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Penteado SRL, Bonduki CE, de Araújo TRE, Alves SV, de Luccas Batista NMT, Ambrogini CC, Sartori MGF. Individualized multidisciplinary therapy for vulvodynia. J Obstet Gynaecol Res 2024; 50:147-174. [PMID: 37968775 DOI: 10.1111/jog.15829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/04/2023] [Indexed: 11/17/2023]
Abstract
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.
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Affiliation(s)
| | - Claudio Emilio Bonduki
- Department of Gynecology, Federal University of São Paulo-UNIFESP, São Paulo, São Paulo, Brazil
| | | | - Suzana Valeska Alves
- Department of Gynecology, Federal University of São Paulo-UNIFESP, São Paulo, São Paulo, Brazil
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Campos MLP, Bianchi-Ferraro AMHM, de Oliveira CD, Nogueira MCC, Sartori MGF, Fusco I, Lugollo AF, De Góis Speck NM. Fractional CO 2 Laser, Radiofrequency and Topical Estrogen for Treating Genitourinary Syndrome of Menopause: A Pilot Study Evaluating the Vulvar Vestibule. Medicina (Kaunas) 2023; 60:80. [PMID: 38256341 PMCID: PMC10818998 DOI: 10.3390/medicina60010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
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.
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Affiliation(s)
| | | | - Carla Dias de Oliveira
- Departamento de Ginecologia, Universidade Federal de São Paulo (UNIFESP), 04024-002 São Paulo, Brazil
| | | | | | | | - Angela Flavia Lugollo
- Departamento de Patologia, Universidade Federal de São Paulo (UNIFESP), 04024-002 São Paulo, Brazil
| | - Neila Maria De Góis Speck
- Departamento de Ginecologia, Universidade Federal de São Paulo (UNIFESP), 04024-002 São Paulo, Brazil
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de Oliveira CD, de Mello Bianchi AMH, Campos MLP, Nogueira MCC, Sartori MGF, de Góis Speck NM. Women with Genitourinary Syndrome of Menopause Treated with Vaginal Estriol, Microablative Fractional CO 2 Laser and Microablative Fractional Radiofrequency: A Randomized Pilot Study. Photobiomodul Photomed Laser Surg 2023; 41:718-724. [PMID: 38085184 DOI: 10.1089/photob.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Objective: This pilot study intended to assess the feasibility of a large-scale randomized clinical trial designed to analyze the effectiveness of microablative fractional CO2 laser (CO2L) and microablative fractional radiofrequency (RF) compared with vaginal estriol (VE) as treatments for women with moderate-to-severe Genitourinary Syndrome of Menopause (GSM). Methods: Participants were randomized into VE, CO2L, or RF groups. In the VE group, women were required to use vaginal estriol cream for 14 days and then twice a week for 4 months. In the CO2L and RF groups, three energy therapies were administered at monthly intervals. Visual Analog Scale (VAS) for GSM symptoms, Female Sexual Function Index (FSF-I), Vaginal Health Index (VHI), and Nugent Score (NS) were analyzed before and 120 days after the beginning of the treatments. Pain scores were verified after each CO2L and RF session. Results: Thirty-four participants completed the study: 11 in the VE group, 11 in the CO2L group, and 12 in the RF group. No unexpected or serious adverse events were observed. We also verified that GSM symptoms, sexual function, and VHI significantly improved (p < 0.05) with no difference among the groups. NS did not show statistically significant difference before and after the treatments. Pain during RF application was associated with higher scores. Conclusions: The study is feasible and does not seem to have safety implications. Preliminary results suggest that CO2L and RF are good alternatives to VE for ameliorating clinical symptoms, FSF-I, and VHI in patients with GSM. Clinical Trial Registration number: NCT04045379.
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Affiliation(s)
- Carla Dias de Oliveira
- Department of Ginecology from Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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Fernandes MFR, Bianchi-Ferraro AMHDM, Sartori MGF, Jármy Di Bella ZIKD, Cantarelli GC, Dedonatto C, Vanzin RB, Dardes RDCM, Logullo ÂF, Patriarca MT. CO 2 laser, radiofrequency, and promestriene in the treatment of genitourinary syndrome of menopause in breast cancer survivors: a histomorphometric evaluation of the vulvar vestibule. Menopause 2023; 30:1213-1220. [PMID: 37963315 DOI: 10.1097/gme.0000000000002274] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
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 were enrolled. The participants were evaluated according to pretreatment and posttreatment protocols using the visual analog scale and clinical assessments, which included a gynecological examination and vestibular biopsy. Participants were randomly assigned into the laser, radiofrequency, or promestriene groups. Participants in the energy treatment groups underwent three consecutive monthly outpatient vulvovaginal treatment sessions, whereas those in the control group were administered promestriene for 4 months. During a follow-up visit 30 days posttreatment, the participant global posttreatment impression of improvement was evaluated using a Likert scale. RESULTS Seventy women completed treatment. Histological vulvar atrophy was identified in four (5.7%) of the pretreatment vulvar samples. Postintervention, all histological parameters were normalized. Significant improvements in symptoms were observed, as all three groups showed a reduction in the visual analog scale score, with no statistically significant differences among them. A high level of satisfaction was reported posttreatment in all groups. No damage to the histological structure of the vulvar vestibule or relevant clinical adverse events were identified posttreatment. CONCLUSIONS Laser, radiofrequency, and promestriene delivered comparable, significant symptom improvements among women with breast cancer receiving adjuvant therapy. These treatments did not cause structural tissue damage or other clinical complications.
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Affiliation(s)
- Marcela Furtado Roberto Fernandes
- From the Department of Gynecology, Federal University of São Paulo-Paulista Medical School, Escola Paulista de Medicina (EPM) of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ana Maria Homem de Mello Bianchi-Ferraro
- From the Department of Gynecology, Federal University of São Paulo-Paulista Medical School, Escola Paulista de Medicina (EPM) of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marair Gracio Ferreira Sartori
- From the Department of Gynecology, Federal University of São Paulo-Paulista Medical School, Escola Paulista de Medicina (EPM) of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Zsuzsanna Ilona Katalin de Jármy Di Bella
- From the Department of Gynecology, Federal University of São Paulo-Paulista Medical School, Escola Paulista de Medicina (EPM) of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Gabriela Cruz Cantarelli
- From the Department of Gynecology, Federal University of São Paulo-Paulista Medical School, Escola Paulista de Medicina (EPM) of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Chayanne Dedonatto
- From the Department of Gynecology, Federal University of São Paulo-Paulista Medical School, Escola Paulista de Medicina (EPM) of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Rafaela Brambatti Vanzin
- From the Department of Gynecology, Federal University of São Paulo-Paulista Medical School, Escola Paulista de Medicina (EPM) of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Rita de Cassia Maio Dardes
- From the Department of Gynecology, Federal University of São Paulo-Paulista Medical School, Escola Paulista de Medicina (EPM) of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ângela Flávia Logullo
- Department of Pathology, Federal University of São Paulo-Paulista Medical School, Escola Paulista de Medicina (EPM) of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marisa Teresinha Patriarca
- From the Department of Gynecology, Federal University of São Paulo-Paulista Medical School, Escola Paulista de Medicina (EPM) of Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Marra JM, Samper IC, Abreu LAXD, Anelvoi RP, Uyeda MGBK, Sartori MGF, Marquini GV. Effectiveness of an Educational Intervention with Guidelines from the Total Acceleration of Postoperative Recovery Project (ACERTO) in Gynecology. Rev Bras Ginecol Obstet 2023; 45:e699-e705. [PMID: 38029772 PMCID: PMC10686752 DOI: 10.1055/s-0043-1772484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/12/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of an educational intervention among gynecologists about recommendations of the Total Acceleration of Postoperative Recovery (ACERTO, in the Portuguese acronym) project derived from the solid foundations of Enhanced Recovery After Surgery (ERAS) guidelines to optimize hospital care for surgical-gynecological patients. METHODS Educational intervention through monthly 1-hour long meetings (3 months), with the application of an objective questionnaire about specific knowledge of the ACERTO project between before and after educational intervention phases, for gynecologists, after approval by the ethics committee and signature of informed consent by participants, in a federal university hospital. RESULTS Among the 25 gynecologists who agreed to participate, the educational intervention could be effective with a statistically significant difference between the phases before and after the intervention for the main recommendations of the ACERTO project, such as abbreviation of preoperative fasting (p = 0.006), venous thromboembolism prophylaxis (p = 0.024), knowledge and replication of ACERTO (p = 0.034), and multimodal analgesia (p = 0.021). CONCLUSION An educational intervention, through clinical meetings with exposition and discussion of the recommendations of the ACERTO project based on the ERAS protocol can be effective for the knowledge and possibility of practical application of the main measures, such as abbreviation of preoperative fasting, multimodal analgesia, and prophylaxis of thrombosis among gynecologists.
