Andrea Moura Rodrigues Maciel da Fonseca

Intensive supervised versus unsupervised pelvic floor muscle training for the treatment of stress urinary incontinence: a randomized comparative trial

Introduction and hypothesisPelvic floor muscle training (PFMT) is considered to be the first-line treatment for female stress urinary incontinence (SUI). There are few studies that have tested the efficacy of unsupervised PFMT. The aim of this study was to compare the effectiveness of intensive supervised PFMT to unsupervised PFMT in the treatment of female SUI.MethodsSixty-two women with SUI were randomized to either supervised or unsupervised PFMT after undergoing supervised training sessions. They were evaluated before and after the treatment with the Oxford grading system, pad test, quality of life questionnaire, subjective evaluation, and exercise compliance.ResultsAfter treatment, there were no differences between the two groups regarding PFM strength (p = 0.20), International Consultation on Incontinence Questionnaire-Short Form score (p = 0.76), pad test (p = 0.78), weekly exercise compliance (p = 0.079), and subjective evaluation of urinary loss (p = 0.145).ConclusionsBoth intensive supervised PFMT and unsupervised PFMT are effective to treat female SUI if training session is provided.

Biomechanical Properties of Vaginal Tissue in Women with Pelvic Organ Prolapse

Background/Aims: To compare biomechanical properties of vaginal tissues between women with and without pelvic organ prolapse (POP) and investigate factors that may influence these properties. Methods: Forty patients submitted to POP surgery and 15 non-POP cadavers were evaluated. The tissue was excised from anterior and posterior middle third vagina. The biomechanical properties considered were stiffness (E) and maximum stress (Smax), and they were evaluated by means of uniaxial tension tests. Results: POP patients were associated with higher values of E (13.1 ± 0.8 vs. 9.5 ± 0.7 MPa; p < 0.001) and Smax (5.3 ± 0.5 vs. 3.2 ± 0.9 MPa; p < 0.001) in the anterior vaginal wall compared to the posterior wall. In contrast, non-POP women presented lower values of E (6.9 ± 1.1 vs. 10.5 ± 1.0 MPa; p = 0.01) and Smax (2.6 ± 0.4 vs. 3.5 ± 0.4 MPa; p = 0.043) in the anterior wall. The occurrence of POP was the only independent predictor of higher values of E and Smax in anterior vaginal samples (p = 0.003 and p = 0.008, respectively). Women with severe anterior vaginal prolapse presented higher levels of E and Smax in the anterior sample compared to those with lower POP stages (p = 0.001 and p = 0.01; respectively). Conclusion: Women with POP present significant changes of biomechanical properties in the vagina.

Evaluation of demographic, clinical characteristics, and genetic polymorphism as risk factors for pelvic organ prolapse in Brazilian women.

Verify the association between genital prolapse, other risk factors and a polymorphism in exon 31 of the collagen III‐a1 gene (COL3A1).

The relationship between the Trp 64 Arg polymorphism of the beta 3–adrenoceptor gene and idiopathic overactive bladder

OBJECTIVE The purpose of this study was to verify the association between the Trp 64 Arg polymorphism and idiopathic overactive bladder (OAB) syndrome. STUDY DESIGN A case-control study was conducted with 218 women. The case group consisted of 49 patients with OAB symptoms; the control group included 169 women without urinary symptoms. The studied polymorphism was detected by restriction fragment length polymorphism analysis. The χ(2) test was used to compare categoric data, with a significance level of 5%. Numeric data were compared with the use of the parametric t test or nonparametric Mann-Whitney U test. RESULTS The distribution of the polymorphism in the investigated women was digested homozygous T allele 69.75%, heterozygotes 29.8%, and homozygous A allele 0.45%. A comparison between the groups showed higher prevalence of the digested homozygous T allele genotype in women with OAB syndrome (P = .001). Multiple logistic regression analysis identified that a family history of OAB syndrome was an independent risk factor for OAB syndrome. CONCLUSION The Trp 64 Arg polymorphism was associated with OAB syndrome in the Brazilian population.

The Effectiveness of Anticholinergic Therapy for Overactive Bladders: Systematic Review and Meta-Analysis

The overactive bladder (OAB) has a significant negative impact on the quality of life of patients. Antimuscarinics have become the pharmacological treatment of choice for this condition. The objective of this systematic review and meta-analysis is to examine the evidence from randomized clinical trials about the outcomes of the antimuscarinic drugs available in Brazil on OABs. We searched MEDLINE and the Cochrane Central Register of Controlled Trials from the inception of these databases through to September 2015. The primary outcome measures were the mean decrease in urge urinary incontinence episodes and the mean decrease in the frequency of micturition. The results suggest that there is a moderate to high amount of evidence supporting the benefit of using anticholinergic drugs in alleviating OAB symptoms when compared with placebo. It is still not clear whether any of the specific drugs that are available in Brazil offer advantages over the others. These drugs are associated with adverse effects (dry mouth and constipation), although they are not related to an increase in the number of withdrawals.

