Factors associated with the prescription of vaginal pessaries for pelvic organ prolapse

OBJECTIVE: To identify the factors associated with the prescription of vaginal pessaries (VPs) as a conservative treatment for pelvic organ prolapse (POP). METHODS: A cross-sectional study was performed during two annual urogynecology and general obstetrics and gynecology meetings in 2017 (São Paulo, SP, Brazil). A 19-item deidentified questionnaire regarding experiences and practices in prescribing VPs for POP patients was distributed among gynecologists. Our primary outcome was the frequency of prescribing VPs as a conservative treatment for POP. The reasons for prescribing or not prescribing VPs were also investigated. Univariate and multivariate analyses with crude and adjusted odds ratios (ORs) were performed for variables associated with the prescription of pessaries. RESULTS: Three hundred forty completed surveys were analyzed. Half of the respondents (53.53%) were between 30-49 years old; most of them were female (73.53%), were from the Southeast Region (64.12%), were trained in obstetrics and gynecology (80.24%) or urogynecology (61.18%) and worked in private offices (63.42%). More than one-third (36.48%) attended four or more POP cases/week, and 97.65% (n=332) had heard or knew about VPs for POP; however, only 47.06% (n=160) prescribed or offered this treatment to patients. According to the multivariate analysis, physicians aged 18-35 years (OR=1.97[1.00-3.91]; p=0.04), those who participated in a previous urogynecology fellowship (OR=2.34[1.34-4.09]; p<0.01), those with relatively high volumes of POP cases (4 or +) (OR=2.23[1.21-4.47]; p=0.01) and those with PhD degrees (OR=2.75[1.01-7.54]; p=0.05) prescribed more pessaries. CONCLUSIONS: Most gynecologists did not prescribe VPs. Younger physician age, participation in a previous urogynecology fellowship, a PhD degree, and a relatively high volume of POP cases were associated with increased VP prescription rates.

Treatment of orgasmic urinary incontinence with physical therapy and weight loss / Tratamento da incontinência urinária orgásmica com fisioterapia e redução de peso

Importance of the problem: Orgasmic urinary incontinence (OUI) is an uncommon finding among other types of urinary leakage. Treatment of this condition is not established. Aims: To describe the case of a patient who presented OUI and had a multidisciplinary treatment. Methods: An obese, 50-year patient complained of OUI with two sexual partners during her consultation. Pharmacological treatment with imipramine and anticholinergics were undertaken, without success. Results: Patient had an important subjective improvement after performing a treatment combination of biofeedback, electrostimulation, pelvic floor muscle training and behavioral measurements such as weight loss, improved after bariatric surgery. Comments: OUI is a complex disorder, without standard treatments and needs to be further investigated with larger, prospective samples. Combined physical therapy approaches should be considered when discussing treatment.

Importância do problema: Incontinência urinária orgásmica (IUO) é um tipo incomum dentre os tipos de perda urinária. O tratamento para esta condição ainda não está estabelecido. Objetivo: Descreve o caso de uma paciente que apresentou IUO e foi submetida ao tratamento multidisciplinar. Metodologia: Paciente obesa, 50 anos, relatando, durante a consulta, IUO com dois parceiros sexuais. Tratamento farmacológico com imipramina e anticolinérgicos foram realizados sem sucesso. Resultados: Paciente apresentou importante melhora subjetiva após a realização de uma combinação de tratamento debiofeedback, eletroestimulação, treinamento muscular do assoalho pélvico e medidas comportamentais, como perda de peso, incrementada após a cirurgia bariátrica. Comentários: IUO é uma doença complexa, sem tratamentos padrão e precisa ser mais bem investigada com amostras prospectivas maiores. Abordagens fisioterapêuticas combinadas devem ser consideradas quando se discute o tratamento.