ABSTRACT
INTRODUCTION AND HYPOTHESIS: Urgency urinary incontinence (UUI) is highly prevalent in elderly individuals and has a great impact on quality of life. Transcutaneous tibial nerve stimulation (TTNS) can be an effective treatment option for UUI in older women. METHODS: This is a single-center randomized clinical trial with a 12-month follow-up involving 106 women > 60 years of age. Kegel exercises and bladder retraining were performed alone or in combination with TTNS, which consisted of using a transcutaneous electrical nerve stimulator for 30 min once a week for 12 weeks with the following settings: continuous mode, 10 Hz, 200 ms, and 10 to 50 mA (according to hallux mobilization). Responders to therapy who experienced failure during follow-up were invited for a 3-week protocol with the same parameters as those used for the initial therapy. Patients were evaluated at baseline, 4 weeks after the 12-week protocol, and every 3 months for 12 months, through subjective satisfaction questionnaires, a 3-day bladder diary and the International Consultation on Incontinence Questionnaire-Short Form. King's Health Questionnaire was applied pretreatment and 4 weeks after the last session of the 12-week protocol. RESULTS: A total of 101 women completed the initial 12-week protocol. TTNS patients reported 66.7% subjective global satisfaction vs. 32.0% in the control group (p < 0.001). The TTNS group showed statistically significant improvement in quality of life (QoL) and UUI parameters compared with the control group. Forty-eight patients were satisfied after the 12-week protocol and completed the 12-month follow-up (32 in the TTNS group and 16 in the control group). A total of 80.5% of responders to TTNS were still satisfied at the end of the 12-month follow-up vs. 30.8% in the control group (p = 0.009). CONCLUSION: TTNS is effective at the 12-month follow-up for the treatment of UUI in elderly women.
Subject(s)
Transcutaneous Electric Nerve Stimulation , Urinary Bladder, Overactive , Urinary Incontinence , Aged , Female , Follow-Up Studies , Humans , Quality of Life , Tibial Nerve , Treatment Outcome , Urinary Incontinence/therapyABSTRACT
Abstract Interstitial cystitis (IC), including bladder pain syndrome (BPS), is a chronic and debilitating disease thatmainly affectswomen. It is characterized by pelvic pain associated with urinary urgency, frequency, nocturia and negative urine culture,with normal cytology. In 2009, the Society for Urodynamics and Female Urology (SUFU) defined the term IC/BPS as an unpleasant sensation (pain, pressure, and discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than 6 weeks duration, in the absence of infection or other identifiable causes. This is the definition used by the American Urological Association (AUA) in the most recent guidelines on IC/BPS. Interstitial cystitis may be sufficiently severe to have a devastating effect on the quality of life, but it may also be associated with moderate symptoms whose effects are less debilitating. Although there are several clinical trials to assess oral and intravesical therapies, the treatment for IC remains far from ideal. This systematic assessment evaluates published randomized clinical trials on oralmedications used totreat symptoms of BPS. This studywas performed according to the preferred reporting items for systematic reviews and metaanalyses (PRISMA)method. Two independent reviewers screened the studies to determine their inclusion or exclusion and to perform the methodological analysis. The inclusion criteria included randomized studiespublishedbetween April of 1988and April of2016 that used oral medications to treat symptoms of BPS or IC. According to the systematic review performed,we should consider pentosan polysulfate as one of the bestoptions of oral drugs for the treatment of BPS symptoms. However, this drug is not an available option in Brazil. Orally administered amitriptyline is an efficacious medical treatment for BPS, and it should be the first treatment offered.
Resumo Cistite intersticial (IC), incluindo a síndrome da bexiga dolorosa (SBD), é uma doença crônica e debilitante que afeta principalmente mulheres. É caracterizada por dor pélvica associada à urgência miccional, frequência urinária, noctúria e exame cultural de urina negativo, com citologia normal. A cistite intersticial pode ser suficientemente severa para ter um efeito devastador na qualidade de vida, mas também pode estar associada a sintomas moderados e menos debilitantes. Embora existam vários ensaios clínicos para avaliar terapias orais e intravesicais, o tratamento para IC permanece longe do ideal. Esta revisão sistemática avaliou ensaios clínicos randomizados publicados sobre medicamentos orais usados para tratar sintomas de SBD. Este estudo foi realizado de acordo com ométodo preferred reporting items for systematic reviews and meta-analyses (PRISMA). Dois revisores independentes examinaram os estudos para determinar sua inclusão ou exclusão e para realizar a análise metodológica. Os critérios de inclusão foram: ensaios clínicos randomizados publicados entre abril de 1988 e abril de 2016 que usaram medicações orais no tratamento dos sintomas da SBD ou CI. De acordo com a revisão sistemática realizada, a melhor opção de medicação oral para o tratamento dos SBD é o pentosano polissulfato sódico. No entanto, esta droga não está disponível no Brasil. A amitriptilina administrada por via oral é um tratamento eficaz para SBD e deve ser oferecida como primeira escolha.
