Introdução: A incontinência urinária feminina é um problema médico e social de grande impacto na qualidade de vida das pacientes. Não há pesquisas sobre os exercícios resistidos como opção de tratamento da IU através do fortalecimento muscular globalizado, mas já há evidências do aumento de força, contração muscular e propriocepção, proporcionado neste tipo de exercício. Objetivo: Observar o efeito dos exercícios resistidos globalizados nas queixas de perdas urinárias e/ou melhora do controle miccional, de um grupo de mulheres com incontinência urinária. Métodos: Realizamos um estudo clínico, prospectivo não controlado com vinte pacientes que foram submetidas ao treinamento resistido, duas vezes na semana por um período total de três meses. Os instrumentos para avaliação foram o diário miccional, questões subjetivas e o exame urodinâmico (todos com intervenção pré e pós tratamento para análise comparativa). Resultados: os resultados obtidos revelaram uma melhora estatisticamente significante nos episódios de perda urinária, volume e troca de protetor/ dia (p<0,001), além da melhora referida em 85% das participantes e todas fariam novamente o treinamento. Porém, não houve resultados estatisticamente significativos no exame urodinâmico Conclusão: Os exercícios resistidos mostraram-se seguros e eficazes na melhora clínica das pacientes, podendo ser uma opção de tratamento mais barato e acessível, podendo diminuir o índice de desistência apresentado pelas pacientes que se submetem aos tratamentos com exercícios perineais habituados. Porém é necessária a realização de novas pesquisas na área / Introduction: Incontinence is a medical problem of great impact on quality of life of patients. There is no research on resistance exercise as a treatment option through the UI muscle strengthening globalization, but there is already evidence of increased strength, proprioception and muscle contraction, providing this type of exercise. Objective: To observe the effect of globalized resistance training in complaints of urinary incontinence and / or bladder control improvement in a group of women with urinary incontinence. Methods: We performed a clinical, prospective, uncontrolled study with twenty patients who were subjected to resistance training twice a week for a total period of three months. The measurement tools were the voiding diary, urodynamic and subjective questions (all with pre and post treatment intervention for comparative analysis). Results: The results revealed a statistically significant improvement in episodes of urinary leakage, and volume change of guard / day (p <0.001) than the improvement reported in 85% of all participants and would re-training. However, no statistically significant urodynamic. Conclusion: The resistance exercises were shown to be safe and effective in clinical improvement of patients and may be a cheaper and more accessible option of treatment, which may reduce the dropout rate presented by patients who undergo the treatments with perineal exercises used. However, it is necessary to conduct further research in the area

O conhecimento acerca dos músculos do assoalho pélvico (MAP) entre mulheres é baixo e muitos motivos podem acarretar essa falta de conhecimento, como falta de acesso aos fóruns de saúde e educacionais, constrangimento ao falar sobre o assunto e preocupação com o estigma social. Essas mulheres ainda convivem com o sofrimento físico e emocional, como depressão, perda da autoestima e isolamento social desencadeado pelas disfunções dos MAP, sendo a incontinência urinária (IU) a mais prevalente entre as disfunções. Além disso, as mulheres também não apresentam boa função dos MAP. O objetivo deste estudo foi avaliar o conhecimento sobre os MAP e sua relação com a capacidade de contrair estes músculos e do conhecimento com os relatos de IU. Trata-se de um estudo observacional transversal. Para verificar os objetivos foram utilizados o questionário de conhecimento sobre os MAP, a palpação e a manometria vaginal e o questionário ICIQ-IU-SF. As análises estatísticas foram realizadas utilizando o software estatístico SAS 9.4 Software. As variáveis foram apresentadas em forma descritivas. O coeficiente de correlação de Pearson foi utilizado para testar a associação entre o conhecimentos sobre os MAP e idade, IMC, paridade, pico, média