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Objetivo: Relatar a atuação do enfermeiro estomaterapeuta no manejo da incontinência urinária de esforço. Métodos: Estudo observacional, do tipo relato de caso, seguindo duas fases, onde a primeira foi a coleta de dados e levantamento do histórico clínico do paciente, e segunda fase foi descrever a atuação do enfermeiro estomaterapeuta no manejo da incontinência urinária de esforço. Resultados: Na primeira etapa revelou-se o diagnóstico de incontinência urinária por esforço. Foram aplicados o diário miccional, a terapia comportamental, a cinesioterapia e a eletroestimulação. Conclusão: A atuação do enfermeiro estomaterapeuta no manejo da incontinência urinária de esforço compreende a implementação do tratamento conservador, perpassando pela prevenção, estimulação da mudança comportamental e manejo de tecnologias para fortalecimento da musculatura do assoalho pélvico. (AU)

Objective: To report the role of the nurse stomatherapist in the management of stress urinary incontinence. Methods: Observational study, of the case report type, following two phases, where the first was the collection of data and survey of the patients clinical history, and the second phase was to describe the role of the nurse stomatherapist in the management of stress urinary incontinence. Results: In the first stage the diagnosis of stress urinary incontinence was revealed. Were applied the mictional diary, behavioral therapy, kinesiotherapy and electrostimulation. Conclusion: The role of the nurse stomatherapist in the management of stress urinary incontinence includes the implementation of conservative treatment, through prevention, stimulation of behavioral change and management of technologies for strengthening the pelvic floor muscles. (AU)

Objetivo: Informar sobre el papel de la enfermera estomaterapeuta en el tratamiento de la incontinencia urinaria de esfuerzo. Métodos: Estudio observacional, del tipo case report, siguiendo dos fases, donde la primera fue la recolección de datos y relevamiento de la historia clínica de la paciente, y la segunda fase fue describir la actuación de la enfermera estomaterapeuta en el manejo de la incontinencia urinaria de esfuerzo. Resultados: En la primera etapa se reveló el diagnóstico de incontinencia urinaria de esfuerzo. Se aplicaron el diario miccional, la terapia comportamental, la cinesiterapia y la electroestimulación. Conclusión: La actuación del enfermero estomaterapeuta en el manejo de la incontinência urinaria de esfuerzo comprende la aplicación del tratamiento conservador, pasando por la prevención, la estimación del cambio de comportamiento y el manejo de tecnologías para el fortalecimiento de la musculatura del assoalado pelviano. (AU)

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Introduction: Urinary incontinence (UI) is highly prevalent in low- and middle-income countries (LMIC). Concurrently, the availability of surgical or conservative UI treatments in LMIC is limited. Methods: We conducted a prospective feasibility study of Belize women with UI treated with pelvic floor physical therapy (PFPT) and education (PFE). Patients received individual PFPT/PFE over 2 days, consisting of biofeedback-enhanced PFMT in addition to behavioral, dietary, and general pelvic education. Patient completed a daily 6-month home regimen including 7 PFMT exercises (total 70 repetitions) comprising both endurance and quick flick exercises. Patients also performed comprehensive dietary and behavioral modification activities. Outcomes were assessed at baseline and 6-months, including validated symptom (ICIQ-FLUTS) and QOL (IIQ-7) questionnaires, and strength testing (PERFECT score, perineometry). Results: Twenty-eight patients underwent baseline assessment. Four patients were lost to in-person 6-month follow-up, with two of these patients completing subjective assessment only by telephone. The mean (±SD) patient age, BMI, and parity were 50.0 (±10.0) years, 33.2 (±5.8), and 2.8 (±1.5). Provider assessment demonstrated patient comprehension of basic, endurance, and quick flick pelvic floor contractions in 28 (100%), 24 (86%), and 24 (86%) patients, respectively. At 6-month follow-up, significant improvements were seen across multiple validated questionnaire and strength measurement assessments. Median patient-reported improvement level was 7.0 on a 10-point Likert scale. Discussion: Study patients demonstrated good understanding of PFMT/PFE and program completion was associated with significant improvements across a variety of subjective incontinence and quality of life outcomes, as well as objective strength testing.

