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INTRODUCTION AND HYPOTHESIS: Our objective was to evaluate the effectiveness of pelvic floor physiotherapy interventions for stress urinary incontinence (SUI) in postmenopausal women. METHODS: Searches were performed in MEDLINE/PubMed, PEDro, Cochrane Library Registry and LILACS databases until October 2021. Only randomized controlled trials (RCTs) which had physiotherapy interventions as primary outcome were included. There were no restrictions on the year of publication or language. Qualitative methodology was evaluated using the PEDro scale. RESULTS: After applying inclusion/exclusion criteria and quality control, 6 randomized controlled trials were included in this systematic review. Methodological quality of trials varied from 5 to 8 (out of 10 possible points in PEDro scale score). Sample consisted of 715 subjects; mean age was between 51.6 and 66.3 years; SUI severity scale ranged from small to severe. Interventions were pelvic floor muscle training (PFMT); vaginal cone (VC); biofeedback (BF); electrical muscle stimulation (EMS); radiofrequency (RF) and electroacupuncture (EA). Pelvic floor physiotherapy was effective in all studies, however, meta-analysis was considered irrelevant due to the heterogeneity of the reported interventions. CONCLUSION: There is not a literature consensus about the most effective pelvic floor physiotherapy intervention applied to stress urinary incontinence in postmenopausal women. It seems appropriate to state that further randomized controlled clinical trials should be done, due to the limited number of studies and heterogeneity of physiotherapeutic interventions applied to date. TRIAL REGISTRATION: This systematic review is registered in PROSPERO in the trial registration CRD42021255062.

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Objective: This pilot study aimed to evaluate the characteristic signs and symptoms of chronic vulvovaginitis after blue light-emitting diode (LED) treatment. Methods: Women with characteristic signs and symptoms of vulvovaginitis were interviewed to obtain clinical and sociodemographic data. They answered the Female Sexual Function Index (FSFI) and the World Health Organization Quality of Life (WHOQOL)-bref questionnaires. Women with a suspected diagnosis of vulvovaginitis underwent clinical examination by a gynecologist, followed by microbiological evaluation, potassium hydroxide testing, vaginal pH assessment, and collection of vaginal fluid for oncotic cytology and fungal culture. The study participants were instructed to return after 15 days to undergo the 405 nm blue LED treatment, which consisted of three biweekly sessions. After 28 days of treatment completion, the patients returned for clinical re-evaluation and reassessment of the FSFI and WHOQOL-bref scores. Results: All eight women reported improvement or cure of at least one characteristic sign or symptom of vulvovaginitis, and five showed improvement in total FSFI and WHOQOL-bref scores. Conclusions: Treatment with blue LED may improve or cure symptoms associated with vulvovaginitis, sexual function, and the global quality of life score. Clinical Trial registration: NCT03075046 dated March 9, 2017.

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BACKGROUND: Genitourinary syndrome of menopause (GSM) involves vaginal dryness (VD), pain during sexual activity (SAPain), vaginal itching (VI), burning, pain, and symptoms in the urinary organs. Non-ablative radiofrequency (RF) is a type of current with electromagnetic waves with a thermal effect that generates an acute inflammatory process with consequent neocolagenesis and neoelastogenesis. We aimed to describe the clinical response to VD, SAPain, vaginal laxity (VL), VI, burning sensation, pain in the vaginal opening, urinary incontinence, sexual dysfunction, cytological changes, and adverse effects of non-ablative RF in patients with GSM. METHODS: This single-arm pilot study included 11 women diagnosed with GSM with established menopause. Patients with hormone replacement initiation for six months, who used a pacemaker, or had metals in the pelvic region, were excluded. Subjective measures (numeric rating scale of symptoms, Vaginal Health Index-VHI) and objective measures (vaginal maturation index-VMI, vaginal pH, sexual function by the FSFI, and urinary function by the ICIQ-SF) were used. A Likert scale measures the degree of satisfaction with the treatment. Five sessions of monopolar non-ablative RF (41°C) were performed with an interval of one week between each application. The entire evaluation was performed before treatment (T0), one month (T1), and three months (T2) after treatment. Adverse effects were assessed during treatment and at T1 and T2. RESULTS: The symptoms and/or signs were reduced after treatment in most patients (T1/T2, respectively): VD 90.9%/81.8%, SAPain 83.3%/66.7, VL 100%/100%, VI 100%/100%, burning 75%/87.5%, pain 75%/75%, and VHI 90.9%/81.9%. Most patients did not show changes in VMI (54.5%) and pH (63.6%) at T1, but there was an improvement in VMI in most patients (54.5%) at T2. Nine patients were satisfied, and two were very satisfied at T1. The treatment was well tolerated, and no adverse effects were observed. There was an improvement in sexual function (72.7%) and urinary function (66.7% in T1 and 83.3% in T2). CONCLUSION: Intravaginal RF reduced the clinical symptoms of GSM in most patients, especially during T1, and women reported satisfaction with treatment. The technique showed no adverse effects, and there were positive effects on sexual and urinary function. Trial registration This research was registered at clinicaltrial.gov (NCT03506594) and complete registration date was posted on April 24, 2018.