Subject(s)
Humans , Female , Cystitis, Interstitial/drug therapy , Brazil , Randomized Controlled Trials as Topic , Administration, Oral , Practice Guidelines as TopicABSTRACT
Interstitial cystitis (IC), including bladder pain syndrome (BPS), is a chronic and debilitating disease that mainly affects women. It is characterized by pelvic pain associated with urinary urgency, frequency, nocturia and negative urine culture, with normal cytology. In 2009, the Society for Urodynamics and Female Urology (SUFU) defined the term IC/BPS as "an unpleasant sensation (pain, pressure, and discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than 6 weeks duration, in the absence of infection or other identifiable causes." This is the definition used by the American Urological Association (AUA) in the most recent guidelines on IC/BPS. Interstitial cystitis may be sufficiently severe to have a devastating effect on the quality of life, but it may also be associated with moderate symptoms whose effects are less debilitating. Although there are several clinical trials to assess oral and intravesical therapies, the treatment for IC remains far from ideal. This systematic assessment evaluates published randomized clinical trials on oral medications used to treat symptoms of BPS. This study was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. Two independent reviewers screened the studies to determine their inclusion or exclusion and to perform the methodological analysis. The inclusion criteria included randomized studies published between April of 1988 and April of 2016 that used oral medications to treat symptoms of BPS or IC. According to the systematic review performed, we should consider pentosan polysulfate as one of the best options of oral drugs for the treatment of BPS symptoms. However, this drug is not an available option in Brazil. Orally administered amitriptyline is an efficacious medical treatment for BPS, and it should be the first treatment offered.
Cistite intersticial (IC), incluindo a síndrome da bexiga dolorosa (SBD), é uma doença crônica e debilitante que afeta principalmente mulheres. É caracterizada por dor pélvica associada à urgência miccional, frequência urinária, noctúria e exame cultural de urina negativo, com citologia normal. A cistite intersticial pode ser suficientemente severa para ter um efeito devastador na qualidade de vida, mas também pode estar associada a sintomas moderados e menos debilitantes. Embora existam vários ensaios clínicos para avaliar terapias orais e intravesicais, o tratamento para IC permanece longe do ideal. Esta revisão sistemática avaliou ensaios clínicos randomizados publicados sobre medicamentos orais usados para tratar sintomas de SBD. Este estudo foi realizado de acordo com o método preferred reporting items for systematic reviews and meta-analyses (PRISMA). Dois revisores independentes examinaram os estudos para determinar sua inclusão ou exclusão e para realizar a análise metodológica. Os critérios de inclusão foram: ensaios clínicos randomizados publicados entre abril de 1988 e abril de 2016 que usaram medicações orais no tratamento dos sintomas da SBD ou CI. De acordo com a revisão sistemática realizada, a melhor opção de medicação oral para o tratamento dos SBD é o pentosano polissulfato sódico. No entanto, esta droga não está disponível no Brasil. A amitriptilina administrada por via oral é um tratamento eficaz para SBD e deve ser oferecida como primeira escolha.
Subject(s)
Cystitis, Interstitial/drug therapy , Administration, Oral , Brazil , Female , Humans , Practice Guidelines as Topic , Randomized Controlled Trials as TopicABSTRACT
ABSTRACT Background Vaginal evisceration is a rare problem, usually related to a previous hysterectomy. We report a case of spontaneous rupture of the cul-de-sac in a premenopausal woman under treatment with glucocorticoids to treat Systemic Lupus Erythematosus (SLE), with uterine prolapse that occurred during evacuation. Case Report A 40-year-old woman with SLE, using glucocorticoids, with uterine prolapse grade 4 (POP-Q), awaiting surgery presented at the emergency room with vaginal bleeding after Valsalva during defaction. Uterine prolapse associated with vaginal evisceration was identified. Under vaginal examination, we confirmed the bowel viability and performed a vaginal hysterectomy and sacrospinous fixation. Case hypothesis This case draws attention to the extreme risk of untreated uterine prolapse, as well as the importance of multidisciplinary care of patients with vaginal prolapse and chronic diseases.
