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1.
BMJ ; 371: m3719, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33055247

RESUMO

OBJECTIVE: To assess the effectiveness of pelvic floor muscle training (PFMT) plus electromyographic biofeedback or PFMT alone for stress or mixed urinary incontinence in women. DESIGN: Parallel group randomised controlled trial. SETTING: 23 community and secondary care centres providing continence care in Scotland and England. PARTICIPANTS: 600 women aged 18 and older, newly presenting with stress or mixed urinary incontinence between February 2014 and July 2016: 300 were randomised to PFMT plus electromyographic biofeedback and 300 to PFMT alone. INTERVENTIONS: Participants in both groups were offered six appointments with a continence therapist over 16 weeks. Participants in the biofeedback PFMT group received supervised PFMT and a home PFMT programme, incorporating electromyographic biofeedback during clinic appointments and at home. The PFMT group received supervised PFMT and a home PFMT programme. PFMT programmes were progressed over the appointments. MAIN OUTCOME MEASURES: The primary outcome was self-reported severity of urinary incontinence (International Consultation on Incontinence Questionnaire-urinary incontinence short form (ICIQ-UI SF), range 0 to 21, higher scores indicating greater severity) at 24 months. Secondary outcomes were cure or improvement, other pelvic floor symptoms, condition specific quality of life, women's perception of improvement, pelvic floor muscle function, uptake of other urinary incontinence treatment, PFMT self-efficacy, adherence, intervention costs, and quality adjusted life years. RESULTS: Mean ICIQ-UI SF scores at 24 months were 8.2 (SD 5.1, n=225) in the biofeedback PFMT group and 8.5 (SD 4.9, n=235) in the PFMT group (mean difference -0.09, 95% confidence interval -0.92 to 0.75, P=0.84). Biofeedback PFMT had similar costs (mean difference £121 ($154; €133), -£409 to £651, P=0.64) and quality adjusted life years (-0.04, -0.12 to 0.04, P=0.28) to PFMT. 48 participants reported an adverse event: for 23 this was related or possibly related to the interventions. CONCLUSIONS: At 24 months no evidence was found of any important difference in severity of urinary incontinence between PFMT plus electromyographic biofeedback and PFMT alone groups. Routine use of electromyographic biofeedback with PFMT should not be recommended. Other ways of maximising the effects of PFMT should be investigated. TRIAL REGISTRATION: ISRCTN57756448.


Assuntos
Eletromiografia/métodos , Terapia por Exercício/métodos , Neurorretroalimentação/métodos , Incontinência Urinária/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , Qualidade de Vida , Resultado do Tratamento , Incontinência Urinária/fisiopatologia
2.
Vet Surg ; 49(7): 1458-1466, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32885840

RESUMO

OBJECTIVE: To describe robot-assisted radical prostatectomy (RARP) and report the short-term outcome of a dog with prostatic cancer treated with RARP. STUDY DESIGN: Case report ANIMALS: Client-owned 6-year-old male-neutered Bernese mountain dog. METHODS: Robot-assisted radical prostatectomy was performed with a daVinci Si Surgical System through a transperitoneal approach. An interfascial nerve-sparing approach was used to preserve the neurovascular bundles and increase the likelihood of postoperative urinary continence. Urinary continence was assessed by placing white cloth bedding in the kennel during hospitalization and by owners' observation at home. RESULTS: The console time was 120 minutes, and the estimated intraoperative blood loss was 30 mL. No intraoperative complications were observed. The urinary catheter was removed after 7 days, at which point the dog urinated normally. Peritoneal carcinomatosis was diagnosed 43 days after surgery, and the dog was euthanized. CONCLUSION: Robot-assisted radical prostatectomy was successfully completed in a dog with prostatic neoplasia and led to postoperative urinary continence. CLINICAL SIGNIFICANCE: This single-case report provides evidence to justify further evaluation of RARP in dogs with prostatic neoplasms.


Assuntos
Adenocarcinoma/veterinária , Doenças do Cão/cirurgia , Prostatectomia/veterinária , Neoplasias da Próstata/veterinária , Robótica , Adenocarcinoma/cirurgia , Animais , Cães , Masculino , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/veterinária , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Resultado do Tratamento , Incontinência Urinária/fisiopatologia , Incontinência Urinária/veterinária
3.
Arch. esp. urol. (Ed. impr.) ; 73(7): 582-592, sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195956

