Orientadores: Cassio Luis Zanettini Riccetto, Paulo Cesar Rodrigues Palma / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T21:41:51Z (GMT). No. of bitstreams: 1 Thiel_Marcelo_D.pdf: 2563508 bytes, checksum: cb0427728a1aecf6795c3443f2f0cea9 (MD5) Previous issue date: 2006 / Resumo: OBJETIVOS: Analisar quantitativamente, com método estereológico, a densidade de fibras colágenas formadas após implante de quatro diferentes tipos de sling;verificar por análise histopatológica a reação inflamatória. MATERIAS E MÉTODOS: Realizou-se o estudo em 70 ratas da raça Wistar, divididas em 3 grupos (A,B,C): No grupo A (30 ratas) implantou-se uma faixa de silicone e outra de submucosa intestinal suína, de 8x 4 mm, no tecido subcutâneo da parede abdominal. No grupo B (30 ratas), implantou-se, da mesma maneira, uma faixa de copolímeros de poligalactina com ácido poliglicólico e outra de polipropileno monofilamentar, de 8x 4 mm. Sutura com fio de nylon 5/0, fixou as faixas e, no grupo C (10 ratas), denominado controle, realizou-se dissecção do subcutâneo e aplicação do mesmo fio, sem implante de material. A coloração de Picro-Sirius, empregada apenas no 90° dia de pós-operatório, permitiu análise das fibras colágenas e a de Hematoxilia-eosina, o estudo histopatológico da reação inflamatória. Nos dias 7, 30 e 90 de pós-operatório, sacrificaram-se 10 ratas de cada grupo. RESULTADOS: No 7° dia, todos os materiais induziram moderada reação inflamatória, sem diferença com o controle. No 30° dia, os copolímeros de poligalactina com ácido poliglicólico apresentaram a menor reação inflamatória, sem diferença com o controle. Neste período, polipropileno monofilamentar e silicone produziram inflamação moderada, enquanto que na submucosa intestinal suína, a intensidade foi severa. No 90° dia, a reação inflamatória, nos copolímeros de poligalactina com ácido poliglicólico, foi maior que antes, porém menor do que a do polipropileno monofilamentar e silicone, que permaneceram semelhantes entre si. Novamente, o grau de inflamação na submucosa intestinal suína continuou o maior de todos. Na análise estereológica, a densidade. de fibras colágenas dos copolímeros de poligalactina com ácido poliglicólico e polipropileno monofilamentar foi significativamente menor (61 % e 65% respectivamente) do que o silicone (85%) e submucosa intestinal suína (86%). CONCLUSÕES: Polipropileno monofilamentar foi o melhor material inabsorvível, pois induziu menos reação inflamatória que os outros materiais testados. Como a submucosa intestinal suína foi completamente removida, a intensa reação fibrótica que produz, toma-se útil, e responsável pelo suporte suburetral após a cirurgia / Abstract: OBJECTIVES: To analyse quantitatively, using stereological methods, the density of the collagen fibres induced by four types of sling materials, and verify by a histopathological analysis the corresponding inflammatory reaction, as fibrosis secondary to sling implantation is considered responsible for restoring urethral support and re-establishing continence in women with stress urinary incontinence, and new synthetic materials that promote adequate fibrosis with the least intensity and duration have been proposed to substitute the aponeurotic sling. MATERIALS AND METHODS: The study comprised 70 isogenic white Wistar rats divided into three groups: group A (30 rats) had 8 x 4 mm strips of silicone and porcine small intestine submucosa (SIS) implanted in the abdominal subcutaneous tissues; group B (30 rats) had 8 x 4 mm strips of polycaprolactone and polylactic acid copolymers and monofilament polypropylene (PLP) implanted the abdominal subcutaneous layer; while a control group of 10 rats had dissection and suturing with 5/0 Nylon in the abdominal subcutaneous layer, as used to fix the strips in the other rats. Picro-Sirius staining was used to assess collagen fibres, and haematoxylin-eosin for the histopathological study. At 7, 30 and 90 days after surgery, 10 rats from each group were killed and assessed. RESULTS: Afier 7 days all the materials induced a moderate inflammatory reaction that did not differ from that in the control group. At 30 days there was no difference between the control and polycaprolactone and polylactic acid copolymers, having the least inflammatory reaction. PLP and silicone produced a moderate inflammatory reaction, while the porcine SIS induced a more intense reaction. At 90 days there was a more intense inflammatory reaction in polycaprolactone and polylactic acid copolymers than before but it was less than with PLP and silicone, which again were no different. During this period the inflammatory reaction induced by SIS was greater. The stereological analysis indicated that collagen fibres induced by polycaprolactone and polylactic acid copolymers and PLP were less dense (61% and 65%, respectively), and significant1y less than with silicone (85%) and SIS (86%). CONCLUSION: PLP was the best nonabsorbable material as it induced a less intense inflammatory reaction than the other tested materials. As porcine SIS was completely absorbed the intense fibrosis induced is useful, as it is exclusively responsible for the urethral support later after surgery / Doutorado / Cirurgia / Mestre em Cirurgia

