RESUMO
The use of stem cells capable of multilineage differentiation in treating Pelvic Floor Dysfunction (PFD) holds great promise since they are susceptible to entering connective tissue of various cell types and repairing damaged tissues. This research investigated the effect of microRNA-181a-5p (miR-181a-5p) on Bone Marrow Mesenchymal Stem Cells (BMSCs) in rats with PFD. BMSCs were transfected and analyzed for their fibroblast differentiation ability. miR-181a-5p, MFN1, and fibroblast-related genes were quantitatively analyzed. Whether MFN1 is a target gene of miR-181a-5p was predicted and confirmed. The efficacy of BMSCs in vivo rats with PFD was evaluated by measuring Leak Point Pressure (LPP), Conscious Cystometry (CMG), hematoxylin and eosin staining, and Masson staining. The present results discovered that miR-181a-5p was up-regulated and MFN1 was down-regulated during the differentiation of BMSCs into fibroblasts. Fibroblast differentiation of BMSCs was promoted after miR-181a-5p was induced or MFN1 was suppressed, but it was suppressed after miR-181a-5p was silenced. miR-181a-5p improved LPP and conscious CMG outcomes in PDF rats by targeting MFN1 expression, thereby accelerating fibroblast differentiation of BMSCs. In brief, miR-181a-5p induces fibroblast differentiation of BMSCs in PDF rats by MFN1, potentially targeting PDF therapeutics.
Assuntos
Diferenciação Celular , Fibroblastos , Células-Tronco Mesenquimais , MicroRNAs , Animais , Células-Tronco Mesenquimais/metabolismo , MicroRNAs/genética , MicroRNAs/metabolismo , Feminino , Ratos Sprague-Dawley , Distúrbios do Assoalho Pélvico/genética , Distúrbios do Assoalho Pélvico/terapia , Ratos , Regulação para Cima , Modelos Animais de Doenças , Regulação para Baixo , Células CultivadasRESUMO
INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is highly prevalent in the general population, with numerous studies conducted in Europe and North America. However, there is a scarcity of data regarding its prevalence and sociodemographic factors in the southern region of Peru. There is an association between sociodemographic factors-such as age, educational level, body mass index, number of pregnancies, parity, mode of delivery, weight of the newborn-along with lifestyle factors such as physical effort, coffee and tobacco consumption with pelvic floor dysfunction (PFD). We anticipate that this association will negatively impact women's quality of life. METHODS: This was a quantitative study, with a non-experimental, descriptive, cross-sectional correlational design. A sample consisting of 468 women between 30 and 64 years old. A previously tested survey was applied to explore prevalence, symptoms, associated factors, and quality of life. RESULTS: The prevalence of PFD was 73.9%. UI was the most common. There is a significant association with overweight, obesity, parity, route of delivery, and physical effort. Even though a large percentage of participants presented with PFD, they reported that their quality of life was not affected (65.9% urinary discomfort, 96.5% colorectal-anal discomfort and 92.2% pelvic organ prolapse discomfort) and only in the case of urinary discomfort did they state that the impact was mild (28.6%) and moderate (5.5%). CONCLUSIONS: Pelvic floor dysfunction in women is very common and it is strongly associated with overweight, obesity, parity, route of delivery, and physical exertion. The impact on quality of life was mild and moderate for those who had urinary discomfort.
Assuntos
Distúrbios do Assoalho Pélvico , Qualidade de Vida , Incontinência Urinária , Humanos , Feminino , Peru/epidemiologia , Adulto , Estudos Transversais , Pessoa de Meia-Idade , Distúrbios do Assoalho Pélvico/epidemiologia , Distúrbios do Assoalho Pélvico/etiologia , Prevalência , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , ParidadeRESUMO
Abstract The use of stem cells capable of multilineage differentiation in treating Pelvic Floor Dysfunction (PFD) holds great promise since they are susceptible to entering connective tissue of various cell types and repairing damaged tissues. This research investigated the effect of microRNA-181a-5p (miR-181a-5p) on Bone Marrow Mesenchymal Stem Cells (BMSCs) in rats with PFD. BMSCs were transfected and analyzed for their fibroblast differentiation ability. miR-181a-5p, MFN1, and fibroblast-related genes were quantitatively analyzed. Whether MFN1 is a target gene of miR-181a-5p was predicted and confirmed. The efficacy of BMSCs in vivo rats with PFD was evaluated by measuring Leak Point Pressure (LPP), Conscious Cystometry (CMG), hematoxylin and eosin staining, and Masson staining. The present results discovered that miR-181a-5p was up-regulated and MFN1 was down-regulated during the differentiation of BMSCs into fibroblasts. Fibroblast differentiation of BMSCs was promoted after miR-181a-5p was induced or MFN1 was suppressed, but it was suppressed after miR-181a-5p was silenced. miR-181a-5p improved LPP and conscious CMG outcomes in PDF rats by targeting MFN1 expression, thereby accelerating fibroblast differentiation of BMSCs. In brief, miR-181a-5p induces fibroblast differentiation of BMSCs in PDF rats by MFN1, potentially targeting PDF therapeutics.
