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BACKGROUND: Women's adherence is essential to physiotherapeutic treatment of pelvic floor dysfunction, but its related factors are not usually considered in the development of treatment approaches. This study aims to understand how women with pelvic floor dysfunction experience pelvic floor conservative non-pharmacological treatment options. METHODS: A systematic review of qualitative studies. The electronic search was performed in MEDLINE/PubMed, CINAHL, Lilacs, SCOPUS, and Web of Science databases. Primary articles on qualitative methods focused on the experience of women regarding pelvic floor conservative non-pharmacological interventions, i.e., pelvic floor muscle training (PFMT), either associated or not with biofeedback, perineal massage, vaginal dilators, and others. A meta-aggregation was performed. RESULTS: It was included 22 manuscripts in this review. It was found seven studies about the use of vaginal devices, two about manual intervention and 14 studies on women's experience with PFMT. The findings were synthesized as follows: I) women's experience of manual interventions; II) women's experience using vaginal devices changes according to health professional attitudes; III) women's experiences using vaginal devices varied depending on their pelvic floor dysfunction; IV) reported side effects due to the use of vaginal devices; V) external factors influencing PFMT performance; VI) women's perception of their own personal factors influencing PFMT performance; VII) PFMT characteristics influencing women's adherence; VIII) strategies used by women to include PFMT in their routine. CONCLUSION: Women's experience with pelvic floor conservative non-pharmacological treatment options is a complex phenomenon that involves many more variables than simply personal aspects. This is a systematic review of qualitative studies registered in the PROSPERO (CRD42018080244).

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INTRODUCTION AND HYPOTHESIS: There seems to be little knowledge about pelvic floor muscles (PFMs) in the general population; however, literature confirming this assertion is scarce, especially in developing countries. The present study hypothesized a low level of knowledge about PFMs in a sample of Brazilian women and a positive relationship between that knowledge and the ability to contract the PFMs, strength, and urinary continence. METHODS: This was a cross-sectional study including 133 women. A questionnaire assessing knowledge about PFMs and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) were applied. Vaginal palpation and manometry were used to assess PFM condition. Pearson's correlation coefficient was used to test the association between PFM knowledge and continuous variables, and Fisher's exact test was used to compare the women's PFM knowledge with the categorical variables. RESULTS: A low level of PFM knowledge was observed in this sample, with a mean total score of 0.48 (±0.97). Vaginal manometry peak, mean, and duration values were 39.1 cmH2O (±23.7), 25.5 cmH2O (±16.1), and 21.1 s (±20.8) respectively. The ICIQ-UI-SF mean score was 7.1 (± 6.8). There were weak correlations between PFM knowledge and age (r -0.2044/ p = 0.01), and parity (r -0.19568/p = 0.02). PFM knowledge was higher among women with higher education levels (p = 0.0012) and those who had previously performed PFM training (p <0.001). CONCLUSION: The participants showed a low level of PFM knowledge. No relationship between PFM knowledge and ability to contract or prevalence of UI was observed.

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OBJECTIVE: To assess the inter-rater reliability of two raters for the mean and single maximal value of three vaginal maximum voluntary contractions (MVCs) using the Peritron™ perineometer for study participants in the first and second trimesters of pregnancy. PARTICIPANTS: Thirty-six low-risk pregnant women. METHODS: The assessments were done by two different examiners with an interval of 2 to 7 days. For statistical analysis, the concordance correlation coefficient (CCC) and Bland-Altman limits of agreement were used. RESULTS: For the overall sample, good reliability of 0.80 was found analyzing the mean of three MVCs and for the single maximal value (CCC = 0.79). Good reliability was found for the mean of three MVCs (0.81 and 0.78) for the first and second trimesters, respectively. Good reliability of 0.89 was found in the first trimester and a moderate reliability of 0.70 for the second trimester when analyzing the single maximal value of three MVCs. CONCLUSION: Good inter-rater reliability was found for the overall sample and first trimester of pregnancy for both mean values and single maximal values of the three MVCs. A good and moderate reliability was respectively found in the second trimester in analyzing the mean and single maximum values of three MVCs.

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INTRODUCTION AND HYPOTHESIS: Pelvic floor disorders [urinary (UI) and/or fecal C (FI) incontinence, pelvic organ prolapse (POP)] may have a significant impact in womens' quality of life (QoL). The Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20) help assess these disorders; however, we do not have them culturally translated in the Brazilian Portuguese language. METHODS: A cross-sectional study was performed of 185 women with pelvic floor disorders (PFD group) and 65 healthy patients (control group). A translated, pilot-tested, Brazilian Portuguese version were given to these women. Internal consistency, construct validity, and floor/ceiling effect were assessed. Test-retest was performed in 79 patients after 4 weeks, and responsiveness was assessed in 42 patients after surgical treatment. RESULTS: Internal consistency (Cronbach's alpha) was adequate between PFD and control groups on the PFDI-20 (0.816-0.844) and PFIQ-7 (0.823-0.846). Test-retest reliability was also adequate [intraclass correlation coefficient (ICC) 0.803-0.843]. Subscales [Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7) and Colorectal-Anal Impact Questionnaire (CRAIQ-7) from the PFIQ-7 demonstrated floor effect (42.70, 60, and 18.38 %, respectively) in the PFD group, with no influence at total score. No ceiling effect was observed. Construct validity was adequate at all correlations between clinical symptoms and subscales in both questionnaires in both groups. Responsiveness was demonstrated by a statistically significant reduction in scale/subscale scores from PFDI-20 and PFIQ-7 after surgical treatment. CONCLUSION: The PFDI-20 and PFIQ-7 presented adequate cultural translation and are reliable and valid in the Brazilian Portuguese language.

