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ABSTRACT: To investigate the effect of adding biofeedback (BF) to the training of pelvic floor muscles (PFMT) for the treatment of stress urinary incontinence (SUI).
A prospective pilot study, randomized and controlled with women with SUI without sphincter deficiency, detected by urodynamic study and who performed the correct PFM contraction. Women with neuromuscular disorders and grade III and IV genital prolapse were excluded. Forty women were randomized into a Control Group and BF Group. The PFMT protocol with BF equipment consisted of three sets of ten slow contractions (tonic), with a holding time of six to eight seconds at each contraction followed by a rest period of equal duration. After each sustained contraction, they performed three to four fast contractions (phasic) in the supine and standing position twice a week, for a total of 12 sessions. We evaluated the effect of adding BF to PFMT on quality of life using King's Health Questionnaire (KHQ) regarding urinary symptoms based on a voiding diary and regarding the function of pelvic floor muscles by digital palpation. The evaluation was performed initially and after 12 treatment sessions. Data are reported as mean and standard deviation. The Mann-Whitney test was used for the analysis of homogeneity and to determine differences between groups, and the Wilcoxon test was used to determine possible differences between the times of observation, with the level of significance set at 0.05.
A significant decrease in the scores of the domains assessed by the KHQ was observed in the comparison between groups, except for the general health domain (BF Group: 32.8±26.9 versus Control Group: 48.4±29.5, p<0.13). Accordingly, there was improvement in PFM function after treatment in the BF Group, regarding power (4.3±0.8, p= 0.001), endurance (6.0±2.2, p<0.001) and fast (9.3±1.9, p=0.001). When comparing the groups, the BF Group showed a positive result regarding power (BF Group 4.3±0.8 versus Control Group 2.5±0.9, p<0.001), endurance (6.0±2.2 BF Group versus Control Group 2.7±1.9, p<0.001) and fast (BF Group 9.3±1.9 versus Control Group 4.6 ± 3.2, p<0.001). Reduction of nocturnal urinary frequency (1.2±1.2 versus 0.7±0.9, p=0.02) and of effort urine loss (1.5±1.4 versus 0.6±0.8, p=0.001) was observed in the BF Group.
The addition of BF to the PFMT for the treatment of SUI, applied according to the protocol described, improved PFM function, reduced urinary symptoms, and improved of the quality of life.
Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 11/2012; 34(11):505-10.
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ABSTRACT: The aim of this study was to compare female sexual function after surgical treatment of anterior vaginal prolapse with either small intestine submucosa grafting or traditional colporrhaphy.
Subjects were randomly assigned, preoperatively, to the small intestine submucosa graft (n = 29) or traditional colporrhaphy (n = 27) treatment group. Postoperative outcomes were analyzed at 12 months. The Female Sexual Function Index questionnaire was used to assess sexual function. Data were compared with independent samples or a paired Student's t-test.
In the small intestine submucosa group, the total mean Female Sexual Function Index score increased from 15.5±7.2 to 24.4±7.5 (p<0.001). In the traditional colporrhaphy group, the total mean Female Sexual Function Index score increased from 15.3±6.8 to 24.2±7.0 (p<0.001). Improvements were noted in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain. There were no differences between the two groups at the 12-month follow-up.
Small intestine submucosa repair and traditional colporrhaphy both improved sexual function postoperatively. However, no differences were observed between the two techniques.
Clinics (São Paulo, Brazil) 08/2012; 67(8):871-5. · 1.59 Impact Factor
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ABSTRACT: Introduction and hypothesisOur objective was to translate and validate a Portuguese version of the Urinary Incontinence-Specific Quality-of-Life Instrument
(I-QOL), a questionnaire that is widely used in clinical trials.
MethodsFifty patients completed the same questionnaire twice at a 2-week interval. During the first visit, we conducted a face-to-face
interview and collected demographic data. The King's Health Questionnaire was completed during the same visit for comparisons.
ResultsThe results showed that the Portuguese version of the I-QOL has very good psychometrics properties. Reliability was assessed
by Cronbach's alpha (0.93), reproducibility was calculated through the intraclass correlation coefficient (0.88), construct
validity was determined by comparing the I-QOL scores and King's Health scores, and discriminant validity was calculated by
comparing the total I-QOL scores with measures of gravity.