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INTRODUCTION AND HYPOTHESIS: This study is aimed at comparing the effectiveness of pelvic floor muscle training (PFMT) and Pilates on the improvement of urinary incontinence (UI), strength, and endurance of the pelvic floor muscles (PFMs), and the impact of UI on the quality of life in postmenopausal women. METHODS: Forty postmenopausal women were randomly divided in to two groups: PFMT (n = 20) and Pilates (n = 20). The participants were followed for 12 weeks, three times a week on nonconsecutive days. UI was assessed using the pad test and the voiding diary, PFM strength and resistance using bidigital assessment and manometry, and the impact of UI on quality of life using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), before and after the 3-month treatment. RESULTS: There was a significant intra-group improvement in both groups for the pad test, mean daily urinary loss, and ICIQ-SF. The strength was significantly improved only in the PFMT group, and the endurance in both groups. Peak strength manometry was significantly improved only in the Pilates group, and the mean strength manometry in both groups. There was also an improvement in both groups for peak endurance manometry and mean endurance manometry. In the inter-group comparison, there was a significant improvement only in muscle strength, which was positive for group. CONCLUSIONS: There was no difference between Pilates and PFMT for the management of women in post-menopause with stress urinary incontinence, provided that voluntary contraction of the PFMs is performed. However, further randomized clinical trials need to be carried out.

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The dysfunctions of the female pelvic floor have a great influence on the quality of life of women, in all areas, social, psychological, and sexual. Stress urinary incontinence is the clinical condition in which the woman involuntarily loses urine to efforts, such as coughing and sneezing, causing great embarrassment and affecting her quality of life. The physiotherapeutic treatments include muscle strengthening; however, muscle fatigue is present when performing the exercises. Here we investigate the effects of photobiomodulation to prevent muscle fatigue in the pelvic floor in the treatment of stress urinary incontinence, associated with a muscle strengthening exercise protocol. We used an infrared laser (808 nm, 100 mW) and 3 J/point and fluence of 107.1 J/cm2. The application was performed at 3 points on the vaginal introits and at another 3 points inside the vaginal canal cavity for the treatment of stress urinary incontinence associated with strengthening exercises with vaginal cones. Twenty-two volunteers participated in the study, divided into two groups: group 1 (laser therapy + strengthening) and group 2 (placebo laser + strengthening). In the group 1 quality of life score, the assessment (11.63 ± 4.33) was the highest score at 17 and in the reevaluation (7.81 ± 5.14) the lowest was 0 (p < 0.05). The muscular strength increased considerably (p < 0.05) for group 1, where the vast majority of patients gained more than twice the strength in the pelvic apparatus (8.36 ± 6.65 before X 13.81 ± 8.92 after). The volunteers acquired an increase in the contraction of the muscles of the pelvic apparatus (p < 0.05) (3.45 ± 1.07); after laser application, this number increased considerably (4.27 ± 0.61). Endurance had an increase of almost 50% compared to placebo, demonstrating the resistance gain in the perineal muscles (3.90 ± 2.35 X 5 ± 1.90). We concluded that photobiomodulation treatment showed significant efficacy in relation to muscle fatigue in the pelvic apparatus right after a strengthening program in women with stress urinary incontinence.

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INTRODUCTION: Female stress urinary incontinence (SUI) is considered a major public health issue. Physical therapy is an important conservative treatment; however, it is primarily limited by poor long-term compliance. Furthermore, surgical treatment entails significant risks. Therefore, new treatment techniques must be identified. OBJECTIVE: To compare the use of laser therapy and pelvic floor (PF) physical therapy for treating postmenopausal women with SUI. METHODS: This pilot study enrolled 40 women with a clinical and urodynamic diagnosis of SUI who were randomized into two groups: those who received erbium-doped yttrium-aluminum-garnet (Er:YAG) laser therapy implemented over three sessions with a 1-month interval (n = 20) and those who received physical therapy with supervision twice a week for 3 months (n = 20). In total, 16 women completed the treatment in each group. The patients were assessed for PF function using the modified Oxford scale and for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System. The 1-h pad test and quality of life questionnaires, King's Health Questionnaire (KHQ), and Incontinence Quality of Life (IQOL) were also administered. Patients were re-evaluated at 1, 3, 6, and 12 months after treatment. RESULTS: The mean patient age was 62.7 ± 9.1 and 57.9 ± 6.1 years, median Oxford score at baseline was 3 (2-4.5) and 4 (3-4), mean IQOL score was 79.8 ± 17 and 74.6 ± 18 for physical therapy group (PTG) and laser group (LG), respectively. For the amount of urine leak in the 1-h pad test evaluation, we found significance for the interaction of group and time points only for the Laser intragroup. The cure rate, that is, the rate of reaching an insignificant score in the pad test, at 6 and 12 months was 43.75% and 50% in PTG and 62.5% and 56.25% in the LG, respectively (p > 0.05). IQOL scores demonstrated considerable improvement in both groups (p > 0.05). Upon comparing the initial and follow-up results, the LG showed an improvement at all consultations, whereas the PTG showed improvements at 1, 3, and 6 months but not at 12 months after treatment. KHQ analysis revealed a considerable improvement in the quality of life (QOL) of patients over time, with no substantial difference between the groups. QOL comparison before and after treatment revealed that the vaginal LG improved more consistently in some domains. Only the PTG showed a significant increase in the mean Oxford score from pretreatment to 1 and 3 months after treatment (p < 0.001 and p = 0.002, respectively). However, no statistically significant difference was observed between the groups. CONCLUSION: Both treatments are safe and have a positive influence on the impact of UI on patients' QOL. The laser caused a greater reduction in the urinary loss, as measured using the weight of pad test, at 6-month and 12-month after treatment without difference with PTG at the end of the follow-up.

