Maíta Poli de Araujo

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.

Transobturator sling compared with single-incision mini-sling for the treatment of stress urinary incontinence: a randomized controlled trial.

OBJECTIVE: To determine the efficacy and safety of a single-incision mini-sling compared with a transobturator midurethral sling for stress urinary incontinence (SUI) treatment. METHODS: This prospective single-center randomized controlled trial involved 130 women with a diagnosis of SUI. Primary outcomes were the objective and subjective cure rates, defined as negative cough stress and pad tests, and satisfaction rates. Quality of life assessed by the Incontinence Quality of Life Questionnaire and the Urogenital Distress Inventory Short Form, operation time, complications, and reoperation rates were also recorded. The efficacy was analyzed using a noninferiority test with a margin of 15%. For the noninferiority test, a P value >.05 rejects the noninferiority hypothesis of the mini-sling. RESULTS: Sixty-four patients in the mini-sling group and 56 in the transobturator group completed the 12-month follow-up. The objective cure rates for the mini-sling and the transobturator sling were 68.1% and 81.9% (absolute difference 13.8; 90% confidence interval [CI] 1.5–26.1; P=.439) and the subjective cure rates were 81.1% and 88.5% (absolute difference 7.4%; 90% CI 2.8–17.6; P=.110), respectively. There was a significant improvement in quality of life in both groups. Thigh pain was greater after the transobturator sling, four patients (7.1%) compared with zero (P=.045). The mean operation time was 5 minutes shorter for the mini-sling procedure (P=.000). Five patients (7.8%) in the mini-sling group and one patient (1.8%) in the transobturator group underwent surgical reintervention for persistent SUI (P=.213). CONCLUSION: The noninferiority of the mini-sling could not be demonstrated in this study at the 12-month follow-up. The mini-sling was associated with shorter operative time and less postoperative thigh pain. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01094353. LEVEL OF EVIDENCE: I

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.

Pelvic floor disorders among indigenous women living in Xingu Indian Park, Brazil

Introduction and hypothesisCurrent assessment for pelvic floor disorders (PFDs) allows comparison between different communities.MethodsA total of 377 indigenous women living in Xingu Indian Park were evaluated. The pelvic organ prolapse quantification (POP-Q) was the system used to quantification the staging of pelvic support. The pelvic floor muscle strength was assessed by a perineometer. Logistic regression analysis was used to determine risk factors that were associated with prolapse.ResultsOnly 5.8% of women reported urinary incontinence. The overall distribution of POP-Q stage system was the following: 15.6% stage 0, 19.4% stage I, 63.9% stage II and 0.8% stage III. Parity and age were the risk factors for pelvic organ prolapse (p < 0.0001).ConclusionsUrinary incontinence was uncommon in Xingu indigenous women. Like non-indigenous communities, age and parity were the most important risk factors to the genital prolapse.

Pre-participation gynecological evaluation of female athletes: a new proposal.

Objective To propose the inclusion of a gynecological investigation during the evaluation of athletes before competitions, using a specific instrument called the Pre-participation Gynecological Examination (PPGE). Methods The study assessed 148 athletes, mean age of 15.4±2.0 years, who engaged in eight different sports modalities, and who responded to a questionnaire named Pre-Participation Gynecological Examination (PPGE), to the International Consultation on Incontinence Questionnaire - Short Form (for urinary loss), and to the Eating Attitudes Test (for eating disorders). Results Fifty percent of the participants reported irregular menstrual intervals, 23.0% did not know about sexually transmitted diseases, and 72.4% denied having, at least, an annual gynecological appointment. The study identified 18.2% who had urinary loss, and 15% presented with an increased risk of eating disorders. Moreover, 89.9% were not familiar with the occurrence of urinary incontinence in athletes and did not know that they were susceptible to the female athlete triad. A total of 87.1% of them stated that would not mention these issues to their coaches even if this would improve their health or performance. Conclusion The Pre-Participation Gynecological Examination can be considered an easy-to-apply instrument that allowed the diagnosis of alterations often underestimated by the athletes themselves. After its application, the alterations were identified, and determined the athletes’ referral to appropriate evaluation and treatment.

