Incontinencia urinaria de urgencia en mujeres adultas: ¿Qué tratamientos ofrecer en APS? / Emergency Urinary Incontinence in Adult Women: what treatments do we offer at PHC?

La incontinencia urinaria de urgencia corresponde a la pérdida involuntaria de orina, cuya causa es presumida multifactorial: hiperactividad del detrusor, hipersensibilidad vesical y distensibilidad reducida del detrusor. Esta patología es bastante frecuente tanto en Chile como en el mundo, con una prevalencia local entre 10% y 15%, a su vez genera un gran impacto en el bienestar físico, mental y socioeconómico del paciente. El diagnóstico es clínico, con apoyo en el uroanálisis y su tratamiento de primera línea puede ser realizado en APS. En cuanto al tratamiento existen tanto terapias no farmacológicas como farmacológicas; correspondiendo las técnicas de reentrenamiento vesical, los cambios de estilo de vida y los fármacos anticolinérgicos a tratamientos efectivos de primera línea. Existen, además, otros fármacos que pueden ser utilizados para el tratamiento de la IUU, cuya evidencia será igualmente revisada en este artículo.

Urge incontinence is defined as an involuntary leakage of urine, presumably with a multifactorial cause: detrusor overactivity, bladder hypersensibility and a reduced bladder compliance. It's a common disease worldwide, with local studies reporting a prevalence around 10-15%, causing a great impact in the physical, mental and socioeconomic well-being of the affected patients. Diagnosis is mainly based on the clinical history, supporting it with laboratory tests to rule out other conditions, and uncomplicated cases can be treated and followed in a primary care setting. There are pharmacologic and non-pharmacologic therapies, being healthy lifestyles changes, bladder retraining programs and anticholinergic drugs the first line of treatment. Additional pharmacologic treatments will be revised in this article.

Can the success of structured therapy for giggle incontinence be predicted?

ABSTRACT Introduction: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities. Material and methods: The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment. Results: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities. Conclusions: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects.

Estimulação elétrica nervosa transcutânea para tratamento de urgência ou urge-incontinência urinária em crianças e adolescentes: ensaio clínico fase II / Transcutaneous electrical neural stimulation for the treatment of urinary urgency or urge-incontinence in children and adolescents: a Phase II clinica

ResumoObjetivo:Determinar a efetividade de 20 sessões de estimulação elétrica nervosa transcutânea (TENS) parassacral com periodicidade de duas vezes semanais no tratamento da urgência ou urge-incontinência urinária em crianças e adolescentes.Métodos:Ensaio clínico fase II, envolvendo pacientes com idade entre 5 e 14 anos com urgência ou urge-incontinência urinária. Realizadas 20 sessões de TENS, duas vezes por semana (aparelho Dualpex 961 Quark®). Os resultados foram avaliados pelo diário miccional, ultrassonografia dinâmica do trato urinário inferior (USGD-TUI) pré e pós-tratamento e questionário sobre perdas urinárias em cada sessão.Resultados:A idade média das 25 crianças envolvidas no estudo foi 7,80 ± 2,22 anos, sendo a maioria do sexo feminino (92%) e com urge-incontinência (92%). A comparação dos eventos de perda urinária pré e pós-tratamento foi estatisticamente significativa (p = 0,04); houve regressão do sintoma de perda urinária referida pelos acompanhantes em todas as crianças que completaram a 20ª sessão; os parâmetros da USGD-TUI, embora não estatisticamente significativos, demonstraram redução do percentual de crianças com contrações detrusoras (62,5% para 43,5%); maior adequação do volume vesical pré-miccional (4,2% versus 19,0%), respectivamente pré e pós-tratamento.Conclusões:A eletroestimulação realizada em duas sessões semanais demonstrou efetividade e metade dos pacientes apresentou regressão da incontinência urinária a partir da 12ª sessão, porém, é necessário maior número de pacientes para confirmação dos resultados obtidos.

AbstractObjective:To determine the effectiveness of 20 twice-weekly sessions of parasacral transcutaneous electrical neural stimulation (TENS) for treatment of urinary urgency and urge-incontinence in children and adolescents.Methods:A Phase II clinical trial was carried out with patients with urinary urgency or urge-incontinence aged between 5 and 14 years. Twenty TENS sessions were conducted, twice weekly, using a Quark® Dualpex 961 apparatus. The variables analyzed were daily micturition, dynamics ultrasonography of the lower urinary tract pre-and post-treatment and responses to a questionnaire on urinary leakage applied during each session.Results:The mean age of the 25 children participating in the study was 7.80 ± 2.22 years, most were female (92%) and had urge-incontinence (92%). The difference in urinary leakage pre- and post-treatment was statistically significant ( p = 0.04); a decline in the symptom of urinary leakage was reported by all caregivers in children who completed the 20th session; the ultrasound parameters, although not statistically significant, showed a reduction in the percentage of children with detrusor contractions (from 62.5% to 43.5%); and a more adequate pre-micturition bladder volume of 4.2% post-treatment compared with 19.0% prior to treatment.Discussion:The electro-stimulation carried out during the twice weekly sessions appeared to be effective and urinary incontinence declined in half of the patients from the 12th session onwards. However, there is a need for a study involving a larger number of patients to confirm the results obtained.

