Viviane Herrmann

Qualidade de vida em mulheres após tratamento da incontinência urinária de esforço com fisioterapia

PURPOSE: to compare womens quality of life (QoL) before and after physical therapy treatment for stress urinary incontinence (SUI). METHODS: an uncontrolled clinical trial of 26 women, who had mainly complaints of SUI. Post-menopausal women with overactive bladder, cystocele >grade II and previous surgical/conservative treatments were excluded from the study. The physiotherapy treatment relied on 12 individual pelvic floor exercises assisted by electromyographyc-biofeedback sessions. A total of 200 contractions were carried out, divided in phasic (quick) and tonic (slow). The tool used to evaluate QoL was the Kings Health Questionnaire (KHQ), before and after the treatment. RESULTS: there was a decrease in the urinary symptoms, particularly in urinary frequency, nocturia, urgency and urinary incontinence. Regarding the QoL, there was a significant improvement in the following domain scores: general health perception (49.0±24.0 versus 26.9±15.7; p=0.0015), incontinence impact (78.2±28.2 versus 32.1±30.5; p=0.001), activity limitation (75.0±28.2 versus 13.5±22.6; p<0.001), physical limitation (72.4±29.4 versus 15.4±24.5; p<0.001), social limitations (38.3±28.6 versus 6.4±14.5; p<0.001), emotions (59.0±33.8 versus 14.1±24.7; p=0.0001, sleep/energy (34.0±23.8 versus 6.4±16.4; p=0.001) and severity measures (66.9±19.6 versus 22.3±24.2; p<0.001), except for personal relationships (60.5±33.9 versus 41.7±16.7; p=0.0679). CONCLUSIONS: there was an improvement in several aspects of womens QoL treated by physiotherapy, when evaluated with a specific tool, the KHQ.

Management of Stress Urinary Incontinence With Surface Electromyography–Assisted Biofeedback in Women of Reproductive Age

Background and Purpose Although surgery has been widely accepted as the treatment of choice for stress urinary incontinence (SUI), there has recently been an increased interest in the conservative management of this condition. The aims of this study were to test the ability of a biofeedback-assisted pelvic-floor muscle exercise (PFME) program to affect symptoms of SUI in premenopausal women and to evaluate a training program that might lead to successful outcomes in a relatively limited number of sessions. Subjects Twenty-six women with SUI were treated with PFME with surface electromyography (sEMG)–assisted biofeedback. All participants were of reproductive age and were treated individually for 12 sessions. Methods Results were evaluated with a 7-day voiding diary, a 1-hour pad test, pelvic-floor muscle strength measurements, sEMG amplitudes, a leakage index, and a quality-of-life questionnaire. These variables were compared before and after the intervention. Results The frequency of urine loss, the occurrence of nocturia, and the number of pads required decreased significantly after the intervention. Objective cure was found in 61.5% of women. There was a significant improvement in the quality of life, in pelvic-floor muscle strength, and in the sEMG amplitudes of all contractions throughout the intervention. Discussion and Conclusion A relatively short-term intervention of PFME with sEMG-assisted biofeedback appeared to be helpful in relieving symptoms of SUI in premenopausal women and represents a reasonable conservative management option.

Prevalence study of stress urinary incontinence in women who perform high-impact exercises

IntroductionStress urinary incontinence is a frequent complaint in medical offices and studies have shown that women who practice high impact sports develop its symptoms.ObjectiveTo evaluate the prevalence of stress urinary incontinence in women who attend gyms and perform high impact exercises and correlate it with women who do not attend gyms.MethodProspective comparative study in which 488 nulliparous women of normal weight were divided into a Study Group, composed of women who attended gyms, and a Comparative Group, composed of women who did not attend gyms. Three questionnaires were used for the evaluation of stress urinary incontinence and the results of the ICIQ-SF questionnaire were used to compare the groups.ResultsThere was a significant difference between groups on the ICIQ-SF. The average in the Study Group was 1.68 (+ 3.46) and in the Comparative Group the average was 1.02 (+ 2.69) (p = 0.006).ConclusionWomen who attend gym and perform high impact exercises have a higher prevalence of urinary incontinence symptoms, independent of the exercise modality, than women who do not perform any high impact exercise.

