ABSTRACT
INTRODUCTION AND HYPOTHESIS: We aimed to identify the prevalence of urinary incontinence (UI) during the postpartum period (12-24 months) in two cities with different socioeconomic indicators in Brazil (Ribeirão Preto, SP, and São Luís, MA) and to determine associated risk factors. METHODS: A cross-sectional study nested in the Brazilian Ribeirão Preto and São Luís Birth Cohort Studies (BRISA) cohort was conducted in two Brazilian municipalities (Ribeirão Preto, and São Luís). A total of 13,214 women delivered in both cities (2010-2011). We interviewed 3,751 postpartum women in Ribeirão Preto and 3275 in São Luís (2011-2013). Univariate and multivariate analyses were performed to assess factors associated with postpartum UI for each municipality. RESULTS: The prevalence of self-reported UI at 12-24 months postpartum was 16.3% (611 out of 3,751) in Ribeirão Preto and 11.4% (375 out of 3,275) in São Luís (p < 0.001). The univariate analysis performed at Ribeirão Preto showed that women who were obese, who had diabetes or gestational diabetes and who presented with excessive weight gain during gestation presented an association with postpartum UI. However, only weight gain during pregnancy remained strongly associated with UI on multivariate analysis (p = 0.009; OR 1.041 [1.010-1.073]). On the other hand, in São Luís, no risk factors were associated with postpartum UI at univariate and multivariate analysis. CONCLUSIONS: The prevalence of UI was higher in Ribeirão Preto (higher socioeconomic level) than in São Luís. Weight gain during pregnancy was statistically associated with UI in Ribeirão Preto. No independent variables remained associated in the final model with UI in São Luís.
Subject(s)
Diabetes, Gestational/epidemiology , Gestational Weight Gain , Obesity/epidemiology , Urinary Incontinence/epidemiology , Adult , Brazil/epidemiology , Cities/epidemiology , Cross-Sectional Studies , Female , Humans , Postpartum Period , Pregnancy , Prevalence , Risk Factors , Socioeconomic Factors , Time Factors , Young AdultABSTRACT
ABSTRACT CONTEXT AND OBJECTIVE: Uterine fibroids (UF), also known as leiomyomas, are the most prevalent gynecological tumors. The Uterine Fibroid Symptoms and Quality of Life (UFS-QOL) is the only specific questionnaire that assesses symptom intensity and quality-of-life issues for women with symptomatic UF; however, it only exists in the English language. Thus, we aimed to translate and culturally validate the UFS-QOL questionnaire for the Brazilian Portuguese language. DESIGN AND SETTING: Cross-sectional study, Department of Gynecology and Obstetrics, FMRP-USP. METHODS: 113 patients with UF (case group) and 55 patients without UF (control group) were interviewed using the UFS-QOL questionnaire after translation and cultural adaptation. The Short Form-36 questionnaire was used as a control. Demographic and psychometric variables were analyzed. RESULTS: Women with UF presented higher mean age, body mass index, weight, parity and comorbidities than the control group (P < 0.05). The most prevalent complaints were abnormal uterine bleeding (93.8%), pelvic pain (36.3%) and extrinsic compression (10.6%) and these presented adequate construct validity regarding UFS-QOL severity (P < 0.05). The UFS-QOL questionnaire presented good internal consistency regarding symptom severity and quality-of-life-related domains (intraclass correlation coefficient, ICC = 0.82/0.88). Structural validity presented correlation coefficients ranging from 0.59 to 0.91. Test-retest comparison did not show differences among the UFS-QOL subscales. After treatment, women with UF presented improvements on all subscales. CONCLUSION: The UFS-QOL questionnaire presented adequate translation to the Brazilian Portuguese language, with good internal consistency, discriminant validity, construct validity, structural validity and responsiveness, along with adequate test-retest results.
