Zsuzsanna Di Bella

• Adjunct Professor at Federal University of São Paulo

CO2 laser (LS) and microablative radiofrequency (RF) are outpatient options for stress urinary incontinence (SUI) treatment. The aim of this study was to evaluate the lasting effects of SUI treatment using intravaginal CO2 LS and microablative RF. This is a long-term follow-up of a prospective double-blind multi-arm randomized controlled trial, inv...

Studies of the correlation between women’s endometrial microbiota and human reproduction are still very recent. Nevertheless, this study aimed to analyze the most recent of such studies. The keywords ‘endometrial microbiota’ and ‘assisted reproduction’ were used to search for articles published in PubMed between 2017 and 2024. After applying both t...

Aim To compare the vaginal wall thickness (VWT) measurement by two‐dimensional ultrasound (2D‐US) and pelvic floor muscle morphometry by four‐dimensional translabial ultrasound (4D‐TLUS) in women with vaginal laxity (VL) who underwent treatment with radiofrequency (RF) or pelvic floor muscle training (PFMT) after 30 days and 6 months. Methods A se...

OBJECTIVE The aim of the study was to provide a golden opportunity to access sexual function in women who act as leaders in companies through the use of an instrument validated for this purpose (the Female Sexual Function Index). The number of women in leadership positions has been gradually increasing, which shows the need for women to prepare the...

Objectives: This study aimed to evaluate the vagina clinically, cytologically, and histologically before and after treating genitourinary syndrome of menopause (GSM) with fractional microablative carbon dioxide LASER (CO2L), radiofrequency (RF), and estrogen vaginal cream (CT). Methods: Women with moderate-to-severe symptoms of GSM, denoted by a GS...

Objective This study aimed to compare the efficacy of CO 2 laser, radiofrequency, and promestriene in treating genitourinary syndrome of menopause in women with breast cancer receiving adjuvant therapy and to analyze the clinical and histological findings of the vulvar vestibule. Methods Women with moderate-to-severe symptoms of vulvar atrophy wer...

Introduction: Excessive menstrual bleeding is menstrual loss that interferes with the woman's quality of life, regardless of the absolute amount. Drug treatment is preferred to avoid surgical risks and preserve fertility. Anti-inflammatory, antifibrinolytic, oral contraceptive and progestogen are prescribed. These therapies result in 40 to 50% redu...

Background: There is an increased risk of becoming pregnant through fertility treatments using assisted reproductive technology (ART) during the COVID-19 pandemic. The aim of this review is to gather comprehensive data from the existing literature on the potential risks of fertility management during the pandemic period, and outline strategies to m...

Objective To evaluate the effectiveness of the levonorgestrel intrauterine system in the treatment of patients with heavy menstrual bleeding and an enlarged uterus and to compare satisfaction and its complications with hysterectomy. Methods This was a comparative cross-sectional observational study of women with heavy menstrual bleeding and an enl...

Background: 74% of women have urogenital symptoms classified as Genito-urinary Syndrome of menopause (GSM) during breast cancer treatment. Promestriene is effective and safe in the treatment of GSM. However, some women and oncologists are not comfortable with long-term use. Therefore, new options for and alleviating GSM have been considered, such a...

Introduction and hypothesis: The objectives were to evaluate clinical and anatomical parameters assessed by three-dimensional pelvic floor ultrasound (3D ultrasound) in parous and nulliparous women of childbearing age and to assess underreported symptoms of sexual dysfunction (SD), urinary incontinence (UI) and flatus incontinence (FI). Methods:...

Background Ex-vivo myography enables the assessment of muscle electrical activity response. This study explored the viability of determining the physiological responses in muscles without tendon, as rectus abdominis muscle (RAM), through ex-vivo myography to assess its potential as a diagnostic tool. Results All tested RAM samples (five different...

Introduction and hypothesis: To investigate relaxin-2 concentration comparing gestational diabetes mellitus (GDM) and non-GDM patients during pregnancy according to urinary incontinence (UI) and pelvic function status. Methods: This is a cross-sectional study evaluating 282 pregnant women from 24 weeks of gestation. The participants were divided...