e resistência dos MAP e escore do ICIQ-UI-SF. O teste exato de Fisher foi utilizado para comparar o conhecimento dos MAP com as variavéis qualitativas. Os valores de p<=0,05 foram considerados estatisticamente significativos. Foram recrutadas 160 mulheres da cidade de Ribeirão Preto, destas 27 não comparecem para avaliação e 133 foram incluídas na pesquisa. A média de idade das mulheres foi de 53,3 (±13,82), 73 (54,9%) eram casadas, 84 (63,2%) brancas, 65 (48,8%) com menos de 8 anos de escolaridade, 107 (80,5%) multíparas, 83 (62,4%) apresentam queixas de sintomas de IU e 123 (92,5%) não realizaram o treinamento dos MAP. As mulheres apresentaram um baixo conhecimento sobre os MAP. A média do escore do questionário de conhecimento sobre os MAP foi de 0,48 (±0,97). Observou-se que 23,3% da amostra não foi capaz de contrair voluntariamente os MAP. Os valores de pico, média e duração da manometria vaginal foram 39,1 cmH2O (±23,7), 25,5 cmH2O (±16,1) e 21,1 segundos (±20,8), respectivamente. A média do escore do ICIQ-IU-SF foi de 7.1 (± 6,8). Entre as 40,6% de mulheres que demonstraram a capacidade de contrair os MAP, nenhuma possuía conhecimento sobre os MAP. Não foi encontrada relação entre o conhecimento e a capacidade de contração dos MAP e entre o conhecimento e os sintomas de IU. Porém foi encontrado uma correlação entre o conhecimento sobre os MAP e idade (r: -0,2044/ p: 0,01), entre conhecimento e paridade (r: -0.19568/ p: 0.02) e uma associação entre o conhecimento e anos de escolaridade (p: 0,0012) e entre conhecimento e o treinamento dos músculos do assoalho pélvico prévio (p: <0,001). / Knowledge about pelvic floor muscles (PFM) among women is low and many reasons can lead to this lack of knowledge, such as lack of access to health and educational forums, embarrassment in talking about this topic and concern with social stigma. These women still live with physical and emotional suffering, such as depression, loss of self-esteem and social isolation triggered by PFM dysfunctions, with urinary incontinence (UI) being the most prevalent among dysfunctions. In addition, women also lack good function of the PFM. This study aims to evaluate the knowledge about the PFM and its relation with the capacity to contract these muscles, and of the relation of knowledge with UI reports. This is an observational cross-sectional study. To verify the objectives, the knowledge questionnaire related to PFM, palpation and vaginal manometry and the ICIQ-UI-SF questionnaire were used. Statistical analyzes were performed using statistical software SAS 9.4 Software. The variables were presented in descriptive form. The Pearson correlation coefficient was used to test the association between knowledge on PFM and age, BMI, parity, peak, mean and resistance of PFM and ICIQ-UI-SF score. Fisher\'s exact test was used to compare knowledge of the PFM with qualitative variables. Values of p<=0.05 were considered statistically significant. A total of 160 women were recruited from the city of Ribeirão Preto, of whom 27 did not attend the evaluation and 133 were included in the study. The mean age of the women was 53.3 (± 13.82), 73 (54.9%) were married, 84 (63.2%) were white, 65 (48.8%) attended school less than 8 years, 107 (80.5%) were multiparous, 83 (62.4%) presented complaints of UI symptoms and 123 (92.5%) had never performed PFM training. The women showed a low level of knowledge about the PFM. The mean score of the PFM knowledge questionnaire s was 0.48 (± 0.97). It was observed that 23.3% of the sample was not able to voluntarily contract their PFM. The values of peak, mean and duration of vaginal manometry were 39.1 cmH2O (± 23.7), 25.5 cmH2O (± 16.1) and 21.1 seconds (± 20.8), respectively. The mean ICIQ-UI-SF score was 7.1 (± 6.8). Among 40.6% of women who demonstrated the ability to contract their PFM, none had knowledge about it. No relationship was found between the knowledge and the contraction capacity of the PFM and between the knowledge and symptoms of UI. However, a correlation was found between knowledge about the PFM and age (r: -0,2044/ p: 0,01), between knowledge and parity (r: -0.19568/ p: 0.02) and an association was found between knowledge and years of education (p: 0,0012), and between knowledge and previous pelvic floor muscle training (p: <0,001).