RESUMO
INTRODUCTION AND HYPOTHESIS: The worldwide prevalence of sexual dysfunction in women is high; therefore, an adequate assessment of this condition is necessary, with instruments validated for the Brazilian population. The aim was to translate and adapt the International Consultation on Incontinence Questionnaire Female Sexual Matters Associated with Lower Urinary Tract Symptoms into Brazilian Portuguese (ICIQ-FLUTSsex-Br) and analyze its measurement properties. METHODS: We recruited Brazilian women, literate, over 18 years old, who had had sexual intercourse in the last 4 weeks and had urinary loss. The translation and cross-cultural adaptation were performed following five stages: translation, synthesis, back translation, expert committee review, and pre-test. Measurement properties were analyzed using SPSS software, as follows: test-retest reliability using the intraclass correlation coefficient (ICC); construct validity using Pearson's correlation coefficient, by correlating the ICIQ-FLUTSsex-Br with the Female Sexual Function Index (FSFI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). RESULTS: A total of 328 women participated in the study. The reproducibility was 0.88, the standard error of measurement was 0.29, and the minimal detectable change was 0.80 (95% CI). Moderate correlations were found between the total scores of the ICIQ-FLUTSsex and PISQ-12 questionnaires (0.54, p<0.01), confirming the hypotheses outlined. Weak correlations were also found for comparisons between the FSFI and ICIQ-FLUTSsex total scores (-0.56, p<0.01) and the PISQ-12 question about fear of incontinence hindering sexual intercourse (0.26, p<0.01). CONCLUSION: The Portuguese-language version of the ICIQ-FLUTSsex-Br showed validity and reproducibility, making it a tool to be used in research and clinical practice by health professionals in Brazil.
RESUMO
BACKGROUND: Urinary incontinence (UI) is a common dysfunction of the pelvic floor, affecting 10-20% of all women, and up to 70% in the elderly general prevalence of 17% 20-year-old women and 38% in women over 60 years. It is estimated that only 25% of patients seek treatment for this debilitating condition. AIM: The aim of this study was to evaluate the efficacy of a device based on top flat magnetic stimulation to treat pelvic floor disorders especially female urinary incontinence. METHODS: A total of 33 volunteer patients were divided into 5 groups according to the type of complaint. Subjects received 8 treatment sessions, with a frequency of twice a week with two different settings. Pelvic Floor Bother Questionnaire (PFBQ), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) and Urinary Incontinence Short Form (ICIQ-UI-SF) were compiled by all patients at the beginning and after 3 months from the end of the last treatment (3MFU). RESULTS: The patient's scores from validated Questionnaires significantly decreased (p < 0.01) from baseline up to 3MFU inside most of the groups. CONCLUSIONS: The noninvasiveness and safety of device make this approach an interesting tool as alternative approach for pelvic floor dysfunctions .
Assuntos
Distúrbios do Assoalho Pélvico , Prolapso de Órgão Pélvico , Incontinência Urinária , Feminino , Humanos , Idoso , Adulto Jovem , Adulto , Diafragma da Pelve , América Latina/epidemiologia , Incontinência Urinária/terapia , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/terapia , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/terapia , Inquéritos e Questionários , Fenômenos Magnéticos , Qualidade de VidaRESUMO
Abstract Objective To assess the relationship involving sexual function (SF), the distress symptoms caused by pelvic floor dysfunction (PFD), and female genital self-image (GSI). Materials and Methods We assessed the GSI, SF and PFD distress symptoms by the Female Genital Self-Image Scale (FGSIS), the Female Sexual Function Index (FSFI), and the Pelvic Floor Distress Inventory (PFDI-20) respectively. Data were analyzed by multiple linear regression. Results Among the 216 women (age: 50.92 ± 16.31 years) who participated in the study, 114 were sexually active in the previous 4 weeks. In the total sample (p < 0.001; adjusted R2 = 0.097) and among sexually active women (p = 0.010; adjusted R2 = 0.162), the distress symptoms caused by pelvic organ prolapse (POP) were related to the GSI. Among sexually active women, sexual desire also was related to the GSI (p < 0.001; adjusted R2 = 0.126). Conclusion The findings of the present study provide additional knowledge about female GSI and suggest that SF and POP distress symptoms should be investigated together with the GSI in the clinical practice.
