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Disfunções do assoalho pélvico são condições que acometem mulheres em idades variadas, porém aquelas que se encontram no período do climatério, assim como as multíparas, são as mais suscetíveis. Entretanto, há relatos na literatura de jovens nulíparas que apresentam sintomas de disfunções nesta região, tais como a incontinência urinária e a anal durante a prática de esportes. Essas condições podem levar ao abandono da atividade física e comprometer a qualidade de vida. Com o intuito de conhecer a ocorrência das disfunções do assoalho pélvico e seus fatores etiológicos em atletas jovens e nulíparas, foi feita uma revisão da literatura. Foram consultadas as bases de dados BVS e PubMed nos últimos dez anos. Os resultados dos estudos revisados indicaram alta prevalência de disfunções do assoalho pélvico entre atletas, muitas delas nulíparas. A incontinência urinária é a disfunção do assoalho pélvico mais documentada e acomete principalmente atletas que praticam atividades consideradas de alto impacto, como trampolim e paraquedismo. As condições que desencadeiam as disfunções do assoalho pélvico em mulheres jovens e nulíparas ainda não estão completamente elucidadas, alterações extrínsecas ou genéticas do tecido conjuntivo frouxo e atividades que envolvem longos saltos são as hipóteses mais frequentes. Apenas um estudo foi encontrado documentando a prevalência das disfunções do assoalho pélvico entre atletas envolvendo os sistemas intestinal e sexual, além do urinário

Pelvic floor dysfunctions are conditions that affect women in various ages, however those in the climacteric period, as well as the multiparous are more susceptible to it. However, there are studies in the scientific literature reporting the occurrence of urinary incontinence during sports among young and nuliparous women. Such conditions can lead to a withdrawn from physical activity compromising the quality of life. A literature review in PubMed and in VHL databases, within the last ten years, was done in order to understand the occurrence of symptoms suggestive of pelvic floor dysfunctions other than urinary incontinence, such as anorectal or sexual dysfunction, and their etiological factors in young and nulliparous athletes. Results indicated a high prevalence of urinary incontinence among athletes, who were engaged in high-impact activities such as trampoline, and skydiving. The conditions that contribute to the urinary incontinence etiology in young and nulliparous women are still not fully understood, extrinsic or genetic changes in loose connective tissue and activities involving long jumps are the most common hypotheses to this condition. Other than urinary tract symptoms, it was found only one study documenting pelvic floor disorders involving the intestinal and sexual systems in such population

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INTRODUCTION AND HYPOTHESIS: Pelvic floor muscle training (PFMT) is a treatment for stress urinary incontinence (SUI) that can be done individually or in a group. The aim of this study was to compare these two types of treatment. METHODS: Sixty women 30 to 75 years old with SUI were randomly assigned to participate in the two groups. They were evaluated before and after the treatment with the Oxford grading system, pad test, voiding diary, and the King's Health Questionnaire. RESULTS: Both groups experienced significant reductions in urinary leakage as measured by the pad test and bladder diary. A negative pad test was observed in about 50% of patients in both groups. There were statistically significant improvements in both muscle strength and quality of life. When the groups were compared, there were no differences in the results between them. CONCLUSIONS: Individual treatment and group PFMT appear to be equally effective for improving SUI.

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INTRODUCTION AND HYPOTHESIS: Our objective was to translate and validate a Portuguese version of the Urinary Incontinence-Specific Quality-of-Life Instrument (I-QOL), a questionnaire that is widely used in clinical trials. METHODS: Fifty patients completed the same questionnaire twice at a 2-week interval. During the first visit, we conducted a face-to-face interview and collected demographic data. The King's Health Questionnaire was completed during the same visit for comparisons. RESULTS: The results showed that the Portuguese version of the I-QOL has very good psychometrics properties. Reliability was assessed by Cronbach's alpha (0.93), reproducibility was calculated through the intraclass correlation coefficient (0.88), construct validity was determined by comparing the I-QOL scores and King's Health scores, and discriminant validity was calculated by comparing the total I-QOL scores with measures of gravity. CONCLUSIONS: We conclude that the Portuguese version of the I-QOL is a very good tool for the evaluation quality-of-life in women with urinary incontinence in Portuguese-speaking countries.

