Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial

ABSTRACT Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not significantly improve urinary continence or erectile function at 3 months after RP.

The effectiveness of post-partum interventions to prevent urinary incontinence: a systematic review / Eficacia de las intervenciones realizadas en el posparto para prevenir la incontinencia urinaria: revisión sistemática / Eficácia das intervenções realizadas no pós-parto para prevenir incontinência urinária: revisão sistemática

ABSTRACT Objective: to assess the effectiveness of post-partum interventions to prevent urinary incontinence: a systematic review. Method: systematic review of randomized controlled studies conducted in the MEDLINE, Cochrane, Scopus and the Virtual Library on Health (Biblioteca Virtual em Saúde, BVS) databases. Results: six articles were included in this review. All studies used the Pelvic Floor Muscle Training as the main procedure to prevent urinary incontinence. The results pointed to a positive and effective intervention in the post-partum period. Conclusion: there is evidence that programs of exercise of the pelvic floor musculature performed both in the immediate and late post-partum result in a significant increase in muscle strength and contribute to prevent urinary incontinence.

RESUMEN Objetivo: analizar la eficacia de las intervenciones realizadas en el posparto para prevenir la incontinencia urinaria. Método: revisión sistemática de estudios aleatorizados controlados, realizada en las bases de datos MEDLINE, Cochrane, Scopus y Biblioteca Virtual en Salud - BVS. Resultados: seis artículos fueron incluidos en la revisión. Todos los estudios utilizaron el Entrenamiento de la Musculatura del Piso Pélvico como intervención principal para prevenir la incontinencia urinaria y los resultados de las intervenciones apunta a un efecto positivo y eficaz del mismo en el posparto. Conclusión: hay evidencias de que programas de ejercicios de la musculatura del piso pélvico realizados tanto en el posparto inmediato como en el tardío resultan en un aumento significativo de la fuerza muscular y contribuyen a la prevención de la incontinencia urinaria.

RESUMO Objetivo: analisar a eficácia das intervenções realizadas no pós-parto para prevenção da incontinência urinária. Método: revisão sistemática de estudos randomizados controlados realizada nas bases de dados MEDLINE, Cochrane, Scopus e Biblioteca Virtual em Saúde - BVS. Resultados: seis artigos foram inclusos na revisão. Todos os estudos utilizaram o Treinamento da Musculatura do Assoalho Pélvico como intervenção principal para prevenção da incontinência urinária e os resultados das intervenções apontaram para um efeito positivo e eficaz do mesmo no pós-parto. Conclusão: há evidências de que programas de exercícios da musculatura do assoalho pélvico realizados tanto no pós-parto imediato quanto no tardio resultam em aumento significativo da força muscular e contribuem para a prevenção da incontinência urinária.

Impacto de la rehabilitación del piso pelviano en la calidad de vida de mujeres con incontinencia urinaria / Impact of Pelvic Floor Rehabilitation on the Quality of Life of Women with Urinary Incontinence

Objetivos: Evaluar el impacto en la calidad de vida de mujeres con diversos tipos de incontinencia urinaria, en quienes se realizó un programa de entrenamiento de la musculatura del piso pelviano (EMPP). Materiales y métodos: Se llevó a cabo un estudio retrospectivo, descriptivo y analítico que evaluó a mujeres con incontinencia urinaria derivadas al Centro Urológico Profesor Bengió para realizar rehabilitación del piso pelviano entre enero de 2014 y diciembre de 2015. Todas las pacientes recibieron EMPP como primera línea de tratamiento. La calidad de vida fue evaluada mediante cuestionarios validados, entre los que se realizó UDI-6 (Urogenital Distress Index), IIQ-7 (Incontinence Impact Questionnaire) versión corta e IQoL (Incontinence Quality of Life). Las variables continuas fueron comparadas a través de pruebas pareadas de T test y las categóricas por el método de chi cuadrado (X2 ). Las puntuaciones fueron evaluadas previo y posterior al EMPP. Se definió una p<0,05 como estadísticamente significativa. Resultados: La población en estudio se remitió a 82 pacientes. La mejoría subjetiva expresada por las pacientes en una escala de 0-10 fue de 6,33 (desvío estándar [DE]=2,42) con una mediana de 7. En la población general existe una declinación en el cuestionario UDI-6 (-2,6; p<0,0001), IIQ-7 (-2,4; p=0,0001) y un aumento en IQoL (11,35; p<0,0001). En los diferentes tipos de incontinencia urinaria (esfuerzo, urgencia y mixta) también se observó una mejoría individual en todos los cuestionarios en cada tipo de incontinencia urinaria, excepto en el cuestionario IQoL (p=0,34) en pacientes con incontinencia de orina de esfuerzo. Conclusiones: El EMPP representa una terapia no invasiva efectiva en el tratamiento de diversas formas de incontinencia de orina, produciendo un impacto favorable en la calidad de vida de mujeres que padecen esta patología.(AU)