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Martins SB, Castro RDA, Takano CC, Marquini GV, Oliveira LMD, Martins Junior PCF, Dias MM, Girão MJBC, Sartori MGF. Efficacy of Sacrospinous Fixation or Uterosacral Ligament Suspension for Pelvic Organ Prolapse in Stages III and IV: Randomized Clinical Trial. Rev Bras Ginecol Obstet 2023; 45:e584-e593. [PMID: 37944925 PMCID: PMC10635794 DOI: 10.1055/s-0043-1772592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/13/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and outcomes of the surgical treatment for pelvic organ prolapse (POP) in stages III and IV by sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) by comparing anatomical and subjective cure rates and quality-of-life parameters (through the version validated for the Portuguese language of the Prolapse Quality of Life [P-QoL] questionnaire) under two definitions: genital prolapse Ba, Bp, and C < -1 (stage I) and Ba, Bp, and C ≤ 0 (stage II). MATERIALS AND METHODS After we obtained approval from the Ethics Committee (under CAAE 0833/06) and registered the study in ClinicalTrials.gov (NCT01347021), 51 patients were randomized into two groups: the USLS group (N = 26) and the SSLF group (N = 25), with follow-up 6 and 12 months after the procedures. RESULTS There was a significant improvement in the P-QoL score and anatomical measurements of all compartments in both groups after 12 months (p < 0.001). The anatomical cure rates in the USLS and SSLF groups, considering stage 1, were of 34.6% and 40% (anterior) respectively; of 100% both for groups (apical); and of 73.1% and 92% (posterior) respectively. The rates of adverse outcomes were of 42% (N = 11) and 36% (N = 11) for the USLS and SSLF groups respectively (p = 0.654), and those outcomes were excessive bleeding, bladder perforation (intraoperative) or gluteal pain, and urinary infection (postoperative), among others, without differences between the groups. CONCLUSION High cure rates in all compartments were observed according to the anatomical criterion (stage I), without differences in P-QoL scores and complications either with USLS or SSLF for the surgical treatment of accentuated POP.
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Affiliation(s)
- Sérgio Brasileiro Martins
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rodrigo de Aquino Castro
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Claudia Cristina Takano
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Gisele Vissoci Marquini
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Leticia Maria de Oliveira
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Márcia Maria Dias
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Grinbaum ML, Bianchi-Ferraro AMHM, Rodrigues CA, Sartori MGF, Bella ZKLJD. Impact of parity and delivery mode on pelvic floor function in young women: a 3D ultrasound evaluation. Int Urogynecol J 2023; 34:1849-1858. [PMID: 36780018 DOI: 10.1007/s00192-022-05440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/08/2022] [Indexed: 02/14/2023]
Abstract
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 Women without complaints of pelvic floor dysfunction, aged 20-50 years, were eligible for this prospective cross-sectional study. They completed the King's Health Questionnaire, Female Sexual Function Index and St Mark's Incontinence Score adapted for this study. Next, a physical examination and 3D ultrasound were performed. The scores obtained in the questionnaires were compared with the 3D ultrasound data. RESULTS In total, 326 women were invited to participate. Of these, 203 women met the inclusion criteria, and their cases were classified as nulliparity (NU, 59), vaginal delivery (VD, 80), forceps delivery (FD, 18) and caesarean section (CS, 48). These groups were homogeneous regarding age (p=0.096), parity (p=0.051) and body mass index (p=0.06). The hiatal dimension (HD; p=0.003) and transverse diameter (TD) (p=0.001) were significantly different among the groups. Compared with the NU and CS groups, the VD and FD groups had an increased HD and TD. The frequencies of underreported symptoms identified by questionnaires were as follows: SD (46.3%), UI (35%) and FI (28%). After VD and FD, women were more likely to present UI (p<0.001), FI (p<0.001) and SD (p=0.002) than the women with NU and those who had undergone a CS. UI was related to a greater HD (p=0.002) and anteroposterior diameter (p=0.022), FI was associated with a thinner left pubovisceral muscle (p=0.013), and SD was related to a greater HD (p=0.026). CONCLUSIONS Three-dimensional ultrasound can identify mild morphological changes in young women with apparently normal physical examinations, mainly after VD and FD. In such individuals, these findings are associated with higher incidences of underreported sexual, urinary and anal symptoms.
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Affiliation(s)
- M L Grinbaum
- Escola Paulista de Medicina of Federal University of São Paulo (EPM-UNIFESP) - Sector of Urogynaecology of the Department of Gynaecology, São Paulo, SP, Brazil.
| | - A M H M Bianchi-Ferraro
- Escola Paulista de Medicina of Federal University of São Paulo (EPM-UNIFESP) - Sector of Urogynaecology of the Department of Gynaecology, São Paulo, SP, Brazil
| | - C A Rodrigues
- Escola Paulista de Medicina of Federal University of São Paulo (EPM-UNIFESP) - Sector of Urogynaecology of the Department of Gynaecology, São Paulo, SP, Brazil
| | - M G F Sartori
- Escola Paulista de Medicina of Federal University of São Paulo (EPM-UNIFESP) - Sector of Urogynaecology of the Department of Gynaecology, São Paulo, SP, Brazil
| | - Z K L Jármy-Di Bella
- Escola Paulista de Medicina of Federal University of São Paulo (EPM-UNIFESP) - Sector of Urogynaecology of the Department of Gynaecology, São Paulo, SP, Brazil
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Sartori LGF, Nunes BM, Farah D, Oliveira LMD, Novoa CCT, Sartori MGF, Fonseca MCM. Mirabegron and Anticholinergics in the Treatment of Overactive Bladder Syndrome: A Meta-analysis. Rev Bras Ginecol Obstet 2023; 45:337-346. [PMID: 37494577 PMCID: PMC10371066 DOI: 10.1055/s-0043-1770093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE To compare the use of mirabegron with anticholinergics drugs for the treatment of overactive bladder (OB). DATA SOURCE 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. DATA COLLECTION 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. DATA SYNTHESIS 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)]. CONCLUSION Mirabegron and antimuscarinics have comparable efficacy and adherence rates; however, mirabegron showed fewer total and isolated adverse events.
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Affiliation(s)
| | | | - Daniela Farah
- Department of Gynecology, Health Technologies Assessment Center, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Leticia Maria de Oliveira
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Marcelo Cunio Machado Fonseca
- Department of Gynecology, Health Technologies Assessment Center, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Carvalho de Cillo PE, Lafraia FM, Carvalho de Souza Bonetti T, Saldanha MG, Reis N, Sartori MGF, Uyeda MGBK. Cross-Sectional study confirms absence of viral RNA in vaginal secretion of SARS-COV-2 infected women. AJOG Glob Rep 2023; 3:100200. [PMID: 37123882 PMCID: PMC10011025 DOI: 10.1016/j.xagr.2023.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Affiliation(s)
- Pedro Ernesto Carvalho de Cillo
- Disciplina de Uroginecologia, Departamento de Ginecologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Fernanda Marino Lafraia
- Disciplina de Uroginecologia, Departamento de Ginecologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Tatiana Carvalho de Souza Bonetti
- Laboratório de Ginecologia Molecular, Departamento de Ginecologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil,Centro de Neurociências e Saúde da Mulher “Professor Geraldo Rodrigues de Lima.”, Departamento de Neurologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil,Corresponding author: Prof. Dra. Tatiana CS Bonetti, Laboratory of Molecular Gynecology – Gynecology Department, Federal University of São Paulo – Paulista School of Medicine, Rua Pedro de Toledo, 781 – 4 andar, Vila Clementino, São Paulo, SP. CEP: 04024-002, Brazil, Phone: +55 11 98481-3107
| | - Maira Garcia Saldanha
- Laboratório de Ginecologia Molecular, Departamento de Ginecologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Nayra Reis
- Laboratório de Ginecologia Molecular, Departamento de Ginecologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Marair Gracio Ferreira Sartori
- Disciplina de Uroginecologia, Departamento de Ginecologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil,Laboratório de Ginecologia Molecular, Departamento de Ginecologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil,Centro de Neurociências e Saúde da Mulher “Professor Geraldo Rodrigues de Lima.”, Departamento de Neurologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
| | - Maria Gabriela Baumgarten Kuster Uyeda
- Disciplina de Uroginecologia, Departamento de Ginecologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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Laino FM, de Araújo MP, Sartori MGF, de Aquino Castro R, Santos JLF, Tamanini JTN. Urinary incontinence in female athletes with inadequate eating behavior: a case-control study. Int Urogynecol J 2023; 34:431-438. [PMID: 36102941 DOI: 10.1007/s00192-022-05349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/14/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Female athletes can develop symptoms of urinary incontinence (UI) as well as risk behaviors for eating disorders owing to the type of training and sports modality. Such symptoms are intensified by the demands for results and an idealized body composition. Our aim is to investigate the possible association between urinary incontinence and risk behaviors for eating disorders in female athletes. METHODS A case-control study was conducted with 270 female athletes who answered the International Consultation on Incontinence Questionnaire (ICIQ-SF) and the Eating Attitudes Test (EAT-26). Different sports modalities and their respective impact levels were considered in the study. Female athletes were divided into two groups, i.e., athletes with UI (case group) and those without UI (control group). Multiple logistic regression was used to calculate associated factors. RESULTS From all variables included in the study, only abnormal eating behavior was found to be associated with UI according to the multiple logistic regression test. Participants with UI were 2.15-fold more likely to have risk behaviors for eating disorders. CONCLUSIONS Female athletes with UI were more likely to have risk behaviors for eating disorders. Multidisciplinary teams that provide care for these athletes should be attentive to symptoms that may not appear to be associated at first glance but may reflect a condition that needs to be treated.
