Introduction
Metabolic syndrome (MS) is a disease of multifactorial etiology characterized by increased waist circumference, elevated triglyceride levels, decreased HDL cholesterol levels, high blood ...pressure and hyperglycemia. The objective of this study was to compare the frequency of MS in patients with and without stress urinary incontinence (SUI).
Methods
The components of MS were evaluated in 85 women with SUI seen at the Urogynecology and Vaginal Surgery Sector of the Gynecology Department of Universidade Federal de São Paulo (UNIFESP-EPM) and in 108 women without SUI seen at the General Gynecology Clinic of the Gynecology Department of UNIFESP-EPM.
Results
The MS diagnosis was more prevalent in patients with SUI, with the frequency according to the International Diabetes Federation criteria being 69.4% in the case group with SUI and 38% in the control group, whereas according to the National Cholesterol Education Program Adult Treatment Panel III recommendations, MS was frequent in 64.7% of the cases and 25% of the controls. Each MS component was evaluated, and the body mass index, weight and waist circumference were significantly higher in the case group (with SUI) compared with the control group (
p
< 0.001). The women in the case group showed an average HDL cholesterol value statistically lower and triglyceride and glycemia values statistically higher than the women in the control group (
p
< 0.001 and
p
= 0.005).
Conclusion
MS frequency was higher in patients with SUI, which shows a possible association between these two conditions.
To compare the use of mirabegron with anticholinergics drugs for the treatment of overactive bladder (OB).
Systematic searches were conducted in EMBASE, PUBMED, Cochrane, and LILACS databases from ...inception to September 2021. We included RCTs, women with clinically proven OB symptoms, studies that compared mirabegron to antimuscarinic drugs, and that evaluated the efficacy, safety or adherence.
RevMan 5.4 was used to combine results across studies. We derived risk ratios (RRs) and mean differences with 95% CIs using a random-effects meta-analytic model. Cochrane Collaboration Tool and GRADE was applied for risk of bias and quality of the evidence.
We included 14 studies with a total of 10,774 patients. Fewer total adverse events was reported in mirabegron group than in antimuscarinics group RR 0.93 (0.89-0.98). The risk of gastrointestinal tract disorders and dry mouth were lower with mirabegron RR 0,58 (0.48-0.68); 9375 patients; RR 0.44 (0.35-0.56), 9375 patients, respectively. No difference was reported between mirabegron and antimuscarinics drugs for efficacy. The adherence to treatment was 87.7% in both groups RR 0.99 (0.98-1.00).
Mirabegron and antimuscarinics have comparable efficacy and adherence rates; however, mirabegron showed fewer total and isolated adverse events.
Introduction and hypothesis
This pilot study aimed to investigate the effectiveness of pelvic floor muscle training (PFMT) for the treatment of pelvic organ prolapse.
Methods
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.
Results
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.
Conclusions
PFMT is effective in the treatment of pelvic organ prolapse.
Introduction and Hypothesis
Hip osteoarthritis (OA) compromises functioning. Total hip replacement (THR) is the indicated treatment and may improve urinary incontinence (UI) and symptoms of ...overactive bladder (OAB).
Objectives
Assess UI, OAB symptoms, and quality of life (QoL) impact in preoperative and postoperative periods of women submitted to THR and investigate associated factors.
Methods
A prospective cohort was conducted with 183 women submitted to THR. The International Consultation on Incontinence Questionnaire—Short Form (ICIQ‐SF), International Consultation on Incontinence Questionnaire—Overactive Bladder (ICIQ‐OAB) and SF‐12 questionnaires were administered pre‐ and 3 and 6 months after surgery.
Results
Significant improvements were found in UI and QoL 3‐ and 6‐month postoperatively in the overall sample and in the subgroup with preoperative UI. The multivariate regression revealed that the preoperative ICIQ‐SF and ICIQ‐OAB final scores were the best predictors of UI 6‐month postoperatively. The factors the best predicted the occurrence of UI 6‐month following THR were the preoperative ICIQ‐OAB scores and preoperative UI. Each unit of increase in the ICIQ‐OAB increases the chances of UI by 26.9% and preoperative UI increases the chances of postoperative UI by 18.7‐fold. A weak but significant negative correlation was found between the ICIQ‐SF score and the SF‐12 score.