Objective The aim of this study was to describe, from a historical perspective, the relevance, resilience and outcomes of vaginal hysterectomy (VH) in gynecology in the age of technological scenario. Methods The authors searched records from January 2011 to January 2021 on the following databases: Medline, EMBASE, and CENTRAL (The Cochrane Library...

Gestational diabetes mellitus (GDM) plus rectus abdominis muscle (RAM) myopathy predicts long-term urinary incontinence (UI). Atrophic and stiff RAM are characteristics of diabetes-induced myopathy (DiM) in pregnant rats. This study aimed to determine whether swimming exercise (SE) has a therapeutic effect in mild hyperglycemic pregnant rats model....

Introduction The Burch procedure (1961) was considered the gold standard treatment for stress urinary incontinence (SUI) before the midurethral slings (MUSs) were introduced, in 2001. Objective This historical perspective of the Burch's timeline can encourage urogynecological surgeons to master the Burch technique as one of the options for surgical...

Introduction: One of most frequent symptoms of breast cancer survivors using antiestrogen therapy (BCSA) is vulvovaginal atrophy (VVA). This condition decreases women's quality of life in many aspects such as social, sexual and psychological. Although this clinical condition is very frequent, few is kwon about morphological consequences that could...

Background Gestational Diabetes Mellitus and long-term urinary incontinence (UI) have a severe impact on women's health. New methods to identify pregnant predictor risk factors of UI are needed. Our study investigated clinical and pelvic floor 3D-ultrasound markers in pregnant women at the second and third trimesters to predict 6-18 months postpart...

Objective To compare, in terms of anatomical, functional, and sexual aspects, two types of treatment for women with vaginal agenesis: progressive dilation or surgical neovaginoplasty. Methods Women with vaginal agenesis underwent either dilation treatment using the Frank method or surgical treatment using the modified Abbé‐McIndoe technique with o...

Background Continuation rates of contraceptive methods in young women vary among studies, and there is scarce data regarding the pregnancy rate in this population. Methods Four independently systematic searches were performed in PUBMED, EMBASE, LILACS, and Cochrane databases from inception until January 2021 for oral contraceptive pill (OCP), copp...

Study question Is magnetic resonance imaging (MRI) a valid method to access antral follicles count (AFC) compared to two-dimensional (2D) transvaginal ultrasonography (USG) and Anti-Mullerian Hormone (AMH) to evaluate the ovarian reserve? Summary answer AFC has a high agreement between MRI and USG methods, as well as with AMH. MRI can be an altern...

Background No consensus regarding the surgical strategy for repairs of pelvic organ prolapse (POP) has existed since the writings of Hippocrates. Archibald Donald of Manchester, in 1888, quite independently began to treat cases of prolapsus uteri with a combined operation of anterior and posterior colporrhaphy and amputation of the cervix. Objecti...

Objective The optimal use of contraceptive methods requires that women participate in targeted choice of methods that meet their individual needs and expectations. The Thinking About Needs in Contraception (TANCO) study is a quantitative online survey of the views of health professionals and women on aspects of contraceptive counseling and contrace...

Background: Pelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated...

Objective: Most women suffering from tubal factor infertility do not have a history of pelvic inflammatory disease, but rather have asymptomatic upper genital tract infection. Investigating the impacts of such infections, even in the absence of clinically confirmed pelvic inflammatory disease, is critical to understanding the tubal factor of infer...

Objective: To evaluate the relationship between the inflammatory profile and mood states in the different phases of the menstrual cycle in soccer players with and without premenstrual syndrome (PMS). Methods: Data on the menstrual cycle and mood states were collected using the Daily Symptom Report and the Brunel Mood Scale. Cytokine and stress h...

Background: Urinary incontinence is a highly prevalent condition that impacts self-esteem and overall quality of life. Many non-surgical treatment options are available, ranging from pharmacological approaches to pelvic exercises. We aimed to summarize the available evidence regarding these non-surgical interventions. Design and setting: Review...

Objective To investigate the level of anxiety and its relationship with interleukin (IL)-10 (anti inflammatory cytokine that modulates mood swings) in a group of female soccer players. Methods Fifty-two eumenorrheic soccer players were evaluated (age 19.8 ± 4.7 years). The presence of premenstrual syndrome (PMS) and phases of the menstrual cycle we...

