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  • Original Article

    Pubovaginal sling and tension-free vaginal tape for surgical treatment of stress urinary incontinence in women

    Rev Bras Ginecol Obstet. 2008;30(3):127-134

    Summary

    Original Article

    Pubovaginal sling and tension-free vaginal tape for surgical treatment of stress urinary incontinence in women

    Rev Bras Ginecol Obstet. 2008;30(3):127-134

    DOI 10.1590/S0100-72032008000300005

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    PURPOSE: to compare sling operations of aponeurosis and tension-free vaginal tape (TVT) for the correction of stress urinary incontinence (SUI) regarding: the rates of subjective and objective healing, the mobility of the bladder neck with ultrasonography, the variation of the absorbent test, the urodynamic alterations and the incidence of complications. METHODS: eighty patients with SUI were selected. Among them, 61 underwent a TVT surgery and 19, an abdominal rectum sling operation of aponeurosis. Average age, index of body mass and parity were 50.1 years old, 29.7 kg/m² and 4.1 deliveries (median=3) for the patients with aponeurosis sling, and 51.7 years old, 28.1 kg/m² and 4.1 deliveries (median=3) for the ones with TVT. All of them have undergone anamnesis, physical examination, bladder neck ultrasonography, absorbent test and urodynamic evaluation before and at least six months after the surgery. After 15 or 19 months and after about four or five years, they were again interviewed concerning the surgery results. RESULTS: after six months, 96.7% of the women with TVT and 89.5% of the ones with sling thought they were healed in the subjective evaluation. Nevertheless, after 15 to 19 months, the TVT Group kept the same subjective healing rate, while among the Sling Group the rate decreased to 77.8%. There was a significant decrease in the mobility of the neck bladder that was similar in both groups and an improvement in the absorbent test. At the end of the urodynamic study, 93.4% of the women from the TVT Group and 78.9% of the ones from the Sling Group were classified as having an objective healing. The average time of bladder probing was higher in the Sling Group. Urinary retention was observed in 42.1% of the sling cases and in 9.8% of the TVT's. The rates of late healing were 90% for TVT and 55.6% for sling. CONCLUSIONS: TVT surgery provided better subjective healing after 15 or 19 months, but the rate of objective healing was the same in both techniques at that time. Among the complications detected, the urinary retention was higher in the Sling Group, in the post-surgery period.

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    Pubovaginal sling and tension-free vaginal tape for surgical treatment of stress urinary incontinence in women
  • Original Article

    Morphological aspects of the urethra in female rats after electrical stimulation of the pelvic floor

    Rev Bras Ginecol Obstet. 2013;35(4):159-163

    Summary

    Original Article

    Morphological aspects of the urethra in female rats after electrical stimulation of the pelvic floor

    Rev Bras Ginecol Obstet. 2013;35(4):159-163

    DOI 10.1590/S0100-72032013000400005

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    PURPOSE: To evaluate the effects of electrical stimulation (ES) of the pelvic floor on the urethra of female rats. METHODS: Forty adult rats were divided at random into four groups of ten animals each: Ctrl - without intervention; Sham - not submitted to ES, but with an electrode inserted into the vagina; Exp6 - submitted to six sessions of ES of the pelvic floor, and Exp12 - submitted to 12 sessions of ES of the pelvic floor. At the end of the experiment, all animals were anesthetized and the middle third of the urethra was removed, fixed in Bouin's fluid and processed for histomorphometric study. Sections were stained with hematoxylin and eosin for morphological and morphometric description, and others were stained with picrosirius red for the quantitation of total collagen. The thicknesses of the muscle layer and of the epithelium were determined, in 4 quadrants of the urethra, by performing 20 measurements per animal. The number of blood vessels present in the lamina propria was counted in the four quadrants over an area of 10³ µm² per quadrant and the images were obtained using the image analysis program AxioVision® REL 4.3 (Carl Zeiss). The collagen and muscle fiber ratios in the urethrae were calculated from two images per quadrant of every slice stained with picrosirius red, employing the Imagelab® Program. Data were subjected to analysis of variance (ANOVA) and the Tukey-Kramer multiple comparison test (p<0.05). RESULTS: The morphometry of the collagen, number of blood vessels and thickness of the epithelium showed no significant changes; however, the thickness of the periurethral muscle tissue increased significantly in Exp12 group, compared to the other groups (Exp12*>Exp6==Ctrl==Sham; *p<0.05). CONCLUSION: Prolonged functional electric stimulation of the pelvic floor induced an increase in periurethral muscle thickness in rats.