Subject(s)
Humans , Female , Adult , Vaginal Diseases/surgery , Visceral Prolapse/surgery , Premenopause , Emergencies , HysterectomyABSTRACT
BACKGROUND: Vaginal evisceration is a rare problem, usually related to a previous hysterectomy. We report a case of spontaneous rupture of the cul-de-sac in a premenopausal woman under treatment with glucocorticoids to treat Systemic Lupus Erythematosus (SLE), with uterine prolapse that occurred during evacuation. Main findings-Case Report: A 40-year-old woman with SLE, using glucocorticoids, with uterine prolapse grade 4 (POP-Q), awaiting surgery presented at the emergency room with vaginal bleeding after Valsalva during defection. Uterine prolapse associated with vaginal evisceration was identified. Under vaginal examination, we confirmed the bowel viability and performed a vaginal hysterectomy and sacrospinous fixation. Case hypothesis: This case draws attention to the extreme risk of untreated uterine prolapse, as well as the importance of multidisciplinary care of patients with vaginal prolapse and chronic diseases.
Subject(s)
Vaginal Diseases/surgery , Visceral Prolapse/surgery , Adult , Emergencies , Female , Humans , Hysterectomy , PremenopauseABSTRACT
A incontinência urinária de esforço é uma condição frequente e é causa de impacto devastador na qualidade de vida das mulheres. Este artigo tem como objetivo mostrar uma revisão das técnicas cirúrgicas mais utilizadas para o tratamento desta disfunção, comparando as principais indicações, complicações e índices de satisfação de cada procedimento.
Stress urinary incontinence is a common condition and cause of devastating impact on quality of life of women. This article aims to show a review of surgical techniques most commonly used today for the treatment of these disorder, comparing the main indications, complications and satisfaction ratings of each procedure.
Subject(s)
Urinary Incontinence, Stress , General SurgeryABSTRACT
A Doença Inflamatória Pélvica (DIP) é a infecção polimicrobiana do trato genital feminino superior, que acomete principalmente as trompas uterinas. Trata-se da doença infecciosa mais comum em mulheres de países industrializado.
The Pelvic Inflammatory Disease (PID) is a polymicrobial infection of the upper female genital tract, which affects mainly the fallopian tubes. It is the most common infectious disease in women from industrialized countries.
Subject(s)
Pelvic Inflammatory Disease , Sexually Transmitted Diseases , WomenABSTRACT
O sangramento vaginal anormal é um sintoma frequente das pacientes que procuram a emergência. Podemos atribuir esse sangramento tanto às doenças do trato genital inferior, quanto do superior. As hipóteses diagnósticas para este sintoma variam de acordo com a faixa etária em que ocorre. Neste trabalho, revisamos os principais diagnósticos e tratamentos relacionados ao sangramento vaginal anormal conforme a idade.
Abnormal vaginal bleeding is a common symptom of patients visiting the emergency room. Diseases either in the lower or in the upper genital tract can cause this disorder. The possible diagnoses for this symptom vary with the age at which it occurs. In this paper, we review the diagnostics and treatments of this condition related to the patient age at which it occurs.
Subject(s)
Uterine Hemorrhage/etiology , Uterine Hemorrhage/therapy , Emergency Medical ServicesABSTRACT
BACKGROUND: Electrical stimulation is commonly recommended to treat urinary incontinence in women. It includes several techniques that can be used to improve stress, urge, and mixed symptoms. However, the magnitude of the alleged benefits is not completely established. OBJECTIVES: To determine the effects of electrical stimulation in women with symptoms or urodynamic diagnoses of stress, urge, and mixed incontinence. SEARCH STRATEGY: Our review included articles published between January 1980 and January 2012. We used the search terms â³urinary incontinenceâ³, â³electrical stimulation â³, â³ intravaginal â³, â³ tibial nerve â³ and â³ neuromodulation â³ for studies including female patients. SELECTION CRITERIA: We evaluated randomized trials that included electrical stimulation in at least one arm of the trial, to treat women with urinary incontinence. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the data from the trials, for inclusion or exclusion, and methodological analysis. MAIN RESULTS: A total of 30 randomized clinical trials were included. Most of the trials involved intravaginal electrical stimulation. Intravaginal electrical stimulation showed effectiveness in treating urge urinary incontinence, but reported contradictory data regarding stress and mixed incontinence. Tibial-nerve stimulation showed promising results in randomized trials with a short follow-up period. Sacral-nerve stimulation yielded interesting results in refractory patients. CONCLUSIONS: Tibial-nerve and intravaginal stimulation have shown effectiveness in treating urge urinary incontinence. Sacral-nerve stimulation provided benefits in refractory cases. Presently available data provide no support for the use of intravaginal electrical stimulation to treat stress urinary incontinence in women. Further randomized trials are necessary to determine the magnitude of benefits, with long-term follow-up, and the effectiveness of other electrical-stimulation therapies.