RESUMO

OBJETIVO: Determinar la prevalencia de IU (Incontinencia Urinaria) en una unidad de hospitalización, identificar el tipo más prevalente, la severidad de los síntomas asociados y su impacto en la calidad de vida de los pacientes afectados, así como la identificación de los factores asociados a la misma. MÉTODOS: Estudio descriptivo de corte transversal, con pacientes en una unidad de hospitalización en Ferrol. Se estimó la prevalencia, el tipo de IU, la valoración de IU y el impacto de la IU en la vida diaria con los cuestionarios: IU-4 (por sexo), la herramienta de severidad ICIQ-SF y el IIQ. RESULTADOS: Participaron 302 pacientes, cuya prevalencia de IU es 41,4%; un 35% padecen IU de esfuerzo, un 27% IU de Urgencia, un 14,6% IU Mixta, un 8,8% IU Funcional y un 2,2% IU Refleja. Al 41,6% las pérdidas de orina le afecta a su salud emocional (nerviosismo, depresión, etc.). Podemos afirmar que ser mujer, es un factor de riesgo para padecer IU [p < 0,001; OR 5,0 - 95% IC (2,8-8,9)]. Por otro lado, la actividad física se objetiva como un factor protector para padecer IU (p = 0,003). CONCLUSIÓN: El impacto en la calidad de vida de la IU es alto, por lo que se debe reforzar la necesidad del manejo de la IU como una prioridad para las enfermeras, durante los ingresos hospitalarios, desde el ámbito comunitario o en situaciones de urgencias, debido a la alta prevalencia descrita


OBJECTIVE: To determine the prevalence of Urinary Incontinence (UI) in a hospitalization unit. METHODS: Descriptive cross-sectional study, with patients in a hospitalization unit in Ferrol. The prevalence, the type of UI, the UI assessment and the impact of UI on daily life were estimated with the questionnaires: IU-4 (by sex), the severity tool ICIQ-SF and the IIQ. RESULTS: 302 patients participated in the study. The prevalence of UI was 41.4%. Regarding the type of incontinence, 35% suffer stress UI, 27% urge UI, 14.6% mixed UI, 8.8% functional UI and 2.2% Reflex UI. We can affirm that being a woman is a risk factor for UI [p < 0.001; OR 5.0-95% CI (2.8-8.9)]. On the other hand, medium physical activity is objectified as a protective factor to suffer UI (p = 0.003). CONCLUSION: The impact on the quality of life of the UI is high. Establishing more real data of predictive factors may help to identify patients. Using standardized methods of study such as validated questionnaires when assessing our patients is also of interest. The need to manage UI should be reinforced as a priority for nursing professionals, not only during hospital admissions, but also at the community level or in emergencies, due to the high prevalence described


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Incontinência Urinária/epidemiologia , Incontinência Urinária/fisiopatologia , Qualidade de Vida , Estudos Transversais , Prevalência , Índice de Gravidade de Doença , Modelos Logísticos , Inquéritos e Questionários , Perfil de Impacto da Doença , Espanha/epidemiologia
4.
Neurourol Urodyn ; 39 Suppl 3: S9-S15, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32662562

RESUMO

AIM: To discuss animal models of lower urinary tract disorders (LUTD) and their translational impact. METHODS: Report of discussions based on presented literature-search based reviews relevant for the purpose. RESULTS: Animal models can be used to investigate fundamental biological mechanisms, but also as tools to elucidate aspects of the pathogenesis of disease and to provide early evidence of any safety risk. Several different models may be required to obtain information that can have a translational impact. The term "translational research" covers not only the process of directly transferring knowledge from basic sciences to human trials to produce new drugs, devices, and treatment options for patients (T1 type translation) but also the implementation of early clinical research findings (phases I-III) into practice to improve care for patients (T2 type). Direct transfer of animal data to T2 is rarely possible, and the process often does not continue after the first trials in humans (phase I). It should be emphasized that many preclinical observations do not have (and do not need to have) immediate translational impact. CONCLUSIONS: No single animal model can mimic the complexity of the human disease. Still, animal models can be useful for gaining information on LUT function in humans, for elucidating pathophysiological mechanisms, and for the definition of targets for future drugs to treat LUT disorders.


Assuntos
Sintomas do Trato Urinário Inferior/fisiopatologia , Pesquisa , Bexiga Urinária/fisiopatologia , Animais , Modelos Animais de Doenças , Humanos , Incontinência Urinária/fisiopatologia
5.
Rev Med Suisse ; 16(692): 907-910, 2020 May 06.
Artigo em Francês | MEDLINE | ID: mdl-32374535

RESUMO

Bladder function is controlled by the autonomic and somatic nervous system in the spinal cord. It is coordinated in the brainstem. Different areas of the brain are involved in the voluntary control of this reflex functioning. Brain lesions often cause an overactive bladder syndrome with increased voiding frequency and urgency. Urinary incontinence, frequently present, may be linked to overactive bladder and associated motor and cognitive disorders. Urinary retention occurs in the acute phase of a hemispherical lesion and following brainstem lesions. The identification, evaluation and treatment of urinary disorders in brain-damaged patients require a global assessment and integrated management taking the other neurological consequences of brain damage into account.