Objectives: To assess the impact on the quality of life in women with different types of urinary incontinence, who was a training of the musculature of the pelvic floor muscle (TMPP) program. Materials and methods: Was a retrospective, descriptive and analytical study evaluated women with urinary incontinence derived for rehabilitation of pelvic floor between January 2014 and December 2015. All patients received TMPP as first line treatment. Quality of life was evaluated performing validated questionnaires, which was carried out: UDI-6 (Urogenital Distress Index), IIQ-7 (Incontinence Impact Questionnaire) short version and IQoL (Incontinence Quality of Life). Continuous variables were compared through the categorical and paired T test tests by chi square (X2 ) method. Scores were assessed pre and post the TMPP. Defined a p<0.05 as statistically significant. Results: The study population was referred to 82 patients. Subjective improvement expressed by patients on a scale of 0-10 was 6.33 (standard deviation [SD]=2.42) with a median of 7. In the general population, there is a decline in the UDI-6 questionnaire (-2.6; p<0.0001), IIQ-7 (-2.4; p=0.0001) and an increase in the IQoL (11.35; p<0.0001). In the different types of urinary incontinence (stress, urgency and mixed) also find an individual improvement in all the questionnaires in each type of urinary incontinence, except in questionnaire IQoL (p=0.34) in patients who are stress urinary incontinence. Conclusions: The TMPP represents a therapy effective non-invasive in the treatment of various forms of urinary incontinence producing a positive impact on the quality of life of women living with this disease.(AU)

Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results

ABSTRACT Background and objective: To prospectively compare the laparoscopic versus open approach to RP in cases with high prostate volume and to evaluate a possible different impact of prostate volume. Materials and Methods: From March 2007 to March 2013 a total of 120 cases with clinically localized prostate cancer (PC) and a prostate volume>70cc identified for radical prostatectomy (RP), were prospectively analyzed in our institute. Patients were offered as surgical technique either an open retropubic or an intraperitoneal laparoscopic (LP) approach. In our population, 54 cases were submitted to LP and 66 to open RP. We analyzed the association of the surgical technique with perioperative, oncological and postoperative functional parameters. Results: In those high prostate volume cases, the surgical technique (laparoscopic versus open) does not represent a significant independent factor able to influence positive surgical margins rates and characteristics (p=0.4974). No significant differences (p>0.05) in the overall rates of positive margins was found, and also no differences following stratification according to the pathological stage and nerve sparing (NS) procedure. The surgical technique was able to significantly and independently influence the hospital stay, time of operation and blood loss (p<0.001). On the contrary, in our population, the surgical technique was not a significant factor influencing all pathological and 1-year oncological or functional outcomes (p>0.05). Conclusions: In our prospective non randomized analysis on high prostate volumes, the laparoscopic approach to RP is able to guarantee the same oncological and functional results of an open approach, maintaining the advantages in terms of perioperative outcomes.

Perfil das pacientes do ambulatório de uroginecologia de um hospital público de Porto Alegre com relação à incontinência urinária e à qualidade de vida / Profile of female patients in the urogynecology ambulatory care of a public hospital in southern Brazil regarding urinary incontinence and quality of life

Introdução: A incontinência urinária (IU) é a perda involuntária de urina e pode ser classificada de acordo com os sintomas, sendo os tipos mais comuns: IU de esforço (IUE), IU de urgência (IUU) e IU mista (IUM). Ela causa impacto físico e psicológico negativo, piorando a qualidade de vida. A fisioterapia pélvica é importante no tratamento conservador da IU, pois é segura, não invasiva e com mínimos efeitos colaterais. Objetivos: Descrever o perfil das mulheres avaliadas pela fisioterapia pélvica no Ambulatório de Uroginecologia do Hospital de Clínicas de Porto Alegre (HCPA) com relação à IU e qualidade de vida. Métodos: Estudo descritivo, transversal e retrospectivo, realizado a partir de informações dos prontuários das pacientes avaliadas pela fisioterapia pélvica no Ambulatório de Uroginecologia do HCPA, de agosto de 2013 a dezembro de 2014. Resultados: Dos 164 prontuários analisados, a média de idade das pacientes foi de 58,07 anos (±10,98), 55% realizaram parto normal, 51% fizeram episiotomia, todas eram multíparas, 60,4% apresentavam prolapso de órgão pélvico e a IUM foi a mais prevalente, sendo que 71,3% perdiam urina em jato. Quanto à força dos músculos do assoalho pélvico, a maioria apresentava grau 2 (31,1%), seguido de grau 1 (28%) e grau 3 (24,4%), conforme a Escala de Oxford Modificada, e 75,6% acionavam musculatura acessória. O International Consultation on Incontinence Questionnaire - Short Form (ICIS-SF) mostrou que o impacto da IU foi grave em 62,8%. Conclusão: Este estudo permitiu identificar as principais demandas da população feminina com IU, facilitando o delineamento de estratégias de reabilitação eficazes e compatíveis com a prática clínica (AU)

