Evaluation of mycational and sexual complaints inwomen practicing physical activity

The pelvic floor has the function of supporting the pelvic organs. In women,changes in the pelvic musculature can result in urinary incontinence, pelvicorgan prolapses and other disorders, which may include sexual disorders. Theaim of this study was to assess sexual and voiding dysfunctions among womenwho practice physical activity. A cross-sectional observational study was carriedout, with 31 female patients, aged between 20 and 35 years (26.0 ± 4.2),divided into group G1 with 18 women practicing physical activity with practicetime less than 3 years and the G2 group with 13 women practicing physicalactivity for more than 3 years. As evaluation instruments were used: TheInternational Consultation on Incontinence Questionnaire (ICIQ –SF) and theICIQ-VS questionnaire. The results showed a greater severity of voidingsymptoms in women in group G2, with a severity score of 6.0 and group G1 hada severity score of 3.1, chi-square=5.19 and p=0.07. Regarding vaginalsymptoms, G2 showed a prevalence of 61.5%, which may be indicative of POP.In the present study, a high prevalence of UI symptoms was observed inwomen who practice physical activity, when related to the time of practice, therewas the presence of mild UI in Group G1 andmoderate in Group G2 (p=0.07),presenting a higher impairment of the quality of life of the G2 group (p=0.01).

Urodynamic changes in women subjected to gynecological surgeries

Introduction: Disorders inherent to aging are increasingly present, with voiding dysfunctions and greater submission to surgeries among them. Objective: To analyze the influence of gynecological surgeries (Hysterectomy-HT and Colpoperineoplasty-CPP) on urodynamic bladder function parameters of adult women. Methods: A comparative study of urodynamic data from 706 patients was performed at the Urology Service of HC/UFPE. Previously, patients with any known clinical factor which could affect bladder function were excluded. These patients were analyzed in groups according to their history of gynecological surgery and age group (Non-elderly/elderly). The control group was composed by women without any gynecological surgery history. Results: All urodynamic parameters were worse in the elderly subgroup. The fundamental difference between the groups consisted of senility and past gynecological surgeries (higher in the elderly group). In the general female population, a history of gynecological surgeries was related to several alterations in urodynamic parameters. All urodynamic micturition phase parameters were significantly worse in patients with colpoplasty history. Hysterectomy history was also associated to a deterioration in some micturition parameters. However, no relationship between gynecological surgeries and urodynamic changes was found in the elderly women subgroup. Conclusion: Gynecological surgeries (HT/CPP) do not alter the prevalence and/or intensity of voiding dysfunctions already expected in the older age group of women from the aging process itself. Functional changes in the lower urinary tract resulting from aging are imposed in elderly women, regardless of their gynecological surgery history.

The Burden of Reoperations and Timeline of Problems in 1,530 Cases of Mesh-Related Complications

<b><i>Background:</i></b> Mesh-related complications resulting from pelvic organ prolapse (POP) reconstruction operations may be a devastating experience leading to multiple and complex interventions. <b><i>Objectives:</i></b> The aim of the study was to describe the experience and time frame of management of mesh-related complications in women treated for POP or stress urinary incontinence in a tertiary center. <b><i>Methods:</i></b> 1,530 cases of mesh-related complications were accessed regarding their clinical presentation, number of surgeries, and timeline of surgical treatments to treat multiple clinical complaints until the ultimate operation where all the meshes were removed in a single tertiary center. <b><i>Results:</i></b> The studied population revealed to be a highly referred one with only 10.2% of the cases implanted at our center. Clinical presentation varied widely with 48.7% referring pain as the chief complaint, while 31.3% complained of voiding dysfunctions, 2.5% reported genital prolapses, 2.2% complained of vaginal problems, and 1.2% noted intestinal problems as the main clinical complaint. Only 4.8% of the cases presented mesh erosion at examination; 57.8% of the cases required more than 1 operation to address the mesh-related problems. Sixty-eight cases had more than 10 operations up to complete removal. Three clusters of patients could be identified: (i)–those from whom the mesh was promptly removed after clinical problems emerged, (ii) those with slowly evolving problems, and (iii) those with escalating problems despite treatment attempts. <b><i>Conclusions:</i></b> Mesh-related complications after pelvic floor reconstruction are an evolving disease with diverse clinical presentation. The identified time-related problems and the multiple failed attempts to treat their complications warrant attention with continuous monitoring of these patients and aggressive removal of the mesh if the clinical complaint cannot be swiftly managed.

The voiding dysfunctions in patients with non-Hunner-type interstitial cystitis/bladder pain syndrome do not affect long-term treatment outcome

Aims: The role of urodynamic studies in the diagnosis and prognosis of interstitial cystitis/bladder pain syndrome (IC/BPS) remains controversial. We evaluated the correlation of baseline voiding dysfunctions with long-term treatment outcome in a large cohort of patients with IC/BPS. Methods: We studied 211 patients with nonulcerative IC/BPS. All patients underwent video urodynamic examination at baseline to identify their voiding conditions and they received subsequent treatments. The primary endpoint was the global response assessment (GRA) at the current interview. Secondary endpoints included O’Leary-Sant score (OSS), Visual Analog Scale (VAS) for pain, and the rate of IC symptom flare-up. Results: Mean patient age was 56.8 ± 12.8 years and mean IC symptom duration was 16.0 ± 9.9 years. At baseline, 83 (39.3%) patients had a voiding problem and 62.7% had one to three comorbidities. The duration, comorbidity, treatments, changes in OSS and VAS, maximum bladder capacity (MBC), glomerulations, GRA, and flare-up rate were not significantly different among the different voiding subtypes. When we divided the patients by their voiding conditions of normal (n = 32) and hypersensitive bladder with (n = 76) and without (n = 103) voiding dysfunctions, only MBC (P = 0.002) and glomerulation (P = 0.021) demonstrated a significant difference. When we analyzed subgroups by GRA, patients with a GRA ≥ 2 had a significantly shorter disease duration. There also were significant associations between GRA and the changes in OSS and VAS (P < 0.001). Conclusions: Voiding dysfunctions in patients with non-Hunner IC/BPS do not affect long-term treatment outcome.

Bladder Management in Palliative Care

Management of urinary difficulties in palliative care should be as much a priority for nursing care as symptoms such as pain and nausea, as these, too, can cause great distress and discomfort. This chapter discusses the urinary and bladder difficulties that may occur in a patient approaching the end of life and the options for nursing care that can be considered with personalized, holistic care in mind. Potential problems for patients in receipt of palliative care can include voiding dysfunctions such as urinary retention, toileting issues such as incontinence, and painful bladder difficulties such as spasm and infection. Priorities for nursing care are detailed, taking into account the patient’s clinical situation and personal preferences.