Assuntos
Lesões Encefálicas/complicações , Bexiga Urinária Hiperativa/complicações , Incontinência Urinária/complicações , Lesões Encefálicas/fisiopatologia , Humanos , Reflexo , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária/fisiopatologia
6.
Neurourol Urodyn ; 39(5): 1529-1537, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32442334

RESUMO

AIMS: The objective of this study is to ascertain whether an early three-month treatment with electrotherapy and biofeedback restores continence in urinary incontinence patients after radical prostatectomy (RP). METHODS: Design: The study performed a randomized, controlled trial of parallel and open groups. Configuration: Secondary care, urology department of a university hospital complex. PARTICIPANTS: Patients sent for RP due to prostate cancer (n = 60), 47 patients finally completed the study. INTERVENTIONS: The treatment group (TG) received physiotherapy consisting of electrotherapy and biofeedback, 3 days a week for 3 months, while the control group (CG) received no specific treatment. Both groups received a guide to perform pelvic floor exercises at home. The measurement instruments used were the 1- and 24-hour pad tests and the International Consultation on Incontinence Questionnaire Short-Form. The recording method used was a micturition (urinary) diary. RESULTS: The results of the 1-hour pad test (PT) show statistically significant differences between groups at 3 months (P = .001) and 6 months (P = .001), in favor of those in the TG. Sixty-four percent of patients in the TG recovered continence as against 9.1% in the CG after 3 months in the 1-hour PT, in line with the objective of this study. CONCLUSIONS: An early physiotherapy program helps RP patients with urinary incontinence recover continence after 3 months. Moreover, they lead a better quality life.


Assuntos
Diafragma da Pelve/fisiopatologia , Modalidades de Fisioterapia , Prostatectomia/efeitos adversos , Incontinência Urinária/terapia , Idoso , Biorretroalimentação Psicológica/métodos , Terapia por Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
7.
Neurourol Urodyn ; 39(5): 1592-1600, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32243660

RESUMO

AIMS: To describe a pelvic floor muscle training (PFMT) isolated and associated with game therapy (PFMT + GT) for women facing mixed urinary incontinence (MUI) during climacteric period. METHODS: To standardize a randomized controlled clinical trial intervention, a protocol was created, in an attempt to decrease women's symptomatology generated by MUI, through pelvic floor and abdomino-loin-pelvic muscles strength, and endurance. This study protocol will be composed of 32 volunteers, divided into two groups of 16. They will perform PFMT isolated or PFMT + GT, twice a week during 8 weeks. Interventions will last 40 minutes and will be divided into warming (5 minutes), training (30 minutes), and 5 minutes will be composed of resting time between exercises (1 minute each). Isolated PFMT sessions will be performed through four modalities of exercises: diaphragmatic, bridge, abdominal (plank), and pelvic mobility. PFMT + GT training will be carried out by using Wii Fit Plus games, such as Lotus Focus, Penguin Slide, Basic Step, and Hula Hoop from Wii equipment. Assessments will occur before, after, and 1 month after interventions. Vaginal manometry, 1-hour Pad Test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Intervention (PGI) will be used to evaluate the sample. CONCLUSIONS: It is expected greater increase on pelvic floor muscle (PFM) strength, endurance, vaginal pressure for PFMT + GG. Moreover, it is supposed that PFMT + GT volunteers present better treatment adherence due to games motivational inclusion.


Assuntos
Terapia por Exercício/métodos , Força Muscular/fisiologia , Diafragma da Pelve/fisiopatologia , Incontinência Urinária/terapia , Idoso , Feminino , Humanos , Manometria , Pessoa de Meia-Idade , Cooperação do Paciente , Inquéritos e Questionários , Incontinência Urinária/fisiopatologia , Vagina/fisiopatologia
8.
Neurourol Urodyn ; 39(5): 1394-1400, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32259358

RESUMO

AIMS: This study aimed to identify the easily obtainable parameters that predict the presence of detrusor overactivity (DO) in male patients with lower urinary tract symptoms (LUTS), because urodynamic studies cannot be performed in all cases. METHODS: A total of 605 treatment-naïve men with non-neurogenic LUTS who underwent subjective and objective evaluations were retrospectively reviewed. We divided patients into two groups (the DO and the non-DO group) according to the presence or absence of DO as determined by urodynamic data and compared the clinical parameters between the two groups to identify clinical signs associated with DO. RESULTS: Of the 605 patients with a mean age of 69.8 years and a mean prostate volume of 45.4 mL, 319 (52.7%) had DO, while DO was not detected in 286 (47.3%). Men with DO were significantly older and had greater prostate volume, longer intravesical prostatic protrusion (IPP), higher international prostate symptom score, higher overactive bladder symptom score (OABSS), smaller bladder capacity, and higher bladder outlet obstruction than those without DO. In a multivariate logistic regression analysis, higher OABSS-urgency subscore and OABSS-urgency urinary incontinence (UUI) subscore and longer IPP were significant predictive signs of DO. Receiver operating characteristic curve analysis identified 3 points, 1 point, and 8.0 mm as the optimal cut-off values for OABSS-urgency subscore, OABSS-UUI subscore, and IPP, respectively, for the diagnosis of DO. CONCLUSIONS: Higher OABSS-urgency subscore, higher OABSS-UUI subscore, and longer IPP were found to be useful parameters to predict the presence of DO in male patients with LUTS.


