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Hosoume RS, Peterson TV, Soares Júnior JM, Baracat EC, Haddad JM. A randomized clinical trial comparing internal and external pessaries in the treatment of pelvic organ prolapse in postmenopausal women: A pilot study. Clinics (Sao Paulo) 2024; 79:100335. [PMID: 38484583 PMCID: PMC10951456 DOI: 10.1016/j.clinsp.2024.100335] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/30/2023] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION AND HYPOTHESIS Internal vaginal pessary is among the leading treatments for pelvic organ prolapse (POP); however, it has a high adverse event rate. An external pessary was recently developed as an alternative. The study's objective was to compare the efficacy of external and internal pessaries in treating POP in postmenopausal women. METHODS This parallel randomized (1:1 ratio) open-blind study included 40 symptomatic women with stage 2 or 3 POP. They were randomized into two groups: group 1 (internal pessary) and group 2 (external pessary) (n = 20 in each); and evaluated at the start of and 3 months after the treatment. Statistical analysis was performed to compare the results within and between the groups before and after the 3-month treatment. RESULTS The groups were homogeneous, except for the variables previous pregnancies (p = 0.030) and POP-Q score of apical prolapse (p = 0.023) whose values were higher in group 2. A significant improvement in quality of life was observed in both groups after 3 months of follow-up; however, internal pessaries were found to be more effective (p < 0.001). In group 1 there were differences between the initial and final POP-Q scores of anterior (0.004) and apical prolapse (p = 0.005). The complication rate associated with internal pessary use was high (p = 0.044). CONCLUSIONS The present data suggested that external pessaries have a similar effect to internal ones for the treatment of POP and improvement of the quality of life of postmenopausal women.
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da Fonseca LC, Giarreta FBA, Peterson TV, Locali PKM, Baracat EC, Ferreira EAG, Haddad JM. A randomized trial comparing vaginal laser therapy and pelvic floor physical therapy for treating women with stress urinary incontinence. Neurourol Urodyn 2023; 42:1445-1454. [PMID: 37449372 DOI: 10.1002/nau.25244] [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: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Female stress urinary incontinence (SUI) is considered a major public health issue. Physical therapy is an important conservative treatment; however, it is primarily limited by poor long-term compliance. Furthermore, surgical treatment entails significant risks. Therefore, new treatment techniques must be identified. OBJECTIVE To compare the use of laser therapy and pelvic floor (PF) physical therapy for treating postmenopausal women with SUI. METHODS This pilot study enrolled 40 women with a clinical and urodynamic diagnosis of SUI who were randomized into two groups: those who received erbium-doped yttrium-aluminum-garnet (Er:YAG) laser therapy implemented over three sessions with a 1-month interval (n = 20) and those who received physical therapy with supervision twice a week for 3 months (n = 20). In total, 16 women completed the treatment in each group. The patients were assessed for PF function using the modified Oxford scale and for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System. The 1-h pad test and quality of life questionnaires, King's Health Questionnaire (KHQ), and Incontinence Quality of Life (IQOL) were also administered. Patients were re-evaluated at 1, 3, 6, and 12 months after treatment. RESULTS The mean patient age was 62.7 ± 9.1 and 57.9 ± 6.1 years, median Oxford score at baseline was 3 (2-4.5) and 4 (3-4), mean IQOL score was 79.8 ± 17 and 74.6 ± 18 for physical therapy group (PTG) and laser group (LG), respectively. For the amount of urine leak in the 1-h pad test evaluation, we found significance for the interaction of group and time points only for the Laser intragroup. The cure rate, that is, the rate of reaching an insignificant score in the pad test, at 6 and 12 months was 43.75% and 50% in PTG and 62.5% and 56.25% in the LG, respectively (p > 0.05). IQOL scores demonstrated considerable improvement in both groups (p > 0.05). Upon comparing the initial and follow-up results, the LG showed an improvement at all consultations, whereas the PTG showed improvements at 1, 3, and 6 months but not at 12 months after treatment. KHQ analysis revealed a considerable improvement in the quality of life (QOL) of patients over time, with no substantial difference between the groups. QOL comparison before and after treatment revealed that the vaginal LG improved more consistently in some domains. Only the PTG showed a significant increase in the mean Oxford score from pretreatment to 1 and 3 months after treatment (p < 0.001 and p = 0.002, respectively). However, no statistically significant difference was observed between the groups. CONCLUSION Both treatments are safe and have a positive influence on the impact of UI on patients' QOL. The laser caused a greater reduction in the urinary loss, as measured using the weight of pad test, at 6-month and 12-month after treatment without difference with PTG at the end of the follow-up.
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Affiliation(s)
- Lucília C da Fonseca
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Thais V Peterson
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Edmund C Baracat
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
| | - Elizabeth A Gonçalves Ferreira
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
- Department of Physical Therapy, Speech and Occupational Therapy, Medical School, Universidade de São Paulo, Sao Paulo, Brazil
| | - Jorge Milhem Haddad
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
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Junqueira SCA, de Mattos Lourenço TR, Júnior JMS, da Fonseca LC, Baracat EC, Haddad JM. Comparison between anterior and posterior vaginal approach in apical prolapse repair in relation to anatomical structures and points of fixation to the sacrospinous ligament in fresh postmenopausal female cadavers. Int Urogynecol J 2023; 34:147-153. [PMID: 35674813 DOI: 10.1007/s00192-022-05248-9] [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: 02/22/2022] [Accepted: 05/03/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The high prevalence of pelvic organ prolapse (POP) in women requires attention and constant review of treatment options. Sacrospinous ligament fixation (SSLF) for apical prolapse has benefits, high efficacy, and low cost. Our objective is to compare anterior and posterior vaginal approach in SSLF in relation to anatomical structures and to correlate them with body mass index (BMI). METHODS Sacrospinous ligament fixation was performed in fresh female cadavers via anterior and posterior vaginal approaches, using the CAPIO®SLIM device (Boston Scientific, Natick, MA, USA). The distances from the point of fixation to the pudendal artery, pudendal nerve, and inferior gluteal artery were measured. RESULTS We evaluated 11 cadavers with a mean age of 70.1 ± 9.9 years and mean BMI 22.4 ± 4.6 kg/m2. The mean distance from the posterior SSLF to the ischial spine, pudendal artery, pudendal nerve, and inferior gluteal artery were 21.18 ± 2.22 mm, 17.9 ± 7.3 mm, 19.2 ± 6.8 mm, and 18.9 ± 6.9 mm respectively. The same measurements relative to the anterior SSLF were 19.7 ± 2.7 mm, 18.6 ± 6.7 mm, 19.2 ± 6.9 mm, and 18.3 ± 6.7 mm. Statistical analysis showed no difference between the distances in the two approaches. The distances from the fixation point to the pudendal artery and nerve were directly proportional to the BMI. CONCLUSIONS There was no difference in the measurements obtained in the anterior and posterior vaginal approaches. A direct correlation between BMI and the distances to the pudendal artery and pudendal nerve was found.
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Affiliation(s)
- Silvia Cristiane Alvarinho Junqueira
- Department of Obstetrics and Gynecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
- , Avenida Dr. Enéas Carvalho de Aguiar, 255 - 10 andar ICHC - ZIP 05403-000, São Paulo, Brazil.
| | - Thais Regina de Mattos Lourenço
- Department of Obstetrics and Gynecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Maria Soares Júnior
- Department of Obstetrics and Gynecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucília Carvalho da Fonseca
- Department of Obstetrics and Gynecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edmund Chada Baracat
- Department of Obstetrics and Gynecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jorge Milhem Haddad
- Department of Obstetrics and Gynecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Moussa R, Rada MP, Durnea C, Falconi G, Betschart C, Haddad JM, Sedgwick P, Doumouchtsis SK. Outcome reporting in randomized controlled trials (RCTs) on the pharmacological management of idiopathic overactive bladder (OAB) in women; a systematic review for the development of core outcome sets (COS). Int Urogynecol J 2022; 33:1243-1250. [PMID: 35006311 PMCID: PMC9120103 DOI: 10.1007/s00192-021-05040-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
Introduction and hypothesis Evidence on OAB management remains suboptimal and methodological limitations in randomized control trials (RCTs) affect their comparability. High quality meta-analyses are lacking. This study aimed to compare selection and reporting of outcomes and outcome measures across RCTs as well as evaluate methodological quality and outcome reporting quality as a first stage in the process of developing core outcome sets (COS). Methods RCTs were searched using Pubmed, EMBASE, Medline, Cochrane, ICTRP and Clinicaltrials.gov from inception to January 2020, in English language, on adult women. Pharmacological management, interventions, sample size, journal type and commercial funding were documented. Methodological and outcome reporting quality were evaluated using JADAD and MOMENT scores. Results Thirty-eight trials (18,316 women) were included. Sixty-nine outcomes were reported, using 62 outcome measures. The most commonly reported outcome domains were efficacy (86.8%), safety (73.7%) and QoL (60.5%). The most commonly reported outcomes in each domain were urgency urinary incontinence episodes (UUI) (52.6%), antimuscarinic side effects (76.3%) and change in validated questionnaire scores (36.8%). A statistically significant correlation was found between JADAD and MOMENT (Spearman’s rho = 0.548, p < 0.05) scores. This indicates that higher methodological quality is associated with higher outcome reporting quality. Conclusions Development of COS and core outcome measure sets will address variations and lead to higher quality evidence. We recommend the most commonly reported outcomes in each domain, as interim COS. For efficacy we recommend: UUI episodes, urgency and nocturia episodes; for safety: antimuscarinic adverse events, other adverse events and discontinuation rates; for QoL: OAB-q, PPBC and IIQ scores. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-021-05040-1.