Eletroestimulação transvaginal do assoalho pélvico no tratamento da incontinência urinária de esforço: avaliações clínica e ultra-sonográfica

BACKGROUND The purpose of this study was to evaluate the efficacy of transvaginal electrical stimulation on the treatment of women with stress urinary incontinence (SUI) in selected cases. METHODS Twenty two women with primary stress urinary incontinence diagnosed by urodynamic study were submitted to transvaginal electrical stimulation. The mean age was 49 years old (range 22 to 74). The treatment consisted of two weekly sessions of stimulation, each 20 minutes long, during 8 weeks. Women were evaluated through history, clinical and urogynecological exam, weekly registration of frequency of urinary leakage, stress test and transperineal ultrasound before and after treatment. A pulse of 700 sec. was used, frequency of 50 Hz and intensity varying from 12 to 53 mA according to the womens sensitivity. RESULTS Eighteen of 22 subjects (81.7%) were satisfied with electrical stimulation and frequency of urinary incontinence reduced significantly (p<0.01). Stress test was negative in 77.2% of the women after treatment. Valsalva leak-point pressure was higher in 14 (63.3%) women after treatment, although not reaching statistical significance (p=0.37). Bladder neck mobility did not change significantly before and after electrical stimulation (p=0.30). CONCLUSION Transvaginal electrical stimulation of the pelvic floor is an effective and safe treatment to women with SUI without sphincter deficiency, with significant reduction of the frequency of urinary leakage.

Prevalence and correlates of stress urinary incontinence during pregnancy: a survey at UNICAMP Medical School, São Paulo, Brazil

The aim of this study was to evaluate the prevalence of stress urinary incontinence (SUI) in women in the third trimester of pregnancy. In total, 340 patients attending the Antenatal Clinic at the State University of Campinas (UNICAMP) were interviewed. Overall, 170 women (50%) presented SUI. Stress urinary incontinence did not correlate to either body mass index (BMI) or race. There was no correlation between parity and SUI, but when considering distinct types of effort, urine leakage on coughing (P=0.0478) and laughing (P=0.0046) were highly more frequent in multiparous women. One hundred eleven women had had only vaginal deliveries and 68 delivered by cesarean section. There was no difference between the two groups concerning incontinence, but multiparous women (≥4) who delivered exclusively vaginally demonstrated 2.0 times more chances to leak urine when compared to nulliparous women. This fact strongly suggests parity to be more relevant than delivery route as a risk factor to stress urinary incontinence. Nulliparous women presented with a high percentage (45.5%) of the symptom, emphasizing the elevated risk of SUI during first pregnancy.

Prevalência de sintomas urinários no terceiro trimestre da gestação

BACKGROUND This study evaluated the prevalence of irritative bladder symptoms of women in the third trimester of pregnancy and the correlation to parity and route of delivery. METHODS Between June and October 2003, 340 women attending the prenatal clinic at the Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) were selected for study. RESULTS On the total, 80.6% presented nocturia, 70.3% presented urinary frequency and 44.4% presented urgency. No statistic correlation was observed between irritative bladder symptoms and route of delivery however, when considering parity, nocturia and urinary frequency were significantly more frequent in multiparous women. CONCLUSION In the population under study pregnancy per se was associated to a high prevalence of irritative bladder symptoms.

Impact of delivery mode on electromyographic activity of pelvic floor: comparative prospective study.

Several studies evidenced the association between pregnancy, mode of delivery and genitourinary symptoms. However, there are still controversies about the role of mode of delivery in the prevention or aggravation of these symptoms. This study aimed to compare the impact of three distinct modes of delivery on pelvic floor muscle contractility.