Resumo Objetivo Avaliar a relação entre a função sexual (FS), o incômodo provocado pelos sintomas de disfunção do assoalho pélvico (DAP) e a autoimagem genital (AIG) feminina. Materiais e Métodos A AIG, a FS e incômodo causado pelos sintomas de DAP foram avaliados pela Genital Self-Image Scale (FGSIS), pelo Female Sexual Function Index (FSFI) e pelo Pelvic Floor Distress Inventory (PFDI-20), respectivamente. Os dados foram analisados por regressão linear múltipla. Resultados Das 216 mulheres (idade: 50,92 ± 16,31 anos) que participaram do estudo, 114 eram sexualmente ativas nas últimas 4 semanas. Na amostra total (p < 0,001; R2 ajustado = 0,097) e entre as mulheres sexualmente ativas (p = 0,010; R2 ajustado = 0,162), o incômodo provocado pelos sintomas de prolapso de órgãos pélvicos (POP) relacionou-se à AIG. Entre as mulheres sexualmente ativas, o desejo sexual também se relacionou à AIG (p < 0,001; R2 ajustado = 0,126). Conclusão Os achados deste estudo fornecem conhecimento adicional sobre a AIG feminina e sugerem que a FS e o incômodo causado pelos sintomas de POP devem ser investigados juntamente com a AIG na prática clínica.
Assuntos
Humanos , FemininoRESUMO
BACKGROUND: Mesh-related complications resulting from pelvic organ prolapse (POP) reconstruction operations may be a devastating experience leading to multiple and complex interventions. OBJECTIVES: The aim of the study was to describe the experience and time frame of management of mesh-related complications in women treated for POP or stress urinary incontinence in a tertiary center. METHODS: 1,530 cases of mesh-related complications were accessed regarding their clinical presentation, number of surgeries, and timeline of surgical treatments to treat multiple clinical complaints until the ultimate operation where all the meshes were removed in a single tertiary center. RESULTS: The studied population revealed to be a highly referred one with only 10.2% of the cases implanted at our center. Clinical presentation varied widely with 48.7% referring pain as the chief complaint, while 31.3% complained of voiding dysfunctions, 2.5% reported genital prolapses, 2.2% complained of vaginal problems, and 1.2% noted intestinal problems as the main clinical complaint. Only 4.8% of the cases presented mesh erosion at examination; 57.8% of the cases required more than 1 operation to address the mesh-related problems. Sixty-eight cases had more than 10 operations up to complete removal. Three clusters of patients could be identified: (i)-those from whom the mesh was promptly removed after clinical problems emerged, (ii) those with slowly evolving problems, and (iii) those with escalating problems despite treatment attempts. CONCLUSIONS: Mesh-related complications after pelvic floor reconstruction are an evolving disease with diverse clinical presentation. The identified time-related problems and the multiple failed attempts to treat their complications warrant attention with continuous monitoring of these patients and aggressive removal of the mesh if the clinical complaint cannot be swiftly managed.
Assuntos
Prolapso de Órgão Pélvico , Incontinência Urinária por Estresse , Feminino , Humanos , Prolapso de Órgão Pélvico/cirurgia , Próteses e Implantes , Reoperação , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/cirurgiaRESUMO
INTRODUCTION AND HYPOTHESIS: The association between social media (SoMe) indicators and citation metrics is still controversial. we aimed to evaluate the frequency of urogynecology-related terms ("urogynecology" [UG] and "pelvic floor/dysfunction" [PF/PFD]) mentioned by traditional databases (Web of Science [WOS]) and journal ranking indicators (SCImago), as well as their association with SoMe (Altmetric database). METHODS: In April 2019, two authors performed a search that was divided into three steps. The first one was to assess journals within the WOS Obstetrics/Gynecology and Urology categories updated to 2017 using UG and PF/PFD. The second step was to rank these studies in SCImago by the highest numbers of WOS and to correlate with journal h-index and SJR. The third step was to analyze SoMe indicators such as the Altmetric Attention Score (AAS) for each study and journal retrieved. RESULTS: The International Urogynecology Journal (IUJ) and Neurourology and Urodynamics (NAU) were the first (n = 1,394) and second (n = 974) most highly cited journals when using UG and PFD. IUJ also presented manuscripts with the highest AAS for UG and PF/PFD. Social media represented 74-93% of AAS calculated among the 20 top cited studies. For UG, SoMe presented 8,050 mentions, led by Twitter (n = 7,326). The same distribution was seen for PFD (8,493 mentions for SoMe, Twitter with 7,653). The higher the WOS citation, the higher the AAS (r = 0.483; p = 0.03). CONCLUSION: UG and PF/PFD terms are highly cited in databases and IUJ was the journal most frequently connected with them. Among SoMe tools, Twitter was the most frequently cited. WOS citations correlated with AAS.