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Affiliation(s)
- Reem Moussa
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Maria Patricia Rada
- 2nd Department of Obstetrics-Gynaecology, "luliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Constantin Durnea
- Department of Obstetrics and Gynaecology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Gabriele Falconi
- Complex Operative Unit of Gynecology, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | | | - Jorge Milhem Haddad
- Hospital das Clinicas da Faculdade de Medicina da, Universidade de São Paulo, São Paulo, Brazil
| | - Philip Sedgwick
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Stergios K Doumouchtsis
- Institute of Medical and Biomedical Education, St George's University of London, London, UK.
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.
- Laboratory of Experimental Surgery and Surgical Research N S Christeas, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
- American University of the Caribbean, School of Medicine, Pembroke Pines, Florida, USA.
- Ross University, School of Medicine, Miramar, Florida, USA.
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Doumouchtsis SK, Nama V, Falconi G, Rada MP, Manonai J, Iancu G, Haddad JM, Betschart C. Developing Core Outcome Sets (COS) and Core Outcome Measures Sets (COMS) in Cosmetic Gynecological Interventions: Protocol for a Development and Usability Study. JMIR Res Protoc 2021; 10:e28032. [PMID: 34779787 PMCID: PMC8663614 DOI: 10.2196/28032] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/31/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Studies evaluating cosmetic gynecological interventions have followed variable methodology and reported a diversity of outcomes. Such variations limit the comparability of studies and the value of research-based evidence. The development of core outcome sets (COS) and core outcome measures sets (COMS) would help address these issues, ensuring a minimum of outcomes important to all stakeholders, primarily women requesting or having experienced cosmetic gynecological interventions. Objective This protocol describes the methods used in developing a COS and COMS for cosmetic gynecological interventions. Methods An international steering group within CHORUS, including health care professionals, researchers, and women with experience in cosmetic gynecological interventions from 4 continents, will guide the development of COS and COMS. Potential outcome measures and outcomes will be identified through comprehensive literature reviews. These potential COS and COMS will be entered into an international, multi-perspective web-based Delphi survey where Delphi participants judge which domains will be core. A priori thresholds for consensus will get established before each Delphi round. The Delphi survey results will be evaluated quantitatively and qualitatively in subsequent stakeholder group consensus meetings in the process of establishing “core” outcomes. Results Dissemination and implementation of the resulting COS and COMS within an international context will be promoted and reviewed. Conclusions This protocol presents the steps in developing a COS and COMS for cosmetic gynecological interventions. Embedding the COS and COMS for cosmetic gynecological interventions within future clinical trials, systematic reviews, and practice guidelines could contribute to enhancing the value of research and improving overall patient care. Trial Registration Core Outcome Measures in Effectiveness Trials (COMET) 1592; https://tinyurl.com/n8faysuh International Registered Report Identifier (IRRID) PRR1-10.2196/28032
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Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynecology, Epsom & St Helier University Hospital NHS Trust, London, United Kingdom.,Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens, Greece.,Institute of Medical and Biomedical Education, St George's University of London, London, United Kingdom.,School of Medicine, American University of the Caribbean, Coral Gables, FL, United States.,School of Medicine, Ross University, Miramar, FL, United States.,CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom
| | - Vivek Nama
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Obstetrics and Gynecology, Croydon University Hospital, London, United Kingdom
| | - Gabriele Falconi
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Surgical Sciences, Complex Operative Unit of Gynecology, Fondazione PTV Policlinico Tor Vergata, University Hospital, Rome, Italy
| | - Maria Patricia Rada
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Obstetrics and Gynecology, Universitatea de Medicina si Farmacie Iuliu Hatieganu din Cluj-Napoca, Cluj-Napoca, Romania
| | - Jittima Manonai
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - George Iancu
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Obstetrics and Gynecology, Universitatea de Medicina si Farmacie Carol Davila din Bucuresti, Bukarest, Romania
| | - Jorge Milhem Haddad
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Urogynecology Division, Department of Obstetrics and Gynecology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cornelia Betschart
- CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, Epsom, United Kingdom.,Department of Gynecology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Rada MP, Jones S, Betschart C, Falconi G, Haddad JM, Doumouchtsis SK. A meta-synthesis of qualitative studies on stress urinary incontinence in women for the development of a Core Outcome Set: A systematic review. Int J Gynaecol Obstet 2021; 158:3-12. [PMID: 34534366 DOI: 10.1002/ijgo.13934] [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: 04/16/2021] [Revised: 09/04/2021] [Accepted: 09/15/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Given the high variation of perceptions of women with stress urinary incontinence (SUI), qualitative meta-synthesis in this field appears warranted. We aimed to synthesize evidence on women's experiences of SUI by analyzing qualitative data. METHODS A literature search of Medline, Embase, Scopus, PsycInfo, and CINAHL databases was performed by a CHORUS Working Group, from inception to August 2020. Qualitative studies on women's perspectives on SUI were included. Thematic analysis was used as a conceptual approach to analyze the data and develop a set of overarching themes. The quality of studies was assessed based on the Critical Appraisal Skills Program tool. RESULTS Seven studies were included. Six themes encompassing women's perspectives on SUI emerged: experiencing SUI, awareness of SUI, treatments for SUI, sexuality, communication, and psychosocial effects. The quality appraisal of the studies showed good coherence. CONCLUSION This study revealed six overarching themes, of which treatment had the highest prevalence. Assessment of women's perceptions of SUI in the context of a qualitative meta-synthesis may inform policy and practice around this condition, may guide and help set research priorities, and will ideally contribute to the development of a Core Outcome Set for SUI.
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Affiliation(s)
- Maria Patricia Rada
- 2nd Department of Obstetrics and Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stephanie Jones
- School of Medicine, American University of the Caribbean, Pembroke Pines, FL, USA
| | - Cornelia Betschart
- Department of Gynecology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Gabriele Falconi
- Complex Operative Unit of Gynecology, Department of Surgical Sciences, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Jorge Milhem Haddad
- Urogynecology Division, Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Stergios K Doumouchtsis
- School of Medicine, American University of the Caribbean, Pembroke Pines, FL, USA.,Department of Obstetrics and Gynecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.,Laboratory of Experimental Surgery and Surgical Research N S Christeas, University of Athens, Medical School, Athens, Greece.,St George's University of London, London, UK.,School of Medicine, Ross University, Miramar, FL, USA
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Khan K, Rada M, Elfituri A, Betschart C, Falconi G, Haddad JM, Doumouchtsis SK. Outcome reporting in trials on conservative interventions for pelvic organ prolapse: A systematic review for the development of a core outcome set. Eur J Obstet Gynecol Reprod Biol 2021; 268:100-109. [PMID: 34894536 DOI: 10.1016/j.ejogrb.2021.08.028] [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: 02/01/2021] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Significant risk of bias and limitations in outcome selections in trials evaluating conservative treatments for the management of Pelvic Organ Prolapse (POP) have been highlighted and preclude comparability of outcomes, synthesis of primary studies and high quality evidence. OBJECTIVES As systematic review of the reported outcomes is the first step in the process of development of a Core Outcome Set (COS), we aimed to systematically review reporting of outcomes and outcome measures in Randomised Control Trials (RCTs) on conservative treatments for POP and develop an inventory of them for consideration as core outcome and outcome measures sets. We evaluated methodological quality, outcome reporting quality and publication characteristics and their associations among published RCTs. STUDY DESIGN Systematic review of RCTs identified from the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and MEDLINE (Pubmed). RCTs evaluating the effectiveness of conservative interventions for the management of POP were considered for inclusion. Outcomes and outcome measures were obtained from the RCTs and an inventory was created. Outcomes were grouped in domains and themes. Methodological quality, outcome reporting quality and publication characteristics were evaluated and statistically analysed. RESULTS Twenty-five trials (3179 women) were included and reported 31 outcomes and 50 outcome measures. Reporting rates of the outcomes investigated ranged between 4% and 56%. The most commonly reported outcome domains were patient reported symptoms, stage of POP expressed as POP-Q stage, and quality of life. Univariate analysis demonstrated no significant correlations of methodological and outcome reporting parameters. CONCLUSIONS There is a need to increase comparability of RCTs. Reporting standardized outcomes included in a COS for conservative interventions for POP will facilitate the comparability across RCTs. While the process of developing COS is in progress, we propose the interim use of the three most commonly reported outcomes in each domain: patient-reported outcomes (symptom distress including bowel and urinary symptoms, sexual function), stage of prolapse and quality of life parameters using validated questionnaires (Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire/Health related quality of life (PFIQ-7/HRQOL) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7).
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Affiliation(s)
- Kimmee Khan
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.
| | - Maria Rada
- Department of Obstetrics and Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Abdullatif Elfituri
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK
| | - Cornelia Betschart
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Gabriele Falconi
- Department of Surgical Sciences, Complex Operative Unit of Gynecology, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Jorge Milhem Haddad
- Department of Obstetrics and Gynaecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK; Laboratory of Experimental Surgery and Surgical Research N. S. Christeas, University of Athens, Medical School, Athens, Greece; St George's University of London, London, UK; American University of the Caribbean, School of Medicine, Pembroke Pines, FL, USA; Ross University, School of Medicine, Miramar, FL, USA.
