INTRODUÇÃO: A incontinência urinária (IU) é uma condição multifatorial, sendo que, para muitas mulheres, a gestação, o trabalho de parto e o parto constituem os eventos-sentinela para o seu aparecimento. A ultrassonografia transperineal (translabial) tem sido utilizada para avaliação das alterações anatômicas que ocorrem após o parto, sendo possível correlacionar seus resultados com os sintomas de IU. Delineamos um estudo para comparar o valor do diâmetro uretral de mulheres após o parto vaginal e após a cesariana eletiva, correlacionando estas medidas com fatores ligados à gestação e ao nascimento, e com a presença de IU no período de seis meses após o nascimento. MATERIAIS E MÉTODOS: Trata-se de um estudo transversal, composto por 205 pacientes. Foi realizada ultrassonografia transperineal para medida do diâmetro uretral, a nível do colo vesical e da uretra média, após o nascimento, e foram obtidas informações sobre a gestação e o parto, utilizando-se uma ficha específica para a coleta de dados. Seis meses após o nascimento, avaliamos a presença de IU nas pacientes, e quantificou-se a perda utrinária através do questionário ICIQ-SF (International Consultation on Incontinence – Short Form) (Tamanini, Dambros et al. 2004). RESULTADOS: Das 151 pacientes, 73 tiveram parto vaginal (grupo 1), e 78, cesariana eletiva (grupo 2). Houve diferença estatisticamente significativa na medida do diâmetro uretral no colo vesical após o parto, a qual foi menor no grupo 2 (p< 0,0001). Não houve diferença significativa na medida do diâmetro na uretra média entre os grupos (p=0,505). A medida do diâmetro uretral na uretra média apresentou correlação inversa com a presença IU em seis meses de seguimento (rs=0,219; p=0,014). Houve correlação positiva entre a presença de incontinência urinária durante a gestação e em seis meses após o nascimento (p=0,016). CONCLUSÕES: Uma diferença na medida ultrassonográfica do diâmetro uretral no colo vesical foi observada entre os grupos. Houve correlação inversa entre a medida do diâmetro uretral na uretra média e a presença de IU após seis meses de acompanhamento. / BACKGROUND: Urinary incontinence (UI) is a multifactorial condition, and for most women, pregnancy, labor and delivery are the main factors that contribute to its appearance. Transperineal ultrasound has been used to evaluate anatomic damages due to vaginal delivery, and these findings can be correlated to postpartum UI symptoms. We outlined a study to compare the measure of the urethral diameter in women who had a vaginal delivery or elective cesarean section and correlate this measure with pregnancy and labor linked factors, as well as with the presence of UI six months after birth. METHODS: A cross-sectional study was outlined, and 205 patients were recruited. Transperineal ultrasound was performed to measure the urethral diameter, both at mid urethra and at vesical bladder level, immediately after delivery, and data regarding pregnancy and labor were obtained. Six months after birth, patients evaluate the presence of UI, symptom through the ICIQ-SF (International Consultation on Incontinence – Short Form) questionnaire RESULTS: Of the 151 patients studied, 73 had a vaginal delivery (group 1) and 78, elective cesarean section (group 2). We found a significant difference between groups in urethral diameter al bladder neck level, which was smaller for the group 2 (p< 0,0001). We didn’t find any significant difference between groups in urethral diameter at the level of mid urethra (p=0,505). The urethral diameter at the level of mid urethra showed an inverse correlation with presence of urinary incontinence at six-month analysis (rs=0,219; p=0.014) and a positive correlation between UI during pregnancy and at six months after delivery (rs=0,214; p=0.016) was observed. CONCLUSIONS: A difference in the urethral diameter at the level of the bladder neck was observed between groups. We found an inverse correlation between urethral diameter at the level of the mid urethra and the presence of UI at six months after delivery.

