical stage cT2cN0M0, PSA of 20-50 ng/mL, or Grade Group 3-5) prostate cancer diagnosed in 2011 through 2012, accrued from 5 Surveillance, Epidemiology and End Results Program sites and a US prostate cancer registry, with surveys through September 2017. Exposures: Treatment with active surveillance (n = 363), nerve-sparing prostatectomy (n = 675), external beam radiation therapy (EBRT; n = 261), or low-dose-rate brachytherapy (n = 87) for men with favorable-risk disease and treatment with prostatectomy (n = 402) or EBRT with androgen deprivation therapy (n = 217) for men with unfavorable-risk disease. Main Outcomes and Measures: Patient-reported function, based on the 26-item Expanded Prostate Index Composite (range, 0-100), 5 years after treatment. Regression models were adjusted for baseline function and patient and tumor characteristics. Minimum clinically important difference was 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritative symptoms, and 4 to 6 for bowel and hormonal function. Results: A total of 2005 men met inclusion criteria and completed the baseline and at least 1 postbaseline survey (median [interquartile range] age, 64 [59-70] years; 1529 of 1993 participants [77%] were non-Hispanic white). For men with favorable-risk prostate cancer, nerve-sparing prostatectomy was associated with worse urinary incontinence at 5 years (adjusted mean difference, -10.9 [95% CI, -14.2 to -7.6]) and sexual function at 3 years (adjusted mean difference, -15.2 [95% CI, -18.8 to -11.5]) compared with active surveillance. Low-dose-rate brachytherapy was associated with worse urinary irritative (adjusted mean difference, -7.0 [95% CI, -10.1 to -3.9]), sexual (adjusted mean difference, -10.1 [95% CI, -14.6 to -5.7]), and bowel (adjusted mean difference, -5.0 [95% CI, -7.6 to -2.4]) function at 1 year compared with active surveillance. EBRT was associated with urinary, sexual, and bowel function changes not clinically different from active surveillance at any time point through 5 years. For men with unfavorable-risk disease, EBRT with ADT was associated with lower hormonal function at 6 months (adjusted mean difference, -5.3 [95% CI, -8.2 to -2.4]) and bowel function at 1 year (adjusted mean difference, -4.1 [95% CI, -6.3 to -1.9]), but better sexual function at 5 years (adjusted mean difference, 12.5 [95% CI, 6.2-18.7]) and incontinence at each time point through 5 years (adjusted mean difference, 23.2 [95% CI, 17.7-28.7]), than prostatectomy. Conclusions and Relevance: In this cohort of men with localized prostate cancer, most functional differences associated with contemporary management options attenuated by 5 years. However, men undergoing prostatectomy reported clinically meaningful worse incontinence through 5 years compared with all other options, and men undergoing prostatectomy for unfavorable-risk disease reported worse sexual function at 5 years compared with men who underwent EBRT with ADT.


Assuntos
Antagonistas de Androgênios/efeitos adversos , Braquiterapia/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Prostatectomia/efeitos adversos , Neoplasias da Próstata/terapia , Radioterapia/efeitos adversos , Idoso , Antagonistas de Androgênios/uso terapêutico , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Radioterapia/métodos , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Incontinência Urinária/etiologia , Conduta Expectante
2.
Int Braz J Urol ; 45(6): 1196-1203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808408

RESUMO

AIMS: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. MATERIALS AND METHODS: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. RESULTS: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). CONCLUSION: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not signifi cantly improve urinary continence or erectile function at 3 months after RP.


