Recursos fisioterapêuticos nas disfunções miccionais em injúrias espinhais congênitas / Physiotherapeutic resources in voiding dysfunctions in congenital spinal injuries

Malformações congênitas são alterações morfológicas com origem no desenvolvimento embrionário e podem ser devido a causas genéticas, ambientais ou ambas. Em indivíduos que sofrem de injúrias espinhais congênitas, a bexiga neurogênica (BN) é um dos acometimentos com maior impacto na vida diária e o principal objetivo urológico é melhorar o manejo urinário e a continência social, para diminuir altas pressões vesicais e prevenir danos renais. Esta condição reflete diversas repercussões, como a diminuição na qualidade de vida, progressão para procedimentos invasivos, lesão renal e ao óbito. Objetivo: Revisar sistematicamente os estudos publicados nos últimos 10 anos a respeito da atuação da fisioterapia na incontinência urinária (IU) nas injúrias espinhais congênitas. Métodos: Revisão sistemática de literatura realizada através de busca, entre os anos de 2009 a 2019, nas bases de dados eletrônicas PubMed, Bireme e PEDro. Resultados: Não houve grande conformidade em relação às técnicas utilizadas, mas sim em relação aos desfechos analisados, sendo verificado estudos sobre IU na espinha bífida. Conclusão: A fisioterapia mostrou-se benéfica para os casos de IU nas injúrias espinhais congênitas, melhorando os parâmetros urodinâmicos e o desfecho no diário miccional. (AU)

Congenital malformations are morphological changes originating from embryonic development and can be due to genetic, environmental or both. In individuals suffering from congenital spinal injuries, the neurogenic bladder (BN) is one of the disorders with the greatest impact on daily life and the main urological objective is to improve urinary management and social continence, to decrease high bladder pressures and prevent kidney damage. This condition reflects several repercussions, such as a decrease in quality of life, progression to invasive procedures, kidney injury and death. Objective: To systematically review the studies published in the last 10 years regarding the role of physical therapy in urinary incontinence (UI) in congenital spinal injuries. Methods: Systematic literature, between the years 2009 to 2019, in the electronic databases Pubmed, Bireme and PEDro. Results: There was no great conformity in relation to the techniques used, but in relation to the analyzed outcomes, with studies on UI in spina bifida being verified. Conclusion: Physical therapy proved to be beneficial for cases of UI in congenital spinal injuries, improving urodynamic parameters and the outcome in the voiding diary. (AU)

Prevalência de incontinência urinária e perfil miccional de mulheres praticantes de Crossfit® / Prevalence of urinary incontinence and voiding pattern of Crossfit® practicing women

Introdução: A Incontinência Urinária (IU) afeta 200 milhões de pessoas de todas as idades, sendo a maioria mulheres. Segundo a International Continence Society (ICS) a IU é definida como qualquer perda involuntária de urina e consiste em uma patologia que leva a diversos efeitos sobre as atividades diárias, a interação social e percepção da própria saúde. Objetivo: Avaliar a prevalência de perda de urina involuntária e padrão miccional em mulheres praticantes de Crossfit® em de Patos de Minas/MG. Métodos: Estudo transversal, exploratório, com abordagem quantitativa em 3 academias de Patos de Minas, cuja amostra foi de 38 mulheres. O perfil da amostra foi traçado por questionário contendo informações sociodemográficas e antecedentes obstétricos elaborados pelas pesquisadoras. Aplicou-se questionário específico para investigar a presença de IU e situações relacionadas ao padrão miccional e outro para uma avaliação da incontinência atlética que identificou o perfil de treinamento da atleta e as atividades específicas do Crossfit®. Resultados: Observou-se que 78,9% eram nulíparas, 13,2% tiveram parto do tipo vaginal e 7,9% partos cesárea. Apenas 7,9% da amostra apresentou incontinência atlética. Conclusão: Apesar da queixa, houve baixa prevalência de Incontinência Atlética na amostra. (AU)

