Telma Guarisi

Incontinência urinária entre mulheres climatéricas brasileiras: inquérito domiciliar

OBJECTIVE: To investigate the prevalence of stress urinary incontinence and its associated factors in perimenopause women using a population-based household survey. METHODS: A descriptive, exploratory cross-sectional population-based study with secondary analysis of a population-based household survey on perimenopause and menopause was conducted among women living in the city of Campinas, Brazil. Through a sampling process, 456 women between 45 and 60 years old were selected. Complaints of urinary incontinence and related risk factors, such as age, socioeconomic status, education level, race, parity, smoking habits, body mass index, previous gynecological surgeries, menopausal status, and hormonal replacement therapy were explored. Data were collected through home interviews using an adapted version of the structured pre-tested questionnaire elaborated by the International Health Foundation, International Menopause Society and the American Menopause Society. Statistical analysis were performed using prevalence rates (CI 95%). RESULTS: Thirty-five percent of the interviewees referred stress urinary incontinence. None of the sociodemographic factors studied was associated to the risk of urinary incontinence. In addition, parity did not significantly change the risk of urinary incontinence. Other factors, such as previous gynecological surgeries, body mass index, and smoking habits, were not associated with the prevalence of stress urinary incontinence. Also, menopausal status and hormonal replacement therapy did not change the risk of stress urinary incontinence. CONCLUSION: Though there was a high prevalence of stress urinary incontinence among perimenopause women, there was not found any associations with sociodemographic and reproductive factors.

Procura de Serviço Médico por Mulheres com Incontinência Urinária

Purpose: to evaluate the percentage of 45- to 60-year-old women complaining of urinary incontinence, who look for medical treatment, and the factors possibly associated with the decision of visiting the doctor and the reasons for not doing so. Methods: a secondary analysis of a population-based survey on climacterium and menopause in women living in the city of Campinas, Sao Paulo state, was carried out through a descriptive, exploratory and cross-sectional population study. A total of 456 women between 45 and 60 years of age were selected through a sampling process. The age at menopause and its associated factors were evaluated, as well as the prevalence of climacteric symptoms, the use of medical care, self-perception of the health status, and the sociocultural, sociodemographic and socioeconomic characteristics. Urinary incontinence complaint and the search for medical help due to the presence of symptoms were explored. The data were collected through home interviews, using a structured and pretested questionnaire provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society, and adapted by the authors. The statistical analysis was performed using Fishers exact test. Results: thirty-five percent of the interviewees reported constant or intermittent stress incontinence, although only 59% of the patients with the complaint sought medical help. Conclusion: the majority of the women presenting urinary incontinence do not complain to the doctor if they are not questioned objectively.

The risk of urinary incontinence of parous women who delivered only by cesarean section

Objectives: To evaluate the association of route of delivery with prevalence of urinary incontinence. Methods: Women with menopause who consulted at the Department of Gynecology and Obstetrics, Universidade Estadual de Campinas, were interviewed and examined to detect urinary incontinence. Obstetrics history and other possible factors that could influence incontinence were also recorded. Results: Urinary incontinence was diagnosed in 98 women (cases) while 91 were free of this problem. The risk of urinary incontinence was approximately five times higher among women with one or more pregnancies than among nulligravida, and 3.5 times higher among women who had had only cesarean sections than among nullipara. Conclusions: Women cannot prevent urinary incontinence by delivering exclusively by cesarean section.

