Urinary Incontinence is a common health problem that can cause both severe medical and social problems, resulting in negative impact on different aspects of Quality of Life. In 2000, the Swedish Council on Health Technology Assessment (SBU) published a systematic review, “Treatment of Urinary Incontinence” where multiple knowledge gaps in the field of UI, all of considerable clinical importance, were pointed out.Several of these knowledge gaps have been the starting points for the projects in this thesis. The overall aim has been to study the impact of different interventions for urinary incontinence in women on the population level but also on the patient group level, for assessessing the significance of UI on general living conditions and to validate instruments to measure quality of life to be used as part of the evaluation of treatment effectiveness. Paper I: A population-based study where UI amongst women was found to be commonly associated with different psychosocial problems and an expressed feeling of vulnerability. Paper II: A population-based study where informative material on UI to the general public in order to increase knowledge and encourage self management was found promising for meeting increasing demands and optimizing healthcare resources. Paper III: A randomized controlled trial where both electrical stimulation and drug therapy reduced the number of micturitions and improved QoL in women with urge or urge incontinence, but electrical stimulation was not found to be superior to drug therapy. Paper IV: A prospective cohort study where the international questionnaires UDI-6 and IIQ-7 after translation and validation, showed good responsiveness and were easy to administer and to fill out. The UDI-6 scale did not accomplish the same solid result in the psychometrical analysis as the IIQ-7 scale but both scales showed good responsiveness and can thereby be recommended for clinical use.

The aim of this thesis was to explore the features of asymptomatic bacteriuria (ASB) in elderly people living in the community, and to seek diagnostic tools to discriminate between ASB and symptomatic urinary tract infection (UTI). All men and women aged 80 and over living in an urban district of Falun, Sweden, were invited to participate. Urine samples were obtained together with information on symptoms and on health indicators. The same cohort was surveyed again after 6 and 18 months. Urinary cytokines were analysed in 16 patients with UTI, in 24 subjects with ASB and in 20 negative controls. ASB occurred at baseline in 19.0% of women and 9.4% of men, and was found at least once in 36.9% of women and in 20.2% of men. ASB in women was associated with reduced mobility and urge urinary incontinence. Of those with ASB at baseline, 60% still had bacteriuria at 6 and 18 months, but among those with repeated findings of ASB with E. coli, only 40% had the same bacterial strain after 18 months. In women, the risk of developing a UTI within 24 months was higher among those with ASB at baseline than in those without. Urinary levels of cytokines (CXCL1, CXCL8 and IL-6) and leukocyte esterase were higher in patients with UTI than in patients with ASB. There is convincing evidence that ASB is harmless and should not be treated with antibiotics. However, such treatment is still often given, thereby unnecessarily contributing to the increased number of bacteria resistant to common antibiotics. This study confirms the high prevalence of ASB in elderly people living in the community. In order not to be misled by a urinary test showing bacteria, it is important to restrict urinary testing for bacteria to patients where there is a suspicion of UTI. In elderly patients with diffuse symptoms or in patients who are unable to communicate their symptoms, further diagnostic help could possibly be obtained by evaluating the urinary levels of leukocyte esterase and/or IL-6.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Made available in DSpace on 2014-12-17T15:43:55Z (GMT). No. of bitstreams: 1 SauloVS_DISSERT.pdf: 1488017 bytes, checksum: b6dafb093bd681e3fd6ec08af1e0b388 (MD5) Previous issue date: 2014-02-24 / Urinary incontinence (UI) is a geriatric syndrome that is especially prevalent in institutionalized individuals, and that causes economic and social impacts derived from treatment costs and overload of caregiver. UI also entails physical consequences to the health of the elderly, such as urinary tract infections or pressure ulcers, among other health problems. However, the existing national research on this condition is still scarce and comprises serious methodological biases. Therefore, the objective of this study is to determine