RESUMO CONTEXTO E OBJETIVO: O leiomioma uterino (LU) é o tumor ginecológico mais comum. Existe apenas um questionário específico que avalia a intensidade de sintomas e qualidade de vida de mulheres com LU sintomático, o Uterine Fibroid Symptom and Quality of Life (UFS-QOL), porém somente na língua inglesa. Dessa forma, objetivamos traduzir e validar culturalmente o questionário UFS-QOL para a língua portuguesa brasileira. TIPO DE ESTUDO E LOCAL: Estudo transversal, Departamento de Ginecologia e Obstetrícia da FMRP-USP. MÉTODOS: 113 pacientes portadoras de LU (grupo caso) e 55 pacientes-controle foram entrevistadas com o questionário UFS-QOL após tradução e adaptação cultural. O questionário Short Form-36 foi utilizado para controle. Variáveis demográficas e psicométricas foram analisadas. RESULTADOS: As mulheres com LU apresentaram maior média de idade, índice de massa corporal, peso, paridade e comorbidades do que o grupo controle (P < 0,05). As queixas mais prevalentes foram sangramento uterino anormal (93,8%), dor pélvica (36,3%) e compressão extrínseca (10,6%) e estas apresentaram adequada validade de constructo com a gravidade indicada pelo UFS-QOL (P < 0,05). O questionário UFS-QOL apresentou boa consistência interna com a gravidade dos sintomas e com os domínios relacionados a qualidade de vida (coeficiente de correlação intraclasse, CCI = 0,82/0,88). A validade estrutural mostrou coeficientes de correlação variando de 0,59 até 0,91. A comparação teste-reteste não mostrou diferença entre as subscalas do UFS-QOL. Depois do tratamento, as mulheres com LU apresentaram melhora em todas as subscalas. CONCLUSÃO: O questionário UFS-QOL apresentou adequada tradução para a língua portuguesa brasileira, com boa consistência interna, validade de constructo/discriminatória, estrutural e responsividade, assim como adequados resultados teste-reteste.
Subject(s)
Humans , Female , Adult , Quality of Life , Translations , Surveys and Questionnaires , Symptom Assessment/methods , Leiomyoma/diagnosis , Uterine Neoplasms , Brazil , Case-Control Studies , Cross-Sectional Studies , Educational Status , Leiomyoma/complicationsABSTRACT
CONTEXT AND OBJECTIVE:: Uterine fibroids (UF), also known as leiomyomas, are the most prevalent gynecological tumors. The Uterine Fibroid Symptoms and Quality of Life (UFS-QOL) is the only specific questionnaire that assesses symptom intensity and quality-of-life issues for women with symptomatic UF; however, it only exists in the English language. Thus, we aimed to translate and culturally validate the UFS-QOL questionnaire for the Brazilian Portuguese language. DESIGN AND SETTING:: Cross-sectional study, Department of Gynecology and Obstetrics, FMRP-USP. METHODS:: 113 patients with UF (case group) and 55 patients without UF (control group) were interviewed using the UFS-QOL questionnaire after translation and cultural adaptation. The Short Form-36 questionnaire was used as a control. Demographic and psychometric variables were analyzed. RESULTS:: Women with UF presented higher mean age, body mass index, weight, parity and comorbidities than the control group (P < 0.05). The most prevalent complaints were abnormal uterine bleeding (93.8%), pelvic pain (36.3%) and extrinsic compression (10.6%) and these presented adequate construct validity regarding UFS-QOL severity (P < 0.05). The UFS-QOL questionnaire presented good internal consistency regarding symptom severity and quality-of-life-related domains (intraclass correlation coefficient, ICC = 0.82/0.88). Structural validity presented correlation coefficients ranging from 0.59 to 0.91. Test-retest comparison did not show differences among the UFS-QOL subscales. After treatment, women with UF presented improvements on all subscales. CONCLUSION:: The UFS-QOL questionnaire presented adequate translation to the Brazilian Portuguese language, with good internal consistency, discriminant validity, construct validity, structural validity and responsiveness, along with adequate test-retest results.
Subject(s)
Leiomyoma/diagnosis , Quality of Life , Surveys and Questionnaires , Symptom Assessment/methods , Translations , Adult , Brazil , Case-Control Studies , Cross-Sectional Studies , Educational Status , Female , Humans , Leiomyoma/complications , Uterine NeoplasmsABSTRACT
The Buschke-Loewenstein tumor is characterized by excessive growth of verrucous lesions on the genitals and/or perianal region. It is considered benign despite the high rate of recurrence and the possibility of malignant transformation. It is commonly associated with subtypes 6 and 11 of the human papillomavirus (HPV), and host's immunity plays an important role in the development of the disease. Surgical excision is the recommended treatment in most cases. We present the case of a 16 years old female patient with extensive vulvar lesions successfully treated surgically.
