Bakgrund: Bäckenbottendysfunktion innebär onormal funktion i bäckenbottenmuskulaturen som orsakas av ökad eller minskad muskeltonus och nedsatt koordination av bäckenbottenmusklerna.  Det innefattar flera olika funktionella problem och delas upp i urologiska, gynekologiska eller kolorektala. Biofeedback är en apparat som kan användas som ett tillägg till vanlig bäckenbottenträning. Den är till för att lära sig använda rätt teknik och kontrollera och identifiera rätt muskler. Man kan använda biofeedback till att träna styrka, uthållighet, koordination samt avslappning. Syfte: Undersöka effekten av bäckenbottenträning med biofeedback på blås- och tarmtömningsbesvär (utöver urin- och fekalinkontinens), livskvalitet och sexuell funktion jämfört med bäckenbottenträning utan biofeedback/sedvanlig behandling/ingen träning alls. Metod: Systematisk litteraturstudie med databaserna PubMed och Web of Science. Studiernas kvalitet granskades med PEDro och resultatets tillförlitlighet granskades enligt Uppsala Universitets Fysioterapeutsprograms bedömningsmall för systematiska översikter.  Resultat: Sju randomiserade kontrollerade studier inkluderades. Alla studier visade signifikant förbättring hos interventionsgrupperna. Fyra studier undersökte tömningssvårigheter, tre undersökte livskvalitet och två studier undersökte sexuell dysfunktion. Fem studier undersökte biverkningar av biofeedback utan fynd. Alla studier hade god kvalitet enligt PEDro, men samtliga visade på mycket låg tillförlitlighet (+) enligt Uppsala Universitets Fysioterapeutsprograms bedömningsmall för systematiska översikter. Konklusion: Det tyder på att bäckenbottenträning med biofeedback har positiv effekter på blås- och tarmtömningssvårigheter, livskvalitet och sexuell funktion hos personer med bäckenbottendysfunktion. Inga fynd av biverkningar av bäckenbottenträning med biofeedback hittades. Studierna hade god kvalitet enligt PEDro och dess sammanvägda resultat hade mycket låg tillförlitlighet (+). Resultatet bör därför tas med försiktighet och fler randomiserade kontrollerade studier behövs för att kunna dra några slutsatser. / Background: Pelvic floor dysfunction means abnormal function of the pelvic floor muscles caused by increased or decreased muscle tone and reduced coordination of the pelvic floor muscles. It includes several different functional problems such as urological, gynecological or colorectal. Biofeedback is a device that can be used as an addition to regular pelvic floor training. It helps people to use the right technique and to control and identify the right muscles. Biofeedback can be used to train strength, endurance, coordination and relaxation. Objective: Investigate the effect of pelvic floor training with biofeedback on bladder- and bowel voiding difficulties (except for urinary- and fecal incontinence), quality of life and sexual function compared to pelvic floor training without biofeedback/usual care/no training. Method: Systematic literature study which used the databases PubMed and Web of Science. The quality of the studies was reviewed using PEDro and the reliability of the results were reviewed according to Uppsala University's Physiotherapy program assessment template for systematic reviews. Results: Seven randomized controlled trials were included in this study. All studies showed significant improvement in the intervention groups. Four studies examined voiding difficulties, three examined quality of life and two studies examined sexual dysfunction. Five studies investigated side effects of biofeedback with no findings. All studies had good quality according to PEDro, however all showed very low reliability (+) according to Uppsala University's Physiotherapy program assessment template for systematic reviews. Conclusion: It indicates that pelvic floor training with biofeedback has positive effects on bladder- and bowel voiding difficulties, quality of life and sexual function in people with pelvic floor dysfunction. There are no findings of side effects of pelvic floor training with biofeedback. The studies were of good quality according to PEDro and their combined results had very low reliability (+). The result should therefore be taken with caution and more randomized controlled trials are needed to reach more reliable conclusions.

