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1.
J Urol ; 203(1): 137-144, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31347951

RESUMO

PURPOSE: We compared early continence recovery after surgical treatment of prostate cancer with Retzius sparing robot-assisted radical prostatectomy and conventional robot-assisted radical prostatectomy. MATERIALS AND METHODS: Robot-assisted radical prostatectomy was done by a single surgeon in 1,863 cases between October 2005 and May 2018 using the conventional and the Retzius sparing technique in 1,150 and 713, respectively. To compare continence outcomes between the groups propensity score matching was performed using 9 preoperative variables, including age, body mass index, prostate specific antigen, biopsy Gleason Grade Group, clinical T stage, prostate volume on transrectal ultrasound, and the I-PSS (International Prostate Symptom Score), I-PSS quality of life score and International Index of Erectile Function-5 scores. Continence was assessed by the pad count every month postoperatively until month 6 and was converted to a binary outcome. RESULTS: After propensity score matching 609 cases per group were matched with no significant difference in all 9 variables. The Kaplan-Meier curve analysis revealed that Retzius sparing robot-assisted radical prostatectomy was associated with a significantly better continence recovery rate than conventional robot-assisted radical prostatectomy during the 6-month study period (p <0.001). CONCLUSIONS: Based on propensity score matching with multiple variables and a large case series, Retzius sparing robot-assisted radical prostatectomy can be a candidate for future robot-assisted radical prostatectomy. It achieves better early continence recovery, a short operative time and early recovery compared to conventional robot-assisted radical prostatectomy.


Assuntos
Complicações Pós-Operatórias/fisiopatologia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Incontinência Urinária/fisiopatologia , Idoso , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Pontuação de Propensão , Neoplasias da Próstata/patologia , Qualidade de Vida , Recuperação de Função Fisiológica
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.
Psychiatr Danub ; 31(Suppl 3): 475-478, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488775

RESUMO

BACKGROUND: Vesico- sphincter and bowel dysfunction have been frequently detected in Autism spectrum disorder (ASD) patients, but to date no consistent information exist on adults affected by the disease. We evaluated the prevalence and types of bladder and bowel disfunction (BBD) in young and adult patients affected by ASD. SUBJECTS AND METHODS: Twenty- seven adults and 20 children/teens with ASD and a matched group of typically developing subjects were enrolled. Daily pads use and episodes of urinary incontinence (UI) were recorded in a 3- day voiding diary. Patients underwent also the measurement of post-void urinary residual volume and 3- day bowel diary. In addition, type and duration of the pharmacological agents assumed by the patients were accurately recorded. RESULTS: Any type of UI was observed in 85.1% of adults and in 90% of children/teens. In adults, nocturnal enuresis (NE, 62.9%) and diurnal intermittent UI (37%) were the most frequently observed bladder dysfunction while in children/ teens were NE (75%) and diurnal continuous UI (40%). In all patients was demonstrated a significant relationship between urinary symptoms and pharmacological agents, particularly NE and clotiapine (p<0.004) and periciazine (p<0.008). CONCLUSIONS: Young and adult patients with ASD present with a high prevalence of BBD and concomitant antipsychotic medications could to play a contribution in induction and/or maintaining of BBD.


Assuntos
Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/fisiopatologia , Enurese Diurna/complicações , Enurese Noturna/complicações , Incontinência Urinária/complicações , Adolescente , Adulto , Transtorno do Espectro Autista/tratamento farmacológico , Criança , Enurese Diurna/diagnóstico , Enurese Diurna/fisiopatologia , Humanos , Enurese Noturna/diagnóstico , Enurese Noturna/fisiopatologia , Estudos Prospectivos , Incontinência Urinária/diagnóstico , Incontinência Urinária/fisiopatologia , Adulto Jovem
4.
Fisioter. Pesqui. (Online) ; 26(3): 285-290, jul.-set. 2019. tab
Artigo em Português | LILACS | ID: biblio-1039890