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OBJETIVO: Presentar una serie de casos de agentes de abultamiento (AA) de nuestro centro. MATERIAL Y MÉTODOS: Estudio retrospectivo. Se evaluaron todos los casos operados con AA entre 2017 y 2022. La inyección de AA se realizó en quirófano, bajo sedación con anestesia local periuretral o raquídea. La inyección se realizó con uretroscopia, 0,5 cc en 4 puntos periuretrales (horas 2, 5, 7 y 10). Se analizaron datos demográficos, quirúrgicos y de seguimiento. RESULTADOS: 15 casos. 13/15 presentaron incontinencia urinaria mixta. Solo dos casos tenían incontinencia de orina de esfuerzo pura. El procedimiento fue ambulatorio. La mediana del tiempo operatorio fue 15 minutos (15-20). La mediana de seguimiento fue 5 meses (1-9). El índice de severidad preoperatorio promedio fue 10,6 y en el seguimiento fue 2,79. La Escala de Mejoría Global mostró mejoría en 12/15, y 12/15 estaban satisfechas con la cirugía con mejoría en la calidad de vida. CONCLUSIÓN: Los AA son una opción quirúrgica efectiva, con una tasa de éxito del 80% en otros reportes, siendo similar con nuestra casuística. Ofrecer esta opción es posible a la hora de hablar de terapias alternativas.

OBJECTIVE: To present a case series of bulking agents (BA) from our center. MATERIAL AND METHODS: Retrospective study. All cases operated with BA between 2017 and 2022 were evaluated. A BA injection was performed in the operating room, under periurethral local anesthesia sedation or spinal anesthesia. The injection was performed with urethroscopy, 0.5 cc in 4 periurethral points (hours 2, 5, 7 and 10). Demographic, surgical, and follow-up data were analyzed. RESULTS: 15 cases were reported. 13/15 patients presented with mixed urinary incontinence. Only 2 cases had pure stress urinary incontinence. The procedure was ambulatory. Median operative time was 15 minutes (15-20). Median follow-up was 5 months (1-9). The average preoperative Sandvik Severity Index was 10.6 and in follow-up was 2.79. The PGI showed improvement in 12/15, and 12/15 were satisfied with the surgery with quality-of-life improvement. CONCLUSION: BA are an effective surgical option, with a success rate of 80%, according to other reports, being similar with our casuistry. Offer this option is possible at the moment of discussing alternative therapies.

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This clinical trial aims to provide evidence about the effectiveness of the Pilates method on stress urinary incontinence (SUI), as well as to elucidate the effects of photobiomodulation therapy associated with static magnetic field (PBMT/sMF) alone or associated with the Pilates Method on Pelvic floor muscle (PFM) in women affected by SUI. For that, a three-arm, parallel randomized, double-blinded, placebo-controlled trial was conducted (NCT05096936). We recruited thirty-three women diagnosed with SUI, randomly allocated to three groups: placebo PBMT/sMF plus method Pilates, PBMT/sMF active plus method Pilates and only PBMT/sMF active. The evaluation consisted of anamnesis and physical examination, muscle strength, completion of the ICIQ-SF questionnaire, and urinary loss. The evaluation of muscle strength and filling the ICIQ-SF were performed on the first and last days, while the Pad test was applied in baseline, one month, two months, and three months of intervention. We observed an increase in strength (p < 0.01), tone (p < 0.01), and quality of life (p < 0.01), in addition to a decrease in urinary lost (p < 0.01) for all groups comparing the pre and post-intervention. The PBMT/sMF alone, the Pilates, and the combination of the two therapies proved to be effective in improving the signs and symptoms of women with SUI.

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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 .