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BACKGROUND: Currently, the advancement cancer treatment technology improves overall survival, however, adverse events are still a challenge for health professional. Genitourinary syndrome of menopause and vaginal stenosis are conditions that impact the quality of life of patients undergoing radiotherapy. We present two such cases in patients with previous cervical and endometrial cancer. These conditions were handled with an innovative method using an energy-based device with blue light emitting diode for concomitant vaginal and vulvar irradiation. Positive impact in clinical findings, cytologic changes, and referred symptoms were documented. CASE SUMMARY: One patient diagnosed with vaginal severe vaginal stenosis with previous cervix cancer treatment and other patient diagnosed with mild stenosis with severe dyspareunia and recent endometrium cancer treatment were considered for vulvovaginal treatment with weekly blue led device and closely evaluated with repeated validated questionnaires and cytological samples. CONCLUSION: This innovative technique showed an improvement in all areas of the examiner's criteria, the cytological criteria, and most bothered symptoms.

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INTRODUÇÃO: A incontinência urinária é definida como qualquer perda involuntária de urina. É um sério problema de saúde pública e as mulheres são as mais afetadas e apresentam como fatores de risco o envelhecimento, mais de duas gestações, parto vaginal com episiotomia, entre outros. Embora a IU não seja uma condição de vida ameaçadora, pode levar a situações com repercussões a nível social e pessoal, com influência na qualidade de vida. OBJETIVO: Descrever a frequência da IUE em um centro especializado na cidade de Salvador, assim como apontar as características clínicas, fatores de risco e comorbidades associadas à IUE feminina. MATERIAIS E MÉTODOS: Estudo transversal descritivo, a partir da análise de dados de prontuários de mulheres portadoras de incontinência urinária de esforço, incluídos dados sociodemográgicos, fatores de risco, comorbidades associadas, queixas clínicas e dados objetivos de Pad Test e Diário Miccional. RESULTADOS: Foram incluídas 28 mulheres com idade média de 48,9 anos (±7,7), de raça parda (46,2%), com ensino médio completo (40%), casadas (52%), trabalhadoras do lar (32,2%), IMC médio 26,2 (±4,9). A comorbidade associada mais predominante foi obesidade (28,6%), o fator de risco dominante foi o consumo de café (70%). A queixa clínica mais prevalente foi perda ao tossir (96,3%). Quando analisado Pad test, notado maior prevalência de perda leve (57,14%), seguido por (39,29%) de perda moderada e perda grave (3,57%). CONCLUSÃO: Mulheres de meia idade, pardas, menopausadas, obesas, hipertensas, multíparas, que realizaram parto vaginal com episiotomia, constipadas e que ingerem cafeína são mais propensas a desenvolver a incontinência urinária de esforço. Houve uma maior prevalência de incontinência urinária leve.