Corrección transobturatoria de los cistoceles

Resumen Objetivo Presentar nuestra experiencia inicial con el sistema Perigee para la correccion de prolapsos de pared anterior vaginal. Material Y metodo 15 pacientes con prolapso de la pared anterior de la vagina (edad media: 62 anos) fueron intervenidas con el sistema Perigee compuesto de una tela para la correccion del defecto central y cuatro astas autofijables para la correccion del defecto lateral. La tecnica de implante consta de cuatro pasos: 1) diseccion lateral vaginal hasta rama isquiopubica; 2) realizacion de dos marcas superiores en el pliegue genito-femoral y dos inferiores a 2 cm lateralmente y 3 cm inferiormente en relacion a las primeras; 3) introduccion agujas superiores paralelas a la rama isquiopubica y conexion con los “brazos” del injerto e introduccion de agujas inferiores verticalmente con conexion a las “piernas” del injerto; 4) ajuste sin tension de la malla. La tasa de curacion fue medida objetivamente utilizando el sistema POP-Q. Resultados El punto Aa preoperatorio paso de 0.09 a -3.00 a las 6 semanas del postoperatorio y se mantuvo en -2.73 a los tres meses. El punto Ba preoperatorio era de 1.73 y paso a -2.82 a las 6 semanas y se mantuvo en -2.82 a los 3 meses. Las complicaciones no fueron significativas. No se produjeron danos vasculares ni sangrados significativos. Conclusiones La correccion transobturadora de los cistoceles es una opcion atrayente. Los buenos resultados iniciales prometen ser duraderos.

Sintomas do trato urinário inferior três anos após o parto: estudo prospectivo

PURPOSE to evaluate the frequency of lower urinary tract symptoms (LUTS), three years after delivery in women previously interviewed at the third gestation trimester, and to compare the gestation and delivery impact on LUTS, analyzing the social and hygienic discomfort associated with micturition complaints. METHODS analytical prospective study. In 2003, 340 pregnant women were selected in the pre-natal outpatient unit, and asked to answer a pre-tested questionnaire about LUTS and obstetric data. Three years after delivery, it was possible to get in touch by telephone with 120 of the 340 women who had been interviewed in the first study. They answered a second questionnaire about obstetric data, LUTS and its social impact. LUTS have been divided into stress urinary incontinence (SUI) and irritative urinary symptoms (IUS). McNemars and chi-square tests were used for statistical analysis (p<0.05). RESULTS SUI and nocturia have occurred in 57.5 and 80% of the pregnant women and the appearance of those symptoms after delivery, in 13.7 and 16.7%, respectively. Urge urinary incontinence has been significantly more frequent after delivery (30.5%) than in gestation (20.8%). Only 35.6% of the women with IUS presented social discomfort, but this rate has gone up to 91.4% in women with IUS associated with SUI. CONCLUSIONS gestation, more than delivery, was associated with the appearance of SUI and nocturia, while the urge urinary incontinence was significantly higher after delivery. Most of the women have mentioned that SUI causes social problems.

Global Postural Re-education: an alternative approach for stress urinary incontinence?

OBJECTIVE The aim of this study was to evaluate the impact of Global Postural Re-education (GPR) on stress urinary incontinence symptoms and to compare it to Pelvic Floor Muscle Training (PFMT). STUDY DESIGN Fifty-two women with stress urinary incontinence were distributed into two groups: Group 1 (G1) was submitted to weekly sessions of GPR for three months and Group 2 (G2) performed Pelvic Floor Muscle Training four times a week for three months. Patients were evaluated through the Kings Health Questionnaire, a three-day voiding diary including daily pad use and a Functional Evaluation of the Pelvic Floor (FEPF), before treatment (T0), at the end of treatment (T1) and six months after treatment (T2). RESULTS The number of leaking episodes dropped significantly in both groups at the end of treatment and at six months follow-up, with a significantly greater decrease in G1. Daily pad use dropped significantly in both groups. At the end of treatment, 72% of the patients in G1 and 41% of the patients in G2 needed no pads and at six-month follow-up, 84% and 50%, respectively. FEPF improved significantly in both groups, with no significant difference between the groups (P=0.628). The Kings Health Questionnaire demonstrated significant improvement in both groups and in all domains. The GPR group presented higher adherence to treatment, with no dropouts. CONCLUSIONS GPR could represent an alternative method to treat stress urinary incontinence in women, should the results be long lasting.