RESUMO

RESUMO A incontinência urinária (IU) está associada à ocorrência de quedas em idosos e pode ter relação com déficits no controle postural. O objetivo deste trabalho é comparar o controle postural estático, na condição de olhos abertos e fechados, e o risco de quedas entre idosas com IU e idosas sem IU. A amostra foi dividida em dois grupos: idosas com IU (n=21, idade=65,33±4,57 anos) e idosas sem IU (n=19, idade=66,37±5,26 anos). As características da perda urinária do grupo com IU foram avaliadas por meio do International Consultation on Incontinence Questionnaire: Short Form (ICIQ-SF). O controle postural estático dos grupos foi mensurado pelo deslocamento do centro de pressão (COP) por meio de uma plataforma de força; e o risco de quedas foi avaliado pelo teste timed up and go. Para a análise estatística, foi utilizado o teste U de Mann-Whitney e o teste qui-quadrado. A maioria das participantes com IU perdiam urina em pequena quantidade e todas perdiam em baixa frequência. Não foi observada diferença entre os grupos em relação às variáveis do COP (p>0,05) e o risco de quedas (p=0,082). Entretanto, na análise intragrupos, houve diferença na velocidade do COP de ambos os grupos na comparação olhos abertos versus olhos fechados (p<0,05). Não houve diferença no controle postural estático e no risco de quedas entre idosas com e sem IU.


RESUMEN La incontinencia urinaria (IU) está asociada con la presencia de caídas en los ancianos y puede estar relacionada con déficits en el control postural de ellos. El presente estudio tuvo como objetivo comparar el control postural estático con los ojos abiertos y con los ojos cerrados y el riesgo de caídas entre mujeres ancianas con IU y mujeres ancianas sin IU. La muestra se dividió en dos grupos: ancianas con IU (n=21, edad=65,33±4,57 años) y ancianas sin IU (n=19, edad=66,37±5,26 años). Las características de pérdida urinaria en el grupo con IU se evaluaron utilizando el International Consultation on Incontinence Questionnaire: Short Forma (ICIQ-SF). El control postural estático de los grupos se midió por el desplazamiento del centro de presión (COP) por medio de una plataforma de fuerza; y el riesgo de caídas fue evaluado por el test del timed up and go. En el análisis estadístico, se utilizaron la prueba U de Mann-Whitney y la prueba de Chi-cuadrado. La mayoría de las participantes con IU perdieron una pequeña cantidad de orina y todas la perdieron a baja frecuencia. No se observó diferencia entre los grupos en relación con las variables COP (p>0,05) y el riesgo de caídas (p=0,082). Sin embargo, en el análisis intragrupo hubo una diferencia en la velocidad de COP de ambos grupos en la comparación ojos abiertos versus ojos cerrados (p<0,05). No hubo diferencias en el control postural estático y en el riesgo de caídas entre las ancianas con y sin IU.


ABSTRACT Urinary incontinence (UI) is associated with the occurrence of falls in older people and may be related to failure in the postural control of older people. This study aims to compare static postural control under eyes-closed and eyes-open conditions as well as the risk of falls in older women with UI and without UI. The sample was divided in two groups: a group of older women with UI (n=21, age=65.33±4.57 years) and a group of older women without UI (n=19, age=66.37±5.26 years). The urinary loss characteristics of the UI group were evaluated with use of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The static postural control of the groups was measured using displacement of center of pressure (COP) through a force platform and the risk of falls was evaluated with the Timed Up and Go test (TUG). Statistical analysis was performed using Mann Whitney's U-Testand the chi-square test. Most participants with UI lost urine in small amounts and at low frequency. No difference was observed between the groups with respect to COP variables (p>0.05) and risk of falls (p=0.082). However, in the intragroup analysis, a difference was observed in the COP velocity of both groups comparing open and closed eyes (p<0.05). No difference was observed in the static postural control and risk of falls in older women with and without UI.


Assuntos
Humanos , Feminino , Idoso , Incontinência Urinária/fisiopatologia , Acidentes por Quedas , Equilíbrio Postural/fisiologia , Bexiga Urinária/fisiologia , Bexiga Urinária/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais
6.
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
7.
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
8.
Einstein (Sao Paulo) ; 17(3): eAO4602, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31271608