Subject(s)
Buschke-Lowenstein Tumor/pathology , Vulvar Neoplasms/pathology , Adolescent , Buschke-Lowenstein Tumor/surgery , Female , Humans , Vulvar Neoplasms/surgeryABSTRACT
Abstract The Buschke-Loewenstein tumor is characterized by excessive growth of verrucous lesions on the genitals and/or perianal region. It is considered benign despite the high rate of recurrence and the possibility of malignant transformation. It is commonly associated with subtypes 6 and 11 of the human papillomavirus (HPV), and host 's immunity plays an important role in the development of the disease. Surgical excision is the recommended treatment in most cases. We present the case of a 16 years old female patient with extensive vulvar lesions successfully treated surgically.
Resumo O tumor de Buschke-Loewenstein se caracteriza pelo crescimento excessivo de lesões verrucosas na região genital e/ou perianal. É considerado benigno apesar da elevada taxa de recorrência e da possibilidade de transformação maligna. Está comumente associado aos sorotipos 6 e 11 do papiloma vírus humano (HPV) e a imunidade do hospedeiro tem importante papel no desenvolvimento da doença. A excisão cirúrgica é o tratamento recomendado na maioria dos casos. Apresentamos o caso de uma paciente do sexo feminino, de 16 anos, com lesão vulvar de grande extensão tratada cirurgicamente com sucesso.
Subject(s)
Humans , Female , Adolescent , Buschke-Lowenstein Tumor/pathology , Vulvar Neoplasms/pathology , Buschke-Lowenstein Tumor/surgery , Vulvar Neoplasms/surgeryABSTRACT
We performed a systematic review and meta-analysis of randomized controlled trials that studied the conservative management of stress urinary incontinence (SUI). There were 1058 results after the initial searches, from which 37 studies were eligible according to previously determined inclusion criteria. For the primary outcomes, pelvic floor muscle training (PFMT) was more efficacious than no treatment in improving incontinence-specific quality of life (QoL) scales (SMD = -1.24SDs; CI 95% = -1.77 to -0.71SDs). However, its effect on pad tests was imprecise. Combining biofeedback with PFMT had an uncertain effect on QoL (MD = -4.4 points; CI 95% = -16.69 to 7.89 points), but better results on the pad test, although with elevated heterogeneity (MD = 0.9g; 95%CI = 0.71 to 1,10g); group PFMT was not less efficacious than individual treatment, and home PFMT was not consistently worse than supervised PFMT. Both intravaginal and superficial electrical stimulation (IES and SES) were better than no treatment for QoL and pad test. Vaginal cones had mixed results. The association of IES with PFMT may improve the efficacy of the latter for QoL and pad test, but the results of individual studies were not consistent. Thus, there is evidence of the use of PFMT on the treatment of SUI, with and without biofeedback.
Subject(s)
Conservative Treatment , Urinary Incontinence, Stress/therapy , Exercise Therapy , Female , Humans , Pelvic Floor , Quality of Life , Randomized Controlled Trials as TopicABSTRACT
We performed a systematic review and meta-analysis of randomized controlled trials that studied the conservative management of stress urinary incontinence (SUI). There were 1058 results after the initial searches, from which 37 studies were eligible according to previously determined inclusion criteria. For the primary outcomes, pelvic floor muscle training (PFMT) was more efficacious than no treatment in improving incontinence-specific quality of life (QoL) scales (SMD = [1]1.24SDs; CI 95% = [1]1.77 to [1]0.71SDs). However, its effect on pad tests was imprecise. Combining biofeedback with PFMT had an uncertain effect on QoL (MD = [1]4.4 points; CI 95% = [1]16.69 to 7.89 points), but better results on the pad test, although with elevated heterogeneity (MD = 0.9g; 95%CI = 0.71 to 1,10g); group PFMT was not less efficacious than individual treatment, and home PFMT was not consistently worse than supervised PFMT. Both intravaginal and superficial electrical stimulation (IES and SES) were better than no treatment for QoL and pad test. Vaginal cones had mixed results. The association of IES with PFMT may improve the efficacy of the latter for QoL and pad test, but the results of individual studies were not consistent. Thus, there is evidence of the use of PFMT on the treatment of SUI, with and without biofeedback.