INTRODUÇÃO: A incontinência urinária (IU) é uma condição multifatorial, sendo que, para muitas mulheres, a gestação, o trabalho de parto e o parto constituem os eventos-sentinela para o seu aparecimento. A ultrassonografia transperineal (translabial) tem sido utilizada para avaliação das alterações anatômicas que ocorrem após o parto, sendo possível correlacionar seus resultados com os sintomas de IU. Delineamos um estudo para comparar o valor do diâmetro uretral de mulheres após o parto vaginal e após a cesariana eletiva, correlacionando estas medidas com fatores ligados à gestação e ao nascimento, e com a presença de IU no período de seis meses após o nascimento. MATERIAIS E MÉTODOS: Trata-se de um estudo transversal, composto por 205 pacientes. Foi realizada ultrassonografia transperineal para medida do diâmetro uretral, a nível do colo vesical e da uretra média, após o nascimento, e foram obtidas informações sobre a gestação e o parto, utilizando-se uma ficha específica para a coleta de dados. Seis meses após o nascimento, avaliamos a presença de IU nas pacientes, e quantificou-se a perda utrinária através do questionário ICIQ-SF (International Consultation on Incontinence – Short Form) (Tamanini, Dambros et al. 2004). RESULTADOS: Das 151 pacientes, 73 tiveram parto vaginal (grupo 1), e 78, cesariana eletiva (grupo 2). Houve diferença estatisticamente significativa na medida do diâmetro uretral no colo vesical após o parto, a qual foi menor no grupo 2 (p< 0,0001). Não houve diferença significativa na medida do diâmetro na uretra média entre os grupos (p=0,505). A medida do diâmetro uretral na uretra média apresentou correlação inversa com a presença IU em seis meses de seguimento (rs=0,219; p=0,014). Houve correlação positiva entre a presença de incontinência urinária durante a gestação e em seis meses após o nascimento (p=0,016). CONCLUSÕES: Uma diferença na medida ultrassonográfica do diâmetro uretral no colo vesical foi observada entre os grupos. Houve correlação inversa entre a medida do diâmetro uretral na uretra média e a presença de IU após seis meses de acompanhamento. / BACKGROUND: Urinary incontinence (UI) is a multifactorial condition, and for most women, pregnancy, labor and delivery are the main factors that contribute to its appearance. Transperineal ultrasound has been used to evaluate anatomic damages due to vaginal delivery, and these findings can be correlated to postpartum UI symptoms. We outlined a study to compare the measure of the urethral diameter in women who had a vaginal delivery or elective cesarean section and correlate this measure with pregnancy and labor linked factors, as well as with the presence of UI six months after birth. METHODS: A cross-sectional study was outlined, and 205 patients were recruited. Transperineal ultrasound was performed to measure the urethral diameter, both at mid urethra and at vesical bladder level, immediately after delivery, and data regarding pregnancy and labor were obtained. Six months after birth, patients evaluate the presence of UI, symptom through the ICIQ-SF (International Consultation on Incontinence – Short Form) questionnaire RESULTS: Of the 151 patients studied, 73 had a vaginal delivery (group 1) and 78, elective cesarean section (group 2). We found a significant difference between groups in urethral diameter al bladder neck level, which was smaller for the group 2 (p< 0,0001). We didn’t find any significant difference between groups in urethral diameter at the level of mid urethra (p=0,505). The urethral diameter at the level of mid urethra showed an inverse correlation with presence of urinary incontinence at six-month analysis (rs=0,219; p=0.014) and a positive correlation between UI during pregnancy and at six months after delivery (rs=0,214; p=0.016) was observed. CONCLUSIONS: A difference in the urethral diameter at the level of the bladder neck was observed between groups. We found an inverse correlation between urethral diameter at the level of the mid urethra and the presence of UI at six months after delivery.

