Bladder neck mobility and functional evaluation of the pelvic floor in primiparae according to the type of delivery.

In this study, 91 primiparous women were selected, with a period of post-delivery variable from 45 to 60 days. These patients were divided according to the type of delivery into three groups: I--consisting of 32 patients who had vaginal delivery; II--comprised 29 patients who were subjected to forceps; III--formed by 30 women who were subjected to cesarean section. Patients with a previous pregnancy were not included, so that the possible previous alterations of the pelvic floor did not interfere with the present evaluation. Patients with a pre-term pregnancy, fetus below 2,500 g or above 4,000 g, anomalous presentations, twin pregnancy, diabetes mellitus, systhemic arterial hypertension, hypertensive disease specific of pregnancy, endocrinopathies and neuropathies were also excluded. After 45 to 60 days from delivery the patients were subjected to anamnesis, gynecological examination, functional evaluation of the pelvic floor (FEAF), Q-Tip test and ultrasound of the bladder neck. As for the functional evaluation of the pelvic floor, it was observed that the patients with cesarean section presented better indexes compared to those who were subjected to forceps. The Q-Tip test showed that in both the patients from group I and group II bladder neck mobility was greater than in those from group III. Concerning bladder neck topography in relation to public symphysis and its mobility, which were evaluated by ultrasound, it was observed that at rest all the groups had the neck in a supra-pubic position, with no differences among them. Yet, during the required strain, the bladder neck stayed in the infra-pubic position with major frequency in group I. Bladder neck mobility was greater in the vaginal delivery group in relation to the other groups. It was also noticed that the group undergoing cesarean section showed less mobility. The obtained results lead us to conclude that despite the fact that vaginal delivery may cause displacement of the urethro-vesical junction during strain, and consequently greater bladder neck mobility, it is the attending physician's role to minimize the damage to the pelvic floor, thus avoiding the emergence of a predisposing factor to future stress urinary incontinence.

Quantitative evaluation of collagen and muscle fibers in the lower urinary tract of castrated and under-hormone replacement female rats.

OBJECTIVE: To evaluate the number of collagen and muscle fibers in the muscle layer of the urethra and in the bladder wall of castrated and under-hormone replacement female rats. METHOD: We studied 37 castrated female rats assigned to the following groups: Group C (n=9): received no medication; Group P (n=8) was given 0.1 ml of placebo, subcutaneous (SC) route; Group E (n=10): 17beta-estradiol, 10 microg/kg/day, SC route; Group PR (n=9): medroxyprogesterone acetate. 0.2 mg/kg/day, SC route; Group E+PR (n=9): association of 17beta-estradiol and medroxyprogesterone acetate. Sections were taken from the bladder wall and from the middle third of the urethra, and the specimens were stained with picrosirius for collagen and muscle fiber identification. RESULTS: Groups C and P showed a similar amount of collagen in the bladder and in the urethra, however greater than the other groups. Group E showed the smallest number of collagen fibers in the urethra. Groups E and E+PR presented a larger number of muscle fibers in the bladder. Group PR presented a larger number of muscle fibers than groups C and P, however smaller than groups E and E+PR. In the muscle layer of the urethra, the number of collagen fibers was smaller in Group E than in all the other groups, which were similar among one another. In regard to the urethral muscles, Group E was found to present the largest number of muscle fibers as compared to the other groups analyzed, while Group PR showed a significant decrease in the muscle layer, even in relation to the groups that were given no hormone medication. CONCLUSION: Estrogens significantly decrease the amount of collagen fibers, increase the amount of muscle fibers and determine a significantly decreased collagen/muscle ratio in both the detrusor muscle and in the urethral muscle layer. It is also noticed that isolated progestogen decreases the amount of collagen fibers and increases the number of muscle fibers in the detrusor muscle, but with less intensity than replacement with estrogens alone. It neither alters the number of collagen fibers nor decreases the muscle fibers in the muscle layer of the urethra, with increased collagen/muscle ratio in that structure. Finally, the estrogen-progestogen combination determines significantly decreased collagen fibers and increased muscle fibers in the detrusor muscle, causing no alteration to the collagen or muscle fibers in the muscle layer of the urethra.

Menopausal genuine stress urinary incontinence treated with conjugated estrogens plus progestogens.

OBJECTIVE: The aim of the study was to investigate clinically and urodynamically the effects of hormonal replacement in the treatment of genuine stress urinary incontinence in postmenopausal females. METHODS: Clinical and urodynamic variables of 30 postmenopausal women with genuine stress urinary incontinence were evaluated after 3 months' treatment with conjugated estrogens plus progestogens. Urodynamic evaluations were performed in all patients before and after treatment. RESULTS: Forty-six percent of the patients treated medically were judged to be cured and 43% were judged to be markedly improved. Maximum urethral closure pressure, maximum cystometric capacity and mean flow were significantly increased. Residual urine and diurnal and nocturnal voluntary micturition were markedly decreased (P < 0.05). CONCLUSION: We conclude that hormone replacement in the form of conjugated estrogens plus progestogens results in the clinical and urodynamic improvement of genuine stress urinary incontinence in postmenopausal women.