Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-11T14:42:01Z No. of bitstreams: 1 dnysonfernandesferreira.pdf: 1078209 bytes, checksum: 266bd23bbd5cf85cb65ab5a2a878bdce (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T17:09:17Z (GMT) No. of bitstreams: 1 dnysonfernandesferreira.pdf: 1078209 bytes, checksum: 266bd23bbd5cf85cb65ab5a2a878bdce (MD5) / Made available in DSpace on 2016-01-25T17:09:17Z (GMT). No. of bitstreams: 1 dnysonfernandesferreira.pdf: 1078209 bytes, checksum: 266bd23bbd5cf85cb65ab5a2a878bdce (MD5) Previous issue date: 2015-03-11 / INTRODUÇÃO: O uso de ferramentas preventivas para o tratamento da incontinência urinária de esforço é de suma importância. Em 2010, foi demonstrado que o método de Pilates pode aumentar a força voluntária máxima dos músculos perineais. O objetivo foi avaliar a prevalência de incontinência urinária de esforço em mulheres praticantes de atividades físicas em academias e avaliar quais fatores estão associados com a prevalência de incontinência urinária de esforço. MATERIAIS E MÉTODOS: Foi realizado um estudo quantitativo, transversal, do tipo prevalência, avaliando as mulheres que praticam atividade física regularmente em academias registradas na Câmara Municipal de Juiz de Fora. Este estudo foi realizado após aprovação pelo Comitê de Ética em Pesquisa "parecer no. 131 401" (18 / outubro / 2012). Foram sorteados aleatoriamente 20 academias e realizou-se uma recolha proporcional. Eram elegíveis para o estudo as mulheres com mais de 18 anos de idade, que praticam atividades físicas com à pelo menos três meses, com uma frequência semanal superior a duas vezes por semana durante 50 minutos. Para avaliar a incontinência urinária de esforço foi aplicado o questionário Internacional para consulta sobre incontinência urinária – versão curta. O tamanho mínimo da amostra calculado foi de 362 mulheres. A importância das associações foi avaliada com o teste do qui-quadrado. RESULTADOS: A prevalência de incontinência urinária de esforço foi de 15,2%. Na análise de regressão logística, a presença de incontinência urinária de esforço foi associada com Pilates (OR 0,39; IC 0,17-0,90), Jump Fit exercício (OR 2,11; IC 1,05-4,32), o parto vaginal (OR 1,94; IC 1,02-3,59) e dor lombar (OR 4,1, IC 1,90 a 8,83). CONCLUSÕES: O único fator de proteção associado à incontinência urinária de esforço foi o Método Pilates. Além disso, a atividade física Jump Fit, dor lombar e o parto vaginal aumentaram as chances de ter incontinência urinária de esforço. / INTRODUCTION: The use of preventive tools for urinary incontinence treatment is paramount importance. In 2010, it was demonstrated that Pilates Method can get an improvement in maximal voluntary strength of the perineal muscles. The aim was to assess the prevalence of stress urinary incontinence in women who practice physical activities in gyms and evaluate which factors are associated with the prevalence of stress urinary incontinence. MATERIALS AND METHODS: A quantitative, cross-sectional, prevalence-type study was performed, assessing women who practice regular physical activity in gyms registered at the City Hall of our city. This study was conducted after approval by the Research Ethics Committee "opinion no. 131 401" (18/Oct./2012). Were drawn 20 gyms randomly and held a proportionate collection. Were eligible for the study women with greater than 18 years of age who have been working out in gyms for at least three months, with a weekly frequency greater than to twice a week for 50 minutes. To assess stress urinary incontinence was applied the International consultation on incontinence questionnaire-short form. The minimum sample size calculated was 362 women. The significance of associations was assessed with chi-square test. RESULTS: The prevalence of stress urinary incontinence was 15.2%. In logistic regression analysis, the presence of stress urinary incontinence was associated with Pilates (OR 0.39, CI 0.17 to 0.90), Jump Fit exercise (OR 2.11, CI 1.05 to 4.32), vaginal delivery (OR 1.94, CI 1.02 to 3.59) and lower back pain (OR 4.1, CI 1,90 to 8.83). CONCLUSIONS: The only protective factor associated with stress urinary incontinence was the Pilates Method. In addition, jump fit exercise, lower back pain and vaginal delivery increases the chances to have stress urinary incontinence.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-12T11:00:34Z No. of bitstreams: 1 dayanamariadeoliveira.pdf: 1528656 bytes, checksum: 044494909e5f7b1da7a230c65e5c389f (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T17:14:15Z (GMT) No. of bitstreams: 1 dayanamariadeoliveira.pdf: 1528656 bytes, checksum: 044494909e5f7b1da7a230c65e5c389f (MD5) / Made available in DSpace on 2016-01-25T17:14:15Z (GMT). No. of bitstreams: 1 dayanamariadeoliveira.pdf: 1528656 bytes, checksum: 044494909e5f7b1da7a230c65e5c389f (MD5) Previous issue date: 2015-03-11 / Introdução: A enurese é definida como uma incontinência urinária intermitente durante o sono e é considerada uma doença quando ocorre em crianças com pelo menos cinco anos de idade. Diversos fatores têm sido associados à enurese primária. Estudos indicam que a prevalência de enurese declina com o aumento da idade, é mais comum entre meninos do que entre meninas e entre indivíduos de níveis socioeconômicos mais baixos. Além disso, outros estudos destacam