INTRODUCTION: Urinary incontinence is defined as any involuntary loss of urine. It is a serious public health problem, and women are the most affected and present aging as risk factors, more than two pregnancies, vaginal delivery with episiotomy, among others. Although UI is not a threatening life condition, it can lead to social and personal repercussions, influencing the quality of life. OBJECTIVE: Describe the frequency of SUI in a specialized center in the city of Salvador, as well as point out the clinical characteristics, risk factors, and comorbidities associated with female SUI. MATERIALS AND METHODS: Descriptive cross-sectional study, based on data analysis of medical records of women with stress urinary incontinence, including sociodemographic data, risk factors, associated comorbidities, clinical complaints, and objective data from Pad Test and Diary Diary. RESULTS: Twenty-eight women with an average age of 48.9 years (± 7.7), brown race (46.2%), complete high school (40%), married (52%), housewives (32.2%), mean BMI 26.2 (± 4.9). The most prevalent associated comorbidity was obesity (28.6%); the dominant risk factor was coffee consumption (70%). The most prevalent clinical complaint was cough loss (96.3%). When analyzed Pad test noted a higher prevalence of mild loss (57.14%), followed by (39.29%) moderate loss and severe loss (3.57%). CONCLUSION: Middle-aged, mulatto, menopausal, obese, hypertensive, multiparous women who had a vaginal delivery with episiotomy, constipation, and caffeine intake are more likely to develop stress urinary incontinence. There was a higher prevalence of mild urinary incontinence.

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OBJECTIVE: Dissatisfaction with body image may extend to the genital region, and the most dissatisfied with their bodies are women. To analyze the relation between body image and genital image in female, and to verify demographic and/or clinical factors related to body image and genital image. MATERIALS AND METHODS: This is a cross-sectional study in 421 women. The Body Shape Questionnaire-34 (BSQ-34) was used to evaluate body image perception; scores ≤110 indicate no dissatisfaction. Also, the female genital self-image scale-7 (FGSIS-7) was used to evaluate genital self-image; scores range between 7 and 28, with higher values considered to indicate a more positive genital self-image. The relation between body image and genital image was determined using the Pearson Correlation test, as well as the relation of these with body mass index (BMI) and age. The relation between these data and genital image was determined by using the ANOVA test or the independent t-test (statistical difference was accepted as p<0.05). In order to verify predictors of dissatisfaction with body image, variables with p<0.10 were inserted into the logistic regression model and checked if they remained significant (p<0.05). RESULTS: Three hundred eighty-nine women were analyzed. The mean age was 34.7±10.2 years. The mean BMI was 24.1±3.6 kg/m², 49% were single, and the mean BSQ-34 and FGSIS scores were 83.2±30.8 and 23.8±3.4, respectively. The correlation (r=-0.24) was found between body image and genital image (p<0.001). A total of 315 women indicated to be satisfied with their body and presented an FGSIS-7 score of 24±3.3. Participants who were dissatisfied with their body had an average FGSIS-7 score of 22.6±3.3. CONCLUSION: Genital image, age, and BMI influence body image. Change in the perception of body image seems to have low correlation with genital self-image in women.

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To describe the clinical response and side effects of radiofrequency treatment in patients with urinary incontinence after radical prostatectomy. This is a phase 1 clinical trial with 10 men up to 65 years of age who had urinary incontinence after radical prostatectomy, post void residual volume < 50 ml verified by ultrasonography, pad test ≥ 1 g, and PSA < 0.2 ng/ml. pad test and self-administered questionnaires were used to assess clinical response. Scales were used to measure treatment satisfaction and improvement in symptoms. Participants underwent five sessions of 2 min of non-ablative endoanal radiofrequency (41 °C). The evaluated co-primary endpoints were urinary incontinence volume and urinary symptoms, analyzed by the Wilcoxon nonparametric test; residual volume, and self-reports to assess safety. The participants' mean age was 57.5 ± 4.9. The initial pad test score was 6.5 g (1.7-50.0) with a final score of 2.0 g (0.0-9.0) (p < 0.01). Ultrasonography showed no alteration of residual volume. A decrease of urinary loss was found in nine patients, three of them showed a complete resolution of urinary loss. A decrease in irritative micturition symptoms was found as well, but no improvement in the quality of life was shown. Regarding treatment satisfaction, two patients were neutral, six satisfied, and two very satisfied. Limitations included pain while the endoanal electrode was inserted. Four patients indicated pain during treatment, but overall results were positive. The reduction of urinary loss and irritative micturition symptoms increased patients' satisfaction scores, without improving their perception of quality of life.

