Association between the rs1036819 polymorphism of the ZFAT gene and pelvic organ prolapse: a case-control study.

INTRODUCTION AND HYPOTHESIS: The identification of risk factors for pelvic organ prolapse (POP) would contribute to planning prevention strategies. This study tests the hypothesis that the rs1036819 polymorphism in the ZFAT gene is associated with POP and investigates other risk factors for prolapse development. METHODS: A case-control study was carried out including 826 postmenopausal women divided into POP cases (stages III and IV) and controls (stages 0 and I), assessed by anamnesis, examination, and peripheral blood samples. DNA was extracted from blood and genotyped by real-time RT-PCR. We used logistic regression models for the association analyses of variables, with p < 0.05 for significance. RESULTS: Five hundred and sixty-eight women were evaluated (315 POP and 253 controls). The minor allele C was found in 19.3% of our sample and the genotype frequencies of AA, AC, and CC were similar in both groups. Age (OR 1.09, 95% CI 1.06-1.13), number of pregnancies (OR 1.23, 95% CI 1.08-1.41), history of one vaginal delivery (OR 3.39, 95% CI 1.38-8.33) or two or more (OR 2.51, 95% CI 1.04-6.07), weight of the largest newborn (OR 1.0001, 95% CI 1-1.001), and family history of POP (OR 2.27, 95% CI 1.24-4.13) were independent risk factors for POP, whereas one cesarean section (OR 0.48, 95% CI 0.27-0.88) or two or more (OR 0.14, 95% CI 0.05-0.38) were protective. CONCLUSIONS: No association was detected between the rs1036819 polymorphism of the ZFAT gene and advanced POP. Age, number of pregnancies, at least one vaginal delivery, weight of the newborn, and POP family history were independent risk factors for POP.

A incontinência urinária nas fases de climatério e menopausa: Efeitos, Consequências e Aceitação / Urinary incontinence in the climacteric and menopause phases: Effects, Consequences and Acceptance

Este trabalho traz a reflexão, através de conhecimentos multidisciplinares, sobre a incontinência urinária em decorrência da menopausa. Conceitua, a critério de informação, as diferentes fases que compõem o período de finalização da menstruação, experenciadas pelo público feminino, mais especificamente o climatério, pré-menopausa, menopausa e pós-menopausa. A discussão tem o objetivo de encontrar alternativas de comunicação e interação com a mulher em menopausa e trabalhar todos os sintomas possíveis encontrados nesta fase da vida, para que ela perceba a importância e a necessidade de procurar ajuda médica, informações inerentes ao tema, para uma melhor qualidade de vida, saúde e segurança nas suas transformações físicas e psíquicas. Reflete-se também sobre a realidade da mulher, os efeitos e impactos da menopausa na vida dela e a incontinência urinária como efeito dessa passagem. Como elas enfrentam essa condição no dia a dia e a insegurança que carregam ao viverem esse momento de transformação e 'perdas' relacionadas. Por isso, os profissionais debatem sobre a importância da comunicação e da disseminação da informação como caminhos para auxiliar na compreensão desse público a tudo relacionado à condição de incontinência urinária, em especial na menopausa. Os temas também debatem sobre a rede de apoio e o papel de cada um na percepção das mulheres ao que elas devem fazer, como fazer e por que fazer os tratamentos preventivos ou remediativos. É ciclo natural da vivência da mulher, mas os sintomas e efeitos não podem ser naturalizados, por isso a necessidade de se entender o panorama da incontinência urinária, nível Brasil, na vida das mulheres em menopausa.(AU)

This work brings reflection, through multidisciplinary knowledge, on urinary incontinence due to menopause. It conceptualizes, at the discretion of information, the different phases that make up the period of completion of menstruation, experienced by the female public, more specifically the climacteric, pre-menopause, menopause and post-menopause. The purpose of the discussion is to find alternatives for communication and interaction with women undergoing menopause and to work on all the possible symptoms found in this phase of life, so that she realizes the importance and need to seek medical help, information inherent to the subject, for a better quality of life, health and safety in their physical and mental transformations. It also reflects on the reality of women, the effects and impacts of menopause on her life and urinary incontinence as an effect of this transition. How they face this condition on a daily basis and the insecurity they carry when experiencing this moment of transformation and related 'losses'. Therefore, professionals discuss the importance of communication and dissemination of information as ways to help this public understand everything related to the condition of urinary incontinence, especially in menopause. The themes also discuss the support network and the role of each one in the women's perception of what they should do, how to do it and why to do preventive or remedial treatments. It is a natural cycle of women's experience, but the symptoms and effects cannot be naturalized, hence the need to understand the panorama of urinary incontinence, at the level of Brazil, in the lives of women undergoing menopause.(AU)