Orientador: Paulo Cesar Rodrigues Palma, Viviane Herrmann / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T10:39:24Z (GMT). No. of bitstreams: 1 Bellette_PatriciaOdila_M.pdf: 1141308 bytes, checksum: 2b1b008fc3d9ef462a5114d38968193e (MD5) Previous issue date: 2007 / Resumo: O objetivo deste estudo foi avaliar a eficácia da eletroestimulação do nervo tibial posterior em mulheres com hipótese diagnóstica de Bexiga Hiperativa e suas repercussões na qualidade de vida. Sujeitos e métodos: para este ensaio clínico prospectivo, controlado e randomizado foram convidadas a participar do estudo 37 mulheres consultadas no ambulatório de uro-ginecologia do Hospital das Clínicas (HC) da UNICAMP, que cumpriram os critérios de inclusão e exclusão. Foram aleatoriamente alocadas em dois grupos. Grupo tratamento: as mulheres foram tratadas com o uso da eletroestimulação transcutânea do nervo tibial posterior (n = 21) e Grupo placebo: as mulheres tiveram os eletrodos alocados, mas sem passagem de corrente elétrica (n = 16). No primeiro contato com a paciente foi feito o convite para participar do estudo e realizada uma avaliação fisioterapêutica, incluindo preenchimento do diário miccional de três dias e dos questionários de qualidade de vida (ICIQ, KHQ e OABq). Na aplicação da técnica utilizou-se oito sessões de eletroestimulação transcutânea do nervo tibial posterior. Resultados: A noctúria apresentou melhora significativa no grupo tratamento (p=0,003) e uma tendência de maior melhora no grupo tratado (p=0,054). A frequência urinária diminuiu significativamente no grupo tratamento (p=0,003) e a urgência miccional diminuiu também em ambos os grupos (placebo:p=0,025 e tratamento:p=0,002). Com relação aos questionários utilizados, apenas o OABq foi responsivo, tanto no escore total (p=0,037), quanto no escore severidade (p=0,018). Conclusão: A eletroestimulação transcutânea do nervo tibial posterior é uma ferramenta eficaz no tratamento fisioterapêutico da Bexiga Hiperativa. / Abstract: The aim of this study was to evaluate the effect of the electrical stimulation of the posterior tibial nerve on the quality of life in women with overactiv bladder syndrome. Subjects and methods: thirty seven women from to Urogynecology Division of the Hospital das Clínicas de Campinas (HC/UNICAMP) were invited to participate in a prospective randomized trial. After screening inclusion and exclusion criteria, they were randomly placed in one of two groups: Treatment group: the women were submitted to tibial posterior nerve electrical stimulation (n = 21) and Sham group: the women had electrodes placed on the tibial posterior nerve, without stimulation (n = 16). At first, the patients were invited to participate in the study and submitted to a physiotherapeutic evaluation, including fulfilling a three days diary, quality of life questionnaires (ICIQ, KHQ an OABq). The approach of the treatment was eigth sessions of electrical stimulation on the posterior tibial nerve. Results: noctury was significantly improved in the treatment group (p=0,003). The urinary frequency was significantly improved in treatment group (p=0,003) and the urgency decreased significantly in both groups (sham:p=0,025 and treatment p=0,002). Comparing the questionnaires applied only the OABq was responsive in both scores, total score (p=0,037) and severity score (p=0,018). Conclusion: The posterior tibial nerve electrical stimulation is an effective physiotherapeutic treatment in overactive bladder. / Mestrado / Mestre em Cirurgia

Orientadores: Adriana Orcesi Pedro, Aarão Mendes Pinto-Neto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T01:05:27Z (GMT). No. of bitstreams: 1 Reigota_RenataBednar_M.pdf: 2285610 bytes, checksum: 1095196692b2d3137069933eb12771ff (MD5) Previous issue date: 2014 / Resumo: Introdução: Associado às mudanças no perfil etário e epidemiológico do Brasil nos últimos anos, as doenças crônicas têm assumido papel de destaque nas questões relacionadas à saúde pública. Nesse contexto, a Incontinência Urinária (IU) desempenha importante papel, em função de sua elevada prevalência, suas consequências e seu subdiagnóstico. Objetivos: Avaliar a prevalência de IU, seus fatores associados e sua associação com multimorbidade entre