RESUMO
INTRODUCTION AND HYPOTHESIS: The objectives were to evaluate clinical and anatomical parameters assessed by three-dimensional pelvic floor ultrasound (3D ultrasound) in parous and nulliparous women of childbearing age and to assess underreported symptoms of sexual dysfunction (SD), urinary incontinence (UI) and flatus incontinence (FI). METHODS: Women without complaints of pelvic floor dysfunction, aged 20-50 years, were eligible for this prospective cross-sectional study. They completed the King's Health Questionnaire, Female Sexual Function Index and St Mark's Incontinence Score adapted for this study. Next, a physical examination and 3D ultrasound were performed. The scores obtained in the questionnaires were compared with the 3D ultrasound data. RESULTS: In total, 326 women were invited to participate. Of these, 203 women met the inclusion criteria, and their cases were classified as nulliparity (NU, 59), vaginal delivery (VD, 80), forceps delivery (FD, 18) and caesarean section (CS, 48). These groups were homogeneous regarding age (p=0.096), parity (p=0.051) and body mass index (p=0.06). The hiatal dimension (HD; p=0.003) and transverse diameter (TD) (p=0.001) were significantly different among the groups. Compared with the NU and CS groups, the VD and FD groups had an increased HD and TD. The frequencies of underreported symptoms identified by questionnaires were as follows: SD (46.3%), UI (35%) and FI (28%). After VD and FD, women were more likely to present UI (p<0.001), FI (p<0.001) and SD (p=0.002) than the women with NU and those who had undergone a CS. UI was related to a greater HD (p=0.002) and anteroposterior diameter (p=0.022), FI was associated with a thinner left pubovisceral muscle (p=0.013), and SD was related to a greater HD (p=0.026). CONCLUSIONS: Three-dimensional ultrasound can identify mild morphological changes in young women with apparently normal physical examinations, mainly after VD and FD. In such individuals, these findings are associated with higher incidences of underreported sexual, urinary and anal symptoms.
Assuntos
Incontinência Fecal , Disfunções Sexuais Fisiológicas , Incontinência Urinária , Feminino , Gravidez , Humanos , Paridade , Cesárea/efeitos adversos , Diafragma da Pelve/diagnóstico por imagem , Estudos Transversais , Estudos Prospectivos , Incontinência Fecal/etiologia , Incontinência Urinária/diagnóstico por imagem , Incontinência Urinária/etiologia , Incontinência Urinária/epidemiologia , Parto Obstétrico/métodosRESUMO
The decline in sex hormone levels that accompanies the menopause has substantial effects on the tissues of the urogenital system, leading to atrophic changes. These changes can have negative effects on sexual and urinary function. The authors evaluate the repercussion of hypoestrogenism and sexual steroids on some elements of the pelvic floor and lower urinary tract. They summarize their research work and review significant published papers. They emphasize the changes in urinary mucosae, periurethral vessels, muscular layer, connective tissue, gene expression, autonomic nervous system receptors, as well as the main clinical aspects involved.
Assuntos
Estrogênios/deficiência , Sistema Urinário/metabolismo , Urotélio/fisiologia , Envelhecimento/fisiologia , Animais , Atrofia , Colágeno/análise , Colágeno/efeitos dos fármacos , Ciclo-Oxigenase 1/genética , Terapia de Reposição de Estrogênios , Estrogênios/fisiologia , Estrogênios/uso terapêutico , Matriz Extracelular/metabolismo , Feminino , Expressão Gênica , Glicosaminoglicanos/metabolismo , Humanos , Ácido Hialurônico/metabolismo , Microcirculação/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Neovascularização Fisiológica/efeitos dos fármacos , Diafragma da Pelve/irrigação sanguínea , RNA Mensageiro/metabolismo , Receptores Muscarínicos/efeitos dos fármacos , Receptores Muscarínicos/fisiologia , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Incontinência Urinária/tratamento farmacológico , Incontinência Urinária/fisiopatologia , Sistema Urinário/irrigação sanguínea , Urotélio/efeitos dos fármacos , Prolapso Uterino/fisiopatologia , Vagina/metabolismo , Vagina/patologia , Fator A de Crescimento do Endotélio Vascular/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/genética , Fator A de Crescimento do Endotélio Vascular/metabolismo , Microglobulina beta-2/genéticaRESUMO
PURPOSE: To study the relationship between topoisomerase IIalpha, active caspase-3 expressions and HPV DNA in uterine cervices with low-grade squamous intraepithelial lesions (LSIL). METHODS: Forty women with LSIL and 32 without cervical neoplasia diagnosed through cytologic and histopathologic examination were evaluated regarding topoisomerase IIalpha and active caspase-3 expressions and HPV DNA detection using PCR (GP5/GP6) in cervicovaginal smears. RESULTS: The mean percentage of cells immunomarked by topoisomerase in the group with LSIL was 11.62% while in the control it was 4.13% (p < 0.0001). In the presence of HPV DNA, topoisomerase expression was higher in the group with productive viral infection than in nonneoplastic tissue (p = 0.004). Caspase-3 expression was observed in 17 patients with LSIL (42.5%) and in five without cervical neoplasia (15.63%). CONCLUSION: The use of topoisomerase IIalpha and active caspase-3 in cervical biopsies may help to define the prognosis of HPV cervical infection.
