Translation, cross-cultural adaptation, and measurement properties of the dysmenorrhea symptom interference (DSI) scale-Brazilian version.

BACKGROUND: The Dysmenorrhea Symptom Interference (DSI) scale is a reliable, valid, and responsive tool to assess the interference of menstrual pain in the physical, mental, and social activities of women. OBJECTIVE: To translate and cross-culturally adapt the DSI scale into Brazilian-Portuguese (DSI-BrPt) and investigate the measurement properties of this version in on- and off-menses versions. METHODS: The original (United States) scale was translated and culturally adapted following existing guidelines. Measurement properties of the DSI-BrPt were investigated in 1387 women with dysmenorrhea. Reliability was analyzed via intraclass correlation coefficients (ICC) and test-retest reliability. Furthermore, structural validity, internal consistency (Cronbach's alpha), cross-cultural validity, construct validity (correlation with WHODAS 2.0 and SPS-6 scores questionnaires), and floor and ceiling effects were determined. RESULTS: No significant adaptations were needed during the translation process of the DSI-BrPt. The values of Cronbach's α were adequate (α ≥0.87) for the unidimensional scale. The test-retest reliability was considered adequate (ICC >0.78) and there was no systematic error for both on-menses and off-menses versions. Moreover, the DSI had a positive and strong correlation with WHODAS 2.0. There were no floor and ceiling effects neither for the total sample, nor among off-menses, or on-menses women. CONCLUSION: The DSI-BrPt scale has been translated and cross-culturally adapted successfully. The DSI-BrPt scale presented adequate measurement properties. The scale is valid and reliable, and, therefore, an adequate tool for monitoring dysmenorrhea symptoms in Brazilian women during and between menses.

WHODAS measurement properties for women with dysmenorrhea.

BACKGROUND: There is an association of dysmenorrhea with human functioning and disability. However, no patient-reported outcome measure has been developed to assess this construct in women with dysmenorrhea. WHODAS 2.0 has been recognized as an important generic patient-reported outcome information of physical function and disability. Thus, the aim of this study was to assess the measurement properties of the WHODAS 2.0 in women with dysmenorrhea. METHODS: This is an online and cross-sectional study conducted with Brazilian women aged 14 to 42 years with self-report of dysmenorrhea in the last three months. According to COSMIN, structural validity was evaluated by exploratory and confirmatory factor analysis; internal consistency by Cronbach's Alpha; measurement invariance by multigroup confirmatory factor analysis between geographic regions of Brazil; and construct validity by correlating WHODAS 2.0 to the Numerical Rating Scale for pain severity. RESULTS: One thousand three hundred and eighty-seven women (24.7 ± 6.5 years) with dysmenorrhea participated in the study. WHODAS 2.0 presented a single factor by exploratory factor analysis and adequate model by confirmatory factor analysis (CFI = 0.924, TLI = 0.900, RMSEA = 0.038), excellent internal consistence (α = 0.892) for all items and an invariancy across geographic regions (ΔCFI ≤ 0.01 and ΔRMSEA < 0.015). Correlation between WHODAS 2.0 and numerical rating scale was positive and moderate (r = 0.337). CONCLUSION: WHODAS 2.0 has a valid structure to assess functioning and disability related to dysmenorrhea in women.

Can running influence women's sexual function?

INTRODUCTION AND HYPOTHESIS: Studies have shown that athletes have three times increased risk of urinary incontinence compared to non-athletes, in addition to anal incontinence and sexual dysfunction (SD). This study aimed to assess the sexual and pelvic floor muscle (PFM) functions and to compare these variables among female athlete runners with and without SD and to identify predictive factors that may be associated with sexual function among the athletes. METHODS: Cross-sectional study including 90 female runners, who ran ≥ 20 km/week for at least 6 months, had had sexual intercourse in the last 4 weeks and were > 18 years old. PFM function was assessed by vaginal palpation and manometry. Women also answered the International Consultation on Incontinence Questionnaire-Short Form to investigate presence of urinary incontinence. Sexual function was assessed by Female Sexual Function Index (FSFI); total scores ≤ 26.5 were considered to indicate SD. The scores of each FSFI domain and the total score were compared individually between each predictor using simple linear regression. In addition, multiple linear regression analysis was performed. RESULTS: Athletes with SD presented lower PFM strength. The results of the multiple linear regression analysis among all the predictor variables, FSFI domains and total score show that the Modified Oxford Scale is a predictor for the desire, excitation, lubrication, orgasm, pain and total score domains. CONCLUSIONS: Female runners with lower PFM strength presented worse sexual function regardless of age, parity, BMI and running practice time.