RESUMO

OBJECTIVE: To compare the results of the standard urotherapy alone and associated with pelvic floor muscle training alone, and in combination with oxybutynin in treatment of nonmonosymptomatic nocturnal enuresis. METHODS: A total of 38 children aged 5 to 10 years were randomized into three groups: Group I (n=12) that was submitted to standard urotherapy; Group II (n=15), standard urotherapy associated with pelvic floor muscle training; and Group III (n=11), standard urotherapy associated with pelvic floor muscle training and oxybutynin; the treatment lasted 12 weeks. The assessment tools used were playful bladder diary, and a 48-hour bladder diary, before and after treatment. After 2 years, patients were assessed by telephone using a standardized questionnaire. RESULTS: The data of children from the three groups were homogeneous at baseline. After 12-week treatment, all children showed improved symptoms and signs of nonmonosymptomatic nocturnal enuresis, but the differences were not significant among the groups. After 2 years, the three groups showed maintenance of treatment results, but no differences among them. CONCLUSION: All treatment modalities were effective regarding improved enuresis and lower urinary tract symptoms, but the sample was not large enough to show differences among groups.


Assuntos
Terapia por Exercício/métodos , Ácidos Mandélicos/uso terapêutico , Enurese Noturna/terapia , Diafragma da Pelve/fisiologia , Incontinência Urinária/terapia , Agentes Urológicos/uso terapêutico , Brasil , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Masculino , Contração Muscular/fisiologia , Força Muscular/fisiologia , Enurese Noturna/fisiopatologia , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/fisiopatologia
9.
J Urol ; 202(5): 1015-1021, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31188733

RESUMO

PURPOSE: In younger men lower body mass is associated with fewer urinary symptoms, including incontinence and nocturia. However, lower body mass may have different implications in older men due to age associated muscle atrophy and decreased strength. MATERIALS AND METHODS: We performed a prospective analysis of community dwelling men 70 to 79 years old in the multicenter Health ABC (Aging and Body Composition) study who underwent measurement of body mass on physical examination, composition using dual x-ray absorptiometry and strength according to grip and lower leg dynamometry. We evaluated associations with prevalent incontinence and nocturia on structured questionnaires as well as concurrent changes in urinary symptoms during 3 years using multivariate logistic regression. RESULTS: Of the 1,298 men analyzed 22% reported incontinence and 52% reported nocturia at baseline. Higher body mass index, fat mass and lower appendicular lean mass, and grip and quadriceps strength corrected for body mass index were associated with an increased prevalence of incontinence (each p <0.05). Higher body mass index and greater fat mass were also associated with an increased nocturia prevalence (each p <0.05). Concurrent 5% or greater decrease in body mass or fat mass was not associated with lower odds of new or worsening incontinence or nocturia, whereas a 5% or greater decrease in maximum grip strength was associated with higher odds of new or worsening incontinence. CONCLUSIONS: Older men with a higher body mass index and greater fat mass are more likely to report prevalent incontinence and nocturia. However, late life decreases in strength but not increases in body mass or fat mass were associated with a concurrent increase in urinary incontinence.


Assuntos
Envelhecimento/fisiologia , Composição Corporal/fisiologia , Força Muscular/fisiologia , Noctúria/epidemiologia , Incontinência Urinária/epidemiologia , Idoso , Índice de Massa Corporal , Seguimentos , Humanos , Masculino , Noctúria/diagnóstico , Noctúria/fisiopatologia , Prevalência , Estudos Prospectivos , Índice de Gravidade de Doença , Incontinência Urinária/diagnóstico , Incontinência Urinária/fisiopatologia
10.
PLoS One ; 14(5): e0217705, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141553

RESUMO

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) causing gait impairment, dementia and urinary incontinence among the elderly, is probably under-diagnosed and under-treated. Despite being known since the 1960s, there is still a lack of prospective, population-based studies on the prevalence of iNPH. Such studies are warranted to minimize selection bias and estimate the true prevalence of the disease. METHODS: The prevalence of iNPH was determined in a randomly selected sample of residents, aged 65 years and older, in the Swedish county of Jämtland. Out of 1,000 individuals invited to participate, 673 (67.3%) completed a questionnaire with seven questions on iNPH symptoms. A subgroup, with and without self-reported symptoms, participated in clinical and radiological evaluations and were diagnosed according to international guidelines. Measurement of cerebrospinal fluid opening pressure was not performed as it was considered too invasive. RESULTS: Those who reported at least two symptoms in the questionnaire (n = 117) and 51 randomly selected individuals with 0-1 symptom participated in further examinations. Out of them, 25 individuals received the diagnosis probable iNPH according to American-European guidelines (except for the criterion of CSF opening pressure) corresponding to a prevalence of 3.7%. The prevalence of iNPH was four times higher among those aged 80 years and older (8.9%) than among those aged 65-79 years (2.1%) (p <0.001). The difference in prevalence between men (4.6%) and women (2.9%) was not significant (p = 0.24). When iNPH was diagnosed according to the Japanese guidelines the prevalence was 1.5. CONCLUSIONS: In this prospective, population-based study the prevalence of iNPH was 3.7% among individuals 65 years and older, and more common in the higher age group, 80 years and above. INPH should be increasingly recognized since it is a fairly common condition and an important cause of gait impairment and dementia among the elderly that can be effectively treated by shunt surgery.


