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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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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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OBJECTIVE: To evaluate the effectiveness of transcutaneous parasacral electrical stimulation (TCPSE) in the treatment of non-monosymptomatic nocturnal enuresis (NMNE). Also, we evaluated possible pretreatment predictors of TCPSE failure. MATERIALS AND METHODS: Nineteen children diagnosed with NMNE who underwent TCPSE were studied prospectively. There were 6 boys and 13 girls with a mean age of 9.05 ± 3.153 years (range 5-17 years). The sessions were performed three times per week for a maximum of 20 sessions, for 20 min each and at a frequency of 10 Hz. RESULTS: For eight children (42%) the nocturnal enuresis resolved, four (21%) presented a reduction in nocturnal episodes to less than one a week, six (32%) presented no change and one (5%) had increased frequency of NMNE. Symptoms present before treatment, such as daytime incontinence, frequency, constipation and occurrence of urinary tract infection, were not predictors of failure after TCPSE. CONCLUSION: TCPSE can be an effective treatment for NMNE, but about a third of patients will need another kind of treatment. No pretreatment factor was determined that predicted TCPSE failure.

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PURPOSE: We evaluated the effectiveness of parasacral transcutaneous electrical nerve stimulation to treat overactive bladder in children. We designed a prospective randomized trial with sham control for this evaluation. MATERIALS AND METHODS: We prospectively randomized 25 girls and 12 boys with an average age of 7.6 years (range 4 to 12) into the test (active treatment) or sham (superficial scapular electrical stimulation) group. A total of 20 sessions, 20 minutes each (10 Hz) were performed 3 times weekly. The criteria used to evaluate the rate of success were 1) self-reported cure, or significant, mild or no improvement; 2) visual analogue scale (level of success 0 to 10); 3) percent improvement; 4) modified Toronto score; and 5) maximum voided volume, average voided volume and number of voids daily based on bladder diary entries. After completion of the 20 sessions controls who were not cured underwent active treatment. RESULTS: A total of 21 patients in the test group and 16 in the sham group underwent treatment. Among the active treatment group 61.9% of parents reported cure. In the sham group no parent reported cure (p <0.001). Regarding visual analogue scale a score of 10 was indicated by 13 parents in the test group, while 1 parent in the sham group indicated a score of 9 (p = 0.002). Additionally 100% improvement was reported by 12 parents in the test group and no parent in the sham group. Toronto score improved significantly in the test group (p <0.001) and sham group (p = 0.008). However, the score was reduced more significantly in the test group compared to the sham group (p = 0.011). In the test group average and maximum voided volumes showed a statistically significant increase and the number of voids daily decreased. After superficial scapular electrical stimulation 13 of the 16 patients who underwent parasacral transcutaneous electrical nerve stimulation were cured. CONCLUSIONS: This is the first known randomized clinical trial to demonstrate that parasacral transcutaneous electrical nerve stimulation is effective in the treatment of children with overactive bladder.

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Introdução: Em Salvador há mais de 380 mil deficientes, e devido a este elevado número de pessoas, objetiva-se descrever a estrutura urbana quanto às barreiras arquitetônicas que podem levar à exclusão dos deficientes físicos. Materiais e métodos: Foram realizadas entrevistas com 11 entidades e foram avaliadas 10 ruas/avenidas da cidade de Salvador comparando com as regras da ABNT, NBR 9050/1994 para deficientes, leis de direitos dos deficientes, censo demográfico do IBGE, estatísticas da OMS, projetos de pesquisa da acessibilidade em Salvador. Resultados: Na análise, verificou-se que 1 por cento dos telefones públicos é rebaixado, 35 por cento tornavam-se obstáculos. 35 por cento dos postes eram obstáculos. Nenhum semáforo apresentava sinalização para cegos, e 16 por cento não tinham área livre adequada. 73 por cento das rampas tinham largura inadequada, 35 por cento sem correspondência, 58 por cento desalinhadas e 90 por cento com larguras inadequadas. 43 por cento das calçadas estavam com larguras inadequadas, e 82 por cento com pisos irregulares. Conclusão: O cumprimento das leis de direitos dos deficientes é pouco respeitado em Salvador. Este dado pode ser notado a partir dos resultados em que todas as avenidas avaliadas estavam totalmente fora dos padrões determinados pela ABNT. Chega-se à conclusão de que esta ainda é uma cidade muito excludente.

Introduction: In Salvador, there are more than 380 thousands of disabled persons and, due to this highest number, this study aimed at describing urban structure related to buildings design which may exclude people with disabilities in this city. Methods: interviews with 11 entities were carried out and 10 streets/avenues of Salvador city were assessed and compared with ABNT norms – Brazilian Association of Technical Norms – for disabled individuals, their legal rights, IBGE’s population statistics, OMS statistics, research works of Salvador’s accessibility. Results: After analysis, it was observed the following: public phones - 1 percent appropriate; 35 percent had obstacles. Street lamps - 35 percent had obstacles. Traffic lights – were inefficient for blind people; 16 percent did not have adequate free space. Ramps – 73 percent with incorrect width; 35 percent only one side; 58 percent were not aligned; 90 percent with incorrect width. Side walk – 43 percent with incorrect width; 82 percent had irregular floor. Conclusion: Through analysis of results we can observe that the legal rights of disabled people of Salvador are rarely fulfilled, which can be noticed through analysis of this research results. We conclude that this city still excludes disabled people.

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