Assuntos
Procedimentos de Cirurgia Plástica , Mídias Sociais , Bibliometria , Feminino , Humanos , Fator de Impacto de Revistas , Diafragma da PelveRESUMO
ABSTRACT Purpose Pelvic floor dysfunction has a high prevalence in the adult population. The Dynamic and Multiplanar Evaluation of the Pelvic Floor (DMRIPF) represents an ideal tool for multidisciplinary management. The purpose of this analysis is to evaluate the added value of the Dynamic and Multiplanar Evaluation of the Pelvic Floor in patients with suspected pelvic floor disorders. Methods Retrospective analysis of a consecutive series of patients who underwent a DMRIPF due to suspected pelvic floor disorders between April 2005 and July 2019. Results 359 patients were included. The average number of diagnoses achieved by physical examination was 1.2 vs. 2.5 by the Dynamic and Multiplanar Evaluation of the Pelvic Floor (p < 0.001). Physical examination found a single pathology in 80.8 % of cases. Anterior rectocele (AR) was the most frequent isolated diagnosis on physical examination (68 %). On the Dynamic and Multiplanar Evaluation of the Pelvic Floor, anterior rectocele was diagnosed as an isolated condition in 10.9 %. In 231 cases, anterior rectocele was associated with up to 5 other pelvic floor disorders. The number of individuals with associated pathologies of the posterior and anterior compartments tripled. It modified physical examination findings in 17 % of individuals and, in 63.5 %, allowed the identification of additional pelvic floor pathologies that were missed by physical examination. The Dynamic and Multiplanar Evaluation of the Pelvic Floor had greater added value in patients with anterior rectocele (59.6 % vs. 20.9 %; p < 0.001). Female gender was also associated with a greater diagnostic yield (p < 0.001). Conclusion The Dynamic and Multiplanar Evaluation of the Pelvic Floor allows the detection of multi-compartment defects that could otherwise go undetected, or even alter the initial clinical diagnosis, representing an ideal tool for multidisciplinary approach of pelvic floor dislocations, allowing a comprehensive therapeutic planning.
RESUMO Objetivo A disfunção do assoalho pélvico tem alta prevalência na população adulta. A avaliação dinâmica e multiplanar do assoalho pélvico (DMRIPF) representa uma ferramenta ideal para o gerenciamento multidisciplinar. O objetivo desta análise é avaliar o valor agregado da avaliação dinâmica e multiplanar do assoalho pélvico em pacientes com suspeita de distúrbios do assoalho pélvico. Métodos Análise retrospectiva de uma série consecutiva de pacientes submetidos à avaliação dinâmica e multiplanar do assoalho pélvico por suspeita de distúrbios do assoalho pélvico entre Abril de 2005 e Julho de 2019. Resultados 359 pacientes foram incluídos. O número médio de diagnósticos alcançados pelo exame físico foi de 1,2vs. 2,5 pela avaliação dinâmica e multiplanar do assoalho pélvico p < 0,001. O exame físico encontrou uma única patologia em 80.8 % dos casos. A retocele anterior (RA) foi o diagnóstico isolado mais frequente no exame físico (68 %). Na avaliação dinâmica e multiplanar do assoalho pélvico, a retocele anterior foi diagnosticada como uma condição isolada em 10.9 %. Em 231 casos, a retocele anterior foi associada a até 5 outros distúrbios do assoalho pélvico. O número de indivíduos com patologias associadas dos compartimentos posterior e anterior triplicou. Modificou os achados do exame físico em 17 % dos indivíduos e em 63.5 %; permitiu a identificação de outras patologias do assoalho pélvico que foram esquecidas pelo exame físico. A avaliação dinâmica e multiplanar do assoalho pélvico teve maior valor agregado em pacientes com retocele anterior (59.6 % vs.20.9 %; p < 0,001. O sexo feminino também foi associado a um maior rendimento diagnóstico p < 0,001. Conclusão A avaliação dinâmica e multiplanar do assoalho pélvico permite a detecção de defeitos multicompartimentários que, de outra forma, poderiam não ser detectados, ou mesmo alterar o diagnóstico clínico inicial, representando uma ferramenta ideal para a abordagem multidisciplinar das luxações do assoalho pélvico, permitindo um planejamento terapêutico abrangente.
Assuntos
Humanos , Masculino , Feminino , Imageamento por Ressonância Magnética/métodos , Distúrbios do Assoalho Pélvico/diagnóstico , Exame Físico/métodos , Diafragma da Pelve/patologia , Retocele/diagnósticoRESUMO
Abstract Objective To examine women with pelvic floor dysfunction (PFDs) and identify factors associated with sexual activity (SA) status that impacts quality of life (QoL). Methods We conducted a cross-sectional study that includedwomen> 18 years old who presented with at least one PFD symptom (urinary incontinence [UI] and/or pelvic organ prolapse [POP]), in outpatient clinics specializing in urogynecology and PFD in Fortaleza, state of Ceará, Brazil, using a service evaluation form and QoL questionnaires. Results The analysis of 659 women with PFD included 286 SA (43.4%) women and 373 non-sexually active (NSA) (56.6%) women, with a mean age of 54.7 (±12) years old. The results revealed that age (odds ratio [OR]= 1.07, 95% confidence interval [CI] 1.03-1.12) and post-menopausal status (OR= 2.28, 95% CI 1.08-4.8) were negatively associated with SA. Being married (OR= 0.43, 95% CI 0.21-0.88) was associated with SA. Pelvic organ prolapse (OR= 1.16, 95% CI 0.81-1.68) and UI (OR= 0.17, 95% CI 0.08-0.36) did not prevent SA. SF-36 Health Survey results indicated that only the domain functional capacity was significantly worse in NSA women (p= 0.012). Two King's Health Questionnaire domains in NSA women, impact of UI (p= 0.005) and personal relationships (p< 0.001), were significantly associated factors. Data from the Prolapse Quality-of-life Questionnaire indicated that NSA women exhibited compromised QoL. Conclusion Postmenopausal status and age negatively affected SA. Being married facilitated SA. Presence of POP and UI did not affect SA. However, NSAwomen with POP exhibited compromised QoL.