a importância de fatores hereditários. Embora a relação entre enurese e amamentação ainda seja pouco documentada na literatura, especula-se uma possível associação uma vez que ambos estão fortemente associados com o desenvolvimento das crianças. Neste contexto, o principal objetivo deste estudo foi avaliar se existe uma associação entre enurese primária e a duração do aleitamento materno exclusivo e a duração do aleitamento materno. Métodos: trata-se de um estudo observacional, caso-controle, envolvendo 200 crianças de 6 a 14 anos de idade, que foram incluídas em um dos dois grupos, grupo enurese (GE), composto por 100 crianças com enurese primária e grupo controle (GC), composto por 100 crianças sem enurese. Os critérios de pareamento foram sexo, idade e nível socioeconômico. Os adultos responsáveis por cada criança responderam a um questionário estruturado para identificar e fornecer informações sobre os fatores biológicos, sociais e comportamentais que foram avaliados, bem como a duração do aleitamento materno. Não foram incluídas as crianças cujos pais não compreendessem o questionário, crianças com doença neurológica, psiquiátrica ou renal, e com enurese secundária. Resultados: Cada grupo foi constituído por 37 participantes do sexo feminino e 63 participantes do sexo masculino (p = 1,0). A idade média foi semelhante em ambos os grupos, 8,81 ± 2,42 (p = 1,0), bem como o nível socioeconômico (p = 0,82). Na análise bivariada, houve uma forte associação entre os sintomas de enurese a uma história familiar positiva de enurese e duração do aleitamento materno exclusivo (p <0,001), também foi associado à duração do aleitamento materno total (p = 0,044), número de filhos (p = 0,045) e escolaridade dos pais (p = 0,045). Após regressão logística, a enurese primária manteve-se associada à duração do aleitamento materno exclusivo e à história familiar positiva de enurese. O razão de chances foi calculado e revelou que o aleitamento materno exclusivo por período menor do que quatro meses aumentou 3,35 vezes a chance de a criança tem enurese quando comparadas àquelas amamentados por um período igual ou superior a este (IC 95%: 1,99-9,50). Conclusão: Este estudo confirmou a associação entre enurese primária e história familiar positiva de enurese. Um novo fator, a duração do aleitamento materno exclusivo por período inferior a quatro meses, foi associada com enurese primária. A duração do aleitamento materno, número de filhos, ordem de nascimento e grau de escolaridade do chefe da família não foram associados com enurese primária. / Introduction: Enuresis is defined as an intermittent urinary incontinence during sleep, and is considered a disease to children who are at least 5 years old. Several factors have been demonstrated to be associated with primary enuresis. Studies indicate that the risk of having enuresis declines with increasing age, it is more common among boys than girls and among individuals from lower socioeconomic levels. Furthermore, other studies highlight the importance of hereditary factors. Although the relationship between enuresis and breastfeeding is still poorly documented in the literature, a possible association is speculated since both are strongly associated with children's development. In this context, the main objective of this study was to evaluate whether there is an association between primary enuresis and the duration of exclusive breastfeeding and the duration of breastfeeding. Methods: This is an observational, case-control study, involving 200 infants from 6 to 14 years old, which were divided into two groups, enuresis group (EG), composed of 100 children with primary enuresis and the control group (CG) of 100 matched children without enuresis. The matching criteria were gender, age and socioeconomic level. Adults responsible for each infant answered a structured questionnaire to identify biological and behavioral factor, as well as the duration of maternal breastfeeding. Children whose parents couldn't comprehend the questionnaire or children with neurological, psychiatrically or secondary enuresis were not included in the study. Results: In each group there were 37 females and 63 male (p=1.0). The mean age were similar in both groups 8,81 ± 2,42 (p=1.0), as well as the socio-economic level (p=0.82). In bivariate analysis, there was a strong association between symptoms of enuresis to a positive family history of enuresis and duration of exclusive breastfeeding (p <0.001), also was associated with full breastfeeding duration (p=0.044), number of children (p=0.045) and parents' education (p=0.045). After logistic regression, primary enuresis continued associated with duration of exclusive breastfeeding and family history of enuresis. The odds ratio was calculated and found that exclusive breastfeeding for less than four months increased 3.35 times the chance of the child has enuresis when compared to those breastfed for a period equal to or exceeding this [1.99- 9.50] 95%CI. Conclusions: This study confirmed the association between primary enuresis and family history of enuresis. A new factor, the duration of exclusive breastfeeding for less than four months, was associated with primary enuresis. The duration of breastfeeding, number of children, birth order and educational level of household head were not associated with primary enuresis.