mulheres acima de 50 anos de idade no município de Campinas/SP. Métodos: Tratou-se de inquérito populacional incluindo 622 mulheres com idade igual ou superior a 50 anos, realizado entre 10 de maio e 31 de outubro de 2011, na cidade de Campinas, São Paulo, Brasil. As entrevistas foram realizadas por assistentes de pesquisa devidamente treinadas, em 68 setores censitários de Campinas. A variável dependente ¿ IU - foi definida como relato de perda involuntária de urina e foi categorizada em IU de Esforço (IUE), IU de Urgência (IUU) e IU Mista (IUM). As variáveis independentes foram características sociodemográficas, hábitos pessoais, comorbidades, autopercepção de saúde e capacidade funcional. Análise Estatística: A análise estatística foi realizada através do teste Qui-quadrado e da análise de regressão múltipla de Poisson com critério de seleção de variáveis backward. O nível de significância foi estabelecido em 5%. Resultados: A média etária das mulheres estudadas foi de 62 anos. A prevalência de IU entre as mulheres avaliadas foi de 52,3%, sendo mais prevalente a IUM (26,6% das entrevistadas) em comparação à IUE (12,4%) e IUU (13,2%). As variáveis que se associaram a maior prevalência de IU foram IMC ? 25 no momento da entrevista (p<0,001), presença de multimorbidade (p<0,001), uso de medicações sob prescrição médica (p=0,017), uso de anti-hipertensivos (p=0,007), uso de medicações para tratamento cardiorrespiratório (p=0,042), uso de tratamentos alternativos (p=0,031), antecedente pessoal de HAS (p<0,001) e de artrose (p=0,002). A limitação da capacidade funcional e a autopercepção negativa de saúde também foram fatores associados à IU (p<0,001 para ambas as variáveis). A regressão de Poisson mostrou que os fatores relacionados a uma maior prevalência de IU foram hipertensão arterial (RP 1.21; IC 1.01 ¿ 1.47; p=0,004), artrose (RP 1.24; IC 1.03 ¿ 1.50; p=0,022), prática de atividade física igual ou superior a 3 dias/semana (RP 1.21; IC 1.01 ¿ 1.44; p=0,039) e IMC ? 25 no momento da entrevista (RP 1.25; IC 1.04 ¿ 1.49; p=0,018). A autopercepção negativa de saúde (RP 1.23; IC 1.06 ¿ 1.44; p=0,007) e a presença de limitações nas atividades diárias (RP 1.56; IC 1.16 ¿ 2.10; p=0,004) também estiveram associadas a uma maior prevalência de IU. Conclusão: A prevalência de IU entre a população feminina após os 50 anos é alta. A IUM é a mais frequente. Os fatores associados à IU foram sobrepeso/obesidade, presença de hipertensão arterial e artrose, limitações nas atividades cotidianas e autopercepção negativa da saúde. Os resultados deste estudo apontam para a existência de fatores mutáveis que se associam à IU (como, por exemplo, sobrepeso/obesidade) e a consequente necessidade de políticas de saúde que conscientizem a população feminina e os profissionais de saúde sobre esta questão / Abstract: Introduction: Associated with changes in the age and epidemiological profile of Brazil in recent years, chronic diseases have assumed a prominent place in public health. In this context, Urinary Incontinence (UI) plays an important role, due to its high prevalence, its consequences and its underdiagnosis. Objectives: To evaluate the prevalence of IU and associated factors in women 50 years or older, living in Campinas / SP. Methods: This was a population survey including 622 women aged 50 years or older, conducted between May 10th and October 31st 2011, in the city of Campinas, São Paulo, Brazil. The interviews were conducted by research assistants specially trained in 68 census tracts of Campinas. The dependent variable - Urinary Incontinence (UI) - was defined as reported involuntary loss of urine and was categorized as Stress UI (SUI), Urgence UI (UUI) and Mixed UI (MUI). The independent variables were sociodemographic characteristics, personal habits, comorbidity, self-perception of health and functional capacity evaluation. Statistical Analysis: Chi-square test and multiple Poisson regression with backward selection criteria variables were used, the latter having been applied to evaluate the variables that were associated with UI. The level of significance was set at 5%. Results: The mean age of the women studied was 62 years old. The prevalence of UI among women was 52.3%, being MUI (26.6% of