the prevalence of urinary incontinence and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December, 2013 and carried out in 10 nursing homes in the city of Natal (Northeast Brazil). UI was verified through the program Minimum Data Set version 3.0, which was also used to assess fecal incontinence, urinary devices and UI control programs. Data collection included sociodemographic information, UI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity and Pfeiffer test for cognitive status). Bivariate analysis was performed using the Chi-Square Test (or Fisher?s Exact Test) and the Linear Chi-Square Test, calculating the prevalence ratio with 95% confidence interval. Variables with p value under 0.20 were included in the multivariate analysis, which was performed using the Stepwise Forward logistic regression. The inclusion of variables in the final model depended on the likelihood ratio test, absence of multicollinearity and on the Hosmer-Lemeshow test. A statistical significance level of 0.05 was considered. Six (1.8%) hospitalized elderly, one individual in palliative care (0.3%) and one (0.3%) individual under the age of 60 were excluded from the study. The final sample consisted of 321 elderly, mostly females, with a mean age of 81.5 years. The prevalence of UI was 59.43% and the final model revealed statistically a significant association between UI and white race, physical inactivity, stroke, mobility constraints and cognitive decline. The most frequent UI type was functional UI due to physical or cognitive disability, and incontinence control measures were applied only to a minority of residents (approximately 8%). It is concluded that UI is a health issue that affects more than half of the institutionalized elderly, and is associated with white race, physical inactivity, stroke and other geriatric syndromes such as immobility and cognitive disability. Most of these associated factors are modifiable and therefore the findings of this study highlight the importance of UI prevention and treatment in nursing homes, which include general measures, such as physical and psychosocial activities, and specific measures, such as prompted voiding / A incontin?ncia urin?ria (IU) ? uma s?ndrome geri?trica especialmente prevalente em indiv?duos institucionalizados, que gera um forte impacto econ?mico e social derivado principalmente dos custos de tratamento e da sobrecarga dos cuidadores. Al?m disso, acarreta consequ?ncias f?sicas ? sa?de do idoso, como infec??o urin?ria ou ?lceras por press?o, entre outros agravos ? sa?de. No entanto, os trabalhos realizados no pa?s sobre este agravo ? sa?de s?o escassos e cont?m s?rios vieses metodol?gicos. Sendo assim, o objetivo do presente trabalho ? verificar a preval?ncia da incontin?ncia urin?ria e fatores associados nos idosos institucionalizados. Trata-se de um estudo transversal realizado entre outubro e dezembro de 2013 e desenvolvido em 10 institui??es de longa perman?ncia para idosos da cidade do Natal. A IU foi aferida mediante o Minimum Data Set vers?o 3.0, que tamb?m se utilizou para avaliar a incontin?ncia fecal, os dispositivos urin?rios e as medidas de controle da IU. Foram coletadas vari?veis sociodemogr?ficas, de caracteriza??o da IU e relacionadas ? institui??o e ?s condi??es de sa?de (comorbidades, medica??o, cirurgias do assoalho p?lvico, ?ndice de Barthel de capacidade funcional e Teste de Pfeiffer de capacidade cognitiva). Foi realizada a an?lise bivariada mediante os testes qui-quadrado de Pearson (ou teste de Fisher) e o teste qui-quadrado de tend?ncia linear, calculando a raz?o de preval?ncia com intervalo de confian?a de 95%. Por fim, as vari?veis com valor de p menor que 0,20, foram inclu?das na an?lise m?ltipla, que foi realizada mediante regress?o log?stica do tipo Stepwise Forward. A perman?ncia das vari?veis no modelo final deu-se segundo o teste da raz?o de verossimilhan?a, aus?ncia de multicolinearidade e teste de Hosmer and Lemeshow. Foi considerado o n?vel de signific?ncia estat?stica de 0,05. Foram exclu?dos 6 (1,8%) indiv?duos hospitalizados, 1 (0,3%) em fase terminal e 1 (0,3%) menor de 60 anos. A amostra foi composta por 321 idosos, a maioria do sexo feminino e com m?dia de idade de 81,5 anos. A preval?ncia de IU foi de 59,43% e o modelo multivariado mostrou associa??o estatisticamente significativa da IU com a ra?a branca, inatividade f?sica, acidente cerebrovascular, restri??o da mobilidade e decl?nio cognitivo. O tipo mais frequente foi a IU funcional por incapacidade f?sica ou cognitiva, e as medidas de controle da incontin?ncia foram aplicadas apenas em uma minoria dos residentes (aproximadamente 8%). Pode-se concluir que a IU ? um agravo ? sa?de que afeta a mais da metade dos idosos institucionalizados, e que est? associado ? ra?a branca, inatividade f?sica, acidente vasculocerebral e outras s?ndromes geri?tricas como a imobilidade e incapacidade cognitiva. A maior parte destes fatores associados s?o modific?veis e, portanto, os achados deste estudo alertam para a import?ncia de a??es de preven??o e tratamento da IU no ?mbito das institui??es, que incluam medidas gerais, como atividades f?sicas e psicossociais, e espec?ficas, como a evacua??o precoce