Estudo exploratório da associação entre o perfil lipídico e a densidade mineral óssea em mulheres menopausadas, em hospital de referência de Campinas

A total of 72 postmenopausal patients presenting no risk factors for cardiovascular disease nor osteoporosis, were studied. The study evaluated total serum cholesterol and fractions and bone mass by densitometry of the lumbar spine and femur using a Lunar-DPX. There was no association between lipid profile variables and bone mineral density, except for high density lipoprotein (HDL), which showed an inverse correlation (p=0.001). Multiple regression showed that total cholesterol levels higher than 240 mg% had a positive association with BMD (p=0.026). In addition, the ratio between LDL and HDL (Castelli 2 index) showed a negative association with BMD (p=0.002). The diagnostic validation test showed that all lipid profile variables had low sensitivity and specificity as indicators for osteoporosis. The conclusions were that lipid profile variables did not show a significant association with bone mass and could not be used as indicators for bone mineral density.O objetivo deste estudo foi avaliar a possivel associacao entre algumas variaveis do perfil lipidico e a densidade mineral ossea e se estas variaveis poderiam ser usadas como indicadoras de massa ossea em mulheres menopausadas, atendidas no ambulatorio de menopausa do CAISM-Unicamp, no ano de 1995. Estudaram-se 72 pacientes pos-menopausadas, sem fatores de risco para doencas cardiovasculares e para osteoporose, por meio da dosagem de colesterol total e fracoes e da avaliacao da densidade mineral ossea por densitometria ossea em aparelho Lunar DPX (Dexa). Dentre as variaveis do perfil lipidico, a densidade mineral ossea associou-se inversamente a lipoproteina HDL de alta densidade (p = 0,001). A analise de regressao multipla observou que niveis de colesterol total acima de 240mg% associaram-se a menor densidade mineral ossea (p = 0,026). A razao entre a lipoproteina de baixa densidade e a lipoproteina de alta densidade (indice de Castelli 2) correlacionou-se positivamente com a densidade mineral ossea (p = 0,002). O teste de validacao diagnostica mostrou que todas as variaveis do perfil lipidico apresentaram baixa sensibilidade e especificidade como indicadoras de diminuicao de massa ossea. Conclui-se que, apesar de algumas variaveis do perfil lipidico apresentarem associacao estatisticamente significativa com a massa ossea, elas foram contraditorias e nao tem boa capacidade diagnostica.A total of 72 postmenopausal patients presenting no risk factors for cardiovascular disease nor osteoporosis, were studied. The study evaluated total serum cholesterol and fractions and bone mass by densitometry of the lumbar spine and femur using a Lunar-DPX. There was no association between lipid profile variables and bone mineral density, except for high density lipoprotein (HDL), which showed an inverse correlation (p = 0.001). Multiple regression showed that total cholesterol levels higher than 240 mg% had a positive association with BMD (p = 0.026). In addition, the ratio between LDL and HDL (Castelli 2 index) showed a negative association with BMD (p = 0.002). The diagnostic validation test showed that all lipid profile variables had low sensitivity and specificity as indicators for osteoporosis. The conclusions were that lipid profile variables did not show a significant association with bone mass and could not be used as indicators for bone mineral density.

Urodynamics in Climacteric Women with Urinary Incontinence: Correlation with Route of Delivery

Abstract: The aim of this study was to compare the urodynamic findings among climacteric women complaining of urinary incontinence who had only vaginal deliveries with those who had only cesarean sections. The study group comprised 30 climacteric women with complaints of urinary incontinence consulting at the Menopause Outpatient Clinic, State University of Campinas, submitted to anamneses and complete urodynamic testing. Nineteen women had had only vaginal deliveries and 11 were delivered only by cesarean section. Vaginal delivery was significantly associated with a reduced normal and strong desire to void and maximum cystometric capacity compared to women who delivered only by Cesarean section. Detrusor instability was four to five times more frequent among women who had had only vaginal deliveries. There was no difference between the two groups concerning uroflowmetry parameters. Climacteric women with urinary incontinence who had had only vaginal deliveries are at a higher risk of urodynamic abnormalities.

