Emerson de Oliveira

Relação entre incontinência urinária em mulheres atletas corredoras de longa distância e distúrbio alimentar

BACKGROUND: To determine the prevalence of urinary incontinence in female long-distance runners and to compare it with the presence or not of eating disorders. Methods - A total of 37 women have completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the short version of the Eating Attitudes Test (EAT-26). A one-hour pad test was performed to determine urine loss. Mean values of continuous variables were compared using an independent sample t-test or the Mann-Whitney U test. RESULTS: 23 athletes (62.2%) reported urine loss. The mean of the ICIQ-SF was 4.03 ± 5.06. There was a significant relation between the 1-hour pad test (p=0.02) and eating disorders (p=0.03). CONCLUSIONS: There was urinary incontinence in female long-distance runners and a correlation with eating disorders. Coaches should improve their knowledge about this problem and establish cooperation with a multidisciplinary team.

Avaliação dos fatores relacionados à ocorrência da incontinência urinária feminina

OBJETIVO: Avaliar os fatores de risco relacionados a ocorrencia da incontinencia urinaria feminina. METODOS: Estudo caso-controle que incluiu 253 mulheres (102 incontinentes e 151 continentes) convidadas a responder a um questionario epidemiologico sobre possiveis fatores de risco para a incontinencia urinaria como: idade, estado hormonal, raca, Indice de Massa Corporal, paridade, tipos de partos (normais, forcipes ou cesarianas), peso do maior recem-nascido, utilizacao de episiotomia e ou analgesia durante o parto, historia de histerectomia, pratica de atividade fisica, tabagismo, diabetes mellitus, constipacao intestinal, historia de asma bronquica e ou doenca pulmonar obstrutiva cronica, uso de diureticos e ou antidepressivos. RESULTADOS: Foram encontrados, apos a aplicacao do modelo de regressao logistica binaria, como fatores de risco para a ocorrencia de incontinencia urinaria: a idade [OR = 1,07 (IC 1,03 - 1,1)], o parto normal [OR = 1,5 (IC 1,1 - 12,0)], o parto forcipe [OR = 35,0 (IC 3,7 - 327)] e o peso do maior recem-nascido [OR = 1,001 (IC 1 - 1,002)]. Alem disso, identificamos como fator de protecao a cesariana [OR = 0,39 (IC 0,23 - 0,65)]. CONCLUSAO: Os fatores de risco independentes para a ocorrencia da incontinencia urinaria foram idade, parto normal, parto forcipe e peso do maior recem-nascido e, como fator de protecao, a cesariana.

Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse

The aim of the study was to compare the effect of hypopressive exercises including pelvic floor muscle contraction, pelvic floor muscle training (PFMT) alone and control on pelvic floor muscle function in women with pelvic organ prolapse (POP).

Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial

CONTEXT AND OBJECTIVE Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. DESIGN AND SETTING Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo. METHODS Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. RESULTS The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816). CONCLUSIONS The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.

The catechol-O-methyltransferase (COMT) gene polymorphism and prevalence of uterine fibroids