Os prolapsos dos órgãos pélvicos (POP) apresentam alta prevalência na população feminina, causando um grande impacto social e econômico negativo. Cerca de 11,1% das mulheres aos 80 anos têm indicação para a cirurgia de reparação de POP ou incontinência urinária. Há evidências de que o tratamento conservador, especificamente o treinamento dos músculos do assoalho pélvico (TMAP) é eficaz na redução dos sintomas do POP. No entanto, a literatura é escassa e controversa em relação à efetividade em associar-se o TMAP a procedimento cirúrgico quando há indicação cirúrgica. O objetivo primário deste estudo foi avaliar a eficácia em associar-se o TMAP a procedimento cirúrgico para correção de POP em relação aos seus sintomas. Os objetivos secundários foram verificar a capacidade de contração dos músculos do assoalho pélvico (MAP), a intensidade da contração voluntária máxima (CVM) dos MAP, percepção de melhora, a qualidade de vida, e função sexual. Foi conduzido um ensaio clínico randomizado e controlado com 96 mulheres com indicação médica para a cirurgia de reparação de POP em estágios II, III e IV alocadas em dois grupos: 48 no grupo submetido ao TMAP e 48 no grupo controle. O TMAP foi realizado em quatro sessões supervisionadas pré-cirúrgicas e sete sessões no pós-operatório. Todas as voluntárias foram avaliadas em três momentos: 15 dias antes da cirurgia e 40 e 90 dias após a cirurgia. O desfecho primário foi avaliado por meio do \"Questionário de desconforto no assoalho pélvico\" (PFDI-20) e os secundários por meio da Escala de Oxford Modificada, perineometria, \"Escala de impressão clínica global de melhora\" (PGI-I) \"Questionário de impacto no assoalho pélvico\" (PFIQ-7) e \"Questionário sexual para incontinência urinária e prolapso de órgãos pélvicos\" (PSIQ-12). Os dados foram analisados pela estatística descritiva por meio de frequências e porcentagens. Utilizou-se o teste t Student para verificar a diferença entre as médias dos dois grupos. Já o teste qui-quadrado para testar a diferença entre as proporções nas respostas dos dois grupos. Um modelo de regressão linear misto foi utilizado para verificar o efeito do tempo e dos grupos em relação aos desfechos. O nível de significância adotado foi p<=0,05. Ambos os grupos apresentaram melhora na sintomatologia após o seguimento. No entanto, não houve diferença significativa entre eles (4,3 IC 95%-14,4 a 23,2, p=0,65). Ambos os grupos apresentaram melhora na capacidade de contração dos MAP. Após 3 meses, a diferença entre os grupos em relação CVM foi -0,8 (IC 95% -8,1 a 6,4, p=0,81), em relação à percepção de melhora foi 0,4 (IC 95% -0,09 a 0,8, p=0,01), à qualidade de vida foi 2,7 (IC 95% -19,5 a 24,9, p=0,81) e em relação à função sexual -1,6 (IC 95% -7,6 a 4,4, p=0,59). Este estudo não demonstrou benefício adicional do TMAP em relação à sintomatologia de POP, capacidade de contração dos MAP, CVM dos MAP, qualidade de vida e função sexual. Entretanto, o grupo que recebeu o TMAP apresentou maior percepção de melhora / Pelvic organ prolapse (POP) has a high prevalence in the female population, causing a great negative social and economic impact. It is estimated that about 11.1% of women at age 80 are eligible for POP repair surgery or urinary incontinence. There is evidence that conservative treatment, specifically pelvic floor muscle training (PFMT), is effective in reducing POP symptoms. However, the literature is scarce and controversial regarding the effectiveness in associating PFMT with a surgical procedure when there is a surgical indication. The primary purpose of this study was to evaluate the efficacy in associating PFMT to a POP surgery in relation to its symptoms. The secondary purposes were to verify the capacity of pelvic floor muscles\' contraction (PFM), the maximum voluntary contraction (MVC) of the PFM, perception of improvement, quality of life and sexual function. A randomised controlled trial with 96 women with a medical indication for POP repair surgery in stage II, III and IV was conducted in two groups: 48 in the TMAP and 48 in control group. TMAP was performed in four supervised preoperative sessions and seven postoperative sessions. All volunteers were evaluated in three moments: 15 days before surgery and 40 and 90 days after surgery. The primary outcome was assessed using the \"Pelvic Floor Distress Inventory\" (PFDI-20) and the secondary endpoints using the \"Modified Oxford Scale\", perineometry, \"Patient Global Impression of Improvement\" (PGI-I), \"Pelvic Floor Impact Questionnaire\" (PFIQ-7) and \"Sexual Questionnaire for Urinary Incontinence /Pelvic Organ Prolapse\" (PSIQ- 12) and. Data were analyzed by descriptive statistics using frequencies and