INTRODUÇÃO: A fibromialgia (FM) foi definida pelo American College of Rheumatology (ACR) em 1990 como a presença de dor crônica e difusa de origem musculoesquelética nos quatro quadrantes e esqueleto axial associada à presença de pelo menos 11 de 18 tender points. Em 2010 uma revisão dos critérios diagnósticos apontou para outros sintomas, como o sono não reparador, dor de cabeça e depressão. A prevalência dos distúrbios do assoalho pélvico é alta e causa impacto negativo na qualidade de vida das mulheres, entretanto existem poucos estudos com esse enfoque em fibromiálgicas. OBJETIVO: Avaliar a força do assoalho pélvico, perda urinária e desempenho sexual em mulheres com fibromialgia e verificar se existe associação entre a FM e a incontinência urinária (IU). MÉTODO: Foram avaliadas 128 mulheres com idade entre 19 e 65 anos distribuídas em dois grupos, sendo um com diagnóstico médico de fibromialgia (GFM) e outro sem fibromialgia (GS). A avaliação foi realizada em um único encontro e com o mesmo avaliador, na qual foram obtidos dados pessoais e ginecológicos, características da incontinência urinária, avaliação do assoalho pélvico segundo o Esquema PERFECT e perineometria, aplicação do King Health Questionnaire (KHQ) para mulheres incontinentes e do questionário Quociente Sexual - Versão Feminina (QS-F). RESULTADOS: As mulheres GFM apresentaram menor grau de força muscular no esquema PERFECT (p < 0,001) e na perineometria (p=0,04). A IU foi frequente nas fibromiálgicas (p < 0,001). As mulheres do GFM tiveram pior desempenho no KHQ nos domínios Saúde Geral (p < 0,001) e sono/ energia (p < 0,003) e quanto ao escore total do QS-F (p<0,001). CONCLUSÃO: A incontinência urinária é frequente nas mulheres com fibromialgia, e está relacionada com o grau de força dos músculos do assoalho pélvico, afetando negativamente sua qualidade de vida, principalmente no que diz respeito a saúde geral e sono/ energia, afetando ainda seu desempenho sexual. / INTRODUCTION: In 1990, fibromyalgia (FM) was defined by the American College of Rheumatology as chronic and widespread pain of musculoskeletal origin in the four quadrants and axial skeleton associated with the presence of 11 of the 18 tender points. The fibromyalgia studies were focused on pain, but a 2010 review of the diagnostic criteria pointed to other symptoms such as non-repairing sleep, headache and depression. The prevalence of pelvic floor disorders is high and has a negative impact on women\'s quality of life, however there are few studies with this focus on women with fibromyalgia. OBJECTIVE: To assess the strength of the pelvic floor, urinary loss and sexual performance in women with fibromyalgia and to verify if there is an association between FM and urinary incontinence (UI). METHOD: A total of 128 women aged 19 to 65 years old were distributed in two groups, one group of 62 that were diagnosed with fibromyalgia (GFM) and one group of 64 that were not (GS). Data were collected in a single meeting with the same evaluator and included personal data, clinical data, and information about urinary tract symptoms, pelvic floor assessment was according to the PERFECT Scheme and perineometry. The King\'s Health Questionnaire was given to women who reported urinary leakage and Sexual Quotient - Female Version questionnaire (QS-F) for sexually active women. RESULTS: GFM women presented lower muscle strength in the PERFECT scheme (p < 0.001) and in perineometry (p=0.04). UI was frequent in GFM (p < 0.001). GFM women had poorer KHQ performance in the General Health (p < 0.001) and Sleep/Energy domains (p < 0.003) and QS-F final score (p < 0.001). CONCLUSION: UI is frequent in women with fibromyalgia and is related to pelvic floor muscle strenght, negatively affecting their quality of life, especially regarding general health and sleep/ energy, also affecting their sexual performance

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-20T20:10:21Z No. of bitstreams: 1 Erica Feio Carneiro Nunes.pdf: 1021018 bytes, checksum: 040c57768f7aed071b8aa73bd056ade6 (MD5) / Made available in DSpace on 2018-07-20T20:10:21Z (GMT). No. of bitstreams: 1 Erica Feio Carneiro Nunes.pdf: 1021018 bytes, checksum: 040c57768f7aed071b8aa73bd056ade6 (MD5) Previous issue date: 2018-03-06 / Contextualization: Weakening of pelvic floor muscles (PMFs) has been considered a major cause of stress urinary incontinence (SUI). In this way, the physiotherapeutic treatment, classically, turned to the strengthening of these muscles. In this study it was hypothesized that, in addition to PMFs weakness, this dysfunction may also be related to a change in the pattern of reflex response of these muscles. Objective: The study objectives were to compare the contraction