Introduction: Urinary Incontinence (UI) affects 200 million people of all ages, mostly women. According to the International Continence Society (ICS), UI is defined as any involuntary loss of urine and consists of pathology that leads to various effects on daily activities, social interaction and perception of one's own health. Objective: To evaluate the prevalence of involuntary urine loss and voiding pattern in women practicing Crossfit® in Patos de Minas/MG. Methods: Crosssectional, exploratory study with a quantitative approach in 2 Patos de Minas gyms, whose sample consisted of 38 women. The sample profile was traced by a questionnaire containing socio-demographic information and obstetric antecedents prepared by the researchers. A specific questionnaire was applied to investigate the presence of UI and situations related to voiding and other patterns and an assessment of athletic incontinence that identified the athlete's training profile and specific Crossfit® activities. Results: It was observed that 78.9% were nulliparous, 13.2% had vaginal delivery and 7.9% cesarean. Only 7.9% of the sample had athletic incontinence. Conclusion: Despite the complaint, there was a low prevalence of athletic incontinence in the sample. (AU)

Prevalência de incontinências anal e dupla em idosas e impacto na qualidade de vida / Prevalence of anal and double incontinence in elderly women and impact on their quality of life

Introdução: A prevalência das incontinências anal e urinária que são mais comuns em mulheres, aumenta com a idade. Tais disfunções podem ser encontradas isoladamente ou em associação (incontinência dupla) e podem provocar grande impacto na qualidade de vida. Objetivos: Avaliar a prevalência das incontinências anal e dupla e o impacto dessas condições sobre a qualidade de vida de mulheres idosas da comunidade. Casuística e Métodos: Estudo observacional descritivo, realizado em mulheres com mais de 60 anos que buscaram a unidade básica de saúde para vacinação. Para a triagem de incontinência urinária e anal, foram utilizadas versões brasileiras dos questionários International Consultation on Incontinence Questionnaire - Short Form e do Índice de Incontinência Anal. Mulheres que apresentaram escores diferentes de zero em ambos questionários receberam diagnóstico de incontinência dupla. A avaliação do impacto da incontinência anal na qualidade de vida foi feita por meio do questionário Fecal Incontinence Quality of Life Questionnaire. As variáveis foram estudadas de maneira descritiva, por meio do cálculo de frequências absolutas e relativas e, no caso da variável idade e dos escores de qualidade de vida, por meio do cálculo da média e desvio-padrão. Resultados: Participaram da pesquisa 66 mulheres, com média de idade de 69,6±7,2 anos. A prevalência de incontinência anal foi de 28,8% (n=19), e a prevalência de incontinência dupla foi de 18,1% (n=12). Pacientes com incontinência anal isolada e dupla apresentaram impacto negativo na qualidade de vida, conforme indicado pelos escores dos domínios avaliados. Conclusão: A prevalência de incontinência anal foi mais elevada do que a prevalência de incontinência fecal isolada ou de incontinência anal encontrada em outras populações. O mesmo foi observado em relação à prevalência de incontinência dupla. Houve impacto negativo de ambas as condições em todos os domínios de qualidade de vida avaliados.

Introduction: The prevalence of anal and urinary incontinence is more frequent in women, and it increases with age. Such dysfunctions may be found alone or in combination (double incontinence), and they may have a major impact on quality of life. Objectives: Evaluate the prevalence of anal and double incontinence, as well as the impact these conditions cause on the quality of life of elderly women residents in a community. Patients and Methods: We carried out an observational descriptive study involving women aged 60 and over who sought the Primary Health Care Unit for vaccination. For the urinary and anal incontinence screening, Brazilian versions of the International Consultation on Incontinence Questionnaire - Short Form and the Anal Incontinence Index were used.Women who presented scores different from zero in bothquestionnaires were diagnosed with double incontinence. Theevaluation on the impact of anal incontinence on quality of lifewas done through the Brazilian version of Fecal IncontinenceQuality of Life Questionnaire. We used descriptive statistics tocalculate relative and absolute frequencies. Age and Qualityof life domain scores were expressed using mean and standarddeviation. Results: Sixty-six women were included in thestudy. Mean age was 69.6±7.2 years. The prevalence of AnalIncontinence was 28.8% (n=19) and the prevalence of doubleincontinence was 18.1% (n=12). Patients with isolated anddouble anal incontinence had a negative impact on qualityof life, as indicated by the scores of the domains evaluated.Conclusions: The prevalence of anal incontinence was higherthan the prevalence of isolated fecal incontinence or analincontinence found in studies carried out in other populations.The same results were observed for the prevalence of doubleincontinence. We identified negative impact of both conditionson all domains of quality of life