percentages. Student\'s test was used to verify the difference between the means in the groups. The chi-square test was performed to test the hypothesis whether there was a difference between the proportions of responses in both groups. A mixed linear regression model was used to verify the effect of time and groups on outcomes. The level of significance was set at p<=0.05. Both groups presented improvement in the symptomatology after the follow-up. However, there was no significant difference between them (4.3 95% CI -14.4 to 23.2, p=0.65). Both groups showed improvement in PFM contraction. After 3 months, the difference between groups in relation to MVC was -0.8 (95% CI -8.1 to 6.4, p=0.81), in relation to the perception of improvement was 0.4 (95% CI -0.09 to 0.8, p = 0.01), in relation to the quality of life was 2.7 (95%CI, p=0.81) and in relation to sexual function -1.6 (95% CI -7.6 to 4.4, p = 0.59) and This study did not demonstrated the additional benefit of PFMT on POP symptoms, PFM contraction, MVC, quality of life and sexual function. However, the group that received TMAP showed a greater perception of improvement

Os prolapsos dos órgãos pélvicos (POP) apresentam alta prevalência na população feminina, causando um grande impacto social e econômico negativo. Cerca de 11,1% das mulheres aos 80 anos têm indicação para a cirurgia de reparação de POP ou incontinência urinária. Há evidências de que o tratamento conservador, especificamente o treinamento dos músculos do assoalho pélvico (TMAP) é eficaz na redução dos sintomas do POP. No entanto, a literatura é escassa e controversa em relação à efetividade em associar-se o TMAP a procedimento cirúrgico quando há indicação cirúrgica. O objetivo primário deste estudo foi avaliar a eficácia em associar-se o TMAP a procedimento cirúrgico para correção de POP em relação aos seus sintomas. Os objetivos secundários foram verificar a capacidade de contração dos músculos do assoalho pélvico (MAP), a intensidade da contração voluntária máxima (CVM) dos MAP, percepção de melhora, a qualidade de vida, e função sexual. Foi conduzido um ensaio clínico randomizado e controlado com 96 mulheres com indicação médica para a cirurgia de reparação de POP em estágios II, III e IV alocadas em dois grupos: 48 no grupo submetido ao TMAP e 48 no grupo controle. O TMAP foi realizado em quatro sessões supervisionadas pré-cirúrgicas e sete sessões no pós-operatório. Todas as voluntárias foram avaliadas em três momentos: 15 dias antes da cirurgia e 40 e 90 dias após a cirurgia. O desfecho primário foi avaliado por meio do \"Questionário de desconforto no assoalho pélvico\" (PFDI-20) e os secundários por meio da Escala de Oxford Modificada, perineometria, \"Escala de impressão clínica global de melhora\" (PGI-I) \"Questionário de impacto no assoalho pélvico\" (PFIQ-7) e \"Questionário sexual para incontinência urinária e prolapso de órgãos pélvicos\" (PSIQ-12). Os dados foram analisados pela estatística descritiva por meio de frequências e porcentagens. Utilizou-se o teste t Student para verificar a diferença entre as médias dos dois grupos. Já o teste qui-quadrado para testar a diferença entre as proporções nas respostas dos dois grupos. Um modelo de regressão linear misto foi utilizado para verificar o efeito do tempo e dos grupos em relação aos desfechos. O nível de significância adotado foi p<=0,05. Ambos os grupos apresentaram melhora na sintomatologia após o seguimento. No entanto, não houve diferença significativa entre eles (4,3 IC 95%-14,4 a 23,2, p=0,65). Ambos os grupos apresentaram melhora na capacidade de contração dos MAP. Após 3 meses, a diferença entre os grupos em relação CVM foi -0,8 (IC 95% -8,1 a 6,4, p=0,81), em relação à percepção de melhora foi 0,4 (IC 95% -0,09 a 0,8, p=0,01), à qualidade de vida foi 2,7 (IC 95% -19,5 a 24,9, p=0,81) e em relação à função sexual -1,6 (IC 95% -7,6 a 4,4, p=0,59). Este estudo não demonstrou benefício adicional do TMAP em relação à sintomatologia de POP, capacidade de contração dos MAP, CVM dos MAP, qualidade de vida e função sexual. Entretanto, o grupo que recebeu o TMAP apresentou maior percepção de melhora / Pelvic organ prolapse (POP) has a high prevalence in the female population, causing a great negative social and economic impact. It is estimated that about 11.1% of women at age 80 are eligible for POP repair surgery or urinary incontinence. There is evidence that conservative treatment, specifically pelvic floor muscle training (PFMT), is effective in reducing POP symptoms. However, the literature is scarce and controversial regarding the effectiveness in associating PFMT with a surgical procedure when there is a surgical indication. The primary purpose of this study