Orientador: Viviane Herrmann Rodrigues / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T08:30:53Z (GMT). No. of bitstreams: 1 DiSessa_RenataGebaradeGrande_M.pdf: 1433274 bytes, checksum: 5feb9e16555674189ca32bbad41f5423 (MD5) Previous issue date: 2012 / Resumo: Introdução: A Incontinência Urinária (IU) tem impacto na qualidade de vida da mulher, física, psicológica e socialmente. A Avaliação Urodinâmica (AU) pode ser considerada o padrão ouro no diagnóstico da etiologia da IU. Entretanto, trata-se de exame invasivo, que provoca desconforto e constrangimento à paciente e cujo resultado nem sempre reproduz a sintomatologia clínica. Objetivo: Avaliar a associação entre o "International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form" (ICIQ-UI/SF) e a Avaliação Urodinâmica, em mulheres com incontinência urinária. Métodos: Foi realizada análise retrospectiva dos dados clínicos e AU de 358 mulheres com IU atendidas em clínica privada. Utilizou-se a curva ROC com os valores de sensibilidade e especificidade dos escores do ICIQ-UI/SF apresentados pelas pacientes, a fim de estabelecer o escore capaz de discriminar o diagnóstico urodinâmico nos grupos estudados. Para o cálculo do p valor foi utilizado o teste de qui-quadrado ou exato de Fisher. O teste de Spearman avaliou a correlação entre o ICIQ-UI/SF e os parâmetros urodinâmicos. O nível de significância foi de 5% e o software utilizado para a análise foi o SAS versão 9.2. Resultados: A média de idade entre as pacientes foi de 51,1 anos, a raça predominante foi branca e 86,5% das pacientes tiveram ao menos duas gestações. As pacientes com Incontinência Urinária de Esforço segundo a AU (grupo 1) representaram 67.3% das pacientes estudadas. As pacientes com IUE na AU e Hiperatividade Detrusora (HD) - grupo 2 - representaram 16,2% da amostra e as pacientes com HD isolada (grupo 3) representaram 7,3% do total. Em 9.2% a Avaliação Urodinâmica foi considerada normal. Pacientes dos grupos 1 e 2 apresentaram escore ? 14 no ICIQ-UI/SF, sendo esta associação significativa (p=0,01 e p=0,001, respectivamente). Foi observada significativa associação entre a PPE ? 90 cmH2O e escore ICIQ-UI/SF ? 15 (p=0,0037). O teste de Spearman mostrou significativa correlação inversa entre o escore do ICIQ-UI/SF e a PPE, porém não mostrou correlação entre este escore e a Capacidade Cistométrica Máxima (CCM) ou com o volume vesical no primeiro desejo miccional (PDM). Conclusão: Mulheres com PPE ? 90 cmH2O apresentaram escores mais altos ao ICIQ-UI/SF, porém não há correlação com a CCM ou o PDM. Foi observada associação significativa entre a IUE e a PPE ? 90 cmH2O e escores mais altos no ICIQ-UI/SF / Abstract: Introduction: Urinary incontinence (UI) compromises women's quality of life, either in physical, psychological or sexual aspects. Urodynamics is considered the gold standard in the diagnosis of urinary symptoms. However it is invasive, expensive, provokes constraints to patients and is not always related to clinical complains. Objective: To evaluate the association between the "International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form" (ICIQ-UI/SF) and urodynamics in women with urinary incontinence. Methods: It was a retrospective analysis of the data of 358 women with urinary incontinence attending a private clinic. A ROC curve was applied for sensitivity and specificity of ICIQ-UI/SF, to identify the score that would discriminate urodynamic diagnosis for the groups considered. P-value was obtained by Q-square and Fishers Exact Test. Spearman's test was used to correlate the ICIQ-UI/SF score to urodinamic parameters. Significance was 5% and the software SAS version 9.2. Results: Mean age was 51.1 years-old, the majority was white and 86.5% has been pregnant at least twice. Two hundred forty one patients (67.3%) presented stress urinary incontinence (SUI) on urodynamics (group 1), 16.2% presented SUI and Detrusor Overactivity (DO) (group 2) and 7.3% only DO. In 9.2% of the cases, urodynamics was considered normal. Women in groups 1 and 2 presented a significant association with ICIQ-UI/SF scores ? 14 (p=0.01 and p=0.001, respectively). A significant association was observed between Leak-point Pressure (LPP) ? 90 cmH2O and an ICIQ-UI/SF ? 15 (p=0.0037). Spearman's test showed a significant inverse correlation between ICIQ-UI/SF and LPP, but not to Maximum Cistometric Capacity (MCC) or First Desire to Void (FDV). Conclusions: Women with LPP ? 90cmH2O presented higher ICIQ-UI/SF scores, but no correlation was observed with MCC or FDV. Higher scores of the ICIQ-UI/SF were significantly associated with SUI and LPP ? 90cmH2O / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