Este trabajo trae la reflexión, a través del conocimiento multidisciplinario, sobre la incontinencia urinaria por menopausia. Conceptualiza, a criterio de la información, las diferentes fases que componen el período de finalización de la menstruación, experimentado por el público femenino, más específicamente el climaterio, la premenopausia, la menopausia y la posmenopausia. El propósito de la charla es encontrar alternativas de comunicación e interacción con la mujer en la menopausia y trabajar todos los síntomas posibles encontrados en esta etapa de la vida, para que ella se dé cuenta de la importancia y necesidad de buscar ayuda médica, información inherente al tema. , para una mejor calidad de vida, salud y seguridad en sus transformaciones físicas y mentales. También reflexiona sobre la realidad de la mujer, los efectos e impactos de la menopausia en su vida y la incontinencia urinaria como efecto de esta transición. Cómo enfrentan esta condición en el día a día y la inseguridad que cargan al vivir este momento de transformación y las 'pérdidas' relacionadas. Por lo tanto, los profesionales discuten la importancia de la comunicación y la difusión de información como formas de ayudar a este público a comprender todo lo relacionado con la condición de incontinencia urinaria, especialmente en la menopausia. Los temas también discuten la red de apoyo y el papel de cada uno en la percepción de las mujeres sobre lo que deben hacer, cómo hacerlo y por qué hacer tratamientos preventivos o curativos. Es un ciclo natural de la experiencia de la mujer, pero los síntomas y los efectos no se pueden naturalizar, de ahí la necesidad de comprender el panorama de la incontinencia urinaria, a nivel de Brasil, en la vida de las mujeres en fase de menopausia.(AU)

Management of Stress Urinary Incontinence With Pelvic Floor Muscle Training for a Woman With Charcot-Marie-Tooth Disease: A Case Report.

Objective: The purpose of this report is to describe the effects of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) of a woman with Charcot-Marie-Tooth (CMT) disease. Clinical Features: A 50-year-old female patient with a diagnosis of type II CMT disease was referred to treatment as a result of a complaint of urinary loss upon effort (ie, coughing and sneezing). She reported that the symptoms started about 36 months prior. The urodynamic study revealed SUI with a Valsalva leak point pressure of 84 cmH2O. Intervention and Outcome: The treatment of SUI was carried out through a PFMT program for 12 weeks (with supervision) and exercises at home for another 12 weeks. A specialized physiotherapist measured symptoms and severity of SUI (3-day urinary diary, 1-hour pad test), pelvic floor muscle function (digital palpation, manometry and dynamometry), effect of the SUI on quality of life (Incontinence Quality of Life Questionnaire), and adherence to the outpatient sessions and to home exercise sets, which also were assessed (exercise diary). Conclusion: In this patient with CMT disease, improvements in urinary symptoms and severity of SUI, pelvic floor muscle function, and effect of SUI on quality of life were noted after PFMT.

Predictors for long-term adherence to vaginal pessary in pelvic organ prolapse: a prospective study.

INTRODUCTION AND HYPOTHESIS: The objective was to investigate the rate of adherence to pessary treatment for pelvic organ prolapse (POP), to identify factors associated with long-term (longer than 1 year) use of vaginal pessaries in Brazilian women with POP and its impact on quality of life (QoL). METHODS: A prospective observational study assessed 247 consecutive women candidates for a pessary to manage symptomatic POP. Patients were fitted with a ring pessary and follow-up visits were performed at 1, 6, and 12 months. Pessary complications and reasons for discontinuation were recorded. Prolapse Quality of Life Questionnaire (P-QoL) was applied at baseline and after 1 year of treatment. We used a logistic regression model for the analyses, with p < 0.05 for significance. RESULTS: A total of 236 women were included in the study, of whom 110 (46.6%) maintained the pessary treatment for longer than 12 months. The main reason for pessary discontinuation was the patient opting for surgery (50.8%). Vulvovaginitis was the main long-term complication (44.5%), followed by vaginal ulceration (16.4%) and urinary urgency (10%). No prior hysterectomy (OR = 2.26; 95% CI 1.19-4.31), vaginal estrogen use (OR = 1.94; 95% CI 1.06-3.52), and mean age (OR = 1.03; 95% CI 1.01-1.06) were variables associated with long-term use of vaginal pessary (p < 0.05 for all). Total P-QoL score significantly changed with pessary use (519.1 at baseline and 260 after 12-month treatment, p < 0.00). CONCLUSIONS: Our study suggests that no prior hysterectomy, the local estrogen therapy, and age might be factors associated with use of a ring vaginal pessary for longer than 1 year. Long-term pessary users had a significant improvement in their quality of life.