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Int. braz. j. urol ; 48(4): 679-685, July-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1385136


ABSTRACT Purpose To characterize the most common presentation and clinical risk factors for artificial urinary sphincter (AUS) cuff erosion to distinguish the relative frequency of symptoms that should trigger further evaluation in these patients. Materials and Methods We retrospectively reviewed our tertiary center database to identify men who presented with AUS cuff erosion between 2007 - 2020. A similar cohort of men who underwent AUS placement without erosion were randomly selected from the same database for symptom comparison. Risk factors for cuff erosion - pelvic radiation, androgen deprivation therapy (ADT), high-grade prostate cancer (Gleason score ≥ 8) - were recorded for each patient. Presenting signs and symptoms of cuff erosion were grouped into three categories: obstructive symptoms, worsening incontinence, and localized scrotal inflammation (SI). Results Of 893 men who underwent AUS placement during the study interval, 61 (6.8%) sustained cuff erosion. Most erosion patients (40/61, 66%) presented with scrotal inflammatory changes including tenderness, erythema, and swelling. Fewer men reported obstructive symptoms (26/61, 43%) and worsening incontinence (21/61, 34%). Men with SI or obstructive symptoms presented significantly earlier than those with worsening incontinence (SI 14 ± 18 vs. obstructive symptoms 15 ± 16 vs. incontinence 37 ± 48 months after AUS insertion, p<0.01). Relative to the non-erosion control group (n=61), men who suffered erosion had a higher prevalence of pelvic radiation (71 vs. 49%, p=0.02). Conclusion AUS cuff erosion most commonly presents as SI symptoms. Obstructive voiding symptoms and worsening incontinence are also common. Any of these symptoms should prompt further investigation of cuff erosion.

Int. braz. j. urol ; 48(4): 649-659, July-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1385138


ABSTRACT Purpose This study examined and compared efficacy, safety, satisfaction, and complications of the retropubic Safyre™ sling and a retropubic hand-made synthetic sling (HMS) in a short-, mid- and long-term follow-up. Methods We retrospectively reviewed a prospectively maintained database of women who underwent Safyre™ or HMS between March 7ths 2005 and December 27ths, 2017. Patients had first assessment (7-10 days), second (40-45 days), and third (sixth month) postoperatively. Between September and December 2018, patients who completed at least one year of surgery, received a telephone call. Follow-up compared quartiles of follow-up time to determine complications (Clavien-Dindo), success rates (International Consultation on Incontinence Modular Questionnaire for Urinary Incontinence Short Form - ICIQ-UI SF), and patient satisfaction. Results Three hundred fifty-one patients underwent surgery and 221 (63%) were evaluated after a median of 78.47 (± 38.69) months, 125 (55%) in the HMS, and 96 (45%) in the Safyre™ group. Higher intraoperative bladder injury was observed with Safyre™ (0% vs. 4.2%, p=0.034), and a tendency for urinary retention, requiring indwelling urinary catheter over 24 hours (2.4% vs. 8.3%, p=0.061). Both HMS (p<0.001) and Safyre™ (p<0.001) presented improvements on ICIQ-UI SF. There were no differences in satisfaction, subjective cure rates, ICIQ-UI SF, or complications between groups. Conclusions Both HMS and Safyre™ have similar satisfaction and subjective cure rates, with marked ICIQ-UI SF score improvement. Higher rates of intraoperative bladder injury were seen in patients who received Safyre™ retropubic sling.

Int. braz. j. urol ; 48(4): 662-671, July-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1385140


ABSTRACT Objective The aim of this study is to evaluate the effect of intravaginal electrical stimulation (IVES) therapies with different treatment frequencies (two or five days in a week) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with refractory idiopathic overactive bladder (OAB). Material and Methods Fifty-two women with refractory idiopathic OAB were randomized into two groups as follows: Group 1 (n:26) received BT and IVES, two times in a week, for 10 weeks and Group 2 (n:26) received BT and IVES five times in a week, for 4 weeks. IVES was performed 20 minutes in a day, a total of 20 sessions for both groups. Women were evaluated for incontinence severity (24h pad test), pelvic floor muscles strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes, and the number of pads), symptom severity (OAB-V8), quality of life (IIQ-7), treatment success (positive response rate), cure/improvement rate and treatment satisfaction (Likert scale). Results There was no statistically significant differences in all parameters between the two groups at the end of the treatment. It was found that the treatment satisfaction scores, cure/improvement and positive response rates were not significantly different between two groups (p>0.05). Conclusion We concluded that the application of IVES twice a week or 5 times a week added to BT were both effective on incontinence-related QoL and clinical parameters in women with refractory idiopathic OAB. These two IVES frequencies had similar clinical efficacy and patient satisfaction with a slight difference between them; 5 times per week IVES has a shorter treatment duration.

Int. braz. j. urol ; 48(3): 389-396, May-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1385107


ABSTRACT Purpose: To report the prevalence of the definitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), and to compare the rates of PPI over time under different criteria. Materials and Methods: In the period from January 1, 2000, until December 31, 2017, we used a recently described methodology to perform evidence acquisition called reverse systematic review (RSR). The continence definition and rates were evaluated and compared at 1, 3, 6, 12, and >18 months post-operative. Moreover, the RSR showed the "natural history" of PPI after LRP. Results: We identified 353 review articles in the systematized search, 137 studies about PPI were selected for data collection, and finally were included 203 reports (nr) with 51.436 patients. The most used criterion of continence was No pad (nr=121; 59.6%), the second one was Safety pad (nr=57; 28.1%). A statistically significant difference between continence criteria was identified only at >18 months (p=0.044). From 2013 until the end of our analysis, the Safety pad and Others became the most reported. Conclusion: RSR revealed the "natural history" of PPI after the LRP technique, and showed that through time the Safety pad concept was mainly used. However, paradoxically, we demonstrated that the two most utilized criteria, Safety pad and No pad, had similar PPI outcomes. Further effort should be made to standardize the PPI denomination to evaluate, compare and discuss the urinary post-operatory function.