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INTRODUCTION: Urethral Pressure Profilometry (UPP) assesses the urethral closing function. The literature is scarce regarding the change in the Maximum Urethral Closure Pressure (MUCP) values during Pelvic Floor Muscle Contraction (PFMC). The objective was to evaluate the change in the urethral closure pressure (UCP) at rest and during a PFMC in patients with Stress Urinary Incontinence. MATERIALS AND METHODS: This was a descriptive, comparative, and observational study. The study comprised female patients with either Pure Stress Urinary Incontinence (PSUI) or Complicated Stress Urinary Incontinence (CSUI). The urethral closure pressure was measured at rest and during PFMC using urethral profilometry. The effect of the pelvic musculature contraction was evaluated by comparing the changes in the indicated values. RESULTS: Patients with pure stress urinary incontinence had a mean age of 57.18 ± 10.74 years (p = 0.12), while those with complicated stress urinary incontinence had a mean age of 58.26 ± 14.39 years (p = 0.12). UCP in PSUI was 58.58 ± 26.96 cmH2O at rest compared to 61.26 ± 34.17 cmH2O in CSUI (p = 0.59), with MUCP increasing to 73.93 ± 31.51 and 79.71 ± 36.26 cmH2O during PFMC (p = 0.001). Between the two measurements, there was an average rise of 26.2% (range 26.2%-32.59%) (p = 0.001). MUCP during PFM contractions was found to be inversely associated to age (r = -0.28, p = 0.007). CONCLUSION: The urethral pressure profile is the same for all types of urinary stress incontinence, whether simple or complicated. When comparing UCP at rest to MUCP during PFMC, there is at least a functional 25% increase.

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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: Investigate the association between pelvic floor muscle function and stress urinary incontinence (SUI) in women in the third trimester of pregnancy. METHODS: Cross-sectional observational study. Urinary symptoms were collected through a questionnaire. The physical examination of the pelvic floor muscle was performed by vaginal palpation and manometry. Multivariate logistic regression analyses were performed to investigate the factors associated with SUI. RESULTS: Analysis of the data collected from nulliparous and multiparous women identified an association between decreased pelvic floor muscle function (i.e. Power, Repetition, and Maximal Voluntary Contraction (MVC)) and the presence of SUI. There were also associations noted between power and SUI [AOR (95% CI) = 1.41 (1.01-1.97)], repetition and SUI [AOR (95% CI) = 1.31 (1.06-1.63)], and MVC and SUI [AOR (95% CI) = 1.02 (1.00-1.03)]. In the analysis of nulliparous women, there was also an association between low resting vaginal pressure (manometry) and SUI [AOR (95% CI) = 1.03 (1.01-1.06)]. CONCLUSIONS: Low pelvic floor muscle strength, low MVC, and decreased ability to repeat sustained pelvic floor muscle contractions were associated with SUI in the third gestational trimester. In nulliparous women, there was an association between low resting vaginal pressure and SUI; however, none these associations were identified in multiparous women.

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La patología de piso pélvico es una entidad multifactorial con un conjunto de síntomas ginecológicos, urinarios, fecales y de sensibilidad pelviperineal. La Teoría Integral de la Continencia propone un tratamiento holístico con la reconstrucción de los ligamentos del piso pélvico. La presente técnica propuesta constituye una alternativa quirúrgica que permite dar respuesta de forma global a los síntomas que refieren las pacientes. Método: Reconstrucción de los ligamentos pubouretrales, cardinales y úterosacros con acortamiento de su longitud y colocación de cinta de malla de polipropileno que permita la formación de colágeno y mejore los resultados a largo plazo. Resultados: Se incluyeron 15 pacientes con prolapso de órganos pélvicos, incontinencia urinaria, vulvodinia, nocturia, alteración del vaciamiento vesical y nocturia. Se realizó seguimiento al 1, 3 y 6 años. Se obtuvo diferencia estadísticamente significativa al año en la incontinencia urinaria de esfuerzo, dolor pélvico, alteración del vaciamiento y nocturia y prolapso ( p = 0,33, 0,033, 0,002 y 0,001 respectivamente). En el seguimiento a 6 años se evaluó el 20 % de la muestra inicial, 2 pacientes con recidiva de la alteración del vaciamiento y la incontinencia urinaria, ninguna con recidiva de prolapso. Vulvodinia: Se incluyeron 2 pacientes las cuales no tuvieron el síntoma a los 3 años de seguimiento. Conclusiones: La técnica propuesta es una alternativa para el tratamiento de la patología del piso pélvico y requiere aumentar el tamaño de la muestra para aumentar el aprendizaje de la técnica y tener mayor evidencia estadística de sus resultados a corto y largo plazo(AU)