respondents) more prevalent when compared to SUI (12.4%) and UUI (13.2%). The variables that were associated with the prevalence of UI were BMI at the moment of interview (p <0.001), multimorbidity (p <0.001), use of prescribed medications (p = 0.017), use of antihypertensives (p = 0.007), use of medications for cardiorespiratory treatment (p = 0.042), use of alternative treatments (p = 0.031), personal history of hypertension (p <0.001) and osteoarthritis (p = 0.002). The presence of limitations in daily activities was also associated with UI (p <0.001), as well as the negative self-perception of health in women with UI (p <0.001). Multiple regression analysis showed that the factors related to a higher prevalence of UI were hypertension (OR 1.21, CI 1:01 to 1:47, p = 0.004), osteoarthritis (OR 1.24, CI 1:03 to 1:50, p = 0.022), frequency of physical activity ? 3 days / week (OR 1.21, CI 1:01 to 1:44, p = 0.039) and BMI ? 25 at the time of interview (OR 1.25, CI 1:04 to 1:49, p = 0.018). Likewise, were associated with a higher prevalence of UI the negative self-perception of health (PR 1:23; CI 1:06 to 1:44, p = 0.007) and the presence of limitations in daily activities (PR 1:56 CI 1:16 to 2:10, p = 0.004). Conclusion: Our findings showed that the prevalence of UI among women is high after 50 years old, with a higher prevalence of MUI. The factors associated with UI were overweight, presence of hypertension and osteoarthritis, limitations in daily activities and negative self-perception of health. Our results point to the existence of mutable factors associated with UI (eg, overweight / obesity) and the consequent need for health policies able to make female population and health professionals aware about this issue. Keywords:urinary incontinence, chronic diseases, multimorbidity, prevalence, women, menopause / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

Orientador: José Martins Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T00:57:41Z (GMT). No. of bitstreams: 1 Filoni_Eduardo_D.pdf: 2809864 bytes, checksum: 4d1a3382abdde72be4311e3d07186c36 (MD5) Previous issue date: 2013 / Resumo: Objetivo: Avaliar a prevalência, a confiabilidade e a severidade dos sintomas de incontinência urinária (IU) em adolescentes mulheres praticantes da modalidade esportiva de futebol e o impacto dos sintomas na qualidade de vida. Método: Trata-se de um estudo transversal, com 59 adolescentes do gênero feminino divididos em grupo de atletas: 35 adolescentes atletas amadoras da modalidade futebol, com idade entre 12 e 19 anos (15,6 ± 2,0) e o grupo controle com 24 adolescentes não praticantes de modalidade esportiva com idade entre 11 e 19 anos (14,8 ± 2,4). Como instrumentos de avaliação foram utilizados: O questionário International Consultation on Incontinence Questionnaire (ICIQ -SF), o pad test e o questionário King?s Health Questionnaire (KHQ). Resultados: O Grupo de Atletas houve 62,8% de positividade em ambos os testes (pad test e ICIQ - SF) e no Grupo Controle a positividade foi de 25%. Estatisticamente pelo coeficiente de Kappa encontrou-se concordância mediana de 0,45 pontos entre as escalas de avaliação utilizadas e em relação a qualidade de vida (KHQ) houve um escore de 35,2 para o domínio saúde geral, 37,3 para emoções e 26,5 para sono/disposição. Conclusão: No presente estudo observou-se alta prevalência de sintomas de IU em atletas de futebol, confiabilidade moderada entre o pad test e ICIQ - SF, presença de IU leve em ambos os grupos. Os domínios Saúde Geral, Emoções e Sono/Disposição foram os que encontraram maior pontuação no grupo de atletas, considerados os de maior comprometimento na qualidade de vida / Abstract: Objective: To evaluate the prevalence, reliability and severity of symptoms of urinary incontinence (UI) in adolescent female soccer players and the impact of those symptoms on quality of life. Methods: The present work is a cross-sectional study of 59 female adolescents divided into a group of athletes, which included 35 adolescent amateur soccer players aged between 12 and 19 years (15.6 ± 2.0), and a control group, which included 24 adolescents aged 11 to 19 years (14.8 ± 2.4) who did not practice any sports. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), the pad test and King's Health Questionnaire (KHQ) were used for evaluation. Results: The athletes displayed 62.8 % positivity the pad test and the ICIQ-SF, whereas the control group exhibited 25 % positivity. A medium agreement of 0.45 was found between the applied evaluation scales, as assessed with Cohen's kappa coefficient. In terms of quality of life (as assessed with the KHQ), the athletes exhibited a score of 35.2 in the General Health domain, 37.3 in the Emotions domain and 26.5 in the Sleep/Energy domain. Conclusion: In the present study, a high prevalence of UI symptoms was found in soccer athletes, with moderate reliability between the pad test and the ICIQ-SF; mild UI was found in both groups. The athletes had the highest scores on the General Health, Emotions and Sleep/Energy domains, which are considered to have the highest impact on quality of life / Doutorado / Saude da Criança e do Adolescente / Doutor em Ciências

Orientadores: Cássio Luís Zanettini Riccetto, Benedicto de Campos Vidal / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculade de Ciências Médicas / Made available in DSpace on 2018-08-21T00:28:08Z (GMT). No. of bitstreams: 1 Feitosa_IsabelCristinaAlbuquerque_M.pdf: 2111462 bytes, checksum: 4056f4a3329834819c83f886cc2bfe79 (MD5) Previous issue date: 2012 / Resumo: Introdução: A incontinência urinária é um problema de saúde muito prevalente, afetando entre 10% a 50% das mulheres em algum momento de sua vida, causando morbidade social e redução na qualidade de vida. Nas mulheres entre 40-59 anos a incontinência urinária de esforço é mais frequente e naquelas acima de 60 anos a urge-incontinência é mais prevalente. A mudança de padrão de incontinência com o aumento da idade pode sugerir que o envelhecimento em geral e as alterações fisiológicas decorrentes deste processo possam contribuir com a sua patogênese. Há vários anos foi demonstrado que os tecidos originados do seio urogenital são sensíveis aos hormônios sexuais, principalmente o estrógeno. Recentemente, tem surgido importante interesse no uso da suplementação de andrógenos nas mulheres. Embora existam significativos interesses nas aplicações clínicas dos andrógenos em mulheres, não se sabe exatamente como se dá a atuação destes hormônios no assoalho pélvico e trato urinário inferior. Objetivo: Analisar o efeito da suplementação de metiltestosterona sobre as propriedades anisotrópicas das fibras musculares e colágenas periuretrais de ratas. Métodos: Foi realizado um estudo experimental com 30 ratas que foram divididas em dois grupos: 15 ratas submetidas a suplementação de metiltestosterona por 60 dias e 15 ratas controles. Posteriormente foi removida a bexiga, uretra e região perineal em bloco. A região periuretral foi analisada através de microscopia de polarização, com quantificação da birrefringência das fibras musculares e colágenas. Resultados: A densidade média de brilho da musculatura, no grupo controle foi de 65,3070. No grupo com suplementação de testosterona foi 84,7624, portanto com diferença estatisticamente significativa (p =0,006). Quanto às medidas da birrefringência do colágeno periuretral nos grupos controle e com suplementação de testosterona, foram obtidas com mediana de 95,9436 no controle e a mediana foi de 100,8646 no grupo com testosterona, com diferença estatisticamente significativa entre os dois grupos avaliados, com p = 0,005. Conclusão: O uso de testosterona promoveu um aumento nos valores de birrefringência das fibras colágenas e musculares periuretrais de ratas submetidas a suplementação de metiltestosterona quando comparadas com o grupo controle / Abstract: Introduction: Urinary incontinence is a prevalent health problem, affecting between 10% and 50% of women at some point in their lives, causing social morbidity and reduced quality of life. Among women between 40-59 years of age, stress urinary incontinence is more frequent and in those above 60 years of age urge incontinence is more prevalent. The changing pattern of incontinence with increasing age may suggest that the aging process and the physiological changes resulting from this process may play a role in its pathogenesis. It has been shown for the last years that the tissues derived from urogenital sinus are sensitive to