Ciênc. Saúde Colet ; 27(6): 2259-2267, jun. 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1375000


Resumo Objetivou-se medir a prevalência de autopercepção negativa da saúde e sintomas depressivos em idosos segundo a presença de incontinência urinária, após nove anos de acompanhamento. Trata-se de um estudo de coorte prospectivo de base populacional intitulado Saúde do Idoso Gaúcho de Bagé, no Rio Grande do Sul. Foram entrevistados 1.593 idosos no estudo de linha de base (2008) e 735 entre setembro de 2016 e agosto de 2017. A exposição "incontinência urinária (IU)" foi avaliada no estudo de linha de base e os desfechos "autopercepção negativa da saúde" e "sintomas depressivos" em 2016/17. A razão de odds e o intervalo de confiança de 95% foram calculados com regressão logística bruta e ajustada para variáveis demográficas, sociais, comportamentais e de condições de saúde. A prevalência de IU foi 20,7% em 2008 e 24,5% em 2016/17; a incidência foi de 19,8%, sendo 23,8% entre as mulheres e 14,6% entre os homens (p = 0,009). Idosos com IU no estudo de linha de base apresentaram chances 4,0 (IC95%:1,8-8,8) e 3,4 (IC95%:1,8-6,2) vezes maior de desenvolver autopercepção negativa da saúde e sintomas depressivos, respectivamente, após nove anos de acompanhamento, comparados àqueles sem IU. Os resultados evidenciam maior chance de problemas mentais entre idosos com IU.

Abstract The scope of this study was to measure the prevalence of negative self-perceived health and depressive symptoms in elderly adults according to the presence of urinary incontinence, after a follow-up of nine years. This is a prospective population-based cohort study entitled Bagé Cohort Study of Aging, from Rio Grande do Sul. A total of 1,593 elderly adults were interviewed in the baseline study (2008) and 735 between September 2016 and August 2017. The "urinary incontinence (UI)" exposure was assessed in the baseline study and the outcomes "negative self-perceived health" and "depressive symptoms" in 2016/17. The odds ratio and 95% confidence interval were calculated by Logistic Regression and adjusted for demographic, social, behavioral and health conditions. The prevalence of UI was 20.7% in 2008 and 24.5% in 2016/17; the incidence was 19.8%, being 23.8% among women and 14.6% among men (p = 0.009). Elderly adults with UI at the baseline study had a 4.0 (CI95%: 1.8-8.8) and a 3.4 (CI95%: 1.8-6.2) greater chance to develop negative self-perception of health and depressive symptoms, respectively, after nine years of follow-up, compared to those without UI. The results show a greater probability of mental problems among elderly adults with UI.

Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388732


Resumen Introducción: La TVT (tension-free vaginal tape) es una cirugía efectiva, pero no exenta de riesgos. Las complicaciones vasculares ocurren en un 0,9-1,7%; solo el 0,33% se presentan como hematoma masivo, en general asociado a la lesión de variante anatómica corona mortis (CM). Objetivo: Reportar tres tipos de manejo en pacientes con hematomas masivos después de cirugía para la incontinencia. Método: Revisión de casos de hematomas masivos tras TVT. Análisis de tres casos con diferente manejo. Resultados: 1086 pacientes operadas en 10 años, 1% hematomas sintomáticos, 0,36% hematomas masivos. Se presentan tres casos. Caso 1: presenta inestabilidad hemodinámica sin respuesta a volumen ni vasoactivos, requirió laparotomía exploradora y se encontró un vaso sangrante retropúbico, compatible con CM, y un hematoma de 1000 cc. Caso 2: hipotensión que responde a volumen, asintomática al día siguiente de alta, reingresó 12 días después con caída de 6 puntos en la hemoglobina y la tomografía computarizada (TC) mostró un hematoma de 550 cc; recibió drenaje percutáneo. Caso 3: asintomática, alta el primer día posoperatorio, reingresa al quinto día con descenso de 4 puntos en la hemoglobina y la TC informa hematoma de 420 cc, que drena espontáneamente por vía vaginal. Todas las pacientes recibieron 14 días de antibióticos, y permanecieron continentes. Conclusiones: Los hematomas retropúbicos masivos son una complicación poco frecuente. Su manejo considera la estabilización hemodinámica, el control del sangrado y el drenaje.

Abstract Introduction: TVT (tension-free vaginal tape) is an effective surgery, not without risks. Vascular complications occur in 0.9 to 1.7%, of which 0.33% present as massive hematoma, generally associated with injury of an anatomical variant, Corona Mortis (CM). Objective: To report three types of management in patients with massive hematomas after anti-incontinence surgery. Method: Review of cases of massive hematomas after TVT surgery. Analysis of three cases with different management. Results: 1086 patients operated in 10 years, 1% symptomatic hematomas, 0.36% massive. Three cases are presented. Case 1: hemodynamic instability without response to volume or vasoactive agents, required reoperation with exploratory laparotomy, a retropubic bleeding vessel, compatible with CM, and hematoma 1000 cc was found. Case 2: hypotension responds to volume, asymptomatic at next day in discharge conditions, she was readmitted 12 days later with falled 6-point in Hb, and CT showed hematoma 550 cc; she received percutaneous drainage. Case 3: asymptomatic, discharge on the first day after TVT, readmitted on the 5th day with falled 4-point in Hb, CT informed hematoma 420 cc, spontaneously drains vaginally. Patients received 14 days of antibiotics, remained continent. Conclusions: Massive retropubic hematomas are an infrequent complication, and management considers hemodynamic stabilization, bleeding control and drainage.