was to evaluate the efficacy in associating PFMT to a POP surgery in relation to its symptoms. The secondary purposes were to verify the capacity of pelvic floor muscles\' contraction (PFM), the maximum voluntary contraction (MVC) of the PFM, perception of improvement, quality of life and sexual function. A randomised controlled trial with 96 women with a medical indication for POP repair surgery in stage II, III and IV was conducted in two groups: 48 in the TMAP and 48 in control group. TMAP was performed in four supervised preoperative sessions and seven postoperative sessions. All volunteers were evaluated in three moments: 15 days before surgery and 40 and 90 days after surgery. The primary outcome was assessed using the \"Pelvic Floor Distress Inventory\" (PFDI-20) and the secondary endpoints using the \"Modified Oxford Scale\", perineometry, \"Patient Global Impression of Improvement\" (PGI-I), \"Pelvic Floor Impact Questionnaire\" (PFIQ-7) and \"Sexual Questionnaire for Urinary Incontinence /Pelvic Organ Prolapse\" (PSIQ- 12) and. Data were analyzed by descriptive statistics using frequencies and percentages. Student\'s test was used to verify the difference between the means in the groups. The chi-square test was performed to test the hypothesis whether there was a difference between the proportions of responses in both groups. A mixed linear regression model was used to verify the effect of time and groups on outcomes. The level of significance was set at p<=0.05. Both groups presented improvement in the symptomatology after the follow-up. However, there was no significant difference between them (4.3 95% CI -14.4 to 23.2, p=0.65). Both groups showed improvement in PFM contraction. After 3 months, the difference between groups in relation to MVC was -0.8 (95% CI -8.1 to 6.4, p=0.81), in relation to the perception of improvement was 0.4 (95% CI -0.09 to 0.8, p = 0.01), in relation to the quality of life was 2.7 (95%CI, p=0.81) and in relation to sexual function -1.6 (95% CI -7.6 to 4.4, p = 0.59) and This study did not demonstrated the additional benefit of PFMT on POP symptoms, PFM contraction, MVC, quality of life and sexual function. However, the group that received TMAP showed a greater perception of improvement

Women can face a wide range of pelvic floor dysfunctions following pregnancy, ranging from urinary incontinence to pelvic pain. Unfortunately, these problems are not routinely checked for in postpartum check-ups and women do not always bring it to the physician’s attention. Strengthening of the pelvic floor muscles may be able to help women prevent these disorders and improve these women’s lifestyles. The purpose of this thesis was to review and analyze different trials to determine if different pelvic floor dysfunctions (urinary incontinence, sexual dysfunction, and pelvic girdle pain) can be treated using pelvic floor muscle training in the postpartum. After reviewing the literature, it was determined that Pelvic floor muscle training may be effective in treating Urinary incontinence, but there is a lack of research to state that it helps treat sexual dysfunction and pelvic pain. Pelvic floor muscle training is a conservative non-invasive treatment and very simple for women to do on their own, therefore more research should be performed to see if this can be a simple fix to a plethora of problems women face in the postpartum.

Title: The biomechanical effects of levator ani muscle laceration injuries after vaginal delivery Objectives: The aim of this thesis is to sum up current knowledge about the normal structure and function of levator ani muscle and findings about dysfunctions of a pelvic floor. By means of biomechanical instruments to analyse how the lower part of levator ani muscle closes (puborectalis muscle) during unilateral avulsion lesion. On the basis of computer simulation of biomechanical properties of the pelvic floor during avulsion lesion to describe the theoretical solutions for the therapy of the main types of dysfunctions of the pelvic floor. Methods: Biomechanical analysis was used with a help of computer model of muscular pelvic floor with a help of the ABAQUS model. This model with matched properties of muscular tissue was influenced by the standard pressure which influences the pelvic floor for a person of 80 kilos standing at rest. This model simulated unilateral avulsion lesion and biomechanical variables were observed during compensatory activation of uninjured parts of levator with the activity 100%, 50% and 10%. The map of the muscular tone and the rate of movement of the muscles of the pelvic floor were evaluated. Results: Only minimal movement is observed in the intact pelvic floor during...