Assuntos
Disfunção Erétil/reabilitação , Exercícios de Alongamento Muscular/métodos , Diafragma da Pelve/fisiopatologia , Assistência Perioperatória/métodos , Prostatectomia/reabilitação , Incontinência Urinária/reabilitação , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Gradação de Tumores , Estadiamento de Neoplasias , Neurorretroalimentação , Estudos Prospectivos , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
3.
Radiologe ; 59(Suppl 1): 28-39, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31832702

RESUMO

Interventional therapies are emerging modalities for the treatment of localized prostate cancer. Their aim is to reduce the morbidity associated with radical therapies (rT) by minimizing damage to non-cancerous tissue, with priority given to sparing key structures such as the neurovascular bundles, external sphincter, bladder neck, and rectum, while maintaining local cancer control. Interventional ablative technologies deliver energy in different ways to destroy cancer cells. The most widely investigated techniques are brachytherapy, external beam radiotherapy, cryotherapy, and high-intensity focused ultrasound. Although functional outcomes of focal therapies have been encouraging, with generally low rates of urinary incontinence and erectile dysfunction, robust medium- and long-term oncological outcomes are not available for all techniques. To date, major controversies in focal therapy concern appropriate patient selection, efficacy of focal therapies, as well as treatment paradigms based on the dominant index lesion hypothesis. This review articles discusses the current status of interventional therapies and the oncological and functional outcomes.


Assuntos
Braquiterapia , Neoplasias da Próstata , Disfunção Erétil/etiologia , Humanos , Masculino , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/terapia , Incontinência Urinária/etiologia
4.
Medicine (Baltimore) ; 98(49): e18103, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804320

RESUMO

INTRODUCTION: Benign prostatic hyperplasia, bladder outlet obstruction, and overactive bladder are major causes of lower urinary tract symptoms (LUTS). Tumor compression of the urinary bladder resulting in LUTS was clinically observed. Gastrointestinal stromal tumors (GISTs) presenting with LUTS have not been reported before. Herein, we report a patient with extraluminal GIST of the ileum who had LUTS without gastrointestinal symptoms during the clinical course. PATIENT CONCERNS: A 68-year-old man visited the genitourinary outpatient department because of frequent urination with mild dysuria. He also complained of poor appetite, fatigue, and body weight loss of 10 kg over 6 months. A large presacral solid mass lesion compressing the bladder and surrounded by the bowel with gas content was identified through abdominal computed tomography. DIAGNOSIS: GIST of the ileum with mesenteric invasion was revealed by pathological examination. INTERVENTIONS: Exploratory laparotomy with removal of the pelvic tumor and segmental resection of the ileum was performed. OUTCOMES: Now, he received adjuvant imatinib target therapy for 1 year with stable condition. CONCLUSION: Extravesical compression or invasion of the urinary bladder by a pelvic mass lesion is common but is rarely accompanied by GISTs of the ileum. Specific findings identified through imaging should alert the surgeon to this specific entity and prepare thoroughly before surgical intervention.


Assuntos
Tumores do Estroma Gastrointestinal/patologia , Neoplasias do Íleo/patologia , Idoso , Quimioterapia Adjuvante , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/cirurgia , Masculino , Incontinência Urinária/etiologia
5.
Anticancer Res ; 39(11): 6339-6346, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704865

RESUMO

BACKGROUND/AIM: To evaluate the chronological changes in health-related quality of life and treatment satisfaction after robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: A total of 196 patients were included, and treatment satisfaction was evaluated using the Expanded Prostate Cancer Index Composite (EPIC) score before and at 1, 3, 6, and 12 months after RARP. RESULTS: At 12 months after RARP, 64.8% of patients were satisfied. On the contrary, 4.6% of patients were dissatisfied at 12 months after RARP. In a multivariate analysis, only urinary bother of EPIC was significantly associated with satisfaction at 12 months after RARP (p=0.025, odds ratio=1.029). CONCLUSION: Treatment satisfaction with RARP was generally acceptable from 1 to 12 months after surgery and did not change over time. Urinary bother was associated with satisfaction at 12 months after RARP. Compared with the objective 24-hour pad test, questionnaires answered subjectively were more associated with satisfaction.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Prostatectomia/psicologia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/psicologia , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/psicologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Antígeno Prostático Específico/sangue , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Terapia de Salvação/métodos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia
6.
J Surg Oncol ; 120(8): 1505-1507, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31721218

