RESUMO
BACKGROUND: Bladder training (BT), the maintenance of a scheduled voiding regime at gradually adjusted intervals, is a common treatment for overactive bladder (OAB). OBJECTIVES: To assess the effects of isolated BT and/or in combination with other therapies on OAB symptoms. METHODS: A systematic review of eight databases was conducted. After screening titles and abstracts, full texts were retrieved. Cochrane RoB 2 and the GRADE approach were used. RESULTS: Fourteen RCTs were included: they studied isolated BT (n = 11), BT plus drug treatment (DT; n = 5), BT plus intravaginal electrical stimulation (IVES; n = 2), BT plus biofeedback and IVES (n = 1), BT plus pelvic floor muscle training and behavioral therapy (n = 2), BT plus percutaneous tibial nerve stimulation, and BT plus transcutaneous tibial nerve stimulation (n = 1). In a meta-analysis of short-term follow-up data, BT plus IVES resulted in greater improvement in nocturia (mean difference [MD]: 0.89, 95% CI: 0.5, 1.20), urinary incontinence (UI; MD: 1.93, 95% CI: 1.32, 2.55), and quality of life (QoL; MD: 4.87, 95% CI: 2.24, 7.50) than isolated BT, while DT and BT improved UI (MD: 0.58, 95% CI: 0.23, 0.92) more than isolated BT. CONCLUSION: In the short term, BT plus IVES improves the OAB symptoms of nocturia and UI while improving QoL. The limited number of RCTs and heterogeneity among them provide a low level of evidence, making the effect of BT on OAB inconclusive, which suggests that new RCTs should be performed.
Assuntos
Bexiga Urinária Hiperativa , Humanos , Terapia por Exercício/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária/diagnóstico , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/terapiaRESUMO
INTRODUCTION AND HYPOTHESIS: Currently, a sling implant is the standard treatment for stress urinary incontinence in women. To be effective, they require an adequate anchoring system. The aim of this study is compare biomechanical features of fixation systems of two mini slings models available on the market (Ophira™ and Mini Arc™) through a tensile test. MATERIALS AND METHODS: Anchoring devices of each sling were surgically implanted in abdominal wall of 15 rats divided into three groups of five animals which were arranged according to the date of post implant euthanasia on 7, 14 and 30 days. Abdominal walls of rats were extracted on bloc containing the anchoring system and were submitted to a tensile strength test to measure the maximum load and elongation until device avulsion from the tissue. The results were compared using Student test t and a 5% cut off was considered significant. RESULTS: The Ophira™ mini sling fixation system demanded a greater maximum load and developed a longer stretch for avulsion from the implanted site at all moments evaluated (p value less than 0.05). CONCLUSION: There were significant differences in fixation patterns of the anchoring systems, which were exclusively related to their designs. The Ophira™ mini sling fixation device provided better fixation to the abdominal wall of rats compared to the Mini Arc™ device, even in the late post implant period.
Assuntos
Slings Suburetrais , Âncoras de Sutura , Animais , Fenômenos Biomecânicos , Feminino , Desenho de Prótese , Ratos , Ratos Wistar , Resistência à TraçãoRESUMO
UNLABELLED: Overactive Bladder Syndrome (OAB) is defined by the ICS (International Continence Society) as urinary urgency, with or without urgency incontinence and frequently associated with increase of frequency and nocturia. PURPOSE: The aim of the study was to establish a correlation between OAB symptoms and Age in women aged 20-45. MATERIALS AND METHODS: We interviewed 1050 women aged 20-45 in the area of Campinas, Brazil, to investigate the prevalence of Overactive Bladder Symptoms. In this study we used the ICIQ-OAB questionnaire (ICS standard), in its validated Portuguese version and a specific questionnaire for the demographics. RESULTS: Overall, women aged 35-45 years showed significantly higher scores in the ICIQ-OAB questionnaire than all other groups (P<.001). Older women (35-45) presented a significantly higher score than younger women (all other groups) (P<.0001) regarding urinary frequency. Regarding frequency, there was a significant difference between the age group 35-45 (higher score) and the age groups 20-22 and 23-27 (P<.0001). Women aged 35-45 presented significantly more nocturia than women in the age groups of 28-34, 23-27 and 20-22. Women in the group of 28-34 also presented more nocturia than women aged 20-22 (P<.0001). Women aged 35-45 experienced more urgency than those in the age groups of 28-34 and 23-27 (P<.0001). Women aged 35-45 had significantly more urgency incontinence than all the other groups, and women in group of 20-22 also presented more incontinence than those aged 23-27 (P<.0001). Significant differences were also found regarding symptom bother, women in group 35-45 years old presented higher scores than the other groups regarding frequency (P<.0001), nocturia (P=.0011), urgency (P=.0015) and urgency incontinence (P<.0001). CONCLUSIONS: In conclusion, older women present more OAB symptoms and therefore a higher score than younger women.
