Perfil clínico de mulheres com incontinência urinária de esforço em centro de referência / Clinical profile of women with stress urinary incontinence in a reference center

INTRODUÇÃO: A incontinência urinária é definida como qualquer perda involuntária de urina. É um sério problema de saúde pública e as mulheres são as mais afetadas e apresentam como fatores de risco o envelhecimento, mais de duas gestações, parto vaginal com episiotomia, entre outros. Embora a IU não seja uma condição de vida ameaçadora, pode levar a situações com repercussões a nível social e pessoal, com influência na qualidade de vida. OBJETIVO: Descrever a frequência da IUE em um centro especializado na cidade de Salvador, assim como apontar as características clínicas, fatores de risco e comorbidades associadas à IUE feminina. MATERIAIS E MÉTODOS: Estudo transversal descritivo, a partir da análise de dados de prontuários de mulheres portadoras de incontinência urinária de esforço, incluídos dados sociodemográgicos, fatores de risco, comorbidades associadas, queixas clínicas e dados objetivos de Pad Test e Diário Miccional. RESULTADOS: Foram incluídas 28 mulheres com idade média de 48,9 anos (±7,7), de raça parda (46,2%), com ensino médio completo (40%), casadas (52%), trabalhadoras do lar (32,2%), IMC médio 26,2 (±4,9). A comorbidade associada mais predominante foi obesidade (28,6%), o fator de risco dominante foi o consumo de café (70%). A queixa clínica mais prevalente foi perda ao tossir (96,3%). Quando analisado Pad test, notado maior prevalência de perda leve (57,14%), seguido por (39,29%) de perda moderada e perda grave (3,57%). CONCLUSÃO: Mulheres de meia idade, pardas, menopausadas, obesas, hipertensas, multíparas, que realizaram parto vaginal com episiotomia, constipadas e que ingerem cafeína são mais propensas a desenvolver a incontinência urinária de esforço. Houve uma maior prevalência de incontinência urinária leve.

INTRODUCTION: Urinary incontinence is defined as any involuntary loss of urine. It is a serious public health problem, and women are the most affected and present aging as risk factors, more than two pregnancies, vaginal delivery with episiotomy, among others. Although UI is not a threatening life condition, it can lead to social and personal repercussions, influencing the quality of life. OBJECTIVE: Describe the frequency of SUI in a specialized center in the city of Salvador, as well as point out the clinical characteristics, risk factors, and comorbidities associated with female SUI. MATERIALS AND METHODS: Descriptive cross-sectional study, based on data analysis of medical records of women with stress urinary incontinence, including sociodemographic data, risk factors, associated comorbidities, clinical complaints, and objective data from Pad Test and Diary Diary. RESULTS: Twenty-eight women with an average age of 48.9 years (± 7.7), brown race (46.2%), complete high school (40%), married (52%), housewives (32.2%), mean BMI 26.2 (± 4.9). The most prevalent associated comorbidity was obesity (28.6%); the dominant risk factor was coffee consumption (70%). The most prevalent clinical complaint was cough loss (96.3%). When analyzed Pad test noted a higher prevalence of mild loss (57.14%), followed by (39.29%) moderate loss and severe loss (3.57%). CONCLUSION: Middle-aged, mulatto, menopausal, obese, hypertensive, multiparous women who had a vaginal delivery with episiotomy, constipation, and caffeine intake are more likely to develop stress urinary incontinence. There was a higher prevalence of mild urinary incontinence.

O impacto da disfunção sexual na qualidade de vida feminina: um estudo observacional / The impact of sexual dysfunction on the quality of life of women: an observational study

INTRODUÇÃO: A saúde sexual envolve diversos componentes em relação à sexualidade, como biológico, cultural, psicológico e social. Quando alguns desses fatores são atingidos, pode-se originar um quadro de disfunção sexual. OBJETIVO: investigar a qualidade de vida em mulheres com disfunção sexual. MATERIAIS E MÉTODOS: Estudo observacional comparativo, de corte transversal, realizado em mulheres de 18 a 59 anos do CAAP da EBMSP. Excluídas: mulheres com histórico de doença psiquiátrica grave, portadoras de doenças crônico-degenerativas neurológicas, com dispareunia de causas orgânicas, em tratamento fisioterapêutico e gestantes. Foi utilizado a FSFI ≥ 26 para o grupo com disfunção e < 26 para o grupo comparação. Instrumentos de avaliação aplicados: FSFI e 36-Item Short-Form Health Survey (SF-36). A comparação das medianas dos domínios do SF-36 e FSFI entre os grupos foi realizada pelo teste Mann-Whitney (teste não paramétrico), e das variáveis categóricas com a disfunção sexual foi feita a partir do teste qui-quadrado. RESULTADOS: Amostra 36 paciente,18 em cada grupo. As variáveis sociodemográficas e clínicas que apresentaram diferença estatística foram renda (0,001) e escolaridade (0,011). No FSFI, todos os domínios apresentaram significância (0,00). No SF-36, ao comparar os dois grupos, 06 domínios apresentaram significância estatística. CONCLUSÃO: Os resultados mostram que mulheres com disfunção sexual apresentam um impacto negativo em alguns dos aspectos da qualidade de vida. Importante salientar que, a escolaridade e a renda familiar não foram homogêneas entre os grupos, sendo assim, diante da característica do estudo, não é possível aferir relação causa e consequência na disfunção sexual com a qualidade vida das participantes. [AU]