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OBJECTIVE: This study was undertaken to compare the use of bipolar vessel sealing system (BVSS) with conventional suture ligature in vaginal hysterectomy (VH) on a non-prolapsed uterus. STUDY DESIGN: Women referred for VH for uterine myoma were randomized to BVSS (n=45) or conventional suture ligature VH (n=45). Exclusion criteria were uterine prolapse and indication associated surgical procedures. Main outcome measures were operative time, blood loss, hospital stay, pain status, peri and post-operative complications. Data of patients were collected prospectively. Statistical analysis was performed using chi-square and Student's t-test as appropriate. RESULTS: There were no differences in patients' mean age, parity and uterine size between groups. Patients in the BVSS group had a significantly reduced operating time (29.2+/-2.1 min vs. 75.2+/-5 min; p<0.001), operative blood loss (84+/-5.9 mL vs. 136.4+/-89.1 mL; p=0.001), requirement of surgical sutures (1.2+/-0.6 units vs. 7.4+/-0.3 units; p<0.001), pain status (1.6+/-0.4 vs. 3.6+/-0.4; p<0.001) and hospital stay (25.6+/-0.9h vs. 33.2+/-1.7h; p<0.001) compared to the control group. The overall complication rate in the study was 7.8% (7/90), and did not differ between patients of the BVSS and control group. CONCLUSION: Bipolar vessel sealing for vaginal hysterectomy appears to be an effective and safe haemostatic control method, with reduced operating time, peri-operative blood losses, post-operative pain and hospital stay.

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PURPOSE: to evaluate risk factors for the development of genital prolapse in the Brazilian population. METHODS: case-control study involving 316 patients submitted to prolapse staging, according to the pelvic organ prolapse quantification system. The patients were divided into two groups: in the Case Group there were 107 patients with prolapse at stage III or IV, and in the Control Group, 209 women at stage 0 or I. In the anamnesis, the selected women have been questioned about the presence of possible risk factors for genital prolapse, such as: age, menopause age, parturition, delivery type (vaginal, caesarean section or forceps), occurrence of fetal macrosomia, family history of genital dystopia in first degree relatives, chronic cough and intestinal constipation. RESULTS: The variables that were different between the groups were: age, body mass index, parturition, number of vaginal, caesarean section or forceps deliveries, newborn weight and positive family history for prolapse. Race, menopause age, chronic cough and intestinal constipation did not present differences between the groups. After logistic regression, only three variables have been shown to be independent risk factors: presence of at least one vaginal delivery, fetal macrosomia and positive family history for dystopia. Cesarean section was shown to be a protective factor. CONCLUSION: in the Brazilian population, the independent risk factor for genital prolapse were: personal antecedent of at least one vaginal delivery, fetal macrosomia and family history of dystopia.

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OBJETIVO: avaliar os fatores de risco para o desenvolvimento de prolapso genital na população brasileira. MÉTODOS: estudo caso-controle envolvendo 316 pacientes que foram submetidas a estadiamento de prolapso, utilizando-se o sistema de quantificação de prolapso dos órgãos pélvicos. As pacientes foram divididas em dois grupos. No Grupo Caso, foram incluídas 107 pacientes com prolapso nos estádios III ou IV, e no Controle, 209 mulheres com estádios 0 ou I. As mulheres selecionadas respondiam à anamnese na qual eram questionadas sobre a presença de possíveis fatores de risco para prolapso genital, tais como: idade, idade da menopausa, paridade, tipos de parto (vaginal, cesariana ou fórcipe), ocorrência de macrossomia fetal, história familiar em parentes de primeiro grau de distopia genital, tosse crônica e constipação intestinal. RESULTADOS: as variáveis que se mostraram diferentes entre os grupos foram: idade, índice de massa corpórea, paridade, número de partos vaginais, de cesarianas, de partos fórcipe, peso do recém-nascido e história familiar positiva para prolapso. Raça, idade da menopausa, tosse crônica e constipação intestinal não se mostraram diferentes entre os grupos. Após a regressão logística, somente três variáveis se apresentaram como fatores de risco independentes: presença de pelo menos um parto vaginal, macrossomia fetal e história familiar positiva. A cesariana se mostrou como fator protetor. CONCLUSÕES: na população brasileira, os fatores de risco independentes para prolapso foram a presença de pelo menos um parto normal, macrossomia fetal e história familiar positiva para distopia.