The Miniarc® sling system in the treatment of female stress urinary incontinence

AIMS: To assess the technical feasibility of a new mini-invasive sling procedure (MiniArc®) and present short-term results in the treatment of female urinary incontinence. MATERIAL AND METHODS: A total of 97 women with mixed or stress urinary incontinence (SUI) were treated by placement of the new single-incision sling. Pelvic organ prolapse was graded using the POP-Q system (pelvic organ prolapse quantification system). Preoperative workup included urodynamic evaluation, cough stress test and introital ultrasound. Postoperatively, introital ultrasound was performed to determine residual urine and check tape position. Quality of life was measured using King's Health Questionnaire. A voiding diary and pad count served to verify the patients' subjective complaints. RESULTS: The MiniArc® single-incision sling procedure was the initial intervention in 37 (38.2 percent) patients and the second intervention in 60 (61.7 percent) patients with recurrent incontinence. The cough stress test was negative in 79 (83.1 percent) women 6 weeks after the sling procedure and in 74 (77.8 percent) at 12 months. De novo urge occurred in 32 (36.8 percent) women. Quality of life was significantly improved at 12-month follow-up in 65 (69.1 percent) patients (p < 0.001). The number of pads decreased significantly from 2.2 to 0.6 (p < 0.001) after the procedure. One patient developed an hematoma and bladder perforation occurred in another. CONCLUSIONS: Our short-term clinical results suggest that the MiniArc® is a safe and effective minimally invasive sling procedure for treating female SUI. Randomized comparative controlled trials and long-term results are still required to define the role of the new sling system in comparison to established mid-urethral tape techniques for treating incontinence.

Voiding Pattern and Incontinence after Orthotopic Ileal Neobladder in Male Patients / 대한비뇨기과학회지

PURPOSE: To report the voiding pattern and continence stati in male patients having undergone a radical cystectomy and orthotopic bladder substitution. MATERIALS AND MATHODS: Between March 2000 and June 2005, 20 men with advanced bladder cancer had a radical cystoprostatectomy and urinary diversion via an ileal orthotopic bladder substitution. The voiding pattern and continence stati were assessed using patient interviews, frequency- volume charts and pad tests at 1, 3, 6, 9 and 12 months after catheter removal. RESULTS: The mean age and follow-up were 60.5 years (41-72) and 34.1 months (12-69), respectively. Neobladder substitution was performed with an ileum in all patients. 17 patients had reconstruction with a Studer neobladder and 3 with a W-pouch Hautmann. All patients had transitional cell carcinoma (TCC) and their tumor stages ranged from T1G3 to T4aN1M0. The frequency of voiding ranged from 4 to 12 times during the day, and 0 to 5 times during the night, with a mean maximum neobladder capacity of 336ml (200-620) and maximum flow rate of 24.6ml/sec (12-46) 12 months after removal of the catheter. No patient required intermittent self-catheterization. All-time continence rates were 15, 30, 65 and 85%, and all-time incontinence rates were 55, 25, 10 and 5% at 1, 3, 6 and 9 months after catheter removal, respectively. CONCLUSIONS: Orthotopic bladder substitution has an excellent functional outcome over time, resulting in high daytime and nighttime continence rates within 9 months of catheter removal.