Parâmetros da urofluxometria e do estudo fluxo/pressão em pacientes uroginecológicas

OBJECTIVE: The purpose was to evaluate urine flow rates in an urodynamic study (US) of patients with symptoms of lower urinary tract dysfunction and to record effects of final urodynamic diagnosis and age on these variables. METHODS: Retrospective analysis of 205 women who had undergone urogynecological investigation. Patients were divided into three age groups: A ( 60 years). Comportment of urine flow rates and opening detrusor pressure with increasing age were studied and resulting charts recorded. Comparison of maximum and average urine flow rates, opening detrusor pressure and detrusor pressure at the maximal flow according to final urodynamic diagnostic were also made. RESULTS: There was a decline of urine flow rates with increase of age, which was more significant between groups A X C and B X C. There was also a decline in opening detrusor pressure with aging, which was significant between groups A X C. When analyzing opening detrusor pressure according to final urodynamic diagnosis, a significant decline of this variable was observed in patients with urinary stress incontinence and intrinsic sphincter deficiency in relation to those who were asymptomatic. CONCLUSION: Urine flow rates decreased with age. Women with urinary stress incontinence and intrinsic sphincter deficiency void at a lower detrusor pressure.

Relationship between Anxiety and Interleukin 10 in Female Soccer Players with and Without Premenstrual Syndrome (PMS)

Objective To investigate the level of anxiety and its relationship with interleukin (IL)-10 (anti inflammatory cytokine that modulates mood swings) in a group of female soccer players. Methods Fifty-two eumenorrheic soccer players were evaluated (age 19.8 ± 4.7 years). The presence of premenstrual syndrome (PMS) and phases of the menstrual cycle were determined by a daily symptom report (DSR) kept for 3 consecutive months. The concentration of cytokine IL-10 was determined from urine samples collected at four moments: at the follicular and luteal phases of the menstrual cycle, and before (pre) and after (post) the simulated game, and it was quantified by flow cytometry (Luminex xMAP - EMD Millipore, Billerica, MA, USA). The level of anxiety was determined through the BAI anxiety questionnaire answered by all athletes at the same time of the urine collection. The Student t-test, analysis of variance (ANOVA) and Pearson correlation with significance level at 5% were used for data analysis. Results We showed that the prevalence of PMS among female soccer players is similar to that reported in the literature. In addition, we showed that the group with PMS has a higher level of anxiety compared with group without PMS (p = 0.002). Interleukin-10 analysis in players without PMS revealed that there was a significant decrease in the level of this cytokine before the game during the luteal phase when compared with the follicular phase (p < 0.05). The correlation analysis between IL-10 and anxiety showed a negative correlation post-game in the luteal phase in the group without PMS (p = 0.02; r = -0.50) and a positive correlation post-game in the luteal phase in PMS group (p = 0.04; r = 0.36). Conclusion Our results suggest that IL-10 may contribute to reduce anxiety in the group without PMS. This could be attributed to the fact that no IL-10 variation was observed in the group with PMS, which presented higher anxiety symptoms when compared with the group without PMS.

Athletic Incontinence: Proposal of a New Term for a New Woman

In 1896, Baron Pierre de Coubertin inaugurated the first modern era Olympic Games. At that time, women could not participate in the competitions, as sports in general were considered dangerous for women’s health. At the Paris Olympics (1900), of the 997 enrolled athletes, 22 were women who competed in sailing, tennis and golf.1 Women’s participation increased considerably, and in the 2016 Olympic Games, which were held in the city of Rio de Janeiro, almost half of the athletes were women.2 However, the “slogan” proposed by Baron de Coubertin during the creation of the International Olympic Committee, “Citius, Altius, Fortius” (faster, higher, stronger), has caused

Prevalence of sexually transmitted diseases in female athletes in São Paulo, Brazil

ABSTRACT Objective: To determine the prevalence of sexually transmitted diseases in female athletes. Methods: An observational, cross-sectional study was conducted including 50 female athletes with mean age of 20±3 years. Colposcopy, pap smear, and polymerase chain reaction for Chlamydia trachomatis, human papillomavirus and Neisseria gonorrhoeae were performed. Blood samples were collected to test for the human immunodeficiency virus, syphilis, hepatitis B and C. The athletes presenting clinical diseases or conditions identifiable by laboratory tests were treated and followed up in the unit. Results: Forty-six percent of the participants were unaware of sexually transmitted diseases. The prevalence of sexually transmitted diseases among athletes was 48% (24 cases). Human papillomavirus was the most frequent agent (44%). Considering the human papillomavirus genotypes, subtype 16 was the most prevalent (53%), followed by 11-6 (22%) and 18 (13%). Two athletes tested positive for C. trachomatis. There were no cases diagnosed of infection by N. gonorrhoeae, syphilis, hepatitis B, hepatitis C and human immunodeficiency virus. However, only 26 athletes had been vaccinated for hepatitis B. Conclusion: The prevalence of sexually transmitted diseases in female athletes was high. Primary prevention measures (hepatitis B and human papillomavirus vaccination) and secondary (serology, pap smears) must be offered to this specific group of women. The matter should be further approached in sports.