Assuntos
Demência/epidemiologia , Marcha/fisiologia , Hidrocefalia de Pressão Normal/epidemiologia , Incontinência Urinária/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Demência/fisiopatologia , Feminino , Humanos , Hidrocefalia de Pressão Normal/fisiopatologia , Masculino , Prevalência , Estudos Prospectivos , Incontinência Urinária/fisiopatologia
11.
Nurse Pract ; 44(6): 21-28, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31045695

RESUMO

Although aging and urinary incontinence are often associated, urinary incontinence is not a normal part of aging. As the population ages, the challenge of urinary incontinence will place a greater demand on the healthcare system. NPs can effectively direct treatments to mitigate the symptoms of urinary incontinence, improving patient quality of life.


Assuntos
Incontinência Urinária/enfermagem , Testes Diagnósticos de Rotina/enfermagem , Feminino , Humanos , Masculino , Programas de Rastreamento/enfermagem , Profissionais de Enfermagem , Diagnóstico de Enfermagem , Exame Físico/enfermagem , Incontinência Urinária/epidemiologia , Incontinência Urinária/fisiopatologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-31119104

RESUMO

Urinary incontinence (UI) is a burdensome condition with high prevalence in middle-aged to older women and an unclear etiology. Advances in our understanding of host-microbe interactions in the urogenital tract have stimulated interest in the urinary microbiome. DNA sequencing and enhanced urine culture suggest that similarly to other mucosal sites, the urinary bladder of healthy individuals harbors resident microbial communities that may play distinct roles in bladder function. This review focused on the urobiome (expanded quantitative urine culture-based or genomic sequencing-based urinary microbiome) associated with different subtypes of UI, including stress, urgency and mixed urinary incontinence, and related syndromes, such as interstitial cystitis and overactive bladder in women, contrasted to urinary tract infections. Furthermore, we examined clinical evidence for the association of the urinary microbiome with responses to pharmacotherapy for amelioration of UI symptoms. Although published studies are still relatively limited in number, study design and sample size, cumulative evidence suggests that certain Lactobacillus species may play a role in maintaining a healthy bladder milieu. Higher bacterial diversity in the absence of Lactobacillus dominance was associated with urgency UI and resistance to anticholinergic treatment for this condition. UI may also facilitate the persistence of uropathogens following antibiotic treatment, which in turn can alter the commensal/potentially beneficial microbial communities. Risk factors of UI, including age, menopausal status, sex steroid hormones, and body mass index may also impact the urinary microbiome. However, it is yet unclear whether the effects of these risks factors on UI are mediated by urinary host-microbe interactions and a mechanistic link with the female urogenital microbiome is still to be established. Strategies for future research are suggested.


Assuntos
Interações entre Hospedeiro e Microrganismos , Microbiota , Incontinência Urinária/epidemiologia , Incontinência Urinária/fisiopatologia , Sistema Urinário/microbiologia , Feminino , Humanos , Prevalência , Fatores de Risco
13.
Int Braz J Urol ; 45(4): 703-712, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136108

RESUMO

INTRODUCTION: Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. OBJECTIVE: Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015. MATERIALS AND METHOD: Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and followup data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. RESULTS: Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. CONCLUSION: Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.