Análise dos recursos para reabilitação da musculatura do assoalho pélvico em mulheres com prolapso e incontinência urinária

This review aimed to assess the capabilities and effectiveness of pelvic floor rehabilitation in the treat- ment of genital prolapse and urinary incontinence. The research was conducted in MEDLINE/PubMed, LILACS/ SciELO and Cochrane Library. There were found 886 ar- ticles, of which were used 34 relevant clinical trials that answered the questions constructed by the authors. The studies analyzed showed that pelvic floor training can be used in prolapse treatment, but further randomized stud- ies are necessary to support this evidence. For urinary incontinence pelvic floor, rehabilitation is effective and should be the treatment of first choice.Esta revision tiene como objetivo analizar los recursos y su eficacia en la rehabilitacion del suelo pelvico en el tratamiento de los prolapsos genitales y la incontinencia urinaria. Las busquedas fueron realizadas en las bases de datos Medline/Pubmed, LILACS/SciELO y Cochrane. Fueron encontrados 886 articulos, de los cuales fueron utilizados 34 estudios clinicos relevantes y que respondian las preguntas construidas por los autores. Los estudios analizados mostraron que el entrenamiento del suelo pelvico puede ser usado en el tratamiento de los prolapsos, sin embargo, son necesarios mas estudios randomizados para sustentar esta evidencia. Para la incontinencia urinaria la rehabilitacion del suelo pelvico es eficiente y debe ser el tratamiento de primera opcion.

Análisis de los recursos para rehabilitación de la musculatura del suelo pélvico en mujeres con prolapso e incontinencia urinaria

This review aimed to assess the capabilities and effectiveness of pelvic floor rehabilitation in the treat- ment of genital prolapse and urinary incontinence. The research was conducted in MEDLINE/PubMed, LILACS/ SciELO and Cochrane Library. There were found 886 ar- ticles, of which were used 34 relevant clinical trials that answered the questions constructed by the authors. The studies analyzed showed that pelvic floor training can be used in prolapse treatment, but further randomized stud- ies are necessary to support this evidence. For urinary incontinence pelvic floor, rehabilitation is effective and should be the treatment of first choice.Esta revision tiene como objetivo analizar los recursos y su eficacia en la rehabilitacion del suelo pelvico en el tratamiento de los prolapsos genitales y la incontinencia urinaria. Las busquedas fueron realizadas en las bases de datos Medline/Pubmed, LILACS/SciELO y Cochrane. Fueron encontrados 886 articulos, de los cuales fueron utilizados 34 estudios clinicos relevantes y que respondian las preguntas construidas por los autores. Los estudios analizados mostraron que el entrenamiento del suelo pelvico puede ser usado en el tratamiento de los prolapsos, sin embargo, son necesarios mas estudios randomizados para sustentar esta evidencia. Para la incontinencia urinaria la rehabilitacion del suelo pelvico es eficiente y debe ser el tratamiento de primera opcion.

Analysis of the resources for rehabilitation of pelvic floor muscles in women with prolapse and urinary incontinence

This review aimed to assess the capabilities and effectiveness of pelvic floor rehabilitation in the treat- ment of genital prolapse and urinary incontinence. The research was conducted in MEDLINE/PubMed, LILACS/ SciELO and Cochrane Library. There were found 886 ar- ticles, of which were used 34 relevant clinical trials that answered the questions constructed by the authors. The studies analyzed showed that pelvic floor training can be used in prolapse treatment, but further randomized stud- ies are necessary to support this evidence. For urinary incontinence pelvic floor, rehabilitation is effective and should be the treatment of first choice.Esta revision tiene como objetivo analizar los recursos y su eficacia en la rehabilitacion del suelo pelvico en el tratamiento de los prolapsos genitales y la incontinencia urinaria. Las busquedas fueron realizadas en las bases de datos Medline/Pubmed, LILACS/SciELO y Cochrane. Fueron encontrados 886 articulos, de los cuales fueron utilizados 34 estudios clinicos relevantes y que respondian las preguntas construidas por los autores. Los estudios analizados mostraron que el entrenamiento del suelo pelvico puede ser usado en el tratamiento de los prolapsos, sin embargo, son necesarios mas estudios randomizados para sustentar esta evidencia. Para la incontinencia urinaria la rehabilitacion del suelo pelvico es eficiente y debe ser el tratamiento de primera opcion.