OBJECTIVE To assess the possible association between the catechol-O-methyltransferase (COMT) polymorphism and uterine fibroids in Brazilian women. DESIGN Case-control study. SETTING Department of Gynecology; teaching hospital. PATIENT(S) One hundred twenty-four premenopausal women with fibroids, and 193 postmenopausal controls not presenting the disease. INTERVENTION(S) The subjects were classified as white or non-white (black and mulatto), and COMT genotypes were determined. DNA was extracted from the uterus of cases and from peripheral blood of controls and submitted to polymerase chain reaction (PCR) and agarose gel electrophoresis. MAIN OUTCOME MEASURE(S) The presence of the COMT polymorphism was recorded for all patients, and the frequency and distribution among cases and controls were compared according to race. Binomial log regression models were used to estimate odds-ratios (OR) for uterine volumes of <290 cm(3) (small fibroids) vs. those >290 cm(3) (large fibroids). Potential confounding variables (age, race and parity) were added to the model. RESULTS Genotypes positive for the COMT polymorphism (heterozygous or mutant homozygous) were found in 45% of white and 28.9% of non-white women (p = .013) and the polymorphic allele frequencies in these groups were 27.2% and 16.3%, respectively (p = .006). However, there were no clear differences between patients and controls within the white subgroup with regard to the presence of COMT polymorphism-containing genotypes (41.5% vs. 46.0%, respectively) (p = .60), or for the polymorphic allele frequency (26.8% vs. 27.3%, respectively) (p = .92). For non-white women, there were also no differences between cases and controls for the frequency of polymorphic genotypes (28.9% vs. 28.9%, respectively) (p = .995), or for the polymorphic allele frequency (17.8 vs. 14.5, respectively) (p = .565). Estimated OR for small or large fibroids in association with the polymorphic allele revealed a positive association between the allele with lower activity and large fibroids (vs. small) (OR = 3.3; 95% confidence interval [CI] = 1.31-8.46). The adjusted OR was 4.35 (95% confidence interval [CI] = 1.58-11.9). CONCLUSIONS The catechol-O-methyltransferase polymorphism is a risk factor for the development of large uterine fibroids in Brazilian women suffering from fibroids.

Urodynamic study and quality of life in patients with fibromyalgia and lower urinary tract symptoms

The aim of this study was to evaluate clinical and urodynamic observations on women with fibromyalgia (FM) and lower urinary tract symptoms (LUTS). Fifty-one patients with FM and LUTS and 50 patients with LUTS without FM answered questions about urinary symptoms and also two questionnaires about quality of life measures: “Medical Outcomes Study 36-Item Short-Form Health Survey” and “Kings Health Questionnaire”. The urodynamic parameters evaluated were the following: maximum cystometric capacity, urine loss due to cough, Valsalva leak point pressure, and detrusor overactivity (DO). The groups were homogeneous concerning age, parity, body mass index, and genital prolapse. Symptoms such as increase of urinary frequency (p = 0.007) and urge urinary incontinence (p = 0.004) were statistically more common in the FM group. DO was the statistically most common urodynamic observation in patients with FM (p = 0.02). Regarding the questionnaires about quality of life, the patients with fibromyalgia and LUTS had the worst results in all fields. In conclusion, patients with FM and LUTS have detrusor overactivity more often as well as an increase of urinary frequency, contributing to the quality of life worsening.

Impacto do estudo urodinâmico em mulheres com incontinência urinária

OBJECTIVE: The purpose was to evaluate tolerance of patients with urinary incontinence undergoing an urodynamic study. METHODS: Forty nine patients with lower urinary tract symptoms submitted to an urodynamic study were evaluated... Prior to and immediately after the procedure each patient completed a self-administered questionnaire about several emotional variables, including anxiety, pain and shame. Answers about pain were given on a visual analog scale. Mean values of continuous variables were compared using a paired t-test, whereas categorical variables were compared using the chi-square test. RESULTS: The mean age was 49.5 (23-84) years. Pain score pre-procedure was 4.29 ± 3 and after procedure was 2.7 ± 2.9 (p=0.001). CONCLUSION: The urodynamic study is well tolerated by female patients and a low morbidity was found. Previous orientation can decrease anxiety.

Ultrasonographic and doppler velocimetric evaluation of the levator ani muscle according to the hormonal status.