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INTRODUCTION AND HYPOTHESIS: Low socioeconomic factors may influence the development of stress urinary incontinence (SUI). Thus far, there is little research available on SUI in developing countries. We aimed to determine whether the prevalence of SUI in a northeastern Brazilian municipality was higher or lower than in the general female population. METHODS: Cross-sectional household cluster study of 1,180 climacteric women in the São Luís municipality (Maranhão state, Brazil) was conducted using a standardized questionnaire that was previously tested in a pilot study and administered by interviewers to obtain socioeconomic and cultural information, climacteric aspects, and life habits related to SUI. RESULTS: From this population, 15.34% (n = 181) had SUI; this prevalence did not change with age. More than half (57.92%) of the patients replied that they had not consulted a physician for their SUI. The presence of SUI was not associated with any socioeconomic or gynecological variables after multivariate analysis. CONCLUSIONS: The prevalence of SUI in São Luís was similar to the rates observed in the general global female population. Socioeconomic and gynecological variables were not associated with SUI.

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Objetivo: avaliar a sensibilidade e a especificidade dos exames de mamografia e de ultrassonografia na detecção de alterações mamárias, em mulheres com hipertrofia mamária em seus diversos graus, fazendo correlação com os achados nos exames histopatológicos. Métodos: foi feito um estudo prospectivo, realizado com 60 pacientes, portadoras de hipertrofia mamária, com idade entre 16 e 72 anos, no Serviço de Cirurgia Plástica do Hospital Universitário da Universidade Federal do Maranhão. De acordo com a faixa etária, foi indicado o exame de imagem, classificando o resultado pelo sistema Breast Imaging Reporting and Date System (BI-RADS®). O resultado desse exame foi correlacionado com o grau de hipertrofia (peso) e com o exame histopatológico das 120 peças cirúrgicas obtidas na cirurgia plástica de redução mamária. Resultados: o exame histopatológico detectou 47,5% de lesões benignas não neoplástica, sendo 7,5% com risco relativo levemente aumentado. O exame de ultrassonografia apresentou especificidade de 80,6% e sensibilidade de 40,5%. A mamografia apresentou especificidade de 54,5% e sensibilidade de 49,0%. A ultrassonografia mamária não apresentou comprometimento da especificidade, mas apresentou baixa sensibilidade. A mamografia apresentou baixa especificidade e sensibilidade. Mesmo em faixas etárias mais avançadas, onde se esperava uma redução da densidade mamária que favorecia a sensibilidade mamográfica, o resultado foi compatível com o encontrado em mamas densas. Conclusão: estes dados sugerem que a hipertrofia mamária deve ser considerada na interpretação de laudos de mamografia e de ultrassonografia em rastreamento de doenças mamárias.

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OBJECTIVE: to evaluate patients suffering from spinal cord injury METHODS: A retrospective, cross-sectional study was conducted with 87 patients admitted to the university hospital of UFMA between January 2008 and June 2009. We assessed sex, age, compromised segment of the spine and cause of injury, subjecting these data to statistical analysis (chi-square test). RESULTS: there was a significant prevalence of males (p <0.001), with 81.6% (71) cases, and age between 21 and 30 years of age (p <0.001), with 39.1% (34) of cases. The average age was 33.96 ± 13.56 years. The proportion of falls from height was significantly greater than the number of traffic (p <0.001) and motorcycle (p <0.001) accidents. The most compromised segment of the spine (p <0.001) was the thoracic (33), with 37.9% of cases. Traffic accidents appear in greater proportion among men (p = 0.014). The cervical spine was the most affected in males (p = 0.043). The thoracolumbar fractures were caused, to a greater extent, by falls from height (p = 0.003), whereas involvement of the thoracic spine was significantly higher (p = 0.016) in traffic accidents. CONCLUSION: The group at higher risk of injury to the spinal cord is the young adult male. Although there is a difference between the sexes when correlated traffic accidents, falling from height is the main cause in both sexes.

