Applicability of vaginal energy-based devices in urogynecology: evidence and controversy

SUMMARY OBJECTIVE: This study aimed to analyze the evidence and controversies about the use of vaginal energy-based devices (laser and radiofrequency) for treatment of genitourinary syndrome of menopause, recurrent urinary tract infection, urinary incontinence, and genital prolapse through a literature review. METHODS: A search of literature databases (PubMed, Medline) was performed for publications in December 2022. Keywords included genitourinary syndrome of menopause, vaginal laxity, vaginal/vulvovaginal atrophy, urinary tract infection, urgency incontinence, frequency, urgency, stress urinary incontinence, genital prolapses AND energy-based devices, AND vaginal laser, AND vaginal radiofrequency, AND CO2 laser, AND Er:YAG laser. Publications in English from the last 7 years were reviewed and selected by the authors. RESULTS: The literature regarding vaginal energy-based devices in the treatment of urogynecological conditions is primarily limited to prospective case series with small numbers and short-term follow-up. Most of these studies showed favorable results, improvement of symptoms with low risk, or no mention of serious adverse events. Consensus statement documents from major medical societies suggest caution in recommending these therapies in clinical practice until more relevant data from well-designed studies become available. CONCLUSION: The potential of the vaginal laser and radiofrequency as a therapeutic arsenal for the evaluated urogynecological conditions is great, but qualified research must be done to prove their efficacy and long-term safety, define application protocols, and recommend the use of these technologies in clinical practice.

Impact of bariatric surgery in patients with stress urinary incontinence / Impacto da cirurgia bariátrica em pacientes com incontinência urinária de esforço

ABSTRACT Objective: To examine epidemiologic, anthropometric and clinical variables associated with stress urinary incontinence in obese women, before and after bariatric surgery, and to identify predictive factors of stress urinary incontinence resolution. Methods: Prospective observational study with women enrolled in a bariatric surgery program between 2015 and 2016. Patients were assessed prior to and 6 months after bariatric surgery using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale. Patient assessment also included physical examination and bladder stress tests. Results: A total of 43 women completed the study. There was a 72.7% reduction in stress urinary incontinence (p=0.021). Predictive factors for preoperative diagnosis of stress urinary incontinence included age (p=0.024) and abdominal waist circumference (p=0.048). Urinary symptoms improved after weight loss, especially nocturia (p=0.001) and stress urinary incontinence (p=0.026). Menopause was the most significant predictive factor for persistence of stress urinary incontinence within six months of bariatric surgery (p=0.046). Self-reported outcomes and scores obtained in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale were associated with significant improvement (p=0.012, p=0.025, and p=0.002 respectively). Conclusion: Older women with larger waist circumference have a higher risk of developing stress urinary incontinence prior to bariatric surgery. Menopausal women are highly prone to persistent stress urinary incontinence, even after weight loss. Weight loss achieved through bariatric surgery improved stress urinary incontinence symptoms and mitigated related impacts on quality of life in the vast majority of women.

RESUMO Objetivo: Examinar as variáveis epidemiológicas, antropométricas e clínicas associadas à incontinência urinária de esforço em mulheres obesas antes e após a cirurgia bariátrica e identificar fatores preditivos da resolução desse tipo de incontinência. Métodos: Estudo observacional prospectivo com mulheres de um programa de cirurgia bariátrica, realizado entre 2015 e 2016. As pacientes responderam ao International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, à Clinical Global Impression-Improvement e à Escala Visual Analógica, sendo submetidas ao exame físico e ao teste de incontinência antes e 6 meses após cirurgia bariátrica. Resultados: Completaram o estudo 43 mulheres. Houve redução de 72,7% na incontinência urinária de esforço (p=0,021). Fatores preditivos para o diagnóstico pré-operatório da incontinência urinária incluíram idade (p=0,024) e circunferência abdominal (p=0,048). Todos os sintomas urinários demonstraram melhora após perda de peso, notadamente noctúria (p=0,001) e incontinência urinária de esforço (p=0,026). A menopausa foi o fator mais crítico para predizer a persistência da incontinência urinária de esforço 6 meses após a cirurgia bariátrica (p=0,046). Os resultados relatados do International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, da Patient Global Impression of Improvement e da Escala Visual Analógica tiveram melhora significativa (p=0,012, p=0,025, p=0,002, respectivamente). Conclusão: Mulheres idosas e com maior circunferência abdominal têm maior risco de desenvolver incontinência urinária de esforço antes da cirurgia. Mulheres na menopausa são fortemente propensas a persistir com a incontinência urinária de esforço, mesmo após a perda de peso. A perda de peso após a cirurgia bariátrica melhora os sintomas de incontinência urinária de esforço e seus impactos na qualidade de vida na maioria das mulheres.

Prevalence of urodynamic changes with risk for upper urinary tract damage in neuroschistosomiasis patients

Abstract INTRODUCTION: This study aimed to identify the prevalence of urodynamic changes with an associated risk of developing upper urinary tract damage in neuroschistosomiasis patients. METHODS: A prospective study was conducted, wherein68 patients were admitted for analysis of urodynamics, urea and creatinine levels, and uroculture. RESULTS: Blood test results did not indicate kidney failure. There were cases of asymptomatic bacteriuria. Common symptoms were frequent nocturia and detrusor overactivity. Results of low compliance and low cystometric capacity were both statistically significant (p = 0.001 and p = 0.002, respectively). CONCLUSIONS: A high prevalence of negative urodynamic changes were found in neuroschistosomiasis patients.