RESUMO

BACKGROUND: Metabolic syndrome (MetS) has a negative impact on functional recovery and complications after many surgical procedures. AIM: To assess the role of Mets on functional outcomes and complications after radical prostatectomy (RP) for prostate cancer. PATIENTS AND METHODS: Complete data were collected from 5758 patients, undergoing RP at a single referral centers in a 10-year period and the presence of MetS before surgery was ascertained in 17.7% of them using a modified version of the IDF-AHA/NHLBI criteria. Outcomes included 1-year continence and potency rates, early (≤90 days) and late (>90 days) complications. RESULTS: Postoperative continence (no pads) was significantly less likely in MetS patients (75.4% vs 82.6%, P < .01), despite no difference in preoperative continence. Erections with or without therapy were reached in 55.8% of non-MetS and 41.8% of MetS patients (P < .01), in this case a significant difference in preoperative function was seen. No differences in early and late complications, except for wound infections (5.8% vs 3.9%, P < .01) were observed. CONCLUSIONS: In the present study RP was safe from the complications standpoint in MetS patients, but the presence of the syndrome was a significant risk factor for post-RP incontinence and impotence.


Assuntos
Disfunção Erétil/etiologia , Síndrome Metabólica/complicações , Prostatectomia , Neoplasias da Próstata/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Incontinência Urinária/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
8.
Urology ; 134: 228-231, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560912

RESUMO

Pudendal nerve decompression surgery has not been studied or reported for the treatment of penile numbness in the absence of pain. Herein, we report a case of a male patient with chronic numbness of the penis and erectile dysfunction in the absence of pelvic pain who was found to have pudendal nerve entrapment. This patient was treated with surgical decompression of the pudendal nerves that resulted in the return of genital sensation and erections. Thus, we propose that pudendal nerve entrapment may be considered as a cause of penile numbness and that pudendal nerve decompression surgery in these patients may be effective.


Assuntos
Disfunção Erétil/etiologia , Hipestesia/etiologia , Pênis/inervação , Neuralgia do Pudendo/diagnóstico , Adulto , Constipação Intestinal/etiologia , Descompressão Cirúrgica , Incontinência Fecal/etiologia , Humanos , Masculino , Exame Neurológico , Neuralgia do Pudendo/complicações , Neuralgia do Pudendo/cirurgia , Incontinência Urinária/etiologia
9.
Urology ; 134: 213-216, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560918

RESUMO

Mayer-Rokitansky-Küster-Hauser syndrome is a congenital malformation disorder resulting in agenesis of the proximal vagina, absence of cervix, and variable development of the uterus. This report describes the repair of a complex iatrogenic urethrovaginal injury due to a missed diagnosis of Mayer-Rokitansky-Küster-Hauser. Our treatment utilized a primary urethroplasty through a transvaginal approach with bladder neck reconstruction and a Martius flap for secondary coverage. Urinary continence was restored postoperatively.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico , Anormalidades Congênitas/diagnóstico , Doença Iatrogênica , Ductos Paramesonéfricos/anormalidades , Uretra/lesões , Bexiga Urinária/lesões , Incontinência Urinária/etiologia , Adolescente , Amenorreia/cirurgia , Feminino , Humanos , Hímen/cirurgia , Imagem por Ressonância Magnética , Uretra/cirurgia , Bexiga Urinária/cirurgia , Incontinência Urinária/cirurgia
10.
Eur J Radiol ; 120: 108668, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31546125

