Introduction Urinary incontinence in young sportswomen is a common disorder that interferes with sports practice. Objective: To determine if there is an association between physical activity and stress urinary incontinence in sportswomen from a private university. Methodology: Analytical cross-sectional study, developed in sportswomen from the Peruvian University of Applied Sciences. The International Physical Activity Questionnaire - short version (IPAQ –SF) was used to determine the level of physical activity and the Abbreviated Form of the International Incontinence Consultation Questionnaire (ICIQ - SF) to determine stress urinary incontinence. Results: Of the 92 athletes analyzed in the study, 75% performed high physical activity, 47.8% presented urinary incontinence, of which 63.3% belonged to stress urinary incontinence. In the bivariate analysis between physical activity and stress urinary incontinence, 46% of the athletes who performed high physical activity presented stress urinary incontinence compared to 10% who performed moderate or low physical activity, being significant (p < 0.05). In the multivariate analysis, it was evidenced that women who perform high physical activity have 7.92 times more prevalence of stress urinary incontinence than women who perform moderate or low physical activity, being significant (p = 0.04) and adjusted to the age variables, kind of sport and sport time. Conclusion: An association was found between high-intensity Physical Activity and Stress Urinary Incontinence in female university athletes. / Introducción: La incontinencia urinaria en mujeres jóvenes deportistas es un trastorno frecuente y que interfiere con la práctica deportiva. Objetivo: Determinar si existe asociación entre la actividad física y la incontinencia urinaria por esfuerzo en mujeres deportistas de una universidad privada. Metodología: Estudio transversal analítico, desarrollado en las mujeres deportistas de la Universidad Peruana de Ciencias Aplicadas. Se utilizó el Cuestionario Internacional de Actividad Física – versión corta (IPAQ –SF) para determinar el nivel de actividad física y el Formulario abreviado del cuestionario de Cuestionario Internacional de Incontinencia de formato corto (ICIQ – SF) para determinar la incontinencia urinaria por esfuerzo. Resultados: De las 92 deportistas analizadas en el estudio, el 75% realizaba actividad física alta, el 47, 8% presentaron incontinencia urinaria, de las cuales el 63.3% pertenecían a incontinencia urinaria por esfuerzo. En el análisis bivariado entre la actividad física y la incontinencia urinaria por esfuerzo, el 46% de las deportistas que realizaba actividad física alta presentaban incontinencia urinaria por esfuerzo en comparación con el 10 % que realizaba actividad física moderada o baja, siendo significativo (p<0.05). En el análisis multivariado, se evidenció que las mujeres que realizan actividad física alta tienen 7.92 veces más prevalencia de Incontinencia Urinaria por Esfuerzo que las mujeres que realizan actividad física moderada o baja, siendo significativo (p=0.04) y ajustado a las variables edad, tipo de deporte y tiempo de deporte. Conclusión: Se encontró asociación entre la Actividad Física de alta intensidad con la Incontinencia Urinaria por Esfuerzo en deportistas mujeres universitarias. / Tesis

Purpose: The literature indicates that normal healthy women can increase the strength of the pelvic floor muscles (PFMs) by simultaneously contracting the transverse abdominus (TrA) muscle. This study investigated the relationship of the PFMs and the TrA in women with stress urinary incontinence (SUI). Subjects: 15 women with SUI, verified by scores on the Questionnaire of Urinary Incontinence Diagnosis (QUID), were randomly assigned, blocked by age, into 2 exercise groups. The 6 women in the PFM only group had a mean age of 63 years and the 9 women in the PFM+TrA group had a mean age of 49 years. Method: For 2 weeks, all women were trained by rehabilitative ultrasound imaging (RUSI) to correctly contract the TrA or relax the TrA during a PFM contraction depending upon the group assignment. Each woman was examined using the PERFECT scheme and prescribed a patient-specific PFM exercise program. The exercise protocols required 6 weeks of supervised patient specific exercises. Data collection occurred at 3 time periods (before intervention, after intervention, and follow-up) and included: measurement of TrA thickness changes and PFM lift by RUSI, PFM strength and endurance with pressure perineometry, number of incontinence episodes and pad use from bladder diaries, and quality of life (QOL) measurements using the Incontinence Impact Questionnaire (IIQ) and the Patient Specific Functional Scale (PSFS). Results: MANOVA identified no significant difference after interventions between groups. All women significantly improved in PFM strength (PConclusion: PFM exercises done in isolation or with recruitment of the TrA increased PFM strength, endurance, lift and decreased incontinence in women with SUI. Recommendations: Women with SUI can benefit from physical therapists prescribing PFM exercises in isolation or in combination with TrA contractions.