Leiomiomatosis intravenosa de localización cervicovaginal / Intravenous cervicovaginal Leiomyomatosis

La leiomiomatosis intravenosa (LIV) es una patología poco frecuente caracterizada por la presencia de músculo liso en las venas miometriales del cuerpo uterino. Se presenta un caso de LIV limitado a cuello uterino y manguito vaginal. Se realizó histerectomía total con diagnóstico prequirúrgico de miomatosis uterina y menometrorragia. El diagnóstico de LIV fue anatomopatológico mediante técnicas de inmunohistoquímica. Si bien el 70 por ciento de las pacientes con LIV pueden ser curadas con cirugía, en un 30 por ciento de los casos existe persistencia o recurrencia a distancia de la enfermedad. En nuestro caso los controles a treinta meses de la cirugía fueron negativos e incluyeron estudios cardiovasculares, pulmonares, hepáticos y cerebrales.

Intravenous leiomyomatosis (IVL) cervicovaginal is an uncommon pathology, characterized by the presence of sooth muscle in the myometrial veins of the uterine body. A case of IVL is reported, limited to the cervix uteri and the vaginal muff. A total hysterctomy was performed, with presurgical diagnosis of uterine myomatosis and menometrorrhagia. The diagnosis of IVL was performed by clinicopathological analysis and by immunohistochemistry techniques. Although the 70 percent of the patients with IVL can be cured by surgery, in a 30 percentof the cases, there exists persistence and recurrency at distancy from the disease. In our case, the controls after 30 months since surgery were negatives, and included cardiovascular, pulmonary, hepatic and cerebral studies.

Abordagem terapêutica da incontinência urinária de urgência / Therapeutic approach of urgent urinary incontinence

Esta revisão bibliográfica visa abordar o tratamento da incontinência urinária de urgência. Serão abordadas técnicas comportamentais, eletroestimulação, tratamento farmacológico e toxina botulínica.

This bibliographic review aims to address the treatment of urgency urinary incontinence. We'll approach behavioral techniques, electrostimulation, pharmacological treatment and botulinum toxin.

Revisão sistemática das influências do hipoestrogenismo e do treinamento sobre a incontinência urinária / Systematic review of hypoestrogenism influences? and training on urinary incontinence

Marcada por mudanças na função ovariana, a menopausa representa redução dos níveis de estrogênio circulante. Os estrogênios aumentam o trofismo e a vascularização dos músculos do assoalho pélvico (MAP), e seu déficit na menopausa pode estar relacionado ao surgimento da incontinência urinária. O uso do estrogênio e o treinamento dos MAP são opções no tratamento da incontinência urinária. O objetivo deste artigo foi realizar uma revisão sistemática da literatura sobre os efeitos do treinamento dos MAP, da terapia hormonal e da associação de ambos na função dos MAP e da incontinência urinária. Foi feito um levantamento bibliográfico nas bases de dados da Literatura da América Latina e do Caribe (Lilacs), Pubmed e na Cochrane Library. Foram incluídos os manuscritos que investigaram os efeitos do treinamento dos MAP, da terapia hormonal ou da associação de ambos na função dos MAP e incontinência urinária. Os estudos analisados sugerem que a terapia hormonal com estrogênio pode levar à melhora da função dos MAP e da incontinência urinária, assim como o treinamento dos MAP. Quanto à associação da terapia hormonal com treinamento dos MAP, mesmo diante da escassez de estudos que tenham avaliado tal associação, os melhores níveis de evidência científica disponíveis parecem assinalar seu benefício.

Marked by changes in the ovarian function, menopause represents a reduction in the estrogen stock levels. The estrogens enhance the pelvic floor muscle (PFM) trophysm and vascularization, so its shortage at menopause may be related to the emergence of urinary incontinence. The use of estrogen and the PFM training are options in the urinary incontinence treatment. The objective of this article was to conduct a systematic literature review of the PFM training effects, the hormone therapy and their association in the function of the PFM and urinary incontinence. A bibliographic survey was conducted in the databases: Latin American and Caribbean Center on Health Sciences Information (Lilacs), Pubmed and Cochrane Library. Some articles that investigated the PFM training effects, the hormone therapy or their association in the PFM and urinary incontinence function were included. The analyzed studies suggest that hormone therapy with estrogen may lead to the improvement of the PFM function and urinary continence, as the PFM training. Regarding the association of hormone therapy with PFM training, even with few studies that have evaluated this association, the highest levels of scientific evidence available seem to note its benefit.

Implementation of treatment protocol on patients with urinary incontinence

It is postulated that 30% of adult women in the world are affected with genuine urinary incontinence. Another report in Kingdom of Saudi Arabia supports the same percentage of the affected Saudi women [30%]. Different treatment protocols have been proposed for the management of genuine urinary incontinence, but other than exercises, they lack scientific support and research evidence. Pulsed electromagnetic field [PEMF] has been proposed to have a great therapeutic input in people with urinary incontinence through improving the metabolic rate of the pelvic floor muscles to relieve pain and muscle spasm. The efficacy of a specific treatment plan, pelvic floor muscle exercises and PEMF. was implemented on twenty patients [male and female] with stress and/or urge incontinence at Physical Therapy Department. King Faisal Specialist Hospital and Research Center. Was to implement the efficacy of pelvic floor muscle training in combination with pulsed electromagnetic stimulation for people with stress incontinence. Twenty patients with stress and/or urge incontinence were participated in this study. The number of usage pads. urge, and the ability of closing urethral orifice during coughing, sneezing, laughing as well as walking, were used as measuring parameters. Patients taught how to do exercises at home at different levels, and received sessions of PEMF. Support the efficacy of the treatment plan of exercises and PEMF on controlling urinary bladder in patients with stress and/or urge incontinence. An average of 16-18 sessions received by the patients were effective to resolve the symptoms in all patients