ConclusionsWe conclude that the Portuguese version of the I-QOL is a very good tool for the evaluation quality-of-life in women with
urinary incontinence in Portuguese-speaking countries.
International Urogynecology Journal 04/2012; 20(10):1183-1189. · 1.83 Impact Factor
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ABSTRACT: To evaluate the impact of pelvic floor muscle (PFM) training on the quality of life (QOL) in women with stress urinary incontinence (SUI).
Prospective clinical trial with 36 women with a diagnosis of SUI confirmed by urodynamic study. Women with neuromuscular diseases, using hormone replacement therapy, and with prolapse stage III and IV were not included. The exercise protocol for the PFM consisted of slow contractions (tonic fibers), followed by rapid contractions (phasic fibers) practiced in the supine, sitting, and standing positions, three times a week for a period of three months. We evaluated the impact of PFM on QOL using the King's Health Questionnaire (KHQ), a voiding diary, and digital palpation to assess the function of the PFMs during the initial evaluation and after three months of treatment. The result was described as means and standard deviations. We used the Wilcoxon test for comparison of the KHQ scores for paired samples, and the significance level was set at 0.05.
There was a significant decrease in the mean scores of the domains assessed by the KHQ regarding the perception of health, impact of the incontinence, limitations of daily activities, physical limitations, social limitations, personal relationships, emotions, sleep/disposition, and measures of severity. In agreement with these results, significant decrease in nocturnal urinary frequency and urinary incontinence, as well as significant increase in muscle strength and endurance were observed.
PFM training resulted in significant improvement in the QOL of women with SUI.
Revista da Associação Médica Brasileira 04/2012; 58(2):155-9. · 0.77 Impact Factor
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ABSTRACT: Biofeedback (BF) has been widely used in the treatment of pelvic floor dysfunctions, mainly by promoting patient learning about muscle contraction with no side effects. However, its effectiveness remains poorly understood with some studies suggesting that BF offers no advantage over the isolated pelvic floor muscle training (PFMT). The main objective of this study was to systematically review available randomized controlled trials assessing the effectiveness of BF in female pelvic floor dysfunction treatment. Trials were electronically searched and rated for quality by use of the PEDro scale (values of 0-10). Randomized controlled trials assessing the training of pelvic floor muscle (PFM) using BF in women with PFM dysfunction were selected. Outcomes were converted to a scale ranging from 0 to 100. Trials were pooled with software used to prepare and update Cochrane reviews. Results are presented as weighted mean differences with 95 % confidence intervals (CI). Twenty-two trials with 1,469 patients that analyzed BF in the treatment of urinary, anorectal, and/or sexual dysfunctions were included. PFMT alone led to a superior but not significant difference in the function of PFM when compared to PFMT with BF, by using vaginal measurement in the short and intermediate term: 9.89 (95 % CI -5.05 to 24.83) and 15.03 (95 % CI -9.71 to 39.78), respectively. We found a few and nonhomogeneous studies addressing anorectal and sexual function, which do not provide the cure rate calculations. Limitations of this review are the low quality and heterogeneity of the studies, involving the usage of distinct protocols of interventions, and various and different outcome measures. The results of this systematic review suggest that PFMT with BF is not more effective than other conservative treatments for female PFM dysfunction.
International Urogynecology Journal 03/2012; · 1.83 Impact Factor
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ABSTRACT: To investigate the prevalence of anal incontinence (AI) in woman with urinary incontinence (UI) and pelvic organ prolapse (POP). We also evaluated the impact on quality of life (QoL).
One hundred and ninety patients with UI or POP and 73 controls were recruited. AI was investigated by the Wexner index and the prevalence rates were obtained in all groups. Patients with AI completed the Fecal Incontinence Quality of Life questionnaire (FIQL). QoL was assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36).
AI prevalence was 40.54% in the UI group and 27.91% in the POP group (p<0.0001). In the UI and POP groups correlations were found between the Wexner score and the domains of the FIQL and SF36.
The UI group had higher prevalence of AI than the other groups. The AI adversely affected the QoL of patients.
European journal of obstetrics, gynecology, and reproductive biology 02/2012; 160(2):228-31. · 1.97 Impact Factor
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ABSTRACT: The aim of the study was to compare the effect of hypopressive exercises including pelvic floor muscle contraction, pelvic floor muscle training (PFMT) alone and control on pelvic floor muscle function in women with pelvic organ prolapse (POP).
