RESUMEN
INTRODUCTION AND HYPOTHESIS: The objectives were to evaluate clinical and anatomical parameters assessed by three-dimensional pelvic floor ultrasound (3D ultrasound) in parous and nulliparous women of childbearing age and to assess underreported symptoms of sexual dysfunction (SD), urinary incontinence (UI) and flatus incontinence (FI). METHODS: Women without complaints of pelvic floor dysfunction, aged 20-50 years, were eligible for this prospective cross-sectional study. They completed the King's Health Questionnaire, Female Sexual Function Index and St Mark's Incontinence Score adapted for this study. Next, a physical examination and 3D ultrasound were performed. The scores obtained in the questionnaires were compared with the 3D ultrasound data. RESULTS: In total, 326 women were invited to participate. Of these, 203 women met the inclusion criteria, and their cases were classified as nulliparity (NU, 59), vaginal delivery (VD, 80), forceps delivery (FD, 18) and caesarean section (CS, 48). These groups were homogeneous regarding age (p=0.096), parity (p=0.051) and body mass index (p=0.06). The hiatal dimension (HD; p=0.003) and transverse diameter (TD) (p=0.001) were significantly different among the groups. Compared with the NU and CS groups, the VD and FD groups had an increased HD and TD. The frequencies of underreported symptoms identified by questionnaires were as follows: SD (46.3%), UI (35%) and FI (28%). After VD and FD, women were more likely to present UI (p<0.001), FI (p<0.001) and SD (p=0.002) than the women with NU and those who had undergone a CS. UI was related to a greater HD (p=0.002) and anteroposterior diameter (p=0.022), FI was associated with a thinner left pubovisceral muscle (p=0.013), and SD was related to a greater HD (p=0.026). CONCLUSIONS: Three-dimensional ultrasound can identify mild morphological changes in young women with apparently normal physical examinations, mainly after VD and FD. In such individuals, these findings are associated with higher incidences of underreported sexual, urinary and anal symptoms.
Asunto(s)
Incontinencia Fecal , Disfunciones Sexuales Fisiológicas , Incontinencia Urinaria , Femenino , Embarazo , Humanos , Paridad , Cesárea/efectos adversos , Diafragma Pélvico/diagnóstico por imagen , Estudios Transversales , Estudios Prospectivos , Incontinencia Fecal/etiología , Incontinencia Urinaria/diagnóstico por imagen , Incontinencia Urinaria/etiología , Incontinencia Urinaria/epidemiología , Parto Obstétrico/métodosRESUMEN
BACKGROUND: Pelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12 months after the Cesarean (C) section in women with GDM. Specifically, differences in PFM/RAM hyperglycemic myopathy will be evaluated. METHODS: The Diamater is an ongoing cohort study of four groups of 59 pregnant women each from the Perinatal Diabetes Research Centre (PDRC), Botucatu Medical School (FMB)-UNESP (São Paulo State University), Brazil. Diagnosis of GDM and PS-UI will be made at 24-26 weeks, with a follow-up at 34-38 weeks of gestation. Inclusion in the study will occur at the time of C-section, and patients will be followed at 24-48 h, 6 weeks and 6 and 12 months postpartum. Study groups will be classified as (1) GDM plus PS-UI; (2) GDM without PS-UI; (3) Non-GDM plus PS-UI; and (4) Non-GDM without PS-UI. We will analyze relationships between GDM, PS-UI and hyperglycemic myopathy at 12 months after C-section. The mediator variables to be evaluated include digital palpation, vaginal squeeze pressure, 3D pelvic floor ultrasound, and 3D RAM ultrasound. RAM samples obtained during C-section will be analyzed for ex-vivo contractility, morphological, molecular and OMICS profiles to further characterize the hyperglycemic myopathy. Additional variables to be evaluated include maternal age, socioeconomic status, educational level, ethnicity, body mass index, weight gain during pregnancy, quality of glycemic control and insulin therapy. DISCUSSION: To our knowledge, this will be the first study to provide data on the prevalence of PS-UI and RAM and PFM physical and biomolecular muscle profiles after C-section in mothers with GDM. The longitudinal design allows for the assessment of cause-effect relationships between GDM, PS-UI, and PFMs and RAMs myopathy. The findings may reveal previously undetermined consequences of GDM.