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Vulvovaginal candidiasis (VVC) is a frequent infection of the female genitourinary tract. It is considered the second most common genital infection in women, after bacterial vaginosis. VVC is treated with oral or topical azole derivatives. However, these agents may lead to adverse reactions and their chronic use might lead to resistance to antifungal agents. Given that the ultraviolet A/blue light-emitting diode (LED) is an electromagnetic radiation source with antimicrobial properties, it is hypothesized that this resource may be a non-drug alternative to the treatment of vulvovaginitis. A technical/experimental safety test was conducted to characterize the light source spectrum and temperature generation of the device, followed by a pilot study in a 52-year-old patient with a clinical diagnosis of VVC confirmed by culture and examination of fresh vaginal samples, owing to the presence of lumpy vaginal discharge and a complaint of pruritus. The vulva and vagina were exposed to 401 ± 5 nm ultraviolet A/blue LED irradiation in a single session, divided into two applications. A reassessment was performed 21 days after the treatment. The light-emitting device had a visible spectrum, in the violet and blue ranges, and a maximum temperature increase of 7 °C. During the reassessment, the culture was found to be negative for fungus, and the signs and symptoms of the patient had disappeared. A light-emitting device with a spectrum in the range of 401 ± 5 nm could potentially be an alternative treatment modality for women with VVC, as it led to the resolution of clinical and microbiological problems in our patient.

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INTRODUCTION: The Ehlers-Danlos Syndrome (EDS) can presentis a reduction in fibroblast proliferation and collagen production. Microneedling a minimally invasive technique that through mechanical stimulus there is incentive to the production of collagen and elastin. OBJECTIVE: Present a case study in a patient with EDS complaining of flaccidity on large genital labia, using microneedling as a therapeutic proposal. METHODOLOGY: A 36-year-old female with EDS type III. The external genitalia showed tissue flaccidity associated with hyperchromia. Microneedling was performed with 0.5 mm needles and the cosmetology was used soon after the application. The level of pain was questioned to the patient through a Likert scale. The clinical response to treatment was evaluated through self-report, visual analogue scale and analysis of photographic images. Five other people evaluated the results through before and after images. RESULTS: Microneedle was shown to be bearable in relation to pain and associated with cosmetology for tissue flaccidity due to EDS in the genital region proved to be very satisfactory for the patient, as well individuals who evaluated the comparative image. CONCLUSION: Microneedle associated with cosmetology may be a new option for studies on skin flaccidity treatments on individuals with EDS and for treatments of genital hyperchromias.

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A healthy female genital mucosa has an ecosystem that remains in balance through interactions between endogenous and exogenous factors. The light-emitting diode (LED) is a device that emits light at different wavelengths, with varying color and effects. Blue light in humans is most commonly used for antimicrobial purposes and has been already applied to treat facial acne and gastric bacteria. Although blue LED therapy in humans has been reported, its properties against vaginal infections have not yet been investigated. This study aims to test the safety and effects of 401 ± 5 nm blue LED on healthy vaginal mucosa. Phase I clinical trial involving 10 women between 18 and 45 years old with healthy vaginal mucosa. The participants were illuminated by 401 ± 5 nm blue LED for 30 min and anamnesis, oncotic cytology, and pH measurement were made again after 21/28 days of treatment. In the re-evaluation, adverse effects were investigated. The mean age was 27 ± 5.4 years and one of the women was excluded due to interruption of use of oral contraceptives. Oncotic cytology done before and after therapy showed that the composition of the microflora remained normal in all participants. Vaginal pH remained unchanged in eight of the women and had a reduction in one woman (5.0-4.0). No adverse effects were observed during or after illumination. 401 ± 5 nm blue LED did not generate any adverse effects or pathogenic changes in the microflora and vaginal pH. The effects of 401 ± 5 nm blue LED still need to be tested in vulvovaginal pathogens. Trial registration number: NCT03075046.