Abstract Though not a life threatening condition, involuntary loss of urine is a miserable situation. It has a multidimensional effect on the afflicted individuals, both men and women – and for the society. The purpose of this study was to evaluate two modern, minimally invasive surgical techniques for the treatment of female stress urinary incontinence (SUI). The techniques evaluated were laparoscopic colposuspension with mesh and staples (LCM) and the tension-free vaginal tape procedure (TVT). The study consisted of four parts. The first part (Study I) was an observational retrospective follow-up study. Data on the first forty patients operated on with LCM at Oulu University Hospital were collected. Patients had SUI or mixed urinary incontinence (MUI) with predominantly stress incontinence. The Studies II–IV were parts of a randomized, multicenter clinical trial, where LCM was compared with TVT. According to the predefined inclusion criteria 128 SUI women were randomly allocated into two treatment groups: 70 patients received TVT treatment as allocated and 51 LCM. There were seven drop-outs after randomization. After one year of follow-up the cure and improvement rate of the patients operated with LCM were ~ 90%. Also a significant improvement was found in Urinary Incontinence Severity Scores (UISS). At base line the score was 12.1 and after one year follow-up 2.7 (p < 0.001). The bladder perforation rate was 15%. In Study II immediate cure rates and complications of LCM and TVT were studied. After six weeks of follow-up there was no difference in cure rates (~ 90%) between the procedures. There was no difference in complication rates. A significant difference was found in the use of anti-inflammatory / opioid drugs in the immediate post-operative period to relief the pain in favour for TVT. Hospital care was also significantly shorter after TVT than LCM. After one year of follow-up (Study III) TVT was found to give better result both objectively and subjectively. Negative stress test result was recorded in 85.7% in the TVT group and 56.9% in the LCM group. A significant difference was also found, when Visual Analoque Scale (VAS), King's College Health Questionnaire (KHQ) and UISS were used as outcome measures, in the favour of TVT. When 48-hour pad test was used as outcome measure there was no statistically significant difference between the groups. The cost-effectiveness (Study IV) of TVT was found to be better than that of LCM after one year of follow-up. In conclusion, the results of this study suggest, that TVT procedure is on the whole a cost-effective alternative for LCM in the treatment of female SUI.

M.Ed. (Educational Psychology) / Research literature regarding functional enuresis indicates that the prevalence of functional enuresis is higher in institutionalised children as opposed to non-institutionalised children. A preliminary survey conducted at the Abraham Kriel Children's Home revealed that approximately 10% of the children experience problems with enuresis. One of the childrens' personal files was studied. From this it appeared that although on a number of occasions there were therapeutic interventions, the girl still experiences problems with enuresis. To enable better understanding of this phenomenon it was decided to obtain a holistic image of the girl's construction of meaning, and, by so doing, establish whether the therapeutic interventions addressed and tackled the crux of the problem. To achieve this goal (which is exploratory and descriptive in nature, with a contextual concern), a qualitative single case study was used as the chosen research format. In this research a developmental exploration of the girl's world of meaning was performed. By means of a holistic analysis her life history was analysed in the light of Erik Erikson's developmental theory. Developmental tasks and needs that are characteristic of each life phase were identified. On the basis of this the girl's circumstances were examined in order to determine her possible self meaning. By means of a play diagnostic investigation an analysis was made of the way in which she presently perceives herself and the world...