Subject(s)
Electric Stimulation Therapy/methods , Urinary Incontinence/therapy , Female , Humans , Randomized Controlled Trials as Topic , Tibial Nerve/physiopathology , Treatment Outcome , UrodynamicsABSTRACT
Background Electrical stimulation is commonly recommended to treat urinary incontinence in women. It includes several techniques that can be used to improve stress, urge, and mixed symptoms. However, the magnitude of the alleged benefits is not completely established. Objectives To determine the effects of electrical stimulation in women with symptoms or urodynamic diagnoses of stress, urge, and mixed incontinence. Search Strategy: Our review included articles published between January 1980 and January 2012. We used the search terms “urinary incontinence”, “electrical stimulation”, “intravaginal”, “tibial nerve” and “neuromodulation” for studies including female patients. Selection Criteria We evaluated randomized trials that included electrical stimulation in at least one arm of the trial, to treat women with urinary incontinence. Data Collection and Analysis Two reviewers independently assessed the data from the trials, for inclusion or exclusion, and methodological analysis. Main Results A total of 30 randomized clinical trials were included. Most of the trials involved intravaginal electrical stimulation. Intravaginal electrical stimulation showed effectiveness in treating urge urinary incontinence, but reported contradictory data regarding stress and mixed incontinence. Tibial-nerve stimulation showed promising results in randomized trials with a short follow-up period. Sacral-nerve stimulation yielded interesting results in refractory patients. Conclusions Tibial-nerve and intravaginal stimulation have shown effectiveness in treating urge urinary incontinence. Sacral-nerve stimulation provided benefits in refractory cases. Presently available data provide no support for the use of intravaginal electrical stimulation to treat stress urinary incontinence in ...
Subject(s)
Female , Humans , Electric Stimulation Therapy/methods , Urinary Incontinence/therapy , Randomized Controlled Trials as Topic , Treatment Outcome , Tibial Nerve/physiopathology , UrodynamicsABSTRACT
As disfunções do assoalho pélvico são prevalentes e apresentam íntima relação com a sexualidade feminina. É fundamental a avaliação conjunta destes sistemas, a fim de reduzir morbidade e agregar qualidade de vida e bem estar sexual a estas mulheres.
Pelvic floor dysfunctions are prevalent and have a narrow relation with female sexuality. It's fundamental to have a joint assessment of both systems, in order to decrease morbidity and improve quality of life and sexual well being of these women.
Subject(s)
Pelvic Floor Disorders , Fecal Incontinence , Sexual Dysfunction, Physiological , Sexuality , Urinary Incontinence , Uterine Prolapse , WomenABSTRACT
Esta revisão bibliográfica visa abordar o tratamento da incontinência urinária de urgência. Serão abordadas técnicas comportamentais, eletroestimulação, tratamento farmacológico e toxina botulínica.
This bibliographic review aims to address the treatment of urgency urinary incontinence. We'll approach behavioral techniques, electrostimulation, pharmacological treatment and botulinum toxin.
Subject(s)
Urinary Incontinence, Urge/therapy , Urinary Bladder, OveractiveABSTRACT
INTRODUCTION: The aim of this study was to examine the efficacy of transcutaneous electrical tibial nerve stimulation (TTNS) to treat urge urinary incontinence (UUI) in older women. MATERIAL AND METHODS: The study design was a randomized clinical trial conducted on 51 elderly women (>60 years) with UUI. All were treated with 12 weeks of bladder retraining and pelvic floor muscle exercises, and 25 were randomly selected to receive TTNS in addition to the standard therapy. The cases were evaluated at the baseline and after the end of therapy by 3-day bladder diary, quality of life questionnaires (QoL), and subjective response. RESULTS: Of the patients, 68.0% in TTNS group reported cure or improvement vs. 34.6% in the control group (P = 0.017). TTNS showed significant improvement in most areas of QoL and in UUI parameters when compared with the control group. CONCLUSION: TTNS is efficacious to treat UUI in older women.