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INTRODUÇÃO: A saúde sexual envolve diversos componentes em relação à sexualidade, como biológico, cultural, psicológico e social. Quando alguns desses fatores são atingidos, pode-se originar um quadro de disfunção sexual. OBJETIVO: investigar a qualidade de vida em mulheres com disfunção sexual. MATERIAIS E MÉTODOS: Estudo observacional comparativo, de corte transversal, realizado em mulheres de 18 a 59 anos do CAAP da EBMSP. Excluídas: mulheres com histórico de doença psiquiátrica grave, portadoras de doenças crônico-degenerativas neurológicas, com dispareunia de causas orgânicas, em tratamento fisioterapêutico e gestantes. Foi utilizado a FSFI ≥ 26 para o grupo com disfunção e < 26 para o grupo comparação. Instrumentos de avaliação aplicados: FSFI e 36-Item Short-Form Health Survey (SF-36). A comparação das medianas dos domínios do SF-36 e FSFI entre os grupos foi realizada pelo teste Mann-Whitney (teste não paramétrico), e das variáveis categóricas com a disfunção sexual foi feita a partir do teste qui-quadrado. RESULTADOS: Amostra 36 paciente,18 em cada grupo. As variáveis sociodemográficas e clínicas que apresentaram diferença estatística foram renda (0,001) e escolaridade (0,011). No FSFI, todos os domínios apresentaram significância (0,00). No SF-36, ao comparar os dois grupos, 06 domínios apresentaram significância estatística. CONCLUSÃO: Os resultados mostram que mulheres com disfunção sexual apresentam um impacto negativo em alguns dos aspectos da qualidade de vida. Importante salientar que, a escolaridade e a renda familiar não foram homogêneas entre os grupos, sendo assim, diante da característica do estudo, não é possível aferir relação causa e consequência na disfunção sexual com a qualidade vida das participantes. [AU]

INTRODUCTION: Sexual health involves several components in relation to sexuality, such as biological, cultural, psychological and social. When some of these factors are reached, a picture of sexual dysfunction may result. OBJECTIVE: To investigate quality of life in women with sexual dysfunction. MATERIALS AND METHODS: A cross-sectional, observational, observational study of 18- to 59-year-old women from the EBMSP CAAP. Excluded: women with a history of severe psychiatric illness, carriers of neurological chronic degenerative diseases, with dyspareunia of organic causes, in physiotherapeutic treatment and pregnant women. FSFI ≥ 26 was used for the group with dysfunction and <26 for the comparison group. Assessment instruments applied: FSFI and 36-Item Short-Form Health Survey (SF-36). The comparison of the medians of the SF-36 and FSFI domains between the groups was performed by the Mann-Whitney test (non-parametric test), and the categorical variables with the sexual dysfunction were done using the chi-square test. RESULTS: Sample 36 patient, 18 in each group. The sociodemographic and clinical variables that presented statistical difference were income (0.001) and schooling (0.011). In the FSFI, all domains presented significance (0.00). In the SF-36, when comparing the two groups, 06 domains presented statistical significance. CONCLUSION: The results show that women with sexual dysfunction have a negative impact on some aspects of quality of life. It is important to emphasize that schooling and family income were not homogeneous between the groups, so, due to the characteristics of the study, it is not possible to measure cause and consequence relationship in sexual dysfunction with quality of life of the participants. [AU]