The influence of the menstrual cup on female pelvic floor muscles variables: a prospective case series.

The aim was to assess and report the effects of menstrual cup on pelvic floor muscles (PFM) function and tone, as well as check the acceptability after a period of three menstrual cycles in healthy young women. The data collected in assessments and reassessments included the International Consultation on Incontinence Questionnaire - Vaginal Symptoms (ICIQ-VS) questionnaire, evaluation of PFM function through PERFECT Scheme, PFM muscle tone, and PFM manometry (Peritron 9300®). A diary regarding the overall colletor acceptability and satisfaction was collected. Ten healthy young women completed the study. There was an improvement in the mean values of maximal voluntary contraction (MVC) (p = 0.032), a decrease in the vaginal resting pressure (VRP) (p = 0.05), and an increase in the number of repetitions of sustained muscle contractions (p = 0.042). Seven women reported some discomfort while using the vaginal cup only in the first cycle while three revealed discomfort during the whole experiment. This study provides preliminary case-based evidence that the use of the vaginal cup for a period of three menstrual cycles changes the VRP, MVC, and PFM tone, as well as improves the repetitions of PFM assessed by digital palpation. Moreover, the women reported the use of vaginal cup as a positive experience.

Pelvic Floor Muscle Training In Women Practicing High-impact Sports: A Systematic Review.

Urinary incontinence (UI) in female athletes can impair their quality-of-life (QoL) and reduce their participation in sports. This review aims to evaluate the effect of pelvic floor muscle training (PFMT) in treating UI in women participating in high-impact sports. Furthermore, to assess the influence of PFMT on pelvic floor muscles (PFM) function and the UI impact on their QoL. For this purpose, a systematic review of randomized controlled trials (RCTs) and non-RCTs was performed. An electronic search was conducted on PubMed, EMBASE, SciELO, and Scopus. The quality of evidence was assessed using the PEDro and ROBINS-I scales. The Consensus on Exercise Reporting Template (CERT) was used to assess the quality of PFMT protocols. All studies were available in full-text including incontinent female participants who are practitioners of high-impact sports, investigating PFMT vs control groups(inactive) or undergoing other treatments. Three RCTs and two non-RCTs (104 participants) were analyzed. PFMT provided a significant improvement in UI symptoms with a reduction in the frequency (n=3) and the amount of UI (n=5). PFM function was assessed in three studies, and two found improvement in maximal contraction and one in vaginal resting pressure in favor of PFMT. None of the two studies that assessed QoL found a difference after PFMT intervention.

Effects of visceral manipulation associated with pelvic floor muscles training in women with urinary incontinence: A randomized controlled trial.