Assuntos
Antígenos de Neoplasias/análise , Biomarcadores Tumorais/análise , Carcinoma de Células Escamosas/diagnóstico , Caspase 3/análise , DNA Topoisomerases Tipo II/análise , Proteínas de Ligação a DNA/análise , Neoplasias do Colo do Útero/diagnóstico , DNA Viral/análise , Progressão da Doença , Feminino , Humanos , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , PrognósticoRESUMO
UNLABELLED: Lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial trophism, resulting in negative effects on continence in postmenopausal women. Therefore, the use of estrogens in these patients may revert these alterations and lead to an expressive improvement of the urinary symptoms. OBJECTIVE: Study the effect of topical estrogen therapy (conjugated equine estrogens, estriol or promestriene) in periurethral vessels detected by Dopplervelocimetric analysis using, as parameters: the number of vessels, resistance and pulsatility indexes, as well as the minimum diastolic value. METHODS: Forty-one postmenopausal women with stress urinary incontinence were randomized into three groups according to different types of topical estrogen received during 3 months. Group 1 received conjugated equine estrogens, group 2 received estriol and group 3 received promestriene. Periurethral Dopplervelocimetry analysis was done before estrogen administration and during treatment in all groups. RESULTS: We observed an increase in the number of the periurethral vessels in group 1 and group 2, being higher in group 1 than in group 2. The pulsatility index remained unchanged in all three groups. The resistance index at the periurethral vessels reduced only at the conjugated estrogen group (group 1). In this same group we noticed an increase in the mean minimal diastolic value, meaning a better periurethral vascularization. CONCLUSION: Topical conjugated equine estrogens and estriol were effective in increasing the number of periurethral vessels in postmenopausal women with urinary stress incontinence, with the conjugated equine estrogens being the most effective intervention studied.
Assuntos
Estradiol/análogos & derivados , Estriol/administração & dosagem , Estrogênios Conjugados (USP)/administração & dosagem , Uretra/irrigação sanguínea , Incontinência Urinária por Estresse/tratamento farmacológico , Administração Intravaginal , Idoso , Estradiol/administração & dosagem , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Fluxometria por Laser-Doppler/métodos , Pessoa de Meia-Idade , Pós-Menopausa , Estatísticas não Paramétricas , Ultrassonografia , Uretra/diagnóstico por imagem , Uretra/efeitos dos fármacos , Incontinência Urinária por Estresse/diagnóstico por imagemRESUMO
This study aims to evaluate the urethral nerve fibers of adult female rats during pregnancy and after vaginal birth, cesarean section or simulated birth trauma. For immunohistochemical analysis of nerve fibers, 70 female rats were distributed in seven groups of ten female rats: group 1, control; group 2, pregnant; group 3, cesarean section; group 4, vaginal birth; group 5, virgin female rats with simulated birth trauma; group 6, cesarean section followed by simulation of birth trauma; and group 7, vaginal birth followed by simulation of birth trauma. The number of nerve fibers in groups 1, 2, and 3 were significantly higher than the other groups. Pregnancy and cesarean section did not cause alterations in the nerve fibers number. Vaginal birth and simulated birth trauma significantly decreased the number of nerve fibers in the female rats' middle urethra.