Um conjunto de evidências sugere que a síndrome da congestão pélvica está associada às varizes pélvicas. A congestão pélvica é explicada em muitos casos pela insuficiência das veias ovarianas em drenar o fluxo venoso dos ovários. No presente estudo, realizou-se a avaliação clínica e técnica do tratamento endovascular percutâneo na síndrome da congestão pélvica através da técnica de embolização. Foram tratadas 113 mulheres, das quais 100 foram acompanhadas pelo período de um ano e a análise dos resultados foi baseada nessa amostra. Os resultados clínicos foram baseados na avaliação da sintomatologia durante o período de acompanhamento, com a utilização da escala visual analógica. A avaliação técnica baseou-se no sucesso da realização dos procedimentos e na avaliação das complicações. As pacientes selecionadas com diagnóstico clínico da síndrome foram submetidas ao estudo angiográfico que revelou insuficiência das veias ovarianas previamente ao tratamento por embolização. Obteve-se sucesso técnico em todos os casos, caracterizado pela possibilidade de realização do cateterismo seletivo das veias ovarianas e ilíacas internas com embolização das mesmas. A remissão total dos sintomas foi observada em 37 pacientes (32.7%) e parcial em 63 pacientes (55.4%). Foi observado significativo alívio dos sintomas (p < 0,001), confirmados pela redução dos valores obtidos através da escala analógica visual. A principal complicação foi a migração do agente embolizante metálico, no entanto, com resolução endovascular de todos os casos e sem repercussão clínica. O tratamento endovascular das varizes pélvicas por meio da embolização apresentou resultados satisfatórios em relação aos sintomas apresentados e mostrou-se como método seguro e com baixos índices de complicação. / A great body of evidence suggests that the pelvic congestion syndrome is associated to female varicocile. Pelvic congestion is explained in many cases by ovarian and internal iliac vein insufficiency. The endpoint of the study was the measurement of clinical outcomes and technical success of transcatheter embolotherapy in order to obtain relief of symptoms. The treatment group included 113 patients but only 100 were submitted for a follow up period. We had initial technical success rate of the ovarian and internal iliac vein embolization in all cases. It was used a visual analog scale (VAS) during the 12 months follow up period. The selected patients with the diagnosis of the syndrome were submitted to an angiographic evaluation to reveal ovaric and internal iliac vein insufficiency previous embolization. The technical success was determined by the ability to successfully embolize the ovarian and internal ilac varices and the clinical evaluation by the improvement of symptoms after the following period. A total relief of symptoms was observed in 37 patients (32.7%) and partial relief in 63 (55.4%). Nevertheless, it was seen an important general relief of every symptom (p < 0.001), as well a reduction of the values. The main complication was coil distal embolization, nevertheless, all of them were solved by endovascular approach without clinical repercussion. The transcatheter embolotherapy of the pelvic congestion syndrome provides significant symptomatic improvement, initial technical success and showed no significant long-term complications.

OBJETIVOS: Avaliar a efetividade da massagem perineal de Thiele e a efetividade da eletroestimulação intravaginal no tratamento de mulheres com dor pélvica crônica (DPC) e dispareunia causada por espasmo dos músculos pélvicos, comparar as duas técnicas e seus efeitos sobre a dor, risco de ansiedade e depressão e na função sexual. MÉTODOS: Foi realizado um estudo clínico randomizado, com alocação aleatória dos sujeitos da pesquisa em grupos paralelos, grupo A: 14 mulheres tradadas com massagem perineal e grupo B: 16 mulheres tradadas com eletroestimulação intravaginal. Foram incluídas mulheres com diagnóstico de DPC e dispareunia superficial causada por espasmo de músculos pélvicos, foram excluídas mulheres com dispareunia sem espasmo de músculos pélvicos, mulheres grávidas, menopausadas e que constassem em seus prontuários: vasculopatias, neuropatias, diabetes ou tireoideopatias. Foram recrutadas no Ambulatório de Dor Pélvica Crônica (AGDP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade São Paulo (HC/FMRP- USP). Sendo realizadas avaliações através de exame físico e aplicação dos questionários EVA, McGILL, HAD e FSFI e coleta de dados demográficos. Após término do tratamento essas mulheres foram reavaliadas com a periodicidade de uma, quatro, doze e 24 semanas por um avaliador alheio ao tipo de tratamento por elas realizado. RESULTADOS: Não foram encontradas diferenças significativas quando comparada a efetividade de uma técnica em relação à outra em nenhum dos tempos de