Introduction: Urinary incontinence (UI) is an involuntary loss of urine and can be classified according to its symptoms. The most common types are the following: stress UI (SUI), urge UI (UUI), and mixed UI (MUI). It causes negative physical and psychological impact and consequent deterioration in quality of life. Pelvic physical therapy plays an important role in the conservative treatment of UI, since it is noninvasive, safe, and with minimal side effects. Objectives: To describe the profile of female patients evaluated through pelvic physiotherapy at the Urogynecology Ambulatory Care of Porto Alegre Clinical Hospital (HCPA) regarding urinary incontinence and quality of life. Methods: A descriptive, cross-sectional, retrospective, documentary study that used information from the medical records of patients evaluated through pelvic physiotherapy at the Urogynecology Ambulatory Care of HCPA, from August 2013 to December 2014. Results: Of the 164 medical records analyzed, patients' average age was 58.07 years (±10.98), 55% of them underwent vaginal delivery, 51% received episiotomy, all were multiparous, 60.4% had pelvic organ prolapse, and 71.3% had urinary leakage in jets. MUI was the most prevalent type of IU. Regarding the strength of pelvic floor muscles, most patients had grade 2 (31.1%), followed by grade 1 (28%) and grade 3 (24.4%), according to the modified Oxford Grading Scale. 75.6% of the patients used some accessory musculature. Quality of life was measured by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), which showed that the impact of UI was severe in 62.8% of the patients. Conclusion: The present study identified the main demands of the female population with symptoms of UI, facilitating the design of effective rehabilitation strategies which are compatible with clinical practice (AU)

The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence / Influencia da intervencao fisioterapeutica ambulatorial sobre a musculatura do assoalho pelvico em mulheres com incontinencia urinaria

OBJECTIVE: To assess the effect of a weekly, short-term physical therapy intervention on the pelvic floor muscles and urinary incontinence (UI) among patients of the public health system. METHOD: Quasi-experimental before-and-after study. Clinical history and function evaluation were performed using perineal bidigital maneuvers and perineometry. The intervention consisted of transvaginal electrical stimulation and pelvic floor kinesiotherapy. Data were analyzed using the paired t test or Wilcoxon signed-rank test, Pearson product-moment correlation coefficient or Spearman's rank correlation coefficient. A value of P<0.05 was considered significant. RESULTS: Eight-two women 55.1±10.9 years-old were evaluated. Mixed urinary incontinence (MUI), stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were observed in 52.4%, 36.6% and 11%, respectively. The length of UI was 6.0 years (3.0-10). Approximately 13.64 physical therapy sessions were held on average. There was no difference in perineometry measurements following the intervention (40.6±24.1 versus 41.7±25.4, P=0.098). Muscle function significantly increased (P<0.01) in the bidigital maneuver. The patients reported being continent or satisfied with the treatment in 88.9% of cases. CONCLUSIONS: The results demonstrated an increase in muscle function and the attainment of urinary continence or treatment satisfaction in most cases. .

OBJETIVO: Verificar a influência de uma intervenção fisioterapêutica semanal e de curta duração sobre a musculatura do assoalho pélvico e sobre a incontinência urinária (IU) em usuárias da rede pública de saúde. MÉTODO: Estudo quase-experimental do tipo antes e depois. Foi realizada anamnese e avaliação da função perineal por meio da manobra bidigital e perineometria. A intervenção consistiu em eletroestimulação transvaginal e cinesioterapia pélvica. Os dados foram analisados por meio do teste t pareado ou Wilcoxon, regressão linear de Pearson ou Spearman. Um valor de P<0,05 foi considerado como significativo. RESULTADOS: Foram avaliadas 82 mulheres com idade de 55,1±10,9 anos. Incontinência urinária mista (IUM), incontinência urinária de esforço (IUE) e incontinência urinária de urgência (IUU) foram observadas em 52,4%, 36,6% e 11%, respectivamente. A duração da IU foi de 6,0 anos (3,0-10). Foram realizadas, em média, 13,64 sessões fisioterapêuticas. Não houve diferença, após a intervenção, nas medidas da perineometria (40,6±24,1 versus 41,7±25,4, P=0,098). Na manobra bidigital, a função muscular aumentou significativamente (P<0,01). Em 88,9% dos casos, as pacientes informaram estar continentes ou satisfeitas com o tratamento. CONCLUSÕES: Os resultados mostraram aumento da função muscular e obtenção da continência urinária ou satisfação com o tratamento na maioria dos casos. .

Between suffering and hope: rehabilitation from urinary incontinence as an intervening component / Entre o sofrimento e a esperança: a reabilitação da incontinência urinária como componente interveniente

This is a qualitative study seeking to understand Brazilian women's experience of urinary incontinence (UI) and design a representative theoretical model for the experience. Theoretical saturation occurred after analysis of the 18th non-directive interview in accordance with Grounded Theory. Two phenomena emerged: living with the challenges of UI and experiencing the hope and disappointment of rehabilitation from UI. Upon re-alignment of the components, the core category emerged, namely: between suffering and hope - rehabilitation from urinary incontinence as an intervening component. From the analysis in light of symbolic interactionism, pregnancy and vaginal birth were observed to be symbols of women's vulnerability to the suffering from living with the moral and physio-psychosocial challenges of UI. It is also inferred that the lack of consideration of the Unified Health System (SUS) in investing in the process of rehabilitation from UI may be having a negative effect on the incentive programs for promoting vaginal birth. Most of all, it reveals the ongoing suffering of women with UI, most of whom do not have access to rehabilitation due to the lack of programs geared to the real needs of these users of the Unified Health System.

