RESUMO
AIMS: To perform a comparative evaluation of Valsalva maneuver techniques, in an attempt to identify the most suitable one for achieving leak point pressure (LPP) during the cystometric phase of the urodynamic study (UDS), in order to propose a method for technical standardization. METHODS: Urodynamic data from women with stress urinary incontinence at three urogynecological medical centers were randomly selected and prospectively analyzed. Valsalva maneuver was executed through forceful attempted exhalation against the dorsal surface of the hand (Group 1), through abdominal strain (Group 2), or through low-elasticity latex balloon-blowing (Group 3). Patients were classified based on age and higher vesical pressure value, as well as time to perform Valsalva maneuver. RESULTS: Initially, 1358 urodynamic studies were identified as eligible for analysis. Among these, 340 belonged to Group 1, 318 to Group 2, and 700 to Group 3. Valsalva maneuver accomplished through abdominal straining was more effective, inducing increased vesical pressure, across age groups. The same maneuver may be sustained for longer than the other two techniques. CONCLUSION: When performed through abdominal strain, the Valsalva maneuver was more effective for stress urinary incontinence urodynamic's investigation.
Assuntos
Uretra/fisiologia , Bexiga Urinária/fisiologia , Incontinência Urinária por Estresse/fisiopatologia , Urodinâmica/fisiologia , Manobra de Valsalva , Adulto , Idoso , Idoso de 80 Anos ou mais , Elasticidade , Feminino , Humanos , Pessoa de Meia-Idade , Pressão , Adulto JovemRESUMO
AIMS: The objective of this study was to evaluate the similarities and differences of the urethral morphological and functional changes following external urethral sphincter EUS injury in male and female rats. METHODS: 30 female and 30 male age-matched Wistar rats were used in the experiments. Half of them underwent electrocauterization of the surrounding tissues lateral to the urethra at the level of the (EUS) and the others, a sham operation. At 2, 6, and 16 weeks after surgeries they underwent anesthetized cystometry, measurement of leak point pressure (LPP) and their urethras were harvested for morphological analyses. RESULTS: There were no differences in cystometric parameters between sex-time-matched animals, ensuring normal bladder function in the manipulated animals. The mean LPP in male and female rats was lower compared with sham animals. Age-time-matched sham operated male rats exhibited a higher LPP compared with female rats. The reduction in LPP comparing electrocauterized and sham time-matched animals was more pronounced in male rats than in female rats. Electrocauterization produced urethral collagen deposition and nerve damage in both male and female animals. Muscle atrophy and disruption also occurred, being more evident in female rats. CONCLUSIONS: The urethras of male and female rats exhibited a similar morphological and functional response to electrocauterization. The time-course evaluation revealed that the male animal model is as reliable, reproducible and long-lasting as the female model. Intact males had a higher LPP than female rats and the nerve injury led to a more drastic impairment of this mechanism.
Assuntos
Uretra/lesões , Incontinência Urinária por Estresse/etiologia , Animais , Colágeno/metabolismo , Modelos Animais de Doenças , Eletrocoagulação , Feminino , Fibrose , Masculino , Atrofia Muscular/etiologia , Atrofia Muscular/patologia , Atrofia Muscular/fisiopatologia , Regeneração Nervosa , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/patologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Pressão , Ratos Wistar , Fatores Sexuais , Fatores de Tempo , Uretra/inervação , Uretra/metabolismo , Uretra/fisiopatologia , Incontinência Urinária por Estresse/metabolismo , Incontinência Urinária por Estresse/patologia , Incontinência Urinária por Estresse/fisiopatologia , UrodinâmicaRESUMO
OBJECTIVE: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI). MATERIALS AND METHODS: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables. RESULTS: Mean follow-ups were 32 + 12 months (range 12-55) for TVT and 31 + 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5 percent) patients showed a VLPP > 60 cm H2O and 50 (34.5 percent) patients had a VLPP < 60 cm H2O. The overall objective cure rates were 75.8 percent for patients with VLPP > 60 cm H2O and 72 percent for those with VLPP < 60 cm H2O (p < 0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures: VLPP > 60 cm H2O (82 percent vs. 68.9 percent p < 0.172); VLPP < 60 cm H2O (68 percent vs. 76 percent p < 0.528). CONCLUSIONS: When patients were stratified for preoperative VLPP (< or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.