Rev. bras. ginecol. obstet ; 44(5): 503-510, May 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1387910


Abstract Objectives To evaluate the impact of surgical treatment of deep infiltrative endometriosis (DIE) on pelvic floor dysfunction (urinary incontinence [UI], pelvic organ prolapse [POP], fecal incontinence [FI)] or constipation, and sexual function [dyspareunia]). Data Source The present systematic review was performed in the PubMed database. For the selection of studies, articles should be published by January 5, 2021, without language restriction. Study Selection Six randomized controlled studies that evaluated surgical treatment for DIE and the comparison of different surgical techniques were included. Data Collection The studies were selected independently by title and abstract by two authors. Disagreements were resolved by a third author. All included studies were also evaluated according to the Cochrane risk of bias tool and the quality of the evidence was analyzed using the GRADE criteria. Subgroup analysis by different treatments and follow-up periods was also performed. Results Six studies were included in the quantitative analysis. The risk of bias between studies showed an uncertain risk of bias for most studies, with concealment of allocation being the least reported category. The quality of the evidence was considered low. High heterogeneity was found between the studies. No study has evaluated UI or POP comparatively before and after surgery. Conclusion Dyspareunia and FI have improved after the surgical procedure, but it was not possible to demonstratewhich surgical technique was related to these outcomes as there was surgical heterogeneity. This diversity was found across data, with the recommendation of future prospective studies addressing pelvic floor disorders withDIE.

Resumo Objetivos Avaliar o impacto do tratamento cirúrgico para endometriose infiltrante profunda (EIP) nas disfunções do assoalho pélvico (incontinência urinária [IU], prolapso de órgãos pélvicos [POP], incontinência fecal [IF] ou constipação e função sexual [dispareunia]). Fonte de Dados A presente revisão sistemática foi realizada na base de dados PubMed. Para a seleção dos estudos, os artigos deveriam ser publicados até 5 de janeiro de 2021, sem restrição de idioma. Seleção dos Estudos Foram incluídos seis estudos randomizados e controlados que avaliaram o tratamento cirúrgico para EIP e a comparação de diferentes técnicas cirúrgicas. Coleta de Dados Os estudos foram selecionados de forma independente por título e resumo por dois autores. As discordâncias foram avaliadas por umterceiro autor. Todos os estudos incluídos foram avaliados de acordo coma ferramenta Cochrane de risco de viés e a qualidade de evidência foi analisada usando os critérios GRADE. A análise de subgrupo por diferentes tratamentos e períodos de acompanhamento também foi realizada. Resultados Seis estudos foram incluídos na análise quantitativa. O risco de viés mostrou um risco incerto de viés para a maioria dos estudos, sendo a ocultação da alocação a categoria menos relatada. A qualidade de evidência foi considerada baixa. Alta heterogeneidade foi encontrada entre os estudos. Nenhum estudo avaliou a IU ou o POP comparativamente antes e após a cirurgia. Conclusão A dispareunia e a IF melhoraram após o procedimento cirúrgico, mas não foi possível demonstrar qual técnica cirúrgica esteve relacionada a estes desfechos, pois houve heterogeneidade cirúrgica. Esta diversidade foi encontrada nos dados, com a recomendação de estudos prospectivos futuros abordando distúrbios do assoalho pélvico com EIP.

Rev. bras. ginecol. obstet ; 44(5): 511-518, May 2022. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1387915


Abstract Introduction The Burch procedure (1961) was considered the gold standard treatment for stress urinary incontinence (SUI) before the midurethral slings (MUSs) were introduced, in 2001. Objective This historical perspective of the Burch's timeline can encourage urogynecological surgeons to master the Burch technique as one of the options for surgical treatment of SUI. Search Strategy and Selection Criteria A bibliographic search was performed in the PubMed and National Library of Medicine (NIH) databases with the terms Burch colposuspension AND history AND stress urinary incontinence in the last 20 years. The original article by Burch (1961) was included. The references were read by three authors. The exclusion criterion was studies in non-English languages. Biomedical Library Special Collections were included as historical relevant search. Data Collection, Analysis and Main Results Some modifications of the technique have been made since the Burch procedure was first described. The interest in this technique has been increasing due to the negative publicity associated with vaginal synthetic mesh products. Twenty-nine relevant articles were included in the present review article, and numerous trials have compared Burch colposuspension with MUS. Conclusion This historical perspective enables the scientific community to review a standardized technique for SUI. Burch colposuspension should be considered an appropriate surgical treatment for women with SUI, and an option in urogynecological training programs worldwide.