Estudo de natureza qualitativa com os objetivos de compreender a experiência de mulheres com incontinência urinária e elaborar um modelo teórico representativo da mesma. A saturação teórica se deu mediante a análise da 18ª entrevista não diretiva, segundo a Teoria Fundamentada nos Dados. Emergiram dois fenômenos: convivendo com os desafios da Incontinência Urinária (IU) e vivenciando a esperança e a desilusão de reabilitar-se da IU. Do re-alinhamento dos componentes provindos dos fenômenos emergiu a categoria central, denominada: entre o sofrimento e a esperança - o apoio e o acesso a reabilitação da IU como componente interveniente. Da análise à luz do Interacionismo Simbólico verificou-se que a gravidez e o parto vaginal emergem como símbolos de vulnerabilidade da mulher ao sofrimento de conviver com o desafio moral e fisiopsicossocial da IU. Bem como a inferência de que a desconsideração do Sistema Único de Saúde (SUS) com investimentos no processo de reabilitação da IU possa estar fragilizando os próprios programas de incentivo ao parto vaginal. Aponta a perpetuação do sofrimento da mulher com a IU, que na maioria não tem acesso à reabilitação por falta de programas voltados às reais necessidades dessas usuárias do SUS.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I

Objective To compare the use of polypropylene mesh (PM) and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP) using objective and subjective tests and evaluation of quality of life (QoL). Materials and Methods One hundred women were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a PM implant and the control group (n = 55) was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System) and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire - Vaginal Symptoms). Complications related to the use of PM or not were also described. Results There was a significant difference between all POP-Q measures of pre- and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. Conclusion The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups. .

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part II

Objective To compare the effects of two surgical procedures for the correction of anterior vaginal wall prolapse (AVWP) on the lower urinary tract symptoms (LUTS) using symptom questionnaires and quality of life (QoL). Materials and Methods One hundred women with Pelvic Organ Prolapse Quantification stage (POP-Q) ≥ 2 were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a polypropylene mesh (PM) implant and the control group (n = 55) was submitted to anterior colporraphy with or without synthetic sling. Postoperatory follow-up was done after 12 months. The primary objective was to compare the effect of the surgeries on LUTS using the final scores of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Overactive Bladder Questionnaire (OAB-V8), as well as the analysis of the incapacitating urinary symptoms and “de novo” urinary symptoms after 12 months of surgery in both groups. Results Although there was a different number of women in each group, randomization was adequate, resulted in homogeneous groups that could be compared regarding socio demographic, clinical and gynecological (POP-Q) variables. Patients of both groups showed improvements regarding LUTS and QoL, whether using polypropylene mesh or not, based on the final scores of the ICIQ-UI SF and OAB-V8 questionnaires after 12-month follow-up. There were few incapacitating and “de novo” urinary symptoms, without any significant statistical difference between both groups after 12 months of surgery. Conclusion There was a general improvement of LUTS and QoL in both groups after 12-month follow-up. However, there was no significant difference of LUTS, as well as the more incapacitating and “de novo” urinary symptoms between both groups after 12 months of surgery. .

Resultados de la rehabilitación kinésica de piso pélvico en un grupo de mujeres con incontinencia de orina / Results of pelvic floor kinesiologic rehabilitation in a group of women with urinary incontinence

Según la ICS, la primera línea de tratamiento para Incontinencia de Orina debería ser la rehabilitación kinésica de piso pélvico ya que se produce una mejoría de los síntomas hasta en un 85 por ciento de los casos. El objetivo de este trabajo fue describir los resultados de una cohorte de mujeres incontinentes tratadas con un protocolo de rehabilitación, comparando la técnica biofeedback manual versus biofeedback electromiográfico. Se analizó un total de 68 mujeres de 30 a 80 años de edad con diagnóstico médico de IU, derivadas a Rehabilitación kinésica de piso pélvico entre marzo de 2011 y marzo de 2012. Se generaron 2 grupos de intervención mediante muestreo dirigido. En el grupo 1 (G1) constó de 48 mujeres que recibieron el siguiente protocolo: biofeedback manual (BM), pauta de ejercicios en domicilio y neuro modulación de tibial posterior. El grupo 2 (G2) constó de 20 mujeres que fueron tratadas con biofeedback electromiográfico (BEM) y la misma pauta de ejercicios en domicilio y protocolo de neuro modulación de tibial posterior. Al evaluar los datos obtenidos no se objetivaron diferencias signi-ficativas entre ambos grupos previo a la intervención. En todos los casos y con ambas técnicas se objetivan mejorías significativas en cuanto a frecuencia miccional diurna / nocturna, numero de apósitos diurno / nocturno, cuantía de la fuga, fuerza muscular y calidad de vida. Sin embargo, se objetivo menor frecuencia de micción diurna al final del seguimiento con técnica BEM (mediana de 5, IC 95 por ciento 1.12 – 7) respecto al BM (mediana de 7, IC 95 por ciento 6-7) p= 0.0208. Conclusión: Ambas protocolos de rehabilitación kinésica del piso pélvico mostraron mejoría significativa en la calidad de vida y fuerza perineal, evidenciando una disminución en los episodios de incontinencia, urgencia y uso de apósitos. Por otra parte, la única diferencia significativa entre el protocolo de biofeedback electromiográfico y manual, fue que el primero mostró menor...