Pelvic floor pathology is a multifactorial entity with a set of gynecological, urinary, fecal and pelviperineal sensitivity symptoms. The Integral Theory of Continence proposes a holistic treatment with the reconstruction of the ligaments of the pelvic floor. This proposed technique constitutes a surgical alternative that allows a global response to the symptoms reported by the patients. Method: Reconstruction of the pubourethral, cardinal and uterosacral ligaments with shortening of their length and placement of polypropylene mesh tape that allows collagen formation and improves long-term results. Results: 15 patients with pelvic organ prolapse, urinary incontinence, vulvodynia, nocturia, impaired bladder emptying and nocturia were included. Follow-up was performed at 1, 3 and 6 years. A statistically significant difference was obtained at one year in stress urinary incontinence, pelvic pain, impaired voiding, and nocturia and prolapse (p = 0.33, 0.033, 0.002, and 0.001, respectively). At 6-year follow-up, 20% of the initial sample was evaluated, 2 patients with recurrence of impaired voiding and urinary incontinence, none with recurrence of prolapse. Vulvodynia: 2 patients were included who did not have the symptom at 3 years of follow-up. Conclusions: The proposed technique is an alternative for the treatment of pelvic floor pathology. A larger sample is necessary to improve the learning curve of this technique and achieve greater statistical evidence of its outcomes at short and long term(AU)

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Resumen OBJETIVO: Describir la experiencia con el cabestrillo reajustable Remeex® en pacientes con incontinencia urinaria de esfuerzo recurrente, como una alternativa de tratamiento. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional, de serie de casos llevado a cabo en un solo centro de la ciudad de Medellín, Colombia, en pacientes atendidas en la Unidad de Uroginecología de la Clínica Universitaria Bolivariana. Criterios de inclusión: mujeres mayores de 18 años, con diagnóstico de incontinencia urinaria recidivante después de una o más cirugías fallidas para corregir la incontinencia urinaria o con diagnóstico de deficiencia intrínseca del esfínter a las que se les practicó el procedimiento de cabestrillo reajustable (Remeex Female Neomedic) entre el 2016 y el 2019. RESULTADOS: Se evaluaron 19 pacientes con media de edad de 62 años (DE ± 9). La mediana de seguimiento fue de 19.4 meses (RIQ 10-26.5). Todas las pacientes tenían urodinamia prequirúrgica que confirmó el diagnóstico de incontinencia urinaria de esfuerzo. Las 19 pacientes tuvieron diagnóstico de incontinencia urinaria moderada-severa-recurrente, 4 con hipoactividad del detrusor y 1 con deficiencia intrínseca del esfínter. De las 19 pacientes, a 10 se les intervino para corrección de prolapso de órganos pélvicos concomitante, que se distribuyeron en: 6 pacientes con colporrafia anterior o posterior, 3 colpocleisis y 1 sacrocolpopexia por laparotomía. CONCLUSIONES: El cabestrillo reajustable es una buena opción para mujeres con intervenciones previas antiincontinencia con recidiva en quienes se demostró la mejoría en el grado de incontinencia en relación con el inicial, beneficio que se reflejó en mejor calidad de vida.

Abstract OBJECTIVE: To describe the experience with the readjustable sling Remeex® in patients with recurrent stress urinary incontinence as a treatment alternative. MATERIALS AND METHODS: Retrospective, observational, case series study carried out in a single center in the city of Medellin, Colombia, in patients attended at the Urogynaecology Unit of the Bolivarian University Clinic. Inclusion criteria: women over 18 years of age, with a diagnosis of recurrent urinary incontinence after one or more failed surgeries to correct urinary incontinence or with a diagnosis of intrinsic sphincter deficiency who underwent the readjustable sling procedure (Remeex Female Neomedic) between 2016 and 2019. RESULTS: Nineteen patients were evaluated with mean age 62 years (SD ± 9). The median follow-up was 19.4 months (RIQ 10-26.5). All patients had preoperative urodynamics that confirmed the diagnosis of stress urinary incontinence. All 19 patients had a diagnosis of moderate-severe-recurrent urinary incontinence, 4 with detrusor hypoactivity and 1 with intrinsic sphincter deficiency. Of the 19 patients, 10 underwent surgery for correction of concomitant pelvic organ prolapse, which were distributed as follows: 6 patients with anterior or posterior colporrhaphy, 3 colpocleisis and 1 sacrocolpopexy by laparotomy. CONCLUSIONS: The readjustable sling is a good option for women with previous anti-incontinence interventions with recurrence in whom improvement in the degree of incontinence in relation to the initial one was demonstrated, a benefit that was reflected in better quality of life.