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    Morphological aspects of the urethra in female rats after electrical stimulation of the pelvic floor
  • Original Article

    Risk factors for genital prolapse in a Brazilian population

    Rev Bras Ginecol Obstet. 2009;31(1):17-21

    Summary

    Original Article

    Risk factors for genital prolapse in a Brazilian population

    Rev Bras Ginecol Obstet. 2009;31(1):17-21

    DOI 10.1590/S0100-72032009000100004

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    PURPOSE: to evaluate risk factors for the development of genital prolapse in the Brazilian population. METHODS: case-control study involving 316 patients submitted to prolapse staging, according to the pelvic organ prolapse quantification system. The patients were divided into two groups: in the Case Group there were 107 patients with prolapse at stage III or IV, and in the Control Group, 209 women at stage 0 or I. In the anamnesis, the selected women have been questioned about the presence of possible risk factors for genital prolapse, such as: age, menopause age, parturition, delivery type (vaginal, caesarean section or forceps), occurrence of fetal macrosomia, family history of genital dystopia in first degree relatives, chronic cough and intestinal constipation. RESULTS: The variables that were different between the groups were: age, body mass index, parturition, number of vaginal, caesarean section or forceps deliveries, newborn weight and positive family history for prolapse. Race, menopause age, chronic cough and intestinal constipation did not present differences between the groups. After logistic regression, only three variables have been shown to be independent risk factors: presence of at least one vaginal delivery, fetal macrosomia and positive family history for dystopia. Cesarean section was shown to be a protective factor. CONCLUSION: in the Brazilian population, the independent risk factor for genital prolapse were: personal antecedent of at least one vaginal delivery, fetal macrosomia and family history of dystopia.

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    Risk factors for genital prolapse in a Brazilian population
  • Original Article

    Validation of a quality of life questionnaire (King’s Health Questionnaire) in Brazilian women with urinary incontinence

    Rev Bras Ginecol Obstet. 2005;27(5):235-242

    Summary

    Original Article

    Validation of a quality of life questionnaire (King’s Health Questionnaire) in Brazilian women with urinary incontinence

    Rev Bras Ginecol Obstet. 2005;27(5):235-242

    DOI 10.1590/S0100-72032005000500002

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    PURPOSE: the proposal of the present study was to translate and to validate King's Health Questionnaire (KHQ) for Brazilian women with urinary incontinence. METHODS: a hundred and thirty-four patients with urinary incontinence, confirmed by urodynamic study, were enrolled from the outpatient clinic of Uroginecology. Initially, we translated the KHQ into the Brazilian Portuguese language in agreement with international criteria. Due to language and cultural differences we performed a cultural, structural, conceptual, and semantic adaptation of the KHQ, in order to make sure that patients were able to fully understand the questions. All patients answered the KHQ twice on the same day, within an interval of 30 min, applied by two different interviewers. After 7 to 14 days, on a second visit, the questionnaire was applied again. Reliability (intra- and interobserver internal consistency), construct and discriminative validity were tested. RESULTS: several cultural adaptations were necessary until we reached the final version. The intra-observer internal consistency (alpha of Cronbach) of the several dimensions varied from moderate to high (0.77-0.90), and the interobserver internal consistency varied from 0.66 to 0.94. Moderate to strong correlation was detected among the specific KHQ urinary incontinence dominions and clinical urinary incontinence manifestations known to affect the quality of life of these patients. CONCLUSION: KHQ was adapted to the Portuguese language and to the Brazilian culture, showing great reliability and validity. It should be included and used in any Brazilian urinary incontinence clinical trial.