According to the ICS, the first line of treatment for urinary incontinence should be pelvic floor rehabilitation, as it shows an improvement of symptoms in 85 percent of cases. The aim of this study was to describe the results of a cohort of incontinent women treated with a rehabilitation protocol, comparing the techniques: Manual versus Electromyographic biofeedback. Material and methods: We analyzed a total of 68 women, 30- 80 years of age, with medical diagnosis of urinary incontinente referred to Pelvic Floor Rehabilitation between March 2011 and March 2012. 2 groups were generated by targeted intervention. Group 1 (G1) consisted of 48 women who received the following protocol: Manual biofeedback (BM), exercise regimen at home and posterior tibial neuromodulation. Group 2 (G2) consisted of 20 women who were treated with Electromyographic biofeedback (BEM) and the same pattern of exercise protocol and posterior tibial neuromodulation. The data obtained showed no signi¬ficant differences between the two groups before the intervention. In all cases and with both techniques are we objectified significant improvements in terms of urinary frequency day / night, number of pads day / night, amount of leakage, muscle strength and quality of life. However, we observed less daytime micturition frequency at follow- up with BEM technique (median 5, 95 percent CI 1.12 - 7) compared to BM (median of 7, 95 percent CI 6- 7) p = 0.0208. Both pelvic floor reahabilitation protocols showed significant improvement in quality of life and perineal strength, showing a decrease in incontinence episodes, urgency and use of pads. Moreover, the only signi¬ficant difference between electromyographic biofeedback protocol and manual biofeedback protocol, was that the daytime voiding frequency was lower in the ¬ first Group compared to the second.

Intervenção fisioterapêutica em mulheres com incontinência urinária associada ao prolapso de órgão pélvico / Physical therapy intervention in women with urinary incontinence associated with pelvic organ prolapse

CONTEXTUALIZAÇÃO: A incontinência urinária (IU) é um sintoma comum que afeta mulheres de todas as idades. A ocorrência de prolapso de órgão pélvico concomitante à IU é muito comum. OBJETIVO: Avaliar o efeito da presença de prolapso pélvico no resultado de tratamento fisioterapêutico de mulheres com IU. MÉTODOS: Participaram do estudo 48 mulheres com idades entre 35 e 78 anos, as quais foram submetidas a anamnese e avaliação da força de contração do assoalho pélvico (teste bidigital e perineometria). A intervenção fisioterapêutica consistiu em eletroestimulação transvaginal e cinesioterapia (até 15 sessões semanais). RESULTADOS: A maioria das mulheres realizou parto normal (29/46) e teve 2,6±1,5 filhos (de 0 a 7). Apresentaram prolapso pélvico 72,4% das mulheres que realizaram parto normal, 100% das que realizaram cesárea e 77,8% das que realizaram parto normal e cesárea. 48% das mulheres tinham IU mista; 39,5%, IU de esforço e 12,5%; IU de urgência. O tempo de duração dos sintomas variou de dois a 28 anos (7,9±5,3). Detectou-se diferença estatística significativa nas comparações pré e pós- tratamento para os músculos do assoalho pélvico, tanto para o grupo de pacientes sem prolapso como para o grupo com. A perineometria pré e pós apresentou diferença estatística significativa apenas nas pacientes com prolapso (p=0,048). 87,5% das participantes ficaram continentes. CONCLUSÕES: O tratamento fisioterapêutico realizado foi eficaz para tratar e/ou curar os sintomas de IU associada ou não ao prolapso pélvico, independente do tipo clínico da incontinência. Registro de Ensaios Clínicos (Registro Brasileiro de Ensaios Clínicos): RBR-3p5s66.

