Noxious electrical stimulation of the pelvic floor and vagina induces transient voiding dysfunction in a rabbit survival model of pelvic floor dystonia

PURPOSE: Existing data supports a relationship between pelvic floor dysfunction and lower urinary tract symptoms. We developed a survival model of pelvic floor dysfunction in the rabbit and evaluated cystometric (CMG), electromyographic (EMG) and ambulatory voiding behavior. MATERIALS AND METHODS: Twelve female adult virgin rabbits were housed in metabolic cages to record voiding and defecation. Anesthetized CMG/EMG was performed before and after treatment animals (n=9) received bilateral tetanizing needle stimulation to the pubococcygeous (PC) muscle and controls (n=3) sham needle placement. After 7 days all animals were subjected to tetanizing transvaginal stimulation and CMG/EMG. After 5 days a final CMG/EMG was performed. RESULTS: Of rabbits that underwent needle stimulation 7 of 9 (78%) demonstrated dysfunctional CMG micturition contractions versus 6 of 12 (50%) after transvaginal stimulation. Needle stimulation of the PC musculature resulted in significant changes in: basal CMG pressure, precontraction pressure change, contraction pressure, interval between contractions and postvoid residual; with time to 3rd contraction increased from 38 to 53 minutes (p=0.008 vs. prestimulation). Vaginal noxious stimulation resulted in significant changes in: basal CMG pressure and interval between contractions; with time to 3rd contraction increased from 37 to 46 minutes (p=0.008 vs. prestimulation). Changes in cage parameters were primarily seen after direct needle stimulation. CONCLUSIONS: In a majority of animals, tetanizing electrical stimulation of the rabbit pelvic floor resulted in voiding changes suggestive of pelvic floor dysfunction as characterized by a larger bladder capacity, longer interval between contractions and prolonged contraction duration.

Atuação da fisioterapia no tratamento de incontinência urinaria de esforço / Role of physical therapy in the treatment of urinary incontinence of effort

A incontinência urinária de esforço é caracterizada por toda perda involuntária de urina causada por uma força excessiva sobre a musculatura do assoalho pélvico. A fisioterapia urológica tem como objetivo reabilitar essa musculatura através de exercícios do assoalho pélvico, biofeedback, eletroestimulação e cones vaginais. O objetivo desta pesquisa foi revisar e apontar a importância da reabilitação fisioterapêutica em paciente com incontinência urinaria de esforço. Este estudo foi realizado com base na revisão literária, obedecendo aos critérios de inclusão. Verificou-se a importância da fisioterapia urológica em pacientes com incontinência urinaria de esforço, pelos métodos utilizados nessa reabilitação, assim proporcionando ao paciente uma melhor opção de tratamento.(AU)

Stress urinary incontinence is characterized by involuntary loss of urine caused by excessive force on the muscles of the pelvic floor. Neurological physiotherapy aims to rehabilitate the musculature through pelvic floor exercises, biofeedback, electrical stimulation and vaginal cones. The objective of this research is to review and point out the importance of Physiotherapeutic Rehabilitation in patients with Stress urinary incontinence. This study was conducted as a literary review, obeying the criteria of inclusion. It was observed the importance of neurological physiotherapy in patients with urinary incontinence of effort, by methods used in rehabilitation, thus giving the patient a better treatment option.(AU)

Manejo dos sintomas climatéricos em pacientes com câncer de mama / Management of menopausal symptoms in patients with breast cancer

O câncer de mama é a neoplasia maligna mais frequente nas mulheres, inclusive na pós-menopausa. O tratamento hormonal e quimioterápico dessa doença pode induzir o aparecimento de sintomas vasomotores, atrofia urogenital, alteração da função sexual e instalação da menopausa precocemente, os quais merecem avaliação e controle. O tratamento dos sintomas climatéricos em pacientes sobreviventes do câncer de mama tem grande relevância clínica, pois, em razão do aumento da incidência e dos avanços na abordagem terapêutica, o número de mulheres que sobrevivem ao câncer de mama e experimentam sintomas climatéricos tem aumentado. Objetivou-se identificar na literatura evidências recentes acerca das opções terapêuticas na redução dos sintomas climatéricos. Dessa forma, foi realizada uma revisão na literatura por meio de consulta nas principais bases de dados, priorizando artigos mais recentes e com maior nível de evidência. Os estudos randomizados controlados sobre o uso de fitoterápicos, acupuntura e ioga no tratamento de fogachos em pacientes com câncer de mama são limitados, tanto nas opções de tratamento e tempo de seguimento quanto na comprovação científica de sua eficácia. Abordando os tratamentos farmacológicos, vários inibidores da recaptação de serotonina (paroxetina, fluoxetina e citalopram) e inibidores da recaptação de serotonina e adrenalina (venlafaxina e desvenlafaxina) têm sido mais eficazes que o placebo na redução dos sintomas vasomotores em estudos a curto prazo em mulheres com câncer de mama. A avaliação dos sintomas e seu impacto na qualidade de vida, além do desejo da paciente, são determinantes na escolha do tratamento. Independentemente do tipo de tratamento indicado, as modificações de estilo de vida devem ser recomendadas.(AU)