Resumo Objetivo Examinar mulheres com disfunções do assoalho pélvico (DAP) e identificar fatores associados ao status de atividade sexual (AS) e impacto na qualidade de vida (QV). Métodos Realizamos um estudo transversal, no qual participaram mulheres > 18 anos, que apresentaram pelo menos um sintoma de DAP (incontinência urinária [UI] e/ou prolapso de órgão pélvico [POP]), em ambulatórios especializados em uroginecologia e DAP emFortaleza, CE, Brasil, utilizando um formulário de avaliação de serviço e questionários de QV. Resultados A análise de 659 mulheres comDAP incluiu 286 mulheres sexualmente ativas (SA) (43,4%) e 373 mulheres não sexualmente ativas (NSA) (56,6%), com idade média de 54,7 (±12) anos. Os resultados revelaram que idade (odds ratio [OR]= 1,07; intervalo de confiança [IC] 95%: 1,03-1,12) e status pós-menopausa (OR= 2,28; IC 95% 1,08-4,8) foram negativamente associados à atividade sexual. O casamento (OR= 0,43; IC 95% 0,21-0,88) foi associado à AS. Por outro lado, POP (OR= 1,16; IC 95% 0,81-1,68) e IU (OR= 0,17; IC 95% 0,08-0,36) não impediram a AS. Os resultados do SF-36 Health Survey indicaram que apenas a capacidade funcional do domínio (p = 0,012) foi significativamente pior em mulheres NSA. Dois domínios King's Health Questionnaire (KHQ, na sigla em inglês) em mulheres NSA, impacto da IU (p = 0,005) e relacionamento pessoal (p< 0,001), foram fatores significativamente associados. Os dados do Prolapse Qualityof- life Questionnaire (P-QoL, na sigla em inglês) indicaram que as mulheres NSA apresentavam QV comprometida. Conclusão O status pós-menopausa e a idade afetaram negativamente a AS, enquanto o casamento facilitou a AS. A presença de POP e IU não afetou a AS. No entanto, as mulheres NSA com POP apresentaram QV comprometida.
Assuntos
Humanos , Feminino , Adulto , Idoso , Distúrbios do Assoalho Pélvico/epidemiologia , Qualidade de Vida , Comportamento Sexual/estatística & dados numéricos , Estudos Transversais , Inquéritos e Questionários , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Nowadays, Pelvic Floor Muscle Training (PFMT) is a first line, level 1 evidence-based treatment for urinary incontinence (UI), but adherence to PFMT is often problematic. Today, there are several mobile applications (mApps) for PFMT, but many lack specific strategies for enhancing adherence. AIMS: To review available mApps for improvement of adherence to PFMT, and to introduce a new App so called iPelvis. METHODS: Review study all available mApps for PFMT and relevant literature regarding adherence by electronic search through the databases Pubmed, Embase, CINAHL, LILACS, PEDro, and Scielo. Based on these results, development of a mApp, called "iPelvis" for Apple™ and Android™ systems, implementing relevant strategies to improve adherence. RESULTS: Based on the current adherence literature we were able to identify 12 variables helping to create the optimal mApp for PFMT. None of the identified 61 mApps found for Android™ and 16 for Apple™ has all these 12 variables. iPelvis mApp and websites were constructed taking into consideration those 12 variables and its construct is now being subject to ongoing validation studies. CONCLUSION: MApps for PFMT are an essential part of first-line, efficient interventions of UI and have potentials to improve adherence, in case these respect the principles of PFMT, motor learning and adherence to PFMT. iPelvis has been constructed respecting all essential variables related to adherence to PFMT and may enhance the effects of UI treatment.