INTRODUÇÃO: A incontinência urinária (IU) é uma condição multifatorial, sendo que, para muitas mulheres, a gestação, o trabalho de parto e o parto constituem os eventos-sentinela para o seu aparecimento. A ultrassonografia transperineal (translabial) tem sido utilizada para avaliação das alterações anatômicas que ocorrem após o parto, sendo possível correlacionar seus resultados com os sintomas de IU. Delineamos um estudo para comparar o valor do diâmetro uretral de mulheres após o parto vaginal e após a cesariana eletiva, correlacionando estas medidas com fatores ligados à gestação e ao nascimento, e com a presença de IU no período de seis meses após o nascimento. MATERIAIS E MÉTODOS: Trata-se de um estudo transversal, composto por 205 pacientes. Foi realizada ultrassonografia transperineal para medida do diâmetro uretral, a nível do colo vesical e da uretra média, após o nascimento, e foram obtidas informações sobre a gestação e o parto, utilizando-se uma ficha específica para a coleta de dados. Seis meses após o nascimento, avaliamos a presença de IU nas pacientes, e quantificou-se a perda utrinária através do questionário ICIQ-SF (International Consultation on Incontinence – Short Form) (Tamanini, Dambros et al. 2004). RESULTADOS: Das 151 pacientes, 73 tiveram parto vaginal (grupo 1), e 78, cesariana eletiva (grupo 2). Houve diferença estatisticamente significativa na medida do diâmetro uretral no colo vesical após o parto, a qual foi menor no grupo 2 (p< 0,0001). Não houve diferença significativa na medida do diâmetro na uretra média entre os grupos (p=0,505). A medida do diâmetro uretral na uretra média apresentou correlação inversa com a presença IU em seis meses de seguimento (rs=0,219; p=0,014). Houve correlação positiva entre a presença de incontinência urinária durante a gestação e em seis meses após o nascimento (p=0,016). CONCLUSÕES: Uma diferença na medida ultrassonográfica do diâmetro uretral no colo vesical foi observada entre os grupos. Houve correlação inversa entre a medida do diâmetro uretral na uretra média e a presença de IU após seis meses de acompanhamento. / BACKGROUND: Urinary incontinence (UI) is a multifactorial condition, and for most women, pregnancy, labor and delivery are the main factors that contribute to its appearance. Transperineal ultrasound has been used to evaluate anatomic damages due to vaginal delivery, and these findings can be correlated to postpartum UI symptoms. We outlined a study to compare the measure of the urethral diameter in women who had a vaginal delivery or elective cesarean section and correlate this measure with pregnancy and labor linked factors, as well as with the presence of UI six months after birth. METHODS: A cross-sectional study was outlined, and 205 patients were recruited. Transperineal ultrasound was performed to measure the urethral diameter, both at mid urethra and at vesical bladder level, immediately after delivery, and data regarding pregnancy and labor were obtained. Six months after birth, patients evaluate the presence of UI, symptom through the ICIQ-SF (International Consultation on Incontinence – Short Form) questionnaire RESULTS: Of the 151 patients studied, 73 had a vaginal delivery (group 1) and 78, elective cesarean section (group 2). We found a significant difference between groups in urethral diameter al bladder neck level, which was smaller for the group 2 (p< 0,0001). We didn’t find any significant difference between groups in urethral diameter at the level of mid urethra (p=0,505). The urethral diameter at the level of mid urethra showed an inverse correlation with presence of urinary incontinence at six-month analysis (rs=0,219; p=0.014) and a positive correlation between UI during pregnancy and at six months after delivery (rs=0,214; p=0.016) was observed. CONCLUSIONS: A difference in the urethral diameter at the level of the bladder neck was observed between groups. We found an inverse correlation between urethral diameter at the level of the mid urethra and the presence of UI at six months after delivery.

Pelvic floor dysfunction in the form of pelvic organ prolapse (POP) is a common gynaecological condition, especially in the elderly. Although the aetiology is poorly understood, several risk factors such as vaginal childbirth, chronically raised intra-abdominal pressure (such as asthma and chronic constipation), ageing, previous hysterectomy and connective tissue disorders are thought to play a role in the pathophysiology of POP. Studies have shown that vaginal childbirth can result in both gross and micro-architectural distortion/alteration of the pelvic floor musculature and is thus considered to play a major role in the development of POP. Although ethnicity has been proposed as a risk factor, there are limited studies on this subject. Recently, transperineal ultrasound (TPUS) has been used to study the structural integrity and the dynamic interaction between the pelvic organs and pelvic floor musculature. Using a specified methodology we intended to determine and compare pelvic floor morphology, namely pelvic organ descent and levator hiatal distensibility in a multi-ethnic South African population (Asian, Caucasian and Black) in both asymptomatic nulliparous and symptomatic multiparous women. Secondly we also intended to study the association between prolapse symptoms and functional anatomy of the pelvic floor, and finally to determine the impact of vaginal childbirth on the pelvic floor morphology 3-6 month postpartum. For all the studies women were