Assuntos
Sintomas do Trato Urinário Inferior/fisiopatologia , Hiperplasia Prostática/complicações , Bexiga Urinária Hiperativa/diagnóstico , Incontinência Urinária/diagnóstico , Urodinâmica/fisiologia , Idoso , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Próstata , Hiperplasia Prostática/fisiopatologia , Estudos Retrospectivos , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
9.
Neurourol Urodyn ; 39(4): 1036-1048, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32187704

RESUMO

OBJECTIVE: The primary objective was to evaluate the impact of app use on urinary incontinence control through pelvic floor muscle training when compared to the postal treatment plan. The secondary objectives were to evaluate how app use may affect the quality of life (QoL) of users and treatment adherence. MATERIAL AND METHODS: Eight databases (PubMed, SciELO, Embase, Web of Science, LILACS, Open Gray, Open Thesis, and OATD) were used as research sources. The protocol was registered in PROSPERO (CRD 42020145709). Randomized controlled trials assessing urinary incontinence (UI) control with app use, with no restriction of year, language, and status of publication were included. The JBI Systematic Reviews Checklist for Randomized Controlled Trials assessed the risk of bias of the studies selected. The mean scores of QoL between the pre- and postintervention periods were compared through standardized mean differences, which were weighted according to the number of months between the two periods. RESULTS: Only three studies met the eligibility criteria and were included. The methodological quality of the studies was from "low" to "moderate" risk of bias. The full sample included 203 patients with app-based treatment e 203 controls of postal treatment. All studies showed the reduction of urinary symptoms. In addition, two studies showed a reduction of QoL scores specific for the condition, while one study presented increased scores. CONCLUSION: Reminder therapy seems to be a promising strategy for controlling UI.


Assuntos
Terapia por Exercício/métodos , Aplicativos Móveis , Diafragma da Pelve/fisiopatologia , Qualidade de Vida , Incontinência Urinária/terapia , Humanos , Resultado do Tratamento , Incontinência Urinária/fisiopatologia
10.
Neurourol Urodyn ; 39(4): 1152-1161, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32162727

RESUMO

AIMS: Pelvic floor and mobility exercises were shown to be effective in managing incontinence in a cluster-randomized trial (CRT) of village women aged 60 to 75 years in Bangladesh. The present analysis examines continence 12 months after the CRT and exercise program implementation with village paramedics as preceptors. METHODS: Women from nine villages in the exercise arm of the CRT were followed-up 12 months after the 6-month intervention. They provided information about exercise since the CRT and a 3-day continence record (3DCR). Posttrial, a further 6-month exercise intervention led by village paramedics was initiated in 20 villages. Women completed the two-item Sandvik severity questionnaire before and after the intervention. Paramedics kept a record of each woman's attendance at the 48 exercise sessions RESULTS: A total of 130 of 150 women from the CRT completed the 12-month follow-up; 61.5% were dry on the 3DCR at follow-up. Total continence was related to the continuation of exercises carried out in the home and absence of urinary tract infection at follow-up. Those exercising at follow-up had an odds ratio (OR) of 3.49 (95% confidence interval [CI], 1.86-6.58) of being continent at follow-up. Higher end-of-CRT body mass index was associated with greater follow-up leakage. In the 20-village roll-out, with 316 incontinent women, improvement in both severity and total continence on the Sandvik questionnaire were related to a total number of sessions attended (OR = 1.09; 95% CI, 1.05-1.13). At roll-out, 38.6% achieved continence, comparable to 43.0% in the CRT using physiotherapy preceptors CONCLUSIONS: Group exercise classes led by paramedics resulted in a marked improvement in continence but maintenance requires exercise postintervention.


