Cassio Riccetto

Tradução para português, adaptação cultural e validação do Female Sexual Function Index

PURPOSE to translate from English into Portuguese, adapt culturally and validate the Female Sexual Function Index (FSFI). METHODS knowing the objectives of this research, two Brazilian translators have prepared a version each from the FSFI into Portuguese. Both versions have then been retro-translated into English by two English translators. After harmonizing the differences, they have been pre-tested in a pilot study. The final versions from the FSFI and from another questionnaire, the Short-Form Health Survey, which had already been translated and published in Portuguese, have then been simultaneously administered to one hundred patients, to test the FSFI psychometric proprieties concerning reliability (internal consistency and testing-retesting) and construct validity. Retesting was done after four weeks from the first interview. RESULTS the process of cultural adaptation has not altered the Portuguese version of the FSFI, as compared to the original. The FSFI standardized Cronbach alpha was 0.96, and the evaluation by domains has varied from 0.31 to 0.97. As a measure of test-retest confidentiality, it was applied the intra-class coefficient, which has been considered strong and identical (1.0). Pearsons correlation coefficient between the FSFI and the Short-Form Health Survey was positive, but weak in most of the interrelated domains, varying from 0.017 to 0.036. CONCLUSIONS the FSFI English version has been translated into Portuguese and culturally adapted, being reliable to evaluate the sexual response of Brazilian women.PURPOSE: to translate from English into Portuguese, adapt culturally and validate the Female Sexual Function Index (FSFI). METHODS: knowing the objectives of this research, two Brazilian translators have prepared a version each from the FSFI into Portuguese. Both versions have then been retro-translated into English by two English translators. After harmonizing the differences, they have been pre-tested in a pilot study. The final versions from the FSFI and from another questionnaire, the Short-Form Health Survey, which had already been translated and published in Portuguese, have then been simultaneously administered to one hundred patients, to test the FSFI psychometric proprieties concerning reliability (internal consistency and testing-retesting) and construct validity. Retesting was done after four weeks from the first interview. RESULTS: the process of cultural adaptation has not altered the Portuguese version of the FSFI, as compared to the original. The FSFI standardized Cronbach alpha was 0.96, and the evaluation by domains has varied from 0.31 to 0.97. As a measure of test-retest confidentiality, it was applied the intra-class coefficient, which has been considered strong and identical (1.0). Pearsons correlation coefficient between the FSFI and the Short-Form Health Survey was positive, but weak in most of the interrelated domains, varying from 0.017 to 0.036. CONCLUSIONS: the FSFI English version has been translated into Portuguese and culturally adapted, being reliable to evaluate the sexual response of Brazilian women.

Prevalence study of stress urinary incontinence in women who perform high-impact exercises

IntroductionStress urinary incontinence is a frequent complaint in medical offices and studies have shown that women who practice high impact sports develop its symptoms.ObjectiveTo evaluate the prevalence of stress urinary incontinence in women who attend gyms and perform high impact exercises and correlate it with women who do not attend gyms.MethodProspective comparative study in which 488 nulliparous women of normal weight were divided into a Study Group, composed of women who attended gyms, and a Comparative Group, composed of women who did not attend gyms. Three questionnaires were used for the evaluation of stress urinary incontinence and the results of the ICIQ-SF questionnaire were used to compare the groups.ResultsThere was a significant difference between groups on the ICIQ-SF. The average in the Study Group was 1.68 (+ 3.46) and in the Comparative Group the average was 1.02 (+ 2.69) (p = 0.006).ConclusionWomen who attend gym and perform high impact exercises have a higher prevalence of urinary incontinence symptoms, independent of the exercise modality, than women who do not perform any high impact exercise.

Is there correlation between electromyography and digital palpation as means of measuring pelvic floor muscle contractility in nulliparous, pregnant, and postpartum women?†‡§¶

The continence mechanisms depend on the integrity of the pelvic floor muscles. It is therefore important to find simple, reliable, and safe methods to assess its contractility in a clinical setting. This study aims to investigate if digital palpation of the pelvic floor muscles presents correlation with its electromyographic activity.

Impact of delivery mode on electromyographic activity of pelvic floor: comparative prospective study.

Several studies evidenced the association between pregnancy, mode of delivery and genitourinary symptoms. However, there are still controversies about the role of mode of delivery in the prevention or aggravation of these symptoms. This study aimed to compare the impact of three distinct modes of delivery on pelvic floor muscle contractility.

Electroestimulación del nervio tibial posterior para el tratamiento de la vejiga hiperactiva. estudio prospectivo y controlado

Resumen Objetivo Evaluar la eficacia y el impacto en la calidad de vida de mujeres con sintomas clinicos de VH, sometidas a estimulacion electrica percutanea del nervio tibial posterior. Material y metodo Ensayo clinico randomizado, controlado, en 37 mujeres con sintomas clinicos de VH evaluadas en el Servicio de urologia femenina del Hospital de Clinicas de UNICAMP. Las pacientes que presentaron los criterios de inclusion, fueron distribuidas, de forma aleatoria, en dos grupos: 21 pacientes en el grupo de tratamiento (electroestimulacion percutanea del nervio tibial posterior) y 16 pacientes en el grupo placebo (solo colocacion de los electrodos sin el paso de corriente electrica). Las mujeres fueron interrogadas sobre: historia de sintomas, cirugias previas, presencia de sintomas menopausicos, frecuencia urinaria, urgencia miccional y nocturia, demostrado mediante diario miccional durante tres dias. Se respondio el cuestionario de calidad de vida “Overactive Bladder Questionnaire” (OABq), en el momento de la evaluacion inicial y final del tratamiento. El tratamiento consistio en 8 sesiones de electroestimulacion, dos veces por semana con duracion de 30 minutos cada sesion. Resultados El trabajo mostro cambios significativos en los sintomas de frecuencia y nocturia, en el grupo sometido a electroestimulacion del nervio tibial posterior (P=0003 = ep 0001, respectivamente). La urgencia miccional y la calidad de vida mejoro en ambos grupos significativamente Conclusion la electroestimulacion del nervio tibial posterior demostro ser un tratamiento fisioterapeutico eficaz en el tratamiento de los sintomas clinicos y mejoria la calidad de vida de las mujeres con VH.