Breast cancer is the most commonly diagnosed malignancy in women, including after menopause. The hormonal and chemotherapeutic treatment of this disease can induce the appearance of vasomotor symptoms, urogenital atrophy, abnormal sexual function and installation of early menopause that require evaluation and control. The treatment of climacteric symptoms in breast cancer survivors is of great clinical relevance, once the number of women experiencing menopausal symptoms has increased because of the high incidence of breast cancer and advances in therapeutic approach. The purpose is to identify recent evidence in the literature on the therapeutic options in reducing these menopausal symptoms. Thus, a literature review through consultation was held in the main databases, prioritizing newer and higher level of evidence items. Randomized controlled trials on the use of herbals, acupuncture and yoga in the treatment of hot flashes in patients with breast cancer are limited, such as treatment options, follow-up time and the scientific evidence of its effectiveness. Addressing the pharmacological treatments, several serotonin reuptake inhibitors (paroxetine, fluoxetine and citalopram) and reuptake inhibitors of serotonin and adrenaline (venlafaxine and desvenlafaxine) have been more effective than placebo in reducing vasomotor symptoms in short-term studies in women with breast cancer. The evaluation of symptoms and their impact on quality of life, beyond the desire of the patient, are determinant in the choice of treatment. Regardless of the type of treatment indicated, changes in lifestyle should be recommended.(AU)

Treatments for invasive carcinoma of the cervix: what are their impacts on the pelvic floor functions?

Aims: Describe the impact of surgery, radiotherapy and chemoradiation in the pelvic floor functions in cervical cancer patients. Materials and Methods: A prospective study with women submitted to radical hysterectomy (RH) (n = 20), exclusive radiotherapy (RT) (n = 20) or chemoradiation (CT/RT) (n = 20) for invasive cervical cancer. Urinary, intestinal and sexual function, as well as vaginal length and pelvic floor muscle contraction were evaluated. Comparisons between groups were performed by Kruskal-Wallis and Chi-square tests (p < 0.05). Results: The groups were similar in stress urinary incontinence incidence (p = 0.56), urinary urgency (p = 0.44), urge incontinence (p = 0.54), nocturia (p = 0.53), incomplete bowel emptying (p = 0.76), bowel urgency (p = 0.12) and soilage (p = 0.43). The CT/RT group presented a higher urinary frequency (p < 0.001) and diarrhea (p = 0.025). Patients in the RH group were more sexually active (p = 0.01) and experienced less dyspareunia (p = 0.021). Vaginal length was shorter in RT group (5.5 ± 1.9cm) and CT/RT(5.3 ± 1.5 cm) than in the RH group (7.4 ± 1.1 cm) (p < 0.001). Pelvic floor muscle contraction was similar (p = 0.302). Conclusions: RT and CT/RT treatment for cervical carcinoma are more associated to sexual and intestinal dysfunctions. .

Urinary incontinence and vaginal squeeze pressure two years post-cesarean delivery in primiparous women with previous gestational diabetes mellitus

OBJECTIVE: To assess the prevalence of urinary incontinence and associated vaginal squeeze pressure in primiparous women with and without previous gestational diabetes mellitus two years post-cesarean delivery. METHODS: Primiparous women who delivered by cesarean two years previously were interviewed about the delivery and the occurrence of incontinence. Incontinence was reported by the women and vaginal pressure evaluated by a Perina perineometer. Sixty-three women with gestational diabetes and 98 women without the disease were screened for incontinence and vaginal pressure. Multiple logistic regression models were used to evaluate the independent effects of gestational diabetes. RESULTS: The prevalence of gestational incontinence was higher among women with gestational diabetes during their pregnancies (50.8 percent vs. 31.6 percent) and two years after a cesarean (44.8 percent vs. 18.4 percent). Decreased vaginal pressure was also significantly higher among women with gestational diabetes (53.9 percent vs. 37.8 percent). Maternal weight gain and newborn weight were risk factors for decreased vaginal pressure. Maternal age, gestational incontinence and decreased vaginal pressure were risk factors for incontinence two years after a cesarean. In a multivariate logistic model, gestational diabetes was an independent risk factor for gestational incontinence. CONCLUSIONS: The prevalence of incontinence and decreased vaginal pressure two years post-cesarean were elevated among women with gestational diabetes compared to women who were normoglycemic during pregnancy. We confirmed an association between gestational diabetes mellitus and a subsequent decrease of vaginal pressure two years post-cesarean. These results may warrant more comprehensive prospective and translational studies.