Magister Scientiae (Physiotherapy) - MSc(Physio) / Urinary incontinence has already been identified worldwide for years as a health problem affecting essentially women, which can interfere with their overall quality of life. However in Rwanda, this problem has yet not been addressed adequately either because of lack of expertise, or because of cultural traditions associated with taboos among women. Social conditions of women facing this problem hinder them from seeking possibly adequate medical assistance. It is important that this problem be addressed because it may lead to disability, social seclusion, psychological stress and economic burdens. This study was a pioneer one, intended to diagnose the extent of the problem through determining the prevalence of urinary incontinence as well as its impact on the quality of life among women. The study will hopefully be followed by the promotion of physiotherapy to tackle the problem and therefore reduce the number of people suffering from urinary incontinence. / South Africa

Dynamic transperineal ultrasound (TPUS) video allows for kinematic analysis of urogenital morphology and mobility, however, measures are often limited to peak displacements of anatomical landmarks and are vulnerable to error incurred by probe rotation during imaging. This thesis aimed to (1) develop an algorithm to calculate kinematic curves of urogenital landmark motion from TPUS video and to (2) investigate the error incurred in these kinematic measures due to in-plane ultrasound probe rotation. UROKIN, a semi-automated software, was developed and, as a proof of concept, was used to identify differences in urogenital kinematics during pelvic floor muscle maximum voluntary contractions between women with and without stress urinary incontinence. A mathematical model revealed that the error incurred by TPUS probe rotation in the x- (anterior-posterior) and y- (cranial-caudal) directions, was a factor of: r, the radius of rotation; Ɵ, the in-plane angular probe rotation; and α, the angular deviation between the anatomical planes and the coordinate system in which error was calculated. As an absolute measure, the error incurred by in-plane probe rotation is reduced to a factor of only r and Ɵ. Moving forward, UROKIN must be adapted to include findings from (1), and must be tested for validity and reliability.

Orientadores: Simone Botelho Pereira, Cássio Luís Zanettini Riccetto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T06:45:26Z (GMT). No. of bitstreams: 1 Alves_FabiolaKenia_M.pdf: 1692641 bytes, checksum: 229f8f470a88f89b5d3255ed8cccd5e1 (MD5) Previous issue date: 2013 / Resumo: O processo de envelhecimento é um dos principais fatores de disfunções uroginecológicas. O treinamento dos músculos do assoalho pélvico (TMAP) é o método de primeira escolha para o tratamento de incontinência urinária e também recomendado para a prevenção e tratamento de prolapsos dos órgãos pélvicos. O objetivo deste estudo foi avaliar o efeito de um programa de TMAP em grupo sobre a contratilidade muscular em mulheres na pós-menopausa, assim como sobre a presença de sintomas urinários e prolapsos de órgãos genitais. Métodos. Foi realizado um ensaio clínico, randomizado, controlado e cego com 30 mulheres na pós-menopausa (idade média de 65.93 ±8.76 anos), divididas em dois grupos: Resumo: Grupo Tratado (n=18) e Grupo Controle (n=12). A avaliação foi realizada antes e após o tratamento em ambos os grupos e consistiu de palpação vaginal (Escala Modificada de Oxford), eletromiografia de superfície dos músculos do assoalho pélvico, avaliação da presença de prolapsos dos órgãos pélvicos e avaliação de sintomas miccionais e vaginais por meio da aplicação dos questionários validados: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF); International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) e International Consultation Questionnaire on Vaginal Symptoms (ICIQ-VS). O protocolo de tratamento consistiu de 12 sessões em grupo de 8-10 participantes, duas vezes na semana, por 30 minutos, totalizando seis semanas. Foram utilizados para análise estatística os Testes ANOVA, Teste de Comparação múltipla de Tukey, Teste de Wilcoxon e Teste Perfil de Contrastes. Resultados. A contratilidade dos músculos do assoalho pélvico aumentou significativamente depois do programa de treinamento tanto na eletromiografia (p=0.003) quanto na palpação digital (p=0.001). Houve decréscimo do escore do questionário ICIQ-OAB apenas no grupo tratado (p<0.001) com diferença significativa entre os grupos através do tempo (p=0.002). Houve decréscimo do escore do questionário ICIQ-UI SF com diferença significativa entre o grupo controle e o grupo tratado depois do tratamento (p=0.03). O grau do prolapso anterior também diminuiu apenas no grupo tratado (p=0.03). Não foram encontradas diferenças significativas no grau do prolapso posterior e no questionário ICIQ-VS. Conclusão. O programa de TMAP em grupo foi eficaz para o aumento da contratilidade muscular, diminuição da gravidade do prolapso de parede anterior e dos sintomas urinários em mulheres na pós-menopausa. / Abstract: Introduction. The aging process is one of the major reasons