Assuntos
Terapia por Exercício/métodos , Diafragma da Pelve/fisiopatologia , Incontinência Urinária/terapia , Idoso , Bangladesh , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/fisiopatologia
11.
BMC Urol ; 20(1): 29, 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32188426

RESUMO

BACKGROUND: The robot-assisted radical prostatectomy (RARP) has been widely applied in recent years; however, only a few studies are reported about long-term urinary continence after surgery. The present study aimed to examine the outcomes of continence rates (CRs) and determine the risk and protective factors of urinary continence in patients with prostate cancer (PCa) undergoing RARP. METHODS: This retrospective study included 650 patients treated with RARP with perioperative data and at least one year of follow-up from September 2009 to November 2017. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. Continence was defined as no pad use. Early and late continence was defined as the return of urinary continence within 3 months and beyond 12 months post-surgery, respectively. CRs were examined from 1 to 48 months postoperatively. Logistic regression analysis evaluated the association between the predictive factors and urinary continence in the early and late stages. RESULTS: No significant difference was detected in the CR from 12 to 48 months postoperatively (P = 0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant risk factor of urinary continence at 1 month. Nerve-sparing (NS) was a significant protective factor of urinary continence at 1, 3, and 6 months. Advanced age was an independent risk factor of urinary continence at 6, 12, and 24 months. Other variables were not statistically significant predictors of urinary continence. CONCLUSIONS: The current results demonstrated that CR gradually improved with time within 1 year and stabilized 1 year after the surgery. PLND, NS, and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperative identification of patients at high risk and counseling about postoperative expectations for urinary continence.


Assuntos
Excisão de Linfonodo/métodos , Complicações Pós-Operatórias/epidemiologia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Procedimentos Cirúrgicos Robóticos/métodos , Incontinência Urinária/epidemiologia , Fatores Etários , Idoso , Humanos , Modelos Logísticos , Linfonodos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão , Pelve , Nervos Periféricos , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Incontinência Urinária/fisiopatologia
12.
BMC Urol ; 20(1): 32, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32197612

RESUMO

BACKGROUND: There is no consensus between urologists on the diagnosis and treatment of female urethral diverticula. Once the diagnosis has been established, the most common treatment approach is surgical excision and reconstruction. Whether a staged procedure or simultaneous management is more appropriate for treating concomitant urethral diverticula and stress urinary incontinence remains controversial. CASE PRESENTATION: A 63-year-old woman was hospitalized for repeated frequent urination, urgent urination, odynuria, and dysuria accompanied by intermittent overflow urinary incontinence for over 10 years. She had a 5 year history of urinary stress incontinence prior to onset of these symptoms and had had four urethral caruncles resected on four separate occasions. There was visible leakage of urine when abdominal pressure was increased during physical examination and urodynamic studies. Additionally, turbid urine was discharged when the anterior vaginal wall was squeezed. Cystourethrography showed circumferential filling with contrast and multiple bladder diverticulae in the mid plane of the pubic symphysis. Urethrocystoscopy showed an orifice to a diverticulum at 7 o'clock in the proximal urethra, into which an F19.8 urethroscope could be inserted, enabling examination of most of the diverticulae. The urethral diverticulae were resected, followed by mesh reconstruction of the urethra. During a 20-month follow-up, the treatment outcomes were satisfactory. CONCLUSION: We here report a case of a giant circumferential urethral diverticulum combined with stress urinary incontinence that was successfully managed by an uncommon surgical reconstructive technique: a minimally invasive "Sandwich" mesh repair procedure utilizing synthetic mesh wrap in the midurethral region.


Assuntos
Divertículo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Telas Cirúrgicas , Doenças Uretrais/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Divertículo/complicações , Divertículo/fisiopatologia , Disuria/etiologia , Disuria/fisiopatologia , Endoscopia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Uretrais/complicações , Doenças Uretrais/fisiopatologia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
13.
BJOG ; 127(8): 1002-1013, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32141709

RESUMO

OBJECTIVE: To compare standard (native tissue) repair with synthetic mesh inlays or mesh kits. DESIGN: Randomised controlled trial. SETTING: Thirty-three UK hospitals. POPULATION: Women having surgery for recurrent prolapse. METHODS: Women recruited using remote randomisation. MAIN OUTCOME MEASURES: Prolapse symptoms, condition-specific quality-of-life and serious adverse effects. RESULTS: A Mean Pelvic Organ Prolapse Symptom Score at 1 year was similar for each comparison (standard 6.6 versus mesh inlay 6.1, mean difference [MD] -0.41, 95% CI -2.92 to 2.11: standard 6.6 versus mesh kit 5.9, MD -1.21 , 95% CI -4.13 to 1.72) but the confidence intervals did not exclude a minimally important clinical difference. There was no evidence of difference in any other outcome measure at 1 or 2 years. Serious adverse events, excluding mesh exposure, were similar at 1 year (standard 7/55 [13%] versus mesh inlay 5/52 [10%], risk ratio [RR] 1.05 [0.66-1.68]: standard 3/25 [12%] versus mesh kit 3/46 [7%], RR 0.49 [0.11-2.16]). Cumulative mesh exposure rates over 2 years were 7/52 (13%) in the mesh inlay arm, of whom four women required surgical revision; and 4/46 in the mesh kit arm (9%), of whom two required surgical revision. CONCLUSIONS: We did not find evidence of a difference in terms of prolapse symptoms from the use of mesh inlays or mesh kits in women undergoing repeat prolapse surgery. Although the sample size was too small to be conclusive, the results provide a substantive contribution to future meta-analysis. TWEETABLE ABSTRACT: There is not enough evidence to support use of synthetic mesh inlay or mesh kits for repeat prolapse surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Satisfação do Paciente/estatística & dados numéricos , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas , Incontinência Urinária/cirurgia , Prolapso Uterino/cirurgia , Adulto , Coito , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/psicologia , Qualidade de Vida , Reoperação/estatística & dados numéricos , Resultado do Tratamento , Incontinência Urinária/fisiopatologia , Incontinência Urinária/psicologia , Prolapso Uterino/fisiopatologia , Prolapso Uterino/psicologia
14.
Neurourol Urodyn ; 39(3): 962-968, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32032453