A stereological analysis of fibrosis and inflammatory reaction induced by four different synthetic slings

To analyse quantitatively, using stereological methods, the density of the collagen fibres induced by four types of sling materials, and verify by a histopathological analysis the corresponding inflammatory reaction, as fibrosis secondary to sling implantation is considered responsible for restoring urethral support and re‐establishing continence in women with stress urinary incontinence, and new synthetic materials that promote adequate fibrosis with the least intensity and duration have been proposed to substitute the aponeurotic sling.

Safyreä: a readjustable minimally invasive sling for female urinary stress incontinence

Introduction: SAFYRE TM is a readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). It is as a pubovaginal sling placed in the medial third of the urethra. The initial experience is described. Materials and Methods: Forty-five patients (mean age = 59 years) underwent a SAFYRE TM implant to treat SUI. Physical examination and urodynamic study were performed before surgery. All patients presented symptoms of SUI and 20% also reported mild urgency. Approximately 60% of this group had a previously failed anti-incontinence procedure. Urethral hypermobility was diagnosed in 40% of the patients and intrinsic sphincter deficiency (ISD) in 60% of the cases. Results: The average follow up period was 10 months. The mean operative time was 20 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 11% of the implants, bladder perforation occurred. During the postoperative period, 9 patients (20%) developed transient urgency symptoms. During the initial follow up period, 90% were found to be continent, 3% reported an improvement and 7% were unchanged. Conclusion: SAFYRE TM is a safe and quick procedure that allows postoperative readjustment. This technique may be an attractive alternative in the management of SUI, should the good result obtained so far prove to be long lasting.

Global Postural Re-education: an alternative approach for stress urinary incontinence?

OBJECTIVE The aim of this study was to evaluate the impact of Global Postural Re-education (GPR) on stress urinary incontinence symptoms and to compare it to Pelvic Floor Muscle Training (PFMT). STUDY DESIGN Fifty-two women with stress urinary incontinence were distributed into two groups: Group 1 (G1) was submitted to weekly sessions of GPR for three months and Group 2 (G2) performed Pelvic Floor Muscle Training four times a week for three months. Patients were evaluated through the Kings Health Questionnaire, a three-day voiding diary including daily pad use and a Functional Evaluation of the Pelvic Floor (FEPF), before treatment (T0), at the end of treatment (T1) and six months after treatment (T2). RESULTS The number of leaking episodes dropped significantly in both groups at the end of treatment and at six months follow-up, with a significantly greater decrease in G1. Daily pad use dropped significantly in both groups. At the end of treatment, 72% of the patients in G1 and 41% of the patients in G2 needed no pads and at six-month follow-up, 84% and 50%, respectively. FEPF improved significantly in both groups, with no significant difference between the groups (P=0.628). The Kings Health Questionnaire demonstrated significant improvement in both groups and in all domains. The GPR group presented higher adherence to treatment, with no dropouts. CONCLUSIONS GPR could represent an alternative method to treat stress urinary incontinence in women, should the results be long lasting.

RESINIFERATOXIN FOR DETRUSOR INSTABILITY REFRACTORY TO ANTICHOLINERGICS

PURPOSE We have evaluated the clinical and urodynamic effects of intravesical instillation of resiniferatoxin in patients with idiopathic detrusor instability refractory to anticholinergics. MATERIALS AND METHODS There were 30 women, median age 56 years old with detrusor instability for over 6 months and a history of anticholinergic use with no response or intolerable collateral effects. A 50 nM solution of resiniferatoxin was prepared for intravesical instillation. All patients were evaluated for urinary symptoms, as well as for urodynamic assessments before and 30 days after instillation. Tolerability was analyzed during the instillation. RESULTS A clinical improvement was observed in 30% of the patients with urinary urgency and in 33% of the patients with urge-incontinence. The mean maximum cystometric capacity before application was 303.9 +/- 78.9 and after application 341 +/- 84.6. No significant difference was observed (p = 0.585). The mean maximum amplitude of the contractions diminished from 47.86 +/- 29.64 to 38.72 +/- 30.77 (p = 0.002). CONCLUSIONS Resiniferatoxin, in this concentration, proved to be useful in a small percentage of patients regarding clinical detrusor instability. Maximum amplitude of the involuntary contractions was significantly reduced and in 33% patients the involuntary contractions disappeared. Further studies with different concentrations are recommended.

Readjustable transobturator sling: a novel sling procedure for male urinary incontinence.

Post-prostatectomy incontinence remains a significant problem for both patients and urologists. We report a case and the surgical technique of successful sling in the treatment of post-prostatectomy urinary incontinence. Sling surgery was performed on a 69-year-old male patient with severe urinary incontinence (6 pads/day) following radical prostatectomy. The procedure was conducted through the transobturator approach using a sling with a silicone foam pad to protect the urethra. At the 7-month follow-up the patient is using only 1 pad/day. We consider this operation an alternative to artificial urinary sphincter in cases of male sphincter incontinence.