Resumo Introdução O procedimento de Burch (1961) foi considerado o tratamento padrão ouro para a incontinência urinária de esforço (IUE) antes da introdução dos slings de uretra média (SUMs), em 2001. Objetivo Esta perspectiva histórica da linha do tempo do procedimento de Burch pode encorajar os cirurgiões uroginecológicos a dominar a técnica deste procedimento como uma das opções para o tratamento cirúrgico da IUE. Estratégia de busca e critérios de seleção A busca bibliográfica foi realizada nas bases de dados PubMed e National Library of Medicine (NIH) com os termos Burch colposuspension AND history AND stress urinary incontinence nos últimos 20 anos. O artigo original de Burch (1961) foi incluído. As referências foram analisadas por três autores com exclusão de estudos em idiomas diferentes do inglês. Coleções de bibliotecas biomédicas foram incluídas por ordem de relevância histórica. Coleta de dados, análise e principais resultados Algumas modificações de técnica foram realizadas desde que o procedimento de Burch foi inicialmente descrito. O interesse por essa técnica vem aumentando devido à publicidade negativa associada aos produtos de tela sintética vaginal. Vinte e nove artigos relevantes foramincluídos, e vários estudos compararam a colposuspensão de Burch com SUMs. Conclusão Essa perspectiva histórica possibilita à comunidade científica revisar uma técnica padronizada para a IUE. A colposuspensão de Burch pode ser considerada um tratamento cirúrgico adequado paramulheres com IUE, e uma opção emprogramas de treinamento uroginecológico em todo o mundo.

Estima (Online) ; 20(1): e0522, Jan-Dec. 2022.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1381968


Objetivo:Verificar a prevalência e os fatores de risco associados à incontinência urinária em mulheres jovens nulíparas. Método: Revisão integrativa da literatura, realizada através de busca nas bases de dados: Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências de Saúde (LILACS), Índice Bibliográfico Espanhol em Ciências da Saúde (IBECS) e na Base de Dados de Enfermagem (BDENF), no período de março a junho de 2021, utilizando os descritores: "incontinência urinária", "prevalência", "mulheres", "estudantes" e "adulto jovem" combinados através do operador booleano "AND". Resultados: A busca inicial resultou em 234 artigos e, após aplicação dos critérios de elegibilidade, obteve-se uma amostra final de 5 artigos. Após as análises, evidenciou-se prevalência de incontinência urinária em mulheres jovens nulíparas de 48%. Os fatores de risco foram: atividade física de alto impacto, duração da atividade física, sintomas intestinais e urinários concomitantes. Conclusão: Observou-se que a ocorrência de incontinência urinária em mulheres jovens nulíparas é uma condição comum, os fatores de risco associados demonstram a necessidade de orientação em saúde a essas mulheres para evitar a cronificação do agravo.

Objective:To verify the prevalence and risk factors associated with urinary incontinence in nulliparous young women. Methods: Integrative literature review, performed by searching the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Spanish Bibliographic Index in Health Sciences (IBECS) and in the Nursing Database (BDENF), from March to June 2021, using the descriptors: "urinary incontinence", "prevalence", "women", "students" and "young adult" combined with the Boolean operator "AND". Results: The initial search resulted in 234 articles and, after applying the eligibility criteria, a final sample of 5 articles was obtained. After the analyses, a prevalence of urinary incontinence in young nulliparous women of 48% was evidenced. Risk factors were: high-impact physical activity, duration of physical activity, concomitant bowel and urinary symptoms. Conclusion: It was observed that the occurrence of urinary incontinence in nulliparous young women is a common condition. The associated risk factors demonstrate the need for health guidance to these women to avoid the chronification of the disease.

Objetivo:Verificar la prevalencia y los factores de riesgo asociados a incontinencia urinaria en mujeres jóvenes nulíparas. Método: Revisión integral de literatura realizada a través de búsqueda en las bases de datos: Medical Literature Analysis and Retrieval System Online (MEDILINE) Literatura Latinoamericana y del Caribe en Ciencias De Salud (LILACS), Índice bibliográfico español en ciencias de salud (IBECS) y en la Base de Datos de Enfermería (BDENF), en el periodo de marzo a junio del 2021 utilizando los descriptores "incontinencia urinaria", "prevalencia", "mujeres", "estudiantes" y "adulto joven" combinados a través del operador booleano "AND". Resultados: Después del análisis se evidenció una prevalencia de incontinencia urinaria en mujeres jóvenes nulíparas de 48%. Los factores de riesgo fueron: actividad física de alto impacto, duración de actividad física, síntomas intestinales y urinarios concomitantes. Conclusión: Se observó que la ocurrencia de incontinencia urinaria en mujeres jóvenes nulíparas es una condición común. Los factores de riesgo asociados demuestran la necesidad de orientación en salud a esas mujeres para evitar la cronificación de la gravedad.

Students , Urinary Incontinence , Prevalence , Enterostomal Therapy
Univ. salud ; 24(1): 36-44, ene.-abr. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS, COLNAL | ID: biblio-1361184


Introducción: La incontinencia urinaria por esfuerzo (IUE) tiene una alta prevalencia en mujeres adultas, afectando variables psicológicas, sociales y funcionales como la disminución de capacidad de equilibrio, debido a una escasa contribución en los movimientos del tronco hacia una corrección postural. Objetivo: Determinar los efectos de un programa basado en ejercicio muscular de piso pélvico y educación sobre el equilibrio estático y la calidad de vida en mujeres con IUE. Materiales y métodos: Participaron 18 mujeres con IUE durante 12 semanas en 10 sesiones de ejercicio muscular de piso pélvico y educación (hábitos de higiene, micción, ingesta de líquidos). Pre y post-intervención se evaluó equilibrio estático mediante oscilografía postural y calidad de vida mediante el International Consultation on Incontinence Questionnaire Short-Form (ICQ-SF). Los datos fueron analizados con la prueba no paramétrica de Wilcoxon. Resultados: Se encontró una disminución significativa en el área de desplazamiento del centro de presión en el subtest ojos abiertos (p=0,027) y en el Subtest ojos cerrados (p=0,006). Disminuyó la sintomatología asociada a IUE (p=0,0001). Conclusiones: Pos-intervención mejora equilibrio estático y calidad de vida, confirmando los efectos positivos de este programa que pueden servir de orientación a profesionales de la salud que trabajan con mujeres con IUE.