Assuntos
Terapia por Exercício/métodos , Cooperação do Paciente , Distúrbios do Assoalho Pélvico/terapia , Diafragma da Pelve , Feminino , Humanos , Aplicativos Móveis , Telemedicina , Incontinência Urinária/terapiaRESUMO
PURPOSE: Disorders related to pelvic floor include urinary incontinence (UI), anal incontinence, pelvic organ prolapse, sexual dysfunction and pelvic pain. Because pelvic floor dysfunctions (PFD) can be diagnosed clinically, imaging techniques serve as auxiliary tools for establishing an accurate diagnosis. The objective is to evaluate the PFD in primiparous women after vaginal delivery and the association between clinical examination and three-dimensional ultrasonography (3DUS). METHODS: A cross-sectional study was conducted in a in tertiary maternity. All primiparous women with vaginal deliveries that occurred between January 2013 and December 2015 were invited. Women who attended the invitation underwent detailed anamnesis, questionnaire application, physical examination and endovaginal and endoanal 3DUS. Crude and adjusted predictor factors for PFD were analyzed. RESULTS: Fifty women were evaluated. Sexual dysfunction was the most prevalent PFD (64.6%). When associated with clinical features and PFD, oxytocin use increased by approximately four times the odds of UI (crude OR 4.182, 95% CI 1.149-15.219). During the multivariate analysis, the odds of UI were increased in forceps use by approximately 11 times (adjusted OR 11.552, 95% CI 11.155-115.577). When the clinical and obstetrical predictors for PFD were associated with 3DUS, forceps increased the odds of lesion of the pubovisceral muscle and anal sphincter diagnosed by 3DUS by sixfold (crude OR 6.000, 95% CI 1.172-30.725), and in multivariate analysis forceps again increased the odds of injury by approximately 7 times (adjusted OR 7.778, 95% CI 1.380-43.846). CONCLUSION: Sexual dysfunction was the most frequent PFD. The use of forceps in primiparous women was associated with a greater chance of UI and pelvic floor muscle damage diagnosed by 3DUS.
Assuntos
Parto Obstétrico/efeitos adversos , Distúrbios do Assoalho Pélvico/epidemiologia , Adolescente , Adulto , Canal Anal/lesões , Estudos Transversais , Parto Obstétrico/métodos , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Feminino , Humanos , Análise Multivariada , Paridade , Distúrbios do Assoalho Pélvico/diagnóstico por imagem , Distúrbios do Assoalho Pélvico/etiologia , Prolapso de Órgão Pélvico/diagnóstico por imagem , Prolapso de Órgão Pélvico/epidemiologia , Prolapso de Órgão Pélvico/etiologia , Gravidez , Prevalência , Fatores de Risco , Disfunções Sexuais Fisiológicas/epidemiologia , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologiaRESUMO
Las disfunciones del suelo pélvico tienen un impacto significativo en la calidad de vida de la mujer que la padece. Ella no solo sufrirá de las manifestaciones físicas de algún grado de prolapso, sino de aquellas derivadas de las perturbaciones psíquicas, sexuales, laborales y sociales que estas originan. Los cuestionarios de calidad de vida proporcionan una amplia información sobre la repercusión de los síntomas y signos en la vida de la paciente lo cual permite entender estas condiciones de manera integral. El objetivo de esta revisión fue describir el impacto en la calidad de vida de las mujeres con disfunciones del suelo pélvico y los cuestionarios empleados para evaluarla, sin mediar intervenciones. Se realizó una búsqueda en las bases de datos de Pubmed, SciELO, Hinari, Cochrane y Clinical Key en junio y julio del 2015. Las disfunciones del suelo pélvico generan un impacto negativo en la calidad, que varía según la severidad de los síntomas. Las mujeres presentan limitaciones en la actividad física, actividades cotidianas, el sueño, la sexualidad y suelen estar angustiadas y deprimidas. La medición de la severidad de los síntomas y de los cambios en la calidad de vida en las pacientes con disfunciones del suelo pélvico es parte esencial de la evaluación para el diagnóstico y tratamiento de las mujeres(AU)
Pelvic floor dysfunction has a significant impact on the quality of life of its female sufferers. These women will not only be affected by the physical manifestations of the disease, such as some degree of prolapse, but also by the psychic, sexual, occupational and social disturbances it brings about. Quality of life questionnaires provide broad information about the effect of the signs and symptoms of the condition upon the patient's daily life, permitting a more comprehensive understanding of the condition. The purpose of the present review was to describe the impact of pelvic floor dysfunction upon the quality of life of sufferers, as well as the questionnaires used to evaluate it, without mediating interventions. A search was conducted in the databases Pubmed, SciELO, Hinari, Cochrane and Clinical Key in June and July 2015. Pelvic floor dysfunction has a negative impact on the quality of life, which varies in keeping with the severity of symptoms. Women patients are faced with limitations in their physical activity, their daily life, sleep and sexuality, and tend to be anguished and depressed. Measurement of the severity of symptoms and changes in the quality of life of patients with pelvic floor dysfunction is an essential part of the evaluation for the diagnosis and treatment of the disease(AU)
Assuntos
Humanos , Feminino , Qualidade de Vida , Distúrbios do Assoalho Pélvico/epidemiologia , Inquéritos e Questionários/normasRESUMO
The pelvic floor (PF) provides support to all pelvic organs, as well as appropriately closure/opening mechanism of the urethra, vagina, and anus. Therefore, it is likely that female athletes involved in high-impact and in strong-effort activities are at risk for the occurrence of urinary incontinence (UI). This study aimed to investigate the occurrence of UI and other PF dysfunctions (PFD) [anal incontinence (AI), symptoms of constipation, dyspareunia, vaginal laxity, and pelvic organ prolapse] in 67 amateur athletes (AT) compared with a group 96 of nonathletes (NAT). An ad hoc survey based on questions from reliable and valid instruments was developed to investigate the occurrence of PFD symptoms. The risk of UI was higher in AT group (odds ratio: 2.90; 95% CI: 1.50-5.61), mostly among artistic gymnastics and trampoline, followed by swimming and judo athletes. Whereas, AT group reported less straining to evacuate (OR: 0.46; 95% CI: 0.22-0.96), manual assistance to defecate (OR: 0.24; 95% CI: 0.05-1.12), and a higher stool frequency (OR: 0.29; 95% CI: 0.13-0.64) than NAT group. The occurrence of loss of gas and sexual symptoms was high for both groups when compared with literature, although with no statistical difference between them. Pelvic organ prolapse was only reported by nonathletes. Athletes are at higher risk to develop UI, loss of gas, and sexual dysfunctions, either practicing high-impact or strong-effort activities. Thus, pelvic floor must be considered as an entity and addressed as well. Also, women involved in long-term high-impact and strengthening sports should be advised of the impact of such activities on pelvic floor function and offered preventive PFD strategies as well.
