Manoel João Batista Castello Girão

Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence

PURPOSE To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS One hundred eighteen subjects were randomly selected to recieve pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment. CONCLUSION Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.

Evaluation of Quality of Life and Sexual Satisfaction in Women Suffering from Chronic Pelvic Pain With or Without Endometriosis

INTRODUCTION Chronic pelvic pain (CPP) is one of the most frequent symptoms in women of reproductive age. This is an enigmatic clinical condition that results from the complex interactions of physiological and psychological factors with direct impact on the social, marital, and professional lives of women. AIM To evaluate the quality of life and sexual satisfaction of women who suffer from CPP with or without endometriosis. METHOD Forty-nine patients who had been diagnosed with endometriosis and 35 patients with CPP diagnosed with another gynecological condition, all 84 of whom were treated at the Chronic Pelvic Pain and Endometriosis Clinic at Universidade Federal de São Paulo (UNIFESP) from January to July of 2008. The controls were 50 healthy women from the Family Planning Clinic at UNIFESP. MAIN OUTCOME MEASURES World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) quality of life questionnaire and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). RESULTS No statistically significant differences were observed between the groups with CPP symptoms, in either the results from the WHOQOL-BREF or in the GRISS questionnaire. In both questionnaires, differences were observed when the two groups of symptomatic women were compared with the group of healthy women. CONCLUSION CPP caused by endometriosis or other gynecological conditions leads to a significant reduction of quality of life and sexual satisfaction.

Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence

CONTEXT AND OBJECTIVE Urinary incontinence is a public health problem that affects more than 200 million people worldwide. Stress incontinence is the most prevalent type. Pelvic floor muscle exercises have been used for treating it, although there is no consensus regarding their application. The aim of this study was to compare the results from treating female stress urinary incontinence with pelvic floor muscle exercises with or without physiotherapist supervision. DESIGN AND SETTING This was a randomized, prospective, controlled trial in the Urogynecology and Vaginal Surgery Sector, Universidade Federal de São Paulo. METHODS Forty-four women were randomized to be treated for stress urinary incontinence with pelvic floor exercises for three consecutive months, into two groups: one with and the other without physiotherapist supervision. They were evaluated before and after treatment using a quality-of-life questionnaire, pad test, micturition diary and subjective evaluation. Descriptive analysis was used to evaluate the population. The homogeneity of the two groups was evaluated using the Kruskal-Wallis and Chi-squared tests. The success of the two groups after treatment was evaluated using the Wilcoxon test. RESULTS The supervised group showed statistically greater improvement in the pad test, micturition diary and quality of life than did the control group. In the subjective evaluation, only 23.8% of the control group patients were satised with their treatment. In the supervised group, 66.8% of patients did not want any other treatment. CONCLUSION Supervised pelvic floor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises.

Validação do questionário de qualidade de vida (King's Health Questionnaire) em mulheres brasileiras com incontinência urinária

Universidade Federal de Sao Paulo (UNIFESP) Escola Paulista de Medicina Ambulatorio de Uroginecologia e Mioma

Genetic polymorphisms of cytochrome P450c17α (CYP17) and progesterone receptor genes (PROGINS) in the assessment of endometriosis risk

We designed the present study in order to evaluate the eventual role of polymorphisms in the genes encoding cytochrome P450c17α (CYP17) and the progesterone receptor (PROGINS) as risk factors for endometriosis development. Eligible cases consisted of 121 women with surgically confirmed endometriosis who underwent treatment in a hospital in São Paulo, Brazil during the period from September 2003 to September 2005. The 281 controls were participants with normal gynecological as well as pelvic ultrasound evaluation, who did not have any gynecological conditions during their reproductive lives such as pelvic pain and/or dyspareunia nor infertility history. Genomic DNA was obtained from buccal cells and processed for DNA extraction using the GFX DNA extraction kit (GE Healthcare). The CYP17 (−34T→C) polymerase chain reaction–restriction fragment length polymorphism assay has been described previously, as has the progesterone receptor polymorphism (PROGINS) detection assay. PROGINS heterozygosis genotype frequencies were shown to be statistically higher in endometriosis cases compared with controls. On the other hand, differences in the CYP17 polymorphism (−34T → C) frequencies were not even close to significance (p = 0.278) according to our findings.