Assuntos
Ereção Peniana/fisiologia , Prostatectomia/métodos , Recuperação de Função Fisiológica/fisiologia , Procedimentos Cirúrgicos Robóticos/métodos , Micção/fisiologia , Adenocarcinoma/fisiopatologia , Adenocarcinoma/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Brasil , Disfunção Erétil/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/fisiopatologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/fisiopatologia
14.
J Sports Sci ; 37(14): 1663-1672, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30822258

RESUMO

Urinary incontinence is the complaint of involuntary loss of urine and is a social and hygienic problem. While pregnancy and delivery have been described as etiological factors, observational studies show that urinary incontinence is also prevalent in nulliparous female athletes. Therefore, the general belief that physically fit women have stronger pelvic floor muscles preventing them from developing urinary incontinence may be questioned. The aim of this study was to systematically review studies investigating the prevalence of urinary incontinence in nulliparous female athletes. The electronic databases Medline, Embase, Cinahl, and Cochrane Library were systematically searched for eligible studies. Two independent researchers assessed the quality of the included studies and extracted the data in a standardised data extraction spreadsheet. Twenty-three studies were included in this systematic review. The urinary incontinence prevalence measured during sport activity varied from 5.7% to 80%. Urinary incontinence prevalence differs based on the type of sport. Trampolinists were found to have the highest prevalence of urinary incontinence. The findings suggest that urinary incontinence occurs often in female athletes, especially those involved in high impact sports. Future studies should investigate the mechanisms by which high impact sport activities may affect pelvic floor muscles leading to the development of urinary incontinence.


Assuntos
Esportes/fisiologia , Incontinência Urinária/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Paridade , Diafragma da Pelve/fisiopatologia , Prevalência , Esportes/psicologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/psicologia
15.
Curr Urol Rep ; 20(5): 21, 2019 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-30904966

RESUMO

PURPOSE OF REVIEW: We highlight the substantial gaps in knowledge on urologic care of female spinal cord injury (SCI) patients. RECENT FINDINGS: Males account for approximately 80% of people living with SCI in developed nations. Although there is a robust body of literature in some aspects of urologic care of individuals with SCI, such as treatments for neurogenic detrusor overactivity, there are relatively few studies focusing specifically on females. There are also few studies focusing on other aspects of urologic care of women with SCI such as sexual dysfunction, pelvic organ prolapse, and bladder cancer. Established guidelines for bladder management exist, generally recommending intermittent catheterization, but the fact remains that a substantial number of women with SCI utilize indwelling catheters for bladder management. There remains a paucity of literature using patient-reported measures regarding both outcomes and experiences of urologic management in the SCI population. Bladder management is challenging for many women with SCI. There are few studies on other urologic concerns in women with SCI.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Cateteres de Demora , Feminino , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Medidas de Resultados Relatados pelo Paciente , Prolapso de Órgão Pélvico/etiologia , Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/terapia , Qualidade de Vida , Fatores Sexuais , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/terapia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/mortalidade , Uretra/patologia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/terapia
16.
Urology ; 127: 124-126, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30822476

RESUMO

Inverted-Y ureteral duplication is one of the rarest anomalies of ureteral branching, which has been found to be more prevalent in females.2 Females commonly present with urinary incontinence often associated with distal limb ectopia to the bladder neck, uterus, or vagina.2 We present the case of a 7-year-old female with intermittent urinary incontinence who was found to have an inverted-Y ureteral duplication with perianal ectopia. We highlight the role of magnetic resonance urography in the evaluation of females with urinary incontinence and a normal renal/bladder ultrasound who are refractory to behavioral therapy.


Assuntos
Coristoma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Ureter/anormalidades , Incontinência Urinária/etiologia , Urografia/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Criança , Coristoma/cirurgia , Feminino , Humanos , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Ureter/diagnóstico por imagem , Ureter/cirurgia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/terapia
17.
Rehabilitación (Madr., Ed. impr.) ; 53(1): 20-27, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185408