AIMS: To compare the effects of manual visceral therapy (MVT) associated with pelvic floor muscle training (PFMT) on urinary incontinence (UI) symptoms, vaginal resting pressure, and maximum voluntary contraction of the pelvic floor muscles (PFM). METHODS: A double-blinded randomized controlled trial of 5 weeks duration with two active intervention arms: PFMT + MVT and PFMT + manual sham therapy (MST). Participants were women over 18 years of age with complaint or diagnosis of UI symptoms. The primary outcome was the severity of UI symptoms, assessed by the International Consultation on Incontinence Questionnaire - Short Form. The secondary outcomes measures included the vaginal resting pressure and the maximum voluntary contraction of PFM assessed by digital manometry. RESULTS: Fifty-two incontinent women participated in the study. There was no significant difference between groups in UI symptoms (F (1.74, 86.9) = 0.406; p = 0.638), vaginal resting pressure (mean difference -1.5 cmH20 [95% confidence interval [CI] -4.5 to 1.5; p = 0.33]), and maximum voluntary contraction of PFM (median 0.0 cmH20 [25%-75% interquartile range 0.0-5.6; p = 0.12]) after the intervention period. CONCLUSIONS: Combining MVT with PFMT was not more effective than PFMT alone in reducing UI symptoms, in change vaginal resting pressure and maximum voluntary contraction of PFM. Due to the limitations of the study, further investigations are still needed to confirm these findings.

Comparison of urinary incontinence, based on pelvic floor and abdominal muscle strength, between nulliparous female athletes and non-athletes: A secondary analysis.

AIMS: To compare the strength of abdominal and pelvic floor muscles (PFM) between nulliparous female athletes (FAs) and non-athletes (FNAs), to determine the frequency of urinary incontinence (UI) in these groups. METHODS: This cross-sectional comparative study of nulliparous women included 39 professional FAs, who competed at the district level or above, and 34 FNAs. Participants underwent pelvic floor and abdominal muscle assessments. PFM function and strength were assessed using the modified Oxford scale and a manometer (PERINA 996-2 QUARK). Abdominal muscle function and strength were assessed using a 4-Pro isokinetic dynamometer. The International Consultation on Incontinence Questionnaire-Short Form was used to assess UI symptoms among the athletes, and the International Physical Activity Questionnaire-Short Form was used to establish the level of physical activity among the non-athletes. RESULTS: The prevalence of UIs in the FAs was 53.8%, while that for FNAs was 35.3%. There was no association between being an athlete and having UI (p = 0.112). FAs were found to weigh more (p = 0.012) and have increased abdominal muscle strength (p = 0.014) and maximum voluntary PFM contraction as recorded by the manometer (p = 0.035), as well as a decreased PFM contraction endurance time (p = 0.025) than FNAs. CONCLUSION: FAs had stronger abdominal muscles and PFM contraction, as assessed by a manometer, but less PFM endurance when compared to FNAs. Despite these differences, the prevalence of UI was similar between groups.

Urine Loss during a Volleyball Competition: Comparison between Amateur and Professional Athletes.

BACKGROUND: High-impact sports can cause dysfunction to the female pelvic floor that leads to the occurrence of stress urinary incontinence. OBJECTIVE: To identify and compare the presence of urine loss between professional and amateur female volleyball athletes during a competition. METHODS: A cross-sectional and comparative study was conducted on 75 volleyball athletes, including 30 amateurs and 45 professional athletes. Female athletes 18 years of age or older were included. Urine loss during the competition was evaluated by self-report and measured by a pad test (in grams). Day-to-day urinary incontinence was identified using the Urinary Distress Inventory 6 (UDI-6). Before the beginning of the game, the instruments were applied by individual interview for data collection and the pad was positioned. After the game, the pad was removed and weighed again. Descriptive and inferential statistics were used, with a significance level of 5%. RESULTS: Half of the professional (50.0%) and amateur (55.6%) athletes have symptoms of urine loss during a competition. Objective urine loss was higher among professional athletes (4.5 ± 1.4 g) compared to amateur athletes (3.8 ± 1.4 g). There was a significant difference (P < .001) in objective urine loss between symptomatic (mean = 5.41, standard deviation [SD] = 0.8) and asymptomatic professional athletes (mean = 3.40, SD = 1.3). CONCLUSION: Self-report of urinary incontinence during the competition was common among professional and amateur athletes. However, objective urine loss was significantly higher among professional athletes.

Quantification of Urinary Loss in Nulliparous Athletes During 1 Hour of Sports Training.