estrogen. Recently, there has been significant interest in the use of androgen supplementation in women. Although there is significant interest in clinical applications of androgens in women, it is not known exactly how occurs the action of these hormones in the pelvic floor and lower urinary tract. Objective: To analyze the effect of methyltestosterone supplementation on the anisotropic properties of the periurethral collagen and muscle fibers of rats. Methods: We conducted an experimental study with 30 female rats that were divided into 2 groups: 15 rats subjected to supplementation of methyltestosterone for 60 days and 15 control rats. Bladder, urethra, and perineum were removed en block after sacrifice. The periurethral region was analyzed by polarized light microscopy with quantification of the birefringence of muscle and collagen fibers. Results: The mean density of brightness of the muscles in the control group was 65.3070. In the group with testosterone supplementation was 84.7624, so the difference was statistically significant (p = 0.006). The measurements of birefringence of periurethral collagen fibers in control and testosterone groups were obtained with a median of 95.9436 in control and 100.8646 in the testosterone group, with statistically significant difference between them, with p = 0.005. Conclusion: The use of testosterone promoted an increase in the values of birefringence of periurethral collagen fibers and muscle tissue of rats submitted to methyltestosterone supplementation when compared with the control group / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Bakgrund: Urininkontinens innebär ofrivilligt urinläckage och är ett folkhälsopro- blem i Sverige. Det är ett tillstånd som främst drabbar kvinnor och äldre. Syftet: Att beskriva kvinnors upplevelse av att leva med urininkontinens. Metod: Litteraturö- versikt, där kvalitativa artiklar analyserades enligt Fribergs femstegsmodell och sammanställdes till ett resultat. Datasökningarna utfördes i Medline och CINAHL, där elva artiklar valdes ut. Resultat: Består av tre huvudteman; maktlöshet, utan- förskap och acceptans som växte fram från följande subteman: förlorad kontroll, ett begränsat liv, en känsla av skam, negativa möten inom vården, anpassning och en del av livet. Kvinnor upplever urininkontinens som en begränsning i vardagen. Kvinnor accepterar sin livssituation och pratar inte öppet om urininkontinens då det upplevs som skamligt och tabubelagt. Kvinnor upplever att det är lättare att prata om sin urininkontinens om sjukvården tar upp och samtalar kring urininkontinens. Slutsats: Det behövs en ökad kunskap och förståelse i samhället och inom vården för kvinnor med urininkontinens. Eftersom kvinnor inte själva talar öppet om sin urininkontinens är det viktigt att bedriva vidare forskning kring samspelet mellan vårdpersonal och kvinnor med urininkontinens. / Background: Urinary incontinence causes involuntary urinary leakage and is a public health problem in Sweden. It is a condition that primarily affects women and the elderly. Aim: To describe women's experience of living with urinary inconti- nence. Method: Literature review, where qualitative articles were analyzed accor- ding to Friberg's five-step model and compiled into a result. Data searches were con- ducted in Medline and CINAHL, where eleven articles were selected. Result: Consi- sts of three main themes; powerlessness, exclusion and acceptance that emerged from the following subthemes: lost control, a limited life, a sense of shame, negative meetings in health care, adaptation and a part of life. Women experience urinary incontinence as a limitation in everyday life. Women accept their life situation and do not talk openly about urinary incontinence because it is felt as shameful and ta- boo-coated. Women also find it easier to talk about their urinary incontinence if the healthcare brings up and talks about urinary incontinence. Conclusion: There is a need for increased knowledge and understanding in society and in the care of women with urinary incontinence. Since women do not speak openly about their urinary in- continence, it is important to conduct further research on the interaction between healthcare and women with urinary incontinence.