Submitted by Emanuel Varela Cardoso (emanuel.varela@ufcg.edu.br) on 2018-06-14T20:51:37Z No. of bitstreams: 1 CARMEM LÚCIA CAVALCANTI COUTINHO – DISSERTAÇÃO (PPG-CEMat) 2015.pdf: 1178536 bytes, checksum: 7b4bc6d75aa15e3438cedfa584239124 (MD5) / Made available in DSpace on 2018-06-14T20:51:37Z (GMT). No. of bitstreams: 1 CARMEM LÚCIA CAVALCANTI COUTINHO – DISSERTAÇÃO (PPG-CEMat) 2015.pdf: 1178536 bytes, checksum: 7b4bc6d75aa15e3438cedfa584239124 (MD5) Previous issue date: 2015-07-09 / A técnica sling pela via transobturadora é eficaz para o tratamento de mulheres com Incontinência Urinária de Esforço e apresenta elevada taxa de cura e melhora da qualidade de vida com baixos índices de complicações. Este trabalho teve como objetivo desenvolver e confeccionar, uma tela de policaprolactona, para uso na técnica de Sling e realizar análises comparativas deste material com a tela de polipropileno, utilizada comercialmente. A pesquisa foi desenvolvida no Laboratório de Avaliação e Desenvolvimento de Biomateriais do Nordeste – CERTBIO. Utilizouse duas amostras de tela, uma confeccionada no CERTBIO e outra de uso comercial. Foram avaliadas as composições químicas e físicas das telas de Policaprolactona (PCL) e Polipropile no (PP), através das técnicas de: Espectroscopia na Região de Infravermelho com Transformada de Fourier (FTIR), Difração de Raios X (DRX) e Microscopia Eletrônica de Varredura (MEV), Tensão superficial, Ensaios Mecânicos de Tração e Teste de Citotoxicidade. Pode-se comprovar pela análise de FTIR, que o material formador das telas era apenas de polipropileno e policaprolactona. A análise de DRX corroborou com os resultados obtidos na análise de FTIR, que indicavam que o material das telas tratava de PP e PCL, apresentando um espectograma característico d estes polímeros. Também, através da análise de DRX, foi possível observar o grau de cristalinidade indicando o PP que possui maior grau de cristalinidade que o PCL. Pode-se comprovar também, que o PP possui maior resistência mecânica que o PCL, verificando assim que o PP é mais frágil e quebradiço do que o PCL. A análise de tensão superficial mostrou que as duas telas possuem molhabilidade parcial devido as cavidade presentes na superfície das telas. A biocompatibilidade dos compostos foi confirmada com o teste de Citotoxicidade. / The sling technique by transobturator approach is effective for the treatment of women with Stress Urinary Incontinence and has a high cure rate and improved quality of life with low complication rates. This work aimed to develop and produce, polycaprolactone, screen for use in Sling surgery and to perform comparative analyses of this material with a polypropylene bladder, used commercially. The survey was developed in the laboratory of evaluation and development of Biomaterials in the Northeast-CERTBIO. Two samples were used to screen; a made in the laboratory and another used commercially. Been evaluated physical and chemical compositions of the Polycaprolactone (PCL) and Polypropylene (PP) screens, through the following techniques: infrared Spectroscopy in the region with a Fourier transform (FTIR), x-ray Diffraction (XRD) and scanning electron microscopy (SEM), surface tension, traction mechanical essays and Cytotoxicity test. You can check by the FTIR analysis, that the trainer material of fabrics was just poliproplieno and polycaprolactone, for examining the computer spectrogram. The XRD analysis corroborated with the results obtained in the FTIR analysis, which indicated that the material was PP screens and PCL, showing a characteristic you might like to look of these polymers. Also, through the analysis of DRX, it was possible to o bserve the degree of crystallinity indicating the PP has higher degree of crystallinity the PCL. One can prove that the PP has higher mechanical strength than the PCL, checking so that the PP is more brittle than the PCL. The analysis of surface tension showed that both screens have partial wettability due to cavity present on the surface of the canvas. The biocompatibility of the compounds has been confirmed with the Cytotoxicity test and it showed low cytotoxicity in two screens.