Realizamos uma revisão sistemática e metanálise de estudos controlados e randomizados que avaliaram o tratamento conservador da incontinência urinária de esforço (IUE). Foram encontrados 1058 resultados depois das buscas iniciais, dos quais 37 trabalhos foram elegíveis de acordo com os critérios de inclusão. Para os desfechos primários, o treinamento muscular do assoalho pélvico (TMAP) foi mais eficaz do que nenhum tratamento em melhorar as escalas de qualidade de vida de incontinência (DM =[1]1,24 DPs; IC95% =[1]1,77 a [1]0,71 DPs), mas o efeito nos pad tests foi impreciso. A combinação do biofeedback com o TMAP teve um efeito incerto na qualidade de vida (DM=[1]4,4 pontos; IC95% =[1]16,69 a 7,89 pontos), mas melhores resultados no pad test, embora com heterogeneidade elevada (DM = 0,9g; IC95% = 0,71 a 1,10g); o grupo com TMAP não foi menos eficaz do que o tratamento individual, e o TMAP domiciliar não foi pior do que o TMAP supervisionado. Tanto a estimulação elétrica intravaginal (EEI) quanto a superficial (EES) foram melhores do que nenhum tratamento para a qualidade de vida e o pad test. Os cones vaginais apresentaram resultados mistos. A associação do EEI com o TMAP pode melhorar a eficácia deste último para a qualidade de vida e o pad test, mas os resultados dos estudos individuais não foram consistentes. Então, existe evidência para o uso do TMAP no tratamento da IUE, com e sem biofeedback.
Subject(s)
Humans , Female , Conservative Treatment , Urinary Incontinence, Stress/therapy , Exercise Therapy , Pelvic Floor , Quality of Life , Randomized Controlled Trials as TopicABSTRACT
INTRODUCTION AND HYPOTHESIS: Pelvic floor disorders [urinary (UI) and/or fecal C (FI) incontinence, pelvic organ prolapse (POP)] may have a significant impact in womens' quality of life (QoL). The Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20) help assess these disorders; however, we do not have them culturally translated in the Brazilian Portuguese language. METHODS: A cross-sectional study was performed of 185 women with pelvic floor disorders (PFD group) and 65 healthy patients (control group). A translated, pilot-tested, Brazilian Portuguese version were given to these women. Internal consistency, construct validity, and floor/ceiling effect were assessed. Test-retest was performed in 79 patients after 4 weeks, and responsiveness was assessed in 42 patients after surgical treatment. RESULTS: Internal consistency (Cronbach's alpha) was adequate between PFD and control groups on the PFDI-20 (0.816-0.844) and PFIQ-7 (0.823-0.846). Test-retest reliability was also adequate [intraclass correlation coefficient (ICC) 0.803-0.843]. Subscales [Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7) and Colorectal-Anal Impact Questionnaire (CRAIQ-7) from the PFIQ-7 demonstrated floor effect (42.70, 60, and 18.38 %, respectively) in the PFD group, with no influence at total score. No ceiling effect was observed. Construct validity was adequate at all correlations between clinical symptoms and subscales in both questionnaires in both groups. Responsiveness was demonstrated by a statistically significant reduction in scale/subscale scores from PFDI-20 and PFIQ-7 after surgical treatment. CONCLUSION: The PFDI-20 and PFIQ-7 presented adequate cultural translation and are reliable and valid in the Brazilian Portuguese language.
Subject(s)
Pelvic Floor Disorders/diagnosis , Adult , Aged , Brazil , Cross-Sectional Studies , Humans , Middle Aged , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
OBJECTIVE: This study aimed to report a unique perineal abscess after placement of a transobturator sling, involving the thighs and obturator regions bilaterally without involving mesh exposure. CASE REPORT: A 66-year-old woman treated for stress urinary incontinence with a transobturator sling developed a late bilateral obturator infection 30 months after surgery. This complication appeared 6 months after chemotherapy for breast cancer. Sling removal through vaginal and bilateral inguinal incisions was performed. The patient evolved well, without recurrence of the infection or incontinence. DISCUSSION: This case presents a unique scenario of muscle and skin infection after sling placement without any mesh exposure or vaginal involvement. The occurrence of the infection only after chemotherapy may indicate that immunosuppression had participation on its development. Care should be taken when exposing this mesh in contaminated perineal areas.