Physiotherapist-supervised pelvic floor muscle (PFM) training is the recommended first-line treatment for women with stress urinary incontinence (SUI); however, only up to 50% of women are cured with this treatment. The primary objective of this study was to develop a predictive model of successful physiotherapy intervention outcomes among women with SUI using predictors that are accessible to clinicians. The secondary objective of this study was to run a preliminary investigation of morphologic differences between women with SUI who were cured with a physiotherapy intervention and those who were not cured, using a subset of ultrasound imaging data. Seventy-nine women with SUI were assessed at baseline on measures of demographic data (i.e. age, body mass index, etc.), 3-day bladder diary, 30-minute standardized pad test, clinical assessments of PFM strength and tone, and transperineal ultrasound assessments of PFM morphology. Women then attended a 12-week physiotherapy intervention and returned for a follow-up assessment. The multivariate logistic regression model was significant (p < .001) with two predictors: baseline ICIQ-FLUTS UI subscale (SUI severity; p = .01) and parity (p = .06). A significant ROC curve for the ICIQ-FLUTS UI subscale (p ˂ .01) predicts physiotherapy intervention outcomes with 55.6% sensitivity and 80.8% specificity at a cut-off score of 7.50. Women most likely to be cured with a physiotherapy intervention were those with lower scores on the ICIQ-FLUTS UI subscale and those who have given birth to fewer children. Significant differences were found in a subset of data between women with SUI who are cured with the physiotherapy intervention and women who are not cured on morphologic measures in standing of bladder neck height at peak cough (p = .03), descent of the bladder neck during maximal Valsalva maneuver (MVM; p = .04), levator hiatus circumference at rest (p = .03) and at maximal voluntary contraction in both standing and supine (MVC; p = .01; p = .03). Variables that were trending towards significance included bladder neck height in standing at rest, levator plate length (LPL) at maximal excursion during a cough and MVM in standing, and mid-urethral wall cross-sectional area. These significant differences indicate potential value in using ultrasound imaging outcomes as predictors of a cure with physiotherapy intervention in future models, and a combination of demographic, clinical, and morphologic variables may build a more robust predictive model.

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.

Urinary incontinence is a health condition that is associated with involuntary leakage of urine. Stress urinary incontinence (SUI) describes involuntary leakage of urine on effort or exertion and can impact one’s ability to participate in activities and affect quality of life. Furthermore, clinical management of this health condition is challenging as individuals who experience urinary incontinence often do not report this concern to a health care provider. Stress urinary incontinence is not typically a health concern associated with young, healthy athletes. However, researchers have begun to examine the presence of this health condition amongst both a younger population and in athletes. Therefore, the purpose of this study is to assess the prevalence of stress urinary incontinence in collegiate female athletes. This study involved the development of an electronic survey tool to assess the prevalence of SUI in the female collegiate athlete. Female collegiate athletes from six different NCAA Division I schools were asked to complete the survey. The overall response rate for the survey was 32.6% (333/1020). Results indicate that SUI does in fact occur in NCAA Division I collegiate female athletes. Overall, 68.5% of female collegiate athletes surveyed reported ever experiencing SUI. During daily life activities (cough, sneeze, laugh), 54.2% of female collegiate athletes reported experiencing SUI. During participation in their sport, 40.0% of female collegiate athletes reported experiencing SUI, referred to as sports-related SUI. When reporting SUI experienced during either sport participation or during other exercise-based activities, 58.2% of female collegiate athletes reported SUI. The proportion of female athletes reporting sports-related SUI varied by sport. The highest prevalence of leakage in sport was reported by gymnasts (80%) and the lowest prevalence was reported by those who participated in rifle (0%). Over half (52.3%) of female athletes who reported sports-related SUI said their symptoms first began in high school. While majority of female collegiate athletes stated they did not avoid their sport because of SUI, one-fifth (20.5%) of athletes with sports-related SUI reported they alter how they move in their sport out of concern for leakage. The impact of sports-related SUI on other aspects of life (family, social, or school life) were reported to be minimal. Athletes who experience sports-related SUI are most likely to tell either a teammate (49%) or no one (36%). Very few female athletes have told someone in healthcare about this concern: doctor (3%), athletic trainer (4%); physical therapist (1%). Furthermore, only 3% of female collegiate athlete with sports-related SUI reported ever seeking treatment and only 25.8% reported they would find value in seeing a healthcare provider to discuss SUI. Most (76.7%) female collegiate athletes, whether they reported SUI or not, stated they had never been instructed on exercises to strengthen the pelvic floor muscles and 60.6% reported they would find educational programs involving exercises to decrease or prevent SUI beneficial. In conclusion, SUI does occur in the female collegiate athlete and is often not reported to healthcare providers. Based on this information, the general practice of screening athletes for relevant health conditions during pre-participation physicals may need to include additional questions for SUI. Further investigation needs to explore how to best engage and educate female collegiate athletes on the subject of SUI and how to successfully communicate with and address those with the condition.