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OBJETIVO: Fazer avaliação epidemiológica de 87 pacientes vítimas de traumatismo da medula espinhal, internados no hospital universitário da UFMA entre Janeiro de 2008 e Junho de 2009. MÉTODOS: Estudo transversal retrospectivo, segundo: sexo; idade; segmento da coluna comprometido e causa do traumatismo, submetendo estes dados à análise estatística (teste do quiquadrado). RESULTADOS: predomínio significativo (p<0,001) do sexo masculino, com 81,6 por cento (71) dos casos, e da faixa etária entre 21 e 30 anos de idade (p<0,001), com 39,1 por cento (34) dos casos. A média de idade foi 33,96±13,56 anos. A proporção de quedas de altura foi significativamente maior do que a dos acidentes automobilísticos (p<0,001) e motociclísticos (p<0,001). O segmento da coluna significativamente (p<0,001) mais comprometido foi o torácico 37,9 por cento (33) dos casos. Os acidentes de trânsito aparecem em maior proporção entre os homens (p=0,014). A coluna cervical foi mais acometida no sexo masculino (p=0,043). As fraturas toracolombares foram provocadas, em maior proporção, pelas quedas de altura (p=0,003), enquanto que acometimento da coluna torácica é significativamente maior (p=0,016) nos acidentes de trânsito. CONCLUSÃO: o grupo de maior risco para o traumatismo da coluna espinhal é o de adultos jovens masculinos. Apesar de existir uma diferença entre os sexos quando se correlacionam os acidentes de trânsito, a queda de altura é a principal causa em ambos os sexos.

OBJECTIVE: to evaluate patients suffering from spinal cord injury METHODS: A retrospective, cross-sectional study was conducted with 87 patients admitted to the university hospital of UFMA between January 2008 and June 2009. We assessed sex, age, compromised segment of the spine and cause of injury, subjecting these data to statistical analysis (chi-square test). RESULTS: there was a significant prevalence of males (p <0.001), with 81.6 percent (71) cases, and age between 21 and 30 years of age (p <0.001), with 39.1 percent (34) of cases. The average age was 33.96 ± 13.56 years. The proportion of falls from height was significantly greater than the number of traffic (p <0.001) and motorcycle (p <0.001) accidents. The most compromised segment of the spine (p <0.001) was the thoracic (33), with 37.9 percent of cases. Traffic accidents appear in greater proportion among men (p = 0.014). The cervical spine was the most affected in males (p = 0.043). The thoracolumbar fractures were caused, to a greater extent, by falls from height (p = 0.003), whereas involvement of the thoracic spine was significantly higher (p = 0.016) in traffic accidents. CONCLUSION: The group at higher risk of injury to the spinal cord is the young adult male. Although there is a difference between the sexes when correlated traffic accidents, falling from height is the main cause in both sexes.

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PURPOSE: To compare the outcomes and costs of stress urinary incontinence (SUI) surgery using a hand-made sling (Marlex®) versus a commerciallyavailable suburethral polypropylene sling (Advantage®). MATERIALS AND METHODS: Thirty-nine women with SUI due to bladder neck hypermobility and/or sphincter incompetence diagnosed by clinical examination and urodynamic studies were divided into two groups: group 1 (n = 19) consisted of patients from an academic center (Department of Urology, University Hospital of Federal University of Maranhao, and group 2 (n = 20) patients from private practice. The hand-made polypropylene suburethral sling was used in group 1 and the commercial sling in group 2. The patients were evaluated 30, 60 and 90 days after surgery. RESULTS: The mean duration of surgery was 43 min. in group 1 and 51 min. in group 2. No postoperative voiding difficulties were observed in group 1 (100%), as well as, in 94.7% of patients of group 2. A bladder catheter was not required in any of the patients of the two groups at the end of the study. The level of satisfaction was 100% in group 1, whereas, one patient of group 2 considered the surgery to be unsuccessful. Urodynamic studies showed low amplitude uninhibited contraction in 11.1% of patients of group 1 and 10.5% of group 2. No complications were observed in either group. CONCLUSION: The hand-made polypropylene mesh (Marlex®) can be used for sling procedures, saving costs and yielding results similar to that obtained with commercial sling systems.

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PURPOSE: To compare the outcomes and costs of stress urinary incontinence (SUI) surgery using a hand-made sling (Marlex®) versus a commerciallyavailable suburethral polypropylene sling (Advantage®). MATERIALS AND METHODS: Thirty-nine women with SUI due to bladder neck hypermobility and/or sphincter incompetence diagnosed by clinical examination and urodynamic studies were divided into two groups: group 1 (n = 19) consisted of patients from an academic center (Department of Urology, University Hospital of Federal University of Maranhao, and group 2 (n = 20) patients from private practice. The hand-made polypropylene suburethral sling was used in group 1 and the commercial sling in group 2. The patients were evaluated 30, 60 and 90 days after surgery. RESULTS: The mean duration of surgery was 43 min. in group 1 and 51 min. in group 2. No postoperative voiding difficulties were observed in group 1 (100 percent), as well as, in 94.7 percent of patients of group 2. A bladder catheter was not required in any of the patients of the two groups at the end of the study. The level of satisfaction was 100 percent in group 1, whereas, one patient of group 2 considered the surgery to be unsuccessful. Urodynamic studies showed low amplitude uninhibited contraction in 11.1 percent of patients of group 1 and 10.5 percent of group 2. No complications were observed in either group. CONCLUSION: The hand-made polypropylene mesh (Marlex®) can be used for sling procedures, saving costs and yielding results similar to that obtained with commercial sling systems.

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