Responsiveness to the Portuguese version of the international consultation on incontinence questionnaire - short form (ICIQ-SF) after stress urinary incontinence surgery

OBJECTIVE: To evaluate the reliability and responsiveness (internal and external) of the Portuguese version of the ICIQ-SF. We assessed the responsiveness of the ICIQ-SF after surgical procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: Prospective open label study in 2 tertiary referral centers. Sixty-one patients of both genders (54 female and 7 male) were enrolled. Patients were treated using surgical procedures, mostly with synthetic sling (82 percent). Patients were assessed before surgery and at least 1 month postoperatively using the ICIQ-SF in its translated and validated Portuguese version. Patients also underwent pre-operative urodynamic tests, Stamey incontinence grading and pad usage assessments. After surgery, patients underwent stress tests, Stamey incontinence grading and pad usage assessments. RESULTS: The mean age was 57.2 (± 11.6) years and the mean duration of follow-up was 7.2 months (± 4.5). Objective parameters such as urodynamic tests (by means of VLPP) and pad usage had significant correlation with changes in post-treatment scores on the ICIQ-SF (p = 0.0062 and p < 0.0001 respectively). The responsiveness expressed in terms of standardized effect sizes (SES) and standardized response means (SRM) was large for both questionnaires (p < 0.0001). CONCLUSION: The results showed high responsiveness (large effect sizes I and II) for the Portuguese version of the ICIQ-SF, indicating that this instrument is suitable for measuring outcomes in clinical trials for Brazilian patients with stress urinary incontinence.

Concurrent validity, internal consistency and responsiveness of the portuguese version of the king's health questionnaire (KHQ) in women after stress urinary incontinence surgery

OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73 percent) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.

Resiniferatoxin for detrusor instability refractory to anticholinergics

PURPOSE: We have evaluated the clinical and urodynamic effects of intravesical instillation of resiniferatoxin in patients with idiopathic detrusor instability refractory to anticholinergics. MATERIALS AND METHODS: There were 30 women, median age 56 years old with detrusor instability for over 6 months and a history of anticholinergic use with no response or intolerable collateral effects. A 50 nM solution of resiniferatoxin was prepared for intravesical instillation. All patients were evaluated for urinary symptoms, as well as for urodynamic assessments before and 30 days after instillation. Tolerability was analyzed during the instillation. RESULTS: A clinical improvement was observed in 30 percent of the patients with urinary urgency and in 33 percent of the patients with urge-incontinence. The mean maximum cystometric capacity before application was 303.9 ± 78.9 and after application 341 ± 84.6. No significant difference was observed (p = 0.585). The mean maximum amplitude of the contractions diminished from 47.86 ± 29.64 to 38.72 ± 30.77 (p = 0.002). CONCLUSIONS: Resiniferatoxin, in this concentration, proved to be useful in a small percentage of patients regarding clinical detrusor instability. Maximum amplitude of the involuntary contractions was significantly reduced and in 33 percent patients the involuntary contractions disappeared. Further studies with different concentrations are recommended.

Safyreã: a readjustable minimally invasive sling for female urinary stress incontinence

INTRODUCTION: SAFIRE TM is a readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). It is as a pubovaginal sling placed in the medial third of the urethra. The initial experience is described. MATERIALS AND METHODS: Forty-five patients (mean age = 59 years) underwent a SAFYRE TM implant to treat SUI. Physical examination and urodynamic study were performed before surgery. All patients presented symptoms of SUI and 20 percent also reported mild urgency. Approximately 60 percent of this group had a previously failed anti-incontinence procedure. Urethral hypermobility was diagnosed in 40 percent of the patients and intrinsic sphincter deficiency (ISD) in 60 percent of the cases. RESULTS: The average follow up period was 10 months. The mean operative time was 20 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 11 percent of the implants, bladder perforation occurred. During the postoperative period, 9 patients (20 percent) developed transient urgency symptoms. During the initial follow up period, 90 percent were found to be continent, 3 percent reported an improvement and 7 percent were unchanged. CONCLUSION: SAFYRE TM is a safe and quick procedure that allows postoperative readjustment. This technique may be an attractive alternative in the management of SUI, should the good result obtained so far prove to be long lasting.

A propósito de um novo "sling" pubovaginal absorvível: experiência inicial / A new absobable pubovaginal sling: Preliminary experience

A utilizaçao de material autólogo na criaçao de "Slings" pubovaginais tem sido a conduta de escolha no tratamento dos casos complexos de incotinência urinária aos esforços (IUE). Esta preferência em relaçao aos materiais sintético deve-se em grande parte a duas preocupações básicas, ou seja, aumento de incidência de infecçoes e a erosao da uretra. Por outro lado, a autilizaçao de slings sintéticos possibilita a realizaçao de uma grande cirurgia, com características minimamente invasivos, simplifica o procedimento e reduz o tempo operatório. Os autores descrevem a experiência inicial com a utilizaçao de um "sling" de colágeno altamente purificado, que por ser biocompatível e absorvível associa as características do material autólogo com as vantagens do material sintético. Este sling foi utilizado em 10 pacientes portadores de IUE complexa. Nao houve infecçao, rejeiçao e tampouco reaçoes alérgicas locais. O seguimento variou de 3 a 15 meses com seguimento médio de 6 meses com 80 por cento de cura. Estes resultados sugerem que o sling de colágeno pode ser útil no tratamento de IUE, caso os bons resultados obtidos até o momento se mostrem duradouros

Análise do programa de vasectomias em uma instituiçäo universitária / Vasectomy in a universitary institution

Foram estudados 255 casais que procuraram o programa de vasectomias da Faculdade de Ciências Médicas - UNICAMP. Destes 233 enquadram-se nos critérios mínimos de aceitaçäo do programa (número de filhos igual ou superior a 2, superior a 30 anos, compreensäo do método, inadequaçäo a outros métodos anticoncepcionais, indicaçäo médica). 172 pacientes foram operados e apenas 3 apresentaram complicaçöes mínimas. Näo se observou nenhum caso de recanalizaçäo espontânea no seguimento médio de 18 meses. O trabalho analisa também os aspectos sociológicos da populaçäo estudada

Analise critica dos metodos de drenagem dos abscessos renais. Percutanea ou aberta? / Analysis of the methods of renal abscesses drainage: open surgery or percutaneous?

Os abscessos renais sao pouco frequentes e apresentam manifestaçoes clinicas complexas. O tratamento adequado deve ser instituido rapidamente, caso contrario a enfermidade evolui com morbidade e mortalidade significativas. Quinze pacientes portadores de abscesso renal foram tratados, sendo nove por drenagem percutanea e seis por drenagem aberta. Apenas um paciente necessitou de uma nova punçao percutanea apos a primeira intervençao, e outro paciente evoluiu para obito, mesmo apos a drenagem percutanea. Com exceçao desses dois casos, houve resoluçao completa do processo infeccioso nos demais. Nao se observou diferença estatisticamente significante nos dois grupos de pacientes em relaçao ao tempo de internaçao. Os resultados observados sugerem que a drenagem percutanea, por ser um procedimento menos agressivo, deve constituir-se na primeira opçao terapeutica no tratamento dos abscessos renais, nao contra-indicando intervençoes posteriores, caso sejam necessarios