Assuntos
Fibras Nervosas/fisiologia , Parto , Uretra/inervação , Animais , Feminino , Gravidez , Ratos , Uretra/citologiaRESUMO
UNLABELLED: The lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial trophism, resulting in negative effects on continence in postmenopausal women. OBJECTIVE: Study the effect of hormone therapy (estrogen and progesterone) in periurethral vessels detected by Doppler velocimetric analysis using, as parameters, the number of vessels, resistance and pulsatility indexes, as well as the minimum diastolic value. METHODS: Thirty-eight postmenopausal women with stress urinary incontinence were randomized into two groups. The first consisted of women receiving 3 months of estrogen therapy previous to 3 months of continuous estrogen and progesterone combined therapy. The second comprised of women receiving 3 months of continuous estrogen and progesterone therapy. Periurethral Doppler velocimetric analysis was done before hormone administration and during treatment in both groups. RESULTS: We observed a statistically significant increased number of periurethral vessels during treatment in both groups. There was an increase in value of the mean minimum diastolic value during estrogen and progesterone therapy in Group 2. The resistance indexes diminished in both groups. However, they were not statistically significant. CONCLUSION: Hormonal therapy of short duration (3-6 months) had a positive effect on the urethral continence mechanism increasing the number of periurethral vessels either with estrogen alone or combined therapy (estrogen and progesterone).
Assuntos
Vasos Sanguíneos/fisiopatologia , Terapia de Reposição Hormonal , Pós-Menopausa/fisiologia , Uretra/irrigação sanguínea , Incontinência Urinária por Estresse/fisiopatologia , Adulto , Idoso , Quimioterapia Combinada , Estrogênios/uso terapêutico , Feminino , Humanos , Fluxometria por Laser-Doppler , Pessoa de Meia-Idade , Progesterona/uso terapêutico , Ultrassonografia , Uretra/diagnóstico por imagem , Uretra/fisiopatologia , Incontinência Urinária por Estresse/tratamento farmacológico , Resistência Vascular/fisiologiaRESUMO
The aim of this study was to evaluate the modifications in the amount of collagen, muscular, and elastic fibers in the mid-urethra of adult female rats during the pregnancy and after the natural childbirth, cesarean, and after simulated trauma of childbirth. The authors evaluated the histomorphometric aspects (collagen, muscular, and elastic fibers) in the mid-urethra of 70 animals distributed in seven groups: group 1 (n = 10)--control, group 2 (n = 10)--pregnant female rats, group 3 (n = 10)--female rats submitted to cesarean, group 4 (n = 10)--female rats with natural childbirth, group 5 (n = 10)--virgin female rats with simulated trauma of childbirth, group 6 (n = 10)--female rats submitted to cesarean followed by simulation of childbirth trauma, and group 7 (n = 10)--female rats with natural childbirth followed by simulation of childbirth trauma. The average concentration of collagen and elastic fibers and the collagen/muscular fiber correlation in groups 1, 2, and 3 were similar and significantly inferior to groups 4, 5, 6, and 7. The average of muscular fibers was similar in groups 1, 2, and 3 and significantly superior to groups 4, 5, 6, and 7. Pregnancy and cesarean did not induce alterations in collagen, muscular, and elastic fibers. However, the vaginal delivery and simulation of childbirth trauma determined the decrease in muscular fibers and the increase in collagen and elastic fibers and the correlation collagen/muscular fiber.
Assuntos
Cesárea/efeitos adversos , Parto Normal/efeitos adversos , Uretra/lesões , Animais , Colágeno/metabolismo , Modelos Animais de Doenças , Tecido Elástico/anatomia & histologia , Tecido Elástico/patologia , Feminino , Músculos/anatomia & histologia , Músculos/patologia , Período Pós-Parto/fisiologia , Gravidez , Complicações na Gravidez/patologia , Ratos , Uretra/patologiaRESUMO
INTRODUCTION: The objective of this study was to evaluate the effect of tibolone on cytochrome oxidase I (COX I), beta-2-microglobulin (B2M) and vascular endothelial growth factor (VEGF) gene expression in the lower urinary tract of castrated rats. These genes are related to cell energy, cellular immunity and vascularization processes. METHODS: Fifty adult castrated rats remained at rest for 28 days. Thereafter they were randomly divided into two groups of 25 animals each. The lower urinary tract (bladder and urethra) was extracted in animals of one group and the other group received tibolone at a dose of 0.25 microg/animal/day for another 28 days followed by removal of the lower urinary tract. Total RNA was extracted from animals of both groups, forming two pools. After RT-PCR (reverse transcriptase polymerase chain reaction), expression of COX I, B2M and VEGF genes was evaluated by agarose gel electrophoresis, visualized by UV illumination. RESULTS: Expression of the three genes (COX I, B2M and VEGF) was greater in the group treated with tibolone. CONCLUSION: The use of tibolone increases the expression of COX, B2M and VEGF genes in the lower urinary tract as compared with that in castrated rats.