Asunto(s)
Diabetes Gestacional/fisiopatología , Enfermedades Musculares/fisiopatología , Incontinencia Urinaria/fisiopatología , Adulto , Brasil , Cesárea , Estudios de Cohortes , Femenino , Edad Gestacional , Ganancia de Peso Gestacional , Humanos , Edad Materna , Contracción Muscular/fisiología , Fuerza Muscular/fisiología , Palpación , Diafragma Pélvico/fisiopatología , Periodo Posparto , Embarazo , Recto del Abdomen/fisiopatología , VaginaRESUMEN
The decline in sex hormone levels that accompanies the menopause has substantial effects on the tissues of the urogenital system, leading to atrophic changes. These changes can have negative effects on sexual and urinary function. The authors evaluate the repercussion of hypoestrogenism and sexual steroids on some elements of the pelvic floor and lower urinary tract. They summarize their research work and review significant published papers. They emphasize the changes in urinary mucosae, periurethral vessels, muscular layer, connective tissue, gene expression, autonomic nervous system receptors, as well as the main clinical aspects involved.
Asunto(s)
Estrógenos/deficiencia , Sistema Urinario/metabolismo , Urotelio/fisiología , Envejecimiento/fisiología , Animales , Atrofia , Colágeno/análisis , Colágeno/efectos de los fármacos , Ciclooxigenasa 1/genética , Terapia de Reemplazo de Estrógeno , Estrógenos/fisiología , Estrógenos/uso terapéutico , Matriz Extracelular/metabolismo , Femenino , Expresión Génica , Glicosaminoglicanos/metabolismo , Humanos , Ácido Hialurónico/metabolismo , Microcirculación/efectos de los fármacos , Músculo Liso/efectos de los fármacos , Neovascularización Fisiológica/efectos de los fármacos , Diafragma Pélvico/irrigación sanguínea , ARN Mensajero/metabolismo , Receptores Muscarínicos/efectos de los fármacos , Receptores Muscarínicos/fisiología , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Incontinencia Urinaria/tratamiento farmacológico , Incontinencia Urinaria/fisiopatología , Sistema Urinario/irrigación sanguínea , Urotelio/efectos de los fármacos , Prolapso Uterino/fisiopatología , Vagina/metabolismo , Vagina/patología , Factor A de Crecimiento Endotelial Vascular/efectos de los fármacos , Factor A de Crecimiento Endotelial Vascular/genética , Factor A de Crecimiento Endotelial Vascular/metabolismo , Microglobulina beta-2/genéticaRESUMEN
UNLABELLED: Lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial trophism, resulting in negative effects on continence in postmenopausal women. Therefore, the use of estrogens in these patients may revert these alterations and lead to an expressive improvement of the urinary symptoms. OBJECTIVE: Study the effect of topical estrogen therapy (conjugated equine estrogens, estriol or promestriene) in periurethral vessels detected by Dopplervelocimetric analysis using, as parameters: the number of vessels, resistance and pulsatility indexes, as well as the minimum diastolic value. METHODS: Forty-one postmenopausal women with stress urinary incontinence were randomized into three groups according to different types of topical estrogen received during 3 months. Group 1 received conjugated equine estrogens, group 2 received estriol and group 3 received promestriene. Periurethral Dopplervelocimetry analysis was done before estrogen administration and during treatment in all groups. RESULTS: We observed an increase in the number of the periurethral vessels in group 1 and group 2, being higher in group 1 than in group 2. The pulsatility index remained unchanged in all three groups. The resistance index at the periurethral vessels reduced only at the conjugated estrogen group (group 1). In this same group we noticed an increase in the mean minimal diastolic value, meaning a better periurethral vascularization. CONCLUSION: Topical conjugated equine estrogens and estriol were effective in increasing the number of periurethral vessels in postmenopausal women with urinary stress incontinence, with the conjugated equine estrogens being the most effective intervention studied.