Fifty-eight women with a mean age of 55.4 (± 9.8) years old with stage II POP were randomly assigned to participate in the PFMT group, the hypopressive exercises associated with PFMT (HE + PFMT) group or the control group. Each treatment group underwent a 3-month course of treatment. The three groups received lifestyle advice regarding weight loss, constipation, coughing, and the avoidance of heavy lifting. Participants were evaluated before and after the treatment. Maximal voluntary contraction (MVC) and endurance were assessed using the Modified Oxford grading system. To evaluate muscle activation, surface electromyography (SEMG) was used.
The two treatment group significantly increase pelvic floor muscle function as measured by MVC (P < 0.001) using the Modified Oxford grading system, as well as muscle activation (P < 0.001), measured by SEMG. The PFMT group was superior regarding endurance (P = 0.007). Both groups were superior to the control group regarding MVC, endurance and muscle activation.
Adding hypopressive exercises to PFMT does not improve PFM function. Both treatment groups performed better than the control group.
Neurourology and Urodynamics 01/2012; 31(1):121-5. · 2.96 Impact Factor
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ABSTRACT: Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse.
Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo.
Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment.
The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816).
The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.
São Paulo medical journal = Revista paulista de medicina 01/2012; 130(1):5-9. · 0.75 Impact Factor
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ABSTRACT: This study aims to evaluate the effects of simulated birth trauma and vaginal and Cesarean delivery on glycosaminoglycans (GAGs) in the vagina of female rats.
One hundred ten rats were divided into six groups: A (control), B (vaginal trauma), C (Cesarean delivery), D (Cesarean delivery followed by vaginal trauma), E (vaginal delivery), and F (20th day of gestation). In each group, half of the animals were killed 4 days after the procedure (time 1) and 12 weeks later (time 2). GAGs were extracted, isolated, and identified by using agarose gel electrophoresis and quantified by densitometry. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney tests.
We observed a significant decrease in total GAGs and dermatan sulfate (DS) at time 1. Evaluation at time 2 showed a significant increase in total GAGs, DS, and heparan sulfate.
Levels of sulfated GAGs in the rat vagina are affected by delivery and simulated birth trauma.
International Urogynecology Journal 08/2011; 22(12):1513-9. · 1.83 Impact Factor
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ABSTRACT: To evaluate the impact of uterine artery embolization (UAE) on uterine volume (UV), greater myoma diameter (GMD) and ovarian function three months after the procedure, by transvaginal pelvic ultrasonography (TVPUS) and by the determination of follicle-stimulating hormone (FSH).
Thirty patients with leiomyomas were submitted to UAE. TVPUS and FSH determination were performed before and three months after UAE. UV was determined in cm³, GMD in cm and FSH in IU/mL. Data are reported as as mean standard deviation (SD) and were analyzed statistically by the nonparametric Mann-Whitney test.
Twenty-nine patients were analyzed. Before UAE, mean UV was 402.4 165.9 cm³ and GMD was 5.9 2.1 cm. After UAE, mean UV was 258.9 118.6 cm³ and GMD was 4.6 1.8 cm. Mean FSH concentration was 4.9 3.5 IU/mL before UAE and 5.5 4.7 IU/mL after UAE, with p=0.5. There was a 35% reduction of UV and a 22% reduction of GMD, with no changes in FSH values after three months.
The procedure significantly reduced UV and GMD but did not cause a significant increase in FSH levels, thus causing no changes in ovarian function.
Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 08/2011; 33(8):201-6.
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ABSTRACT: Verify the association between genital prolapse, other risk factors and a polymorphism in exon 31 of the collagen III-a1 gene (COL3A1).
The etiology of genital prolapse is multifactorial, and genetic defects have been proposed. Also, there is evidence that changes in collagen may be responsible for defects in pelvic floor support. The exon 31 polymorphism results in structural changes in the triple helical of the collagen and appears to lead to abnormal synthesis of type III collagen.
Basic science study.
The studied group consisted of 107 patients with stage III and IV genital prolapse (POP-Q). The control group included 209 women with stage 0 and I prolapse.