Introduction The presence of bacteria in urine is called bacteriuria, which may be symptomatic or asymptomatic. The manipulation of the urinary tract during urodynamic study (UDS), which is an invasive procedure, can result in urinary tract infection (UTI). Studies on the use of prophylactic antibiotics for UDSs are contradictory. Some investigator...

Menopause is an endocrine phenomenon characterized by gradual estrogen decline. This is a stage in a woman's life in which contraception is extremely important as the risks associated with pregnancy and childbirth increase, both maternal issues associated with higher incidence of comorbidities and issues related to fetal abnormalities, mitochondria...

Introduction and hypothesis The purpose of this study was to evaluate the effectiveness of adding voluntary pelvic floor muscle contraction (PFMC) to a Pilates exercise program in sedentary nulliparous women. Methods Fifty-seven healthy nulliparous and physically inactive women were randomized to a Pilates exercise program (PEP) with or without PFM...

Background: Muscular strength imbalance is an important risk factor for ACL injury, but it is not clear the impact of menstrual cycle on muscular strength balance. Our aims were to verify whether muscular balance (hamstring-to-quadriceps peak torque strength balance ratio) during menstrual cycle (luteal and follicular phases) and compare gender di...

This study aimed to evaluate the levator hiatus area (LHA) at rest and during the performance of maximal pelvic floor muscle (PFM) contractions, during the abdominal hypopressive technique (AHT), and during the combination of PFM contractions (PFMCs) and the AHT. The study included 17 healthy nulliparous women who had no history of pelvic floor dis...

The aim of the study was to compare the expression of oestrogen receptor alpha (ERα) in neovaginal tissue of patients with vaginal agenesis following neovaginoplasty using regenerated, oxidised cellulose in premenopausal women. A prospective, observational case–control study was performed on eight patients with vaginal agenesis following modified A...

Objective: To propose the inclusion of a gynecological investigation during the evaluation of athletes before competitions, using a specific instrument called the Pre-participation Gynecological Examination (PPGE). Methods: The study assessed 148 athletes, mean age of 15.4±2.0 years, who engaged in eight different sports modalities, and who resp...

Objective: To compare bladder wall thickness in two kinds of urinary incontinent women-stress urinary incontinence (SUI) and overactive bladder (OAB) with urodynamic detrusor overactivity (DO), and to compare them with continent patients by ultrasound, also, correlate with cystometric results in incontinent women. Methods: 91 women were divided...

Introduction and hypothesis: This trial aimed to compare the outcomes of native vaginal tissue repair versus polypropylene mesh repair for the treatment of severe genital prolapse. Methods: This multicenter randomized trial included 184 women, with POP-Q stage 3 or 4. They were randomly assigned to undergo surgical treatment using native tissue...

Objectives: The purpose of this study was to compare the morphologic characteristics of the pelvic floor musculature between women with twin and singleton pregnancies. Methods: We conducted a cross-sectional case-control study of 40 nulliparous women aged 20 to 38 years to compare women with singleton pregnancies (n = 23) to women with twin preg...

To evaluate female runners' pelvic floor muscles using three-dimensional ultrasonography (3DUS) and surface electromyography (SEMG). A cross-sectional study was conducted on 24 female runners. SEMG was performed using surface electrodes inserted in the vagina. 3DUS was performed using perineal convex transducer. SEMG was evaluated at rest and with...

To identify and relate body fat percentage (skin fold measures), body mass index (BMI) and age at menarcheto aerobic capacity using the indirect VO2 maximum value (VO2 max) of girls in the second cycle of primary school. A total of 197 girls aged 13.0±1.2 years on average, students from two public schools in the city of Atibaia in São Paulo, were e...

OBJETIVO: Identificar e relacionar a composição corporal, baseada na porcentagem de gordura corporal e o índice de massa corpórea (IMC), e a idade da menarca, com a capacidade aeróbia, utilizando-se os valores de VO2 máximo indireto, de estudantes do segundo ciclo do ensino fundamental. MÉTODOS: Foram avaliadas 197 meninas com média de idade de 13...

Objective: The purpose of this study was to evaluate the postoperative morphologic aspects of neovaginoplasty by the McIndoe technique with the use of an oxidized cellulose membrane (Interceed®) - an absorbable adhesion barrier - to correct congenital vaginal defects. Design: This study was designed as a prospective study. Patients and Methods: The...