RESUMO

PURPOSE: To evaluate standardized measurements of the membranous urethra length (MUL), the membranous urethra angle (MUA) and the prostate's apex type (AT) among further clinical parameters as potential preoperative risk factors of urinary incontinence (UI) after radical prostatectomy (RP). METHOD: Our institutional review board approved this retrospective single center study. 316 patients (mean age 65 years) underwent MRI at 3 T prior to prostatectomy. MUL, MUA and AT were measured according to a standardized approach on T2w- sagittal sequences. In a second reading the inter-rater agreement for the MUL was determined. Image findings and clinical data were correlated by logistic regression to UI as evaluated by a standardized questionnaire determining the number of necessary hygiene pads (HP) at three different time points with corresponding patient subsets (one week, six months and 12 months after RP). RESULTS: There was a significant impact of the MUL on postoperative UI with odds ratios (OR) of 0.8 [p < 0.001; confidence interval (CI) 0.73-0.91], 0.8 (p = 0.01; CI 0.68-0.94) and 0.7 (p < 0.01; CI 0.56-0.89) at the respective time points. No significant impact was demonstrated regarding the MUA and AT. Of all clinical parameters there was significant impact of the patients' age and the degree of nerve-sparing surgery. Inter-rater agreement with respect to the MUL was good with an intraclass correlation coefficient of 0.82. The mean deviation of raters measuring the MUL was 1.2 mm. CONCLUSIONS: A shorter MUL in mpMRI should be considered as a risk factor of UI after RP. Standardized measurements enabling good inter-rater agreement should be considered for routine assessments to facilitate prospective classifications.


Assuntos
Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Uretra/anatomia & histologia , Incontinência Urinária/etiologia , Idoso , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários
11.
J Ayub Med Coll Abbottabad ; 31(3): 331-335, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535500

RESUMO

BACKGROUND: Urinary incontinence is an uncommon problem in males but has major impact on daily living. This study aimed to highlight the outcome of surgical treatment in terms of safety, efficacy and cost-effectiveness in the management of urinary incontinence.. METHODS: A Total of 48 patients, prospective experimental study, in the duration of 4 years conducted at Department of Urology, Liaquat National Hospital & Medical College. Patients having moderate to severe urinary incontinence for 1 year after transurethral resection of prostate, radical prostatectomy, road traffic accident with pelvic fracture causing neurologic damage were included in this study. Patients having mild incontinence, having multiple co-morbid conditions were excluded from this study. Outcome of surgery was noted during follow up visit after 13 month (median). The data was obtained and analysed by using SPSS version 20. Mean and standard deviation for quantitative data, frequency and percentage for categorical variables were presented. RESULTS: Out of 48 patients having urinary incontinence, 28 (58.3%) had severe urinary incontinence while 20 (41.7%) had moderate incontinence. After surgery, 28 (58.3%) patient had no leakage all day, 12 (25%) had some leakage while bending and 8 (16.7%) had no improvement in symptoms. On ultrasound recorded after voiding in post-surgery patients, 40 (83.3%) had no residual found in bladder while 8(16.7%) could not be assessed due to persistence of urinary incontinence. CONCLUSIONS: Our study predicted that in patients having moderate to severe urinary incontinence, Prolene Mesh repair anchoring with Prolene suture can be an efficient and costeffective treatment for the urinary incontinence with least complications.


Assuntos
Polipropilenos/uso terapêutico , Complicações Pós-Operatórias , Telas Cirúrgicas , Incontinência Urinária , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Prostatectomia/efeitos adversos , Suturas , Centros de Atenção Terciária , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia
12.
Pan Afr Med J ; 33: 126, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558925

RESUMO

Vesicovaginal fistula (VVF) continues to be a major public health problem in developing countries. Given the particular association of VVF with stones, the question that arises is whether the fistula is primary or secondary to bladder stone and then whether to use single-stage or two-stage treatment. But what is special about this study is that these rare clinical features are due to tuberculosis. We here report the case of a 62-year old female patient with a history of treated tuberculous spondylodiscitis. The patient had been declared cured 4 years before. For the previous 2 years she had been suffering from continuous urinary incontinence. Clinical examination showed almost complete vaginal synechia. Complementary scannography and cystography showed the presence of 3 stones on the way to the VVF. The largest stone measured 6cm along its longer axis with passage of contrast material into the uterovaginal cavity through the fistula. The patient was admitted to the operating room where she underwent cystolithotomy with ablation of the stones that were on the way to the fistula, biopsy of the fistulous tract and single-stage closure of the VVF in two layers without interposition of the autologous tissue. Anatomopathological results confirmed the presence of active tuberculosis on the way to the fistula, requiring resumption of antibacillary treatment for 9 months. During the follow-up visit at 3, 6 and 9 months the patient showed good clinical status with absence of urinary incontinence. VVF secondary to tuberculosis associated with urinary stones appears very little in literature. Our case demonstrates the feasibility of antibacillar medical treatment associated with single-stage surgical treatment with very satisfactory results despite the history of our patient and the duration of his disease.