reavaliação. Porém foram encontrados resultados significativos dentro de cada grupo entre os tempos antes do tratamento e depois do tratamento (1, 4, 12 e 24 semanas após). Em relação à melhora da dor (EVA, McGILL) e função sexual (FSFI), não foram encontradas diferenças significativas em relação às técnicas de tratamento e o risco para ansiedade e depressão. CONCLUSÃO: As duas modalidades de tratamento foram efetivas na melhora da dor, sugerindo assim o uso delas separadamente ou em associação nos casos de DPC associado a dispareunia superficial secundária a espasmos de músculos pélvicos. / OBJECTIVES: Evaluate the effectiveness of Thiele perineal massage and the effectiveness of intravaginal electrostimulation in treating women with Chronic pelvic pain (CPP) and dyspareunia caused by spasm of the pelvic muscles, to compare two techniques and their pain effects, anxiety and depression risks and sexual function. METHODS: Was realized a clinical trial randomized with random allocation of people in parallel groups. Group A:14 women treated with perineal massage and group B:16 women treated with intravaginal electrostimulation. Inclusion criteria: Women with CPP and superficial dyspareunia caused by spasms of the pelvic muscles diagnosed and exclusion criteria: Dyspareunia without spasm in pelvic muscles, pregnant, menopause and with medical records of vasculopathies, neuropathies, diabetes, thyroid disease. These women were recruited in the Clinic of Chronic Pelvic Pain of the Hospital of Ribeirão Preto Medical School of the University of São Paulo (HC/FMRP-USP). Evaluation with physical examination and application of VAS, McGill pain, HAD and SFIF and the collection of demographic data were performed. After end of treatment these women were re-evaluated after 1, 4, 12 and 24 weeks follow-up by a foreign evaluator to the type of treatment. RESULTS: No significant differences were found when comparing the effectiveness of one technique in relation to the other in any of the reevaluation times. However, significant results were found within each group between pre-treatment and post-treatment times (1, 4, 12, and 24 weeks post-treatment). In relation to the improvement of pain (EVA, McGILL) and sexual function (FSFI), no significant differences were found regarding treatment techniques and the risk for anxiety and depression. CONCLUSION: The two treatment modalities were effective in improving pain, thus suggesting their use separately or in combination in cases of DPC associated with superficial dyspareunia secondary to pelvic muscle spasms.

Bei Patienten, die auf Grund einer schweren Beckenverletzung hämodynamisch instabil sind, ist die primäre Stabilisierung des Beckens und damit die Reduktion des intrapelvinen Volumens entscheidend für den Erfolg der weiteren Therapie. Die Beckenzwinge hat sich als Notfallmaßnahme bewährt, erfordert jedoch in den meisten Fällen eine weitere operative Versorgung. Dieser Sekundäreingriff bedingt in vielen Fällen bei traumatisch geschädigten Weichteilen zusätzliche Wundheilungsstörungen. Ein weiteres Verfahren, der ventrale Fixateur externe, zeichnet sich durch einfache und schnelle Montage bei nur geringem Weichteilschaden aus. In vielen Fällen ist jedoch keine für die Mobilisierung ausreichende biomechanische Stabilisierung des vertikal instabilen dorsalen Beckenringes zu erreichen. Anhand biomechanischer Überlegungen wurde ein neuer schräg dorsaler Beckenfixateur für Becken- C-Verletzungen entwickelt, der die Vorteile des supraacetabulären Fixateur externe nutzt und dabei den hinteren Beckenring von ventral mit einer der Beckenzwinge nahe kommenden Effektivität stabilisieren kann. Er ermöglicht bereits initial eine minimal invasive sowie definitive Stabilisierung des dorsalen Beckenrings. Mehrere Variationen mit zwei unterschiedlichen Pin- Applikationsformen dieses asymmetrischen Fixateurs wurden getestet. In einer zweiten Testreihe wurde die in der ersten Testreihe favorisierte Version des neuen schräg dorsalen Fixateurs mit dem Supraacetabulärem Fixateur externe und der Beckenzwinge (ACE) verglichen. Beide Testreihen erfolgten an Kunststoff-Beckenmodellen im Einbeinstand in einer Materialprüfmaschine. Als Instabilitätsmodell dienten Verletzungen vom Typ C1.2 sowie C1.3 entsprechend der AO Klassifikation. In den Testreihen wurde kein signifikanter Unterschied des neuen verspannten schräg dorsalen Fixateurs zur Beckenzwinge gefunden. Er war jedoch deutlich stabiler als das unverspannte Modell oder der supraacetabuläre Fixateur allein. / In haemodynamically unstable patients with an unstable pelvic ring injury the primary stabilisation of the pelvis and thus reduction of pelvic volume is important for the success of the treatment. The pelvic C-clamp is an approved emergency device for these unstable pelvic ring injuries. A secondary procedure