RESUMO

Introducción y objetivos: Las disfunciones del sistema nervioso autónomo (SNA) en pacientes con lesión medular (LM) impactan de forma severa su morbimortalidad. Sin embargo, siguen siendo escasas las iniciativas de investigación destinadas a conocer dicha patología. Por ello, este artículo tiene como objetivos: 1) traducir al español el documento International Standards on documentation of remaining Autonomic Function after SCI (ISAFSCI), y 2) describir la influencia de la alteración del SNA en una muestra de pacientes con LM. Material y métodos: Estudio piloto observacional de tipo transversal, en 51 pacientes con LM traumática (> 1 año de evolución). Se recogiero datos sociodemográficos, médicos, ISAFSCI. Resultados: La versión española del ISAFSCI mostró que los sistemas más alterados fueron el control de la sudoración (hiperhidrosis supralesional 33,3%, hiperhidrosis infralesional 17,6%, hipohidrosis infralesional 21,6%) y de la temperatura (hipertermia 76,5%). El 74,5% tenía ausencia completa de control urinario inferior y el 82,4% no tenía control del intestino. La excitación genital fue refleja en el 47,1% de la muestra y el orgasmo y la eyaculación estaban alterados o reducidos en la mayoría de los casos (92,2% y 84,3%, respectivamente). Conclusiones: La versión española del ISAFSCI es una herramienta práctica y de gran utilidad en contextos clínicos para la evaluación de la función del SNA en personas con una LM. Entender el papel del SNA en personas con una LM es crucial para mejorar su estado de salud general y reducir complicaciones secundarias derivadas de la LM, y consecuentemente contribuye a un mejor manejo clínico


Introduction and objectives: Autonomic nervous system (ANS) dysfunction in patients with spinal cord injury (SCI) severely impacts morbidity and mortality. However, research initiatives aiming to gain insight into the direct impact of ANS dysfunction on health outcomes in persons with SCI are still lacking. Thus, this study had 2main objectives: 1) to translate into Spanish the revised edition of the International Standards on documentation of remaining Autonomic Function after SCI (ISAFSCI), and 2) to describe the impact of ANS dysfunction in a sample of SCI patients. Material and methods: Cross-sectional observational pilot study in 51 traumatic SCI patients (> 1 year after injury). Demographic, medical and ISAFSCI data were studied. Results: The Spanish version of the ISAFSCI showed that the most altered systems in the sample were sweating control (above-lesion hyperhidrosis in 33.3%; below-lesion hyperhidrosis in 17.6%; below-lesion hypohidrosis in 21.6%) and temperature control (hyperthermia in 76.5%). In addition, 74.5% of the sample had complete loss of control of the lower urinary tract, and 82.4% had no control of the bowel. Finally, genital arousal was reflex in 47.1% and orgasm and ejaculation were reduced or altered in most of the patients (92.2% and 84.3%, respectively). Conclusion: The Spanish version of the ISAFSCI is a useful and practical tool, and can be employed in clinical practice to assess ANS function in patients with SCI. Understanding the role of ANS in persons with SCI is crucial to improve their health status and reduce secondary complications post-SCI, and consequently help to improve the clinical management in these individuals


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Traumatismos da Medula Espinal/classificação , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Psicometria/instrumentação , Traumatismos da Medula Espinal/reabilitação , Hiperidrose/fisiopatologia , Incontinência Urinária/fisiopatologia , Incontinência Fecal/fisiopatologia
18.
Rev Bras Epidemiol ; 21Suppl 02(Suppl 02): e180018, 2019 Feb 04.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30726363

RESUMO

OBJECTIVES: The prevalence of sleep problems in elderly, such as insomnia, is a relevant issue in our society. Poor sleep quality is viewed by many as an inevitable result of aging. In this context, this study aimed to estimate the prevalence and associated factors of sleeping disturbances in elderly men and women (60 years and older). METHODS: The present study is part of SABE Study (Health, Well-being and Aging), a cohort conducted in São Paulo, Brazil. The sample included in the present cross-sectional study comprised 1,334 elderly people aged 60 years or older. Sleep disturbances were assessed based on responses of study participants on whether they had experienced any sleep disturbance in the past month. RESULTS: Among the elderly assessed, 44.9% had overall sleep disturbances, which were more frequent in women (51.5%) and in 75 to 79 years old (48.2%). According to the regression analysis, the variables gender, joint diseases, as well as nocturia and urinary incontinence, were associated with sleep disorders. Increase in sleep disturbances was found not to be linearly age-dependent. CONCLUSIONS: Gender, pain, urinary and nocturia incontinence were factors associated with sleep disorders. Thus, we might conclude that the absence of sleep disturbances in older adults depends on gender and health status.