response time and strength of cough-induced PMFs among continents and SUI women, and to conduct a literature review on the use of biofeedback for pelvic floor muscle training in women with this dysfunction. Methods: Study II: A systematic review was conducted with a search of the databases Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL and LILACS for randomized clinical trials that had biofeedback (BF) as a therapeutic tool for SUI. Study II: This was a cross-sectional study that evaluated the cough PMFs of 20 healthy women and 20 women with SUI. The clinical evaluation consisted of the application of questionnaires that assessed the severity of urinary incontinence and quality of life. Signal capture was performed with a 4-channel acquisition system (EMG System do Brasil Ltda®) to capture the signals obtained through vaginal dynamometry, electromyography (EMG) of the right external obliquus muscle and accelerometry. Statistical analysis was performed using the Shapiro-Wilk, independent t test or Mann-Whitney test according to the data distribution and the covariance analysis (ANCOVA) with post hoc Bonferrone test. The statistical significance considered for all tests was p <0.05. Results: Study I: the training of the PMFs with BF was not better than the control group (without training and orientation, vaginal electrical stimulation). However, these contradictory results and poor quality of the studies are probably not clinically significant. Study II: the contraction response of the PMFs was significantly different between the groups for the activation time of the PMFs (F = 19.51, P <0.0001, p2= 0.61), external oblique muscle activation time (F = 11.41, P <0.002, p2= 0.23) and time of the cough pulse (F = 4.21, P <0.04, p2= 0.10). Conclusion: The systematic review provides evidence that the training of BF-PMFs does not offer superior therapeutic benefits to other types of interventions in the treatment of female SUI. The cross-sectional study showed that women with SUI have delayed cough-induced contraction of PMFs. / Contextualização: O enfraquecimento dos músculos do assoalho pélvico (MAPs) tem sido considerada uma das principais causas da incontinência urinária por esforço (IUE). Dessa maneira, o tratamento fisioterapêutico, classicamente, se voltou para o fortalecimento desses músculos. Nesse estudo foi hipotetizado que, além da fraqueza dos MAP, essa disfunção também pode estar relacionada à uma alteração no padrão de resposta reflexa desses músculos. Objetivo: Os objetivos deste estudo foram comparar o tempo de resposta da contração e a força dos MAPs induzidos pela tosse entre mulheres continentes e com IUE e, realizar uma revisão de literatura sobre o uso do biofeedback para treinamento muscular do assoalho pélvico em mulheres com essa disfunção. Métodos: Estudo I: Foi realizada uma revisão sistemática com uma busca nas bases de dados Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL e LILACS por ensaios clinicos randomizados que tivessem o biofeedback (BF) como instrumento terapeutico para a IUE. Estudo II: Esse foi um estudo transversal que avaliou os MAPs durante a tosse de 20 mulheres saudáveis e 20 mulheres com IUE. A avaliação clínica consistiu na aplicação dos questionários que avaliaram a gravidade da incontinência urinária e a qualidade de vida. A captação dos sinais foi realizada com um sistema de aquisição com 4 canais (EMG System do Brasil Ltda®) para captar os sinais obtidos por meio da dinamometria vaginal, da eletromiografia (EMG) do músculo obliquo externo direito e da acelerometria. Para análise estatística foram utilizados os testes de Shapiro-Wilk, t independente ou Mann-Whitney test de acordo com a distribuição dos dados e a análise de covariância (ANCOVA) com test post hoc de Bonferrone. A significância estatística considerada para todos os testes foi de p<0,05. Resultados: Estudo I: o treinamento dos MAPs com BF não foi melhor do que o grupo controle (sem treinamento e orientação, estimulação elétrica vaginal). No entanto, estes resultados contraditórios e a má qualidade dos estudos provavelmente não são clinicamente significativos. Estudo II: A resposta de contração dos MAPs foi significativamente diferente entre os grupos para o tempo de ativação dos MAPs (F=19.51, P <0.0001,p2=0.61), Tempo de ativação do músculo obliquo externo (F=11.41, P < 0.002, p2=0.23) e tempo do pulso da tosse (F=4.21, P < 0.04, p2=0.10). Conclusão: A revisão sistemática fornece evidências de que a treinamento dos MAPs com BF não oferece benefícios terapêuticos superiores a outros tipos de intervenções no tratamento da IUE feminina. O estudo tranversal mostrou que mulheres com IUE apresentam atraso na resposta da contração dos MAPs induzidos pela tosse.