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Affiliation(s)
- Fernanda Mies Laino
- Sports Gynecology Sector, Department of Gynecology, Federal University of São Paulo, Rua Botucatu, 821, São Paulo, SP, Brazil.
| | - Maíta Poli de Araújo
- Division of Sports Medicine and Physical Activity, Department of Orthopedics and Traumatology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Marair Gracio Ferreira Sartori
- Sector of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Rodrigo de Aquino Castro
- Sector of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Jair Lício Ferreira Santos
- Department of Social Medicine, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Marquini GV, Oliveira LMD, Takano CC, Dias MM, Silva EV, Nunes ABA, Bella ZIKDJD, Sartori MGF. Feminization of science: female pioneering in the healthcare area. Rev Assoc Med Bras (1992) 2023; 69:e20221009. [PMID: 37194902 DOI: 10.1590/1806-9282.20221009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/11/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Gisele Vissoci Marquini
- Universidade Federal de São Paulo, Department of Gynecology, Urogynecology and Vaginal Surgery Sector - São Paulo (SP), Brazil
| | - Letícia Maria de Oliveira
- Universidade Federal de São Paulo, Department of Gynecology, Urogynecology and Vaginal Surgery Sector - São Paulo (SP), Brazil
| | - Claudia Cristina Takano
- Universidade Federal de São Paulo, Department of Gynecology, Urogynecology and Vaginal Surgery Sector - São Paulo (SP), Brazil
| | - Marcia Maria Dias
- Universidade Federal de São Paulo, Department of Gynecology, Urogynecology and Vaginal Surgery Sector - São Paulo (SP), Brazil
| | - Eduarda Vilela Silva
- Universidade Federal de Uberlândia, Academic of the Medicine Course - Uberlândia (MG), Brazil
| | | | | | - Marair Gracio Ferreira Sartori
- Universidade Federal de São Paulo, Department of Gynecology, Urogynecology and Vaginal Surgery Sector - São Paulo (SP), Brazil
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Takano CC, Sartori MGF. The Use of Three-dimensional Printer Molds for Treatment of Vaginal Agenesis. Rev Bras Ginecol Obstet 2022; 44:1081-1082. [PMID: 36580934 PMCID: PMC9800144 DOI: 10.1055/s-0042-1760208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Claudia Cristina Takano
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Fernandes MS, Takano CC, Chrispin TTB, Marquini GV, Girão MJBC, Sartori MGF. Three-dimensional Printer Molds for Vaginal Agenesis: An Individualized Approach as Conservative Treatment. Rev Bras Ginecol Obstet 2022; 44:1110-1116. [PMID: 36138536 PMCID: PMC9800147 DOI: 10.1055/s-0042-1756214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with vaginal agenesis (VA). METHODS A total of 16 patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, total androgen insensitivity syndrome, and cervicovaginal agenesis) from the Federal University of São Paulo were selected. Device production was performed in a 3D printer, and the polymeric filament of the lactic polyacid (PLA) was used as raw material. A personalized treatment was proposed and developed for each patient. RESULTS There were 14 patients who reached a final vaginal length of 6 cm or more. The initial total vaginal length (TVL) mean (SD) was 1.81(1.05) and the final TVL mean (SD) was 6.37 (0.94); the difference, analyzed as 95% confidence interval (95% CI) was 4.56 (5.27-3.84) and the effect size (95% CI) was 4.58 (2.88-6.28). CONCLUSION The 3D printing molds for vaginal dilation were successful in 87.5% of the patients. They did not present any major adverse effects and offered an economical, accessible, and reproducible strategy for the treatment of VA.
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Affiliation(s)
| | | | | | - Gisele Vissoci Marquini
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil,Address for correspondence Gisele Vissoci Marquini, MD Escola Paulista de Medicina, Universidade Federal de São PauloRua Napoleão de Barros, 608, 04024-002, São Paulo, SPBrazil
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De Freitas VM, Chiloff DM, Bosso GG, Teixeira JOP, Hernandes ICDG, Padilha MDP, Moura GC, De Andrade LGM, Mancuso F, Finamor FE, Serodio AMDB, Arakaki JSO, Sartori MGF, Ferreira PRA, Rangel ÉB. A Machine Learning Model for Predicting Hospitalization in Patients with Respiratory Symptoms during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11154574. [PMID: 35956189 PMCID: PMC9369854 DOI: 10.3390/jcm11154574] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 12/28/2022] Open
Abstract
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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Affiliation(s)
- Victor Muniz De Freitas
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Daniela Mendes Chiloff
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Giulia Gabriella Bosso
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | | | | | - Maira do Patrocínio Padilha
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Giovanna Corrêa Moura
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | | | - Frederico Mancuso
- Discipline of Emergency Medicine, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Francisco Estivallet Finamor
- Discipline of Emergency Medicine, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Aluísio Marçal de Barros Serodio
- Sector of Bioethics, Department of Surgery, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Jaquelina Sonoe Ota Arakaki
- Pneumology Division, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Marair Gracio Ferreira Sartori
- Department of Obstetrics, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Paulo Roberto Abrão Ferreira
- Infectious Disease Division, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Érika Bevilaqua Rangel
- Nephrology Division, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
- Correspondence:
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Moreno TRP, Araujo MPD, Benayon PC, Faroni RP, Barsottini CGN, Sartori MGF. BRAZILIAN OLYMPIC FEMALE ATHLETES’ MULTIDISCIPLINARY CARE: AN OBSERVATIONAL STUDY. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228042021_0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Female participation in sports had reached a milestone in 1972 when a constitutional amendment was implemented to ensure equal opportunities for men and women. Since then, the percentage of participants in competitive sports has grown. In 1992, an association was made between three disorders related to female athletes called the “Female Athlete Triad”. After that, much has been studied about this and other particularities of female athletes. Objective: To identify the professionals who follow-up Brazilian female Olympic athletes and the association between a multidisciplinary approach and athletes’ knowledge about gynecological issues related to the practice of sport, i.e., female athlete triad, urinary incontinence, and weight control concerns. Methods: This observational study was conducted in Rio de Janeiro, Brazil, in 2016, during the Olympic Games. It included 120 female members of the Brazilian teams. A self-applied questionnaire, validated and adapted from the pre-participation gynecological evaluation of female athletes, was used to evaluate their multidisciplinary follow-ups, weight control concerns, and knowledge about the Female Athlete Triad and urinary incontinence. Results: The athletes practiced 28 different sports. For 66%, it was their first participation in Olympic Games; 56% were unaware of the female athlete triad, 77% indicated weight concerns, and 52% were on a diet. The use of diuretics or laxatives or vomiting was reported by 11%; 67.5% were aware that sports are a risk factor for urinary incontinence, and 40% had already experienced urine loss. Decreased sportive performance was mentioned by 31%. Several athletes presented multidisciplinary follow-ups psychological (83%), nutritional (96%), and gynecological (83%). Conclusion: Brazilian Olympic athletes sought multidisciplinary follow-ups during the Olympic cycle; however, participants’ knowledge of sports-related issues remains limited. An orientation program regarding the above conditions is needed for female athletes and the professionals working with them to improve health and performance. Evidence Level IV; Cross-sectional observational study.