BACKGROUND: Urinary incontinence (UI) is a prevalent condition that affects women of all ages. Pelvic organ prolapse in conjunction with UI is a common occurrence. OBJECTIVE: To assess the effect of pelvic prolapse on the outcome of physical therapy treatment for women with UI. METHODS: The study included 48 women aged between 35 and 78 years who underwent anamnesis and measurement of pelvic floor strength (bi-digital test and perineometry). The physical therapy intervention consisted of transvaginal electrical stimulation and pelvic floor exercise for up to 15 weekly sessions. RESULTS: The majority of the women had normal delivery and 2.6±1.5 children (range=0-7). Pelvic prolapse was observed in 72.4% of the women who had normal delivery, in 100% of those who had cesarean section, and in 77.8% of those who had both normal and cesarean deliveries. 48% of the women had mixed UI, 39.5% had stress UI, and 12.5% had urge UI. The duration of symptoms varied from 2 to 28 years (7.9±5.3). In the participants with and without prolapse, a significant difference was observed in the pre- and post-treatment comparisons for the pelvic floor muscles. The pre- and post-treatment perineometry showed a significant increase only in the women with prolapse (p=0.048). 87.5% of the participants became continent. CONCLUSIONS: The physical therapy treatment was effective in treating and/or curing the symptoms of UI, whether or not associated with pelvic prolapse, regardless of the clinical type of incontinence. Clinical Trial Registration (Brazilian Clinical Trial Registry): RBR-3p5s66.

Exercícios de Kegel associados ao uso de cones vaginais no tratamento da incontinência urinária: estudo de caso / Kegel exercises with the use of vaginal cones in treatment of urinary incontinence: a case study

Objetivos: identificar os efeitos dos exercícios de Kegel associados ao uso dos cones vaginais na incontinência urinária.Descrição do Caso: participou da pesquisa uma mulher com dois partos cesáreos prévios, sendo que o primeiro filho nasceu com 3.600 g e o segundo com 4.100 g. A paciente tinha diagnóstico médico de incontinência urinária de urgência. Na avaliação geniturinária realizada na primeira sessão com fisioterapeuta, verificou-se hipotonia e flacidez acentuada da musculatura perineal, segundo a escala de Ortiz com grau 2 de força muscular. O pad-test indicou perda urinária de 35 g. Após realizar 10 sessões de fisioterapia com os exercícios de Kegel associados ao uso dos cones vaginais, foi realizada a avaliação final, quando a paciente apresentou grau 3 de força muscular na escala de Ortiz e perda urinária de 25 g no pad-test. A paciente referiu estar sentindo os resultados positivos após as10 sessões.Conclusões: concluiu-se que os exercícios de Kegel associados ao uso dos cones vaginais, nesta paciente, levaram à melhora da incontinência urinária em um curto período de tratamento.

Aims: To identify the effects of Kegel exercises associated with the use of vaginal cones in urinary incontinence.Case Description: A woman with two prior cesarean deliveries participated in the study. Her first child was born with 3,600 g and the second with 4,100 g. The patient was medically diagnosed with urge incontinence. The genitourinary evaluation held in the first session with a physiotherapist showed marked hypotonia and laxity of the perineal muscles, which according to the scale of Ortiz had grade 2 muscle strength. The Pad-test indicated urinary loss of 35 g. After performing 10 sessions of physiotherapy with Kegel exercises associated with the use of vaginal cones, the final evaluation was performed. The patient then had grade 3 muscle strength in the range of Ortiz, and urine loss was25 g according the pad-test. The patient reported to be feeling the positive results after 10 sessions.Conclusions: we concluded that Kegel exercises associated with the use of vaginal cones in this patient, led to the improvement of urinary incontinence in a short period of treatment.

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.

Ligação do king's heath questionário com a classificação internacional de funcionalidade, incapacidade e saúde, para avaliação de pacientes com incontinência urinária pós cirurgia oncológica ginecológica / Link between the king's health questionnaire and the international classification of functioning, disability and health, for the evaluation of patients with urinary incontinence after gynecological oncology surgery

O tumor de colo uterino é o segundo mais incidente entre as mulheres no mundo e no Brasil estimam-se para 2008, 18.680 casos novos. O tratamento de escolha para esta neoplasia envolve procedimentos cirúrgicos, quimioterápicos e radioterápicos, que possibilitam a cura, mas que de forma negativa permitem o surgimento de seqüelas, como incontinência urinária. A incontinência apresenta-se como uma complicação precoce e comum ao tratamento cirúrgico destas pacientes e envolve deterioração da qualidade de vida, gerando níveis de morbidade, afetando domínios psicológicos, ocupacionais, domésticos, físicos e sexuais. Para a avaliação de qualidade de vida em pacientes portadoras de incontinência existem vários questionários que são divulgados na literatura científica mundial, dentre estes, o King s Health questionário (KHQ) é o mais utilizado como instrumento de pesquisa. Além dos questionários de qualidade (QV), a OMS vem preconizando a utilização da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), como ferramenta de estatística, pesquisa, clinica e política social, para proporcionar uma linguagem comum das condições relacionadas à saúde. O presente trabalho teve como objetivo estabelecer a ligação entre o KHQ e a CIF. O KHQ foi relacionado através de dois profissionais (individualmente), seguido de discussão e conclusão dos domínios codificados. Foram encontrados 12 categorias de funções corporais (b), 22 para atividades e participação (d) e 4 para fatores ambientais (e), no entanto, 7 conceitos significativos do questionário não puderam ser ligados com a CIF. O KHQ tem enfoque predominante nas questões referentes à atividade e participação. Trata-se de um estudo piloto que necessita de mais evidências para conclusão dos achados.