(1) Background: This study examined outcomes of second-line ATOMS implantation after failure of the fixed male sling (FMS) AdVance/AdVance XP. (2) Methods: A retrospective multicenter cohort analysis was carried out in men implanted with an ATOMS between 2011 and 2020 after failure of an AdVance/AdVance XP. Success was assessed on the basis of objective (dryness, 0–1 pad/24 h or >20 g/24 h pad test) and subjective results (PGI-I). We performed the Wilcoxon rank sum test, Fisher’s exact test, logistic regression, and multivariate analysis. (3) Results: The study included 88 patients from 9 centers with a mean age of 71.3 years. No Clavien–Dindo > II complications occurred within the first 3 months after ATOMS implantation. A total of 10 cases (9%) required revision in the ensuing clinical course. After a mean follow-up of 42.5 months, 76.1% achieved social continence, and 56.8% used no pads at all. Mean urine leakage/24 h dropped from 422 g (3.9 pads) to 38 g (0.69 pads) and the mean ICIQ-SF decreased from 16.25 to 5.3 (p < 0.0001). PROMs (patient-reported outcome measures) showed improvement in 98.9% of cases, and 63.6% gave a “very much better” PGI-I rating. Multivariate analysis identified a lower probability of achieving maximum satisfaction for the following factors: the AdVance XP as first-line therapy (OR 0.35), a lower ICIQ-SF question 1 (OR 0.26), status post-irradiation (OR 0.14), and more severe pain prior to ATOMS implantation (OR 0.51). (4) Conclusions: Implantation of an ATOMS is an effective and safe second-line treatment option for recurrent urinary incontinence after implantation of an AdVance/AdVance XP sling. High patient satisfaction was demonstrated in a long-term follow-up.

No description available.

L’incontinence urinaire d’effort (IUE) est une condition fréquente en période postnatale pouvant affecter jusqu’à 77% des femmes. Neuf femmes sur dix souffrant d’IUE trois mois après l’accouchement, vont présenter une IUE cinq ans plus tard. Le traitement en physiothérapie de l’IUE par le biais d’un programme d’exercices de renforcement des muscles du plancher pelvien est reconnu comme étant un traitement de première ligne efficace. Les études ont prouvé l’efficacité de cette approche sur l’IUE persistante à court terme, mais les résultats de deux ECR à long terme n’ont pas démontré un maintien de l’effet de traitement. L’effet d’un programme en physiothérapie de renforcement du plancher pelvien intensif et étroitement supervisé sur l’IUE postnatale persistante avait été évalué lors d’un essai clinique randomisé il y a sept ans. Le but principal de la présente étude était d’évaluer l’effet de ce programme sept ans après la fin des interventions de l’ECR initial. Un objectif secondaire était de comparer l’effet de traitement à long terme entre un groupe ayant fait seulement des exercices de renforcement du plancher pelvien et un groupe ayant fait des exercices de renforcement du plancher pelvien et des abdominaux profonds. Un troisième objectif était d’explorer l’influence de quatre facteurs de risques sur les symptômes d’IUE et la qualité de vie à long terme. Les cinquante-sept femmes ayant complétées l’ECR initial ont été invitées à participer à l’évaluation du suivi sept ans. Vingt et une femmes ont participé à l’évaluation clinique et ont répondu à quatre questionnaires, tandis que dix femmes ont répondu aux questionnaires seulement. L’évaluation clinique incluait un pad test et la dynamométrie du plancher pelvien. La mesure d’effet primaire était un pad test modifié de 20 minutes. Les mesures d’effets secondaires étaient la dynamométrie du plancher pelvien, les symptômes d’IUE mesuré par le questionnaire Urogenital Distress Inventory, la qualité de vie mesurée par le questionnaire Incontinence Impact Questionnaire et la perception de la sévérité de l’IUE mesuré par l’Échelle Visuelle Analogue. De plus, un questionnaire portant sur quatre facteurs de risques soit, la présence de grossesses subséquentes, la v présence de constipation chronique, l’indice de masse corporel et la fréquence des exercices de renforcement du plancher pelvien de l’IUE, venait compléter l’évaluation. Quarante-huit pour-cent (10/21) des participantes étaient continentes selon de pad test. La moyenne d’amélioration entre le résultat pré-traitement et le suivi sept ans était de 26,9 g. (écart-type = 68,0 g.). Il n’y avait pas de différence significative des paramètres musculaires du plancher pelvien entre le pré-traitement, le post-traitement et le suivi sept ans. Les scores du IIQ et du VAS étaient significativement plus bas à sept ans qu’en prétraitement (IIQ : 23,4 vs 15,6, p = 0,007) et (VAS : 6,7 vs 5,1, p = 0,001). Les scores du UDI étaient plus élevés au suivi sept ans (15,6) qu’en pré-traitement (11,3, p = 0,041) et en post-traitement (5,7, p = 0,00). La poursuite