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AIMS: To Compare the angular parameters of the pelvis of continents and incontinent women and to correlate them with the electrical activity and the function of the pelvic floor muscles. METHODS: Cross-sectional study. Incontinent and continent women, aged between 18 and 59 years. The anatomical points were marked following the SAPO protocols, the photographic records were made and analyzed through the SAPO Software. The evaluation of the function of the MPF was performed by bidigital vaginal palpation, using the PERFECT scheme. Surface electromyographic analysis was performed in dorsal decubitus and orthostasis. RESULTS: The sample consisted of 40 women, 20 with SUI (IG) and 20 continents (CG), matched by age. The mean age in the CG was 43.5 years (SD 8.4), while in the IG it was 47.1 years (SD 7.8) (P = 0.16). The pelvic angle in the CG presented a mean of -14.3 ± 4.6 and the IG -16.6 ± 4.4 (P = 0.02). When compared to normality, IG presented an accentuation of anterior slope in both analyzed views (P = 0.01). There was a moderate correlation in the IG between the electrical activity of the basal pelvis in orthostasis and the anterior pelvic tilt angles in the right lateral views r = 0.51 (P = 0.02) and left lateral r = 0.46 (P = 0.04). No correlation was found in the CG. CONCLUSIONS: In the present sample, incontinent women have a greater anterior slope of the pelvis, and the greater the degree of anterior slope, the greater the electrical activity of the PFM, during rest, and in orthostasis.

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ABSTRACT Purpose: To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women. Materials and Methods: This phase one study included ten women with Stress Urinary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects. Results: Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation. Conclusion: The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted.

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PURPOSE: To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women. MATERIALS AND METHODS: This phase one study included ten women with Stress Urinary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects. RESULTS: Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation. CONCLUSION: The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted.

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INTRODUCTION AND HYPOTHESIS: Female sexual behavior goes through cultural changes constantly, and recently, some women have shown the desire the ideal genitalia. In this study, we aimed to evaluate clinical responses to nonablative radiofrequency (RF) in terms of its cosmetic outcome in the female external genitalia and its effect on sexual function. METHODS: A single-masking randomized controlled trial was conducted in 43 women (29 sexually active) who were unsatisfied with the appearance of their external genitalia. The women were divided into an RF group (n = 21, 14 sexually active) and a control group (n = 22, 15 sexually active). Eight sessions of RF were performed once a week. Photographs (taken before the first session and 8 days after the last session) were evaluated by the women and three blinded health professionals by using two 3-point Likert scales (unsatisfied, unchanged, and satisfied; and worst, unchanged, and improved). Sexual function was evaluated using the Female Sexual Function Index (FSFI) and analyzed using the Student t test. Women's satisfaction and health professional evaluation were analyzed using the chi-square test and inter- and intragroup binomial comparisons. RESULTS: Satisfaction response rates were 76 and 27 % for the RF and control groups, respectively (p = 0.001). All professionals found a clinical improvement association in the treated group with RF in comparison with the control group (p < 0.01). The overall FSFI sexual function score increased by 3.51 points in the RF group vs 0.1 points in the control group (p = 0.003). CONCLUSIONS: RF is an alternative for attaining a cosmetic outcome for the female external genitalia, with positives changes in patients' satisfaction and FSFI scores.

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OBJECTIVE: To evaluate the urodynamic changes immediately after the first session (acute effect) and after the last session of parasacral TENS in children with idiopathic OAB. MATERIALS AND METHODS: We performed urodynamic evaluation immediately before and after the first session of parasacral TENS and immediately after the last session (7 weeks later). Only children with idiopathic isolated OAB were included. Patients with dysfunctional voiding were not included. RESULTS: 18 children (4 boys and 14 girls, mean age of 8.7) were included in the first analysis (urodynamic study before and immediately after the first session) and 12 agreed to undergo the third urodynamic study. Urodynamic before and immediately after the first session: There was no change in the urodynamic parameters, namely low MCC, low bladder compliance, presence of IDC, the average number of IDC, or in the maximum detrusor pressure after the first exam. Urodynamic after the last session: The bladder capacity improved in most patients with low capacity (58% vs. 8%). Detrusor overactivity was observed in 11 (92%) before treatment and 8 (76%) after. There was not a significant reduction in the average number of inhibited contractions after TENS (p=0.560) or in the detrusor pressure during the inhibited contraction (p=0.205). CONCLUSION: There was no change in the urodynamic parameters immediately after the first session of stimulation. After the last session, the only urodynamic finding that showed improvement was bladder capacity.