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Abstract Introduction The Burch procedure (1961) was considered the gold standard treatment for stress urinary incontinence (SUI) before the midurethral slings (MUSs) were introduced, in 2001. Objective This historical perspective of the Burch's timeline can encourage urogynecological surgeons to master the Burch technique as one of the options for surgical treatment of SUI. Search Strategy and Selection Criteria A bibliographic search was performed in the PubMed and National Library of Medicine (NIH) databases with the terms Burch colposuspension AND history AND stress urinary incontinence in the last 20 years. The original article by Burch (1961) was included. The references were read by three authors. The exclusion criterion was studies in non-English languages. Biomedical Library Special Collections were included as historical relevant search. Data Collection, Analysis and Main Results Some modifications of the technique have been made since the Burch procedure was first described. The interest in this technique has been increasing due to the negative publicity associated with vaginal synthetic mesh products. Twenty-nine relevant articles were included in the present review article, and numerous trials have compared Burch colposuspension with MUS. Conclusion This historical perspective enables the scientific community to review a standardized technique for SUI. Burch colposuspension should be considered an appropriate surgical treatment for women with SUI, and an option in urogynecological training programs worldwide.

Resumo Introdução O procedimento de Burch (1961) foi considerado o tratamento padrão ouro para a incontinência urinária de esforço (IUE) antes da introdução dos slings de uretra média (SUMs), em 2001. Objetivo Esta perspectiva histórica da linha do tempo do procedimento de Burch pode encorajar os cirurgiões uroginecológicos a dominar a técnica deste procedimento como uma das opções para o tratamento cirúrgico da IUE. Estratégia de busca e critérios de seleção A busca bibliográfica foi realizada nas bases de dados PubMed e National Library of Medicine (NIH) com os termos Burch colposuspension AND history AND stress urinary incontinence nos últimos 20 anos. O artigo original de Burch (1961) foi incluído. As referências foram analisadas por três autores com exclusão de estudos em idiomas diferentes do inglês. Coleções de bibliotecas biomédicas foram incluídas por ordem de relevância histórica. Coleta de dados, análise e principais resultados Algumas modificações de técnica foram realizadas desde que o procedimento de Burch foi inicialmente descrito. O interesse por essa técnica vem aumentando devido à publicidade negativa associada aos produtos de tela sintética vaginal. Vinte e nove artigos relevantes foramincluídos, e vários estudos compararam a colposuspensão de Burch com SUMs. Conclusão Essa perspectiva histórica possibilita à comunidade científica revisar uma técnica padronizada para a IUE. A colposuspensão de Burch pode ser considerada um tratamento cirúrgico adequado paramulheres com IUE, e uma opção emprogramas de treinamento uroginecológico em todo o mundo.

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INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence affects about 34% of all adult women. The mid-urethral sling (MUS), considered the gold-standard treatment, has widespread use but also potential complications. This study aims to demonstrate a new surgical technique that releases urethral obstruction caused by MUS with urinary continence maintenance. METHODS: This video presents a 43-year-old patient with acute urinary retention after a suburethral sling procedure treated with a double opposite tape incision through a "U"-shaped inverted incision at the anterior vaginal wall. RESULTS: The patient resumed her usual activities 1 week later with urinary continence. After 6 weeks, she was allowed to resume physical activities and sexual intercourse. At 3-month follow-up, she is still satisfied without urine leakage recurrence. CONCLUSIONS: The double opposite tape incision is feasible and effective for urethral loosening after the MUS procedure. Concerned that this is a unique case, further studies are required to compare this technique to other surgical treatment options.

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Introducción: La incontinencia urinaria por esfuerzo (IUE) tiene una alta prevalencia en mujeres adultas, afectando variables psicológicas, sociales y funcionales como la disminución de capacidad de equilibrio, debido a una escasa contribución en los movimientos del tronco hacia una corrección postural. Objetivo: Determinar los efectos de un programa basado en ejercicio muscular de piso pélvico y educación sobre el equilibrio estático y la calidad de vida en mujeres con IUE. Materiales y métodos: Participaron 18 mujeres con IUE durante 12 semanas en 10 sesiones de ejercicio muscular de piso pélvico y educación (hábitos de higiene, micción, ingesta de líquidos). Pre y post-intervención se evaluó equilibrio estático mediante oscilografía postural y calidad de vida mediante el International Consultation on Incontinence Questionnaire Short-Form (ICQ-SF). Los datos fueron analizados con la prueba no paramétrica de Wilcoxon. Resultados: Se encontró una disminución significativa en el área de desplazamiento del centro de presión en el subtest ojos abiertos (p=0,027) y en el Subtest ojos cerrados (p=0,006). Disminuyó la sintomatología asociada a IUE (p=0,0001). Conclusiones: Pos-intervención mejora equilibrio estático y calidad de vida, confirmando los efectos positivos de este programa que pueden servir de orientación a profesionales de la salud que trabajan con mujeres con IUE.