des exercices de renforcement du plancher pelvien à domicile était associée à une diminution de 5,7 g. (p = 0,051) des fuites d’urine observées au pad test selon une analyse de régression linéaire. Les limites de cette étude sont ; la taille réduite de l’échantillon et un biais relié au désir de traitement pour les femmes toujours incontinentes. Cependant, les résultats semblent démontrer que l’effet du traitement à long terme d’un programme de renforcement des muscles du plancher pelvien qui est intensif et étroitement supervisé, est maintenu chez environ une femme sur deux. Bien que les symptômes d’IUE tel que mesuré par les pad test et le questionnaire UDI, semblent réapparaître avec le temps, la qualité de vie, telle que mesurée par des questionnaires, est toujours meilleure après sept qu’à l’évaluation initiale. Puisque la poursuite des exercices de renforcement du plancher pelvien est associée à une diminution de la quantité de fuite d’urine au pad test, les participantes devraient être encouragées à poursuivre leurs exercices après la fin d’un programme supervisé. Pour des raisons de logistique la collecte de donnée de ce projet de recherche s’est continuée après la rédaction de ce mémoire. Les résultats finaux sont disponibles auprès de Chantale Dumoulin pht, PhD., professeure agrée à l’Université de Montréal. / Stress urinary incontinence is a common condition in the postpartum period affecting up to 77% of women. Nine women out of ten still suffering from SUI three months after giving birth will have symptoms of SUI five years later. Physiotherapy treatment via pelvic floor muscles strengthening exercises is recognized as an efficient first line of treatment for SUI. Although studies have shown good short term cure rates for persistent SUI, two long term follow-ups RCT’s have demonstrated that the effect was not maintained through time. The effect of an intensive and supervised physiotherapy pelvic floor strengthening program was evaluated in a previous randomized controlled trial (RCT) seven years ago. The main objective of the present study was to evaluate the effect of this program seven years after cessation of treatment. A secondary objective is to investigate the influence of four possible predictors of long term SUI symptoms and quality of life. The 57 women who completed the initial trial were contacted by telephone and invited to participate in a 7 year follow-up. Twenty-one participants underwent the clinical evaluation and answered four questionnaires while 10 participants answered only the questionnaires. The clinical evaluation included a provocative pad test and dynamometry of the pelvic floor muscles. The main outcome measure was the 20-minute modified pad test. Secondary outcomes were pelvic floor muscle strength measure by the Montreal dynamometer, symptoms of incontinence measured by the Urogenital Distress Inventory questionnaire, quality of life measured by the Incontinence Impact Questionnaire and the perceived burden of SUI measured by the Visual Analog Scale. The evaluation was completed by a questionnaire on four potential predictors of SUI: subsequent pregnancies, chronic constipation, body mass index and the frequency of pelvic floor muscle exercises. Forty-eight percent (10/21) of the participants were continent according to the pad test. The mean improvement between baseline and seven year follow-up was 26.9 g. (SD = vii 68.0g.). There was no statistically significant difference in pelvic floor muscle strength between baseline, after treatment and the follow-up (p = 0.74). The IIQ and VAS score were significantly lower at the seven year follow-up than at baseline (IIQ: 23.4 vs 15.6 , p = 0.007 and VAS: 6.7 vs 5.1, p = 0.001). The UDI scores were higher at follow-up (15.6) than baseline (11.3, p = 0.041) and after treatment (5.7, p = 0.00). Maintaining pelvic floor exercise at seven years after treatment had a strong trend towards a decrease of 5.7 g. for pad test results (p = 0.051). Limits of this study are the small sample size and the bias related to treatment seeking behavior amongst women who agreed to participate. Nevertheless, results seem to indicate that an intensive closely supervised pelvic floor training program is effective in the long run for one woman out of two. Although symptoms of SUI, as measured by the pad test and the UDI questionnaire, seem to reappear with time, quality of life is still better seven years after treatment than at baseline. Continuation of pelvic floor exercises seems to decrease the urine leakage upon exertion and thus should be encouraged even after cessation of intense training. For logistic reasons, the data collection for this research project continued after the writing of this thesis. Final results are available from Chantale Dumoulin pht, PhD, professor at the University of Montreal.