OBJECTIVE We aimed to study the cross-sectional area of levator ani muscle and the doppler velocimetric parameters of vessels its in premenopausal and postmenopausal women. STUDY DESIGN Sixty-four patients, divided into 3 groups, were assessed: group I (20 women-average age 28 years) premenopausal and nulliparous (control); group II (24 women-average age 38 years, vaginal delivery 1-4) premenopausal with vaginal deliveries; group III (20 women-average age 55 years, parity 0-4) postmenopausal without hormonal therapy. Doppler velocimetry of levator ani muscle vessels through resistance and pulsatility indices was used and the means of the groups compared by adjusting the weighed variance model with multiple comparisons, according to Tukeys method. Similarly, we measured the cross-sectional area of the muscle using ultrasonography. RESULTS There was a significant increase in resistance and pulsatility indices in postmenopausal patients as compared to the other two groups. We also observed a significant decrease in the cross-sectional area of the muscle of postmenopausal patients when compared to those in premenopausal. CONCLUSION The obtained results allow us to conclude that levator ani muscle vascularization significantly decreases after menopause (age and/or hipoestrogenism) and that it can be assumed that vaginal delivery does not promote long-term alterations in levator ani muscle vascularization. We also observed a significant decrease in the cross-sectional area of the muscle in postmenopausal women when compared to those in premenopausal.

Influência do índice de massa corporal na incontinência urinária feminina

PURPOSE to evaluate and compare the effects of body mass index (BMI) on the severity of female urinary incontinence (UI) using the quality of life questionnaire Kings Health Questionnaire (KHQ), variables of urodynamic studies and the medical history taken. METHODS cross-sectional clinical study. We selected 65 patients with stress urinary incontinence (SUI) who were divided into three groups: Group I (BMI: 18-25 kg/m²), Group II (BMI: 25-30 kg/m²) and Group III (BMI>30 kg/m²). The KHQ domains were compared between these groups. In addition, some clinical history urodynamic data (presence of nocturia, enuresis, urgency and urge incontinence) were also related to BMI by calculating the Odds Ratio (OR). The BMI in the presence and absence of non-inhibited detrusor contractions and Valsalva leak point pressure (VLPP) <60 or > 60 cmH2O were evaluated. Finally, the correlation between BMI and the nine KHQ domains has been tested in order to detect some association. RESULTS the KHQ did not record deterioration of quality of life in women with UI with increasing BMI in any of its areas. The OR for the presence of enuresis in relation to a BMI was 1.003 [CI: 0.897-1.121], p=0.962. The OR for nocturia was 1.049 [CI: 0.933-1.18], p=.425. The OR for urgency was 0.975 [CI: 0.826-1.151], p=0.762, and the OR for incontinence was 0.978 [CI: 0.85-1.126], p=0.76. We studied the BMI in patients with and without non-inhibited detrusor contractions and detected medians of 26.4 ± 4.8 and 28.3 ± 5.7 kg/m², respectively (p=0.6). Similarly, the median BMI values for the groups with VLPP <60 and >60 cmH2O were 29.6 ± 4.1 and 27.7 ± 5.7 kg/m², respectively (p=0.2). Finally, we failed to demonstrate an association between BMI and any of the nine KHQ domains by means of the Spearman correlation. CONCLUSION there was no association of KHQ scores with BMI. There was also no correlation between the parameters of clinical history and of the urodynamic study with BMI.

Clinical and urodynamic evaluation in women with stress urinary incontinence treated by periurethral collagen injection

OBJECTIVE To evaluate the success of treatment with periurethral collagen injections in patients suffering from stress urinary incontinence (SUI) with bladder neck hypermobility and intrinsic sphincter deficiency. MATERIALS AND METHODS Forty women suffering from (SUI) were selected and divided into GI (consisting of 13 women with SUI and bladder neck hypermobility) and GII (consisting of 27 women with SUI and intrinsic sphincter deficiency). Periurethral collagen was injected followed by a subjective evaluation (the need for urinary protectors) and an objective evaluation through urodynamic study before and after the treatment. RESULTS It was noticed that after 9 months there was a decrease in the need of urinary protectors in the two groups. It was observed through the urodynamic study that either cure or improvement was achieved in 46% in GI and 40.7% in GII. There was a significant increase in the leak pressure in GII. Moreover, there was a decrease in the volume of urine leak in the two groups, being the results in GII statistically significant. CONCLUSIONS It was concluded that the periurethral collagen injection is useful for the treatment of the SUI. The results in hypermobility are similar to those in intrinsic sphincter deficiency. In fact, it is a very simple out patients procedure, with little side effects.