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Marquini GV, de Oliveira LM, Martins SB, Takano CC, de Jarmy Di-Bella ZIK, Sartori MGF. Historical perspective of vaginal hysterectomy: the resilience of art and evidence-based medicine in the age of technology. Arch Gynecol Obstet 2022; 307:1377-1384. [PMID: 35589991 DOI: 10.1007/s00404-022-06607-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/01/2022] [Indexed: 11/02/2022]
Abstract
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) for combinations of the terms "vaginal hysterectomy," "outcomes" AND "history"; and before that period, if the search had historical relevance. INCLUSION CRITERIA randomized clinical trials; hysterectomy performed for benign gynecological conditions; and VH outcomes compared with Abdominal Hysterectomy (AH), Laparoscopic Hysterectomy (LH) or Robotic Hysterectomy (RH). RESULTS The VH combines sequences of reproducible techniques which have been developed over the years to safely and effectively overcome the limitations of difficult cases of vaginal extirpation from the uterus. CONCLUSION The authors support endoscopic surgical approaches in complex surgery for benign indications, urogynecology, and gynecologic oncology when appropriate. However, what makes the gynecological surgeon different from the general surgeon is the vaginal access. It is essential to continue to train residents in vaginal surgical skills and provide safe and cost-effective patient care. The art of technology is the resilience of keeping only the patient at the center of innovation.
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Affiliation(s)
- Gisele Vissoci Marquini
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
| | - Leticia Maria de Oliveira
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Sérgio Brasileiro Martins
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Claudia Cristina Takano
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | | | - Marair Gracio Ferreira Sartori
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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Marquini GV, Martins SB, Oliveira LM, Dias MM, Takano CC, Sartori MGF. Effects of the COVID-19 Pandemic on Gynecological Health: An Integrative Review. Rev Bras Ginecol Obstet 2022; 44:194-200. [PMID: 35213918 PMCID: PMC9948067 DOI: 10.1055/s-0042-1742294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the existing scientific literature to find out if the coronavirus disease 2019 (COVID-19) pandemic has an effect on gynecological health. SEARCH STRATEGY We performed an integrative review of articles published between April 2020 and April 2021 on the PubMed, SciELO, and LILACS databases, using COVID-19 and the following relevant terms: Menstrual change; Ovarian function; Violence against women; Contraception; HPV; Mental health; and Urogynecology. SELECTION CRITERIA Among the eligible studies found, editorials and primary research articles, which describe the dynamics between severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection (the cause of the COVID-19 pandemic) and gynecological health, were included. DATA COLLECTION AND ANALYSIS Through qualitative synthesis, data were extracted from the included publications and from guidelines of national and international societies of gynecology. MAIN RESULTS The 34 publications included in the present study showed that some factors of the SARS-CoV-2 infection, and, consequently, the COVID-19 pandemic, might be associated with menstrual abnormalities, effects on contraception, alterations in steroid hormones, changes in urogynecological care, effects on women's mental health, and negative impact on violence against women. CONCLUSION The COVID-19 pandemic has significantly impacted the health of women. The scientific community encourages the development of recommendations for specialized care for women and strategies to prevent and respond to violence during and after the COVID-19 pandemic.
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Affiliation(s)
- Gisele Vissoci Marquini
- Departament of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Sérgio Brasileiro Martins
- Departament of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Letícia Maria Oliveira
- Departament of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Márcia Maria Dias
- Departament of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Claudia Cristina Takano
- Departament of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Marquini GV, Bella ZIKDJD, Sartori MGF. Burch Procedure: A Historical Perspective. Rev Bras Ginecol Obstet 2022; 44:511-518. [PMID: 35181882 PMCID: PMC9948263 DOI: 10.1055/s-0042-1744312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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 treatment of SUI. SEARCH STRATEGY AND SELECTION CRITERIA A bibliographic search was performed in the PubMed and National Library of Medicine (NIH) databases with the terms Burch colposuspension AND history AND stress urinary incontinence in the last 20 years. The original article by Burch (1961) was included. The references were read by three authors. The exclusion criterion was studies in non-English languages. Biomedical Library Special Collections were included as historical relevant search. DATA COLLECTION, ANALYSIS AND MAIN RESULTS Some modifications of the technique have been made since the Burch procedure was first described. The interest in this technique has been increasing due to the negative publicity associated with vaginal synthetic mesh products. Twenty-nine relevant articles were included in the present review article, and numerous trials have compared Burch colposuspension with MUS. CONCLUSION This historical perspective enables the scientific community to review a standardized technique for SUI. Burch colposuspension should be considered an appropriate surgical treatment for women with SUI, and an option in urogynecological training programs worldwide.
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Martines GA, Tamanini JTN, Mota GMDS, Barreto ET, Santos JLF, Sartori MGF, Girão MJBC, Castro RDA. Urinary incontinence, overactive bladder, and quality of life in women submitted to total hip replacement. Neurourol Urodyn 2022; 41:830-840. [PMID: 35114028 DOI: 10.1002/nau.24888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Guilherme Augusto Martines
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, SP, Brazil
| | | | | | - Eduardo Tavares Barreto
- Department of Orthopedics, Evangelical Hospital of Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Jair Lício Ferreira Santos
- Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Rodrigo de Aquino Castro
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, SP, Brazil
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Araujo MPD, Brito LGO, Pochini ADC, Ejnisman B, Sartori MGF, Girão MJBC. Prevalence of Urinary Incontinence in CrossFit Practitioners before and during the COVID-19 Quarantine and its Relationship with Training Level: An Observational Study. Rev Bras Ginecol Obstet 2021; 43:847-852. [PMID: 34872143 PMCID: PMC10183929 DOI: 10.1055/s-0041-1739463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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.
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Affiliation(s)
- Maita Poli de Araujo
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Alberto de Castro Pochini
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Marquini GV, Martins SB, Oliveira LM, Dias MM, Takano CC, Sartori MGF. Asymptomatic microscopic hematuria in women. Rev Assoc Med Bras (1992) 2021; 67:900-902. [PMID: 34709338 DOI: 10.1590/1806-9282.20210437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Márcia Maria Dias
- Universidade Federal de São Paulo, Department of Gynecology - São Paulo (SP), Brazil
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Marquini GV, Martins SB, Oliveira LM, Dias MM, Takano CC, Sartori MGF. Hydronephrosis associated with pelvic organ prolapse: a review study. Rev Assoc Med Bras (1992) 2021; 67:1061-1064. [DOI: 10.1590/1806-9282.20210434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/28/2021] [Indexed: 11/22/2022] Open
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Chrispin TTB, Fernandez MS, Novoa CCT, Sartori MGF. Development of personalized molds for neovagina creation by 3D printer. Rev Assoc Med Bras (1992) 2020; 66:1498-1502. [PMID: 33295399 DOI: 10.1590/1806-9282.66.11.1498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Additive Manufacturing (AM), also known as Rapid Prototyping, is a set of production technologies used in the synthesis of a particular physical object by adding layers to form a part based on data generated by Computer-Aided Design (CAD) systems. These technologies are widely used to quickly create prototypes of products and tools for commercial purposes. Over time, it has also been integrated with other areas, such as healthcare, since these tools have allowed health professionals to assist in diagnoses, surgical planning, and synthesis of orthoses and prostheses for patient rehabilitation. To develop models for the construction of dilators for the treatment of vaginal agenesis. METHODS Use CAD software and create a physical model using AM to analyze the viability of its production in the elaboration of customized dilators for each patient. RESULTS The production through AM provides an advantage in the development, facilitating physical alterations just by adjusting the three-dimensional models made by the software in a quick way, thus making the customization process viable. CONCLUSION The proposed procedure for the manufacture of dilators presented good results and technological feasibility, indicating that it can be a good solution for the production and customization of gynecological devices.
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Affiliation(s)
- Thyeres Teixeira Bueno Chrispin
- Pós-graduando em Ginecologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp) - São Paulo, SP, Brasil
| | - Marina Silva Fernandez
- Pós-graduanda em Uroginecologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp) - São Paulo, SP, Brasil
| | - Claudia Cristina Takano Novoa
- Doutora em Ginecologia e Obstetrícia Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp) - São Paulo, SP, Brasil
| | - Marair Gracio Ferreira Sartori
- Professora Associada do Departamento de Ginecologia da Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp) - São Paulo, SP, Brasil
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Marquini GV, da Silva Pinheiro FE, da Costa Vieira AU, da Costa Pinto RM, Kuster Uyeda MGB, Girão MJBC, Sartori MGF. Preoperative fasting abbreviation (Enhanced Recovery After Surgery protocol) and effects on the metabolism of patients undergoing gynecological surgeries under spinal anesthesia: A randomized clinical trial. Nutrition 2020; 77:110790. [DOI: 10.1016/j.nut.2020.110790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 01/30/2023]
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Marquini GV, Pinheiro FEDS, Vieira AUDC, Pinto RMDC, Uyeda MGBK, Girão MJBC, Sartori MGF. Preoperative Fasting Abbreviation and its Effects on Postoperative Nausea and Vomiting Incidence in Gynecological Surgery Patients. Rev Bras Ginecol Obstet 2020; 42:468-475. [PMID: 32559794 PMCID: PMC10309243 DOI: 10.1055/s-0040-1712994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Objective To investigate the effects of preoperative fasting abbreviation with a carbohydrate and protein-enriched solution, on postoperative nausea and vomiting (PONV) incidence in gynecological surgery patients, a population naturally at risk for such unpleasant episodes.