Assuntos
Bexiga Urinária Hiperativa/diagnóstico , Adulto , Fatores Etários , Brasil , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To evaluate the biomechanical properties of a type of monofilament polypropylene mesh used to repair vaginal prolapse, as well as the effects of the inclusion of standard size orifices, called "helper orifices," on the interface resistance in the receiving area. MATERIAL AND METHODS: Forty female Wistar rats, 3 month-old, received an implant of monofilament polypropylene mesh, measuring 24 x 11 mm with no orifices, on left side of the abdominal wall (block 1). On the right side, a similar mesh with two circular orifices (6 mm diameter) was implanted (block 2). The rats were euthanized 90 days later and their abdominal walls were removed and divided into two blocks. The biomechanical study used a precision tensiometer in which the mesh was uniaxially tensioned until it was loosened from the tissue interface. In order to determine the tissue adherence and elasticity in each group, the following variables were analyzed: maximum load; deflection at maximum load; work to maximum load; stiffness as well as load, deflection and work at detachment the mesh. RESULTS: With the exception of stiffness, all the other variables showed statistical differences between the groups, considering that they were increased in meshes with orifices (p<0.001). The inclusion of standard size orifices reduced 30% of the mesh weigth. CONCLUSION: Besides reducing the weight and amount of material, the inclusion of standard size orifices in the monofilament macroporous polypropylene mesh improved the elasticity and adherence to the tissues when implanted in the interface of the abdominal wall in adult female rats.
Assuntos
Telas Cirúrgicas , Parede Abdominal/cirurgia , Animais , Fenômenos Biomecânicos , Elasticidade , Desenho de Equipamento , Feminino , Teste de Materiais , Polipropilenos , Ratos , Ratos Wistar , Resistência à Tração , Suporte de Carga , CicatrizaçãoRESUMO
INTRODUCTION: few studies have been carried out on therapeutic options in patients with painful bladder syndrome associated with interstitial cystitis. The aim is to verify the safety and effectiveness of treatment with sodium hyaluronate through intravesical instillation in patients with painful bladder syndrome. MATERIALS AND METHODS: a series of 18 female patients is presented, with a mean age of 51 years and prior diagnosis of painful bladder syndrome, who were treated by means of the weekly infusion of an intravesical solution of 40mg of sodium hyaluronate in sterile solution, over a period of eight weeks. The patients were examined clinically and urodynamically prior to their inclusion in the study and eight months after the instillations had concluded. RESULTS: there was a statistically significant improvement in the urodynamic parameters and in the symptoms measured quantitatively by means of the questionnaire "Pelvic Pain and Urgency/Frequency" between the baseline situation and after the vesical instillation of sodium hyaluronate in patients with painful bladder syndrome. There was no toxicity arising from the treatment, given that no adverse effects were recorded in relation to it. CONCLUSION: the clinical use of intravesical hyaluronic acid in patients with painful bladder syndrome possibly associated with interstitial cystitis has been demonstrated. The clinical improvement is also associated both with increased bladder capacity and improved bladder sensitivity. Tolerance was excellent. Clinical tests that more profoundly evaluate the therapeutic potential of this drug in this type of patients are required.
Assuntos
Cistite Intersticial/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Urodinâmica , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Adulto JovemRESUMO
INTRODUCTION AND OBJECTIVE: During pregnancy, hormonal change, increase in the body mass index and the pressure caused by the enlarged uterus over the bladder and pelvic floor, are some factors involved in lower urinary tract symptoms (LUTS). This study was made to evaluate the correlation between pregnancy and delivery way with LUTS. MATERIAL AND METHOD: This open prospective study was carried out using the overactive bladder questionnaire short form (OABq-SF). A total of 60 patients enrolled this study. The mean age was 24 year, raging from 14 to 40 years. The patients were evaluated during the third trimester and 6 months after delivery. Statistical analysis of the OABq-SF scores was made using the Pearson method. RESULTS: Mean OABq-SF score during pregnancy was 35.2 and 6 months after delivery decreased to15. Quality of life was 82.9 during pregnancy and increased to 88.4 at 6 month after delivery. Patient's perception, that is correlation, was 55.02 (p=0.0001) during pregnancy and 36.1% (p=0.0046). Clinical correlation index was 6.7%. CONCLUSIONS: Our study demonstrated that in spite of LUTS being more important during pregnancy, there is no significant clinical correlation in patient's perception.