Title: Comparison of rehabilitation approaches for female urinary incontinence at different departments in the CR. Objectives: The aim of this thesis was to determine the percentage of physiotherapists who have offices in their encounter with incontinent patients and percentage distinguish whether they are sent to a specialist or incontinence is known only by them. Determine which method of pelvic examination with stress incontinence (diagnosed and undiagnosed) is performed most often. Find out what the age group of women with stress incontinence with physiotherapists meet in their offices often. Determine which method of pelvic examination with stress incontinence (diagnosed and undiagnosed) is usually a percentage, carried out to determine how many of the respondents used physical therapists in the treatment of stress incontinence "Ostrava concept." Another objective of this work is expressed as a percentage of physiotherapists awareness about the new clinical standard for treatment of stress incontinence and technology PELVICORE. Inform the public about female stress urinary incontinence. Methods: The research was conducted using nonstandardized fifteen-page questionnaire. This e-mail questionnaire was distributed to 30 hospitals. We managed to get a total of 54 questionnaires were processed and...

L’incontinence urinaire d’effort (IUE) est une condition fréquente en période postnatale pouvant affecter jusqu’à 77% des femmes. Neuf femmes sur dix souffrant d’IUE trois mois après l’accouchement, vont présenter une IUE cinq ans plus tard. Le traitement en physiothérapie de l’IUE par le biais d’un programme d’exercices de renforcement des muscles du plancher pelvien est reconnu comme étant un traitement de première ligne efficace. Les études ont prouvé l’efficacité de cette approche sur l’IUE persistante à court terme, mais les résultats de deux ECR à long terme n’ont pas démontré un maintien de l’effet de traitement. L’effet d’un programme en physiothérapie de renforcement du plancher pelvien intensif et étroitement supervisé sur l’IUE postnatale persistante avait été évalué lors d’un essai clinique randomisé il y a sept ans. Le but principal de la présente étude était d’évaluer l’effet de ce programme sept ans après la fin des interventions de l’ECR initial. Un objectif secondaire était de comparer l’effet de traitement à long terme entre un groupe ayant fait seulement des exercices de renforcement du plancher pelvien et un groupe ayant fait des exercices de renforcement du plancher pelvien et des abdominaux profonds. Un troisième objectif était d’explorer l’influence de quatre facteurs de risques sur les symptômes d’IUE et la qualité de vie à long terme. Les cinquante-sept femmes ayant complétées l’ECR initial ont été invitées à participer à l’évaluation du suivi sept ans. Vingt et une femmes ont participé à l’évaluation clinique et ont répondu à quatre questionnaires, tandis que dix femmes ont répondu aux questionnaires seulement. L’évaluation clinique incluait un pad test et la dynamométrie du plancher pelvien. La mesure d’effet primaire était un pad test modifié de 20 minutes. Les mesures d’effets secondaires étaient la dynamométrie du plancher pelvien, les symptômes d’IUE mesuré par le questionnaire Urogenital Distress Inventory, la qualité de vie mesurée par le questionnaire Incontinence Impact Questionnaire et la perception de la sévérité de l’IUE mesuré par l’Échelle Visuelle Analogue. De plus, un questionnaire portant sur quatre facteurs de risques soit, la présence de grossesses subséquentes, la v présence de constipation chronique, l’indice de masse corporel et la fréquence des exercices de renforcement du plancher pelvien de l’IUE, venait compléter l’évaluation. Quarante-huit pour-cent (10/21) des participantes étaient continentes selon de pad test. La moyenne d’amélioration entre le résultat pré-traitement et le suivi sept ans était de 26,9 g. (écart-type = 68,0 g.). Il n’y avait pas de différence significative des paramètres musculaires du plancher pelvien entre le pré-traitement, le post-traitement et le suivi sept ans. Les scores du IIQ et du VAS étaient significativement plus bas à sept ans qu’en prétraitement (IIQ : 23,4 vs 15,6, p = 0,007) et (VAS : 6,7 vs 5,1, p = 0,001). Les scores du UDI étaient plus élevés au suivi sept ans (15,6) qu’en pré-traitement (11,3, p = 0,041) et en post-traitement (5,7, p = 0,00). La poursuite des exercices de renforcement du plancher pelvien à domicile était associée à une diminution de 5,7 g. (p = 0,051) des fuites d’urine observées au pad test selon une analyse de régression linéaire. Les limites de cette étude sont ; la taille réduite de l’échantillon et un biais relié au désir de traitement pour les femmes toujours incontinentes. Cependant, les résultats semblent démontrer que l’effet du traitement à long terme d’un programme de renforcement des muscles du plancher pelvien qui est intensif et étroitement supervisé, est maintenu chez environ une femme sur deux. Bien que les symptômes d’IUE tel que mesuré par les pad test et le questionnaire UDI, semblent réapparaître avec le temps, la qualité de vie, telle que mesurée par des questionnaires, est toujours meilleure après sept qu’à l’évaluation initiale. Puisque la poursuite des exercices de renforcement du plancher pelvien est associée à une diminution de la quantité de fuite d’urine au pad test, les participantes devraient être encouragées à poursuivre leurs exercices après la fin