Introdução: Ensaio clínico randomizado e controlado com o propósito de comparar a eficácia da técnica de treinamento dos músculos do assoalho pélvico (TMAP) com ou sem biofeedback eletromiográfico (BFE) e a qualidade de vida (QV) em mulheres com queixas de perda urinária aos esforços. Métodos: Após seleção, as mulheres pós-menopáusicas com Incontinência Urinária de Esforço (IUE) foram randomizadas e alocadas em três grupos: grupo controle (GC), grupo treinamento assoalho pélvico (GTMAP) e grupo treinamento assoalho pélvico + biofeedback (GTMAP+BIO) Após a coleta de dados demográficos, antropométricos e gestacionais aplicou-se o questionário de qualidade de vida (QV) o International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) e a escala de OXFORD. Foi realizada a avaliação eletromiográfica do repouso inicial e final, presença de contração automática durante a tosse, contração voluntária máxima (CVM) e tempo de sustentação da contração, antes e depois da intervenção do GC, GTMAP e GTMAP+BIO. A intervenção no GTMAP e GTMAP+BIO foi de 20 minutos por dia, 2 vezes por semana, durante 4 semanas. Resultados: O estudo foi concluído com 45 mulheres. Houve aumento significativo nos grupos GTMAP e GTMAP+BIO no incremento da força muscular na OXFORD, na contração automática durante a tosse, na CVM, no tempo de sustentação e no ICIQ-SF em relação ao GC e na comparação ao tempo basal e pós-tratamento. O grupo GTMAP+BIO, quando comparado ao GTMAP, foi superior no incremento na força muscular na escala de OXFORD, na contração automática durante a tosse, na CVM e no tempo de sustentação (p<0.05). Considerações finais: O TMAP foi eficaz para a amostra estudada, porém, foi superior na adição do Biofeedback Eletromiográfico (BFE), sendo recomendado a utilização do TMAP associado ao BFE para pacientes com Incontinência Urinária de Esforço. / Introduction: This randomized controlled trial sought to compare the efficacy of pelvic floor muscle exercises (PFME) with and without electromyographic biofeedback (EMG-BF) and quality of life in women with stress urinary incontinence (SUI). Methods: Postmenopausal women with SUI were randomly allocated across three groups: control, pelvic floor muscle exercises (PFME), and PFME + biofeedback (PFME+BF). Demographic, anthropometric and gestational data were collected and the ICIQ-SF QoL questionnaire and Oxford grading scale were administered. Before and after the study intervention, women in all groups underwent EMG assessment to evaluate initial and final baseline, presence of automatic contraction while coughing (“the Knack”), maximum voluntary contraction (MVC), and duration of endurance contraction. In the PFME and PFME+BF groups, the duration of intervention was 20 min/day, twice weekly for 4 weeks. Results: The study involved 45 women. The PFME and PFME+BF groups exhibited significant increases in muscle strength (Oxford scale), automatic contraction while coughing, MVC, duration of endurance contraction, and ICIQ-SF as compared to controls and when comparing baseline vs. post-treatment. PFME+BF was associated with significantly superior improvement of muscle strength, automatic contraction while coughing, MVC, and duration of endurance contraction as compared to PFME alone (p<0.05). Conclusion: PFME was effective in this sample, but superior results were achieved when EMG-BF was added. We recommend that PFME+BF be offered to women with SUI.