Methods The present prospective double-blind randomized study was performed at The Hospital Municipal e Maternidade Dr. Odelmo Leão Carneiro (HMMOLC, in the Portuguese acronym), in Uberlândia, state of Minas Gerais, Brazil, in partnership with the Gynecology Department of the Universidade Federal de São Paulo (UNIFESP), approved by the Human Research Ethics Committee of UNIFESP and the board of HMMOLC, and included in the Brazil Platform and in the Brazilian Clinical Trial Registry. After signing the consent form, 80 women, who were submitted to gynecological surgery in the period from January to June 2016, were randomized into 2 groups: control group (n = 42) and juice group (n = 38). They received, respectively, 200 mL of inert solution or liquid enriched with carbohydrate and protein 4 hours presurgery. The incidence, frequency and intensity of PONV were studied using the Visual Analogue Scale (VAS), with statistical analysis performed by the software IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp, Armonk, NY, USA).
Results The incidence of nausea and vomiting was lower than in the literature, to this population, with 18.9% (14/74) for the control group and 10.8% (8/74) for the juice group, respectively, with no statistically significant difference between the groups.
Conclusion The incidence of nausea and vomiting was lower than in the literature, but it cannot be said that this is due to the abbreviation of fasting. It can provide greater comfort, with the possibility of PONV prevention in patients at risk for these episodes.
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Affiliation(s)
- Gisele Vissoci Marquini
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Tamanini JTN, Reis LO, da Mota Tamanini MM, Aquino Castro R, Sartori MGF, Girão MJBC. No mesh versus mesh in the treatment of anterior vaginal wall prolapse: prospective, randomised, controlled trial, long-term follow-up. Int Urol Nephrol 2020; 52:1839-1844. [PMID: 32440838 DOI: 10.1007/s11255-020-02503-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/11/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To compare the efficacy and safety of anterior colporrhaphy (AC) versus transvaginal polypropylene mesh (PM) for the treatment of anterior vaginal wall prolapse (AVWP) at long-term follow-up. METHODS Prospective and randomized controlled trial, 100 women with AVWP stage ≥ II assessed by the Pelvic Organ Prolapse Quantification System (POP-Q) underwent AC (control group) or PM insertion (mesh group). At baseline and at 60-month follow-up, safety profile, anatomical outcomes by POP-Q measurements and staging, subjective outcomes and quality of life (QoL) impact by ICIQ (SF and VV) and OAB-V8 questionnaires were assessed RESULTS: 76 women completed the study, 43 in Control versus 33 in Mesh group. Significant improvements were observed in all variables between the 2 times in each group (p < 0.0001), without differences between groups. Objective cure (POP-Q Ba ≤ - 2 and Ba ≤ - 1) occurred in 22 and 36 (51.2 and 83.7%) versus 23 and 31 (69.7 and 93.9%), p = 0.10 and 0.29; and subjective cure (VSS, no vaginal symptom) in 21 (48.8%) versus 17 (51.5%), p = 0.82, respectively, at 60-month follow-up. When adjusted for the other variables, Mesh group showed worse QoL impact due to subjective vaginal symptoms (odds ratio 3.99, CI 95% 1.13; 14.13). AVW asymptomatic mesh exposure occurred in 2 patients (6.06%) in the Mesh group. CONCLUSIONS AC and PM provided good overall objective and subjective outcomes for a minimum 60-month follow-up. Vaginal and urinary symptoms improved post-operatively in both groups. Mesh group experienced four times more negative impact on QoL compared to Control at 60-month follow-up.
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Affiliation(s)
| | - Leonardo Oliveira Reis
- Uroscience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, Jardim Ipaussurama, Campinas, SP, Brazil.
| | | | - Rodrigo Aquino Castro
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Marair Gracio Ferreira Sartori
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, SP, Brazil
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Marquini GV, Seki AS, Dias V, de Jarmy di Bella ZIK, Girão MJBC, Sartori MGF. Infected Diverticulum of the Urethra in Pregnancy. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Ana Silvia Seki
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Vanessa Dias
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
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Marquini GV, Girão MJBC, Martins JTC, Jarmy di Bella ZIKD, Sartori MGF. Transvaginal Mesh Implant Procedures: Use Them or Not? J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Boaretto JA, Mesquita CQ, Lima AC, Prearo LC, Girão MJBC, Sartori MGF. Comparação entre oxibutinina, eletroestimulação do nervo tibial posterior e exercícios perineais no tratamento da síndrome da bexiga hiperativa. Fisioter Pesqui 2019. [DOI: 10.1590/1809-2950/17020026022019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivou-se avaliar a eficácia dos exercícios perineais, da eletroestimulação transcutânea do nervo tibial posterior (ETNTP) e da oxibutinina em mulheres com síndrome da bexiga hiperativa, que é a segunda causa mais comum de incontinência urinária, com sintomas urinários extremamente incômodos que prejudicam a qualidade de vida. Foram randomizadas 65 mulheres, das quais 57 completaram o tratamento. Formaram-se três grupos: o de exercícios perineais, ETNTP e o grupo controle, que utilizou oxibutinina. Os exercícios foram realizados em grupo, nas posições em pé, supino e sentado, duas vezes por semana, com duração de 30 minutos cada sessão, totalizando 12 sessões. Na ETNTP utilizou-se eletrodo transcutâneo posicionado em maléolo medial e outro 10cm acima, com frequência de 10Hz e largura de pulso de 200 microssegundos, por 30 minutos, duas vezes por semana, totalizando 12 sessões. Na medicação as pacientes receberam oxibutinina de 10mg/dia de liberação imediata divididos e duas doses de 5mg/dia, durante 12 semanas consecutivas. Antes e depois dos tratamentos, as pacientes passaram por uma avaliação composta pela análise do diário miccional, avaliação funcional do assoalho pélvico e aplicação de questionário de qualidade de vida OAB-V8. Houve redução da incontinência de urgência em 50%, 70,5% e 41% nos grupos de exercício, ETNTP e oxibutinina, respectivamente, com significância estatística somente da eletroestimulação. As três modalidades de tratamento foram eficazes na melhora da qualidade de vida para a terapêutica em curto prazo, estatisticamente semelhantes entre si.
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Kuster Uyeda MGB, Batista Castello Girão MJ, Carbone ÉDSM, Machado Fonseca MC, Takaki MR, Ferreira Sartori MG. Fast-track protocol for perioperative care in gynecological surgery: Cross-sectional study. Taiwan J Obstet Gynecol 2019; 58:359-363. [PMID: 31122525 DOI: 10.1016/j.tjog.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare clinical and surgical outcomes in patients admitted to a gynecological surgery ward before and after the implementation of an evidence-based multimodal and multiprofessional care protocol by the hospital staff. MATERIAL AND METHODS In this historically-controlled cross-sectional study, we compared clinical and surgical outcomes among all women admitted to the gynecological ward of a university public hospital for elective surgery for various reasons before and after the implementation of a multimodal care protocol. The protocol had been implemented to adjust the following procedures to evidence-based recommendations: fluid management/hydration, antimicrobial prophylaxis, management of nausea and vomiting, antithrombotic prophylactic therapy, preoperative fasting, mechanical bowel preparation (reduction), pain management, use of urinary catheters, and stimulus to ambulation. RESULTS After the protocol implementation, fasting time was reduced in approximately 10 h. Patients had to undergo bowel preparation significantly less frequently, and the volume of fluids was reduced too. The use of nausea and vomit prophylaxis increased almost 20 times, but only nausea episodes were reduced. The frequency of antithrombotic prophylactic therapy more than doubled. Hospitalization time decreased significantly. CONCLUSIONS In this study, we observed significant improvements in clinical outcomes after the implementation of a multimodal protocol for perioperative care in the gynecological ward of a public university hospital in Brazil. The protocol implementation was associated with reductions in fasting time, bowel preparation, administration of fluids, pain, nausea and hospitalization time, allowing the treatment of more patients per year in the same ward.