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Estradiol/análogos & derivados , Estriol/administración & dosificación , Estrógenos Conjugados (USP)/administración & dosificación , Uretra/irrigación sanguínea , Incontinencia Urinaria de Esfuerzo/tratamiento farmacológico , Administración Intravaginal , Anciano , Estradiol/administración & dosificación , Terapia de Reemplazo de Estrógeno/métodos , Femenino , Humanos , Flujometría por Láser-Doppler/métodos , Persona de Mediana Edad , Posmenopausia , Estadísticas no Paramétricas , Ultrasonografía , Uretra/diagnóstico por imagen , Uretra/efectos de los fármacos , Incontinencia Urinaria de Esfuerzo/diagnóstico por imagenRESUMEN
UNLABELLED: The lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial trophism, resulting in negative effects on continence in postmenopausal women. OBJECTIVE: Study the effect of hormone therapy (estrogen and progesterone) in periurethral vessels detected by Doppler velocimetric analysis using, as parameters, the number of vessels, resistance and pulsatility indexes, as well as the minimum diastolic value. METHODS: Thirty-eight postmenopausal women with stress urinary incontinence were randomized into two groups. The first consisted of women receiving 3 months of estrogen therapy previous to 3 months of continuous estrogen and progesterone combined therapy. The second comprised of women receiving 3 months of continuous estrogen and progesterone therapy. Periurethral Doppler velocimetric analysis was done before hormone administration and during treatment in both groups. RESULTS: We observed a statistically significant increased number of periurethral vessels during treatment in both groups. There was an increase in value of the mean minimum diastolic value during estrogen and progesterone therapy in Group 2. The resistance indexes diminished in both groups. However, they were not statistically significant. CONCLUSION: Hormonal therapy of short duration (3-6 months) had a positive effect on the urethral continence mechanism increasing the number of periurethral vessels either with estrogen alone or combined therapy (estrogen and progesterone).
Asunto(s)
Vasos Sanguíneos/fisiopatología , Terapia de Reemplazo de Hormonas , Posmenopausia/fisiología , Uretra/irrigación sanguínea , Incontinencia Urinaria de Esfuerzo/fisiopatología , Adulto , Anciano , Quimioterapia Combinada , Estrógenos/uso terapéutico , Femenino , Humanos , Flujometría por Láser-Doppler , Persona de Mediana Edad , Progesterona/uso terapéutico , Ultrasonografía , Uretra/diagnóstico por imagen , Uretra/fisiopatología , Incontinencia Urinaria de Esfuerzo/tratamiento farmacológico , Resistencia Vascular/fisiologíaRESUMEN
Estrogen deficit causes significant alterations in the lower urinary tract of women, largely affecting urinary continence mechanisms. The urethral vascular bed accounts for about one-third of urethral pressure, and as it undergoes marked hormonal influence we became interested in investigating its behaviour both prior to and during estrogen replacement. We selected 25 postmenopausal patients with urinary stress incontinence and studied the periurethral vessels by means of Doppler velocimetry, analyzing the number of vessels, systolic peak, minimum diastole, resistance and pulsatility indexes and the A/B ratio, prior to estrogen replacement and after 1 and 3 months of hormone use. We concluded that estrogen replacement alone in postmenopausal women with urinary stress incontinence increased the number of periurethral vessels, systolic peak and minimum diastole; however, a trend of no statistical significance towards the reduction of resistance and pulsatility rates of periurethral vessels was found; nor was a significant difference in the A/B ratio shown.
Asunto(s)
Terapia de Reemplazo de Estrógeno/efectos adversos , Flujometría por Láser-Doppler , Posmenopausia/fisiología , Uretra/irrigación sanguínea , Uretra/fisiopatología , Incontinencia Urinaria de Esfuerzo/etiología , Incontinencia Urinaria de Esfuerzo/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Posmenopausia/efectos de los fármacos , Flujo Pulsátil/efectos de los fármacos , Flujo Pulsátil/fisiología , Uretra/efectos de los fármacos , Urodinámica/efectos de los fármacos , Resistencia Vascular/efectos de los fármacos , Resistencia Vascular/fisiologíaRESUMEN
Urethral pressure should exceed bladder pressure, both at rest and on stress, for urinary continence to occur. A decrease in urethral pressure is a major factor explaining the pathogenesis of urinary incontinence. A number of elements, such as smooth and striated periurethral muscles, and connective, vascular and elastic tissues, contribute to urethral pressure. The periurethral vessels are influenced by hormonal changes during the menstrual cycle, during pregnancy and postmenopause. We studied the periurethral vessels in 97 women, 57 of whom were incontinent and 40 continent, using power color Doppler velocimetry. The number of periurethral vessels, systolic peak, minimum diastolic values, pulsatility and resistance indexes, as well as systolic-diastolic ratio, were assessed. Statistically significant differences were found between incontinent women in the premenopausal period and those in the postmenopausal period, regarding the number of periurethral vessels, systolic peak, minimum diastolic values, pulsatility and resistance indexes.