Introduction: Stress urinary incontinence (SUI) has high prevalence in adult women, affecting psychological, social and functional variables, including decreased balance capacity, due to a lack of trunk movements that contribute to postural correction. Objective: To determine how a program based on pelvic floor muscle exercises and education affects static balance and quality of life of women with SUI. Materials and methods: 18 SUI female patients participated in a 12 week/10 sessions program that included pelvic floor muscle exercises and education (hygiene habits, urination, fluid intake). Static balance and quality of life were assessed before and after the intervention using postural oscillography and the International Consultation on Incontinence Questionnaire Short Form(ICQ-SF), respectively. Data were analyzed with the non-parametric Wilcoxon test. Results: The displacement area of the center of pressure in the open (p=0.027) and closed (p=0.006) subtests showed a significant reduction. Likewise, the amount of symptoms associated with SUI decreased (p=0.0001). Conclusions: Intervention improves static balance and quality of life, confirming the positive effects of this program, which can serve as a guide for health professionals who work with women with SUI.

Humans , Female , Adult , Middle Aged , Urologic Diseases , Exercise , Quality of Life , Urinary Incontinence , Urinary Incontinence, Stress , Postural Balance , Healthy Lifestyle
Int. braz. j. urol ; 48(2): 316-325, March-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364940


ABSTRACT Purpose: Overactive bladder (OAB) is a common syndrome associated with lower urinary tract symptoms (LUTS), especially urinary incontinence in children, which may affect the patient's quality of life (QoL). Vitamin D deficiency has been shown to be associated with OAB syndrome. This study evaluated the relationship between vitamin D status and OAB-related symptoms and QoL in children. Materials and Methods: The study included 52 pediatric patients with OAB-related urinary incontinence and 41 healthy children. LUTS were assessed using the Dysfunctional Voiding and Incontinence Symptoms Score (DVISS) questionnaire, and QoL was assessed using the Pediatric Incontinence Questionnaire (PINQ). Oral vitamin D supplementation was given to patients with OAB with vitamin D deficiency. Urinary symptoms and QoL were evaluated before and after vitamin D supplementation. Results: Vitamin D deficiency was more common in the OAB group (75%) than in the control group (36.6%). Logistic regression analysis revealed that vitamin D status (<20ng/mL) was a significant predictor of OAB. Both pre-treatment and post-treatment DVISS and PINQ scores showed a positive correlation. After vitamin D supplementation, 8 (23.5%) patients had a complete response and 19 (55.9%) patients had a partial response. Significant improvement in QoL was also achieved. Conclusions: Vitamin D deficiency is more common in children with urinary incontinence and OAB than in healthy children. Although vitamin D deficiency is not routinely evaluated for every patient, it should be evaluated in treatment-resistant OAB cases. Vitamin D supplementation may improve urinary symptoms and QoL in patients with OAB.

Humans , Child , Urinary Incontinence/complications , Vitamin D Deficiency/complications , Urinary Bladder, Overactive/complications , Urinary Bladder, Overactive/etiology , Quality of Life , Surveys and Questionnaires
Estima (Online) ; 20(1): e0122, Jan-Dec. 2022.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1379800


Objetivo:objetivou-se descrever os procedimentos técnicos operacionais e dados clínicos relacionados à implantação de um programa de atenção à saúde das pessoas com distúrbios do assoalho pélvico em um serviço público de atenção secundária. Método: trata-se de um relato de experiência, baseado em vivências relacionadas à assistência acadêmico-profissional na implantação de serviço voltado aos distúrbios do assoalho pélvico na região do Cariri cearense, realizado de maio a julho de 2021. Resultados: para a implantação do serviço, adotaram-se as seguintes estratégias: rastreamento da rede de atenção à saúde da pessoa com distúrbios do assoalho pélvico; estruturação organizacional do serviço; captação de pessoas com disfunções pélvicas; início dos atendimentos; e seguimento terapêutico. Conclusão: face ao exposto, evidencia-se que o programa de atenção à saúde das pessoas com distúrbios do assoalho pélvico pôde ser implantado satisfatoriamente, tendo em vista a infraestrutura, ao expressivo quantitativo de atendimentos realizados e ao seguimento terapêutico alcançado. Assim, com este relato, espera-se contribuir para o desenvolvimento de novos serviços ambulatoriais voltados a essa área de atuação do enfermeiro estomaterapeuta e da equipe multidisciplinar.

Objective:the objective was to describe the technical operational procedures and clinical data related to the implementation of a health care program for people with pelvic floor disorders in a public secondary care service. Method: this is an experience report, based on experiences related to academic and professional assistance in the implementation of a service aimed at pelvic floor disorders in the Cariri region of Ceará, carried out from May to July 2021. Results: for the implementation of the service, the following strategies were adopted: tracking the health care network for people with pelvic floor disorders; organizational structuring of the service; capturing people with pelvic dysfunctions; start of care; and therapeutic follow-up. Conclusion: in view of the above, it is evident that the health care program for people with pelvic floor disorders could be implemented satisfactorily, considering the infrastructure, the significant amount of care provided and the therapeutic follow-up achieved. Thus, with this report, it is expected to contribute to the development of new outpatient services aimed at this area of work of the stomatherapist nurse and the multidisciplinary team.