Assuntos
Constipação Intestinal/epidemiologia , Dispareunia/epidemiologia , Incontinência Fecal/epidemiologia , Prolapso de Órgão Pélvico/epidemiologia , Esportes/estatística & dados numéricos , Incontinência Urinária/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Ginástica/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Artes Marciais/estatística & dados numéricos , Natação/estatística & dados numéricos , Voleibol/estatística & dados numéricos , Adulto JovemRESUMO
Objetivo: Evaluar la utilidad del Biofeedback perineal en las disfunciones del piso pélvico. Método: Se realizó una búsqueda bibliográfica en las bases de datos electrónicas Pubmed, Ovid, Elsevier, Interscience, EBSCO, Scopus, SciELO. Resultados: La reeducación de los músculos del suelo pélvico, con técnicas de biofeedback, es el tratamiento conservador más utilizado para las mujeres con síntomas de incontinencia urinaria de esfuerzo o con prolapsos del piso pélvico. El biofeedback ayuda a la realización correcta de los ejercicios, y es especialmente útil en los pacientes que tienen dificultades en la localización de la musculatura perineal. Conclusiones: En el biofeedback los ejercicios musculares del suelo pélvico se realizan, asistidos por un equipo que traduce la contracción muscular en una señal gráfica, acústica o ambas, para que el paciente y el fisioterapeuta perciban el trabajo realizado. La introducción del biofeedback en las técnicas de rehabilitación perineal han mejorado los resultados, siendo hoy por hoy la técnica más eficaz en la recuperación perineal.
Objective: To evaluate the usefulness of perineal Biofeedback in pelvic floor dysfunction. Methods: Ca bibliographic search in electronic databases PubMed, Ovid, Elsevier, Interscience, EBSCO, Scopus, SciELO. Results: The rehabilitation of the pelvic floor muscles with biofeedback techniques, conservative treatment is most commonly used for women with symptoms of urinary incontinence or pelvic floor prolapse. Biofeedback helps the successful completion of the exercises, and is especially useful in patients who have difficulty in locating the perineal musculature. Conclusions: In the biofeedback of pelvic floor muscle exercises are performed assisted by a team that translates muscle contraction in a graphic, sound or signal both to the patient and physiotherapist perceive their work. The introduction of biofeedback in perineal rehabilitation techniques have improved outcomes, still today, the most effective in the perineal recovery technique.
Objetivo: Para avaliar a utilidade da perineal Biofeedback em disfunção do assoalho pélvico. Método: Ca pesquisa bibliográfica em bases de dados eletrônicas PubMed, Ovid, Elsevier, Interscience, EBSCO, Scopus, SciELO. Resultados: A reabilitação dos músculos do assoalho pélvico, técnicas de biofeedback, o tratamento conservador é mais comumente usado para mulheres com sintomas de incontinência urinária ou prolapso do assoalho pélvico. Biofeedback ajuda a conclusão bem sucedida dos exercícios, e é especialmente útil em pacientes que têm dificuldade em localizar os músculos perineais. Conclusões: Em biofeedback os exercícios músculos do pavimento pélvico são realizadas assistida por uma equipa que traduz a contração muscular em um gráfico, sinal acústico ou ambos para o paciente eo terapeuta perceber o trabalho. A introdução de biofeedback em técnicas de reabilitação perineais melhoraram os resultados, sendo hoje o mais eficaz na técnica de recuperação perineal.