After extracting genomic DNA from the peripheral blood, the exon 31 COL3A1 polymorphism was typed by restriction fragment length polymorphism analysis.
Association between genital prolapse and exon 31 COL3A1 polymorphism.
No statistically significant differences in genotype and allele frequencies were found between cases and controls (P = 0.75 and 0.66, respectively). Multiple logistic regression analyses identified age (OR = 1.05; 95%CI = 1.01-1.10), BMI (OR = 1.09; 95%CI = 1.01-1.17), presence of at least one vaginal delivery (OR = 7.22; 95%CI = 1.84-28.27), positive family history of POP (OR = 2.27; 95%CI = 1.05-4.93) and a macrosomic foetus (OR = 2.91; 95%CI = 1.24-6.79) as independent risk factors for genital prolapse. In contrast, the number of caesarean deliveries was found to be an independent protective factor (OR = 0.43; 95%CI = 0.24-0.78).
The type III collagen exon 31 polymorphism is not a risk factor for pelvic genital prolapse in this sample.
Neurourology and Urodynamics 05/2011; 30(7):1325-8. · 2.96 Impact Factor
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ABSTRACT: Objective
Verify the association between genital prolapse, other risk factors and a polymorphism in exon 31 of the collagen III-a1 gene (COL3A1).SettingThe etiology of genital prolapse is multifactorial, and genetic defects have been proposed. Also, there is evidence that changes in collagen may be responsible for defects in pelvic floor support. The exon 31 polymorphism results in structural changes in the triple helical of the collagen and appears to lead to abnormal synthesis of type III collagen.DesignBasic science study.PopulationThe studied group consisted of 107 patients with stage III and IV genital prolapse (POP-Q). The control group included 209 women with stage 0 and I prolapse.Methods
After extracting genomic DNA from the peripheral blood, the exon 31 COL3A1 polymorphism was typed by restriction fragment length polymorphism analysis.Main outcome measuresAssociation between genital prolapse and exon 31 COL3A1 polymorphism.ResultsNo statistically significant differences in genotype and allele frequencies were found between cases and controls (P = 0.75 and 0.66, respectively). Multiple logistic regression analyses identified age (OR = 1.05; 95%CI = 1.01–1.10), BMI (OR = 1.09; 95%CI = 1.01–1.17), presence of at least one vaginal delivery (OR = 7.22; 95%CI = 1.84–28.27), positive family history of POP (OR = 2.27; 95%CI = 1.05–4.93) and a macrosomic foetus (OR = 2.91; 95%CI = 1.24–6.79) as independent risk factors for genital prolapse. In contrast, the number of caesarean deliveries was found to be an independent protective factor (OR = 0.43; 95%CI = 0.24–0.78).Conclusions
The type III collagen exon 31 polymorphism is not a risk factor for pelvic genital prolapse in this sample. Neurourol. Urodynam. 30:1325–1328, 2011. © 2011 Wiley-Liss, Inc.
Neurourology and Urodynamics 05/2011; 30(7):1325 - 1328. · 2.96 Impact Factor
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ABSTRACT: This pilot study aimed to investigate the effectiveness of pelvic floor muscle training (PFMT) for the treatment of pelvic organ prolapse.
Thirty-seven women with stage II prolapse were randomized to either the intervention group (n = 21) or the control group (n = 16). The evaluation included assessments of pelvic floor muscle function and surface electromyography at baseline and post 14 weeks of treatment. The severity of prolapse was quantified by the POP-Q method and symptoms by P-QoL questionnaire.
The intervention group showed significantly greater anatomic improvements in the anterior and posterior vaginal wall prolapses than did the control group (P < 0.001 and 0.025, respectively) and a decrease of symptoms. In addition, the intervention group had greater improvements in muscle strength (P < 0.001), endurance (P < 0.001), and electromyography parameters (P = 0.008) compared to the control group.
PFMT is effective in the treatment of pelvic organ prolapse.
International Urogynecology Journal 04/2011; 22(10):1233-9. · 1.83 Impact Factor
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ABSTRACT: The cytochrome P-450 1A1 (CYPA1A) gene plays an important role in the metabolization of estrogen and is therefore a candidate marker for fibroids. In a case-control study, we were unable to demonstrate any association between MSP I CYP1A1 polymorphism and the risk of leiomyoma in Brazilian women.