Introdução: Atualmente, a primeira linha de tratamento para bexiga hiperativa (BH), incontinência urinária de urgência (IUU) e incontinência urinária mista (IUM), envolve medicação, treinamento da musculatura do assoalho pélvico (TMAP) e terapia comportamental. Outra abordagem que vem apresentando resultados positivos no tratamento dessas disfunções é a eletroestimulação do nervo tibial (ENT). Objetivo: Comparar a efetividade das técnicas de ENT e TMAP no tratamento da BH, IUU e IUM, e validar um equipamento portátil para aplicação domiciliar de ENT. Métodos: O estudo apresenta delineamento de Ensaio Clínico Randomizado tipo cross-over. A amostra foi composta por 40 mulheres acima de 18 anos com diagnóstico de BH, IUU e IUM. As participantes foram randomizadas em dois grupos: grupo ENT, iniciou a pesquisa realizando eletroestimulação, e o grupo TMAP, iniciou a pesquisa realizando exercícios pélvicos padronizados, ambos de forma domiciliar. Após 8 semanas, as participantes trocaram suas abordagens terapêuticas, totalizando 16 semanas. Todas foram submetidas a uma anamnese e avaliadas em três momentos por meio dos questionários Índice da Severidade da Incontinência (ISI), King´s Health Questionnarie (KHQ) e dados do diário miccional (DM). Resultados: Para todas as variáveis, o grupo ENT apresentou resultados estatisticamente significativos após a intervenção quando comparado ao grupo TMAP (p<0,05). Conclusão: Os dados apresentados indicam maior efetividade da ENT quando comparados ao TMAP após intervenção domiciliar. Com isto, acredita-se que o aparelho desenvolvido pelo Serviço de Engenharia Biomédica do Hospital de Clínicas de Porto Alegre (SEB/HCPA) possa ser uma alternativa de tratamento da BH, IUU e IUM, validando o equipamento para uso clínico. / Introduction: The first-line therapy in overactive bladder (OAB), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI) presently involves drug treatment, pelvic floor muscle training (PFMT) and behavioral intervention (BI). An approach that has shown positive results in the treatment of these dysfunctions is the electrical stimulation of the tibial nerve (TNES). Objective: To compare the effectiveness of TNES and PFMT for treatment of OAB, UUI and MUI, and validate a portable TNES unit designed for home use. Methods: Randomized, crossover clinical trial. The sample consisted of 40 women older than 18 with OAB, UUI and MUI. Participants were randomly assigned to two groups: TNES group, which started the experiment undergoing electrical stimulation, and PFMT group, which started the experiment doing standardized pelvic exercises, both at home. After 8 weeks, the groups exchanged their initial therapeutic approach for the other, thus totalizing 16 weeks of treatment. All the subjects underwent anamnesis and assessment in three different moments with the use of Incontinence Severity Index (ISI), King´s Health Questionnaire (KHQ) and data from a voiding diary (VD). Results: For all the variables, TNES group presented statistically significant results after intervention in comparison to PFMT group (p<0.05). Conclusion: Data have evidenced greater effectiveness of TNES as compared with PFMT after intervention. The device designed by the Department of Biomedical Engineering of Hospital de Clinicas de Porto Alegre (SEB/HCPA) may be an alternative for the treatment of OAB, UUI and MUI, and could have its validation established for clinical practice.

