Raquel Martins Arruda

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.

Analysis of Collagen in Parametrium and Vaginal Apex of Women with and without Uterine Prolapse

Abstract: Our objective was to compare the amount of collagen in parametrium and vaginal apex between women with uterine prolapse at pre- and postmenopause, and in women without prolapse. The study included 22 premenopausal women without prolapse (group A), 10 premenopausal women with prolapse (group B), and 23 postmenopausal women with prolapse (group C) (total 55). Patients in group A underwent abdominal hysterectomy for uterine leiomyoma, and patients in groups B and C underwent vaginal hysterectomy. During the surgical procedure we obtained biopsies from the lateral parametrium and vaginal apex. The tissue was stained for histological analysis with picrosirius. We observed a lower amount of collagen in the parametrium of women with uterine prolapse, both in menacme and in postmenopause, than in the parametrium of women without prolapse. We observed no statistically significant difference in vaginal apex between the groups.

Hiperatividade do detrusor: comparação entre oxibutinina, eletroestimulação funcional do assoalho pélvico e exercícios perineais. Estudo randomizado

PURPOSE: to evaluate and to compare the effectiveness of oxybutynin, electrostimulation (ES) and pelvic floor training (PFT) in the management of women with detrusor overactivity. METHODS: a total of 64 women, 35 to 80 years old, were enrolled in this randomized prospective trial. Patients were randomized in three groups: Oxybutynin (n=22), ES (n=21) and PFT (n=21). There were no statistical differences between the three groups with regards to race (p=0.948), age (p=0.747), hormonal status (p=0.813), time of symptomatology (p=0.789), previous surgery for urinary incontinence (p=0.993), or body mass index (p=0.897). Patients were assessed before and after treatment by urodynamic test, a seven-day voiding diary, and subjective response. The duration of the treatment was twelve weeks. For statistical analyses, the Pearson c2, analysis of variance (ANOVA) and the paired t-test were used. RESULTS: there was a decrease in the urge-incontinence episodes and in the number of pads required in all groups (p 0.05). Urgency was resolved in 14 (63.6%), 11 (52.4%) and 12 (57.1%) patients of the Oxybutynin, ES and PFT Groups, respectively, without differences among the groups (p=0.754). Subjectively, 17 (77.3%), 11 (52.4%) and 16 (76.2%) women who had accomplished oxybutynin, ES and PFT, respectively, were satisfied, without differences among the groups (p = 0.142). Urodynamic was normal in 8 (36.4%), 12 (57.1%) and 11 (52.4%) patients of the Oxybutynin, ES and PFT Groups, respectively. This urodynamic analysis revealed no differences between the three groups (p=0.358). The reduction of urge-incontinence correlated with patient satisfaction (p<0.05). CONCLUSIONS: treatments were equally effective; reduction of urge-incontinence was correlated with patient satisfaction.

Female urinary incontinence: effective treatment strategies

Abstract Urinary incontinence is a dysfunction that tremendously affects womens quality of life, involving social, emotional and economic aspects. Although various treatments for urinary incontinence have been described, it is important to know which of them are truly effective. This review seeks to determine the current available therapies for women with stress urinary incontinence and overactive bladder syndrome, based on the best scientific evidence.

Comparison between oxybutynin, functional electrical stimulation and pelvic floor training for treatment of detrusor overactivity in women: a review.

Purpose of review Overactive bladder syndrome is a chronic condition characterized by urgency with or without urge incontinence, usually with frequency and nocturia. The usual urodynamic diagnosis is the presence of detrusor overactivity. Overactive bladder is a common condition that has a negative impact on the quality of life of the affected individuals. In this review we provide a summary of relevant recent publications concerning the effectiveness of oxybutynin, functional electrical stimulation and pelvic floor training alone or in combination for the management of this syndrome. Recent findings Oxybutynin, electrical stimulation and pelvic floor training are well tolerated and effective therapeutic options for overactive bladder. However, most patients do not achieve complete symptom relief with each therapy alone. Evidence for the efficacy of combination therapy over either treatment alone is scarce. Summary Future well designed randomized clinical trials are needed to determine whether combined drug and conservative treatments can improve clinical outcomes for patients with overactive bladder. Standardization of both the diagnostic criteria and exercise training programs might facilitate comparisons of the results obtained by different studies.