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Doumouchtsis SK, Loganathan J, Fahmy J, Falconi G, Rada M, Elfituri A, Haddad JM, Pergialiotis V, Betschart C. Patient-reported outcomes and outcome measures in childbirth perineal trauma research: a systematic review. Int Urogynecol J 2021; 32:1695-1706. [PMID: 34143238 DOI: 10.1007/s00192-021-04820-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/15/2020] [Accepted: 04/18/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS In evaluating the effectiveness of interventions in perineal trauma research, outcomes reported by patients should have a prominent focus. There is no international consensus regarding the use of either patient-reported outcomes (PROs) or tools used to determine these outcomes (patient-reported outcome measures, PROMs). The objective was to evaluate the selection, reporting and geographical variations of PROs and PROMs in randomised controlled trials (RCTs) on perineal trauma. METHODS We performed a systematic review of RCTs in perineal trauma research evaluating outcome and outcome measure reporting. We identified PROs and PROMs and grouped PROs into domains and themes, a classification system based on a medical outcome taxonomy. RESULTS Of 48 included RCTs, 47 reported PROs. In total, we identified 51 PROs. Outcome reporting consistency was low, with 27 PROs reported only once. Nine PROs were reported more than five times, the most frequent being perineal pain, with no geographical variation in reporting. Four themes encompassing 12 domains were identified. The most frequently reported theme was "Clinical", with 25 PROs grouped within four domains. "Resource use" and "Adverse events" themes were rarely reported, with only five PROs. PROMs also exhibited variation. Most common were visual analogue scale (VAS; 100 mm), Cleveland Clinic Continence Score, The Faecal Incontinence Quality of Life scale, VAS (0-10) and the McGill Pain Questionnaire. CONCLUSIONS Significant heterogeneity in PROs and PROMs was observed among RCTs. Despite inconsistency, PROs are the most prevalent outcome in perineal trauma research. Patient-reported adverse events are underreported. Their use in determining the effectiveness and safety of interventions makes their integration important in perineal trauma core outcome sets. Identification and grouping of outcomes will assist future core outcome consensus studies.
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Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, London, UK.,St George's University of London, London, UK.,Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", National and Kapodistrian University of Athens, Medical School, Athens, Greece.,School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten.,School of Medicine, Ross University, Miramar, Florida, United States
| | - Jemina Loganathan
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, London, UK.
| | - John Fahmy
- St George's University of London, London, UK
| | - Gabriele Falconi
- Department of Obstetrics and Gynaecology, San Bortolo Hospital, Vicenza, Italy
| | - Maria Rada
- 2nd Department of Obstetrics and Gynaecology, "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Abdullatif Elfituri
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, London, UK
| | - Jorge Milhem Haddad
- Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, Butanta, Brazil
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Athens University Medical School, Athens, Greece
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
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Soares-Júnior JM, Barbosa MTA, Aguiar LM, Seganfredo IB, de Pereyra EAG, de Melo NR, Haddad JM, Baracat EC. Energy-based devices in gynecology: the new frontier for the treatment of genitourinary syndrome of postmenopause? Clinics (Sao Paulo) 2021; 76:e3066. [PMID: 34190856 PMCID: PMC8221554 DOI: 10.6061/clinics/2021/e3066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/06/2021] [Indexed: 12/04/2022] Open
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10
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Pierre ML, Friso B, Casarotto RA, Haddad JM, Baracat EC, Ferreira EAG. Comparison of transcutaneous electrical tibial nerve stimulation for the treatment of overactive bladder: a multi-arm randomized controlled trial with blinded assessment. Clinics (Sao Paulo) 2021; 76:e3039. [PMID: 34406271 PMCID: PMC8341038 DOI: 10.6061/clinics/2021/e3039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of tibial nerve transcutaneous electrical nerve stimulation (TENS) for an overactive bladder, considering the sites of application and frequency of attendance. METHODS This multi-arm randomized controlled trial enrolled 137 adult women (61.0±9.0 years) with overactive bladder from a university hospital. They underwent 12 sessions of 30-min TENS application and were assigned to five groups: one leg, once a week (n=26); one leg, twice a week (n=27); two legs, once a week (n=26); two legs, twice a week (n=28); and placebo (n=30). Symptoms of overactive bladder and its impact on quality of life were evaluated before and after 6 or 12 weeks of treatment using the Overactive Bladder Questionnaire-V8 and voiding diary. ClinicalTrials.gov: NCT01912885. RESULTS The use of one leg, once a week TENS application reduced the frequency of urgency episodes compared with the placebo (1.0±1.6 vs. 1.4±1.9; p=0.046) and frequency of incontinence episodes compared with the placebo (0.7±1.4 vs.1.4±2.2; p<0.0001). The one-leg, twice a week protocol decreased the urinary frequency compared with the two legs, once a week protocol (8.2±3.5 vs. 9.0±5.1; p=0.026) and placebo (8.2±3.5 vs. 7.9±2.7; p=0.02). Nocturia improved using the two legs, once a week protocol (1.5±1.8) when compared with the one leg, twice a week protocol (1.9±2.0) and placebo (1.7±1.6) (p=0.005 and p=0.027, respectively). Nocturia also improved using the two legs, twice a week protocol when compared with the one leg, twice a week protocol (1.3±1.2 vs.1.9±2.0; p=0.011). CONCLUSION One-leg stimulation improved the daily urinary frequency, urgency, and incontinence, and the two-leg stimulation once and twice weekly improved nocturia.
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Affiliation(s)
- Munick Linhares Pierre
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Beatriz Friso
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Raquel Aparecida Casarotto
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jorge Milhem Haddad
- Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edmund Chada Baracat
- Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Elizabeth Alves Gonçalves Ferreira
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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11
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Ferreira CHJ, Driusso P, Haddad JM, Pereira SB, Fernandes ACNL, Porto D, Reis BM, Mascarenhas LR, Brito LGO, Ferreira EAG. A guide to physiotherapy in urogynecology for patient care during the COVID-19 pandemic. Int Urogynecol J 2020; 32:203-210. [PMID: 32986147 PMCID: PMC7521075 DOI: 10.1007/s00192-020-04542-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/14/2020] [Indexed: 12/15/2022]
Abstract
Introduction and aim Physiotherapy in urogynecology faces challenges to safely continuing its work, considering the adoption of social distancing measures during the COVID-19 pandemic. Some guidelines have already been published for urogynecology; however, no specific documents have been produced on physiotherapy in urogynecology. This article aimed to offer guidance regarding physiotherapy in urogynecology during the COVID-19 pandemic. Methods A group of experts in physiotherapy in women’s health performed a literature search in the Pubmed, PEDro, Web of Science and Embase databases and proposed a clinical guideline for physiotherapy management of urogynecological disorders during the COVID-19 pandemic. This document was reviewed by other physiotherapists and a multidisciplinary panel, which analyzed the suggested topics and reached consensus. The recommendations were grouped according to their similarities and allocated into categories. Results Four categories of recommendations (ethics and regulation issues, assessment of pelvic floor muscle function and dysfunction, health education and return to in-person care) were proposed. Telephysiotherapy and situations that need in-person care were also discussed. Regionalization is another topic that was considered. Conclusion This study provides some guidance for continuity of the physiotherapist's work in urogynecology during the COVID-19 pandemic, considering the World Health Organization recommendations and the epidemiological public health situation of each region. Telephysiotherapy can also be used to provide continuity of the care in this area during the COVID-19 pandemic, opening new perspectives for physiotherapy in urogynecology.
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Affiliation(s)
- Cristine Homsi Jorge Ferreira
- Pelvic Floor Function Laboratory, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
| | - Patricia Driusso
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Jorge Milhem Haddad
- Department of Obstetrics and Gynecology, Urogynecology Section, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Simone Botelho Pereira
- Department of Surgery, School of Medical Sciences, Postgraduate Program in Surgery Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Motor Science Institute, Post-Graduate Program in Rehabilitation Sciences, Federal University of Alfenas (UNIFAL-MG), Alfenas, MG, Brazil
| | - Ana Carolina Nociti Lopes Fernandes
- Pelvic Floor Function Laboratory, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Debora Porto
- Physiotherapy in Women's Health Research Laboratory, Department of Physiotherapy, Communication Sciences & Disorders and Occupational Therapy, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Bianca Manzan Reis
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Elizabeth Alves Gonçalves Ferreira
- Physiotherapy in Women's Health Research Laboratory, Department of Physiotherapy, Communication Sciences & Disorders and Occupational Therapy, University of São Paulo (USP), São Paulo, SP, Brazil
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12
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do Rêgo AD, Peterson TV, Bernardo WM, Baracat EC, Haddad JM. Comparison of stress urinary incontinence between urban women and women of indigenous origin in the Brazilian Amazon. Int Urogynecol J 2020; 32:395-402. [PMID: 32681348 DOI: 10.1007/s00192-020-04439-6] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/09/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study compared two populations in the Brazilian Amazon, one comprising urban women and the other indigenous origin women from a riparian population, to assess the prevalence of and risk factors associated with stress urinary incontinence (SUI). METHODS Following sample calculation, 120 indigenous and 260 urban women underwent evaluations including medical history, UI-oriented physical examination, pelvic organ prolapse, and functional assessment of the pelvic floor. Women with complaints of SUI underwent a urodynamic study and completed a quality of life questionnaire (King's Health Questionnaire). Univariate ORs were calculated, and multiple logistic regression models were then built using the stepwise backward method. RESULTS The prevalence of SUI was similar in both groups (25.8% in indigenous origin women and 20.4% in the urban group (P > 0.05). The parity and number of spontaneous deliveries and home births were higher in the indigenous origin group. Multivariate analysis showed a decreased prevalence of SUI in patients with modified Oxford Scale scores ≥ 3. Women with homebirths had a 3.45-fold higher likelihood of having SUI than women with hospital deliveries (OR 3.45 -CI 1.78-6.70). Quality of life was worse in the domains of SUI impact, hindering daily and physical activities as well as jeopardizing personal and emotional relationships in urban women. CONCLUSIONS No significant difference in SUI was observed between the groups, despite significantly higher risk factors for SUI in the indigenous origin group.