BACKGROUND: Urinary incontinence (UI) is a pelvic floor dysfunction that can affect nulliparous female athletes because of the effect of sports activities on pelvic floor muscles. OBJECTIVES: To verify and quantify urine loss in nulliparous athletes during 1 hour of sports training using a modified pad test protocol. DESIGN: Cross-sectional. SETTING: Secondary, institutional practice. PARTICIPANTS: Nulliparous athletes (N = 104). METHODS: Athletes completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) and underwent a maximal resistance test of the abdominal muscles followed by the new modified pad test during 1 hour of training. OUTCOMES: Presence or absence of UI was the dependent variable; the initial hypothesis was that high-impact activities could lead to the development of UI. RESULTS: Almost 52% of athletes (n = 54) self-reported UI according to the ICIQ-UI-SF score. Of athletes who reported stress or mixed UI (n = 32), only 43.7% (n = 14) had leakage during the training pad test. Interestingly, 24% of athletes (n = 12) who did not report UI had a positive pad test result. In total, 27.9% of athletes (n = 29) presented a positive pad test during the training. Mean urinary loss was 1.57 ± 0.4 g. CONCLUSION: Athletes did not seem to have a good knowledge of UI symptoms, and the modified pad test could be an alternative to quantify urine loss; however, it is necessary to perform accuracy tests. None of the athletes reported discomfort or decreased performance when performing the pad test. LEVEL OF EVIDENCE: II.

Assessment of abdominal and pelvic floor muscle function among continent and incontinent athletes.

INTRODUCTION AND HYPOTHESIS: Studies have shown that there is a co-contraction between the pelvic floor and abdominal muscles. This study aimed to evaluate pelvic floor and abdominal muscle function in continent and incontinent female athletes and to investigate the association between these muscle groups. METHODS: This was a cross-sectional study. Forty nulliparous professional female athletes who competed at the municipal level or above participated in this study. All participants underwent a pelvic floor muscle (PFM) and abdominal muscle assessment. PFM function and strength were assessed using the modified Oxford Scale and a perineometer. Abdominal muscle function and strength were assessed using a 4-Pro isokinetic dynamometer. To assess athletes' urinary continence, the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-UI-SF) was used. RESULTS: There was a positive association between PFM and abdominal muscle strength among the incontinent athletes (p = 0.006; r = 0.577). The incontinent athletes had greater PFM strength than the continent athletes (p = 0.02). There was no difference in abdominal muscle function between the groups. CONCLUSIONS: We found that incontinent athletes have greater PFM strength than continent athletes. This suggests that urinary incontinence in this population is not due to PFM weakness. The positive association between abdominal and PFM strengths in incontinent athletes may be due to frequent co-contraction between these muscle groups.

Association Between Physical Activity Level and Pelvic Floor Muscle Variables in Women.

In order to investigate the potential impact of physical activity (PA) on pelvic floor muscle (PFM) function, a cross-sectional study was made to analyse the association between PA level and vaginal resting pressure (VRP) and PFM strength and endurance. Thirty-eight continent women and 20 women with stress urinary incontinence (SUI) aged 19 to 49 years were enrolled in the study. PFM variables were assessed by manometry. The PA level was assessed through the International Physical Activity Questionnaire - Short Form. The International Consultation on Incontinence Questionnaire-Urinary Incontinence - Short Form was applied to identify SUI. Pearson's correlation coefficients were applied to estimate the association between PA and PFM variables. Incontinent women were classified as having a high PA level compared to the continent ones (65.0% vs 34.2%, respectively; p=0.030). There was a positive weak association between PA and VRP in continent (r=0.377) and an inverse association in incontinent women (r=-0.458). No associations were found between PA and PFM strength and endurance. Further studies are needed in order to identify a causal association between PA and SUI.

Female sexual function and urinary incontinence in nulliparous athletes: An exploratory study.