though is necessary in most of the cases with a big rate of wound problems in already traumatized soft tissue areas. The ventrally placed external fixator is a simple and quick procedure with little soft tissue damage. Though primary stability is sufficient even for C-type injuries, biomechanic stability of the posterior pelvic ring is often insufficient for mobilization. Based on biomechanic considerations, a new dorsal oblique pelvic external fixator was developed for pelvic C-type injuries. With the advantages of the supraacetabular fixator and two additional Schanz screws the ventral fixator should stabilize the posterior pelvic ring with comparable stability to the pelvic C-clamp. A primary and already definitive minimal invasive stabilization of the posterior pelvic ring was the aim. In the first series several variations of this asymmetric fixator with two different Schanz screw applications were tested biomechanically. In a second series the favourite version was tested versus the supraacetabular fixator and the pelvic C-clamp. Both of the biomechanic test series were performed with artificial pelves in the one leg stance model in the material testing machine. SI disruption and sacral fracture were the posterior instability types in 6 pelves each. There was no statistically significant difference between the dorsal oblique fixator and the pelvic C-clamp. But the new fixator was significantly more stable than the supraacetabular fixator or the new fixator without pretension.

Um conjunto de evidências sugere que a síndrome da congestão pélvica está associada às varizes pélvicas. A congestão pélvica é explicada em muitos casos pela insuficiência das veias ovarianas em drenar o fluxo venoso dos ovários. No presente estudo, realizou-se a avaliação clínica e técnica do tratamento endovascular percutâneo na síndrome da congestão pélvica através da técnica de embolização. Foram tratadas 113 mulheres, das quais 100 foram acompanhadas pelo período de um ano e a análise dos resultados foi baseada nessa amostra. Os resultados clínicos foram baseados na avaliação da sintomatologia durante o período de acompanhamento, com a utilização da escala visual analógica. A avaliação técnica baseou-se no sucesso da realização dos procedimentos e na avaliação das complicações. As pacientes selecionadas com diagnóstico clínico da síndrome foram submetidas ao estudo angiográfico que revelou insuficiência das veias ovarianas previamente ao tratamento por embolização. Obteve-se sucesso técnico em todos os casos, caracterizado pela possibilidade de realização do cateterismo seletivo das veias ovarianas e ilíacas internas com embolização das mesmas. A remissão total dos sintomas foi observada em 37 pacientes (32.7%) e parcial em 63 pacientes (55.4%). Foi observado significativo alívio dos sintomas (p < 0,001), confirmados pela redução dos valores obtidos através da escala analógica visual. A principal complicação foi a migração do agente embolizante metálico, no entanto, com resolução endovascular de todos os casos e sem repercussão clínica. O tratamento endovascular das varizes pélvicas por meio da embolização apresentou resultados satisfatórios em relação aos sintomas apresentados e mostrou-se como método seguro e com baixos índices de complicação. / A great body of evidence suggests that the pelvic congestion syndrome is associated to female varicocile. Pelvic congestion is explained in many cases by ovarian and internal iliac vein insufficiency. The endpoint of the study was the measurement of clinical outcomes and technical success of transcatheter embolotherapy in order to obtain relief of symptoms. The treatment group included 113 patients but only 100 were submitted for a follow up period. We had initial technical success rate of the ovarian and internal iliac vein embolization in all cases. It was used a visual analog scale (VAS) during the 12 months follow up period. The selected patients with the diagnosis of the syndrome were submitted to an angiographic evaluation to reveal ovaric and internal iliac vein insufficiency previous embolization. The technical success was determined by the ability to successfully embolize the ovarian and internal ilac varices and the clinical evaluation by the improvement of symptoms after the following period. A total relief of symptoms was observed in 37 patients (32.7%) and partial relief in 63 (55.4%). Nevertheless, it was seen an important general relief of every symptom (p < 0.001), as well a reduction of the values. The main complication was coil distal embolization, nevertheless, all of them were solved by endovascular approach without clinical repercussion. The transcatheter embolotherapy of the pelvic congestion syndrome provides significant symptomatic improvement, initial technical success and showed no significant long-term complications.