Objetivo:El objetivo es describir los procedimientos técnicos operativos y datos clínicos relacionados a la implementación de un programa de atención a la salud de las personas con trastornos del suelo pélvico en un servicio público de atención secundaria. Método: se trata de un reporte de experiencia, basado en vivencias relacionadas a la asistencia académico-profesional en la implementación de servicio destinado a los trastornos del suelo pélvico en la región del Cariri cearense, realizado de mayo a julio de 2021. Resultados: para la implementación del servicio, se adoptaron las siguientes estrategias: rastreo de la red de atención a la salud de personas con trastornos del suelo pélvico; estructuración organizacional del servicio; captación de personas con disfunciones pélvicas; inicio de la atención; y seguimiento terapéutico. Conclusión: frente a lo expuesto, queda evidente que el programa de atención a la salud de las personas con trastornos del suelo pélvico puede ser implementado satisfactoriamente, teniendo en cuenta la infraestructura, el importante número de atenciones realizadas y al seguimiento terapéutico alcanzado. Así, con este informe, se espera contribuir al desarrollo de nuevos servicios ambulatorios destinados a esta área de trabajo del enfermero estomaterapeuta y del equipo multidisciplinario.

Urinary Incontinence , Delivery of Health Care , Fecal Incontinence , Pelvic Floor Disorders , Enterostomal Therapy
J. coloproctol. (Rio J., Impr.) ; 42(1): 32-37, Jan.-Mar. 2022. tab
Article in English | LILACS | ID: biblio-1375765


Objective: To evaluate the association of fecal incontinence (FI) and lower urinary tract symptoms (LUTS) in patients diagnosed with initial prostate cancer (PC) and after any therapeutic approach (surgery and radiotherapy). Methods: Cross-sectional study using the Cleveland Clinic Incontinence Score (CCIS), the Fecal Incontinence Quality of Life (FIQL) questionnaire, and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). Results: A total of 84 patients with PC were included: 40 of them had not started treatment, 31 were submitted to radical prostatectomy (RP), and 13 were submitted to radiotherapy (RT). Those submitted to RT presented higher scores on the ICIQ-OAB (p=0.01). When comparing the whole sample reagarding the patients with and without FI, we observed that the incontinents presented a higher frequency of urinary incontinence (UI) (p<0.001). Moreover, when comparing patients with/without FI within their treatment groups regarding the presence of UI and FIQL scores, we identified that patients undergoing RP presented an association between UI and FI (p<0.001) and a greater impact of FI on the FIQL (p<0.001). Conclusion: Patients submitted to RT present more intense LUTS. Moreover, patients with FI present a higher association with UI, and this association is more marked in those with FI submitted to RP. (AU)

Prostatic Neoplasms/radiotherapy , Lower Urinary Tract Symptoms , Quality of Life , Radiotherapy/adverse effects , Surveys and Questionnaires , Fecal Incontinence
Int. braz. j. urol ; 48(1): 70-77, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356275


ABSTRACT Purpose: To evaluate the use of transperineal ultrasonography while diagnosing stress urinary incontinence (SUI) by comparing the urethral angle (α), posterior urethrovesical angle (β), and bladder neck descent (BND) during rest and Valsalva maneuver in continent women and women with SUI. Materials and methods: This prospective observational study was conducted with 50 women with SUI and 50 continent women. Transperineal ultrasonography was performed at rest and during Valsalva maneuver. Q-tip test was performed. Results: During the Valsalva maneuver, both α and β angles were significantly higher in women with SUI (p <0.001). The difference between Valsalva and rest measurements of α and β angles (R α, R β) were also significantly higher in women with SUI (p <0.001). The cut-off point determined for the R α in the diagnosis of stress incontinence was 16° (80% sensitivity, 98% specificity). A statistically significant strong correlation was found between Q-tip test angle and R α value (p=0.000; r=0.890). Q-tip VAS pain scores were significantly higher than ultrasonography VAS pain scores (p <0.001). In relation to the bladder neck descent comparison between the two groups showed that BND was significantly higher in SUI group (p <0.001). The cut-off point determined for BND in the diagnosis of SUI was >11mm (90% sensitivity, 98% specificity). Conclusion: Transperineal ultrasonography is a practical, reliable, non-invasive and comfortable method for evaluation of SUI. It has the advantage of dynamic evaluation during the Valsalva maneuver. Rotation angles and BND have high sensitivity and specificity for detection of SUI. The change in α angle with Valsalva (Rα) can be used as an alternative to Q-tip test.

Humans , Male , Female , Urinary Incontinence, Stress/diagnostic imaging , Bandages , Urethra/diagnostic imaging , Prospective Studies , Ultrasonography
Acta sci., Health sci ; 44: e58236, Jan. 14, 2022.
Article in English | LILACS | ID: biblio-1366306


The article has the purpose of identify the factors associated with the occurrence of urinary incontinence (UI) among volleyball athletes. This is a cross-sectional study conducted with female athletes of court volleyball. An interview was conducted to identify the factors associated with UI. The presence of urinary loss was identified using the Urinary Distress Inventory 6 (UDI-6). The associated factors found were divided into those related to sociodemographic (education and marital status), behavioral (constipation occurrence), obstetric (previous pregnancies), hereditary (skin color), and sports practice variables (sports level, volleyball position, time of sports practice in years, physical and tactical training routine, and daily water intake). The Chi-square test or Fisher's exact test, Mann-Whitney U test, and binary logistic regression model were used. This study included 83 volleyball athletes with a mean age of 26.6 (± 7.2) years. It was found that 25.3% of the volleyball athletes presented UI and those that reported symptoms of constipation were 10 times more likely to develop UIthan those without constipation.Women who practice high-impact sports in a professional manner, such as volleyball, should be aware of the symptoms of pelvic floor dysfunction, since they will be predisposed to urine leakage. The finding that a considerable number of athletes report UI and that long-term sports practice exposes athletes to a higher risk of UI indicates that pelvic exercises should be proposed in order to reduce these symptoms.