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Affiliation(s)
- Maria Gabriela B Kuster Uyeda
- Department of Gynecology and Obstetrics, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), Brazil.
| | | | - Ébe Dos Santos Monteiro Carbone
- Department of Gynecology and Obstetrics, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), Brazil.
| | - Marcelo Cunio Machado Fonseca
- Department of Gynecology and Obstetrics, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), Brazil.
| | - Mayara Ronzini Takaki
- Department of Gynecology and Obstetrics, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), Brazil.
| | - Marair Gracio Ferreira Sartori
- Department of Gynecology and Obstetrics, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), Brazil.
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Ströher RLM, Sartori MGF, Takano CC, de Araújo MP, Girão MJBC. Metabolic syndrome in women with and without stress urinary incontinence. Int Urogynecol J 2019; 31:173-179. [PMID: 30721325 DOI: 10.1007/s00192-019-03880-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/14/2019] [Indexed: 11/26/2022]
Abstract
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.
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Marquini GV, Pinheiro FES, Vieira AUC, Pinto RMC, Uyeda MGBK, Girão MJBC, Sartori MGF. Efeitos da abreviação do jejum pré-operatório com solução de carboidrato e proteína em sintomas pós-operatórios de cirurgias ginecológicas: ensaio clínico randomizado controlado duplo-cego. Rev Col Bras Cir 2019; 46:e20192295. [DOI: 10.1590/0100-6991e-20192295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/10/2019] [Indexed: 12/20/2022] Open
Abstract
RESUMO Objetivo: investigar os efeitos da abreviação do jejum pré-operatório, uma recomendação do protocolo de “Aceleração da Recuperação Total Pós-operatória” (ACERTO), em sintomas pós-operatórios de pacientes submetidas à cirurgias ginecológicas. Métodos: estudo controlado, randomizado, duplo-cego, de 80 cirurgias ginecológicas realizadas no período de janeiro a junho de 2016. As pacientes foram aleatoriamente alocadas em dois grupos: Grupo Controle, com 42 pacientes, e Grupo Suco, com 38, e que receberam, respectivamente, 200ml de solução inerte ou 200ml de líquido enriquecido com carboidrato e proteína quatro horas antes da cirurgia. Os sintomas pós-operatórios estudados foram sede, fome, dor, agitação, satisfação e bem-estar, em ambos os grupos. Para medir a intensidade dos sintomas foi utilizada a Escala Visual Analógica (EVA), associada à Escala Facial (EF) para dor, aplicadas dez horas após a cirurgia. Resultados: as pacientes do Grupo Suco apresentaram menos dor (3,51x1,59), sede (3,63x0,85), fome (3,86x2,09) e agitação (2,54x0,82) em relação ao Grupo Controle (P<0,05). As variáveis satisfação (6,89x8,68) e bem-estar (5,51x7,12) foram maiores (P<0,05) quando houve a ingestão do líquido contendo carboidrato e proteína (Grupo Suco) em relação à solução inerte (Grupo Controle). Conclusão: a abreviação do jejum pré-operatório com líquido contendo carboidrato e proteína antes de cirurgias ginecológicas reduz sede, fome, dor, agitação e favorece maior satisfação e bem-estar do que a ingestão de solução inerte.
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Monteiro Carbone ÉDS, Takaki MR, Uyeda MGBK, Sartori MGF. Early physical therapy intervention in gynaecological surgery: "Case series". Int J Surg Case Rep 2018; 52:95-102. [PMID: 30336388 PMCID: PMC6197772 DOI: 10.1016/j.ijscr.2018.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/22/2018] [Accepted: 09/29/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To implement a physical therapy intervention protocol targeting patients admitted for gynaecological surgery to the gynaecological ward of XXXX Hospital. METHOD A prospective, cross-sectional and observational study was conducted with women admitted to the gynaecology ward, from June 2014 through June 2015. The study was divided into three phases with data on admissions to the gynaecology ward. A total of 565 women were included, corresponding to phases I (197), II (178) and III (190). The physical therapy staff implemented an early ambulation protocol as well as a mobility assessment. RESULTS The physical therapy protocol was implemented, and the rate of adherence was 100%. All participants received preoperative instruction on the importance of early mobilisation. On postoperative day 1, the participants in phase I walked a mean of 77.4 m. Following implementation of the physical therapy protocol, the walked distance increased to 292.6 m in phase II, followed by a slight decrease to a mean of 233 m in phase III. CONCLUSIONS The physical therapy protocol could be implemented, and the patients' adherence was satisfactory. Early ambulation can be optimised, and the participants began ambulation starting at 13 h after surgery.
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Affiliation(s)
- Ébe Dos Santos Monteiro Carbone
- Urogynecology and, Department of Gynecology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Mayara Ronzini Takaki
- Urogynecology and, Department of Gynecology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Brito LGO, Santos JDC, Sartori MGF. A Decline at Inpatient Benign Hysterectomy is Perceived in Brazil: What are the Strategies to Improve Surgical Resident Training? Rev Bras Ginecol Obstet 2018; 40:239-241. [PMID: 29775971 PMCID: PMC10309460 DOI: 10.1055/s-0038-1655748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- Luiz Gustavo Oliveira Brito
- Department of Tocogynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Juliana da Costa Santos
- Department of Tocogynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Oliveira ED, Tavares KADS, Gomes MTV, Salzedas-Netto AA, Sartori MGF, Castro RA, Fernandes CE, Girão MJBC. Description and evaluation of experimental models for uterine transplantation in pigs. Einstein (Sao Paulo) 2017; 15:481-485. [PMID: 29267429 PMCID: PMC5875164 DOI: 10.1590/s1679-45082017ao4066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/15/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the technique of uterine transplantation and the use of drugs used in the process of immunosuppression. Methods We included 12 sows, and immunosuppression was performed with minimal doses of cyclosporine, and cross-match was done to exclude the possibility of blood incompatibility. Hysterectomy was performed in the donor under general anesthesia, with the removal of the aorta and inferior vena cava in monobloc, and anastomosis of these vessels was made in the recipient. Results Six experiments were performed, and on the immediate postoperative period, five animals had good reperfusion. However, on the seventh postoperative day, histological analysis showed rejection in five animals. Conclusion The experimental model of uterine transplantation is feasible, but monitoring doses of immunosuppressants is pivotal to prevent rejection episodes.
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Affiliation(s)
| | | | | | | | | | - Rodrigo Aquino Castro
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Santos MD, Palmezoni VP, Torelli L, Baldon VSP, Sartori MGF, Resende APM. Evaluation of pelvic floor muscle strength and its correlation with sexual function in primigravid and non-pregnant women: A cross-sectional study. Neurourol Urodyn 2017; 37:807-814. [PMID: 28762553 DOI: 10.1002/nau.23353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/12/2017] [Indexed: 12/28/2022]
Abstract
AIMS We aimed to compare pelvic floor muscle (PFM) strength and sexual function in primigravid and non-pregnant women and compare PFM strength between those who exhibited and did not exhibit sexual dysfunction. METHODS A cross-sectional observational study was conducted. The sample consisted of 154 women, including 76 primigravid and 78 non-pregnant women. The inclusion criteria were as follows: non-pregnant nulliparous women or primigravid women who were pregnant with a single foetus at least 14 weeks of gestational age and reported having sexual intercourse at least once during the last 4 weeks. The exclusion criteria were as follows: inability to contract the PFMs and prior urogynaecologic surgery. PFM strength was assessed via vaginal palpation (using the Modified Oxford Scale) and vaginal squeeze pressure (using the Peritron™ manometer). Sexual function was assessedusing the Female Sexual Function Index (FSFI) questionnaire. Sexual dysfunction was identified based on low FSFI scores.The data were analyzed using the Mann-Whiney and Spearman correlation tests. RESULTS To discussion, primigravid women had lower FSFI scores and lower PFM strength than non-pregnant women. Women with sexual dysfunction had lower PFM strength than women without sexual dysfunction, as indicated by vaginal palpation (scores of 2 out of 5 and 4 out of 5, respectively; P < 0.001) and vaginal squeeze pressure (17.5 and 36.8 cm H2 O, P < 0.001, respectively)regardless of whether they were non-pregnant nulliparous women and primigravid. CONCLUSIONS Primigravid women exhibited worse sexual function and lower PFM strength than non-pregnant women. Women who had higher FSFI scores demonstrated greater PFM strength.