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Affiliation(s)
- Aljerry Dias do Rêgo
- School of Medicine, Federal University of Amapá, Rod. Juscelino Kubitschek, km 02 - Jardim Marco Zero, Macapá, Amapá, 68903-419, Brazil.
| | - Thais Villela Peterson
- Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, Butanta, Brazil
| | | | - Edmund Chada Baracat
- Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, Butanta, Brazil
| | - Jorge Milhem Haddad
- Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, Butanta, Brazil
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13
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Vaccari NA, da Silveira LTY, Bortolini MAT, Haddad JM, Baracat EC, Ferreira EAG. Content and functionality features of voiding diary applications for mobile devices in Brazil: a descriptive analysis. Int Urogynecol J 2020; 31:2573-2581. [PMID: 32592019 DOI: 10.1007/s00192-020-04382-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/22/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS A voiding diary is a method to investigate lower urinary tract symptoms. The purpose was to elaborate a descriptive analysis of nonpaid voiding diaries for mobile applications and to compare them regarding their quality. METHODS We searched the platforms of iTunes (Apple Inc., Brazil) and Google Play (Google Inc., Brazil) using the keywords: "voiding diary," "bladder diary," "urinary diary," "urinary incontinence," and "pelvic floor." Inclusion criteria were: apps free of charge and specific for voiding diaries in the Portuguese, Spanish, French, or English language. Exclusion criteria were: access or technical problems and pediatric apps. We quantitatively analyzed and compared the apps with each other according to their functionality features and voiding diary topics (type and volume of fluid intake, voiding episodes and volume, type and episodes of incontinence, amount of leakage, urgency, and use of pads and nocturia). We rated the apps using the Mobile App Rating Scale (MARS), whose scores for each feature vary from 1 (worst score) to 5 (best score). RESULTS Fifty-five apps were eligible; 16 were included for analyses. None presented all 11 topics of the voiding diary, and the median number of available features was 6 (3.75-7). "Incontinence episodes" was present in eight apps, and "nocturia" was present in five. The mean score of apps ranged between 1.7 and 4.5. CONCLUSION There is variation in the content of voiding topics among the apps. Patients and professionals should choose the app based on the topics of most or particular interest.
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Affiliation(s)
- Natalie Alves Vaccari
- Department of Physiotherapy, Communication Sciences & Disorders and Occupational Therapy. Faculdade de Medicina, Universidade de São Paulo, R. Cipotânea, 51 - Cidade Universitária, São Paulo, SP, ZIP Code: 05360-000, Brazil
| | - Leda Tomiko Yamada da Silveira
- Department of Physiotherapy, Communication Sciences & Disorders and Occupational Therapy. Faculdade de Medicina, Universidade de São Paulo, R. Cipotânea, 51 - Cidade Universitária, São Paulo, SP, ZIP Code: 05360-000, Brazil
| | | | - Jorge Milhem Haddad
- Department of Obstetrics and Gynecology, Urogynecology Section, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Elizabeth Alves Gonçalves Ferreira
- Department of Physiotherapy, Communication Sciences & Disorders and Occupational Therapy. Faculdade de Medicina, Universidade de São Paulo, R. Cipotânea, 51 - Cidade Universitária, São Paulo, SP, ZIP Code: 05360-000, Brazil.
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14
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Doumouchtsis SK, Rada MP, Pergialiotis V, Falconi G, Haddad JM, Betschart C. A protocol for developing, disseminating, and implementing a core outcome set (COS) for childbirth pelvic floor trauma research. BMC Pregnancy Childbirth 2020; 20:376. [PMID: 32591018 PMCID: PMC7318474 DOI: 10.1186/s12884-020-03070-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 09/04/2019] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background More than 85% of women sustain different degrees of trauma during vaginal birth. Randomized controlled trials on childbirth pelvic floor trauma have reported a wide range of outcomes and used different outcome measures. This variation restricts effective data synthesis, impairing the ability of research to inform clinical practice. The development and use of a core outcome set (COS) for childbirth pelvic floor trauma aims to ensure consistent use of outcome measures and reporting of outcomes. Methods An international steering group, within CHORUS, an International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women’s Health, including academic community members, researchers, healthcare professionals, policy makers and women with childbirth pelvic floor trauma will lead the development of this COS. Relevant outcome parameters will be identified through comprehensive literature reviews. The selected outcomes will be entered into an international, multi-perspective online Delphi survey. Subsequently and based on the results of the Delphi surveys consensus will be sought on ‘core’ outcomes. Discussion Dissemination and implementation of the resulting COS within an international context will be supported and promoted. Embedding the COS for childbirth pelvic floor trauma within future clinical trials, systematic reviews, and clinical practice guidelines is expected to enrich opportunities for comparison of future clinical trials and allow better synthesis of outcomes, and will enhance mother and child care. The infrastructure created by developing a COS for childbirth pelvic floor trauma could be leveraged in other settings, for example, advancing research priorities and clinical practice guideline development.
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Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.,Laboratory of Experimental Surgery and Surgical Research N S Christeas, Athens University Medical School, Athens, Greece.,St George's University of London, London, UK.,American University of the Caribbean School of Medicine, Coral Gables, USA.,CHORUS, an International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, London, UK
| | - Maria Patricia Rada
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.,CHORUS, an International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, London, UK.,2nd Department of Obstetrics-Gynaecology, "Dominic Stanca" Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N S Christeas, Athens University Medical School, Athens, Greece.,CHORUS, an International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, London, UK
| | - Gabriele Falconi
- CHORUS, an International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, London, UK.,Department of Obstetrics and Gynaecology, San Bortolo Hospital, Vicenza, Italy
| | - Jorge Milhem Haddad
- CHORUS, an International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, London, UK.,Department Obstetrics and Gynaecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cornelia Betschart
- CHORUS, an International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health, London, UK. .,Department of Gynecology, University Hospital of Zurich, Frauenklinikstrasse 10, CH-8091, Zurich, Switzerland.
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15
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Silveira SDRB, Auge APF, Jarmy‐Dibella ZIK, Margarido PFR, Carramao S, Alves Rodrigues C, Doumouchtsis SK, Chada Baracat E, Milhem Haddad J. A multicenter, randomized trial comparing pelvic organ prolapse surgical treatment with native tissue and synthetic mesh: A 5‐year follow‐up study. Neurourol Urodyn 2020; 39:1002-1011. [DOI: 10.1002/nau.24323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/07/2020] [Indexed: 12/12/2022]
Affiliation(s)
| | - Antomio PF. Auge
- Medical Science University of Holy House of Sao Paulo Sao Paulo Brazil
| | | | - Paulo FR. Margarido
- Division of GynecologyUniversity Hospital, University of Sao Paulo Sao Paulo Brazil
| | - Silvia Carramao
- Medical Science University of Holy House of Sao Paulo Sao Paulo Brazil
| | | | - Stergios K. Doumouchtsis
- Urogynecology Female Pelvic Medicine and Reconstructive Surgery UnitSt George's Hospital London UK
| | - Edmund Chada Baracat
- Discipline of Gynecology, Clinic Hospital of Sao PauloUniversity of Sao Paulo Sao Paulo Brazil
| | - Jorge Milhem Haddad
- Discipline of Gynecology, Clinic Hospital of Sao PauloUniversity of Sao Paulo Sao Paulo Brazil
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16
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Rada MP, Jones S, Falconi G, Milhem Haddad J, Betschart C, Pergialiotis V, Doumouchtsis SK. A systematic review and meta-synthesis of qualitative studies on pelvic organ prolapse for the development of core outcome sets. Neurourol Urodyn 2020; 39:880-889. [PMID: 32040864 DOI: 10.1002/nau.24297] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 11/13/2019] [Accepted: 01/23/2020] [Indexed: 01/08/2023]
Abstract
AIMS In the current climate of evidence-based health care, the aim of this meta-synthesis was to collect and systematically analyse data from primary qualitative studies on pelvic organ prolapse (POP), to identify patient-centered perspectives on the natural course of POP. Information acquired in this study may be useful for ongoing research towards the development of core outcome sets (COS) in pelvic floor disorders. METHODS A CHORUS Working Group performed a standardized search of three different databases (Medline, Embase, Scopus), from inception to October 2019. We selected qualitative studies on women's perspectives on POP that were published in the English language. Three reviewers independently evaluated the quality of eligible papers and highlighted recurrent themes based on patient perspectives. RESULTS Eighteen qualitative studies including a total of 497 patients were assessed in this analysis. Our study revealed five superordinate themes, recurrently encountered in qualitative studies on POP: awareness of POP (6 studies), communication (9 studies), treatments (10 studies), effects on quality of life (6 studies), and self-image (3 studies). Five out of 10 quality criteria were met by all the studies included, based on an assessment performed using the critical appraisal skills program. CONCLUSIONS This is the first synthesis of qualitative studies that address POP-related experiences of women, highlighting five superordinate themes, of which treatment was the most commonly reported one. This synthesis' findings may guide quantitative research priorities and will hopefully contribute to the development of a COS for POP.