Uterine cervix tumors are the second most common type of tumor among women in the world. In Brazil, 18,680 new cases were estimated for 2008. The treatment of choice for this type of cancer involves surgery, chemotherapy, and radiotherapy that encourage healing but, on the down side, impairments develop such as urinary incontinence. This incontinence appears as an early and common complication of the surgical treatment and involves deterioration in the quality of life, generating levels of morbidity, affecting psychological, occupational, domestic, physical, and sexual areas. To asses the quality of life in patients with incontinence there are several questionnaires in the scientific literature. Among them, the King?s Health Questionnaire (KHQ) is the most widely used as a research tool. In addition to accessing quality of life, the World Health Organization is advocating the use of the International Classification of Functioning, Disability and Health (ICF) as a tool for statistics, research, clinical and social policies, to provide a common language for the conditions related to health. The objective of this study is to establish a correlation between the KHQ and the ICF. The KHQ was correlated by two separate professionals, and followed by a discussion and conclusion of the coded domains. Twelve categories were found for body functions (b), 22 for activities and participation (d), and 4 for environmental factors (e), however, 7 significant concepts of the questionnaire could not be linked to the ICF. The KHQ has focused predominantly on issues related to activity and participation. This is a pilot study that needs more evidence to conclude its findings.

Sintomas urinários pós-histerectomia radical: revisão de literatura e análise de dados / Urinary symptons after radical hysterectomy: bibliographic review and analysis of data

O carcinoma do colo uterino representa um importante problema de saúde pública. Mundialmente é a quarta maior causa de mortes por câncer, e no Brasil é a neoplasia mais frequente do trato genital feminino, sendo a segunda maior causa de morte por câncer em mulheres e a primeira de morte em mulheres em idade reprodutiva. Uma das formas de tratamento é a histerectomia radical, sendo que neste tratamento 70 por cento das mulheres apresentam disfunção vesical após o procedimento. O objetivo do estudo foi analisar a relação de sintomas urinários pós-cirurgia. Foi realizado levantamento bibliográfico com publicações entre os anos de 1997 a 2007. Percebeu-se que sintomas urinários são cada vez mais frequentes após histerectomia radical e entre as causas a mais provável é a lesão nervosa durante o procedimento, prejudicando ainda mais a qualidade de vida destas pacientes. Sabendo-se disto, é de fundamental importância o acompanhamento multidisciplinar destas doentes, incluindo-se nesta equipe o fisioterapeuta, o qual poderá contribuir significantemente no tratamento proposto.

The carcinoma of the uterine cervix is a great public health problem. In the world, it is the fourth leading cause of cancer deaths and in Brazil, it is the most common cancer of the female genital tract, and the second cause of cancer deaths in women and the first of death in women at reproductive age. One of the treatment methods is the radical hysterectomy. In this treatment, 70 percent of women present bladder dysfunction after surgery. The objective of the study was to examine the relation of urinary symptoms after radical hysterectomy for cancer of the cervix, and to examine the causes of the presence of urinary symptoms after surgery. The bibliographic survey was done on publications between the years of 1997 and 2007. It is possible to emphasize that urinary symptoms are increasingly frequent after radical hysterectomy. The disease itself undermines the physical, psychological and social well-being of the patient, and after the withdrawal of the uterus other consequences may appear, further damaging the quality of life of these patients. Bearing this in mind, it is a fundamental importance multidisciplinary monitoring of these patients, including in this team the physical therapist, who could contribute significantly in the proposed treatment.

Fisioterapia no tratamento da incontinência urinária feminina / Physical therapy in the treatment of female urinary incontinence

A incontinência urinária (IU) consiste em um problema de saúde pública comum entre as mulheres em qualquer período da vida e em todas as faixas etárias, cujo risco aumenta com a idade, podendo determinar uma série de consequências físicas, econômicas, psicológicas, emocionais, sexuais e sociais que poderão interferir de forma negativa em sua qualidade de vida. Os tipos de IU que mais acometem as mulheres são a IU de esforço (IUE), a bexiga hiperativa idiopática (BH) e a IU mista (IUM). Existem diversas formas de tratamento para a IU; o tratamento conservador fisioterapêutico tem sido considerado uma opção relevante nos últimos tempos. Este estudo tem por objetivo analisar a atuação da fisioterapia no tratamento da IU feminina. Baseou-se no levantamento de referências bibliográficas nacionais e internacionais. Conclui-se que a atuação da fisioterapia é importante para o tratamento da IU, principalmente nos casos leves e moderados, pois proporciona a melhora e/ou a cura dos sintomas provocados pela IU e a melhora da qualidade de vida dessas mulheres. Além disso, consiste em um tratamento com menos reações adversas, não oneroso em relação aos tratamentos cirúrgico e medicamentoso, menos invasivo e de baixo custo em comparação a outras formas de tratamento.