Incontinência urinária após parto vaginal ou cesáreo

RESUMOObjetivo:Avaliar a prevalencia de incontinencia urinaria de esforco, urge incontinencia e incontinencia urinaria mista entre mulheres residentes no municipio de Jundiai, e a relacao entre o tipo de incontinencia e historia obstetrica dessas mulheres.Metodos:Foi realizado estudo de corte transversal, do tipo inquerito populacional, no qual foram entrevistadas 332 mulheres, que compareceram por qualquer motivo as unidades basicas de saude do municipio de Jundiai, entre Marco de 2005 e Abril de 2006. Para isso, foi utilizado um questionario pre-testado contendo questoes [...]

Urinary incontinence after vaginal delivery or cesarean section

OBJECTIVE To assess the prevalence of stress urinary incontinence, urge incontinence and mixed urinary incontinence among women residing in the city of Jundiaí (São Paulo, Brazil), and the relation between the type of incontinence and the obstetric history of these women. METHODS A cross-sectional community-based study was conducted. A total of 332 women were interviewed; they were seen for whatever reason at the public primary healthcare units of the city of Jundiaí, from March 2005 to April 2006. A pre-tested questionnaire was administered and consisted of questions used in the EPINCONT Study (Epidemiology of Incontinence in the County of Nord-Trondelag). Statistical analysis was carried out using the χ2 test and odds ratio (95%CI). RESULTS Urinary incontinence was a complaint for 23.5% of the women interviewed. Stress urinary incontinence prevailed (50%), followed by mixed urinary incontinence (35%) and urge incontinence (15%). Being in the age group of 35-64 years, having a body mass index of 30 or greater and having had only vaginal delivery or cesarean section, with uterine contraction, regardless of the number of pregnancies, were factors associated with stress urinary incontinence. However, being in the age group of 55 or older, having a body mass index of 30 or greater and having had three or more pregnancies, only with vaginal deliveries, were factors associated with mixed urinary incontinence. CONCLUSIONS One third of the interviewees complained of some type of urinary incontinence, and half of them presented stress urinary incontinence. Cesarean section, only when not preceded by contractions, was not associated with stress urinary incontinence. The body mass index is only relevant when the stress factor is present.

Correlation between urodynamic tests, history and clinical findings in treatment of women with urinary incontinence

OBJECTIVE The aim of this study was to evaluate the role of urodynamic test in diagnosis of urinary incontinence, comparing detailed data of history and physical examination, and some easy- to-apply clinical tests. METHODS A cross-sectional retrospective study was carried out by reviewing the medical charts of 55 patients with complaint of loss of urine, seen at the Urogynecology Service of Womens Health Outpatient Clinic of Hospital Universitário de Jundiaí, between October 2006 and March 2007. The patients answered a specific questionnaire involving the epidemiological and physical examination variables considered in this study. They were submitted to physical examination and urodynamic tests. RESULTS The complaint of loss of urine upon exertion, either isolated or associated with urge incontinence, was confirmed by urodynamic tests in most women, and only 4 of 49 symptomatic women had negative results. The clinical sign was present in 35 patients (63.6%), and 46 patients (83.6%) had the exertion component in the urodynamic test. The exertion component was observed in 10 (18%) out of 15 patients without symptoms (30%). The positive and negative predictive values of the clinical sign for diagnosis of any type of urinary incontinence in this studied group were 97.1 and 26.7%, respectively. As for the clinical complaint of urinary loss upon exertion, the positive and negative predictive values for any type of urinary incontinence were 92 and 40%, respectively. For the clinical complaint of urge incontinence, the positive and negative predictive values of 92.5 and 23.1%, respectively. CONCLUSIONS It was concluded that the urodynamic evaluation is an important instrument to evaluate the severity of incontinence, although it was not necessary to diagnose loss of urine. The finding of urinary loss during physical examination had low sensitivity and specificity in diagnosis of the type of loss of urine. Urodynamic tests had better performance in demonstrating urinary incontinence in patients with complaint of incontinence upon exertion and without loss of urine seen upon physical examination than in confirming urge incontinence in patients with those symptoms.