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Affiliation(s)
- Maria Patricia Rada
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.,2nd Department of Obstetrics and Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stephanie Jones
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.,2nd Department of Obstetrics and Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriele Falconi
- Department of Obstetrics and Gynaecology, San Bortolo Hospital, Vicenza, Italy
| | - Jorge Milhem Haddad
- Urogynaecology Division, Department of Obstetrics and Gynaecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N. S. Christeas, Athens University Medical School, Athens, Greece
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK.,School of Medicine, American University of the Caribbean, Pembroke Pines, Florida.,Laboratory of Experimental Surgery and Surgical Research N. S. Christeas, Athens University Medical School, Athens, Greece.,Institute of Medical and Biomedical Education, St George's University of London, London, UK
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17
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Gluck O, Blaganje M, Veit-Rubin N, Phillips C, Deprest J, O'reilly B, But I, Moore R, Jeffery S, Haddad JM, Deval B. Laparoscopic sacrocolpopexy: A comprehensive literature review on current practice. Eur J Obstet Gynecol Reprod Biol 2019; 245:94-101. [PMID: 31891897 DOI: 10.1016/j.ejogrb.2019.12.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 09/07/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/28/2022]
Abstract
Sacrocolpopexy is considered the preferred treatment for vaginal vault. However, numerous technical variants are being practiced. We aimed to summarize the recent literature in relation to technical aspects of laparoscopic sacrocolpopexy (LSC). We focused on surgical technique, mesh type, concomitant surgeries, and training aspects. We performed 2 independent literature searches in Medline, Scopus, the Cochrane library, and Embase electronic databases including the keywords: 'sacrocolpopexy', 'sacral colpopexy' and 'promontofixation'. Full text English-language studies of human patients, who underwent LSC, published from January 1, 2008 to February 26, 2019, were included. Levels of evidence using the modified Oxford grading system were assessed in order to establish a report of the available literature of highest level of evidence. Initially, 953 articles were identified. After excluding duplicates and abstracts screening, 35 articles were included. Vaginal fixation of the mesh can be performed with barbed or non-barbed (level 1), absorbable or non-absorbable sutures (level 2). Fixation of the mesh to the promontory can be performed with non-absorbable sutures or non-absorbable tackers (level 2). The current literature supports using type 1 mesh (level 2). Ventral mesh rectopexy can safely be performed with LSC while concurrent posterior repair has no additional benefit (level 2). There is no consensus regarding the preferred type of hysterectomy or the benefit of an additional anti urinary incontinence procedure. A structured learning program, as well as the number of procedures needed in order to be qualified for performing LSC is yet to be established. There are numerous variants for performing LSC. For many of its technical aspects there is little consensus.
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Affiliation(s)
- Ohad Gluck
- Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Mija Blaganje
- Department of Gynecology, University Medical Center, Ljubljana, Slovenia
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Christian Phillips
- Department of Gynecology and Urogynecology, Hampshire Hospitals NHS Trust & University of Winchester, Hampshire, United Kingdom
| | - Jan Deprest
- Department of Obstetrics and Gynecology, Unit Pelvic Floor Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Barry O'reilly
- Department of Obstetrics & Gynecology, Cork University Maternity Hospital, Cork, Ireland
| | - Igor But
- Department of General Gynecology and Gynecologic Urology, University Medical Center, Maribor, Slovenia
| | - Robert Moore
- Department of Obstetrics and Gynecology, Emory School of Medicine, Atlanta, USA
| | - Stephen Jeffery
- Department of Gynecology and Obstetrics, University of Cape Town, Cape Town, South Africa
| | - Jorge Milhem Haddad
- Urogynaecology Division, Hospital das clinicas da faculdade de medicina da universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Deval
- Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France.
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18
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Doumouchtsis SK, Pookarnjanamorakot P, Durnea C, Zini M, Elfituri A, Haddad JM, Falconi G, Betschart C, Pergialiotis V. A systematic review on outcome reporting in randomised controlled trials on surgical interventions for female stress urinary incontinence: a call to develop a core outcome set. BJOG 2019; 126:1417-1422. [DOI: 10.1111/1471-0528.15891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 12/22/2022]
Affiliation(s)
- SK Doumouchtsis
- Department of Obstetrics and Gynaecology Epsom & St Helier University Hospitals NHS Trust London UK
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas University of Athens, Medical School Athens Greece
- St George's University of London London UK
| | | | - C Durnea
- Department of Obstetrics and Gynaecology Epsom & St Helier University Hospitals NHS Trust London UK
| | - M Zini
- Department of Obstetrics and Gynaecology Epsom & St Helier University Hospitals NHS Trust London UK
| | - A Elfituri
- Department of Obstetrics and Gynaecology Epsom & St Helier University Hospitals NHS Trust London UK
| | - JM Haddad
- Chair of Urogynaecology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - G Falconi
- Department of Obstetrics and Gynaecology San Bortolo Hospital Vicenza Italy
| | - C Betschart
- Department of Gynaecology University Hospital of Zurich Zurich Switzerland
| | - V Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas University of Athens, Medical School Athens Greece
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Rada MP, Pergialiotis V, Betschart C, Falconi G, Haddad JM, Doumouchtsis SK. A protocol for developing, disseminating, and implementing a core outcome set for stress urinary incontinence. Medicine (Baltimore) 2019; 98:e16876. [PMID: 31517813 PMCID: PMC6750288 DOI: 10.1097/md.0000000000016876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Randomized trials evaluating interventions for stress urinary incontinence (SUI) have been using variable outcome measures, reporting a variety of outcomes. Alongside this variation across studies, outcome-reporting flaws contribute to a limited use of research to inform clinical practice. The development and use of core outcome sets (COSs) in future trials would ensure that outcomes important to different stakeholders and primarily women with SUI are reported more consistently and comprehensively. METHODS An international steering group including healthcare professionals, researchers, and women with urinary incontinence will guide the development of this COS. Potential outcomes will be identified through comprehensive literature reviews. These outcomes will be entered into an international, multiperspective online Delphi survey. All key stakeholders, including healthcare professionals, researchers, and women with urinary incontinence, will be invited to participate. The modified Delphi method encourages stakeholder group convergence toward collective agreement, also referred as consensus, core outcomes. DISCUSSION Dissemination and implementation of the resulting COS within an international context will be promoted and reviewed. Embedding the COS for SUI within future clinical trials, systematic reviews and clinical practice guidelines could make a significant contribution to advancing the value of research in informing clinical practice, enhancing patient care and improving outcomes. The infrastructure created by developing a COS for SUI could be leveraged in other settings, for example, selecting research priorities and clinical practice guideline development.
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Affiliation(s)
- Maria-Patricia Rada
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, United Kingdom
- “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 2nd Department of Obstetrics and Gynaecology, “Dominic Stanca” Clinic, Romania
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N S Christeas, Athens University Medical School, Athens, Greece
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Gabriele Falconi
- Department of Obstetrics and Gynaecology, San Bortolo Hospital, Vicenza, Italy
| | - Jorge Milhem Haddad
- Department Obstetrics and Gynaecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Stergios K. Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, United Kingdom
- Laboratory of Experimental Surgery and Surgical Research N S Christeas, Athens University Medical School, Athens, Greece
- St George's University of London, London, UK
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Fiorelli-Arazawa LR, Haddad JM, Nicola MH, Machado JJDS, Coimbra AC, Santamaria X, Soares JM, Baracat EC. Hormonal oral contraceptive influence on isolation, Characterization and cryopreservation of mesenchymal stem cells from menstrual fluid. Gynecol Endocrinol 2019; 35:638-644. [PMID: 30835574 DOI: 10.1080/09513590.2019.1579788] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The purpose of the study was to evaluate whether the intake of hormonal oral contraceptive influences the viability of mesenchymal stem cell. Sixteen healthy female volunteers with regular menstrual cycles were invited to participate. Menstrual fluid was collected on the day of maximum flux, and collected cells were analyzed by a 'minimal standard' for MSC characterization: plastic adherence, trilineage (adipogenic, osteogenic, chondrogenic) in vitro differentiation and a minimalistic panel of markers assessed by flow cytometry (CD731, CD901, CD1051, CD34-, CD45-) using monoclonal antibodies. The participants were divided into two groups: Group 1 - no hormonal contraceptive use; Group 2 - hormonal oral contraceptive use. The median of the menstrual fluid volume was 5.0 and the median number of cells was 5.2 × 106. Median of cell viability was 89.3%. After culture, mesenchymal stem cells increased from 0.031% of the total cells to 96.9%. The cells formed clusters and reached confluence after 15-21 days of culture in the first passage. In the second passage, clusters and the confluence were observed after 3 days of culture. No difference was observed between the groups. Our data suggest that oral hormonal contraceptive intake maintains the viability of mesenchymal stem cells from menstrual fluid.