d’un programme supervisé. Pour des raisons de logistique la collecte de donnée de ce projet de recherche s’est continuée après la rédaction de ce mémoire. Les résultats finaux sont disponibles auprès de Chantale Dumoulin pht, PhD., professeure agrée à l’Université de Montréal. / Stress urinary incontinence is a common condition in the postpartum period affecting up to 77% of women. Nine women out of ten still suffering from SUI three months after giving birth will have symptoms of SUI five years later. Physiotherapy treatment via pelvic floor muscles strengthening exercises is recognized as an efficient first line of treatment for SUI. Although studies have shown good short term cure rates for persistent SUI, two long term follow-ups RCT’s have demonstrated that the effect was not maintained through time. The effect of an intensive and supervised physiotherapy pelvic floor strengthening program was evaluated in a previous randomized controlled trial (RCT) seven years ago. The main objective of the present study was to evaluate the effect of this program seven years after cessation of treatment. A secondary objective is to investigate the influence of four possible predictors of long term SUI symptoms and quality of life. The 57 women who completed the initial trial were contacted by telephone and invited to participate in a 7 year follow-up. Twenty-one participants underwent the clinical evaluation and answered four questionnaires while 10 participants answered only the questionnaires. The clinical evaluation included a provocative pad test and dynamometry of the pelvic floor muscles. The main outcome measure was the 20-minute modified pad test. Secondary outcomes were pelvic floor muscle strength measure by the Montreal dynamometer, symptoms of incontinence measured by the Urogenital Distress Inventory questionnaire, quality of life measured by the Incontinence Impact Questionnaire and the perceived burden of SUI measured by the Visual Analog Scale. The evaluation was completed by a questionnaire on four potential predictors of SUI: subsequent pregnancies, chronic constipation, body mass index and the frequency of pelvic floor muscle exercises. Forty-eight percent (10/21) of the participants were continent according to the pad test. The mean improvement between baseline and seven year follow-up was 26.9 g. (SD = vii 68.0g.). There was no statistically significant difference in pelvic floor muscle strength between baseline, after treatment and the follow-up (p = 0.74). The IIQ and VAS score were significantly lower at the seven year follow-up than at baseline (IIQ: 23.4 vs 15.6 , p = 0.007 and VAS: 6.7 vs 5.1, p = 0.001). The UDI scores were higher at follow-up (15.6) than baseline (11.3, p = 0.041) and after treatment (5.7, p = 0.00). Maintaining pelvic floor exercise at seven years after treatment had a strong trend towards a decrease of 5.7 g. for pad test results (p = 0.051). Limits of this study are the small sample size and the bias related to treatment seeking behavior amongst women who agreed to participate. Nevertheless, results seem to indicate that an intensive closely supervised pelvic floor training program is effective in the long run for one woman out of two. Although symptoms of SUI, as measured by the pad test and the UDI questionnaire, seem to reappear with time, quality of life is still better seven years after treatment than at baseline. Continuation of pelvic floor exercises seems to decrease the urine leakage upon exertion and thus should be encouraged even after cessation of intense training. For logistic reasons, the data collection for this research project continued after the writing of this thesis. Final results are available from Chantale Dumoulin pht, PhD, professor at the University of Montreal.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Este estudo teve como objetivo verificar, através de uma revisão sistemática de ensaios clínicos aleatorizados, os benefícios da estimulação elétrica funcional endovaginal ou dos tratamentos conservadores às pacientes com incontinência urinária de esforço, e demonstrar qual modalidade de tratamento conservador apresenta melhores resultados na terapêutica dessas mulheres: a estimulação elétrica funcional endovaginal, em comparação com os cones vaginais ou a realização de exercícios perineais. Para tanto, foram realizadas buscas nas principais bases de dados científicos, por estudos que atendessem a pergunta da pesquisa, tipo de intervenção e tipo de participantes selecionados. Destes, foram selecionados 7 estudos que foram submetidos à análise dos revisores, que avaliaram os seguintes desfechos: episódios de perda urinária, quantificação das perdas urinárias através do pad-test, força da musculatura perineal, qualidade de vida, volume residual, capacidade cistométrica máxima, melhora dos sintomas, satisfação e cura. Todas as terapias pesquisadas apresentaram melhora dos sintomas da incontinência urinária de esforço; no entanto, segundo os desfechos avaliados, apresentaram diferença no resultado comparativo. Quanto às perdas urinárias, ao pad-test e à força da musculatura perineal, a realização dos exercícios pélvicos obteve os melhores resultados. Já a terapia por estimulação elétrica endovaginal e a terapia com os cones apresentaram resultados semelhantes, não sendo encontrada diferença significativa em nenhum dos desfechos analisados. De acordo com os achados obtidos nesta revisão sistemática, entendemos que o