Subject(s)
Abscess/etiology , Gram-Positive Bacterial Infections/etiology , Perineum , Prosthesis-Related Infections/etiology , Suburethral Slings/adverse effects , Device Removal , Enterococcus faecalis , Female , Humans , Recurrence , Urinary Incontinence, Stress/surgeryABSTRACT
A síndrome da bexiga hiperativa é um distúrbio caracterizado pela presença de urgência miccional, podendo ou não haver incontinência urinária associada. Afeta homens e mulheres em iguais proporções, mas tem maior impacto sobre a população feminina, já que a incidência de incontinência é maior. O tratamento de primeira linha consiste em medidas comportamentais, treinamento vesical e fisioterapia, podendo-se associar tratamento farmacológico em casos persistentes. As drogas mais frequentemente utilizadas são os anticolinérgicos, medicações eficazes, porém associadas a efeitos adversos incômodos que frequentemente limitam a aderência. Uma proporção considerável de mulheres não obtém êxito com a combinação de medidas conservadoras e medicações anticolinérgicas, seja por eficácia limitada, seja por efeitos colaterais intoleráveis. Para essa população, modalidades de tratamento de segunda e terceira linha podem trazer alívio sintomático e melhora da qualidade de vida. Além disso, foi recentemente aprovada uma nova classe de drogas para o tratamento da bexiga hiperativa, os agonistas de receptores ?3-adrenérgicos, que prometem eficácia equivalente aos anticolinérgicos sem os efeitos adversos que os limitam...
Overactive bladder syndrome is a condition characterized by urgency, with or without urinary incontinence. It affects men and women equally, but has a greater impact on the female population, given the higher prevalence of urgency-incontinence. First line treatment consists on lifestyle interventions, bladder drills and physical therapy. Pharmacological treatment may be associated in persistent cases. The most commonly used medications are anticholinergics, which are efficacious, but limited by a variety of bothersome adverse effects that impair treatment compliance. A significant proportion of women don?t experience a successful outcome with the combination of conservative measures and treatment with anticholinergics, owing both to limited efficacy and to intolerable adverse effects that lead to treatment discontinuation. For this population, second and third line therapies may provide symptomatic relief, with great improvement in health related quality of life. Also, a new class of drugs, the ?3-adrenergic receptor agonists, has recently been approved for the treatment of overactive bladder, and may provide similar efficacy to currently used anticholinergic drugs without the associated adverse effects...
Subject(s)
Humans , Male , Female , Cholinergic Agonists/therapeutic use , Urinary Bladder, Overactive/drug therapy , Transcutaneous Electric Nerve Stimulation , Physical Therapy Modalities , Electric Stimulation Therapy/methods , Botulinum Toxins, Type A/administration & dosage , Cholinergic Agonists/adverse effects , Urinary Bladder, Overactive/therapy , Urinary Incontinence, Urge/etiology , Botulinum Toxins, Type A/urineABSTRACT
OBJECTIVE: To evaluate whether the conventional autologous fascial (AF) sling is superior or equal to the readjustable transobturator (TOT) sling in efficacy and safety in women with stress urinary incontinence (SUI). STUDY DESIGN: This was a retrospective study comprised of a sample of 463 patients from 2003 to 2009. A total of 203 women received TOT slings for urodynamically confirmed SUI, and 260 patients received AF slings. We analyzed the subjective success rate (cure and/or improvement) after 12 and 24 months of surgery as well as any immediate and late surgical complications. RESULTS: Both groups were statistically similar with regard to age, parity, body mass index, number of previous gynecological surgeries, and antiincontinence therapies. After 12 months patients with the TOT sling had a higher subjective percentage efficacy rate when compared to those with the AF sling (94% vs. 88%, p < 0.05); however, after 24 months this percentage was no longer statistically significant (88.7% vs. 84.6%, p = 0.20). The TOT sling presented fewer postoperative complication rates (14.1% vs. 25.6%, p < 0.05), similar intraoperative complication rates (1.15% vs. 2.3%, p = 0.22) and a shorter mean operative time (23 vs. 112 minutes, p < 0.05) than the AF sling. CONCLUSION: Both techniques had similar subjective efficacy rates, but the TOT sling demonstrated fewer postoperative surgical complications than the AF sling.