Assuntos
Complicações na Gravidez/diagnóstico , Transtornos Puerperais/diagnóstico , Qualidade de Vida , Bexiga Urinária Hiperativa/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVE: This study aims to evaluate of the impact of NO molecules in Pluronic F-127 gel, applied topically in the clitoris, on the clitoridian blood flow of healthy volunteer women, using the Doppler ultra-sound. METHOD: A total of 20 healthy women over 18 years old and sexually active with no sexual hormones alteration were enrolled. The Doppler ultra-sound procedure was performed on the artery of the clitoris in patients without the NO donor gel, and then after fifteen minutes of its application the same procedure was done again, to compare the values. RESULTS: The hemodynamic results showed, that this formulation was responsible for the increase of the systolic and diastolic speeds in about 2,5 times after 15 min of the administration of the gel. The initial resistance index was increased in 1.2 due to the local venous congestion in only 15 min after the administration of gel. Indicating that this product can be used to promote the dilatation of the artery of the clitoris to treat women with sexual dysfunction. CONCLUSION: The use of topic hidrogel as a donor drug in the clitoris of women resulting in a local vasodilatation, without systemic effects. These findings suggest that this preparation may be useful in the management of selected cases of female sexual dysfunction.
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Clitóris/irrigação sanguínea , Clitóris/efeitos dos fármacos , Doadores de Óxido Nítrico/administração & dosagem , Administração Tópica , Clitóris/diagnóstico por imagem , Excipientes , Feminino , Géis , Humanos , Poloxâmero , Estudos Prospectivos , Fluxo Sanguíneo Regional/efeitos dos fármacos , Ultrassonografia Doppler , Adulto JovemRESUMO
OBJECTIVES: A prospective study was conducted to assess the efficacy of sacrospinous vaginal vault fixation and its impact on the anterior compartment. The Pelvic Organ Prolapse Quantification (POP-Q) system was used to quantify pelvic organ prolapse in the apical and anterior vaginal compartments. METHODS: Fifty-eight patients underwent a procedure to correct apical prolapse from March 2003 to February 2006. Mean preoperative and postoperative POP-Q scores were respectively: Aa (+0.74; -1.45); Ba (+3.17; -1.36); C (+3.41; -7.71) (p<0.001). RESULTS: Cure rate was 93.1%. Preoperative and postoperative evaluation of the anterior vaginal compartment was respectively: stage 1 (5.2%; 48.3%), stage 2 (6.9%; 34.5%), stage 3 (74.1%; 5.2%), and stage 4 (13.8%; 0%). De novo cystocele occurred in 87.9% of cases. An improvement was seen in lower urinary tract symptoms of urgency, nocturia, and urge incontinence. CONCLUSIONS: Sacrospinous vaginal vault suspension is effective for the treatment of apical prolapse and leads to formation of cystocele in most cases.
Assuntos
Ligamentos , Prolapso de Órgão Pélvico/cirurgia , Técnicas de Sutura , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistocele/etiologia , Cistocele/prevenção & controle , Cistocele/cirurgia , Feminino , Humanos , Histerectomia/métodos , Pessoa de Meia-Idade , Noctúria/etiologia , Noctúria/prevenção & controle , Noctúria/cirurgia , Prolapso de Órgão Pélvico/complicações , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Recuperação de Função Fisiológica , Recidiva , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle , Incontinência Urinária/cirurgia , Prolapso Uterino/cirurgiaRESUMO
Reports on postoperative complications of anti-incontinence surgery followed the widespread use of synthetic slings. In this paper we describe the more frequent complications, such as obstruction, pelvic hematoma, bladder and urethral injuries, to facilitate the management of these complications.
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Hematoma/etiologia , Hematoma/terapia , Slings Suburetrais/efeitos adversos , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/terapia , Algoritmos , Feminino , Humanos , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/fisiopatologiaRESUMO
The prolapse is the exteriorization of the pelvic organs through the vagina, this condition may affect the quality of life. The prolapse was diagnosed in 50% of multiparous women. It is estimated that a woman throughout her life, has 11% risk of needing surgery for correction of pelvic organ prolapse or urinary incontinence. The prolapse may occur at the anterior vaginal wall (cystocele) at the vaginal, uterus (histerocele) or at the posterior wall (or rectocele enterocele). For the unfit patient obliteratives procedures may be indicated and recontructives for pacients wih good performance status. It is important for reconstructive surgery a correct diagnosis, for the specific defect repair. When indicated, meshes can be used to add strength to the poor quality tissues.