Bakgrund: I Sverige drabbas cirka 10 000 män per år av prostatacancer och av dessa är det cirka 3000 som genomgår en radikal prostatektomi. Vanliga komplikationer som uppstår efter operationen är erektil dysfunktion och urininkontinens. Detta kan medföra att livskvalitet påverkas och ett lidande kan uppstå. Sjuksköterskan har en betydande roll för att främja livskvaliteten och lindra lidande. Syfte: Syftet var att belysa mäns upplevelser av sexuell hälsa och urininkontinens efter en radikal prostatektomi. Metod: En analys av narrativer med kvalitativ ansats av fyra självbiografier. Resultat: Resultatet består av fem teman: Känsla av att mista kontroll, känsla av sexuell uppgivenhet, att våga vara öppen om sina känslor, när lusten äventyras och att känna hoppfullhet. Det är tydligt att den sexuella hälsan och urininkontinens är det som påverkar männens livskvalitet mest efter operationen. De känner en rädsla för att förbli impotenta och inkontinenta. Slutsats: Det framkommer att män inte pratar om den sexuella hälsan och urininkontinens vilket leder till att de kan känna sig ensamma med sina problem. Genom att öka medvetenheten kring området kan det främja männens livskvalitet och lindra lidande. Via denna studie har författarna förhoppningen om att hälso- och vårdpersonal ska få en djupare förståelse för hur det är att leva med dessa komplikationer och hur de på bästa sätt ska bli bemötta vid kontakt med vården. Samt att information är en viktig aspekt att beakta. / Background: In Sweden, there are about 10 000 men per year who suffer from prostate cancer and of these, about 3000 of them undergo radical prostatectomy. Common complications that occur after surgery are erectile dysfunction and urinary incontinence, affecting the quality of life and suffering can occur. The nurse has a significant role to play in promoting quality of life and relieving suffering. Purpose: This study aimed to describe how men experience their sexual health and urinary incontinence after radical prostatectomy. Method: An analysis of narratives with a qualitative approach of four autobiographies. Results: The results consist of five themes: Feelings of losing control, feeling of sexual resignation, to dare to be open about feelings, when lust and erection fail and feeling hopefulness. Sexual health and urinary incontinence affects men’s quality of life after the surgery. They have a feeling of fear that they will remain impotent and incontinent for therest of their lives. Conclusion: It turns out that men do not talk about sexual health and urinary incontinence, leading to feelings of lonliness with their problems. By raising awareness around the area, it can promote men’s quality of life and alleviate suffering. Through this study, the authors hope that health care professionals will gain a deeper understanding of what it is like to live with these complications and how they will best be dealt with in contact with healthcare. Furthermore, that information is an important aspect to consider.

Introduction: Intrinsic and extrinsic urethral factors play a significant role in urinary continence mechanism in women. Urethral wall structure including inervation, perfusion of submucosal layer etc. is not clinically assessed despite its important role in urethral closure function. The association of incontinence and pelvic floor reconstructive surgery is well known. Every postoperative healing process is associated with factors of ischemia and neovascularisation. According those facts we would expect that the healing and scaring should involve intrinsic urethral mechanism. After reconstructive surgery Implants further increase scaring process. Methods: In our study we included patients with anterior compartment defect. We randomized patients into three interventional arms according the surgical approach and use of implants. Before and 3-5 month after the surgery we performed urodynamic studies and pelvic floor ultrasound examination, including Doppler for urethral perfusion assessment. Another early ultrasound scan was added forth day after surgery. We correlated ultrasound and urodynamic parameters. Results: We randomized 87 patients. We couldn't find any correlation between the morphologic changes and severity of incontinence. Methods for urethral perfusion assessment showed high inaccuracy...