Glycosaminoglycan profile in bladder and urethra of castrated rats treated with estrogen, progestogen, and raloxifene

OBJECTIVE This study was undertaken to evaluate the action of conjugated equine estrogens alone, medroxyprogesterone, the combination of these estrogens with progestogens, and of raloxifene on the glycosaminoglycan profile in the bladder and urethra of adult oophorectomized rats in comparison with noncastrated rats. STUDY DESIGN Sixty adult rats, of which 50 were submitted to bilateral oophorectomy, were studied. After 4 days, the latter were assigned to five groups of 10 animals each. For 30 consecutive days the following treatments were given: group 1, conjugated equine estrogens; group 2, conjugated equine estrogens combined with medroxyprogesterone acetate; group 3, medroxyprogesterone; group 4, raloxifene; and group 5, placebo. Thereafter the bladders and urethras of the animals were removed, processed to yield a dry powder of which the sulfated glycosaminoglycan content was determined by densitometry after agarose gel electrophoresis and that of hyaluronic acid by a fluorimetric assay. RESULTS Glycosaminoglycans found in the bladder and urethra were dermatan sulfate, heparan sulfate, and hyaluronic acid. In the bladder, hypoestrogenism or replacement with estrogens led to a lower sulfated glycosaminoglycan content. Replacement with estrogens and/or medroxyprogesterone reverted this effect. Hypoestrogenism decreased the dermatan sulfate/heparan sulfate ratio and reduced hyaluronic acid content. Estrogen therapy reverted this alteration and medroxyprogesterone addition annulled the estrogenic effect. In the urethra, castration did not alter hyaluronic acid content and sulfated glycosaminoglycan content, but raloxifene decreased the latter. CONCLUSION Castrated rats had a decrease in sulfated glycosaminoglycans and hyaluronic acid content in the bladder. Hormonal replacement altered the quantity and quality of glycosaminoglycans. In the urethra, raloxifene reduced sulfated glycosaminoglycans.

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.

COL1A1 Sp1-binding site polymorphism as a risk factor for genital prolapse.

The objective of this study was to verify the possible association between the Sp1-binding site polymorphism and genital prolapse. A case–control study was conducted in 107 patients with stages III and IV genital prolapse. The control group included 209 women with stages 0 and I. The polymorphism of type I collagen Sp1-binding site was identified by amplification of the first intron of the COL1A1 gene. We did not find differences in the prevalence of the GT and TT genotypes between the groups (p = 0.34), even when we grouped patients with at least one polymorphic allele (GT and TT) and compared them with patients without the polymorphic allele (GG; p = 0.17) The presence of at least one vaginal delivery, family history for prolapse, and macrosomatic fetus were independent risk factors for prolapse. In conclusion, the COL1A1 Sp1-binding site was not significantly associated with genital prolapse among our study subjects.

Estrogen receptor alpha polymorphism and susceptibility to uterine leiomyoma

Uterine leiomyoma is the most frequent pelvic tumor found in female genital tract. Some studies have suggested an association between single nucleotide polymorphisms (SNPs) in estrogen receptors genes with susceptibility in developing uterine leiomyoma. In this work, we estimated the frequency of two SNPs: one located in the intron 1 (rs9322331) and other in the exon 1 (rs17847075) of the estrogen receptor alpha (ESR1) gene in 125 women with uterine leiomyoma and 125 healthy women. To do this we used a PCR-RFLP method with MspI and HaeIII restriction enzymes to respectively detect C/T SNPs in the intron 1 and in the exon 1 of ESR1. To our knowledge this is the first study aimed to investigate the association of ESR1 SNPs with the risk of developing uterine leiomyoma in Brazilian women. Our results showed that the allele frequencies of the exon 1 and the intron 1 of the ESR1 gene did not differ between cases and controls (P = 0.325 and 0.175, respectively). Furthermore, our findings provided little support for the association of these SNPs on ESR1 with leiomyoma. However, we found that the SNP in the intron 1 of the ESR1 gene was underrepresented in the Brazilian female population.

Diagnóstico clínico e subsidiário da incontinência urinária

Female lower urinary tract symptoms are nonspecific and a clinical evaluation is required to establish the correct diagnosis. Such evaluation should consist of a structured micturition history or questionnaire, physical examination, micturition diary, pad test, and urodynamic evaluation. Urodynamic investigation was developed as an extension of patient history and physical examination in order to reveal the etiology of the patients complaints. The goal of the present article is to review clinical and subsidiary diagnosis of urinary incontinence.