Humans , Female , Adult , Middle Aged , Urinary Incontinence/diagnosis , Women , Volleyball , Athletes , Exercise , Cross-Sectional Studies/methods , Women's Health , Drinking , Sociodemographic Factors
Journal of Preventive Medicine ; (12): 311-315, 2022.
Article in Chinese | WPRIM | ID: wpr-920774


Objective@#To investigate the health-seeking intention for urinary incontinence among adult women in Gansu Province, so as to provide insights into the management of female urinary incontinence.@*Methods @#Women at ages of 20 years and older who lived in 8 communities and 8 villages of Gansu Province for at least one year were recruited using the multi-stage stratified cluster random sampling method. A face-to-face questionnaire survey was conducted from October 2019 to February 2020, and the demographic features, urinary incontinence status and health-seeking intention were collected and descriptively analyzed.@*Results@#A total of 3 580 questionnaires were allocated and 3 485 were recovered, with a recovery rate of 97.35%. The respondents had a mean age of ( 51.18±17.13 ) years, with 1 759 respondents ( 50.47% ) that lived in urban areas, and 1 726 ( 49.53% ) that lived in rural areas. There were 1 150 respondents with self-reported urinary incontinence ( 33.00% prevalence ), including 340 cases with stress urinary incontinence ( 29.57% ), 78 cases with urge urinary incontinence ( 6.78% ) and 732 cases with mixed urinary incontinence ( 63.65% ). The overall proportion of health-seeking intention for urinary incontinence was 41.57%, and the proportions of health-seeking intention were 51.76%, 39.74% and 37.02% for stress, urge and mixed urinary incontinence, respectively. The proportion of health-seeking intention for urinary incontinence appeared a tendency towards a decline with the increase in household monthly income per capita and frequency of urinary leakage, and appeared a tendency towards a rise with the increase in educational levels ( P<0.05 ). In addition, a higher proportion of health-seeking intention for urinary incontinence was seen in women living in urban areas than in rural areas (5 3.63% vs. 31.98%, P<0.05 ), and a higher proportion was found in women with mental labors than in those with physical labors ( 60.81% vs. 40.24%, P<0.05 ), while a higher proportion was found in married women than in divorced or widowed women ( 44.33% vs. 23.53%, P<0.05 ).@*Conclusions@#There is a low proportion of health-seeking intention for urinary incontinence among adult women in Gansu Province. Age, occupation, place of residence, educational level, income, marital status, and frequency of urine leakage may affect the intention to seek medical care for urinary incontinence among adult women.

Journal of Medical Biomechanics ; (6): E131-E136, 2022.
Article in Chinese | WPRIM | ID: wpr-920680


Objective To investigate the influence of internal and external sphincter loss synergy on stress distributions and urine flow rates of lower urinary tract organs and tissues. Methods Based on collodion slice, the geometric model of the lower urinary tract was reconstructed, and finite element model of the lower urinary tract with muscle active force was established. Through fluid structure coupling simulation, the changes of tissue stress and urine flow rate were simulated under four conditions: normal contraction of internal and external sphincter, total loss of muscle active force and single loss of muscle active force for internal and external sphincters at the end of urination. Results The urethral stress changes in normal contraction of internal and external sphincter muscles were the same as the clinically measured urethral pressure changes. Compared with normal contraction, when the internal sphincter lost its muscle active force alone, stress of the internal sphincter and the urethra of the prostate was reduced by 33.6% and 13.8%, and flow rate of urine in this position was also reduced. When the external sphincter lost its muscle active force alone, the urethral stress of the external sphincter and external urethra was reduced by 59.5% and 24.03%, respectively. When the internal and external sphincter lost muscle active force, stress of the internal sphincter, the prostate, the external sphincter and the external urethra were reduced by 38.77%, 18.6%, 63.58%, 29.74%, respectively, and flow velocity in the corresponding position was also reduced. Conclusions Internal and external sphincter loss synergy resulted in the difference of tissue stress and urine flow rate. The results can provide the theoretical basis for surgical treatment of urinary incontinence caused by sphincter.

Article in Japanese | WPRIM | ID: wpr-924607


Pelvic floor trauma developing into pelvic frailty is a significant concern in urogynecology or orthopedics. The majority of women who have experienced vaginal childbirth are affected, to a certain extent, by some form of pelvic floor damage, thereby eliciting substantial alterations of functional anatomy in the pelvic cavity which are manifested as urinary incontinence or pelvic organ prolapse (e.g., uterine prolapse). With the above in mind, medical researchers, continence experts, and continence exercise practitioners in the research areas of sports medicine and rehabilitation medicine believe that the coordinated activity of pelvic floor muscles, in association with the abdominal muscles, is a prerequisite for urinary and defecatory continence. Since the pelvic floor forms the base of the abdominal cavity, stronger pelvic floor muscles are crucial in maintaining such capabilities. Opposing action of the abdominal and pelvic floor muscles ensures that exercises for one may also strengthen the other. Appropriate abdominal maneuverability or logical exercise training of the abdominal muscles may thus be beneficial in maintaining not only strength but also coordination, flexibility, and endurance of pelvic floor muscles and abdominal muscles. Such exercises, collectively known as pelvic floor muscle training, may be effective for long-term pelvic cavity care and also in rehabilitating cases of pelvic floor dysfunction. Further research is needed, however, in determining whether pelvic floor muscle function can be truly enhanced or maintained by such exercises in cases of pelvic floor dysfunction and/or decreased urinary continence.