RESUMO

AIMS: To enable the use of ICIQ-FLUTS, ICIQ-FLUTS-long-form (ICIQ-FLUTS-LF), ICIQ-LUTS-quality-of-life (ICIQ-LUTSqol), and ICIQ-FLUTS sexual functions (ICIQ-FLUTSsex) in Turkish speaking women, questionnaires were translated into Turkish and validity, reliability, and sensitivity to change were evaluated in women suffering from urinary incontinence (UI). MATERIALS AND METHODS: Permissions were obtained from ICIQ Advisory Board, English versions of the questionnaires were initially translated into Turkish, then back-translated into English and translations were modified according to recommendations of ICIQ Advisory Board. Pilot testing was performed in 10 women. Validity (content/face validity and discriminant validity), reliability (test-retest reliability and internal consistency), and sensitivity to change were evaluated. RESULTS: A total of 58 women with UI completed ICIQ-FLUTS, ICIQ-LUTSqol, and the ICIQ-FLUTS-LF, and 37 who were sexually active completed ICIQ-FLUTSsex. All women completed same questionnaires 15 days later. More than 90% of women thought that the questions were clear, unequivocal, and comprehensive. Missing data were less than 1% indicating adequate content/face validity. Cronbach's α coefficients were .933 (ICIQ-FLUTS), .979 (ICIQ-LUTSqol), .865 (ICIQ-FLUTS-LF), and .863 (ICIQ-FLUTSsex), representing adequate internal consistency. Kappa values and intraclass correlation coefficient for individual items were over 0.70, indicating adequate test-retest reliability. A total of 52 healthy volunteers completed ICIQ-FLUTS and ICIQ-FLUTS-LF, 30 completed ICIQ-LUTSqol, and 30 sexually active healthy volunteers completed ICIQ-FLUTSsex. All four questionnaires had good discriminant validity. Twenty-eight women with UI were analyzed 3 months after treatment. There was significant improvement in four questionnaires in correlation with pre- and posttreatment bladder diary results showing good sensitivity to change. CONCLUSION: Turkish versions of four ICIQ modules were shown valid and reliable and can be used in Turkish speaking women in the evaluation of UI.


Assuntos
Sintomas do Trato Urinário Inferior/fisiopatologia , Qualidade de Vida , Disfunções Sexuais Fisiológicas/fisiopatologia , Incontinência Urinária/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Dispareunia/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Sintomas do Trato Urinário Inferior/psicologia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Traduções , Turquia , Incontinência Urinária/psicologia , Adulto Jovem
15.
Neurourol Urodyn ; 39(3): 978-986, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32040860

RESUMO

BACKGROUND: There is a lack of evidence to assess whether gait functionality can be affected by the condition of the pelvic floor musculature in patients with multiple sclerosis (MS). OBJECTIVE: To evaluate the relationship between pelvic floor functionality and general functional performance, and also their relationship depending on dependence degree in MS patients. PARTICIPANTS: Forty-three MS patients performed the study. The pelvic floor musculature and its functionality were evaluated by urinary incontinence (UI), fecal incontinence, and constipation. General functional performance was evaluated by the Barthel index, the Health Status Questionnaire Short Form-12 (SF-12), and the Timed Up and Go (TUG) test. RESULTS: UI was moderately related to general functional performance (SF-12 Physical: R = -0.413; Barthel index: R = -0.501; TUG: R = 0.482). The comparative analysis showed differences between UI and gait functionality (P = .008), with poorer results in the TUG in patients with moderate/severe dependence (P < .001). CONCLUSION: UI appears to have a negative impact on the performance of daily living activities, walking, and the physical dimension of quality of life in patients with MS. In addition, patients with moderate or severe dependence showed higher UI and gait disturbance compared with those with mild dependence or independence.