Résumé : Introduction : Parmi les structures anatomiques impliqués dans la statique pelvienne, la continence urinaire et anale, le muscle élévateur de l’anus (MEA), le sphincter urétral (SU) et son innervation ont un rôle déterminant. Au cours de la grossesse, de l’accouchement par voie vaginale, de la chirurgie radicale pelvienne, des lésions des muscles du plancher pelvien ou de son innervation peuvent survenir. Ces lésions sont à l’origine de dysfonctions du plancher pelvien telle que le prolapsus uro-génital ou l’incontinence urinaire. Une meilleure connaissance de l’anatomie musculaire et nerveuse pelvi-périnéale est nécessaire pour diminuer la survenue et traiter ces troubles fonctionnels. Classiquement les muscles du plancher pelvien sont décrits comme entièrement striés sous contrôle somatique (nerf du MEA et/ou nerf pudendal (NP)). La dissection Anatomique Assisté par Ordinateur (DAAO) en utilisant des marqueurs nerveux et musculaires spécifiques peut aujourd’hui compléter les données établies par la dissection conventionnelle classique de sujets anatomiques.Objectif : L’objectif était de décrire l’innervation (origine, topographie, trajet, rapports, fonction) et la structure musculaire du MEA, de décrire l’innervation (origine, topographie, trajet, rapports, fonction) du sphincter urétral pour mettre en perspective les implications potentielles dans les dysfonctions du plancher pelvien.Méthodes : Nous avons étudié 9 fœtus humains (6 féminins et 3 masculins). Des coupes histologiques sériées de 5 µm d’épaisseur ont été effectuées dans les régions pelviennes de 7 fœtus âgés de 18 à 40 semaines de gestation. Pour chaque niveau de coupe, des lames ont été colorées puis traitées en immunohistochimie pour détecter : l’ensemble des fibres nerveuses (anticorps anti-protéine S100), les fibres autonomes cholinergiques (anti-VAChT), les fibres autonomes adrénergiques (anti-TH), les fibres autonomes nitrergiques (anti-nNOS), les fibres somatiques (anti-PMP 22), les fibres sensorielles (anti-CGRP), les fibres musculaires lisses (anti-SMA) et les fibres musculaires striées (anti-MYOG). Les coupes ont ensuite été numérisées par un scanner de haute résolution optique et les images ont été reconstruites en 3D avec le logiciel Winsurf®. Un fœtus additionnel a été entièrement destiné à réaliser de la microscopie électronique afin de confirmer nos résultats au niveau architectural musculaire.Résultats : Nous avons observé une innervation à la fois autonome (plexus hypogastrique inférieur (PHI)) et somatique (nerf du MEA et NP) du MEA. Nous avons individualisé des zones de cellules musculaires lisses au sein du plancher pelvien notamment de la partie médiane sous contrôle autonome (PHI) que nous nommons « compartiment médian musculaire lisse ».Nous avons systématisé le plancher pelvien musculaire en une zone médiale lisse sous contrôle nerveux autonome réalisant une interface entre les viscères pelviens, et une zone musculaire striée latérale sous contrôle nerveux somatique.Enfin, nous avons mis en évidence une double innervation à la fois somatique et autonome du sphincter urétral.Conclusion : La DAAO a permis de mettre en évidence une innervation pelvi-périnéale complexe avec l’intrication du système nerveux somatique et autonome. La fonction du contingent musculaire lisse pelvien reste à préciser. / Abstract : Levator ani muscle (LAM), urethral sphincter (US), and their innervation play a major role in pelvic status, urinary continence and anal continence. During pregnancy, vaginal delivery, pelvic radical surgery, damage of pelvic floor muscles or of their innervation may occur. These lesions are responsible for pelvic floor dysfunction such as urogenital prolapse or urinary incontinence. Better knowledge of pelvi-perineal muscle and nerve anatomy is needed to reduce the occurrence and treat these pelvic floor dysfunctions. Classically pelvic floor muscles are described as entirely striated under somatic control (levator ani nerve (LAN) and /or pudendal nerve (PN)). Computer Assisted Anatomical Dissection (CAAD) using specific nerve and muscle markers can nowadays complete data established by conventional dissection of anatomical subjects.The objective was to describe the innervation and the muscular structure of the levator ani muscle, to describe nerve supply of the urethral sphincter in order to better understand pelvic floor dysfunction.Methods : We studied nine human fetuses (6 female and 3 male). Serial histological sections of 5 μm of thickness were performed in the lumbar and pelvic regions of seven human fetuses aged 18 to 40 weeks of gestation. For each level, slides were stained and then treated in immunohistochemistry to detect: general nerve fibers (anti-protein S100), autonomic cholinergic fibers (anti-VAChT), autonomic adrenergic fibers (anti-tyrosine hydroxylase), autonomic nitrergic fibers (anti-nNOS), somatic nerve fibers (anti-peripheral myelin protein 22), sensory fibers (anti-CGRP), smooth muscle fibers (anti-SMA) and striated muscle fibers (anti-MYOG). The slides were then digitized by a high-resolution optical scanner and the images were reconstructed in 3D using the Winsurf® software. One fetus was entirely reserved for electronic microscopy in order to confirm our results.Results: We observed that LAM innervation is supplied by both autonomic (inferior hypogastric plexus (IHP)) and somatic (LAN and PN). We have individualized areas of smooth muscle cells in the pelvic floor, particularly the median part controlled by the autonomic system that we named “smooth muscle medial compartment”.We systematized within the pelvic floor muscle a smooth medial part under an autonomic nervous control as interface between the pelvic viscera and a lateral striated muscle part under somatic nervous control.Finally, we have demonstrated a dual innervation both somatic and autonomic sphincter urethral.Conclusion : CAAD has demonstrated complex pelvic-perineal innervation with the interaction of the somatic and autonomic nervous system. The function of the pelvic smooth muscle contingent remains to be clarified.