tratamento pela estimulação elétrica traz benefícios às pacientes com incontinência urinária de esforço. Os exercícios pélvicos demonstraram ser a terapia que reduz mais significativamente os sintomas ocasionados por esta condição / This study aimed to verify, through a systematic review of randomized clinical trials, if the endovaginal functional electrical stimulation provides or not benefits to patients with stress urinary incontinence, and show what kind of conservative treatment produces better results in the treatment of these women: endovaginal functional electrical stimulation, vaginal cones or perineal exercises. To do so, we searched in major scientific databases for studies that met the research question, type of intervention and type of selected participants. Of these, seven studies were selected and analyzed by the reviewers who assessed the following outcomes: frequency of urinary leakage, quantification of urinary leakage through the pad-test, perineal muscle strength, quality of life, residual volume, maximum cystometric capacity, improvement, satisfaction and healing. All therapies surveyed showed improvement of symptoms of stress urinary incontinence; however, according to the outcome parameters, they showed differences in the comparative result. As for urinary leakage, the pad-test and strength of the perineal muscles, the pelvic exercises achieved the best results. The electrical stimulation therapy and transvaginal cone therapy showed similar results, no significant difference was found in any of the outcomes. According to the findings of this systematic review, we believe that treatment by electrical stimulation is beneficial to patients with stress urinary incontinence. The pelvic exercises have proven to be the therapy that more significantly reduces the symptoms caused by this condition

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Este estudo teve como objetivo verificar, através de uma revisão sistemática de ensaios clínicos aleatorizados, os benefícios da estimulação elétrica funcional endovaginal ou dos tratamentos conservadores às pacientes com incontinência urinária de esforço, e demonstrar qual modalidade de tratamento conservador apresenta melhores resultados na terapêutica dessas mulheres: a estimulação elétrica funcional endovaginal, em comparação com os cones vaginais ou a realização de exercícios perineais. Para tanto, foram realizadas buscas nas principais bases de dados científicos, por estudos que atendessem a pergunta da pesquisa, tipo de intervenção e tipo de participantes selecionados. Destes, foram selecionados 7 estudos que foram submetidos à análise dos revisores, que avaliaram os seguintes desfechos: episódios de perda urinária, quantificação das perdas urinárias através do pad-test, força da musculatura perineal, qualidade de vida, volume residual, capacidade cistométrica máxima, melhora dos sintomas, satisfação e cura. Todas as terapias pesquisadas apresentaram melhora dos sintomas da incontinência urinária de esforço; no entanto, segundo os desfechos avaliados, apresentaram diferença no resultado comparativo. Quanto às perdas urinárias, ao pad-test e à força da musculatura perineal, a realização dos exercícios pélvicos obteve os melhores resultados. Já a terapia por estimulação elétrica endovaginal e a terapia com os cones apresentaram resultados semelhantes, não sendo encontrada diferença significativa em nenhum dos desfechos analisados. De acordo com os achados obtidos nesta revisão sistemática, entendemos que o tratamento pela estimulação elétrica traz benefícios às pacientes com incontinência urinária de esforço. Os exercícios pélvicos demonstraram ser a terapia que reduz mais significativamente os sintomas ocasionados por esta condição / This study aimed to verify, through a systematic review of randomized clinical trials, if the endovaginal functional electrical stimulation provides or not benefits to patients with stress urinary incontinence, and show what kind of conservative treatment produces better results in the treatment of these women: endovaginal functional electrical stimulation, vaginal cones or perineal exercises. To do so, we searched in major scientific databases for studies that met the research question, type of intervention and type of selected participants. Of these, seven studies were selected and analyzed by the reviewers who assessed the following outcomes: frequency of urinary leakage, quantification of urinary leakage through the pad-test, perineal muscle strength, quality of life, residual volume, maximum cystometric capacity, improvement, satisfaction and healing. All therapies surveyed showed improvement of symptoms of stress urinary incontinence; however, according to the outcome parameters, they showed differences in the comparative result. As for urinary leakage, the pad-test and strength of the perineal muscles, the pelvic exercises achieved the best results. The electrical stimulation therapy and transvaginal cone therapy showed similar results, no significant difference was found in any of the outcomes. According to the findings of this systematic review, we believe that treatment by electrical stimulation is beneficial to patients with stress urinary incontinence. The pelvic exercises have proven to be the therapy that more significantly reduces the symptoms caused by this condition