PURPOSE: to evaluate risk factors for the development of genital prolapse in the Brazilian population. METHODS: case-control study involving 316 patients submitted to prolapse staging, according to the pelvic organ prolapse quantification system. The patients were divided into two groups: in the Case Group there were 107 patients with prolapse at stage III or IV, and in the Control Group, 209 women at stage 0 or I. In the anamnesis, the selected women have been questioned about the presence of possible risk factors for genital prolapse, such as: age, menopause age, parturition, delivery type (vaginal, caesarean section or forceps), occurrence of fetal macrosomia, family history of genital dystopia in first degree relatives, chronic cough and intestinal constipation. RESULTS: The variables that were different between the groups were: age, body mass index, parturition, number of vaginal, caesarean section or forceps deliveries, newborn weight and positive family history for prolapse. Race, menopause age, chronic cough and intestinal constipation did not present differences between the groups. After logistic regression, only three variables have been shown to be independent risk factors: presence of at least one vaginal delivery, fetal macrosomia and positive family history for dystopia. Cesarean section was shown to be a protective factor. CONCLUSION: in the Brazilian population, the independent risk factor for genital prolapse were: personal antecedent of at least one vaginal delivery, fetal macrosomia and family history of dystopia.

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Nos últimos anos, a toxina botulínica (BTX) vem surgindo como uma opção para tratamento de algumas disfunções do trato urinário, como, por exemplo, a síndrome da bexiga hiperativa. Ela foi descrita pela primeira vez por Emile Pierre Marie van Ermengem em 1897 e desde então, vem se tornando uma importante arma terapêutica. Dos sete tipos distintos de BTX, somente os tipos A e B estão disponíveis para uso clínico. Seu mecanismo de ação consiste em causar paralisia flácida ao ser injetada no músculo, inibindo a ação da acetilcolina nas junções colinérgicas pré-sinápticas. Seu efeito é transitório e dose-dependente. A bexiga hiperativa é doença comum, que atinge cerca de 17% da população européia e norteamericana. Geralmente, ela é tratada de forma conservadora, principalmente com drogas antimuscarínicas, que são as drogas de escolha. Realizamos revisão da literatura, por meio do PubMed com o objetivo de verificar as indicações desta medicação, sua posologia, técnica de aplicação, efeitos colaterais, complicações e eficácia nas pacientes portadores de bexiga hiperativa neurogênica e idiopática. Foi concluído que a BTX parece ser uma opção de tratamento segura e eficaz para estas pacientes, porém mais estudos precisam ser realizados, principalmente para os portadores de bexiga hiperativa idiopática refratária aos tratamentos convencionais.

In the past few years, botulinum toxin (BTX) is being recognized as an option for the treatment of the urinary tract dysfunctions like overactive bladder syndrome. It was first isolated by Emile Pierre Marie van Ermengem in 1897 and, since then it is becoming an important treatment option. Of the seven distinct types of the toxin, only types A and B are available for clinical use. When injected into the muscle, the toxin acts by inhibiting acetylcholine release at the presynaptic cholinergic neuromuscular junction. Its effect is transient and dose-related. The overactive bladder is a commun disease that affects about 17% of the population in Europe and in the United States. Usually, the treatment is conservative and the mainstay is anticholinergic drugs. It was reviewed the literature using PubMed with the objective of verifying the indications, posology, technique of administration, side effects, complications and efficacy in patients with neurogenic and idiopathic overativity bladder. It was concluded that BTX seems to be a treatment option, which is safe and effective for these patients, but more studies are needed especially on the idiopathic overactive bladder.

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The objective of this study was to verify the possible association between the Sp1-binding site polymorphism and genital prolapse. A case-control study was conducted in 107 patients with stages III and IV genital prolapse. The control group included 209 women with stages 0 and I. The polymorphism of type I collagen Sp1-binding site was identified by amplification of the first intron of the COL1A1 gene. We did not find differences in the prevalence of the GT and TT genotypes between the groups (p = 0.34), even when we grouped patients with at least one polymorphic allele (GT and TT) and compared them with patients without the polymorphic allele (GG; p = 0.17) The presence of at least one vaginal delivery, family history for prolapse, and macrosomatic fetus were independent risk factors for prolapse. In conclusion, the COL1A1 Sp1-binding site was not significantly associated with genital prolapse among our study subjects.

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