for urogynecological dysfunctions. Pelvic floor muscle training (PFMT) is the method chosen in the first place for the treatment of urinary incontinence, also indicated for the prevention and treatment of the pelvic organs' prolapses. The aim of this study was to evaluate the effects of a group pelvic floor muscle training program on post-menopausal women's pelvic floor muscle contractility , as well as on the presence of urinary symptoms and genital organ prolapses. Methods. A clinical, randomized, controlled and assessor-blinded study was conducted with 30 post-menopausal women (mean age 65.93 ±8.76 years), divided into two groups: Treatment Group (n=18) and Control Group (n=12). The evaluation was carried out using digital palpation (Modified Oxford Grading Scale), pelvic floor surface electromyography (sEMG), the Pop-Q System to evaluate the presence of pelvic organ prolapse using validated questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF); International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and International Consultation Questionnaire on Vaginal Symptoms (ICIQ-VS). The treatment protocol consisted of 12 group sessions, with 8-10 participants, carried out by a physiotherapist (main investigator), twice a week, with 30 minutes of duration each, totaling six weeks. The statistical analysis was performed using ANOVA, Tukey¿s Multiple Comparison Test, McNemar¿s Test and the Contrast Profile Test. Results. The pelvic floor muscle contractility increased after the training program, assessed by sEMG (p=0.003) and by vaginal palpation (p=0.001). There was a decrease in the ICIQ-OAB scores only in the treated group's final evaluation (p<0.001) with a significant difference between the groups along the time (p=0.002). There was a decrease in the ICIQ-UI SF scores (p=0.03) between the treated and control groups after the treatment. There was a significant decrease in the anterior pelvic organ prolapse (p=0.03) in the treated group. No significant differences were found in the posterior pelvic organ prolapse and the ICIQ-VS scores. Conclusion. Group pelvic floor muscle training program is an effective way to increase the pelvic floor muscle contractility and to decrease the anterior pelvic organ prolapse as well as urinary symptoms in post-menopausal women. / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22153号 / 社医博第101号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 小川 修, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Urinary incontinence (UI) is a worldwide problem with negative consequences on women's health and day-to-day life. Yet, the problem is partly unexplored and often stigmatized. Thus, the aim of the study was to describe nurses’ experience of women suffering from UI, their associated health needs and provision of care for these women in Arusha, Tanzania. A qualitative study with semi-structured interviews with a convenient sample was an applicable and preferable method to proceed the research. The collected data from eight interviews with nurses from various hospitals formed the foundation of the result, as it was analyzed with an inductive content analysis. The main findings consisted by; the experience of what is making women suffer from UI; the experience of the associated health needs; and the experience of providing care to the affected women. The result in this study highlighted how the nurse responded to the affected women’s needs. Though, it indicated that the women's health needs might go beyond the possibilities of care a nurse can provide. The health needs were often more complex and profound than the health care could manage. Thus, this emphasized the importance of identification and caring for these women. Giving that the nurse role was to give support, both physically and mentally, and to increase the knowledge among women, but also on a societal level in Tanzania.

Summary Background: Urinary incontinence is a condition in which the patient experience involuntary leakage of urine. It is a significant global health issue which annually affect millions of people. However, statistics on prevalence and epidemiology on the condition is limited, which might be as the condition is considered stigmatizing in many populations. Aim: The aim of this empirical study was to describe the nurse’s role in the care of females with urinary incontinence. Method: A qualitative study with semi-structured interviews was the most appropriate method to use. Twelve nurses was interviewed, the data was analysed with an inductive approach and content analysis. Result: Three main themes were identified; To give emotional support, Providing knowledge and access to information and The nurse’s interaction with the female. The findings show that the role of the nurse in the care of females with urinary incontinence is more complex than expected. Conclusion: The result indicates that the role of the nurse is an important part for the female to feel secure and understood. The emotional support provided by the nurses' is a central element of the care. It is important to increase the knowledge about the condition since the female’s often feel ashamed to talk about their condition.