Subject(s)
Tibial Nerve , Transcutaneous Electric Nerve Stimulation/methods , Urinary Incontinence, Urge/therapy , Aged , Female , Humans , Quality of Life , Retrospective Studies , Surveys and Questionnaires , Treatment Outcome , Urinary Incontinence, Urge/physiopathology , UrinationABSTRACT
Este artigo tem como objetivo mostrar a evolução do tratamento cirúrgico da incontinência urinaria de esforço feminina e revisar as indicações, complicações e taxas de satisfação de cada procedimento. Tendo em vista a alta prevalência da incontinência urinaria e o impacto devastador na qualidade de vida da mulher, buscamos destacar os procedimentos cirúrgicos mais utilizados para o tratamento desta disfunção.
Subject(s)
Humans , Female , Urinary Incontinence, Stress/surgery , Quality of LifeABSTRACT
Este artigo tem como objetivo sistematizar a avaliação da hematúria microscópica assintomática em mulheres, revisando as possibilidades diagnósticas mais prevalentes, bem como os exames laboratoriais e de imagem mais adequados. Tendo em vista a alta prevalência desse achado ocasional em exame de urina de rotina, os autores buscam encontrar um consenso sobre definição e forma de investigação mais adequada.
Subject(s)
Humans , Female , Adult , Clinical Laboratory Techniques , Hematuria/diagnosisABSTRACT
Os slings suburetrais vêm se tornando o procedimento cirúrgico preferencial para correção da incontinência urinária aos esforços; variam em forma, materiais e métodos de fixação. Os slings podem ser classificados em autólogos, extraídos de cadáveres, xenográficos e sintéticos e o ideal deve ser resistente, disponível e reajustável. O desenvolvimento de slings sintéticos é o alvo de diversas pesquisas, sendo que, na literatura revisada, nenhum estudo demonstrou ampla superioridade de qualquer um dos materiais sintetizados. A escolha do sling deve ser baseada principalmente na segurança, resultados, complicações, custos e tempo de seguimento. Este estudo propõe-se a realizar uma revisão das opções disponíveis para utilização em slings suburetrais comparando suas vantagens e desvantagens e norteando a escolha do melhor a ser utilizado.
Suburethral slings are becoming preferential surgical procedure to treat stress urinary incontinence; they have varied shapes, materials and attachment methods. Slings can be classified in autologous, cadaveric, xenologous and synthetics. The ideal sling should be resistent, readily available and readjustable. Synthetic slings are the target of several researches and in the reviewed literature no trial has shown any great superiority of the sythetic slings. Slings choice must be based essentially on the security, success rates, complications, costs and follow up. This study proposes a review on the available options for use in suburethral slings, comparing the advantages and disadvantages and guidance for the best sling choice.
Subject(s)
Female , Urinary Incontinence, Stress/surgery , Biocompatible Materials/adverse effects , Biocompatible Materials/therapeutic use , Prostheses and Implants , Urologic Surgical Procedures/methods , Urethra/surgeryABSTRACT
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.
Subject(s)
Humans , Female , Child , Adolescent , Adult , Urinary Incontinence/drug therapy , Urinary Incontinence/rehabilitation , Pelvic FloorABSTRACT
O Aumento da expectativa de vida deu-se em ambos os sexos, em todas as idades, sendo que os mais expressivos incrementos foram observados na população feminina. Caso se queira adicionar qualidade de vida à longevidade dessas mulheres, deve-se estar atento também a doenças como o descenso genital, que, certamente, não diminui a longevidade, mas reduz drasticamente a qualidade de vida, limitando o convívio social e o desempenho das atividades diárias. Em função disso, os autores desenvolvem uma revisão relativa à gênese do descenso genital, abordando aspectos pertinentes ao envelhecimento do trato genitourinário, fatores de risco, anatomia e biomecânica da doença, incluindo, o papel desempenhado pelo colágeno, além das implicações clínicas relacionadas a todos esses aspectos
Subject(s)
Humans , Female , Middle Aged , Aging , Collagen/deficiency , Risk Factors , Uterine ProlapseABSTRACT
Os autores fazem uma revisão sobre a avaliação inicial da paciente com incontinência urinária, incluindo métodos diagnósticos. O objetivo é fornecer informações que permitam uma melhor compreensão e investigação desse problema