OBJECTIVES: To estimate the prevalence of Female Sexual Dysfunction (FSD) and Urinary Incontinence (UI) symptom in nulliparous athletes and analyze the risk factors for these dysfunctions. DESIGN: A cross-sectional study. SETTING: The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) and the Female Sexual Function Index (FSFI) were applied to assess the UI and the FSD. PARTICIPANTS: 50 athletes with ≥18 years old. RESULTS: We found a prevalence of 48% of UI and 44% of FSD among nulliparous athletes. The rate of athletes having concomitant FSD and UI was 24%. We found a significant difference between high and low impact sports in the ICIQ-UI-SF score (p = 0.028). Hours of training (p = 0.007; R2 = 0.21) was found to be a risk factor for UI. Incontinent athletes demonstrated a Relative Risk of 2.7 to develop sexual desire problem when compared to the continents (p = 0.04; 95% CIs: 1.50-4.89). CONCLUSIONS: This study found a high prevalence of both UI and FSD among nulliparous athletes. Furthermore, nulliparous athletes practicing high-impact modalities are the most susceptible to UI. The hours of training per day was considered a risk factor to develop UI, and incontinent athletes have more chances of showing difficulties in sexual desire.

Urinary Incontinence in Physically Active Young Women: Prevalence and Related Factors.

This cross-sectional survey aims to (1) verify the prevalence of urinary incontinence and its impact on the quality of life among nulliparous fit women, and to (2) analyze whether urinary incontinence is influenced by the intensity of the sport (high- vs. low-impact) or by the volume of physical activity (minutes per week) performed. Two hundred forty-five nulliparous women (18-40 years) completed the International Consultation on Incontinence Questionnaire-Short Form, the Kings Health Questionnaire and a questionnaire regarding demographic and training variables. Overall 22.9% of the participants self-reported urinary incontinence, and among them, 60.7% had stress urinary incontinence. Incontinent women demonstrated worse quality of life than continent females (p=0.000). Women practicing high-impact sports presented higher frequency in loss of urine than those practicing low-impact sports (p=0.004). Regardless the intensity of the sport, the volume of exercise showed positive association with the frequency of loss of urine (p=0.005, r=0.475). In conclusion, almost one fourth of the women enrolled in this study reported symptoms of urinary incontinence and worse quality of life than those who were continent. Women who practice high-impact sports or who have higher volume of training should be aware of the symptoms associated with pelvic floor dysfunction, since they seem to predispose to urine leakage.

On the Stiffness of the Mesh and Urethral Mobility: A Finite Element Analysis.

Midurethral slings are used to correct urethral hypermobility in female stress urinary incontinence (SUI), defined as the complaint of involuntary urine leakage when the intra-abdominal pressure (IAP) is increased. Structural and thermal features influence their mechanical properties, which may explain postoperative complications, e.g., erosion and urethral obstruction. We studied the effect of the mesh stiffness on urethral mobility at Valsalva maneuver, under impairment of the supporting structures (levator ani and/or ligaments), by using a numerical model. For that purpose, we modeled a sling with "lower" versus "higher" stiffness and evaluated the mobility of the bladder and urethra, that of the urethrovesical junction (the α-angle), and the force exerted at the fixation of the sling. The effect of impaired levator ani or pubourethral ligaments (PUL) alone on the organs displacement and α-angle opening was similar, showing their important role together on urethral stabilization. When the levator ani and all the ligaments were simulated as impaired, the descent of the bladder and urethra went up to 25.02 mm, that of the bladder neck was 14.57 mm, and the α-angle was 129.7 deg, in the range of what was found in women with SUI. Both meshes allowed returning to normal positioning, although at the cost of higher force exerted by the mesh with higher stiffness (3.4 N against 2.3 N), which can relate to tissue erosion. This finite element analysis allowed mimicking the biomechanical response of the pelvic structures in response to changing a material property of the midurethral synthetic mesh.