Submitted by Maria Anália Conceição (marianaliaconceicao@gmail.com) on 2016-08-19T12:20:31Z No. of bitstreams: 1 Publico-11.pdf: 1127586 bytes, checksum: 2b1f52ae36e8b94445b0d0fd436ab4b5 (MD5) / Approved for entry into archive by Maria Anália Conceição (marianaliaconceicao@gmail.com) on 2016-08-19T12:21:53Z (GMT) No. of bitstreams: 1 Publico-11.pdf: 1127586 bytes, checksum: 2b1f52ae36e8b94445b0d0fd436ab4b5 (MD5) / Made available in DSpace on 2016-08-19T12:21:53Z (GMT). No. of bitstreams: 1 Publico-11.pdf: 1127586 bytes, checksum: 2b1f52ae36e8b94445b0d0fd436ab4b5 (MD5) Previous issue date: 2007 / Objetivo: Avaliar os resultados após um ano das cirurgias de faixa de prolene por via transobturatória - TVT-O - realizadas para o tratamento da incontinência urinária de esforço recidivada. Metodologia: Pacientes operadas pela técnica de TVT-O para o tratamento de incontinência urinária recidivada no Setor de Uroginecologia e Cirurgias Vaginais do Serviço de Ginecologia e Obstetrícia do Hospital do Servidor Público Estadual de São Paulo entre dezembro de 2004 e março de 2006, realizaram, com um ano de pós-operatório, avaliação clínica, estudo urodinâmico, teste do absorvente e avaliação de qualidade de vida. Na avaliação subjetiva, classificou-se o grau de perda urinária aos esforços em relação ao pré-cirúrgico em: curadas, com melhora ou com falha da cirurgia e se comparou dados de qualidade de vida pré e póscirurgia. Objetivamente, foram comparados o teste do absorvente e o estudo urodinâmico pré e pós-TVT-O. As complicações cirúrgicas foram avaliadas no intra e pós-operatórios precoce e com um ano da cirurgia. Para todos os testes estatísticos o nível de significância de 5% foi adotado. Resultados: Após um ano da cirurgia, subjetivamente, 90% das pacientes referiam cura, 5% melhora e 5% falha cirúrgica com melhora significativa na qualidade de vida de 94,9% das pacientes. Pelo estudo urodinâmico, 92,5% estavam curadas, 2,5% com melhora e 5% apresentaram falha. O teste do absorvente apresentou cura equivalente a 89,75%, sendo positivo em 4 pacientes, duas destas com bexiga hiperativa. Houve diminuição de 65,7% da queixa de urgência. Dois casos de erosão da uretra pela faixa de polipropileno foram relatados. Conclusões: A cirurgia de TVT-O apresentou alta taxa de cura da IUE recidivada, com baixa morbidade. / Objectives: To evaluate the treatment of feminine recurrent stress urinary incontinence (SUI) with the inside-out transobturator tension-free tape (TVT-O) technique one-year-after the surgeries. Methods: TVT-O was performed on 43 patients that had recurrent SUI between December 2004 and March 2006, 40 of them had been were invited to participate of the study and were evaluated before and one-year-after the procedure by clinic exam, urodynamic test, 20 minutes PAD test and quality of life questionnaire. Exclusion criteria were neurological disease, post void residual greater than 100 ml. Results: The mean follow-up was 15.3 months (11.6-25.7). The mean age was 58 years old (43-78) and 31 patients (77.5%) were menopausal. Thirty-five patients (87.5%) had urge urinary incontinence symptoms associated to SUI and 5 of these (12.5%) had also detrusor overactivity in urodynamics. Ten patients (25%) had intrinsic sphincter deficiency (VLPP <60cmH2O) and 12 patients (30%) had genital prolapse, that required surgical corrections. Three patients (7.5%) had two previous antiincontinence procedures while 37 patients (92.5%) had one surgery before. Objective urodynamic SUI and Pad–test cure rates were 92.5% and 89.7% respectively. Subjective SUI cure was 90%. The King’s Health Questionnaire has shown great improvement in the quality of life in 92.3% of patients. Urge incontinence cure rate was 65.7%. The mean operative time was 23 minutes (10- 38). Intra-operative complications (5%) were one case (2.5%) of vaginal perforation and one case (2.5%) of bleeding. No case of bladder perforation, urethral injure, nerve lesion, haematoma, abscess or blood transfusion was noted. There were 8 cases (20%) of post operative obstruction, four patients (10%) had loosening of the tape, one patient (2.5%) had one side tape cut and one patient (2.5%) had the tape taken off due to urethral invasion. Besides the significantly decrease of urine leakage, no other urodynamic parameters had changed. Conclusion: The inside-out transobturator tape (TVT-O) surgery was effective and safe for treatment of recurrent stress urinary incontinence, improved the quality of life and resulted in few complications rate.