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-12-09T14:00:09Z No. of bitstreams: 1 arquivototal.pdf: 2927512 bytes, checksum: 3b3d23f79a7a54fa4a14cbfb71803ed7 (MD5) / Made available in DSpace on 2016-12-09T14:00:09Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2927512 bytes, checksum: 3b3d23f79a7a54fa4a14cbfb71803ed7 (MD5) Previous issue date: 2016-04-29 / In recent decades has arisen interest in options of less invasive treatments, low cost and proven efficiency for stress urinary incontinence, such as behavioral therapy. There is currently a variety of care that does not follow a standardized and evidence-based practice. Thus, the need for the development of specific nursing care protocols is justified to improve the quality of care for incontinent elderly women. In order to support the care practice of nurses in the empowerment process of elderly women as behavioral therapy, the Urinary Control Theory was used as the theoretical framework of this study, derived from the Roy’s Adaptation Theory. Objective: To create a protocol of nursing interventions about behavioral therapy for the adaptation process of elderly women with stress urinary incontinence before the urinary control. Method: This is a methodological study. The World Health Organization guided the steps for the protocol creation. Data collection occurred from July 2015 to February 2016. Initially, there was an integrative literature review for selection of clinical guidelines, in addition to nursing interventions and activities proposed by the Nursing Interventions Classification for the control of urinary incontinence. Immediately, there was the synthesis of empirical material and critical and reflexive analysis for the selection of the best clinical evidence. These findings supported the elaboration of the data collection tool to the validation step by expert consensus. This study was appreciated by the Ethics Committee of the Science and Health Center of the Federal University of Paraíba and approved under protocol registration number 0561/15 and CAAE (Presentation Certificate for Ethical Appreciation): 50061015.1.0000.5188. Results: 14 interventions were selected among the best evidences about the behavioral therapy of three international clinical guidelines that were addressed in 11 nursing interventions of the Nursing Interventions Classification. Also, 138 activities were enumerated, proposed by the Nursing Interventions Classification, consensually validated by experts for implementation of nursing interventions. Interventions and eligible Nursing activities were related to four guiding principles of behavioral therapy that include Urinary Control Theory Adaptation modes. In the motivation axis for continence, the behavior and education modification was addressed: individual; in the lifestyle change, weight control and water monitoring; in control of micturition habits, control of urinary elimination, urinary incontinence care, self-care assistance: toilet use, perineum care, bladder retraining and control of medicines; while in the pelvic floor training, exercises for pelvic muscles. Conclusion: The protocol in question generates, in the target-population, a simultaneous adaptive answer between the adaptation modes supported by Urinary Control Theory, supporting important contributions to research, teaching and the Nursing practice, being applicable in Primary Care services, especially in the implementation of permanent education that incorporates technical and scientific material resources to guarantee and an effective nursing care with a view to the management of stress urinary incontinence. / En las últimas décadas ha surgido interés por opciones de tratamientos cada vez menos invasivos, de bajo costo y de eficacia comprobada para la incontinencia urinaria, tales como la terapia del comportamiento. Existen, en la actualidad, una variedad de cuidados que no siguen una estandarización y la práctica basada en evidencia. Por lo tanto, se justifica, la necesidad de elaboración de protocolos asistenciales específicos de enfermería para mejorar la calidad de la atención para las mujeres mayores con incontinencia. Con el fin de apoyar el cuidado de enfermeras en el proceso de potenciación de las mujeres mayores en la terapia del comportamiento, se utilizó como marco teórico de este estudio, la Teoría de Control urinaria, derivada de la Teoría de la Adaptación de Roy. Objetivo: Construir un protocolo de intervenciones de enfermería relativo a la terapia del comportamiento para el proceso de adaptación de las mujeres de edad avanzada con incontinencia antes del control urinario. Método: Se trata de un estudio metodológico. Los pasos para la organización del protocolo fueron guiados por la Organización Mundial de la Salud. Los datos fueron recolectados a partir de julio del año 2015 a febrero de 2016. Inicialmente, se realizó una revisión integradora para la selección de las guías clínicas, además de las intervenciones y actividades de enfermería propuesto por la Clasificación de Intervenciones de Enfermería para el control de la incontinencia urinaria de esfuerzo. Enseguida se realizó la síntesis del material empírico y análisis crítico, reflexivo, para la selección de las mejoras en la evidencia clínica. Estos hallazgos subvencionaron la elaboración de la herramienta de recolección de datos para validar el paso por el consenso de expertos. Este estudio fue evaluado por el Comité de Ética del Centro de Ciencias de la Salud de la Universidad Federal de Paraíba y aprobado en virtud del protocolo de registro nº 0561 / 15 