A PERDA DE URINA É INFLUENCIADA PELA MODALIDADE ESPORTIVA OU PELA CARGA DE TREINO? UMA REVISÃO SISTEMÁTICA / IS URINE LOSS INFLUENCED BY TYPE OF SPORT OR TRAINING LOAD? A SYSTEMATIC REVIEW / ¿LA PÉRDIDA DE ORINA SE VE INFLUENCIADA POR LA MODALIDAD DEPORTIVA O POR LA CARGA DEL ENTRENAMIENTO? UNA REVISIÓN SISTEMÁTICA

RESUMO Atualmente, diversos estudos relatam incontinência urinária (IU) entre mulheres jovens nulíparas e fisicamente ativas. Contudo, alguns investigam a prevalência da IU de acordo com as modalidades esportivas, enquanto outros investigam a carga de treino. A finalidade do presente estudo foi verificar se a modalidade esportiva é mais determinante na prevalência de IU do que a carga de treino entre mulheres jovens nulíparas. Para esta revisão sistemática, três revisores independentes realizaram uma busca de publicações originais nas bases de dados PubMed, LILACS e SciELO, entre 1994 e 2015. Foram utilizadas como estratégia de busca as palavras-chave: urinary incontinence AND (physical activity OR women OR nulliparous OR athletes), registradas na MeSH e no DeCS. Foram incluídos apenas estudos originais publicados nas línguas português, inglês e espanhol, que verificaram a IU em mulheres nulíparas, atletas ou praticantes de atividade física. Foram selecionados 873 estudos, mas somente dez artigos satisfizeram os critérios de inclusão e exclusão. Todos os artigos foram do tipo transversal, dos quais quatro relacionaram a IU com as modalidades esportivas, cinco verificaram a carga de treino com a perda de urina e um estudo verificou ambos os aspectos. Foi encontrada uma alta taxa de prevalência de IU entre atletas. Parece haver evidência de que as atividades que exigem salto, aterrissagem longa e corrida são as mais propensas a provocar perda de urina. Além disso, a maior carga de treino parece estar associada com a quantidade de urina perdida. Esta revisão evidencia as altas taxas de IU em praticantes de grandes cargas de treinamento associadas a esportes com salto, especialmente entre atletas. Contudo, ainda não há resposta para qual fator esportivo é mais determinante para a perda de urina entre mulheres nulíparas.

ABSTRACT Currently, several studies report urinary incontinence (UI) among young nulliparous and physically active young women. However, some studies investigate the prevalence of UI according to sports modality, while others use the training load. The purpose of this study was to verify if the sport modality is more crucial to the prevalence of UI than the training load among nulliparous young women. For this systematic review, three independent reviewers carried out a search of original studies in PubMed, LILACS and SciELO databases between 1994 and 2015. As search strategy we used the keywords urinary incontinence AND (physical activity OR women OR nulliparous OR athletes), registered in MeSH and DeCS. Only original studies published in Portuguese, English and Spanish, which examined UI in nulliparous women, athletes or physical activity practitioners were included. A total of 873 studies were selected, but only ten articles met the inclusion and exclusion criteria. All articles were about cross-sectional studies, of which four related UI to the sport modality, five verified the training load with the urine loss and one study verified both aspects. A high prevalence rate of UI was found among athletes. There seems to be evidence that activities that require jumping, long landing, and running are the most likely to cause loss of urine. Furthermore, the higher training load seems to be associated with the amount of urine lost. This review shows the high UI rates in practitioners of high training loads associated with sports that require jumping, particularly in athletes. However, there is still no answer as to which sporting factor is most decisive for the loss of urine among nulliparous women.