Assuntos
Atividades Cotidianas , Marcha , Esclerose Múltipla/fisiopatologia , Distúrbios do Assoalho Pélvico/fisiopatologia , Diafragma da Pelve/fisiopatologia , Desempenho Físico Funcional , Qualidade de Vida , Adulto , Idoso , Constipação Intestinal/fisiopatologia , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diafragma da Pelve/fisiologia , Estudos Prospectivos , Inquéritos e Questionários , Incontinência Urinária/fisiopatologia
16.
Neurourol Urodyn ; 39(3): 926-934, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32049380

RESUMO

AIM: To characterize purinergic signaling in overactive bladder (OAB). METHODS: Mucosal biopsies were taken by flexible cystoscopy from patients with storage symptoms referred to Urology Departments of collaborating hospitals. Immunohistochemistry (n = 12) and Western blot analysis (n = 28) were used to establish the qualitative and quantitative expression profile of P2Y6 in human mucosa. Participants from the general population provided a mid-stream urine sample. Bioluminescent assays were used to quantify adenosine triphosphate (ATP; n = 66) and adenosine diphosphate (ADP; n = 60) concentrations, which were normalized to creatinine (Cr) concentration. All participants completed a questionnaire (International Consultation on Incontinence Questionnaire - Overactive Bladder) to score urinary symptoms of OAB. RESULTS: P2Y6 immunoreactivity, more prominent in the urothelium (colocalized with the uroepithelial marker pan-cytokeratin), was more greatly expressed in OAB compared to age- and sex-matched controls (benign prostatic hyperplasia) without OAB symptoms. Mucosal P2Y6 was positively correlated only with incontinence (P = .009). Both urinary ATP and its hydrolysis product, ADP, an agonist to P2Y6, were positively correlated with total OAB symptom score (P = .010 and P = .042, respectively). CONCLUSIONS: The positive correlation of P2Y6 only with incontinence may indicate a different phenotype in OAB wet and warrants further investigation. Positive correlations of ATP and ADP with total OAB symptom score demonstrate upregulation in purinergic signaling in OAB; shown previously only in animal models. Further research is required to validate whether purinoceptors are indeed new therapeutic targets for this highly prevalent symptom complex.


Assuntos
Difosfato de Adenosina/urina , Trifosfato de Adenosina/urina , Membrana Mucosa/metabolismo , Receptores Purinérgicos P2/metabolismo , Bexiga Urinária Hiperativa/metabolismo , Bexiga Urinária/metabolismo , Incontinência Urinária/metabolismo , Urotélio/metabolismo , Adulto , Idoso , Estudos de Casos e Controles , Creatinina/urina , Cistoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/metabolismo , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Inquéritos e Questionários , Bexiga Urinária/patologia , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/patologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária/patologia , Incontinência Urinária/fisiopatologia
17.
Neurourol Urodyn ; 39(3): 898-906, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32050054

RESUMO

BACKGROUND: Although pelvic floor dysfunction (PFD) has a multifactorial etiology, pregnancy and childbirth are considered crucial events predisposing to urinary incontinence as well as pelvic organ prolapse, which are highly prevalent. Rats are the most frequently used animal model and pudendal nerve crush (PNC) and vaginal distension (VD) are often used to mimic vaginal delivery. OBJECTIVE: To document the time course of events after simulated vaginal delivery (SVD) on the urethral sphincter and the vaginal smooth muscle layer. MATERIALS AND METHODS: Virgin female Sprague-Dawley rats were subjected to SVD (PNC + VD) or sham surgery and evaluated at 7, 14, 21, and 42 days after the injury. Urethral function was determined in vivo by microultrasound during cystometry and vaginal smooth muscle layer was harvested for in vitro pharmacologic investigation by isometric tension recording. Furthermore, vaginal and urethral samples were investigated by immunohistochemistry and real-time quantitative polymerase chain reaction. RESULTS: Microultrasound showed no bursting of the urethral sphincter in the SVD group at 7 days with a functional recovery starting at 14 days, and normal bursting at 21 and 42 days. Vaginal smooth muscle showed higher sensitivity to carbachol at 14 and 21 days after injury; however, at 42 days, its sensitivity decreased when compared with sham. CONCLUSION: SVD induces urethral dysfunction and a shift in vaginal smooth muscle contractile responses to carbachol.