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Affiliation(s)
- Marília Duarte Santos
- Post Graduation Program in Health Sciences, Medical School, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Vanessa Pinho Palmezoni
- Post Graduation Program in Health Sciences, Medical School, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Luiza Torelli
- Department of Gynecology, Federal University of São Paulo/Escola Paulista de Medicina, São Paulo, São Paulo, Brazil
| | - Vanessa Santos Pereira Baldon
- Post Graduation Program in Health Sciences, Medical School, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.,Department of Physiotherapy, Post Graduation Program in Physiotherapy, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Ana Paula Magalhães Resende
- Department of Physiotherapy, Post Graduation Program in Physiotherapy, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
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Hirakauva EY, Bianchi-Ferraro AMHDM, Zucchi EVM, Kajikawa MM, Girão MJBC, Sartori MGF, Jarmy-Di Bella ZIKD. Incidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence. Rev Bras Ginecol Obstet 2017; 39:534-540. [PMID: 28666299 PMCID: PMC10309375 DOI: 10.1055/s-0037-1604066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
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 investigators concluded that they were valuable and others did not. The objective of this study is to evaluate the efficacy of antibiotic prophylaxis before UDS. This is a placebo-control randomized double-blind study. Methods Two-hundred and seventeen women affected by urinary incontinence were eligible for this study. All patients had presented negative urine culture previous to the UDS. They were randomized in four groups: group A received placebo, group B received 500 mg of levofloxacin, group C received 80 mg trimethoprim and 400 mg sulfamethoxazole and group D received 100 mg of nitrofurantoin. A urine culture was performed 14 days after the UDS. Results We observed asymptomatic bacteriuria after the UDS in five patients in group A, one in group B, one in group C and one in group D. Only one patient on group A had symptomatic bacteriuria. We didn't observe statistical difference between the groups. When we recategorized the patients in two groups, the incidence of bacteriuria was significantly higher in the placebo group compared with the antibiotic group. Conclusion The conclusion is that antibiotic prophylaxis before the UDS did not reduce the incidence of UTI in women within the target population.
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Fernandes CFK, Ruano JMC, Kati LM, Noguti AS, Girão MJBC, Sartori MGF. Assessment of laparoscopic skills of Gynecology and Obstetrics residents after a training program. Einstein (Sao Paulo) 2017; 14:468-472. [PMID: 28076592 PMCID: PMC5221371 DOI: 10.1590/s1679-45082016ao3752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/21/2016] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate laparoscopic skills of third-year Gynecology and Obstetrics residents after training at a training and surgical experimentation center. Methods Use of a prospective questionnaire analyzing demographic data, medical residency, skills, competences, and training in a box trainer and in pigs. Results After the training, there was significant improvement in laparoscopic skills according to the residents (before 1.3/after 2.7; p=0.000) and preceptors (before 2.1/after 4.8; p=0.000). There was also significant improvement in the feeling of competence in surgeries with level 1 and 2 of difficulty. All residents approved the training. Conclusion The training was distributed into 12 hours in the box trainer and 20 hours in animals, and led to better laparoscopic skills and a feeling of more surgical competence in laparoscopic surgery levels 1 and 2.
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Affiliation(s)
| | | | - Lea Mina Kati
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Fitz FF, Stüpp L, Costa TF, Sartori MGF, Girão MJBC, Castro RA. Correlation between maximum voluntary contraction and endurance measured by digital palpation and manometry: An observational study. Rev Assoc Med Bras (1992) 2017; 62:635-640. [PMID: 27925042 DOI: 10.1590/1806-9282.62.07.635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/06/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction: Digital palpation and manometry are methods that can provide information regarding maximum voluntary contraction (MVC) and endurance of the pelvic floor muscles (PFM), and a strong correlation between these variables can be expected. Objective: To investigate the correlation between MVC and endurance, measured by digital palpation and manometry. Method: Forty-two women, with mean age of 58.1 years (±10.2), and predominant symptoms of stress urinary incontinence (SUI), were included. Examination was firstly conducted by digital palpation and subsequently using a Peritron manometer. MVC was measured using a 0-5 score, based on the Oxford Grading Scale. Endurance was assessed based on the PERFECT scheme. Results: We found a significant positive correlation between the MVC measured by digital palpation and the peak manometric pressure (r=0.579, p<0.001), and between the measurements of the endurance by Peritron manometer and the PERFECT assessment scheme (r=0.559, P<0.001). Conclusion: Our results revealed a positive and significant correlation between the capacity and maintenance of PFM contraction using digital and manometer evaluations in women with predominant symptoms of SUI.
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Affiliation(s)
- Fátima Faní Fitz
- PT, MSc, Department of Gynecology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Liliana Stüpp
- PT, PhD, Department of Gynecology, Unifesp, São Paulo, SP, Brazil
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Lordêlo P, Leal MRD, Brasil CA, Santos JM, Lima MCNPC, Sartori MGF. Radiofrequency in female external genital cosmetics and sexual function: a randomized clinical trial. Int Urogynecol J 2016; 27:1681-1687. [PMID: 27116198 DOI: 10.1007/s00192-016-3020-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/01/2016] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Patrícia Lordêlo
- Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, Brazil.
| | | | - Cristina Aires Brasil
- Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, Brazil
| | - Juliana Menezes Santos
- Bahiana School of Medicine and Public Health, Av Dom João VI, 275 - Brotas, Salvador, Bahia, Brazil
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Di Bella ZIKDJ, Bianchi AMHDM, Araujo FFD, Sartori MGF, Girão MJBC. Contraception and family planning at the extreme of reproductive life - climacteric. Rev Assoc Med Bras (1992) 2016; 62:454-7. [PMID: 27656856 DOI: 10.1590/1806-9282.62.05.454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/04/2015] [Indexed: 11/22/2022] Open
Abstract
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, mitochondrial abnormalities, or genetic syndromes. On the other hand, there is a growing number of women who have postponed motherhood and need effective contraception, but without prolonging the return to fertility. Long-acting reversible contraceptives (LARCs), low-dose oral hormonal contraceptives and non-oral contraceptives are preferred. The levonorgestrel-releasing intrauterine system is a very good alternative that can maintain endometrial protection after menopause. Definitive methods such as tubal ligation and vasectomy are options for couples that already have their offspring. In this review, we present evidence for contraceptive indication and the effects of hormonal methods on climacteric including options for contraception, control of bleeding during perimenopause and of climacteric symptoms, as well as the transition from such methods to hormone therapy if indicated.
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Affiliation(s)
- Zsuzsanna Ilona Katalin de Jármy Di Bella
- PhD - Coordinator of the Sector of Family Planning and Adjunct Professor of the Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Fabio Fernando de Araujo
- PhD - Coordinator of the Sector of Family Planning, and Affiliate Professor of the Department of Gynecology, EPM-Unifesp, São Paulo, SP, Brazil
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Torelli L, de Jarmy Di Bella ZIK, Rodrigues CA, Stüpp L, Girão MJBC, Sartori MGF. Effectiveness of adding voluntary pelvic floor muscle contraction to a Pilates exercise program: an assessor-masked randomized controlled trial. Int Urogynecol J 2016; 27:1743-1752. [PMID: 27250831 DOI: 10.1007/s00192-016-3037-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Luiza Torelli
- Gynecology Department of Federal University of São Paulo, Rua Diogo Jacome 1000 apt 23 Moema, Cep:04512-001, São Paulo, SP, Brazil.