Mansoni's schistosomiasis of a leiomyoma: case report

The literature is limited regarding reports of S. man-soni infection in the female genital tract. We report a caseof a 44-years-old woman who underwent a laparoscopicmomentum due to persistent pelvic pain. Histological ex-amination of the specimen revealed an intramural leio-myoma with areas of hyaline and cystic degeneration. Theleiomyoma contained many schistosoma eggs, consistentwith S. mansoni, along with inflammation.

Treatment of Non-neurogenic Overactive Bladder with OnabotulinumtoxinA: Systematic Review and Meta-analysis of Prospective, Randomized, Placebo-controlled Clinical Trials

We performed a systematic review and meta-analysis of randomized placebo-controlled trials that studied non-neurogenic overactive bladder patients who were treated with 100 units of onabotulinumtoxinA or placebo. The primary purpose of our study was to evaluate the clinical effectiveness with regard to urinary urgency, urinary frequency, nocturia, and incontinence episodes. Our secondary purpose consisted of evaluating the adverse effects. Our initial search yielded 532 entries. Of these, seven studies met all the inclusion criteria (prospective, randomized, placebo-controlled studies, ≥ 3 points on the Jadad scale) and were selected for analysis. For all primary endpoints, the toxin was more effective than placebo (p < 0.0001; 95% confidence interval [95CI]), namely: urgency (mean difference = -2.07; 95CI = [-2.55-1.58]), voiding frequency (mean difference = -1.64; 95CI = [-2.10-1.18]), nocturia (mean difference = -0.25; 95CI = [-0.39-0.11]) and incontinence episodes (mean difference = -2.06; 95CI= [-2.60-1.52]). The need for intermittent catheterization and the occurrence of urinary tract infection (UTI) were more frequent in patients treated with onabotulinumtoxinA than in patients treated with placebo (p < 0.0001). Compared with placebo, onabotulinumtoxinA had significantly and clinically relevant reductions in overactive bladder symptoms and is associated with higher incidence of intermittent catheterization and UTI.

Avaliação do impacto da correção cirúrgica de distopias genitais sobre a função sexual feminina

PURPOSE: to identify the impact of pelvic reconstructive surgery on female sexual function, as well as the changes in vaginal anatomy, and to detect possible correlations between them. METHODS: a prospective, descriptive study, including 43 sexually active women with genital dystopy, undergoing surgery for pelvic organ prolapse, conducted between October 2004 and September 2006. The women completed the same multiple-choice questionnaire regarding sexual function, and analogic scales to quantify the degree of desire, arousal and satisfaction, and were clinically assessed using the pelvic organ prolapse quantification (POP-Q) staging system, before the surgery and three and six months after it. Statistical analysis was performed through the Bowker test for symmetry, Wilcoxon test, Student t test, c2 and analysis of variance (ANOVA) as appropriate, with statistical significance set at 5% (p<0.05). RESULTS: all 43 women completed the follow-up at three and six months after the surgery, but two of them lost their partners after the surgery. Quality of sexual life improved significantly (p=0.03). Symptoms such as dyspareunia (25.6% before versus 17.1% after surgery), discomfort (27.9 versus 0%), embarrassment (20.9% versus 0%) and fear (2.3% versus 0%) significantly improved (p<0.001). Analogical scales scores regarding desire (5 versus 7, p=0.001), arousal (6 versus 8, p<0.001) and satisfaction with sexual life (5 versus 7, p<0.001) also improved. There was a statistically significant improvement (p<0.001) of the POP-Q stages after the surgery. However, there was no statistically significant correlation between changes in vaginal dimensions and changes in sexual function. CONCLUSIONS: after pelvic reconstructive surgery, there was a significant improvement in the quality of sexual life and of the POP-Q stages. However, there was no correlation between them.