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    Validation of a quality of life questionnaire (King’s Health Questionnaire) in Brazilian women with urinary incontinence
  • Original Article

    Relation between progesterone receptor gene polymorphism, race, parity, and uterine leiomyoma occurrence

    Rev Bras Ginecol Obstet. 2006;28(5):278-284

    Summary

    Original Article

    Relation between progesterone receptor gene polymorphism, race, parity, and uterine leiomyoma occurrence

    Rev Bras Ginecol Obstet. 2006;28(5):278-284

    DOI 10.1590/S0100-72032006000500003

    Views1

    PURPOSE: to analyze race, parity and presence of the progesterone receptor polymorphism, named PROGINS, as factors related to uterine leiomyoma occurrence in Brazilian women. METHODS: we carried out a case-control study, composed of 122 patients with the diagnosis of uterine fibroid and 125 women without the disease. After recording the clinical data, we collected biological material for DNA extraction, polymerase chain reaction and agarose gel electrophoresis in order to identify the presence of PROGINS polymorphism. Statistical analysis was performed using the non-parametric Mann-Whitney test or the chi2 test, depending on the studied variable. The risk for the occurrence of the disease was calculated by the logistic regression model, providing the odds ratio (OR). The adopted significance level was 5% (p<0.05) and the confidence interval was 95% (95% CI). RESULTS: we observed a higher prevalence of "non-white"women - mulatto and black - (50 vs 22.4%) and nulliparas (23.8 vs 11.2%) in the cases, while the progesterone receptor genotype was more often PROGINS positive - heterozygous or mutant homozygous - among the controls (21.6 vs 10.7%). The OR indicated an elevated risk for leiomyoma related to the "non-white"race (OR=3.46; 95% CI: 2.0-6.0) and the nulliparity (OR=3.30; 95% CI: 1.9-5.6), with reduction in the presence of PROGINS-positive genotypes (OR=0.43; 95% CI: 0.2-0.9). CONCLUSIONS: the "non-white"race and nulliparity were considered risk factors for the occurrence of uterine fibroid in the studied population, while PROGINS polymorphism showed to be a protective factor.

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    Relation between progesterone receptor gene polymorphism, race, parity, and uterine leiomyoma occurrence
  • Original Article

    Detrusor overactivity: comparative study among oxybutynin, functional electrostimulation and pelvic floor training. A randomized clinical trial

    Rev Bras Ginecol Obstet. 2007;29(9):452-458

    Summary

    Original Article

    Detrusor overactivity: comparative study among oxybutynin, functional electrostimulation and pelvic floor training. A randomized clinical trial

    Rev Bras Ginecol Obstet. 2007;29(9):452-458

    DOI 10.1590/S0100-72032007000900003

    Views1

    PURPOSE: to evaluate and to compare the effectiveness of oxybutynin, electrostimulation (ES) and pelvic floor training (PFT) in the management of women with detrusor overactivity. METHODS: a total of 64 women, 35 to 80 years old, were enrolled in this randomized prospective trial. Patients were randomized in three groups: Oxybutynin (n=22), ES (n=21) and PFT (n=21). There were no statistical differences between the three groups with regards to race (p=0.948), age (p=0.747), hormonal status (p=0.813), time of symptomatology (p=0.789), previous surgery for urinary incontinence (p=0.993), or body mass index (p=0.897). Patients were assessed before and after treatment by urodynamic test, a seven-day voiding diary, and subjective response. The duration of the treatment was twelve weeks. For statistical analyses, the Pearson chi2, analysis of variance (ANOVA) and the paired t-test were used. RESULTS: there was a decrease in the urge-incontinence episodes and in the number of pads required in all groups (p<0.05). There was reduction in the frequency of micturition in the Oxybutynin Group (p=0.014). Oxybutynin and ES Groups had reduction in nocturia episodes (p=0.003 and p=0.036, respectively). There were no significant differences in improvement between the three groups (p>0.05). Urgency was resolved in 14 (63.6%), 11 (52.4%) and 12 (57.1%) patients of the Oxybutynin, ES and PFT Groups, respectively, without differences among the groups (p=0.754). Subjectively, 17 (77.3%), 11 (52.4%) and 16 (76.2%) women who had accomplished oxybutynin, ES and PFT, respectively, were satisfied, without differences among the groups (p = 0.142). Urodynamic was normal in 8 (36.4%), 12 (57.1%) and 11 (52.4%) patients of the Oxybutynin, ES and PFT Groups, respectively. This urodynamic analysis revealed no differences between the three groups (p=0.358). The reduction of urge-incontinence correlated with patient satisfaction (p<0.05). CONCLUSIONS: treatments were equally effective; reduction of urge-incontinence was correlated with patient satisfaction.