Introduction: Stress urinary incontinence (SUI) has high prevalence in adult women, affecting psychological, social and functional variables, including decreased balance capacity, due to a lack of trunk movements that contribute to postural correction. Objective: To determine how a program based on pelvic floor muscle exercises and education affects static balance and quality of life of women with SUI. Materials and methods: 18 SUI female patients participated in a 12 week/10 sessions program that included pelvic floor muscle exercises and education (hygiene habits, urination, fluid intake). Static balance and quality of life were assessed before and after the intervention using postural oscillography and the International Consultation on Incontinence Questionnaire Short Form(ICQ-SF), respectively. Data were analyzed with the non-parametric Wilcoxon test. Results: The displacement area of the center of pressure in the open (p=0.027) and closed (p=0.006) subtests showed a significant reduction. Likewise, the amount of symptoms associated with SUI decreased (p=0.0001). Conclusions: Intervention improves static balance and quality of life, confirming the positive effects of this program, which can serve as a guide for health professionals who work with women with SUI.

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INTRODUCTION AND HYPOTHESIS: Female stress urinary incontinence (SUI) is a prevalent condition, and conservative treatment options are needed. Were evaluated CO2 laser and radiofrequency as treatment for SUI. METHODS: One hundred thirty-nine women with SUI were eligible and randomized in a three-arm double-blind randomized controlled trial into radiofrequency (RF), laser (LS) and sham control (SCT) groups, with 3-monthly outpatient treatment sessions. One hundred fourteen women were included, 38 in each group, during a 12-month follow-up. The primary outcomes were: subjective improvement of SUI, evaluated on a Likert scale, and objective cure, which was a composite outcome defined according to negative stress tests, voiding diary and pad test. Questionnaires were also applied. The sample size was calculated to provide 80% power to identify a 20% difference between groups, p < 0.05. RESULTS: Subjective improvement and objective cure of SUI were identified respectively in 72.6% and 45.2% in LS and in 61.7% and 44.7% in RF, both significantly higher than the 30.0% and 14.0% in SCT. Considering only mild cases (pad test < 10 g), objective cure was achieved in 66.7% in LS, 63.6% in RF and 22.2% in SCT. Significant reduction in the number of episodes of urinary incontinence was found according to voiding diaries (p = 0.029) and pad weight (p = 0.021). A significant reduction in urgency and urinary loss during sexual intercourse was observed only with LS and RF. Improvement in quality of life was also verified by the I-QoL and ICIQ-SF in favor of the energy-treated groups. CONCLUSIONS: CO2 laser and radiofrequency are outpatient options for SUI treatment, with no major complications. They had similar results and presented better results than in the sham control group.

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Stress urinary incontinence (SUI) is a common health problem that affects roughly 35% of women in the reproductive period. A prospective uncontrolled study was conducted to assess the long-term efficacy and safety of a non-ablative Er:YAG laser treatment of SUI. Forty-three patients participated in the study. All women underwent three sessions of IncontiLase® procedure, and efficacy of laser treatment was assessed by 1-h pad test, 24-h pad test, 3-day voiding diary, and ICIQ-UI SF questionnaire at multiple follow-ups. Statistical analysis was performed using one-way repeated measures ANOVA. Patients were questioned about discomfort during treatment and any adverse events following the laser procedures. All outcome measures showed a significant change over a period of the entire clinical trial. Eighteen-month follow-up revealed a fading of the effect, which was alleviated by single-session maintenance treatments every 6 months. There were no serious adverse events reported during the study. All reported side effects were mild and transient. The application of non-ablative Er:YAG laser for SUI treatment significantly improves the SUI symptoms. High improvement rates and patient satisfaction can be maintained with single-session maintenance treatments performed every 6 months. Long-term safety profile of multiple non-ablative Er:YAG laser treatment is shown. NCT04348994, 16.04.2020, retrospectively registered.