Submitted by WESLEY JUSTINO MAGNABOSCO null (wesley.urologia@hotmail.com) on 2016-04-25T10:30:06Z No. of bitstreams: 1 Doutorado_versao final.pdf: 1346455 bytes, checksum: 378b7c9054c2630188a3afe44b97b7e6 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-26T13:14:26Z (GMT) No. of bitstreams: 1 magnabosco_wj_dr_bot.pdf: 1346455 bytes, checksum: 378b7c9054c2630188a3afe44b97b7e6 (MD5) / Made available in DSpace on 2016-04-26T13:14:26Z (GMT). No. of bitstreams: 1 magnabosco_wj_dr_bot.pdf: 1346455 bytes, checksum: 378b7c9054c2630188a3afe44b97b7e6 (MD5) Previous issue date: 2016-02-26 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivo: A incontinência urinária é uma complicação importante da prostatectomia radical, causando deterioração na qualidade de vida, inclusive no pós-operatório inicial. O objetivo desse estudo foi identificar fatores preditores do retorno precoce da continência após essa cirurgia. Métodos: Foram avaliados 130 pacientes submetidos a prostatectomia radical por meio de um questionário clínico, o estudo urodinâmico, os instrumentos ICIQ-SF (International Consultation on Incontinence Questionnaire – Short Form) e EISP (Escore Internacional de Sintomas Prostáticos), o teste do absorvente de 1 hora, além da perineometria e da eletromiografia do assoalho pélvico. As avaliações foram realizadas antes e 1 mês após a cirurgia. Resultados: A idade mais avançada (> 60 anos) (OR=1,078 IC: 1,007-1,154, p=0,03) foi um fator de risco para a incontinência urinária precoce após a prostatectomia radical enquanto uma maior força de contração do assoalho pélvico antes da cirurgia foi um fator protetor (OR=0,986 IC: 0,974-0,998, p=0,018). No período pós-operatório, os pacientes incontinentes também apresentavam menor força de contração do assoalho pélvico, além de terem mais queixas miccionais, principalmente relacionadas a urgência, além de estarem menos satisfeitos. As taxas de continência variaram de acordo com o critério de avaliação adotado e apresentaram baixo coeficiente de concordância. A presença de contração involuntária do detrusor antes da cirurgia relacionou-se com uma maior taxa de incontinência urinária e padrão urodinâmico de obstrução infra-vesical pré-operatórios, mas não com a perda de urina após a cirurgia. Conclusão: A idade mais avançada e uma menor força de contração do assoalho pélvico foram fatores de risco para a incontinência urinária precoce após a cirurgia. Pacientes incontinentes no pós-operatório tiveram mais sintomas miccionais e uma pior força de contração do assoalho pélvico. / Objective: Urinary incontinence is a major complication of radical prostatectomy, causing quality of life to become worse, even in the initial post operatory period. This article aims to evaluate prognostic factors for early urinary continence following radical prostatectomy. Methods: 130 patients who underwent radical prostatectomy were assessed. The following tests and instruments were used: clinical data questionnaire, urodynamic study, International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF), International Prostate Symptom Score (IPSS), 1-hour pad test, and pelvic floor muscles perineometry and electromyography. The assessments were performed before, and 1 month after surgery. Results: Older age (OR=1.078 CI: 1.007-1.154, p=0.03) was a risk factor for early urinary incontinence after radical prostatectomy, whereas a stronger contraction force of the pelvic floor before surgery was considered a protective factor (OR=0.986 CI: 0.974-0998, p=0018). In the post operatory period, incontinent patients also presented worse contraction force of the pelvic floor, had more mictional complaints, especially related to urgency, and were less satisfied. Rates of continence varied according to the adopted criteria, and presented low concordance coefficient. Presence of detrusor instability before surgery related to a higher rate of urinary incontinence and urodynamic pattern of bladder outlet obstruction in the preoperative period, but not to urine loss after surgery. Conclusion: Older age and worse contraction force of the pelvic floor were risk factors for urinary incontinence after the surgery. Incontinent patients in the post operatory period had more mictional symptoms and worse contraction force of the pelvic floor.