Assuntos
Transtornos do Sono-Vigília/epidemiologia , Incontinência Urinária/epidemiologia , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Dor/complicações , Dor/epidemiologia , Dor/fisiopatologia , Distribuição de Poisson , Prevalência , Distribuição por Sexo , Fatores Sexuais , Transtornos do Sono-Vigília/fisiopatologia , Incontinência Urinária/complicações , Incontinência Urinária/fisiopatologia
19.
Braz J Phys Ther ; 23(2): 116-124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30704906

RESUMO

BACKGROUND: Although the efficacy of pelvic floor muscle training (PFMT) and bladder training are well established, there is a paucity of patient centered models using these interventions to treat women with UI at primary level of health assistance in Brazil. OBJECTIVE: To investigate the effectiveness of a physical therapy intervention to treat women with UI in primary health centers. METHODS: Pragmatic non-randomized controlled trial in which women with UI from the community participated in a supervised physical therapy program consisting of bladder training plus 12 weeks of PFMT, performed either at home or in the health center. Outcome measures were amount and frequency of urine loss measured by the 24-h pad-test and the 24-h voiding diary; secondary outcome was the impact of UI on quality of life measured by the ICIQ-SF. Outcomes were measured at baseline, at the 6th and 12th weeks of the intervention and 1 month after discharge. RESULTS: Interventions reduced the amount (pad-test, p=0.004; d=0.13, 95% CI=-0.23 to 0.49) and frequency of urine loss (voiding diary, p=0.003; d=0.51, 95%CI=0.14 to 0.87), and the impact of UI on quality of life (ICIQ-SF, p<0.001; d=1.26, 95%CI=0.87 to 1.66) over time, with positive effects from the 6th week up to 1 month for both intervention setting (home and health center), and no differences between them. CONCLUSION: Interventions were effective, can be implemented in primary health centers favoring the treatment of a greater number of women who do not have access to specialized physical therapy. TRIAL REGISTRATION: RBR-8tww4y.


Assuntos
Diafragma da Pelve , Bexiga Urinária/fisiopatologia , Incontinência Urinária/fisiopatologia , Brasil , Terapia por Exercício , Feminino , Humanos , Modalidades de Fisioterapia , Atenção Primária à Saúde , Incontinência Urinária/reabilitação
20.
Female Pelvic Med Reconstr Surg ; 25(2): 149-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807418

RESUMO

OBJECTIVE: In women with pelvic floor disorders, we sought to determine time-to-teach (TTT) correct pelvic floor muscle (PFM) contraction, prevalence of inappropriate muscle contractions, and the association between TTT with PFM strength (PFMS). METHODS: From August 2017 to April 2018, patients from 2 pelvic floor disorder clinics participated in a prospective study examining PFMS. Assessment of PFMS was performed to obtain TTT, inappropriate accessory muscle, and Modified Oxford Grading Scale scores for pelvic floor muscle contractions 1 to pelvic floor muscle contractions 2. RESULTS: Of 100 women, 77 were from low-resource setting and 23 from high-resource setting. Mean TTT overall was 64.1 seconds (±26.0; range, 9-160 seconds), and mean TTT between settings was not significant. Mean overall TTT was significantly less than 90 seconds. Seventy-one women (71%) demonstrated at least 1 inappropriate accessory muscle, and of those, up to 50% of patients contracting 2 accessory muscle groups with abdominal muscles most frequently contracted at baseline. Thirty-nine percent of patients had a PFM contraction of at least 3 at baseline compared with 82% of patients upon completion of teaching, with 60% of women with scores of 4 or 5. The mean difference overall between baseline and pelvic floor muscle contractions 3 was 1.27 (confidence interval, 1.08-1.46; P < 0.001), and this increase was significant. CONCLUSIONS: One-time PFMS teaching can be done in a time-proficient fashion and is translatable across high-resource and low-resource settings. Most patients show improvement in PFMS immediately and can quickly acquire this learned skill for proper home practice.


Assuntos
Terapia por Exercício , Educação de Pacientes como Assunto , Diafragma da Pelve/fisiopatologia , Prolapso de Órgão Pélvico/terapia , Incontinência Urinária/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Exame Ginecológico , Humanos , Pessoa de Meia-Idade , Contração Muscular , Força Muscular , Prolapso de Órgão Pélvico/fisiopatologia , Estudos Prospectivos , Fatores de Tempo , Incontinência Urinária/fisiopatologia
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