INTRODUCTION: Sexual health involves several components in relation to sexuality, such as biological, cultural, psychological and social. When some of these factors are reached, a picture of sexual dysfunction may result. OBJECTIVE: To investigate quality of life in women with sexual dysfunction. MATERIALS AND METHODS: A cross-sectional, observational, observational study of 18- to 59-year-old women from the EBMSP CAAP. Excluded: women with a history of severe psychiatric illness, carriers of neurological chronic degenerative diseases, with dyspareunia of organic causes, in physiotherapeutic treatment and pregnant women. FSFI ≥ 26 was used for the group with dysfunction and <26 for the comparison group. Assessment instruments applied: FSFI and 36-Item Short-Form Health Survey (SF-36). The comparison of the medians of the SF-36 and FSFI domains between the groups was performed by the Mann-Whitney test (non-parametric test), and the categorical variables with the sexual dysfunction were done using the chi-square test. RESULTS: Sample 36 patient, 18 in each group. The sociodemographic and clinical variables that presented statistical difference were income (0.001) and schooling (0.011). In the FSFI, all domains presented significance (0.00). In the SF-36, when comparing the two groups, 06 domains presented statistical significance. CONCLUSION: The results show that women with sexual dysfunction have a negative impact on some aspects of quality of life. It is important to emphasize that schooling and family income were not homogeneous between the groups, so, due to the characteristics of the study, it is not possible to measure cause and consequence relationship in sexual dysfunction with quality of life of the participants. [AU]

New concept for treating female stress urinary incontinence with radiofrequency

ABSTRACT Purpose: To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women. Materials and Methods: This phase one study included ten women with Stress Urinary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects. Results: Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation. Conclusion: The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted.

Urodynamic outcome of parasacral transcutaneous electrical neural stimulation for overactive bladder in children

ABSTRACTObjective:To evaluate the urodynamic changes immediately after the first session (acute effect) and after the last session of parasacral TENS in children with idiopathic OAB.Materials and methods:We performed urodynamic evaluation immediately before and after the first session of parasacral TENS and immediately after the last session (7 weeks later). Only children with idiopathic isolated OAB were included. Patients with dysfunctional voiding were not included.Results:18 children (4 boys and 14 girls, mean age of 8.7) were included in the first analysis (urodynamic study before and immediately after the first session) and 12 agreed to undergo the third urodynamic study. Urodynamic before and immediately after the first session: There was no change in the urodynamic parameters, namely low MCC, low bladder compliance, presence of IDC, the average number of IDC, or in the maximum detrusor pressure after the first exam. Urodynamic after the last session: The bladder capacity improved in most patients with low capacity (58% vs. 8%). Detrusor overactivity was observed in 11 (92%) before treatment and 8 (76%) after. There was not a significant reduction in the average number of inhibited contractions after TENS (p=0.560) or in the detrusor pressure during the inhibited contraction (p=0.205).Conclusion:There was no change in the urodynamic parameters immediately after the first session of stimulation. After the last session, the only urodynamic finding that showed improvement was bladder capacity.

Lower urinary tract dysfunction in children: what do pre-school teachers know about it?

OBJECTIVE: To evaluate the basic knowledge of pre-school teachers who deal with children between the ages of 4 and 7 years, who present signs of lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS: We performed a survey with 50 teachers from 9 private schools working with pre-school children. The criteria for selection were if teachers were certified or non-certified elementary school teachers - NCEST and the amount of professional experience. RESULTS: Thirty-three teachers considered that the normal daily urinary frequency should be from 4 to 7 times. Two of the 50 teachers considered it normal to urinate less than 4 times per day and 15 teachers considered more than 7 times per day as normal. There was no difference between the 2 categories of certified or NCEST nor between those with more or less than five years of professional experience. Thirty-three percent believed that to urinate more than 4 times during a class period (4-5 hours) could indicate a urinary problem. There was a statistically significant difference among the certified and NCEST but not in terms of time of professional experience. If during this period the child would not ask to urinate, only 18 percent considered that as an indication of urinary problem. When asked about the symptoms that would indicate urinary urgency and urge incontinence, only 24 percent of the teachers connected it with urinary problem. There was no difference in terms of professional background or professional experience in these 2 last analyses. CONCLUSION: Our data shows evidences that private pre-schools teachers are not well informed of the clinical manifestation of LUTD.

Comparative analysis of the symptomatology of children with lower urinary tract dysfunction in relation to objective data

OBJECTIVES: To assess the clinical presentation of children with lower urinary tract dysfunction (LUTD) relating to objective examination data. MATERIALS AND METHODS: Forty-four children (36 girls and 8 boys with mean age of 6.8 years) with LUTD were prospectively assessed through a specific questionnaire that analyzed clinical presentation of those patients. These data were then compared to objective data, such as micturition diary and uroflowmetry with electromyography. RESULTS: A urinary tract infection (UTI) antecedent was observed in 31 cases (70.5 percent), and of those, 24 cases of UTI were accompanied by fever. All children presented micturition urgency. Daily urinary incontinence was observed in 33 cases (75 percent) and nocturnal enuresis in 23 (52.3 percent). As for micturition frequency, 15 (34.1 percent) had normal frequency 19 (43.2 percent) presented more than 10 daily micturition episodes and 10 (22.7 percent) thought they urinated less than 5 times a day. In the uroflowmetry and electromyography examination, 14 (31.8 percent) experienced lack of coordination during micturition. Of 10 children with infrequent micturition, 5 confirmed this in their micturition diaries and 2 listed more than 5 micturition episodes per day in the diary. Of 19 patients presenting polaciuria, only 5 confirmed this in their micturition diaries, while 7 had less than 10 micturition episodes per day. CONCLUSION: Most children with LUTD presented a previous UTI, and daily incontinence was verified in around 75 percent of the patients. Complaints of polaciuria or infrequent micturition are not noted completely in the micturition diaries and there is no parameter in the clinical history that offers good sensitivity or specificity for the diagnosis of lack of perineal coordination.