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ABSTRACTObjective:To evaluate the urodynamic changes immediately after the first session (acute effect) and after the last session of parasacral TENS in children with idiopathic OAB.Materials and methods:We performed urodynamic evaluation immediately before and after the first session of parasacral TENS and immediately after the last session (7 weeks later). Only children with idiopathic isolated OAB were included. Patients with dysfunctional voiding were not included.Results:18 children (4 boys and 14 girls, mean age of 8.7) were included in the first analysis (urodynamic study before and immediately after the first session) and 12 agreed to undergo the third urodynamic study. Urodynamic before and immediately after the first session: There was no change in the urodynamic parameters, namely low MCC, low bladder compliance, presence of IDC, the average number of IDC, or in the maximum detrusor pressure after the first exam. Urodynamic after the last session: The bladder capacity improved in most patients with low capacity (58% vs. 8%). Detrusor overactivity was observed in 11 (92%) before treatment and 8 (76%) after. There was not a significant reduction in the average number of inhibited contractions after TENS (p=0.560) or in the detrusor pressure during the inhibited contraction (p=0.205).Conclusion:There was no change in the urodynamic parameters immediately after the first session of stimulation. After the last session, the only urodynamic finding that showed improvement was bladder capacity.

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PURPOSE: We determined the effectiveness of 2 methods to treat overactive bladder in children using intragroup and intergroup comparisons in a randomized clinical trial. MATERIALS AND METHODS: Nine boys and 19 girls with a mean ± SD age of 6.4 ± 2.18 years were randomly divided into group 1-parasacral transcutaneous electrical stimulation with placebo drug and group 2-oxybutynin with sham scapular electrical therapy. Success was assessed by 1) the rate of complete symptom resolution, 2) a visual analog scale of 0 to 10, 3) the dysfunctional voiding score system, 4) voiding diary records, 5) Rome III criteria and 6) side effect frequency in each group. RESULTS: A total of 13 and 15 patients were randomized to groups 1 and 2, respectively. Symptoms completely resolved in 6 patients in group 1 (46%) and 3 in group 2 (20%) (p = 0.204). A statistically significant improvement was found in the 2 groups in the dysfunctional voiding score system and voiding diary records. However, no statistically significant difference was found between the groups in the visual analog scale score, voiding frequency, and maximum and mean voided volume (p = 0.295, 0.098, 0.538 and 0.650, respectively). Constipation improved in 100% of group 1 patients but in only 55% in group 2 (p = 0.031 vs 0.073). Group 1 showed no side effects while dry mouth, hyperthermia and hyperemia developed in 58%, 25% and 50% of group 2 patients (p = 0.002, 0.096 and 0.005, respectively). Treatment was discontinued by 13.3% of patients in group 2. CONCLUSIONS: Parasacral transcutaneous electrical stimulation was as effective as oxybutynin to treat overactive bladder in children. However, transcutaneous parasacral electrical stimulation was more effective against constipation and showed no detectable side effects. Oxybutynin was more effective for decreasing voiding frequency.

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PURPOSE: We conducted a cross-sectional study to evaluate whether the different positions during urination influence the electrical activity of the abdominal and perineal musculature, as well as the uroflowmetric parameters of children with lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS: Ninety-four children between the ages of 3 and 14 years with symptoms of LUTD were evaluated. All underwent uroflowmetry and electromyography tests (abdominal and perineal) in two different positions: oriented position (trunk bent slightly forward and feet flat) and atypical position (standing on toes for boys and buttocks not in contact with the lavatory seat and legs flexed in girls). We excluded nine patients due to suspicions of outside interference or elements complicating the analysis of charts. RESULTS: Among patients evaluated 55 (64.7%) were girls and 30 (35.3%) were boys with an average age of 8.5 years. Children urinating in atypical position showed higher levels of perineal electrical activity than when they were in normal position (p=0.018). However, there was no difference in the pattern of the curve if normal or abnormal when comparing the two groups (p=0.824). When evaluated separately, the boys demonstrated no difference between positions, in relation to perineal electrical activity (p=0.412) or abdominal electrical activity (p=0.202). CONCLUSIONS: The electrical activity of the pelvic floor musculature is decreased in the oriented position when compared to atypical positions in female children. Our data suggest that special attention should be given to adopting an adequate posture during urination for girls with LUTD.

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