Chronic pelvic pain (CPP) is defined as constant or intermittent lower, cyclical or non-cyclical abdominal pain of at least six months’ duration. In the United Kingdom, over 1 million women suffer from CPP, with an estimated annual healthcare cost above £150 million. The aetiology of CPP is unknown in up to 50% of women, and in the remainder, the symptoms of CPP is associated with endometriosis, pelvic adhesions, irritable bowel syndrome or painful bladder syndrome. CPP is often accompanied by painful periods, pain during sexual intercourse and defaecation. Fatigue, sleep disturbances and depression are also common among this group of women. CPP asserts a heavy emotional, social and economic burden. Standard treatments such as hormonal and analgesic regimens are often associated with unacceptable side effects, even if helpful for the pain, underlining an urgent need for a satisfactory treatment. The meridian balanced method (BM) electro-acupuncture (EA) treatment (acupuncture needling + traditional Chinese medicine health consultation [TCM HC]) may be effective in managing CPP symptoms. Thus, I have completed a pilot study comprising of a three-armed randomised controlled trial (RCT), using a mixed methods research (MMR) approach, to assess the feasibility of a future large-scale RCT to determine the effectiveness of the meridian BMEA treatment on CPP in women. My hypothesis is that it is feasible to conduct such a large-scale RCT for CPP in women. The primary objectives were to determine recruitment and retention rates. The secondary objectives were to evaluate the, acceptability of the methods of recruitment, randomisation, interventions and assessment tools and any signals of effectiveness of the interventions. Thirty (30) women with CPP were randomised into three groups: BMEA treatment, TCM HC, or National Health Service standard care (NHS SC) group. The effects of my interventions were assessed by validated pain, physical and emotional functioning questionnaires, completed at weeks 0, 4, 8 and 12 of the study. Semi-structured telephone interviews and focus group discussions to explore participants’ experience of the study were conducted. Of the 59 women who were referred to the study, 30 women (51%) were randomised. There was a statistically significant difference in retention rates between the three groups. The retention rates were 80% (95% CI 74-96), in the BMEA treatment group, 53 % (95% CI 36- 70) in the TCM HC group and 87% (95% CI 63-90) in the NHS SC group. (Chi-square test, p=0.08) The attendance rates of the BMEA treatment group were 90% compared to 56% in the TCM HC group. There was a statistically significant difference (Mann-Whitney test, p=0.023) in attendance between the two intervention groups. Telephone interviews regarding the acceptability of the methods of recruitment, randomisation, assessment tools and interventions were positive. No adverse effects that were directly related to BMEA treatments were reported or observed. A higher proportion of the BMEA treatment group achieved clinical significance in the VAS-pain, BPI-pain severity, interference, and sleep scores, when compared to the other two groups. Due to small sample sizes, there was insufficient power to show statistically significant difference. (Fishers Exact Test, p=1.0) Analyses of the questionnaire data per group showed statistically significant differences in the following: the BMEA treatment group experienced less in pain at weeks 4 (p=0.01) and 8 (p=0.005); less helplessness (p=0.03) and their anxiety and depression scores declined at week 4 (p=0.04). The NHS SC group also reported less pain at week 4 (p=0.04). However, this group scored higher in anxiety and depression at weeks 8 and 12 (p=0.04). No statistically significant differences were achieved between the three groups at baseline, weeks 4, 8 and 12 in all scores. The therapeutic benefits gained by the TCM HC group were less compared to those of the BMEA treatment group, but better when compared to the NHS SC group. The BMEA treatment and TCM HC groups showed lower scores in anxiety and depression while the NHS SC group showed higher scores in anxiety and depression. The NHS SC group also tended to ruminate and magnify their problems as well as feeling more helpless than the other two groups. The three key themes that emerged from thematic analysis of focus group discussions were the “whole person effects” where participants reported an improvement in pain, sleep and a general sense of wellbeing in the two intervention groups; the “experience of standard care” and “impact of living with CPP”. In conclusion, the results of my pilot study are supportive of the feasibility of a future large-scale study. There were signals of effectiveness of interventions but the sample size was too small to make a definitive conclusion.