Assuntos
Contração Muscular/fisiologia , Músculo Liso/fisiopatologia , Parto , Nervo Pudendo/lesões , Recuperação de Função Fisiológica/fisiologia , Uretra/fisiopatologia , Vagina/fisiopatologia , Animais , Carbacol/farmacologia , Agonistas Colinérgicos/farmacologia , Parto Obstétrico/efeitos adversos , Feminino , Modelos Animais , Contração Muscular/efeitos dos fármacos , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Músculo Liso/efeitos dos fármacos , Gravidez , Ratos , Ratos Sprague-Dawley , Ultrassonografia , Uretra/diagnóstico por imagem , Uretra/patologia , Incontinência Urinária/fisiopatologia , Vagina/efeitos dos fármacos , Vagina/patologia
18.
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
19.
BMC Pregnancy Childbirth ; 20(1): 117, 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32075598

RESUMO

BACKGROUND: Pelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12 months after the Cesarean (C) section in women with GDM. Specifically, differences in PFM/RAM hyperglycemic myopathy will be evaluated. METHODS: The Diamater is an ongoing cohort study of four groups of 59 pregnant women each from the Perinatal Diabetes Research Centre (PDRC), Botucatu Medical School (FMB)-UNESP (São Paulo State University), Brazil. Diagnosis of GDM and PS-UI will be made at 24-26 weeks, with a follow-up at 34-38 weeks of gestation. Inclusion in the study will occur at the time of C-section, and patients will be followed at 24-48 h, 6 weeks and 6 and 12 months postpartum. Study groups will be classified as (1) GDM plus PS-UI; (2) GDM without PS-UI; (3) Non-GDM plus PS-UI; and (4) Non-GDM without PS-UI. We will analyze relationships between GDM, PS-UI and hyperglycemic myopathy at 12 months after C-section. The mediator variables to be evaluated include digital palpation, vaginal squeeze pressure, 3D pelvic floor ultrasound, and 3D RAM ultrasound. RAM samples obtained during C-section will be analyzed for ex-vivo contractility, morphological, molecular and OMICS profiles to further characterize the hyperglycemic myopathy. Additional variables to be evaluated include maternal age, socioeconomic status, educational level, ethnicity, body mass index, weight gain during pregnancy, quality of glycemic control and insulin therapy. DISCUSSION: To our knowledge, this will be the first study to provide data on the prevalence of PS-UI and RAM and PFM physical and biomolecular muscle profiles after C-section in mothers with GDM. The longitudinal design allows for the assessment of cause-effect relationships between GDM, PS-UI, and PFMs and RAMs myopathy. The findings may reveal previously undetermined consequences of GDM.


Assuntos
Diabetes Gestacional/fisiopatologia , Doenças Musculares/fisiopatologia , Incontinência Urinária/fisiopatologia , Adulto , Brasil , Cesárea , Estudos de Coortes , Feminino , Idade Gestacional , Ganho de Peso na Gestação , Humanos , Idade Materna , Contração Muscular/fisiologia , Força Muscular/fisiologia , Palpação , Diafragma da Pelve/fisiopatologia , Período Pós-Parto , Gravidez , Reto do Abdome/fisiopatologia , Vagina
20.
Eur J Obstet Gynecol Reprod Biol ; 246: 106-112, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32006916

RESUMO

OBJECTIVE: To explore the prevalence of various Pelvic Floor Disorders (PFD) and the degree of symptom bother in a convenience sample of Armenian women in the Republic of Armenia. METHODS: Fifty women ages 20-85 years from each Armenian region (Marz) were included in the study. The survey included the validated Armenian version of the Global Pelvic Floor Bother Questionnaire (PFBQ) and general questions on demographics and comorbidities related to these disorders. RESULTS: A total of 540 women (90%) attending primary care clinics completed the validated PFBQ questionnaire. Initial analysis showed that the PFBQ score was significantly higher in older women, and those with higher vaginal parity and BMI. Women with prior hysterectomy (37.1+22.4) and prior pelvic prolapse or anti-incontinence surgeries (40.6+21.6) had significantly higher PFBQ scores than women without prior surgeries (18.8+20,0 and 19.4+19.7) and were associated with an increased odds of developing pelvic prolapse symptoms and obstructed defecation. CONCLUSIONS: PFD symptoms were observed to be common and significantly correlated with demographic characteristics and self-reported comorbidities in Armenian women. We need to start promoting proper training of physicians in Female Pelvic Medicine and Reconstructive Surgery.


Assuntos
Dispareunia/epidemiologia , Distúrbios do Assoalho Pélvico/epidemiologia , Prolapso de Órgão Pélvico/epidemiologia , Incontinência Urinária/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Armênia/epidemiologia , Cesárea , Defecação , Dispareunia/fisiopatologia , Incontinência Fecal/epidemiologia , Incontinência Fecal/fisiopatologia , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Histerectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Paridade , Distúrbios do Assoalho Pélvico/fisiopatologia , Distúrbios do Assoalho Pélvico/cirurgia , Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/cirurgia , Prevalência , Atenção Primária à Saúde , Procedimentos Cirúrgicos Reconstrutivos , Inquéritos e Questionários , Bexiga Urinária Hiperativa/epidemiologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/cirurgia , Transtornos Urinários/epidemiologia , Transtornos Urinários/fisiopatologia , Adulto Jovem
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