Subject(s)
Fascia/transplantation , Rectus Abdominis/transplantation , Suburethral Slings , Surgical Mesh , Urinary Incontinence, Stress/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Operative Time , Prosthesis Failure , Retrospective Studies , Suburethral Slings/adverse effects , Surgical Mesh/adverse effects , Surgical Wound Dehiscence/etiology , Surgical Wound Infection/etiology , Time Factors , Treatment Outcome , Urethra/injuries , Urinary Bladder/injuries , Urinary Retention/etiologyABSTRACT
A 78-year-old woman presented with a large bulge in the right labium majus. She had a previous history of two anterior and posterior vaginal wall prolapse repairs, a vaginal hysterectomy for uterovaginal prolapse, a sacrospinous ligament fixation for vaginal vault prolapse, and a LeFort partial colpocleisis for recurrent vault prolapse. Magnetic resonance imaging (MRI) revealed an anterior perineal hernia containing small bowel. Surgery was performed to close the pelvic floor defect through a perineal approach, and polypropylene mesh was used as a bolster. The hernial sac contained small bowel with very thin adhesions. Over 6 months of follow-up, there was no recurrence of the hernia or mesh complications. Perineal hernias after gynecological surgeries for benign diseases are rare. The indications for repair and the optimal surgical approach are not well described.
Subject(s)
Hernia/etiology , Herniorrhaphy , Postoperative Complications/etiology , Postoperative Complications/surgery , Aged , Female , Hernia/diagnosis , Humans , Middle Aged , Pelvic Organ Prolapse/surgery , Perineum/surgery , Recurrence , Reoperation , Vulva/surgeryABSTRACT
Benign leiomyomas are common soft tumors, arising especially in the female genital tract; unlike uterine leiomyomas, they rarely occur in perineal regions. They can develop wherever smooth muscle is present. Herein is reported the case of a large perineal leiomyoma in a 36-year-old woman who noted a palpable mass close to the rectum 1 year after she had delivered vaginally, in the same region of as a mediolateral episiotomy. Complete surgical excision was performed. Histopathologic findings were compatible with benign leiomyoma. At postoperative follow-up, no signs of anal dysfunction were noted. There was no pathologic correlation between formation of the leiomyoma and the episiotomy despite a possible association between the presence of fibrosis and development of leiomyomas, which was found during a literature review. Microarray analysis will be necessary to elucidate this hypothesis.
Subject(s)
Leiomyoma/pathology , Perineum/pathology , Soft Tissue Neoplasms/pathology , Episiotomy , Female , Humans , Leiomyoma/surgery , Perineum/surgery , Soft Tissue Neoplasms/surgeryABSTRACT
Os autores descrevem uma histerectomia abdominal realizada devido ao grande sangramento causado pelo leiomioma cervical de grande volume, e fazem uma revisão de literatura sobre o tratamento cirúrgico e as variações técnicas. Verificou-se que o tratamento de escolha é a miomectomia, embora não exista padrão definido para o tipo intracervical. Porém, a via laparoscópica, apesar de benéfica para a paciente, apresenta inúmeras dificuldades técnicas, como suturar a base pedicular após enucleação do leiomioma, sangramento no intraoperatório e distorção anatômica causada pelo tamanho tumoral. Diversas técnicas para minimizar tais dificuldades também são descritas.
The authors describe an abdominal hysterectomy performed due to large bleeding caused by a giant cervical leiomyoma, and they carry out a literature review about the surgical treatment and techniques variations. It was verified that the first surgical choice is myomectomy, although there is not a defined pattern for intracervical type. However, the laparoscopic approach presents several technical difficulties, such as suture of leiomyoma pedicle after its enucleation, intraoperative bleeding, and anatomic distortion caused by tumor size, despite it has more benefits for the patient. Other techniques for minimize such difficulties are also described.