Article in Japanese | WPRIM | ID: wpr-924606


Urinary incontinence (UI) among older people is a common problem. Several treatments are available for older people with UI including surgery, drug therapies, and behavioral interventions. Recently, much attention has been placed on the behavioral treatments for UI, including pelvic floor muscle (PFM) exercise, weight loss exercise, and thermal therapy, as they have few risks, no side effects, and are effective. These therapies are often recommended as first line treatments for older people with UI. PFM exercise programs often incorporate alternations of fast contractions that are usually held for about two to three seconds interspersed with relaxation intervals of four to five seconds, and sustained contractions, where participants hold the contraction for about eight to ten seconds followed by a relaxation interval of ten to twelve seconds between the contractions. While exercise periods vary between 3 to 24 weeks, 8 to 12 weeks seems to be the most effective length for PFM exercise. The effectiveness of PFM exercise for the improvement of UI has been validated by many studies, with improvement rates ranging widely from 17 to 84%. Also, research has shown that UI is associated with obesity. Increases in body weight cause increases in abdominal wall weight, which in turn increases intra-abdominal pressure and intra-vesicular pressure. Therefore, abdominal fat reduction from exercise may decrease intra-abdominal pressure, perhaps causing improvements in urethral sphincter contraction and, hence, decreasing UI risk. Evidence reveals that PFM exercise and fitness training targeted at reducing modifiable risk factors are effective strategies for treating UI in older people, regardless of UI type.

Texto & contexto enferm ; 31: e20210398, 2022.
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1377406


ABSTRACT Objective: to understand how aged people with intestinal ostomies experience this situation together with urinary incontinence. Method: a qualitative, descriptive and exploratory research study, developed with 77 aged individuals with intestinal ostomies assisted by the Unified Health System, in four municipalities from the Metropolitan Region of Florianópolis. Data collection was conducted using semi-structured interviews from October 2019 to February 2020. The theoretical framework used was Dorothéa Orem's Self-Care Theory and the data were submitted to content analysis, in its thematic modality. Results: the analysis allowed generating three thematic categories: 1) Feelings generated by the intestinal ostomy and urinary incontinence: acceptance, denial, fear, insecurity, constraints experienced due to the ostomy and to the urinary incontinence symptoms; 2) Lifestyle changes; and 3) Deficit in self-image. Conclusion: it was evidenced that, for most of the research participants, it is difficult to accept the experience of living with an intestinal ostomy and urinary incontinence, which generally produce negative feelings. However, the participants proved to be resilient and able to adapt to the changes in lifestyle. Many of these behaviors are due to the health professionals' important contribution in providing them the necessary attention, encouraging self-care strategies in both situations.

RESUMEN Objetivo: comprender de qué manera los ancianos con ostomías intestinales viven esta situación junto con la incontinencia urinaria. Método: investigación cualitativa, descriptiva y exploratoria, desarrollada con 77 ancianos con estomías intestinales atendidos por el Sistema Único de Salud en cuatro municipios de la Región Metropolitana de Florianópolis. La recolección de datos se realizó entre octubre de 2019 y febrero de 2020 por medio de entrevistas semiestructuradas. El marco de referencia teórico empleado fue la Teoría de Autocuidado de Dorothéa Orem; los datos se sometieron a análisis de contenido, en su modalidad temática. Resultados: el análisis permitió generar tres categorías temáticas: 1) Sentimientos generados por la estomía intestinal y por la incontinencia urinaria: aceptación, negación, miedo, inseguridad, restricciones experimentadas a raíz de la ostomía y de los síntomas de la incontinencia urinaria; 2) Cambios en el estilo de vida; y 3) Déficit en la imagen propia. Conclusión: se hizo evidente que a la mayoría de los participantes de la investigación les resulta difícil aceptar la vida con una estomía intestinal e incontinencia urinaria, que generalmente les provocan sentimientos negativos. Sin embargo, los participantes se mostraron resilientes y aptos para adaptarse a los cambios en el estilo de vida. Muchos de estos comportamientos se deben al importante aporte de los profesionales de la salud al brindarles la atención necesaria, estimulando estrategias de autocuidado en ambas situaciones.

RESUMO Objetivo: compreender como o idoso com estomia intestinal vivencia essa situação em conjunto com a incontinência urinária. Método: pesquisa qualitativa, descritiva e exploratória, desenvolvida junto a 77 idosos com estomia intestinal atendidos pelo Sistema Único de Saúde, em quatro municípios da Região Metropolitana de Florianópolis. A coleta de dados foi realizada de outubro/2019 a fevereiro/2020, por meio de entrevista semiestruturada. O referencial teórico utilizado foi a Teoria de Autocuidado de Dorothéa Orem; os dados foram submetidos à análise de conteúdo, na modalidade temática. Resultados: a análise permitiu a geração de três categorias temáticas: 1) sentimentos gerados pela estomia intestinal e pela incontinência urinária: aceitação, negação, medo, insegurança, constrangimentos vivenciados pela estomia e os sintomas da incontinência urinária; 2) alterações do estilo de vida; 3) déficit na autoimagem. Conclusão: evidenciou-se que para a maioria dos participantes da pesquisa é difícil aceitar a vivência com estomia intestinal e incontinência urinária, que geralmente lhes provocam sentimentos negativos. No entanto, os participantes mostraram-se resilientes e aptos a se adaptar às mudanças no estilo de vida. Muitos desses comportamentos se devem à importante contribuição dos profissionais da saúde em dar-lhes a necessária atenção, estimulando estratégias de autocuidado em ambas as situações.