Assuntos
Tuberculose da Coluna Vertebral/diagnóstico , Cálculos da Bexiga Urinária/diagnóstico , Incontinência Urinária/etiologia , Fístula Vesicovaginal/diagnóstico , Antituberculosos/administração & dosagem , Biópsia , Discite/microbiologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/tratamento farmacológico , Cálculos da Bexiga Urinária/patologia , Fístula Vesicovaginal/etiologia
13.
Einstein (Sao Paulo) ; 17(4): eRW4508, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553360

RESUMO

Urinary incontinence after prostatectomy has a significant negative impact on the quality of life of the patient. The surgical treatment includes several models of male slings, such as adjustable slings. The objective of this study was to evaluate the effectiveness and safety of adjustable sling in the treatment of post-prostatectomy urinary incontinence. This is a systematic review of literature. The following electronic databases were searched until January 2018: PubMed®, Embase, CENTRAL and LILACS. The keywords used in the search strategies were: "prostatectomy" [Mesh], "urinary incontinence" [Mesh] and "suburethral slings" [Mesh]. Randomized clinical trials and observational studies, with or without Control Group, and follow-up of more than 12 months were included. Only one randomized study with high risk of bias was included and it concluded the effectiveness equivalence between adjustable and non-adjustable slings. All other studies were cases series with patients of varying levels of incontinence intensity and history of pelvic radiation therapy and previous surgeries. The meta-analysis for 0 pad in 24 hours demonstrated an effectiveness of 53%. For the 0 to 1 pad test in 24 hours, the meta-analysis resulted in an effectiveness of 69%. Risk factors for surgery failure include prior radiation, severity of post-prostatectomy urinary incontinence, and previous surgeries. The meta-analysis of the extrusion rate was 9.8% and the most commonly reported adverse effects were pain and local infection. Evidence of low quality indicates that adjustable slings are effective for treating post-prostatectomy urinary incontinence, with frequency of adverse events similar to the surgical option considered gold standard (the artificial urinary sphincter implant).


Assuntos
Prostatectomia/efeitos adversos , Slings Suburetrais/normas , Incontinência Urinária/etiologia , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Fatores de Risco , Resultado do Tratamento
14.
Urology ; 134: 221-224, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31494213

RESUMO

Ureteral triplication is a rare congenital anomaly of urinary tract with wide spectrum of presentation. The presentation with incontinence has usually been taken as a sign of ureteral ectopia in these cases. However, ectopia cannot explain all cases with incontinence. We report a case of a 14-year-old girl with ureteral triplication with contralateral duplication and vesicoureteral reflux of the upper moiety on the triplicate side and dysplastic upper moiety on duplicated side, who had persistent incontinence following a left ureteroureterostomy and right heminephrectomy. The clinical features of this rare case and the management of this peculiar postoperative situation is discussed herewith.