RESUMEN En la actualidad, varios estudios señalan incontinencia urinaria (IU) entre las mujeres nulíparas jóvenes y físicamente activas. Sin embargo, algunos investigan la prevalencia de la IU según las modalidades deportivas, mientras otros investigan la carga de entrenamiento. El propósito de este estudio fue verificar si la modalidad deportiva es más decisiva en la prevalencia de la IU que la carga de entrenamiento entre las mujeres nulíparas jóvenes. Para esta revisión sistemática, tres revisores independientes realizaron una búsqueda de las publicaciones originales en PubMed, LILACS y SciELO, entre 1994 y 2015. Se utilizaron como estrategia de búsqueda las siguientes palabras clave: urinary incontinence AND (physical activity OR women OR nulliparous OR athletes), registradas en MeSH y DeCS. Se incluyeron solo los estudios originales publicados en los idiomas: portugués, inglés y español, que analizaron la IU en mujeres nulíparas, atletas o practicantes de actividad física. Se seleccionaron 873 estudios, pero sólo diez artículos cumplieron los criterios de inclusión y exclusión. Todos los artículos fueron del tipo transversal, de los cuales cuatro relacionaron la IU con las modalidades deportivas, cinco analizaron la carga del entrenamiento con la pérdida de orina y un estudio examinó ambos aspectos. Se encontró una alta prevalencia de la IU entre los atletas. Parece haber evidencias de que las actividades que requieran saltar, largo aterrizaje y correr son las más propensas a causar la pérdida de orina. Además, la mayor carga de entrenamiento parece estar asociada con la cantidad de orina perdida. Esta revisión destaca las altas tasas de IU en practicantes con grandes cargas de entrenamiento relacionadas con los deportes de salto, especialmente entre atletas. Sin embargo, todavía no hay respuesta sobre cual factor deportivo es más decisivo para la pérdida de orina en las mujeres nulíparas.

Pubovisceralis Muscle Fiber Architecture Determination: Comparison Between Biomechanical Modeling and Diffusion Tensor Imaging.

Biomechanical analysis of pelvic floor dysfunction requires knowledge of certain biomechanical parameters, such as muscle fiber direction, in order to adequately model function. Magnetic resonance (MR) diffusion tensor imaging (DTI) provides an estimate of overall muscle fiber directionality based on the mathematical description of water diffusivity. This work aimed at evaluating the concurrence between pubovisceralis muscle fiber representations obtained from DTI, and the maximum principal stress lines obtained through the finite element method. Seven datasets from axial T2-weighted images were used to build numerical models, and muscle fiber orientation estimated from the DT images. The in-plane projections of the first eigenvector of both vector fields describing muscle fiber orientation were extracted and compared. The directional consistency was evaluated by calculating the angle between the normalized vectors for the entire muscle and also for the right and left insertions, middle portions, and anorectal area. The values varied between 28° ± 6 (right middle portion) and 34° ± 9 (anorectal area), and were higher than the angular precision of the DT estimates, evaluated using wild bootstrapping analysis. Angular dispersion ranged from 17° ± 4 (left middle portion) to 23° ± 5 (anorectal area). Further studies are needed to examine acceptability of these differences when integrating the vectors estimated from DTI in the numerical analysis.

Football practice and urinary incontinence: Relation between morphology, function and biomechanics.

Current evidence points to a high prevalence of urinary incontinence among female athletes. In this context, this study aims to assess if structural and biomechanical characteristics of the pubovisceral muscles may lead to urine leakage. Clinical and demographic data were collected, as well as pelvic Magnetic Resonance Imaging. Furthermore, computational models were built to verify if they were able to reproduce similar biomechanical muscle response as the one measured by dynamic imaging during active contraction by means of the percent error. Compared to the continent ones (n=7), incontinent athletes (n=5) evidenced thicker pubovisceral muscles at the level of the midvagina (p=0.019 and p=0.028 for the right and left sides, respectively). However, there were no differences neither in the strength of contraction in the Oxford Scale or in the displacement of the pelvic floor muscles during simulation of voluntary contraction, which suggests that urine leakage may be related with alterations in the intrafusal fibers than just the result of thicker muscles. Additionally, we found similar values of displacement retrieved from dynamic images and numerical models (6.42 ± 0.36 mm vs. 6.10 ± 0.47 mm; p=0.130), with a percent error ranging from 1.47% to 17.20%. However, further refinements in the mechanical properties of the striated skeletal fibers of the pelvic floor muscles and the inclusion of pelvic organs, fascia and ligaments would reproduce more realistically the pelvic cavity.

