Long-term results of a clinical trial comparing isolated vaginal stimulation with combined treatment for women with stress incontinence.

OBJECTIVE: To determine the efficacy of stress urinary incontinence treatments adding pelvic floor muscle training to vaginal electrical stimulation. METHODS: Forty-eight women with stress urinary incontinence were randomized into 2 groups: 24 underwent isolated vaginal electrical stimulation, and 24 vaginal electrical stimulation plus pelvic floor muscle training. History, physical examination, voiding diary, perineum strength test, and urodynamic study were assessed. Comparisons were made for adherence to treatment, muscle strength improvement, urinary symptoms, and degree of satisfaction immediately, 12 and 96 months after treatment. RESULTS: Patients' degree of satisfaction on vaginal electrical stimulation, and on vaginal electrical stimulation plus pelvic floor muscle training immediately, 12 and 96 months post treatment, were, respectively: 88.2% versus 88.9% 64.7% versus 61.1% and 42.9% versus 28.6% (p>0.05). CONCLUSION: Vaginal electrical stimulation associated to pelvic floor muscle training did not show better results than vaginal electrical stimulation alone.

Long-term results of a clinical trial comparing isolated vaginal stimulation with combined treatment for women with stress incontinence / Resultados a longo prazo de um estudo clínico comparando estimulação vaginal isolada com tratamento combinado para mulheres com incontinência urinária de esforço

Objective To determine the efficacy of stress urinary incontinence treatments adding pelvic floor muscle training to vaginal electrical stimulation. Methods Forty-eight women with stress urinary incontinence were randomized into 2 groups: 24 underwent isolated vaginal electrical stimulation, and 24 vaginal electrical stimulation plus pelvic floor muscle training. History, physical examination, voiding diary, perineum strength test, and urodynamic study were assessed. Comparisons were made for adherence to treatment, muscle strength improvement, urinary symptoms, and degree of satisfaction immediately, 12 and 96 months after treatment. Results Patients’ degree of satisfaction on vaginal electrical stimulation, and on vaginal electrical stimulation plus pelvic floor muscle training immediately, 12 and 96 months post treatment, were, respectively: 88.2% versus 88.9% 64.7% versus 61.1% and 42.9% versus 28.6% (p>0.05). Conclusion Vaginal electrical stimulation associated to pelvic floor muscle training did not show better results than vaginal electrical stimulation alone. .

Objetivo Determinar a eficácia da eletroestimulação vaginal combinada com treinamento muscular do assoalho pélvico para o tratamento da incontinência urinária de esforço. Métodos Um total de 48 mulheres com incontinência urinária de esforço foi randomizado em 2 grupos, sendo 24 submetidas a eletroestimulação vaginal isolada e 24 a eletroestimulação vaginal e treinamento muscular do assoalho pélvico. Foram avaliados anamnese, exame físico, diário miccional, força perineal e urodinâmica. Compararam-se a adesão ao tratamento, a melhora da força muscular perineal e dos sintomas urinários, e o grau de satisfação imediatamente, 12 e 96 meses após o tratamento. Resultados O grau de satisfação das pacientes no grupo da eletroestimulação isolada e do segundo grupo, imediatamente, com 12 e com 96 meses foi, respectivamente, 88,2% versus 88,9% 64,7% versus 61,1% e 42,9% versus 28,6% (p>0,05). Conclusão A eletroestimulação vaginal associada ao treinamento muscular do assoalho pélvico não foi mais eficaz do que a eletroestimulação isolada. .

Female urethral diverticulum associated witha large urinary calculus / Divertículo de uretra feminina associado a grande cálculo urinário

The diverticula of female urethra are very uncommon, but more frequently found between the third and fifth decade of life. Diverticula area mostly relate to repeated urinary infections of the periurethral glands or urethras trauma. The diverticula may cause infection, calculus formation and rarely endometriosis or cancer. A case of a 65-year old Caucasian female with vaginal mass over six months is herein reported. There was no urinary loss, urethral secretion or urinary symptoms. A cystourethrography showed diverticula with calculus inside. The patient was submitted to surgery and dismissed from the hospital on the first postoperative day. The pathologic examination revealed no malignancy. In six months of follow-up, the patient was continent with no complaints.

Os divertículos de uretra feminina são incomuns, porém mais frequentes entre a terceira e a quinta década de vida. A maioria dos divertículos de uretra está relacionada a infecções recorrentes das glândulas periuretrais ou traumatismo uretral. Os divertículos podem ser sítio de infecções, formação de cálculos e, mais raramente, endometriose ou neoplasia. Relata-se o caso de paciente de 65 anos, branca, com queixa de nódulo em parede vaginal notado há seis meses. Negava incontinência urinária, derrame uretral e sintomas urinários de armazenamento ou de esvaziamento. A uretrocistografia miccional revelou divertículo uretral associado a cálculo. Submetida à cirurgia, teve alta hospitalar no primeiro dia pós-operatório. O resultado do exame anatomopatológico não evidenciou malignidade. Após seis meses de seguimento, a paciente encontra-se sem queixas urinárias ou vaginais e com continência urinária preservada.

Prostate innervation and local anesthesia in prostate procedures

The nerve supply of the human prostate is very abundant, and knowledge of the anatomy contributes to successful administration of local anesthesia. However, the exact anatomy of extrinsic neuronal cell bodies of the autonomic and sensory innervation of the prostate is not clear, except in other animals. Branches of pelvic ganglia composed of pelvic (parasympathetic) and hypogastric (sympathetic) nerves innervate the prostate. The autonomic nervous system plays an important role in the growth, maturation, and secretory function of this gland. Prostate procedures under local anesthesia, such as transurethral prostatic resections or transrectal ultrasound-guided prostatic biopsy, are safe, simple, and effective. Local anesthesia can be feasible for many special conditions including uncomplicated prostate surgery and may be particularly useful for the high-risk group of patients for whom inhalation or spinal anesthesia is inadvisable

Prostate innervation and local anesthesia in prostate procedures.

The nerve supply of the human prostate is very abundant, and knowledge of the anatomy contributes to successful administration of local anesthesia. However, the exact anatomy of extrinsic neuronal cell bodies of the autonomic and sensory innervation of the prostate is not clear, except in other animals. Branches of pelvic ganglia composed of pelvic (parasympathetic) and hypogastric (sympathetic) nerves innervate the prostate. The autonomic nervous system plays an important role in the growth, maturation, and secretory function of this gland. Prostate procedures under local anesthesia, such as transurethral prostatic resections or transrectal ultrasound-guided prostatic biopsy, are safe, simple, and effective. Local anesthesia can be feasible for many special conditions including uncomplicated prostate surgery and may be particularly useful for the high-risk group of patients for whom inhalation or spinal anesthesia is inadvisable.

Micoplasma e trato genital feminino: revisão bibliográfica / Microplasm and female genital system: bibliographic revision

Os micoplasmas representam uma das menores espécies bacterianas existentes, sendo todas elas parasitárias. Nas infecções do trato genital, dois agentes merecem destaque: Mycoplasma hominis e Ureaplasma urealyticum. Estes pertencem ao grupo das doenças sexualmente transmissíveis (DSTs), reconhecidas como problema de Saúde Pública. Podem gerar, na mulher, uretrites não-gonocócicas, doença inflamatória pélvica e vulvovaginites. Atribui-se a estes patógenos associação com infertilidade, abortamento, natimortalidade, baixo peso do concepto ao nascer e infecções pós-aborto e pós-parto. Percebe-se, assim, o importante incremento na morbimortalidade materno-fetal gerada por esses agentes