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OBJECTIVE: Investigate the impact of urinary incontinence (UI) on quality of life (QoL) in female CrossFit practitioners and to verify the strategies used by them to minimize the occurrence of urine leakage. In addition, to verify whether anthropometric and clinical characteristics increase the UI impact on QoL of female CrossFit practitioners. STUDY DESIGN: This was an online cross-sectional survey. The impact of UI on QoL was investigated by International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Associations between the impact of UI on QoL and the clinical (age, BMI, gestations, mode of delivery, practice of other physical activities) and the others pelvic floor dysfunctions (PFD) related independent variables were tested using logistic regression analysis. RESULTS: A total of 828 female CrossFit practitioners answered the questionnaire and 36% reported UI symptoms. The women who obtained the highest score on the ICIQ-SF have high UI interference in QoL. Previous history of two or more gestations and sexual dysfunctions (dyspareunia or vaginismus) or pelvic organ prolapse increase 2.65 and 1.82 times the risk of female CrossFit practitioners with UI having a high impact of UI on their QoL, respectively (OR = 2.65 95% CI 1.30-5.40, p = 0.01; and OR = 1.82 95% CI 1.04-3.21, p = 0.04, respectively). The most strategies used by them to minimize the occurrence of urine leakage were emptying the bladder before training (77.5%) and use absorbent (17.8%). CONCLUSIONS: Women who had higher scores on the ICIQ-SF reported greater impact on QoL, and the previous history of two or more gestations and sexual dysfunction/pelvic organ prolapse increase the risk of women with UI who practice CrossFit to have a greater impact on QoL. Multigravida and women with sexual dysfunction/pelvic organ prolapse who practice CrossFit could have more attention on the UI symptoms due to the high impact on their QoL.

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Abstract Introduction: Urinary incontinence (UI) is present in the lives of a considerable number of women worldwide. This condition and its associated factors have been sufficiently investigated in recent years, however, prevalence estimates are still not fully clarified, as UI is seen as stigmatizing in a cultural context, and the search for treatment is not always considered by affected individuals. So, this dysfunction and its subtypes must be better understood so that it is possible to alleviate its consequences. Objective: To identify the prevalence of urinary incontinence subtypes, in women from a reference clinic in a public hospital in Curitiba, PR, Brazil. Methods: This was an observational and analytical study, with 227 women affected by UI, evaluated by means of a questionnaire including sociodemographic and general health information, in addition to defining the UI subtype. The SPSS version 25 was used for statistical analysis. Results: The patients presented a mean age of 60.33 ± 12.26 years. Mixed UI was the prevalent subtype (87.2%; n = 198), followed by stress (7.5%; n = 17), and urge (5.3%; n = 12). Among women with mixed UI, 60.6% had only completed elementary school, 59.1% were housewives, and 87.6% had experienced two or more pregnancies. Conclusion: Outlining UI subtypes, and the general and obstetric characteristics of the studied population enables the development of coping strategies for this condition, ranging from planning, diagnosis and treatment, to costs and public health management.

Resumo Introdução: A incontinência urinária (IU) está presente na vida de considerável número de mulheres no mundo. Essa condição e fatores associados a ela vêm sendo suficientemente investigados nos últimos anos, no entanto, as estimativas de prevalência ainda não são totalmente esclarecidas visto que a IU é vista como estigmatizante em âmbito cultural e a procura por tratamento nem sempre é considerada por indivíduos acometidos. Torna-se importante, portanto, esclarecer cada vez mais essa disfunção e seus subtipos para que seja possível amenizar suas consequências. Objetivo: Identificar a prevalência dos subtipos de IU em mulheres de um ambulatório de referência em um hospital público de Curitiba, PR. Métodos: Estudo observacional e analítico com 227 mulheres com IU, avaliadas por meio de um questionário para coleta de informações sociodemográficas e de saúde geral, além da definição do subtipo de IU. Utilizou-se o pacote estatístico SPSS versão 25 para a análise estatística. Resultados: A idade média da amostra foi de 60,33 ± 12,26 anos. IU mista foi o subtipo mais prevalente (87,2%; n = 198), seguida por esforço (7,5%; n = 17) e urgência (5,3%; n = 12). Das mulheres com IU mista, 60,6% tinham apenas o ensino fundamental, 59,1% eram donas de casa e 89,4% passaram por duas ou mais gestações. Conclusão: Delinear os subtipos de IU e as características gerais e obstétricas da população estudada permite que sejam elaboradas estratégias de enfrentamento desta condição, que vão desde planejamento envolvendo diagnóstico e tratamento até custos e gestão de saúde pública.