| | | | - Claudinei Alves Rodrigues
- Gynecology Department of Federal University of São Paulo, Rua Diogo Jacome 1000 apt 23 Moema, Cep:04512-001, São Paulo, SP, Brazil
| | - Liliana Stüpp
- Gynecology Department of Federal University of São Paulo, Rua Diogo Jacome 1000 apt 23 Moema, Cep:04512-001, São Paulo, SP, Brazil
| | | | - Marair Gracio Ferreira Sartori
- Gynecology Department of Federal University of São Paulo, Rua Diogo Jacome 1000 apt 23 Moema, Cep:04512-001, São Paulo, SP, Brazil
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Araujo MPD, Parmigiano TR, Negra LGD, Torelli L, Carvalho CGD, Wo L, Manito ACA, Girão MJBC, Sartori MGF. AVALIAÇÃO DO ASSOALHO PÉLVICO DE ATLETAS: EXISTE RELAÇÃO COM A INCONTINÊNCIA URINÁRIA? REV BRAS MED ESPORTE 2015. [DOI: 10.1590/1517-869220152106140065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introdução O assoalho pélvico feminino é formado por um conjunto de músculos, fáscias e ligamentos que sustentam os órgãos pélvicos (bexiga, ânus e vagina). A lesão destas estruturas, devido à idade avançada e parto podem levar à incontinência urinária. Entretanto, ainda não se sabe se o exercício de alta intensidade é capaz de lesar este conjunto músculo-aponevrótico, levando à incontinência urinária. Objetivo Comparar a capacidade de contração dos músculos do assoalho pélvico entre mulheres sedentárias e atletas de elite, e verificar se existe associação com a ocorrência de incontinência urinária durante a atividade física. Métodos Estudo caso-controle que incluiu 93 mulheres (49 atletas e 44 sedentárias) convidadas a responder o questionário "International Consultation on Incontinence Questionnaire - Short Form" e realizar avaliação funcional do assoalho pélvico. As atletas (grupo caso) eram praticantes de corrida de longa distância, basquete e ginástica olímpica. As sedentárias (grupo controle) realizavam menos de 150 minutos por semana de atividades moderadas ou vigorosas. A aferição da pressão de contração foi feita por meio de um perineômetro digital de precisão. Resultados Os grupos foram homogêneos quanto à idade e índice de massa corpórea. As atletas apresentaram maiores valores de pressão vaginal máxima (70,1±2,4 cmH2O) quando comparadas às sedentárias (34,3±1,7 cmH2O), (p<0,001). As atletas praticantes de basquete tiveram os maiores valores da pressão vaginal máxima (77,2 cmH2O) quando comparadas às ginastas (65,5 cmH2O) e corredoras (65,4 cmH2O). A prevalência de incontinência urinária nas atletas foi de 76% e somente 16% nas sedentárias (p=0,005). Conclusão Embora a capacidade de contração do assoalho pélvico em atletas de elite seja superior às sedentárias, a prevalência de incontinência urinaria foi elevada neste grupo de praticantes de esporte de alto rendimento e alto impacto.
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Affiliation(s)
| | | | | | | | | | - Liris Wo
- Universidade Federal de São Paulo, Brasil
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Parmigiano TR, Zucchi EVM, Araujo MPD, Guindalini CSC, Castro RDA, Di Bella ZIKDJ, Girão MJBC, Cohen M, Sartori MGF. Pre-participation gynecological evaluation of female athletes: a new proposal. ACTA ACUST UNITED AC 2015; 12:459-66. [PMID: 25628197 PMCID: PMC4879912 DOI: 10.1590/s1679-45082014ao3205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 10/22/2014] [Indexed: 11/22/2022]
Abstract
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 responded to a questionnaire named Pre-Participation Gynecological Examination (PPGE), to the International Consultation on Incontinence Questionnaire - Short Form (for urinary loss), and to the Eating Attitudes Test (for eating disorders). RESULTS Fifty percent of the participants reported irregular menstrual intervals, 23.0% did not know about sexually transmitted diseases, and 72.4% denied having, at least, an annual gynecological appointment. The study identified 18.2% who had urinary loss, and 15% presented with an increased risk of eating disorders. Moreover, 89.9% were not familiar with the occurrence of urinary incontinence in athletes and did not know that they were susceptible to the female athlete triad. A total of 87.1% of them stated that would not mention these issues to their coaches even if this would improve their health or performance. CONCLUSION The Pre-Participation Gynecological Examination can be considered an easy-to-apply instrument that allowed the diagnosis of alterations often underestimated by the athletes themselves. After its application, the alterations were identified, and determined the athletes' referral to appropriate evaluation and treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Moisés Cohen
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Kajikawa MM, Jármy-Di Bella ZIK, Dornelas J, Crema LC, Takano CC, Focchi GRDA, Rolo LC, Araujo Júnior E, Castro RA, Girão MJBC, Sartori MGF. Oestrogen receptor alpha expression in neovaginal tissue of women following modified Abbé-McIndoe technique and in premenopausal women. Gynecol Endocrinol 2015; 31:327-31. [PMID: 25561399 DOI: 10.3109/09513590.2014.995618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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 Abbé-McIndoe neovaginoplasty and 10 control premenopausal women following benign gynaecologic surgery. 6F11 monoclonal antibody was used to determine ERα expression in the vaginal mucosa. Quantitative and qualitative evaluations were performed, respectively, in vaginal epithelium and stroma. The thickness of the vaginal epithelium was determined as the vertical distance between the basal layer cells and the apical surface of the superficial layer. The percentage of ERα-expressing cells was higher in the control group, except in the superficial zone of the epithelium. In the stromal tissue, ERα was detected in only one patient from the neovagina group compared with nine women in the control group. The neovagina group had a statistically thinner epithelium. Our study suggests that women with vaginal agenesis following modified Abbé-McIndoe neovaginoplasty using regenerated oxidised, cellulose experience relatively local hypo-oestrogenism in the first year after surgery, with repercussion in vaginal trophism.
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Affiliation(s)
- Marcio Masashi Kajikawa
- Department of Gynaecology at Paulista School of Medicine - São Paulo Federal University (EPM-UNIFESP) , São Paulo-SP , Brazil
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Tamanini JTN, de Oliveira Souza Castro RC, Tamanini JM, Castro RA, Sartori MGF, Girão MJBC. A Prospective, Randomized, Controlled Trial of the Treatment of Anterior Vaginal Wall Prolapse: Medium Term Followup. J Urol 2015; 193:1298-304. [DOI: 10.1016/j.juro.2014.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 11/24/2022]
Affiliation(s)
- José Tadeu Nunes Tamanini
- Department of Urology, Faculty of Medicine of São Carlos, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Rodrigo Aquino Castro
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Marair Gracio Ferreira Sartori
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
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Araujo MPD, Kleine HT, Parmigiano TR, Gomes NT, Caparroz GP, Silva IDCGD, Girão MJBC, Sartori MGF. Prevalence of sexually transmitted diseases in female athletes in São Paulo, Brazil. Einstein (Sao Paulo) 2014; 12:31-5. [PMID: 24728243 PMCID: PMC4898236 DOI: 10.1590/s1679-45082014ao2949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/05/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the prevalence of sexually transmitted diseases in female athletes. METHODS An observational, cross-sectional study was conducted including 50 female athletes with mean age of 20 ± 3 years. Colposcopy, pap smear, and polymerase chain reaction for Chlamydia trachomatis, human papillomavirus and Neisseria gonorrhoeae were performed. Blood samples were collected to test for the human immunodeficiency virus, syphilis, hepatitis B and C. The athletes presenting clinical diseases or conditions identifiable by laboratory tests were treated and followed up in the unit. RESULTS Forty-six percent of the participants were unaware of sexually transmitted diseases. The prevalence of sexually transmitted diseases among athletes was 48% (24 cases). Human papillomavirus was the most frequent agent (44%). Considering the human papillomavirus genotypes, subtype 16 was the most prevalent (53%), followed by 11-6 (22%) and 18 (13%). Two athletes tested positive for C. trachomatis. There were no cases diagnosed of infection by N. gonorrhoeae, syphilis, hepatitis B, hepatitis C and human immunodeficiency virus. However, only 26 athletes had been vaccinated for hepatitis B. CONCLUSION The prevalence of sexually transmitted diseases in female athletes was high. Primary prevention measures (hepatitis B and human papillomavirus vaccination) and secondary (serology, pap smears) must be offered to this specific group of women. The matter should be further approached in sports.
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Fitz FF, Resende APM, Stüpp L, Costa TF, Sartori MGF, Girão MJBC, Castro RA. [Effect the adding of biofeedback to the training of the pelvic floor muscles to treatment of stress urinary incontinence]. Rev Bras Ginecol Obstet 2013; 34:505-10. [PMID: 23288261 DOI: 10.1590/s0100-72032012001100005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 09/12/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the effect of adding biofeedback (BF) to the training of pelvic floor muscles (PFMT) for the treatment of stress urinary incontinence (SUI). METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Fátima Faní Fitz
- Departamento de Ginecologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
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Crema L, Jármy Di-Bella Z, Takano C, Castro R, Simões MDJ, Ferreira Sartori MG, Batista Castello Girão MJ. The Morphological Aspects of Neovaginoplasty Using Oxidized Cellulose Membrane (Interceed®). J Gynecol Surg 2013. [DOI: 10.1089/gyn.2011.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luciana Crema
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Claudia Takano
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo Castro
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
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Tamanini JTN, Tamanini MMDM, Castro RCDOS, Feldner Jr PC, Castro RDA, Sartori MGF, Girao MJBC. Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I. Int Braz J Urol 2013; 39:519-30. [DOI: 10.1590/s1677-5538.ibju.2013.04.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 06/07/2013] [Indexed: 11/21/2022] Open
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