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Affiliation(s)
- Lilian Renata Fiorelli-Arazawa
- a Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia , Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Jorge Milhem Haddad
- a Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia , Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Maria Helena Nicola
- b Cryopraxis Criobiologia Ltda , Avenida Carlos Chagas Filho , Rio de Janeiro , Brazil
| | | | - Anna Carolina Coimbra
- b Cryopraxis Criobiologia Ltda , Avenida Carlos Chagas Filho , Rio de Janeiro , Brazil
| | | | - José Maria Soares
- a Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia , Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Edmund Chada Baracat
- a Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia , Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
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Fusco HCSDC, Pontes Filho MAG, Haddad JM, Zanetti MRD, Marques AP, Ferreira EAG. Lower urinary tract symptoms and perineal function in women with and without fibromyalgia: a cross-sectional study. Clin Rheumatol 2019; 38:2885-2890. [PMID: 31152258 DOI: 10.1007/s10067-019-04617-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/22/2018] [Revised: 02/09/2019] [Accepted: 05/19/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Fibromyalgia (FM) studies have focused on pain, but a 2010 review of the diagnostic criteria pointed to other symptoms including urinary incontinence (UI). Women with FM present pain, fatigue, and reduced muscle strength; the research hypothesis was that pelvic floor (PF) muscles would be weaker; therefore, FM could be associated with lower urinary tract symptoms (LUTS) and compromise quality of life (QoL). The aim of this paper was to compare PF function, urinary symptoms, and their impact on QoL in women with and without FM and to verify if there is association between FM and LUTS. METHODS We performed a cross-sectional study with 126 sexually active women aged between 19 and 65 years old, distributed in two groups, women with FM (FG n = 62) and without FM (NFG n = 64). Perineal function was the primary outcome and was assessed by perineometry and bidigital vaginal palpation (PERFECT Scheme). Presence of LUTS was assessed by interview based on international definition, and the impact of UI on QoL was evaluated by the King's Health Questionnaire (KHQ). RESULTS FG presented worse PF function on clinical exam (p < 0.001) and perineometry (p = 0.04). LUTS was more frequent among FG (p < 0.001). In terms of QoL, FG obtained lower KHQ scores for general health perception (p < 0.001) and sleep/energy (p < 0.003) domains. The odds of presenting LUTS is 5.03 (95%CI 2.35-10.75) higher in women with FM. CONCLUSION Women with FM had worse perineal function, had more LUTS, and presented UI more frequently, which negatively impacts on QoL.
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Affiliation(s)
- Hellen Cristina Souza de Carvalho Fusco
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, Brazil.
| | | | - Jorge Milhem Haddad
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Amélia Pasqual Marques
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, Brazil
| | - Elizabeth Alves Gonçalves Ferreira
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, Brazil
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Ortega Martell JA, Naber KG, Milhem Haddad J, Tirán Saucedo J, Domínguez Burgos JA. Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America. Ther Adv Urol 2019; 11:1756287218824089. [PMID: 31105773 PMCID: PMC6502980 DOI: 10.1177/1756287218824089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 10/09/2018] [Accepted: 12/03/2018] [Indexed: 12/16/2022] Open
Abstract
The branches of the immune system work in concert to defend against pathogens and
prevent tissue damage due to excessive inflammation. Uropathogens in general,
and uropathogenic Escherichia coli (UPEC) in particular, have
evolved a diverse range of virulence mechanisms to avoid detection and
destruction by the mucosal immune system of the urinary tract. Research towards
a vaccine active against UPEC continues but has yet to be successful. Orally
administered immunomodulatory bacterial lysates both stimulate and modulate the
immune response in the urinary tract via the integrated mucosal
immune system. The 2018 European Association of Urology (EAU) guidelines on
treating acute uncomplicated cystitis recommend aiming for rapid resolution of
symptoms, reduction of morbidity, and prophylaxis against reinfection.
Recommended short-term antibiotic therapy has the advantage of good compliance,
low cost, few adverse events, and low impact on bacterial flora. Antibiotic
treatment of asymptomatic bacteriuria is only indicated during pregnancy and
before invasive interventions. For recurrent infection, prophylaxis using
behavioral modification and counseling should be employed first, then
nonantibiotic prophylaxis, and, finally, low-dose continuous or postcoital
antibiotic prophylaxis. The 2018 EAU guidelines give a strong recommendation for
the oral bacterial lysate immunomodulator OM-89. All other nonantibiotic
prophylactic strategies require more data, except for topical estrogen for
postmenopausal women. For last-resort antibiotic prophylaxis, nitrofurantoin or
fosfomycin trometamol are recommended. Guidelines for Latin America are
currently being drafted, taking into account the unique ethnicity, availability
of medicines, prevalence of antibiotic resistance, and healthcare practices
found throughout the region.
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Affiliation(s)
- José Antonio Ortega Martell
- Universidad Autónoma del Estado de Hidalgo, Carr. Pachuca - Actopan, Campo de Tiro, 42039, Pachuca de Soto, Mexico
| | | | | | - José Tirán Saucedo
- Instituto Mexicano de Infectología, Ginecología y Obstetricia, Universidad de Monterrey, Monterrey, Mexico
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Muir BC, Haddad JM, van Emmerik REA, Rietdyk S. Changes in the control of obstacle crossing in middle age become evident as gait task difficulty increases. Gait Posture 2019; 70:254-259. [PMID: 30909004 DOI: 10.1016/j.gaitpost.2019.01.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Age-associated physiological changes result in modified gait, such as slower speed, for older adults. Identifying the onset of age-related gait changes will provide insight into the role of aging on locomotor control. It is expected that a more challenging gait task (obstacle crossing) puts more demands on physiological systems, and may reveal gait modifications in a middle-aged group that are not evident in an easier gait task (level walking). RESEARCH QUESTION To identify the effect of advancing age on gait as a function of increasing locomotor challenge during an obstacle crossing task. METHODS Three age groups (young, middle-aged, and older adults) stepped over an obstacle placed in a 15 m walkway. Task challenge ranged from low to high in four conditions: unobstructed gait, 3, 10, and 26 cm obstacles. Gait measures were calculated during the approach and crossing steps. RESULTS Significant interactions were observed for gait speed (age by height by step, p < 0.01), foot placement variability (age by step, p < 0.01) and foot clearance (age by height, p = 0.05). Relative to young adults, older adults walked slower in all conditions and had higher foot clearances for the 10 and 26 cm obstacles. Middle-aged adults walked with speeds and foot clearances that were not different from young adults in the lower gait challenge conditions, and changed to values that were not different from older adults in the highest gait challenge conditions. Foot placement variability was greater for the middle-aged and older groups, but only in the last two steps before the obstacle. SIGNIFICANCE Multiple gait changes were observed as early as middle-age, and changes in speed and foot clearance became more evident as task difficulty increased. The increased gait challenge placed more demands on the neuromuscular system, revealing age-related gait modifications that were not evident in the level walking gait task.
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Affiliation(s)
- B C Muir
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA; RR&D Center for Limb Loss and MoBility (CLiMB), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
| | - J M Haddad
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center for Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| | - R E A van Emmerik
- Department of Kinesiology University of Massachusetts, Amherst, MA, USA
| | - S Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center for Aging and the Life Course, Purdue University, West Lafayette, IN, USA
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Mattos Lourenço TR, Pergialiotis V, Durnea C, Elfituri A, Haddad JM, Betschart C, Falconi G, Doumouchtsis SK. A systematic review of reported outcomes and outcome measures in randomized controlled trials on apical prolapse surgery. Int J Gynaecol Obstet 2019; 145:4-11. [DOI: 10.1002/ijgo.12766] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 10/16/2018] [Accepted: 01/22/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Thais Regina Mattos Lourenço
- Department of Obstetrics and GynaecologyUrogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Vasilis Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N. S. ChristeasAthens University Medical School Athens Greece
| | - Constantin Durnea
- Department of Obstetrics and GynaecologyEpsom & St Helier University Hospitals NHS Trust London UK
| | - Abdullatif Elfituri
- Department of Obstetrics and GynaecologyEpsom & St Helier University Hospitals NHS Trust London UK
| | - Jorge Milhem Haddad
- Department of Obstetrics and GynaecologyUrogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Cornelia Betschart
- Department of GynecologyUniversity Hospital of Zurich Zurich Switzerland
| | - Gabriele Falconi
- Department of Obstetrics and GynaecologySan Bortolo Hospital Vicenza Italy
| | - Stergios K. Doumouchtsis
- Laboratory of Experimental Surgery and Surgical Research N. S. ChristeasAthens University Medical School Athens Greece
- Department of Obstetrics and GynaecologyEpsom & St Helier University Hospitals NHS Trust London UK
- St George's University of London London UK
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Matsuoka PK, Castro RA, Baracat EC, Haddad JM. Occult Urinary Incontinence Treatment: Systematic Review and Meta-analysis-Brazilian Guidelines. Rev Bras Ginecol Obstet 2019; 41:116-123. [PMID: 30786309 PMCID: PMC10418705 DOI: 10.1055/s-0038-1676842] [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] [Received: 06/05/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To evaluate if performing anti-incontinence procedures during surgical anterior and/or apical prolapse correction in women with asymptomatic urinary incontinence (UI) may prevent stress urinary incontinence (SUI) postoperatively. METHODS We have performed a systematic review of articles published in the PubMed, Cochrane Library, and Lilacs databases until March 31, 2016. Two reviewers performed the data collection and analysis, independently. All of the selected studies were methodologically analyzed. The results are presented as relative risk (RR), with a 95% confidence interval (CI). RESULTS After performing the selection of the studies, only nine trials fulfilled the necessary prerequisites. In the present review, 1,146 patients were included. Altogether, the review included trials of three different types of anti-incontinence procedures. We found that performing any anti-incontinence procedure at the same time of prolapse repair reduced the incidence of SUI postoperatively (RR = 0.50; 95% CI: 0.28-0.91). However, when we performed the analysis separately by the type of anti-incontinence procedure, we found different results. In the subgroup analysis with midurethral slings, it is beneficial to perform it to reduce the incidence of SUI (RR = 0.08; 95% CI: 0.02-0.28). On the other hand, in the subgroup analysis with Burch colposuspension, there was no significant difference with the control group (RR = 1.47; 95% CI: 0.28-7.79]). CONCLUSION Performing any prophylactic anti-incontinence procedure at the same time as prolapse repair reduced the incidence of SUI postoperatively. The Burch colposuspension did not show any decrease in the incidence of SUI postoperatively.