Conclusion
Significant improvements in UI, OAB and QoL were found at 3‐ and 6‐month postoperatively. Preoperative ICIQ‐SF and ICIQ‐OAB final scores were the best predictors of UI at 6 months after surgery. We found significant association between urinary symptoms and THR, but this association is partially explained by current literature.
Introduction and hypothesis
Female sexual behavior goes through cultural changes constantly, and recently, some women have shown the desire the ideal genitalia. In this study, we aimed to evaluate ...clinical responses to nonablative radiofrequency (RF) in terms of its cosmetic outcome in the female external genitalia and its effect on sexual function.
Methods
A single-masking randomized controlled trial was conducted in 43 women (29 sexually active) who were unsatisfied with the appearance of their external genitalia. The women were divided into an RF group (
n
= 21, 14 sexually active) and a control group (
n
= 22, 15 sexually active). Eight sessions of RF were performed once a week. Photographs (taken before the first session and 8 days after the last session) were evaluated by the women and three blinded health professionals by using two 3-point Likert scales (unsatisfied, unchanged, and satisfied; and worst, unchanged, and improved). Sexual function was evaluated using the Female Sexual Function Index (FSFI) and analyzed using the Student
t
test. Women’s satisfaction and health professional evaluation were analyzed using the chi-square test and inter- and intragroup binomial comparisons.
Results
Satisfaction response rates were 76 and 27 % for the RF and control groups, respectively (
p
= 0.001). All professionals found a clinical improvement association in the treated group with RF in comparison with the control group (
p
< 0.01). The overall FSFI sexual function score increased by 3.51 points in the RF group vs 0.1 points in the control group (
p
= 0.003).
Conclusions
RF is an alternative for attaining a cosmetic outcome for the female external genitalia, with positives changes in patients’ satisfaction and FSFI scores.
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 PFMC. Forty-eight women concluded this study (24 participants for each group). Each woman was evaluated before and after the PEP, by a physiotherapist and an urogynecologist (UG). Neither of the professionals was revealed to them. This physiotherapist measured their pelvic floor muscle strength by using both a perineometer (Peritron) and vaginal palpation (Oxford Scale). The UG, who performed 3D perineal ultrasound examinations, collected their data and evaluated the results for pubovisceral muscle thickness and the levator hiatus area (LA). Both professionals were blinded to the group allocation. The protocol for both groups consisted of 24 bi-weekly 1-h individual sessions of Pilates exercises, developed by another physiotherapist who specializes in PFM rehabilitation and the Pilates technique.
Results
The PEP+ PFMC group showed significantly greater strength improvements than the PEP group when comparing the Oxford scale, vaginal pressure and pubovisceral muscle thickness during contraction measurements at baseline and post-treatment.
Conclusions
Our findings suggest that adding a voluntary PFMC to a Pilates exercise program is more effective than Pilates alone in improving PFM strength in sedentary nulliparous women.
Abstract
Objective
To compare the prevalence of urinary incontinence (UI) before and during the COVID-19 quarantine in CrossFit women and their relationship with training level.
Methods
A ...cross-sectional study was performed among 197 women practicing CrossFit. The inclusion criteria were nulliparous women, between 18 and 45 years old, who had trained, before quarantine, in accredited gyms. The exclusion criteria were not following the COVID-19 prevention protocols and having UI on other occasions than just sport. An online questionnaire was emailed containing questions about frequency, duration, and intensity of training and data related to the COVID-19 pandemic. The participants were invited to answer whether they were infected with COVID-19 and what treatment/recommendation they have followed. Whether UI stopped among participants, they were asked about the possible reasons why this happened. The training intensity was categorized as “the same,” “decreased” or “increased.”
Results
The mean age of the participants was 32 years old and most (98.5%) could practice CrossFit during the pandemic. There was a decrease in training intensity in 64% of the respondents. Exercises with their own body weight, such as air squat (98.2%), were the most performed. Urinary incontinence was reported by 32% of the participants before the COVID-19 pandemic, and by only 14% of them during the pandemic (odds ratio OR = 0.32 0.19–0.53;
p
< 0.01; univariate analysis). Practitioners reported that the reason possibly related to UI improvement was the reduction of training intensity and not performing doubleunder exercise.
Conclusion
The reduction in the intensity of CrossFit training during the COVID-19 quarantine decreased the prevalence of UI among female athletes.
Individualized multidisciplinary therapy for vulvodynia Penteado, Sonia Regina Lenharo; Bonduki, Claudio Emilio; Araújo, Teresa Raquel Embiruçu ...