Assuntos
Ureter/anormalidades , Adolescente , Feminino , Humanos , Ureter/diagnóstico por imagem , Ureter/cirurgia , Incontinência Urinária/etiologia , Refluxo Vesicoureteral/etiologia
15.
BJOG ; 126(12): 1424-1433, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376211

RESUMO

BACKGROUND: Adiposity has been associated with elevated risk of urinary incontinence in epidemiological studies; however, the strength of the association has differed between studies. OBJECTIVES: To conduct a systematic literature review and dose-response meta-analysis of prospective studies on adiposity and risk of urinary incontinence. SEARCH STRATEGY: We searched PubMed and Embase databases up to 19 July 2017. SELECTION CRITERIA: Prospective cohort studies were included. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and checked for accuracy by a second reviewer. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. MAIN RESULTS: Twenty-four prospective studies were included. The summary RR per 5 kg/m2 increment in body mass index (BMI) was 1.20 (95% CI 1.16-1.25, I2  = 62%, n = 11) for population-based studies and 1.19 (95% CI 1.08-1.30, I2  = 87.1%, n = 8) for pregnancy-based studies, 1.18 (95% CI 1.14-1.22, I2  = 0%, n = 2) per 10 cm increase in waist circumference and 1.34 (95% CI 1.11-1.62, I2  = 90%, n = 2) per 10 kg of weight gain. Although the test for nonlinearity was significant for BMI, P = 0.04, the association was approximately linear. For subtypes of urinary incontinence the summary RR per 5 BMI units was 1.45 (95% CI 1.25-1.68, I2  = 85%, n = 3) for frequent incontinence, 1.52 (95% CI 1.37-1.68, I2  = 34%, n = 4) for severe incontinence, 1.33 (95% CI 1.26-1.41, I2  = 0%, n = 8) for stress incontinence, 1.26 (95% CI 1.14-1.40, I2  = 70%, n = 7) for urge incontinence, and 1.52 (95% CI 1.36-1.69, I2  = 0%, n = 3) for mixed incontinence. CONCLUSION: These results suggest excess weight may increase risk of urinary incontinence. TWEETABLE ABSTRACT: Overweight and obesity increase the risk of urinary incontinence.


Assuntos
Obesidade Abdominal/complicações , Incontinência Urinária/etiologia , Índice de Massa Corporal , Feminino , Humanos , Estudos Prospectivos , Fatores de Risco , Ganho de Peso
16.
Zhonghua Fu Chan Ke Za Zhi ; 54(8): 522-526, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31461808

RESUMO

Objective: To describe the situation of early stage of pelvic floor function and investigate the effect factors in postpartum women. Methods: A retrospective survey was conducted, and women who did regular examination and gave birth in Peking University People's Hospital and had an annual pelvic floor examination at 6-12 weeks after delivery from Sep. 2012 to Dec. 2017 were interviewed. General information and pelvic floor electrical physiological indexes were collected and analyzed. Results: Totally 5 143 puerpera were included in the study. The normal strength of type Ⅰ muscle was 52.40% (2 695/5 143) and the normal strength of type Ⅱ muscle was 52.69% (2 710/5 143). The abnormal degree of fatigue of type Ⅰ muscle was 55.84% (2 872/5 143) and the abnormal degree of fatigue of typeⅡmuscle was 27.34% (1 406/5 143). Pelvic floor dynamic pressure was (93±37) cmH(2)O (1 cmH(2)O=0.098 kPa). The incidence of stress urinary incontinence (SUI) was 23.49% (1 208/5 143) after delivery and it was as high as 57.58% (95/165) for women who had family history of pelvic floor dysfunction. Family history of pelvic floor dysfunction was the risk factor of the fatigue index of type Ⅰ and type Ⅱ muscle (P<0.05). The incidence of SUI was associated with vaginal delivery and age (≥30 years old) and family history of pelvic floor dysfunction (P<0.01). Conclusions: Pelvic floor electrical physiological indicators are reduced in about half of women in early postpartum stage. Age (≥30 years old) and vaginal delivery and family history of pelvic floor dysfunction are the risk factors.