Urininkontinens är ett folkhälsoproblem och förekomsten ökar med stigande ålder. Tidigare forskning visar att äldre kvinnor upplever urininkontinens som skamligt samt ser tillståndet som en oundviklig del av naturligt åldrande. Urininkontinens upplevs besvärande att prata om vilket medför att få äldre kvinnor söker vård. Distriktssköterskan har med sin kompetens om urininkontinens samt vårdande samtal möjlighet att möta den äldre kvinnans livsvärld. Syftet var att belysa äldre kvinnors erfarenheter av att leva med urininkontinens. En systematisk litteraturöversikt med induktiv ansats genomfördes och tio kvalitativa artiklar analyserades enligt Popeone, Langius-Eklöf, Stenwall och Jervaeus (2021) analysmetod. Analysen resulterade i en huvudkategori och fyra kategorier med två till tre underkategorier. Huvudkategorin var stigmatiseringen kring urininkontinens tycks påverka äldre kvinnors livsvärld och kategorierna följande: samspel av känslor kring urininkontinens, betydelsen av påverkan på det dagliga livet, betydelsen av hälso- och sjukvårdens agerande samt strategier för att hantera urininkontinens. Ur resultatet framkom det att urininkontinens är stigmatiserat och påverkar den äldre kvinnans livsvärld, främst genom en förändrad självbild och isolering. Resultatet visar vidare att vården både kan ge stöd och orsaka lidande beroende på bemötande. Sammanfattningsvis kan det konstateras att genom ett vårdande samtal med livsvärlden i fokus kan distriktssköterskan möta den äldre kvinnan ur ett holistiskt perspektiv, vilket kan leda till att värdighet och autonomi bevaras samtidigt som stöd erbjuds. Översikten kan vara av värde för fortsatt reflektion hos distriktssköterskor som möter äldre kvinnor med urininkontinens. / : Urinary incontinence is a public health problem, and the incidence increases with age. Previous research shows that older women experience urinary incontinence as shameful and see the condition as an inevitable part of natural aging. The condition is therefore perceived as troublesome to talk about, which means that few older women seek care. With the expertise in urinary incontinence and caring communication, the district nurse can meet the older women’s lifeworld. The aim was to shed light on older women's experiences of living with urinary incontinence. A systematic literature review with an inductive approach was carried out and ten qualitative articles were analyzed according to Popeone, Langius-Eklöf, Stenwall and Jervaeus (2021) analysis method. The analysis resulted in one main category and four categories with two to three subcategories. The main category was the stigma surrounding urinary incontinence seems to affect the life world of older women and the categories were as follows: interplay of feelings around urinary incontinence, the importance of the impact on daily life, the importance of the healthcare system's actions and strategies for managing urinary incontinence. The results showed that urinary incontinence is stigmatized and affects the older woman's lifeworld, mainly through a changed self-image and isolation. Healthcare can both provide support and cause suffering depending on the treatment. In summary, it can be stated that through a caring conversation with the life world in focus, the district nurse can meet the older woman from a holistic perspective, which can lead to dignity and autonomy being preserved while offering support. The results may be of value for continued reflection by district nurses who meet older women with urinary incontinence.