RESUMO
Las disfunciones sexuales van en detrimento de la calidad de vida de la mujer, y las afecciones del suelo pélvico tienen un peso importante. Con esta revisión bibliográfica se pretende delimitar hasta qué punto y cuáles soluciones o propuestas deberían ser asumidas por el ginecólogo, no solamente con la óptica quirúrgica, sino sobre todo, en el terreno de la prevención. Se realizó una revisión de artículos publicados en torno al tema en diversas bases de datos (MedLine, PubMed, Hinari, Cochrane), que toca tan de cerca a los ginecólogos a nivel mundial por las crecientes demandas en torno a calidad de vida y disfrute de la sexualidad aún en edades avanzadas. Se comenta en torno a las posibilidades preventivas a nuestro alcance y se brindan recomendaciones emanadas de la revisión y la experticia de los autores.
Sexual dysfunctions are detrimental to women quality of life, and pelvic floor disorders play an important role. In this literature review, we aim to define how far and what solutions or proposals should be undertaken by gynecologists, not only with surgical optics, but especially in the field of prevention. It was conducted a review of articles published on the subject in various databases (Medline, PubMed, Hinari, Cochrane). These articles are closely related to gynecologists worldwide by increasing demands regarding quality of life and sexuality enjoyment even in the elderly. It is discussed here, preventive possibilities within our reach and recommendations are provided based on the review and the expertise of the authors.
RESUMO
Evaluar la prevalencia de la disfunción del piso pélvico, factores relacionados, tratamientos y evolución en pacientes gineco-obstétricas de un hospital privado. Estudio descriptivo, retrospectivo, epidemiológico. Se revisaron 4555 historias desde 1998 a 2008 y se seleccionaron 430 con alteraciones del piso pélvico. Se evaluaron los factores asociados: edad, embarazos, partos, distocias, episiotomías, peso máximo fetal, masa corporal, incontinencia urinaria de esfuerzo, infecciones urinarias bajas recurrentes, alteraciones tiroideas, diabetes, fibromatosis uterina, menopausia, intervenciones ginecológicas previas, estreñimiento, trabajos forzados, tos crónica y uso de fajas. Se clasificaron los tipos y grados de prolapsos, tratamientos y complicaciones. Instituto Médico Quirúrgico Ribas. Los Teques, Estado Miranda, Venezuela. Promedio de edad 47,72 ± 11,88 años. Incidencia de disfunción 9,4 por ciento; en 72 por ciento fue un hallazgo del médico, 73,2 por ciento referían incontinencia urinaria de esfuerzo, 18 por ciento infecciones urinarias bajas recurrentes, paridad promedio 3,86 ± 2,59; 21,4 por ciento distocias y 48,8 por ciento episiotomías. Diagnóstico de prolapso 97,4 por ciento, grado II más frecuente 73,3 por ciento. Entre los factores relacionados se encontró: masa corporal elevada, fibromatosis uterina, estreñimiento e intervenciones anteriores. Se indicó tratamiento conservador en 67,3 por ciento, cirugía vaginal 8 por ciento y abdominal 11 por ciento. La incidencia de disfunciones es baja, el cistocele grado II es el más frecuente y está relacionados con incontinencia urinaria de esfuerzo, infecciones urinarias bajas recurrentes, grupo etario entre 40 y 50 años, multiparidad, mayor índice de masa corporal, estreñimiento, fibromatosis uterinas e intervenciones pélvicas previas. El tratamiento más aceptado es la rehabilitación muscular
To evaluate the prevalence of pelvic floor dysfunction, related factors, treatment and evolution in gyneco-obstetric patients in a private hospital. A descriptive, retrospective, epidemiologic study. 4555 records were reviewed from 1998 to 2008 and 430 with pelvic floor disorders were selected. Associated factors such as age, pregnancy, dystocia, episiotomy, fetal weight, body mass, stress urinary incontinence, recurrent lower urinary tract infections, thyroid disorders, diabetes, uterine fibromatosis, menopause, previous gynecologic interventions, constipation, hard work, chronic cough and use of belts were evaluated. Types and degrees of prolapse, treatments and complications were classified. Instituto Médico Quirúrgico Ribas. Los Teques, Estado Miranda, Venezuela. Average age 47.72 ± 11.88 years. 9.4 percent dysfunction incidence; in 72 percent was medical finding, 73.2 percent referred stress urinary incontinence, 18 percent urinary tract infections, average parity 3.86 ± 2.59, 21.4 percent dystocia and 48.8 percent episiotomy. Prolapse diagnosis 97.4 percent, grade II 73.3 percent more frequent. Among the factors were: high body mass, uterine fibromatosis, constipation, and previous interventions. Non surgical treatment was indicated in 67.3 percent, 8 percent vaginal surgery and abdominal 11 percent. The incidence of dysfunction is low, the grade II cystocele is the more common and is associated with stress urinary incontinence, urinary tract infections, age group between 40 and 50 years, multiparity, higher body mass index, constipation, uterine fibromatosis and previous pelvic interventions. The most accepted treatment is the muscular rehabilitation