Assuntos
Distúrbios do Assoalho Pélvico/epidemiologia , Diafragma da Pelve/fisiologia , Incontinência Urinária por Estresse/epidemiologia , Adulto , Feminino , Humanos , Músculo Esquelético , Distúrbios do Assoalho Pélvico/etiologia , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Incontinência Urinária/etiologia
17.
BMC Womens Health ; 19(1): 94, 2019 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296215

RESUMO

BACKGROUND: Reproductive history and urogynecological disorders have been associated with limitations in physical function. However, little is known about the relationship between symptoms of urinary incontinence and pelvic organ prolapse, and physical performance. Therefore, the purpose of this study was to examine whether symptoms of urinary incontinence and pelvic organ prolapse are independently associated factors with indicators of lower physical performance in middle-aged women from Northeast Brazil. METHODS: This is a cross-sectional study of 381 women between 40 to 65 years old living in Parnamirim, Northeast Brazil. Physical performance was assessed by gait speed, chair stand and standing balance tests. Urinary incontinence and pelvic organ prolapse were self-reported. Multiple linear regression analyses were performed to model the effect of self-reported urinary incontinence and pelvic organ prolapse on each physical performance measure, adjusted for covariates (age, family income, education, body mass index, parity). RESULTS: In the analysis adjusted for confounders, women reporting urinary incontinence spent, on average, half a second longer to perform the chair stand test (ß = 0.505 95% CI: 0.034: 0.976). Those reporting pelvic organ prolapse shortened the balance time with eyes open by 2.5 s on average (ß = - 2.556; CI: - 4.769: - 0.343). CONCLUSIONS: Symptoms of pelvic organ prolapse and urinary incontinence are associated to worse physical performance in middle-aged women. These seemingly small changes in physical performance levels are of clinical importance, since these conditions may influence women's physical ability, with implications for other tasks important to daily functioning and should be addressed by health policies targeting women's health and functionality.


Assuntos
Prolapso de Órgão Pélvico/fisiopatologia , Desempenho Físico Funcional , Incontinência Urinária/fisiopatologia , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Paridade , Prolapso de Órgão Pélvico/etiologia , Gravidez , Incontinência Urinária/etiologia
18.
BMC Urol ; 19(1): 70, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345192

RESUMO

BACKGROUND: Due to the usage of various measurement methods and definitions, comparing continence rates after radical prostatectomy is a challenging task. This study compares continence rates based on different methods and aims to identify the definition for continence which agrees best with the patients' subjective assessment of continence. Additionally, continence was controlled for multiple influencing factors. METHODS: This prospective multicentre study was carried out in seven hospitals throughout Germany. Before and at 3, 6, and 12 months after surgery self-reporting questionnaires were completed and returned by 329 (84.4%) of 390 eligible patients. The questionnaires were independently evaluated and analysed by a third party. Association of continence with demographic, operative, and tumour factors in an ongoing comprehensive prostate cancer database was evaluated. RESULTS: The continence rate drops substantially for patients undergoing radical prostatectomy but increases again with time. Concrete numbers vary considerably depending on definition - 44% at 3 months and 68% at 12 months after surgery (0 pads) vs. 71 and 90% (0-1 pads). Significant confounding variables regarding continence rate are nerve-sparing procedure, categorized Gleason score, rehabilitative cure treatment, and pelvic floor training. The definition of 0 pads for continence coincides greater than 0-1 pads with the patients' self-assessment of being continent. CONCLUSION: A standardized definition for continence would be desirable, as it is one of the most important preconditions to guarantee sound comparison of continence rates. Since there are enough other factors that make comparison difficult, we suggest using the definition of "0 pads". It is easily measured objectively, leaves no room for interpretation, and agrees best with the patients' self-assessment.


