Andrea Marques

Management of Stress Urinary Incontinence With Surface Electromyography–Assisted Biofeedback in Women of Reproductive Age

Background and Purpose Although surgery has been widely accepted as the treatment of choice for stress urinary incontinence (SUI), there has recently been an increased interest in the conservative management of this condition. The aims of this study were to test the ability of a biofeedback-assisted pelvic-floor muscle exercise (PFME) program to affect symptoms of SUI in premenopausal women and to evaluate a training program that might lead to successful outcomes in a relatively limited number of sessions. Subjects Twenty-six women with SUI were treated with PFME with surface electromyography (sEMG)–assisted biofeedback. All participants were of reproductive age and were treated individually for 12 sessions. Methods Results were evaluated with a 7-day voiding diary, a 1-hour pad test, pelvic-floor muscle strength measurements, sEMG amplitudes, a leakage index, and a quality-of-life questionnaire. These variables were compared before and after the intervention. Results The frequency of urine loss, the occurrence of nocturia, and the number of pads required decreased significantly after the intervention. Objective cure was found in 61.5% of women. There was a significant improvement in the quality of life, in pelvic-floor muscle strength, and in the sEMG amplitudes of all contractions throughout the intervention. Discussion and Conclusion A relatively short-term intervention of PFME with sEMG-assisted biofeedback appeared to be helpful in relieving symptoms of SUI in premenopausal women and represents a reasonable conservative management option.

Eletroestimulação transvaginal do assoalho pélvico no tratamento da incontinência urinária de esforço: avaliações clínica e ultra-sonográfica

BACKGROUND The purpose of this study was to evaluate the efficacy of transvaginal electrical stimulation on the treatment of women with stress urinary incontinence (SUI) in selected cases. METHODS Twenty two women with primary stress urinary incontinence diagnosed by urodynamic study were submitted to transvaginal electrical stimulation. The mean age was 49 years old (range 22 to 74). The treatment consisted of two weekly sessions of stimulation, each 20 minutes long, during 8 weeks. Women were evaluated through history, clinical and urogynecological exam, weekly registration of frequency of urinary leakage, stress test and transperineal ultrasound before and after treatment. A pulse of 700 sec. was used, frequency of 50 Hz and intensity varying from 12 to 53 mA according to the womens sensitivity. RESULTS Eighteen of 22 subjects (81.7%) were satisfied with electrical stimulation and frequency of urinary incontinence reduced significantly (p<0.01). Stress test was negative in 77.2% of the women after treatment. Valsalva leak-point pressure was higher in 14 (63.3%) women after treatment, although not reaching statistical significance (p=0.37). Bladder neck mobility did not change significantly before and after electrical stimulation (p=0.30). CONCLUSION Transvaginal electrical stimulation of the pelvic floor is an effective and safe treatment to women with SUI without sphincter deficiency, with significant reduction of the frequency of urinary leakage.

Existe diferença na contratilidade da musculatura do assoalho pélvico feminino em diversas posições

OBJETIVO: avaliar e comparar resultados da eletromiografia de superficie do assoalho pelvico feminino em diversas posicoes (decubito dorsal, na posicao sentada e ortostatica). METODOS: foram avaliadas 26 mulheres submetidas a um protocolo de exercicios para o fortalecimento do assoalho pelvico como tratamento da incontinencia urinaria de esforco por hipermobilidade do colo vesical. Utilizou-se sensor intravaginal conectado ao equipamento Myotrac 3GTM e a avaliacao consistia em: 60 segundos iniciais de repouso, cinco contracoes fasicas, uma contracao tonica de 10 segundos e outra de 20 segundos. As amplitudes destas contracoes foram obtidas pela diferenca entre a amplitude final da contracao menos a amplitude de repouso (em µV) e foram comparadas com o uso do teste de Wilcoxon para amostras pareadas (p<0,05). RESULTADOS: as amplitudes das contracoes foram maiores em decubito dorsal, decrescendo sucessivamente nas posicoes sentada e ortostatica. Em decubito dorsal, as medianas das contracoes fasicas e tonicas de 10 s e 20 s foram respectivamente 23,5 (5-73), 18,0 (3-58) e 17,0 (2-48). Na posicao sentada foram 20,0 (2-69), 16,0 (0-58) e 15,5 (1-48), e na posicao ortostatica 16,5 (3-67), 12,5 (2-54) e 13,5 (2-41). Quando se comparou a posicao ortostatica, com o decubito dorsal, observou-se diferenca significativa em todas as contracoes (p<0,001, p<0,001 e p=0,003). Resultados semelhantes tambem foram encontrados comparando-se a posicao ortostatica com a posicao sentada. Todavia, entre o decubito dorsal e a posicao sentada, nao foi observada diferenca significativa. CONCLUSAO: as amplitudes de todas as contracoes do assoalho pelvico feminino foram inferiores na posicao ortostatica, sugerindo que o fortalecimento muscular deve ser intensificado nesta posicao.

Avaliação de dor e depressão em mulheres com endometriose após intervenção multiprofissional em grupo

OBJECTIVE: Evaluate pain and depression scores before and after multi-professional group intervention in women with endometriosis as compared to those who did not participate in this activity. METHODS: A total of 128 women attended at the Endometriosis Outpatient Facility CAISM/UNICAMP, was assessed and distributed equally into two groups: women who received group intervention and those who did not. All women completed the Beck Depression Inventory and the Analogical Visual Scale. RESULTS: There was a significant decrease in pain and depression scores at the end of group intervention. Women who had not participated in the intervention had higher initial scores of pain when compared to those who had. On the other hand, in the group without intervention,depression scores were lower. A positive correlation was identified between pain and depression in both groups. CONCLUSION: Group intervention was efficient in diminishing pain and depression in women with endometriosis and may be included in the conventional treatment for patients affected by this disease.