Síndrome de Mayer-Rokitansky-Kuster-Hauser: experiencia con cinco casos / Syndrome of Mayer-Rokitan-sky-Kuster-H: experience with five cases

Se presentan cinco casos de anomalías congénitas del aparato reproductor femenino, alteraciones secundarias a una falla en el desarrollo de los conductores de Müller, todos considerados como síndrome de Mayer-Rokitansky-Kuster-Hauser, y se señalan la embriogénesis, las anomalias urológicas asociadas, las modalidades diagnósticas y el tratmiento quirúrgico

Imperforate hymen: a new technique for management

Imperforate hymen is a rare congenital anomaly. It may present early in infancy due to accumulation of secretion in vagina caused by excessive intrauterine stimulation of cervical mucous glands by maternal estrogen. Most cases present by urinary symptoms caused by hydrometrocolpos as well as bulging of imperforate hymen between the labia. 9 cases have been operated upon in Pediatric Surgical Department by hymenostomy. A new technique was used to drain the hydrometrocolpos and at the same time preserving the hymen intact and not deflorated. Follow up by ultrasound scanning showed that the technique is sufficient for drainage and no recurrence occurred

Transvesical repair of vesico-vaginal fistula

Vesico-vaginal fistula is a common problem in our socioeconomic setup. Poor antental care and neglected prolonged labour, usually conducted by untrained "Village Dai", is the commonest cause. The affected women in their early reproductive life, are condemned to live with it. Various methods of repair have been used. One simple method of repair of V.V.F using omental patch interposition is being described. Six cases of V.V.F have been dealt with All patients have recovered fully. However, this method needs further evaluation

Transvaginal sonographic histerohydrotubation versus hysterosalpingography in infertile women

Lipoidal hysterosalpingography [HSG] and vaginal sonographic histerohydrotubation [VSHT] were done in forty infertile women VSHT was done by transcervical injection of saline [20 - 50 ml] through a Foley's catheter [8 - 10] with sonographic detection of saline passage through the uterine cavity [expansion and decompression with turbulence] to be collected in Douglas pouch [tubal patency] VSHT versus HSG findings were bilateral patency [29 [72.5%] vs 26 [65%]], bilateral block [8 [20%] vs 10 [25%]], right block [2] [5%] for each] and left block [1 [2.5%] vs 2 [5%]], Sensitivity and negative predictive values of VSHT were 100% vs specificity was also above 90%, while the positive predictive value was ranged from 75% up to 80%, so VSHT is a useful diagnostic procedure in evaluation of tubal factor in problem of infertility

Diagnostic value of transvaginal color and pulsed doppler in pelvic congestion syndrome

Pelvic vasculature and homodynamics of the female pelvis were studied in twenty patients complaining of chronic pelvic pain of unknown etiology and 10 women, without gynecologic complaint, as control were evaluated using transuterine pelvic phIebogrophy and transvaginal color and pulsed Doppler. Blood flow velocity waveform of each of the ovarian arteries were recorded, and pulsatility index [PI] value was measured. The phlebogram was considered pathologic if either of the ovarian veins reached >/= 8 mm at lumbar 5. Ovarian vein dilation was found to be a predominant pathology in patients complaining of chronic pelvic pain without evident cause [75%]. We have found significant positive correlation between the ovarian artery PI value and the ipsilateral ovarian vein diameter, in both study and control cases [r = 0.75, P < 0.05]. Thus transvaginal color and pulsed Doppler can be used as an alternative to phlebography for studying perfusion characteristics of the female pelvis. It has the advantage of being safe, non-invasive, reproducible, and easily interpreted

Group B streptococci carriage in pregnant women: acquisition by newborn infants and obstetrics complications

Group B streptococcal [GBS] carriage rate and its acquisition by newborns was investigated by culturing specimens from mother genital tract and from different sites of newborns in Holy Family Hospital Rawalpindi. Incidence of preterm rupture of membranes [PROM], preterm delivery and history of vaginal discharge was observed in the GBS colonized and uncoIonized population. The condition of placenta and liquor amni and the mean time between ruptures of membranes and delivery was also observed amongst colonized and uncolonized mothers. Cultures were done on starch serum agar described by Islam [1977] anaerobically and golden yellow colonies were subjected to serological diagnosis. A carriage rate of 9.3% amongst mothers and an acquisition rate of 71.4% by infants of colonized and 1.4% by infants of uncolonized mothers was found. PROM and preterm delivery was observed in 14.2% of the colonized mothers while 9.5% and 5.1% of the uncolonized mothers had PROM and preterm delivery respectively. From the data obtained it appears that GBS infection may not be uncommon in Pakistan and the association of GBS with gynaecological, obstetric and perinatal complication is significant