recruited from the local nursing school, general gynaecology and tertiary urogynaecology clinic. Pregnant women were recruited from the district antenatal clinic. This cohort included only Black pregnant women. After informed consent all ultrasound volumes were acquired at rest, maximal pelvic floor contraction and Valsalva maneuver. Volumes were deindentified and analysed 6-8 weeks later using GE Kretz 4D View (GE Kretztechnik Gmbh, Zipf, Austria). In the nulliparous cohort, we found that Black South African women had greater pelvic organ descent on ultrasound and clinically and greater distensibility compared to South Asian and Caucasian women. Multivariate modelling revealed that Black 2 ethnicity remained a significant factor for pelvic organ mobility on clinical examination, (P=0.024). In women with symptomatic POP, there was significant variation in clinical prolapse stage, levator distensibility and pelvic organ descent in this racially diverse population presenting with pelvic organ prolapse, with South Asians having a lower avulsion rate than the other two ethnic groups (P= 0.014). As regards the association between prolapse symptoms and functional anatomy of the pelvic floor we found a significant association between awareness, visualization and/or feeling of a vaginal lump and abnormal pelvic floor functional anatomy, that is, hiatal ballooning and levator avulsion (all P< 0.05). The fourth part of the study included eighty four women who returned at a mean of 4.8 months postpartum. We found significant alteration in pelvic organ support and levator hiatal distensibility after vaginal delivery i.e. a significant increase in mean values from ante to postpartum measurements, more so for the vaginal delivery group. 15% of Black primiparous women sustained levator trauma after their first vaginal delivery. In conclusion, to the author‘s knowledge this is the first study on pelvic floor morphology in South African women. Contrary to previous publications inferring that Black women rarely develop PFD, we have shown that this particular ethnic group had significantly different pelvic floor dynamics than Caucasian and South Asian women for both nulliparous and multiparous symptomatic women. Levator trauma occurs in 15% of Black women after vaginal childbirth. / Thesis (PhD)--University of Pretoria, 2017. / Obstetrics and Gynaecology / PhD / Unrestricted

Orientador: Eliana Aguiar Petri Nahas / Resumo: Objetivo: Avaliar a associação entre a força dos músculos do assoalho pélvico (MAP) e a função sexual em mulheres na pós-menopausa. Métodos: Realizou-se estudo de corte transversal com 156 mulheres, idade entre 45-65 anos, sexualmente ativas, em amenorreia >12 meses e sem alterações do assoalho pélvico. A função sexual foi avaliada por questionário validado, o Índice de Função Sexual Feminina (FSFI), em que escore total ≤26.5 indica disfunção sexual. A força dos MAP foi avaliada por meio da palpação vaginal bidigital, graduada 0 a 5 pela escala de Oxford, categorizados em não funcional (escores 0–1, sem contração dos MAP) e funcional (escores 2–5, com contração dos MAP). A biometria dos MAP foi realizada por ultrassom transperineal tridimensional (3D) (Voluson E6, GE) para avaliação da área total do hiato urogenital e diâmetros anteroposterior e transverso, e espessura do músculo levantador do ânus. Resultados: As participantes foram divididas de acordo com a força dos MAP, em funcional (n=93) e não funcional (n=63). Não houve diferenças entre os grupos quanto a idade, tempo de menopausa, paridade e tipo de parto e índice de massa corpórea (IMC). Foi observado maior percentual de usuárias de terapia hormonal (TH) no grupo com MAP funcional (36.6%) quando comparadas ao não funcional (12.7%) (p=0.002). Na comparação da biometria dos MAP não foram constatadas diferenças entre os grupos (p>0,05). Observou-se que as mulheres com MAP não funcional apresentaram piora na função sex... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: To evaluate the association between pelvic floor muscles (PFM) strength and sexual function in postmenopausal women. Methods: An analytical cross sectional study was conducted with 226 women, aged 45-65 years, sexually active, in amenorrhea >12 months and without pelvic floor disorders or urinary incontinence. For the evaluation of sexual function, the Female Sexual Function Index (FSFI) was used (total score ≤26.5 indicates sexual dysfunction). PFM strength was assessed by bidigital vaginal palpation, graded 0 to 5 by the Modified Oxford scale, categorized as non-functional (scores 0-1, without contraction) and functional (scores 2-5, with contraction). Transperineal 3-dimensional ultrasound (Voluson E6, GE) was used to evaluate the total urogenital hiatus area, transverse and anteroposterior diameters and levator ani muscle thickness. Results: Participants were categorized as functional PFM (n=143) and nonfunctional PFM (n = 83). There were no differences between the groups in age, time since menopause, parity and type of delivery, body mass index (BMI) and waist circumference. A higher percentage of hormone therapy (HT) users was observed in the group with functional MAP (39.2%) when compared to nonfunctional (24.1%) (p=0.043). The women classified as functional PFM presented greater thickness of levator ani muscle when compared to those classified as nonfunctional (p=0.049). Women with nonfunctional PFM had worsening of sexual function in relation to the doma... (Complete abstract click electronic access below) / Mestre