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Oliveira LMD, Dias MM, Martins SB, Haddad JM, Girão MJBC, Castro RDA. Surgical Treatment for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis. Rev Bras Ginecol Obstet 2018; 40:477-490. [PMID: 30142667 PMCID: PMC10316922 DOI: 10.1055/s-0038-1667184] [Citation(s) in RCA: 4] [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] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To compare surgical treatments for stress urinary incontinence in terms of efficiency and complications. DATA SOURCES We searched the MEDLINE and COCHRANE databases using the terms stress urinary incontinence, surgical treatment for stress urinary incontinence and sling. SELECTION OF STUDIES Forty-eight studies were selected, which amounted to a total of 6,881 patients with scores equal to or higher than 3 in the Jadad scale. DATA COLLECTION Each study was read by one of the authors, added to a standardized table and checked by a second author. We extracted data on intervention details, follow-up time, the results of treatment and adverse events. DATA SYNTHESIS Comparing retropubic versus transobturator slings, the former was superior for both objective (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.05-1.54) and subjective (OR, 1.23; 95% CI, 1.02-1.48) cures. Between minislings versus other slings, there was a difference favoring other slings for subjective cure (OR, 0.58; 95% CI, 0.39-0.86). Between pubovaginal sling versus Burch surgery, there was a difference for both objective (OR, 2.04; 95% CI, 1.50-2.77) and subjective (OR, 1.64; 95% CI, 1.10-2.44) cures, favoring pubovaginal sling. There was no difference in the groups: midurethral slings versus Burch, pubovaginal sling versus midurethral slings, transobturator slings, minislings versus other slings (objective cure). Retropubic and pubovaginal slings are more retentionist. Retropubic slings have more bladder perforation, and transobturator slings, more leg and groin pain, neurological lesion and vaginal perforation. CONCLUSION Pubovaginal slings are superior to Burch colposuspension surgery but exhibit more retention. Retropubic slings are superior to transobturator slings, with more adverse events. Other slings are superior to minislings in the subjective aspect. There was no difference in the comparisons between midurethral slings versus Burch colposuspension surgery, pubovaginal versus midurethral slings, and inside-out versus outside-in transobturator slings.
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Affiliation(s)
- Letícia Maria de Oliveira
- Department of Gynecology, Paulista School of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcia Maria Dias
- Department of Gynecology, Paulista School of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Sérgio Brasileiro Martins
- Department of Gynecology, Paulista School of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Jorge Milhem Haddad
- Department of Gynecology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Rodrigo de Aquino Castro
- Department of Gynecology, Paulista School of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Arruda RM, Takano CC, Girão MJBC, Haddad JM, Aleixo GF, Castro RA. Treatment of Non-neurogenic Overactive Bladder with OnabotulinumtoxinA: Systematic Review and Meta-analysis of Prospective, Randomized, Placebo-controlled Clinical Trials. Rev Bras Ginecol Obstet 2018; 40:225-231. [PMID: 29747213 PMCID: PMC10316908 DOI: 10.1055/s-0038-1642631] [Citation(s) in RCA: 3] [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: 10/16/2022] Open
Abstract
We performed a systematic review and meta-analysis of randomized placebo-controlled trials that studied non-neurogenic overactive bladder patients who were treated with 100 units of onabotulinumtoxinA or placebo. The primary purpose of our study was to evaluate the clinical effectiveness with regard to urinary urgency, urinary frequency, nocturia, and incontinence episodes. Our secondary purpose consisted of evaluating the adverse effects. Our initial search yielded 532 entries. Of these, seven studies met all the inclusion criteria (prospective, randomized, placebo-controlled studies, ≥ 3 points on the Jadad scale) and were selected for analysis. For all primary endpoints, the toxin was more effective than placebo (p < 0.0001; 95% confidence interval [95CI]), namely: urgency (mean difference = -2.07; 95CI = [-2.55-1.58]), voiding frequency (mean difference = -1.64; 95CI = [-2.10-1.18]), nocturia (mean difference = -0.25; 95CI = [-0.39-0.11]) and incontinence episodes (mean difference = -2.06; 95CI= [-2.60-1.52]). The need for intermittent catheterization and the occurrence of urinary tract infection (UTI) were more frequent in patients treated with onabotulinumtoxinA than in patients treated with placebo (p < 0.0001). Compared with placebo, onabotulinumtoxinA had significantly and clinically relevant reductions in overactive bladder symptoms and is associated with higher incidence of intermittent catheterization and UTI.
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de Mattos Lourenco TR, Matsuoka PK, Baracat EC, Haddad JM. Urinary incontinence in female athletes: a systematic review. Int Urogynecol J 2018; 29:1757-1763. [DOI: 10.1007/s00192-018-3629-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
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Haddad JM, Chen ES. 1129 PSYCHIATRIC COMORBIDITIES ASSOCIATED WITH OBSTRUCTIVE SLEEP APNEA: A PRELIMINARY ANALYSIS AND COMPARISON OF BIOMEDICAL AND CLINICAL DATA SOURCES. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Silva Filho ALD, Contreras S, Haddad JM. Recurrent Urinary Tract Infection in the Gynecologic Practice: Time for Reviewing Concepts and Management. Rev Bras Ginecol Obstet 2016; 39:1-3. [PMID: 28038477 DOI: 10.1055/s-0036-1597324] [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: 10/20/2022] Open
Affiliation(s)
- Agnaldo Lopes da Silva Filho
- Department of Gynecology and Obstetrics, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Susan Contreras
- Unit of Urogynecology and Dysfunction of the Pelvic Floor, Dr. Carlos Arvelo Military Hospital, Caracas, Venezuela
| | - Jorge Milhem Haddad
- Discipline of Gynecology, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
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Juliato CRT, Santos Júnior LCD, Haddad JM, Castro RA, Lima M, Castro EBD. Mesh Surgery for Anterior Vaginal Wall Prolapse: A Meta-analysis. Rev Bras Ginecol Obstet 2016; 38:356-64. [PMID: 27472812 PMCID: PMC10374238 DOI: 10.1055/s-0036-1585074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/01/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022] Open
Abstract
Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6-8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: 'anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)' in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score (> 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07-1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72-82,25]), longer surgery time (MD = 15,08 [0,48-29,67]), but less prolapse recurrence (OR = 0,22 [01,3-0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.
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Affiliation(s)
| | | | | | - Rodrigo Aquino Castro
- Department of Obstetrics and Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Lima
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Haddad JM, Monaco HEMG, Kwon C, Bernardo WM, Guidi HGDC, Baracat EC. Predictive value of clinical history compared with urodynamic study in 1,179 women. Rev Assoc Med Bras (1992) 2016; 62:54-8. [PMID: 27008494 DOI: 10.1590/1806-9282.62.01.54] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/16/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to determine the positive predictive value of clinical history in comparison with urodynamic study for the diagnosis of urinary incontinence. METHODS retrospective analysis comparing clinical history and urodynamic evaluation of 1,179 women with urinary incontinence. The urodynamic study was considered the gold standard, whereas the clinical history was the new test to be assessed. This was established after analyzing each method as the gold standard through the difference between their positive predictive values. RESULTS the positive predictive values of clinical history compared with urodynamic study for diagnosis of stress urinary incontinence, overactive bladder and mixed urinary incontinence were, respectively, 37% (95% CI 31-44), 40% (95% CI 33-47) and 16% (95% CI 14-19). CONCLUSION we concluded that the positive predictive value of clinical history was low compared with urodynamic study for urinary incontinence diagnosis. The positive predictive value was low even among women with pure stress urinary incontinence.
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Affiliation(s)
- Jorge Milhem Haddad
- Gynecology Division, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Clarice Kwon
- Gynecology Division, FM, USP, São Paulo, SP, Brazil
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Matsuoka PK, Locali RF, Pacetta AM, Baracat EC, Haddad JM. The efficacy and safety of urethral injection therapy for urinary incontinence in women: a systematic review. Clinics (Sao Paulo) 2016; 71:94-100. [PMID: 26934239 PMCID: PMC4760362 DOI: 10.6061/clinics/2016(02)08] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/27/2015] [Indexed: 11/18/2022] Open
Abstract
To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled trials was performed. The subjects were women with urinary incontinence. The primary outcomes were clinical and urodynamic parameters. The results were presented as a weighted mean difference for non-continuous variables and as relative risk for continuous variables, both with 95% confidence intervals. Initially, 942 studies were identified. However, only fourteen eligible trials fulfilled the prerequisites. Altogether, the review included 1814 patients in trials of eight different types of bulking agents, and all studies were described and analyzed. The measured outcomes were evaluated using a large variety of instruments. The most common complications of the bulking agents were urinary retention and urinary tract infection. Additionally, there were certain major complications, such as one case of death after use of autologous fat. However, the lack of adequate studies, the heterogeneous populations studied, the wide variety of materials used and the lack of long-term follow-up limit guidance of practice. To determine which substance is the most suitable, there is a need for more randomized clinical trials that compare existing bulking agents based on standardized clinical outcomes.