Assuntos
Prostatectomia/tendências , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/cirurgia , Incontinência Urinária/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Prostatectomia/efeitos adversos , Incontinência Urinária/etiologia
19.
Prog Urol ; 29(8-9): 456-463, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31300267

RESUMO

AIM: The usual morbidity after radical prostatectomy (RP) implies, the possible need for inflatable penile prosthesis (IPP). This study aims to validate the efficacy and safety of a sling called "Mini-Jupette" concomitantly with the implantation of an IPP that will counteract mild UI (<2 pads/day) associated or not with climacturia for patients resistant to non-invasive therapeutic approach. METHODS: We provide a detailed description with robust illustration of an original surgical technique. The method the criteria analyzed in the study and the statistical method. Retrospective data from 15 patients from 2006 to 2016 are detailed. RESULTS: Data about erectile function, continence before and after operation are documented for this cohort with mild incontinence (15pts - 100% - mean pad/day was 1.5, SD=0.6) and climacturia (6pts-40%). Mean age was 65.9 years (SD=6.3). There were no complications but 2 patients had dysuria and one patient present urinary retention requiring temporary bladder drainage. At 6 months, incontinence were objectively cured for 80% of patients and 2 patients (13%) improve their continence by a slight activation of the implant, the climacturia disappeared in 5 patients (82%). A telephone interview shows a good durability of the results. with a mean time of 107 months follow-up. CONCLUSION: Concomitant insertion of the "Mini-Jupette" sling during implantation of an IPP contributes reliably, safely and durably to the treatment of post-radical prostatectomy mild incontinence and/or climacturia. LEVEL OF EVIDENCE: 3.


Assuntos
Disfunção Erétil/cirurgia , Implante Peniano/métodos , Prostatectomia/efeitos adversos , Incontinência Urinária/cirurgia , Idoso , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prótese de Pênis , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/cirurgia , Slings Suburetrais , Resultado do Tratamento , Incontinência Urinária/etiologia
20.
Taiwan J Obstet Gynecol ; 58(4): 505-513, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307742

RESUMO

OBJECTIVES: This study aims to compare pelvic floor muscle (PFM) functions in midwifes and nurses of reproductive age with and without pelvic floor dysfunction (PFD) and investigate the relationship between PFM function and the number, type and symptoms of PFDs. MATERIALS AND METHODS: 82 midwifes and nurses of reproductive age with (n = 51) and without PFD (n = 31) participated in the study. PFM function was assessed by digital palpation using PERFECT scale. Gynecological examination, ultrasonography, disease-specific questionnaires, questions and tests were used to assess symptoms of PFD. PFD was assessed in terms of risk factors, urinary incontinence, fecal incontinence, pelvic organ prolapse (POP), pelvic pain and sexual dysfunctions. RESULTS: Power parameter of PERFECT scheme was significantly lower in subjects with PFD compared to Non-PFD group (p = 0.002). 41% of the subjects with Power 5 PFM strength in PFD group were diagnosed as stage 1 POP, 5.8% as stage 2 POP, 15.7% of urge incontinence, 23.3% of stress incontinence and 10.5% of mixed incontinence. Both urinary incontinence and POP were detected in 15.7% of them. Among all subjects, incontinence symptoms decreased whereas POP and sexual function did not change as PFM increased. PFM strength was negatively correlated with the number of PFD (p = 0.002, r = -0.34). The type of dysfunction did not correlate with PFM strength (p > 0.05). CONCLUSION: PFM strength only affects of urinary incontinence sypmtoms among all PFDs in midwifes and nurses of reproductive age. PFM strength may not be the main factor in the occurrence of PFDs as pelvic floor does not consist solely of muscle structure. However, it strongly affects the number of dysfunctions. Therefore, PFM training should be performed to prevent the occurrence of extra dysfunctions in addition to the existing ones even if it does not alter the symptoms.


Assuntos
Incontinência Fecal/fisiopatologia , Prolapso de Órgão Pélvico/complicações , Inquéritos e Questionários , Incontinência Urinária/fisiopatologia , Adulto , Fatores Etários , Estudos Transversais , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Feminino , Exame Ginecológico/métodos , Humanos , Incidência , Pessoa de Meia-Idade , Tocologia , Força Muscular/fisiologia , Enfermeiras e Enfermeiros , Diafragma da Pelve/fisiopatologia , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/diagnóstico , Prolapso de Órgão Pélvico/diagnóstico , Prolapso de Órgão Pélvico/terapia , Prognóstico , Medição de Risco , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
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