Comparison of otoacoustic emissions in patients with tinnitus having normal hearing versus mild hearing loss.

INTRODUCTION: Tinnitus is an auditory sensation whose source comes from external stimulus to the body. All studies that can help people with this disorder are very imperative. OBJECTIVE: This study investigates the cochlear function in patients with tinnitus, using Distortion Products Otoacoustic Emissions (DPOAE). MATERIAL AND METHODS: Ears where the subjects referred to feel the tinnitus were considered for the study group while other ears without this sensation of tinnitus acted as a control group. Fifty subjects suffering from unilateral or bilateral tinnitus with normal hearing sensitivity or mild hearing loss were recruited. RESULTS AND CONCLUSIONS: Where comparing the control and study group, the highest percentage of cases of DPOAE detected was in the control group, although these differences were not statistically significant. When the analyzed frequency is the same as the tinnitus frequency, the prevalence of detected DPOAE is in tinnitus ears (50.0 %). In ears where tinnitus was not perceived (73.5 %) a p value of 0.024 (< 0.05) was found, which means that the undetected DPOAE could be influenced by tinnitus. Based on the results, tinnitus might not be caused by changes in the outer hair cells but seems to be affected by that.

Volume of training and the ranking level are associated with the leakage of urine in young female trampolinists.

OBJECTIVES: The aim of this study was to investigate in young nulliparous female trampolinists the hypothetical associations between the level of athletic performance and the volume of training with urine leakage. DESIGN: Cross-sectional cohort study. SETTING: Professional trampolinists. PARTICIPANTS: Twenty-two female athletes participating in a trampoline national championship were included in this study. ASSESSMENT OF RISK FACTORS: The associations for player-related performance variables were evaluated using Spearman rank correlation and Kruskal-Wallis H test verified the differences between the tertiles. MAIN OUTCOME MEASURES: Rate of urinary incontinence (UI) among young athletes and the relationship with the athletic performance. Screening was performed through a questionnaire. This included the demographic sample characterization, the assessment of training volume, and the athletes' ranking in the championship. Additionally, it included the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-UI-SF) to assess the leakage. RESULTS: About 72.7% of the participants reported that they experienced urine leakage during trampoline practice and described that the episodes of leakage started after the beginning of the trampoline. Significant associations between the athletic performance and the training volume were observed with the severity of incontinence. Dividing the sample in tertiles of training volume, it was observed that the third tertile was the one with greatest impact of incontinence on their quality of life (ICIQ score). CONCLUSIONS: The results confirm a high frequency of UI in young trampolinists and reveal a clear identification of the athletes' ranking and the training volume as risk factors to develop and worsen urine loss. CLINICAL RELEVANCE: Special attention from team physicians and trainers is required for this athletes' problem that is often hidden by shame. In addition, female athletes practicing high-impact sports should be informed about the risk to develop pelvic floor muscles dysfunction and should be encouraged to seek help from health professionals to minimize or even eliminate the urine incontinence.

Magnetic resonance imaging of the pelvic floor: from clinical to biomechanical imaging.

This article reviews the current role of magnetic resonance imaging in the study of the pelvic floor anatomy and pelvic floor dysfunction. The application of static and dynamic magnetic resonance imaging in the clinical context and for biomechanical simulation modeling is assessed, and the main findings are summarized. Additionally, magnetic resonance-based diffusion tensor imaging is presented as a potential tool to evaluate muscle fiber morphology. In this article, focus is set on pelvic floor muscle damage related to urinary incontinence and pelvic organ prolapse, sometimes as a consequence of vaginal delivery. Modeling applications that evaluate anatomical and physiological properties of pelvic floor are presented to further illustrate their particular characteristics. Finally, finite element method is described as a method for modeling and analyzing pelvic floor structures' biomechanical performance, based on material and behavioral properties of the tissues, and considering pressure loads that mimic real-life conditions such as active contraction or Valsalva maneuver.