y CAAE (Certificado de Presentación para Apreciación Ética): 50061015.1.0000.5188. Resultados: Se seleccionaron 14 intervenciones entre las mejores evidencias acerca de la terapia del comportamiento en las tres guías clínicas internacionales que fueron contempladas en 11 intervenciones de enfermería de la Clasificación de Intervenciones de Enfermería. Además, se listaron 138 actividades propuestas por la Clasificación de Intervenciones de Enfermería que fueron consensualmente validadas por expertos para la ejecución de las intervenciones de enfermería. Las intervenciones y actividades de Enfermería elegibles se relacionan con los cuatro principios rectores de la terapia de conducta que contemplan los modos Adaptación de la Teoría de Control Urinario. En la guía motivación de la continencia se abordó la modificación del comportamiento y la educación: individual; el cambio en el estilo de vida, el control del peso y el monitoreo hídrico; en el control de los hábitos de micción, el control de la eliminación urinaria, el cuidado de la incontinencia urinaria, la asistencia en el auto-cuidado: usar el W.C, cuidado con el perineo, re-educación de la vejiga y el control de los medicamentos; mientras que en el entrenamiento del suelo pélvico, ejercicios para los músculos pélvicos. Conclusión: El protocolo en cuestión genera en las personas de la población objetivo una respuesta de adaptación simultánea entre los modos de adaptación soportados por la Teoría de control urinario, apoyando importantes contribuciones a la investigación, a la enseñanza y a la práctica de enfermería, siendo aplicable en los servicios de Atención Primaria especialmente en la implementación de la educación continuada que incorpore recursos materiales técnicos y científicos para garantizar la atención eficaz de enfermería con miras a la gestión de la incontinencia urinaria de esfuerzo continuo. / nas últimas décadas tem surgido o interesse por opções de tratamentos cada vez menos invasivos, de baixo custo e com eficácia comprovada para incontinência urinária de esforço, a exemplo da terapia comportamental. Verifica-se, atualmente, uma diversidade de cuidados que não seguem uma padronização e a prática baseada em evidências. Assim, justifica-se a necessidade da elaboração de protocolos assistenciais específicos de enfermagem para melhoria da qualidade da assistência às mulheres idosas incontinentes. Com o intuito de respaldar a prática assistencial do enfermeiro no processo de empoderamento de mulheres idosas quanto à terapia comportamental, utilizou-se como referencial teórico deste estudo a Teoria do Controle Urinário, derivada da Teoria de adaptação de Roy. Objetivo: construir um protocolo de intervenções de enfermagem relativa à terapia comportamental para o processo adaptativo de mulheres idosas com incontinência urinária de esforço perante o controle urinário. Método: trata-se de um estudo metodológico. Os passos para construção do protocolo foram norteados pela Organização Mundial de Saúde. A coleta dos dados ocorreu no período de julho de 2015 a fevereiro de 2016. Inicialmente, realizou-se revisão integrativa da literatura para seleção das diretrizes clínicas, além das intervenções e atividades de enfermagem propostas pela Classificação de Intervenções de Enfermagem para o controle da incontinência urinária de esforço. Em seguida, realizou-se a síntese do material empírico e análise crítica e reflexiva para seleção das melhores evidências clínicas. Esses achados subsidiaram a elaboração do instrumento de coleta de dados para etapa de validação por consenso de especialistas. Este estudo foi apreciado pelo Comitê de Ética do Centro de Ciências e Saúde da Universidade Federal da Paraíba e aprovado sob registro de Protocolo nº 0561/15 e CAAE: 50061015.1.0000.5188. Resultados: foram selecionadas 14 intervenções entre as melhores evidências acerca da terapia comportamental das três diretrizes clínicas internacionais que foram contempladas em 11 intervenções de enfermagem da Classificação das Intervenções de Enfermagem. Além disso, elencaram-se 138 atividades propostas pela Classificação das Intervenções de Enfermagem, que foram consensualmente validadas pelos especialistas, para operacionalização das intervenções de enfermagem. As intervenções e atividades de Enfermagem elegíveis foram relacionadas a quatro eixos norteadores da terapia comportamental que contemplam os modos de Adaptação da Teoria do Controle Urinário. No eixo motivação para continência, abordou-se a modificação do comportamento e ensino: indivíduo; na mudança no estilo de vida, o controle do peso e monitorização hídrica; no controle dos hábitos miccionais, o controle da eliminação urinária, cuidados na incontinência urinária, assistência no autocuidado: uso do vaso sanitário, cuidado com o períneo, reeducação vesical e controle de medicamentos; enquanto que no treinamento do assoalho pélvico, os exercícios para musculatura pélvica. Conclusão: o protocolo em questão gera na população-alvo uma resposta adaptativa simultânea entre os modos de adaptação sustentados pela Teoria do Controle Urinário, subsidiando importantes contribuições para a pesquisa, para o ensino e para a prática da Enfermagem, sendo aplicável nos serviços de Atenção Primária, especialmente na implementação de educação continuada que incorpore recursos materiais técnico-científicos para a garantia e um cuidado de enfermagem efetivo com vistas ao manejo da incontinência urinária de esforço.