Functional outcomes and quality of life after transobturatory slings: hand - made vs. commercial slings

ABSTRACT Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings. Data from 57 women who underwent consecutive TO sling surgery to treat SUI were pros- pectively collected between 2012 and 2014, and divided in two groups for further compa- rison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test. Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All de- mographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.

Anterior six arms prolene mesh for high stage vaginal prolapse: five years follow-up

ABSTRACT Introduction In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. The pre-molded commercial mesh kits are expensive and not always available. Alternative effective and safe treatment ways, with lower costs are desirable. Objective To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses. Materials and Methods We describe prospectively 18 patients with anterior and apical vaginal prolapses, stages III and IV, repaired using this specific design of mesh. All patients were submitted to pre-operative clinical evaluation and urodynamics. Prolapse was classified using the pelvic organ prolapse quantification (POP-Q). Intervention Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision. Outcome Measurements: POP-Q, patients satisfaction, descriptive statistical analysis. Results Between February 2009 and Oct 2010, 18 consecutive women underwent the above-mentioned surgery. Mean age was 68 years. At a mean follow-up of .,4 years (5 to 5.8 years), 16 (89%) patients were continent, mean Ba point came from +4.7cm to - 2.5cm, mean C point from +2.8cm to -6.6cm and mean Bp point from +1.3 to -1.7cm. There were two (11%) objective failures, but all the patients were considered success subjectively. There were two cases of mesh vaginal extrusion. Conclusions The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed.

Endoscopic use of cyanoacrylate glue in the treatment of urethral fistula

Purpose The aim of this video is to demonstrate an endoscopic and minimally invasive repair of an urethrocutaneous fistula with cyanoacrylate glue. Materials and Methods: A 56 year-old-man with post-infectious urethral stricture and recurrent perineal abscess formation due to urethral fistulas. Results The operative time was 60 minutes, no major complications were observed perioperatively and postoperatively. At a follow-up time of 6 months the patient had no evidence of recurrent fistula and abscess formation. CONCLUSIONS The endoscopic use of cyanoacrylate glue represents a safe and minimally invasive approach that might be offered as a first line option for the treatment of urinary fistulas in selected patients, especially those with narrow and long tracts. .

Fístula vesicovaginal continente / Continent vesicovaginal fistula

A fístula vesicovaginal é uma comunicação anormal entre a bexiga e a vagina, sendo o tipo mais comum de fístula do trato urinário. A causa mais frequente no Brasil é a iatrogênica, secundária à histerectomia. Classicamente, as mulheres nessa condição, apresentam perda urinária contínua pela vagina e ausência de micção, com forte impacto negativo na qualidade de vida. Apresentamos um caso de fístula vesicovaginal totalmente continente, com seguimento de 11 anos, sem complicações.

Vesicovaginal fistula is an abnormal communication between the bladder and vagina and represents the most frequent type of fistula in the urinary tract. The most common cause in Brazil is iatrogenic fistula, secondary to histerectomia. Classically these women present continuous urinary leakage from the vagina and absence of micturition, with strong negative impact on their quality of life. We present a case of totally continent vesicovaginal fistula, with a follow-up of 11 years with no complications.

Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure

PURPOSE: To analyze the influence of urethral mobility and Valsalva leak point pressure on postoperative outcomes of transobturator sling (TOT) for female stress urinary incontinence. MATERIALS AND METHODS: A prospective cohort was conducted including 66 patients submitted to TOT from March 2006 to May 2009. Urethral hypermobility was defined as mobility ≥ 30º on Q-tip test, and Valsalva leak point pressure (VLPP) was classified as greater than 60 cmH2O or 60 and less on preoperative urodynamics. These parameters were compared through well defined postoperative objective and subjective success criteria. Intensity of urinary leakage and quality of life was analysed by ICIQ-SF. Statistical analysis was accomplished and the results rendered significant if p < 0.05. RESULTS: Mean follow up was 10 months (3 to 28). Mean age was 55 years (33 to 80), 70% were white and 30% African descendent, mean body mass index was 27 (21 to 38), average vaginal and abdominal deliveries were 2.8 and 0.5 respectively. A quarter had prior stress incontinence surgery. Patients with urethral hypermobility had higher objective success rates (98% versus 81.25%, p = 0.04). The subjective success rate was also greater in the hypermobility group (84% versus 62.5%), but statistical significance was not reached (p = 0.07). VLPP had no influence on either objective or subjective postoperative success rates (p = 0.17 and 0.34, respectively). In the subgroup analysis, those with low mobility and high VLPP had worse objective success rates in comparison to the group with hypermobility and low VLPP (p = 0.04) and also in relation to the remaining of the studied population. Other possible prognostic factors (previous surgery, mixed incontinence, gestational status) had no influence on success rates. CONCLUSIONS: High urethral mobility, regardless of the sphincteric status indicated by VLPP, is a favorable prognostic factor for tension-free transobturator tape procedure. No relationship was demonstrated between postoperative success rates and VLPP.

A historia familial e a prevalencia de dependencia de alcool e tabaco em area metropolitana na regiao Sul do Brasil / Familial history and prevalence of alcohol and tobacco dependence in a metropolitan area of southern Brasil

No presente estudo, foram analisadas a historia familial e a prevalencia de dependencia de alcool e tabaco nas regioes Norte, Sul e Oeste da cidade de Londrina, estado do Parana, Sul do Brasil, com uma populacao estimada de 277.391 habitantes, por meio de uma amostra aleatoria de 4.280 residencias, totalizando 42.517 pessoas...