The urinary incontinence (UI) is a common public health problem among women, which can occur in any life period, any age group, with increase in the risk due to ageing, and possibility of determining physical, economical, psycological, emotional, sexual and social consequences that can interfere negativelly in their life quality. The most commom kinds of UI in women are: stress urinary incontinence (SUI), idiopatic overactive bladder (OAB) and mixed urinary incontinence (MI). There are different treatments for UI; but the conservative physiotherapeutic treatment has been considered as a relevant option. The objective of this study was to analyse the actuation of physical therapy in the treatment of urinary incontinence in women. The study was based on a gathering of national and international references. As conclusion, we can say that the actuation of physical therapy is important in the treatment for urinary incontinence mainly in mild and moderate cases, for it provides improvement and/or healing of the symptoms provoked by UI and improves women's quality of life. Besides, it is a less invasive treatment, with less side effects, and cheaper than other kinds of treatment.

Desenvolvimento de recurso de animação como suporte informativo na incontinência urinária / Development of animation resource as information support in urinary incontinence

Esta pesquisa buscou descrever as etapas do desenvolvimento de um recurso de animação como suporte informativo no tratamento da incontinência urinária, culturalmente adaptado em termos de linguagem, características e necessidades de mulheres idosas. Realizou-se estudo descritivo em serviço de atenção à saúde secundária. Subgrupo determinado entre março e abril de 2007. Levantou-se através de formulário, na primeira fase do trabalho, dados sobre variáveis sociodemográficas e antecedentes pessoais relacionados à perda urinária. Para a segunda fase utilizou-se a técnica de associação livre de palavras buscando conhecer o vocabulário empírico adotado pelas participantes para anatomia dos órgãos genitais e assoalho pélvico. Simultaneamente, trabalhou-se junto ao G 1000 para elaboração da tecnologia com imagens animadas e associadas às expressões culturais. Destacam-se 8 mulheres com história de incontinência urinária, destas 04 corresponderam ao subgrupo. A idade variou de 63 a 78 anos. Observou-se número elevado de gestações e de partos vaginais, o tempo de perda urinária variou de 1 a 8 anos, sendo que os episódios semanais aconteciam diariamente. Obteve-se uma diversidade de expressões que auxiliaram o processo de elaboração do recurso com o G1000. O recurso de animação poderá contribuir como estratégia de abordagem clínica na incontinência urinária pelo profissional de saúde.

iThis research project sought to describe the steps in the development of an animation resource with informative support for the treatment of urinary incontinence, culturally adapted in terms of language, characteristics, and the needs of older women. A descriptive study was carried out in a secondary health service. Subgroup determined between March and April of 2007. Data concerning socio-demographic variables and personal history related to urinary loss were surveyed by a questionnaire in the first phase of the study. For the second phase, the technique of free word association was used to learn the empirical vocabulary used by the participants for the anatomy of the genitals and pelvic region. At the same time, a partnership was formed with the G-1000 to develop technology with animated images associated with cultural expressions. Eight women were chosen with a history of urinary incontinence, four of which corresponded to the subgroup. Ages varied from 63 to 78 years. A high number of gestations and vaginal childbirths were observed, and the time of urinary leakage varied from one to eight years, since the weekly episodes happened daily. A wealth of expressions were collected which helped in developing the resource with the G-1000. The animation resource will be able to contribute strategically to the clinical approach to urinary incontinence by the health professional.

Tratamento conservador da incontinência urinária na mulher / Treatment conservative of urinary incontinence in the woman

Os autores fazem uma revisão sobre os tratamentos não-cirúrgicos para a incontinência urinária feminina, enfatizando a importância de seu emprego em nível primário de assistência e mostrando os bons índices de satisfação destes métodos.

Effectiveness of a Behavioral Intervention Program for Urinary Incontinence in a Community Setting / 간호학회지

PURPOSE: The purposes of this study were to examine the effectiveness of a behavioral intervention program combining pelvic floor muscle exercise with bladder training for urinary incontinence and also to conduct follow-up assessment after self-training. METHODS: This study was conducted using a non-equivalent control group, pretest-posttest design. The subjects were 60 middle-aged women (control group, n=30; intervention group, n=30) who experienced an episode of urinary incontinence at least once a week. The program was run over a 4 week period (once a week) and composed of urinary incontinence education, pelvic floor muscle exercise, and bladder training. RESULTS: Overall, there was a significant difference in urinary incontinence symptoms and psycho-social wellbeing related to urinary incontinence between the treatment and control group. Of the variables, weekly leakage frequencies, leakage amounts on each occasion, leakage index, frequencies of nocturia, and quality of life were significantly different between the groups. Follow-up assessment (9th week) indicated that overall incontinence symptoms and psycho-social well-being were significantly different between the posttest and follow-up assessments. Most variables of incontinence symptoms and psycho-social well-being were significantly improved at follow-up assessment versus posttest. CONCLUSIONS: The program was overall effective in terms of relieving symptoms and improving psycho-social well-being related to urinary incontinence, and this effect continued after a 4-weeks self-training period. In the respect that this is a community-based application study, the results can be meaningful and applicable.