The journal of obstetrics and gynaecology research,
February 2024, 2024-Feb, 2024-02-00, 20240201, Letnik:
50, Številka:
2
Journal Article
Recenzirano
Objective
The main objective of this review was to develop strategies for individualizing multidisciplinary therapy for vulvodynia.
Methods
We conducted two literature searches; the first one focused ...on clinical trials assessing vulvodynia treatments published after the recommendations of the expert committee of the Fourth International Consultation on Sexual Medicine. The second search targeted studies identifying predictive factors and mediators of vulvodynia treatments, published from the earliest date to October 2022.
Results
Based on data from 55 relevant studies, we developed models of individualized multidisciplinary therapy targeting groups of women less responsive to multidisciplinary therapy (characterized by women with higher vulvar pain intensity, impaired sexual functioning, and vulvodynia secondary subtype) and to physical therapy, as an isolated treatment (characterized by women with increased pelvic floor muscle tone and vulvodynia primary subtype). Each individualized multidisciplinary therapy model comprises three components: psychotherapy, medical care, and physical therapy. These components provide distinct therapeutic modalities for distinct subgroups of women with vulvodynia; the women subgroups were identified according to the characteristics of women, the disease, partners, and relationships. Additionally, for women with provoked vestibulodynia who exhibit less benefits from vestibulectomy (such as those with higher levels of erotophobia, greater vulvar pain intensity, and the primary subtype) and encounter resistance to individualized multidisciplinary therapy, we suggest additional conservative treatments before performing vestibulectomy.
Conclusion
Our study is a pioneer in the development of models that allow the individualization of multidisciplinary therapy for vulvodynia and represents a significant advance in the clinical practice of gynecologists, physiotherapists, and psychologists.
Background and Objectives: Genitourinary syndrome of menopause (GSM) affects more than half of postmenopausal women. This study aimed to evaluate the clinical and histological aspects of ...microablative fractionated CO2 laser (CO2L), microablative fractionated radiofrequency (RF) and intravaginal estrogen (ET) therapy as GSM treatments for the vulvar vestibule. Materials and Methods: This study included postmenopausal women with at least one moderate-to-severe complaint of GSM. Women in the CO2L and RF groups received three monthly sessions of outpatient vulvovaginal therapy. The procedures were performed 30 min after applying 4% lidocaine gel to the vulva and vaginal introitus. Vulvar vestibular pain was assessed after each application using a 10-point VAS. A follow-up evaluation was performed 120 days after beginning each treatment. Digital images of the vulva were obtained and a 5-point Likert scale (1 = much worse, 2 = worse, 3 = neutral, 4 = better, 5 = much better) was used to assess the global post-treatment women’s impression of improvement regarding GSM. Results: A significant change in clinical aspects of the vulva was observed after all treatments with a reduction in the atrophic global vulvar aspect and an enhancement of the trophic aspect. High satisfaction was also reported after treatment according to the Likert scale evaluation: CO2L (4.55 ± 0.97), RF (4.54 ± 0.95), CT (4 ± 1.41), p = 0.066. Histological evaluation revealed enhanced dermal papillae before pre-treatment, significantly reducing post-treatment in all groups (p = 0.002). No unintended effects were reported. Conclusions: CO2L, RF, and ET significantly improved GSM concerning the vulvar vestibule at the 4 months follow-up.
A machine learning approach is a useful tool for risk-stratifying patients with respiratory symptoms during the COVID-19 pandemic, as it is still evolving. We aimed to verify the predictive capacity ...of a gradient boosting decision trees (XGboost) algorithm to select the most important predictors including clinical and demographic parameters in patients who sought medical support due to respiratory signs and symptoms (RAPID RISK COVID-19). A total of 7336 patients were enrolled in the study, including 6596 patients that did not require hospitalization and 740 that required hospitalization. We identified that patients with respiratory signs and symptoms, in particular, lower oxyhemoglobin saturation by pulse oximetry (SpO2) and higher respiratory rate, fever, higher heart rate, and lower levels of blood pressure, associated with age, male sex, and the underlying conditions of diabetes mellitus and hypertension, required hospitalization more often. The predictive model yielded a ROC curve with an area under the curve (AUC) of 0.9181 (95% CI, 0.9001 to 0.9361). In conclusion, our model had a high discriminatory value which enabled the identification of a clinical and demographic profile predictive, preventive, and personalized of COVID-19 severity symptoms.
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