Made available in DSpace on 2014-06-11T19:35:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-08-05Bitstream added on 2014-06-13T19:24:58Z : No. of bitstreams: 1 000738057.pdf: 830577 bytes, checksum: a20ebbaa6b3916817e75948bbc8a9429 (MD5) / A gestação e o parto podem levar à redução ou perda da função muscular do assoalho pélvico, o qual acarreta deficiência funcional de sua musculatura, e, consequentemente, incontinência urinária. Assim, o objetivo foi verificar a evolução da função muscular do assoalho pélvico no pós-parto; a associação entre a realização de exercícios perineais durante a gestação e incontinência urinária no pós-parto; e validar as medidas perineométricas na predição de incontinência urinária. Para tanto, 120 primíparas foram divididas: G1, realizou exercícios perineais durante a gestação com supervisão do fisioterapeuta; G2, realizou exercícios perineais durante a gestação sem supervisão do fisioterapeuta; G3, não realizou exercícios perineais durante a gestação, mas tiveram contato com G1 e G2; e G4, não teve contato com exercícios perineais durante a gestação. As participantes foram avaliadas pelo teste bidigital e perineômetro, e receberam diário miccional. As pressões musculares foram estatisticamente diferentes entre os grupos, e G1 manteve sempre função muscular maior que G2, G3 e G4, enquanto que G2 se diferenciou de G3 e G4 conforme o tempo pós-parto aumentou. Verificou-se que valores registrados no perineômetro em 8,5cmH2O geram o melhor balanço entre sensibilidade (91,16%) e especificidade (82,42%). Aos 12mPP, o G1 e G2 apresentaram a menor incidência de incontinência urinária, enquanto o G3 apresentava 37,9%, e o G4, 39,4%. Com 18mPP essas observações se mantém, e aos 24mPP, G1 e G2 deixaram de apresentar participantes com o problema, e G3 e G4 mantiveram a incidência. Concluiu-se que os exercícios perineais foram efetivos na manutenção e aumento da função da musculatura pélvica em participantes que os realizaram durante a gestação; o treinamento muscular reduz significativamente a incidência de incontinência urinária; e as que contrações perineias... / Pregnancy and childbirth can lead to the reduction or loss of pelvic floor muscle function, which leads to functional impairment of their muscles, and hence urinary incontinence. The objective was to assess the evolution of pelvic floor muscle function in post-partum, the association between perineal exercises during pregnancy and urinary incontinence postpartum, and validate the measures perineometrics in predicting urinary incontinence. Therefore, 120 primiparous were divided: G1, held perineal exercises during pregnancy under the supervision of physiotherapists, G2, held perineal exercises during pregnancy without supervision of a physiotherapist, G3, did not do perineal exercises during pregnancy, but had contact with G1 and G2; and G4, had no contact with perineal exercises during pregnancy. The participants were evaluated by bidigital test and perineometer, and received voiding diary. The muscle pressures were statistically different between groups, and G1 muscle function remained always greater than G2, G3 and G4, whereas G2 differed G3 and G4 as time postpartum increased. It was found that the values recorded in the perineometer 8.5 cmH2O generate the best balance between sensitivity (91.16%) and specificity (82.42%). To 12mPP, the G1 and G2 showed a lower incidence of urinary incontinence, while G3 had 37.9%, and G4, 39.4%. With 18mPP these observations remains, and 24mPP, G1 and G2 failed to present participants with the problem, and G3 and G4 remained incidence. It was concluded that the perineal exercises were effective in maintaining and increasing function of the pelvic musculature in which participants performed during gestation; the muscle training significantly reduces the incidence of urinary incontinence; and that perineal contractions of greater than or ...