Assuntos
Complexo IV da Cadeia de Transporte de Elétrons/efeitos dos fármacos , Moduladores de Receptor Estrogênico/farmacologia , Norpregnenos/farmacologia , Sistema Urinário/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/efeitos dos fármacos , Microglobulina beta-2/efeitos dos fármacos , Animais , Castração , Expressão Gênica/efeitos dos fármacos , Ratos , Ratos WistarRESUMO
In this study, 91 primiparous women were selected, with a period of post-delivery variable from 45 to 60 days. These patients were divided according to the type of delivery into three groups: I--consisting of 32 patients who had vaginal delivery; II--comprised 29 patients who were subjected to forceps; III--formed by 30 women who were subjected to cesarean section. Patients with a previous pregnancy were not included, so that the possible previous alterations of the pelvic floor did not interfere with the present evaluation. Patients with a pre-term pregnancy, fetus below 2,500 g or above 4,000 g, anomalous presentations, twin pregnancy, diabetes mellitus, systhemic arterial hypertension, hypertensive disease specific of pregnancy, endocrinopathies and neuropathies were also excluded. After 45 to 60 days from delivery the patients were subjected to anamnesis, gynecological examination, functional evaluation of the pelvic floor (FEAF), Q-Tip test and ultrasound of the bladder neck. As for the functional evaluation of the pelvic floor, it was observed that the patients with cesarean section presented better indexes compared to those who were subjected to forceps. The Q-Tip test showed that in both the patients from group I and group II bladder neck mobility was greater than in those from group III. Concerning bladder neck topography in relation to public symphysis and its mobility, which were evaluated by ultrasound, it was observed that at rest all the groups had the neck in a supra-pubic position, with no differences among them. Yet, during the required strain, the bladder neck stayed in the infra-pubic position with major frequency in group I. Bladder neck mobility was greater in the vaginal delivery group in relation to the other groups. It was also noticed that the group undergoing cesarean section showed less mobility. The obtained results lead us to conclude that despite the fact that vaginal delivery may cause displacement of the urethro-vesical junction during strain, and consequently greater bladder neck mobility, it is the attending physician's role to minimize the damage to the pelvic floor, thus avoiding the emergence of a predisposing factor to future stress urinary incontinence.
Assuntos
Parto Obstétrico , Diafragma da Pelve/fisiologia , Bexiga Urinária/fisiologia , Incontinência Urinária por Estresse/fisiopatologia , Cesárea , Extração Obstétrica , Feminino , Humanos , Forceps Obstétrico , Paridade , Período Pós-PartoRESUMO
OBJECTIVE: Our study aimed at determining the effects of pelvic floor electrical stimulation assessed by the number of leakages per day recorded in a voiding diary over 90 days of treatment and urodynamic parameters. STUDY DESIGN: This prospective study was carried out with 34 patients presenting stress urinary incontinence who were treated and evaluated by voiding diaries and urodynamic tests. The primary outcome measure was the number of leakages during the 90 days of treatment. Urodynamic tests were performed before and after treatment. RESULTS: In our series, average and maximum flow rates and residual urine volume were within normal range in all subjects before and after treatment. Maximum urethral closure pressure and functional profile length on urethral pressure profiles did not change after treatment. In the cystometry, bladder capacities at the first (p < 0.0082) and maximum sensations (p < 0.01) improved significantly after treatment. During the 90 days of treatment, we observed a gradual drop in the number of leakages. This decrease began around day 22. It dropped in half around day 45, tending to zero close to day 90 of treatment (p < 0.01). CONCLUSIONS: The number of incontinent leakage dropped to half around the 8th week, and on average, there was a tendency of the patients to be cured after the 12th week of treatment. At urodynamic studies we observed a significant increase in bladder capacity at the first desire to void and in the maximum cystometric capacity.