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  • Review Article

    Surgical Treatment for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis

    Rev Bras Ginecol Obstet. 2018;40(8):477-490

    Summary

    Review Article

    Surgical Treatment for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis

    Rev Bras Ginecol Obstet. 2018;40(8):477-490

    DOI 10.1055/s-0038-1667184

    Views3

    Abstract

    Objective

    To compare surgical treatments for stress urinary incontinence in terms of efficiency and complications.

    Data Sources

    We searched the MEDLINE and COCHRANE databases using the terms stress urinary incontinence, surgical treatment for stress urinary incontinence and sling. Selection of Studies Forty-eight studies were selected, which amounted to a total of 6,881 patients with scores equal to or higher than 3 in the Jadad scale.

    Data Collection

    Each study was read by one of the authors, added to a standardized table and checked by a second author. We extracted data on intervention details, follow-up time, the results of treatment and adverse events.

    Data Synthesis

    Comparing retropubic versus transobturator slings, the former was superior for both objective (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.05-1.54) and subjective (OR, 1.23; 95% CI, 1.02-1.48) cures. Between minislings versus other slings, there was a difference favoring other slings for subjective cure (OR, 0.58; 95% CI, 0.39- 0.86). Between pubovaginal sling versus Burch surgery, there was a difference for both objective (OR, 2.04; 95% CI, 1.50-2.77) and subjective (OR, 1.64; 95% CI, 1.10-2.44) cures, favoring pubovaginal sling. Therewas no difference in the groups: midurethral slings versus Burch, pubovaginal sling versus midurethral slings, transobturator slings, minislings versus other slings (objective cure). Retropubic and pubovaginal slings are more retentionist. Retropubic slings have more bladder perforation, and transobturator slings, more leg and groin pain, neurological lesion and vaginal perforation.

    Conclusion

    Pubovaginal slings are superior to Burch colposuspension surgery but exhibit more retention. Retropubic slings are superior to transobturator slings, with more adverse events. Other slings are superior to minislings in the subjective aspect. There was no difference in the comparisons between midurethral slings versus Burch colposuspension surgery, pubovaginal versus midurethral slings, and inside-out versus outside-in transobturator slings.

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    Surgical Treatment for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis
  • Original Article

    Uterine Fibroid Symptom – Quality of Life questionnaire translation and validation into Brazilian Portuguese

    Rev Bras Ginecol Obstet. 2016;38(10):518-523

    Summary

    Original Article

    Uterine Fibroid Symptom – Quality of Life questionnaire translation and validation into Brazilian Portuguese

    Rev Bras Ginecol Obstet. 2016;38(10):518-523

    DOI 10.1055/s-0036-1593833

    Views1

    Abstract

    Purpose

    To translate into Portuguese, culturally adapt and validate the Uterine Fibroid Symptom - Quality of Life (UFS-QoL) questionnaire for Brazilian women with uterine leiomyoma.

    Methods

    Initially, the UFS-QoL questionnaire was translated into Brazilian Portuguese in accordance with international standards, with subsequent cultural, structural, conceptual and semantic adaptations, so that patients were able to properly answer the questionnaire. Fifty patients with uterine leiomyoma and 19 patients without the disease, confirmed by abdominal pelvic examination and/or transvaginal ultrasound, were selected at the outpatient clinics of the Department of Gynecology of the Universidade Federal de São Paulo (Unifesp). The UFS-QoL questionnaire was administered to all women twice on the same day, with two different interviewers, with an interval of 15 minutes between interviews. After 15 days, the questionnaire was readministered by the first interviewer. Reliability (internal consistency and test-retest), construct and discriminative validity were tested to ratify the questionnaire.

    Results

    The reliability of the instrument was assessed by Cronbach’s α coefficient with an overall result of 0.97, indicating high reliability. The survey results showed a high correlation (p= 0.94; p 0.001).

    Conclusion

    The UFS-QoL questionnaire was successfully adapted to the Brazilian Portuguese language and Brazilian culture, showing reliability and validity.

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