Fertility and sterility 12/2010; 94(7):2783-5. · 3.97 Impact Factor
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ABSTRACT: This study seeks to compare the small intestine submucosa (SIS) graft with traditional colporrhaphy (TC) for surgical treatment of anterior vaginal prolapse.
Subjects were randomly assigned to SIS (n = 29) or to TC (n = 27) preoperatively and outcomes analyzed at 12 months postoperatively. The primary outcome was the absence of POP-Q stage >or= II prolapse, and secondary outcome was improvement in quality of life. Data were compared with independent samples or paired Student's t test.
SIS group had 86.2% anatomic cure compared to 59.3% in TC (p = 0.03). SIS improved point Ba measurement significantly (-1.93 cm versus -1.37 cm, p = 0.02). Both operations significantly improved quality of life, although there were no differences between the groups. We observed a greater number of complications in the SIS group, with no infections or erosion.
SIS repair improved point Ba significantly. However, there were no differences observed in quality of life between the techniques.
International Urogynecology Journal 09/2010; 21(9):1057-63. · 1.83 Impact Factor
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ABSTRACT: Pelvic organ prolapse (POP) is a downward descent of pelvic organs that results in protrusions of the vagina, the uterus, or both. The cause of this disorder is likely to be multifactorial, attributable to a combination of risk factors, especially connective tissue disorders. Our objective was to characterize and quantify a component of the extracellular matrix (ECM)-sulfated glycosaminoglycan (GAG)-in the parametrium and vaginal apex of women with and without uterine prolapse.
Parametrium and vaginal apex tissue was obtained from 42 women who underwent surgery. Patients underwent a physical examination and were divided into groups according to the type of genital prolapse. Standard biopsies were taken during surgery and were assessed by biochemical methods. GAGs were obtained by proteolysis. The relative concentration of GAGs was determined by densitometry. Data were compared using an independent sample t-test or chi(2) test.
In both groups (with and without prolapse) and in both types of tissue, dermatan sulfate (DS) was the most predominant glycosaminoglycan, followed by chondroitin sulfate (CS) and heparan sulfate (HS). We did not observe significant differences in the total amounts of GAGs, DS, CS, or HS.
This study did not show altered biochemical characteristics in the ECM of parametrium and vaginal apex tissue of women either with or without uterine prolapse.
Journal of Women s Health 07/2010; 19(7):1341-4. · 1.57 Impact Factor
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ABSTRACT: To evaluate the clinical and epidemiological risk factors for endometrial cancer in postmenopausal women with endometrial polyps, as well as the genetic polymorphism of the progesterone receptor (PROGINS).
A case-control study was designed with 160 postmenopausal women with endometrial polyps, compared to a normal Control Group of 400 postmenopausal women. The genotyping of PROGINS polymorphism was determined by the polymerase chain reaction. Clinical and epidemiological data were compared between benign endometrial polyps and 118 of the control subjects. Variables were also compared with regard to benign and malignant endometrial polyps.
Comparison of the epidemiological variables between groups showed a significant difference for age, ethnicity, time since menopause, parity, tamoxifen use, hypertension and breast cancer, all of them more prevalent in the polyp group. After adjustment for age, statistical significance remained only for parity (OR=1.1), hypertension (OR=2.2) and breast cancer (OR=14.4). There were six cases of malignant polyps (3.7%). The frequency of bleeding was 23.4% for benign polyps and 100% for malignant polyps, with large polyps being detected in 54.6% of the benign cases and in 100 of the malignnat ones. The frequency of arterial hypertension was 54.5% for benign polyps and 83.3% for the malignant ones. The frequency of PROGINS T1/T1, T1/T2 and T2/T2 polymorphism was 79.9%, 19.5% and 0.6%, respectively, for the polyp group, and 78.8%, 20.8% and 0.5% for the Control Group.
Elderly age, hypertension, and breast cancer were significantly associated with endometrial polyps. The presence of PROGINS polymorphism was not significantly associated with endometrial polyps. The incidence of malignant polyps was low and strongly associated with bleeding, large-sized polyp and arterial hypertension.
Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 07/2010; 32(7):327-33.
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Femina: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 02/2010; 38(2):101-104.
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Neurourology and Urodynamics 01/2010; 29:973-975. · 2.96 Impact Factor