Förekomsten av urininkontinens ökar med åldern. Fler blir idag äldre än förut vilket tyder på att urininkontinens är ett växande problem. Inkontinensskydd är oftast den mest prioriterade åtgärder vilket medför ökade samhällskostnader och ökad klimatpåverkan. Distriktssköterskor inom hemsjukvård bör vid utredning, åtgärd och behandling av urininkontinens sträva efter ett hållbart och hälsofrämjande arbetssätt.   Syftet var att undersöka distriktssköterskors upplevelser gällande utredningar, behandlingar och åtgärder av äldre personers urininkontinens i hemsjukvård. Kvalitativ metod och innehållsanalys med induktiv ansats användes. Semi-strukturerade enskilda och fokusgruppsintervju utfördes. 16 kvinnliga distriktssköterskor (eller sjuksköterskor med förskrivningsrätt) från 11 kommuner inom södra Sverige deltog.   Resultatet visade att utredning av urininkontinens inte upplevdes tillhöra hemsjukvårdens uppdrag.  Ålder samt tids- och personalbrist beskrevs utgöra ett hinder för erbjudande om andra åtgärder och behandlingar än förskrivning av inkontinensskydd. Utprovning av inkontinensskydd skedde utifrån andrahandsinformation vilket gav distriktssköterskor en känsla av att gissa vid ordination av inkontinensskydd.   Individuellt utprovade inkontinensskydd var önskvärt och kunde minska belastningen för miljö och ekonomi. Distriktssköterskorna hanterade äldres urininkontinens genom förskrivning av inkontinensskydd. För att kunna erbjuda utredning samt andra åtgärder och behandlingar än förskrivning behövs resurser i form av mer tid och personal. / The incidence of urinary incontinence increases with age. More people gets older than before, which indicates that urinary incontinence is a growing problem. Incontinence protection is often the most prioritized action, which entails increased societal costs and climate impact.  District nurses within home healthcare should strive for sustainable and health-promoting efforts during management of urinary incontinence.   The purpose was to investigate district nurses' experiences regarding management of older people's urinary incontinence in home healthcare. Qualitative method and content analysis with an inductive approach were used. Semi-structured individual and focus group interview were conducted. 16 female district nurses (or nurses with prescribing rights) from 11 municipalities in southern Sweden participated.   Investigation of urinary incontinence was not felt to be part of the mission of home healthcare. Age and resource shortages were described as an obstacle to offering other management than prescribing incontinence protection. Trial of incontinence protection consisted of secondary information, which gave a sense of guesswork when prescribing incontinence protection.    Individually customized incontinence protection was desirable and could reduce the burden on the environment and economy. The elderly´s incontinence was managed by prescribing incontinence protection. To offer investigation, actions and treatments, other than prescription, more resources are needed.

Bakgrund: Urininkontinens är ett vanligt förekommande besvär hos kvinnor i världen. Äldre kvinnor är den grupp som främst drabbas och orsakerna till detta kan variera. Tidigare forskning visar att leva med urininkontinens påverkar livskvalitén negativt och är förknippat med en känsla av skam. Distriktssköterskor inom primärvården har som uppgift att ge vård till äldre kvinnor med urininkontinens. Syfte: Syftet var att belysa distriktssköterskans upplevelser av att möta äldre kvinnliga patienter med urininkontinens i primärvården. Metod: En kvalitativ intervjustudie genomfördes och informanterna bestod av åtta distriktssköterskor. Analysen av intervjuerna gjordes utifrån en kvalitativ innehållsanalys enligt Graneheim och Lundman. Resultat: De tre huvudkategorierna som framkom var: I mötet med den äldre kvinnan, distriktssköterskans utmaningar i mötet och organisationens utformning. I mötet med den äldre kvinnan beskrivs subkategorierna att känna sig tillräcklig och att kunna ge stöd. I distriktssköterskans utmaningar i mötet beskrivs synen på urininkontinens, hur svårt det kan vara att prata om ämnet och en känsla av att inte räcka till. Organisationens utformning handlar om bristen av tillgång på distriktssköterska med inkontinensansvar, att urininkontinens inte prioriteras inom primärvården samt önskan om mer kunskap inom området.  Slutsats: Distriktssköterskan upplever att det är viktigt att ge stöd till den äldre kvinnan med urininkontinens. Enligt distriktssköterskorna saknar de kunskap inom ämnet. Att arbeta med urininkontinens kan vara utmanande men det finns också möjligheter att kunna hjälpa kvinnan och ge stöd. / Background: Urinary incontinence is a common issue among women worldwide. Older women are most commonly affected, and the causes are varied. Previous research shows that living with urinary incontinence has a negative impact on quality of life as well as being associated with feelings of shame. District nurses working in primary health care are tasked with providing care to older women with urinary incontinence.  Aim: The aim of the study was to shed light upon the experiences of district nurses when encountering older women with urinary incontinence within primary health care. Method: A qualitative interview study was conducted, with eight district nurses serving as informants. The interviews were analyzed using a qualitative content analysis following the method of Graneheim and Lundman.  Results: Three main themes were identified: The encounter with the older woman, the district nurse's challenges during the encounter and the structure of the organization. In the encounter with the older woman, the subcategories feeling adequate and being able to provide support are described. In the district nurse's challenges during the encounter, the perception of urinary incontinence, the difficulty of approaching the subject as well as a feeling of inadequacy are described. The structure of the organization adress the lack of access to continence nurses, urinary incontinence not being prioritized as an issue within primary health care and a desire to gain more knowledge in the field. Conclusion: District nurses feel that providing support to older women with urinary incontinence is essential. According to the district nurses, they lack knowledge on the subject. Working with urinary incontinence can be challenging, but also provides opportunities to assist and provide support to the women affected by it.