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Affiliation(s)
- Priscila Katsumi Matsuoka
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, Divisão de Uroginecologia, São Paulo/SP, Brazil
- E-mail:
| | - Rafael Fagionato Locali
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Departamento de Cirurgia, Disciplina de Urologia, São Paulo/, SP, Brazil
| | - Aparecida Maria Pacetta
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, Divisão de Uroginecologia, São Paulo/SP, Brazil
| | - Edmund Chada Baracat
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, São Paulo/, SP, Brazil
| | - Jorge Milhem Haddad
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, Divisão de Uroginecologia, São Paulo/SP, Brazil
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Moroni RM, Magnani PS, Haddad JM, Castro RDA, Brito LGO. Conservative Treatment of Stress Urinary Incontinence: A Systematic Review with Meta-analysis of Randomized Controlled Trials. Rev Bras Ginecol Obstet 2016; 38:97-111. [PMID: 26883864 PMCID: PMC10309479 DOI: 10.1055/s-0035-1571252] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
We performed a systematic review and meta-analysis of randomized controlled trials that studied the conservative management of stress urinary incontinence (SUI). There were 1058 results after the initial searches, from which 37 studies were eligible according to previously determined inclusion criteria. For the primary outcomes, pelvic floor muscle training (PFMT) was more efficacious than no treatment in improving incontinence-specific quality of life (QoL) scales (SMD = -1.24SDs; CI 95% = -1.77 to -0.71SDs). However, its effect on pad tests was imprecise. Combining biofeedback with PFMT had an uncertain effect on QoL (MD = -4.4 points; CI 95% = -16.69 to 7.89 points), but better results on the pad test, although with elevated heterogeneity (MD = 0.9g; 95%CI = 0.71 to 1,10g); group PFMT was not less efficacious than individual treatment, and home PFMT was not consistently worse than supervised PFMT. Both intravaginal and superficial electrical stimulation (IES and SES) were better than no treatment for QoL and pad test. Vaginal cones had mixed results. The association of IES with PFMT may improve the efficacy of the latter for QoL and pad test, but the results of individual studies were not consistent. Thus, there is evidence of the use of PFMT on the treatment of SUI, with and without biofeedback.
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Affiliation(s)
- Rafael Mendes Moroni
- Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Pedro Sergio Magnani
- Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jorge Milhem Haddad
- Department of Gynecology, School of Medicine, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Luiz Gustavo Oliveira Brito
- Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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Betschart C, Cervigni M, Contreras Ortiz O, Doumouchtsis SK, Koyama M, Medina C, Haddad JM, la Torre F, Zanni G. Management of apical compartment prolapse (uterine and vault prolapse): A FIGO Working Group report. Neurourol Urodyn 2015; 36:507-513. [DOI: 10.1002/nau.22916] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/07/2015] [Indexed: 01/21/2023]
Affiliation(s)
| | - Mauro Cervigni
- Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart; Rome Italy
| | | | | | - Masayasu Koyama
- Department of Obstetrics and Gynecology; Osaka City Graduate School of Medicine; Osaka Japan
| | - Carlos Medina
- Department of Obstetrics and Gynecology; University of Miami School of Medicine; Miami Florida
| | | | - Filippo la Torre
- Surgical Department; Policlinico “Umberto I”, Sapienza University; Rome Italy
| | - Giuliano Zanni
- Department of Obstetrics and Gynecology; Hospital of Vicenza; Vicenza Italy
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Haddad JM, Fiorelli LR, de Lima Takami T, Peterson TV, Soares JM, Baracat EC. Relationship between BMI and three different devices used in urinary incontinence procedures and anatomical structures in fresh cadavers. A pilot study. Eur J Obstet Gynecol Reprod Biol 2015; 194:49-53. [PMID: 26322590 DOI: 10.1016/j.ejogrb.2015.08.014] [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: 05/04/2015] [Revised: 07/20/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To demonstrate the needle positioning during three types of slings in relation to anatomical structures in fresh cadavers and to evaluate if this positioning is influenced by body mass index (BMI). METHODS TVTr sling (retropubic), TVT-O sling (transobturator) and mini-sling (TVT-Secur™) were performed in ten fresh cadavers, followed by dissection of the pudendal (genital) area (external evaluation) and abdominal cavity (internal evaluation). The distance between the devices used in each technique and specific anatomical structures (vessels and bowel) was measured. RESULTS The mean distance between TVTr needles and the closest segment of the bowel was 5.0±1.1cm. The mean distance between the TVTr needles and iliac vessels was 8.55±1.59cm, and this distance was inversely proportional to BMI. However, the both correlations were not significantly (p<0.05). The mean distance from TVT-O needle to obturator vessels and nerve was 2.25±0.34cm. This distance was inversely proportional to BMI, but it was not statistically significant. CONCLUSION Our data suggested that BMI may be not an important factor for influencing the relationship between the devices and anatomical structures in three different slings in fresh cadavers.
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Affiliation(s)
- Jorge Milhem Haddad
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lilian Renata Fiorelli
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tatiane de Lima Takami
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Villela Peterson
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Maria Soares
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Edmund C Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Muir BC, Haddad JM, Heijnen MJH, Rietdyk S. Proactive gait strategies to mitigate risk of obstacle contact are more prevalent with advancing age. Gait Posture 2015; 41:233-9. [PMID: 25455212 DOI: 10.1016/j.gaitpost.2014.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/28/2014] [Accepted: 10/06/2014] [Indexed: 02/02/2023]
Abstract
The purposes of this study were to determine if healthy older adults adopt strategies to decrease the likelihood of obstacle contact, and to determine how these strategies are modified as a function of advancing age. Three age groups were examined: 20-25 yo (N = 19), 65-79 yo (N = 11), and 80-91 yo (N = 18). Participants stepped over a stationary, visible obstacle on a walkway. Step length and gait speed progressively decreased with advancing age; the shorter step length resulted in closer foot placement to the obstacle and an associated increased risk of obstacle contact. Lead (first limb to cross the obstacle) and trail (second) limb trajectories were examined for behavior that mitigated the risk of contact. (1) Consistent trail foot placement before the obstacle across all ages allowed space and time for the trail foot to clear the obstacle. (2) To avoid lead limb contact due to closer foot placement before and after the obstacle, the lead toe was raised more vertically after toe-off, and then the foot was extended beyond the landing position (termed lead overshoot) and retracted backwards to achieve the shortened step length. Lead overshoot progressively increased with advancing age. (3) Head angle was progressively lower with advancing age, an apparent attempt to gather more visual information during approach. Overall, a series of proactive strategies were adopted to mitigate risk of contact. However, the larger, more abrupt movements associated with a more vertical foot trajectory and lead overshoot may compromise whole body balance, indicating a possible trade-off between risk of contact and stability.
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Affiliation(s)
- B C Muir
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| | - J M Haddad
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| | - M J H Heijnen
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - S Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA.
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Matsuoka PK, Pacetta AM, Baracat EC, Haddad JM. Should prophylactic anti-incontinence procedures be performed at the time of prolapse repair? Systematic review. Int Urogynecol J 2014; 26:187-93. [PMID: 25348932 DOI: 10.1007/s00192-014-2537-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Women with high-grade pelvic organ prolapse (POP) are considered at risk of developing postoperative stress urinary incontinence (SUI) once the prolapse has been repaired. The probable explanation for patients remaining subjectively continent is that POP can cause urethral kinking or compression. We hypothesized that performing prophylactic anti-incontinence procedures during surgical POP correction in women with no symptoms for urinary incontinence (UI) may prevent SUI postoperatively. METHODS A systematic review of randomized trials was performed. Participants were women with severe POP and no symptoms of SUI. The primary outcomes were UI or treatment for this condition after the surgical procedure. Results are presented as relative risk (RR), with 95% confidence interval (95% ). RESULTS Initially, 5,618 studies were identified by the search strategy, but only seven trials met the inclusion criteria. We performed a meta-analysis with common variables of studies and with the same scale of quantification. We found that performing an anti-incontinence procedure at the same time of prolapse repair reduced the incidence of SUI postoperatively (RR 0.51; 95% CI 0.38-0.68). However, when the types of anti-incontinence procedure were analyzed separately, we found different results. The subgroup of patients who underwent retropubic midurethral sling surgery was the only group that benefited from the anti-incontinence procedure, with a decrease in the incidence of SUI (RR 0.09; 95% 0.02-0.36). CONCLUSIONS Prophylactic treatment of women with severe POP using retropubic midurethral sling was the only procedure that reduced the risk of UI.
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Affiliation(s)
- Priscila Katsumi Matsuoka
- Discipline of Gynecology, School of Medicine, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255, 10° andar, Cerqueira César, 05403-000, São Paulo, SP, Brazil,
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Muir BC, Rietdyk S, Haddad JM. Gait initiation: the first four steps in adults aged 20-25 years, 65-79 years, and 80-91 years. Gait Posture 2013; 39:490-4. [PMID: 24074729 DOI: 10.1016/j.gaitpost.2013.08.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 02/02/2023]
Abstract
Transitioning from standing to walking requires equilibrium to be maintained while a forward propulsive force is generated. The ability to manage these competing demands is compromised by the progressive sensory, neural and motor declines associated with aging. The purpose of this study was to establish the age-related changes in the first four steps of gait in three age groups: 20-25 years old (yo) (N=19), 65-79 yo (N=11), and 80-91 yo (N=18). Participants stood comfortably and then walked at a self-selected pace for 3.2m. Gait speed and step length (SL) both significantly decreased with each age category at each of the first four steps. However, the gait speed changes suggest that older groups control speed in a principled manner across the four steps, which was similar to the speed control of 20-25 yo. With successive steps, 20-25 yo demonstrated a progressive decrease in SL variability, but SL variability of the two older groups did not change. Step width (SW) did not change as a function of age, but SW variability was higher for the two older groups. Higher SL and SW variability may reflect more errors in foot placement and/or decreased center of mass control in the older groups. Further, it appears that AP COM control improves with successive steps in young adults while ML COM control decreases with successive steps in all age groups. When comparing the two older groups, healthy 80-91 yo walked slower with a shorter SL, but did not demonstrate changes associated with falls (SL and/or SW variability).
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Affiliation(s)
- B C Muir
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center for Aging and the Life Course, Purdue University, West Lafayette, IN, USA
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Haddad JM, Ribeiro RM, Bernardo WM, Abrão MS, Baracat EC. Vaginal cone use in passive and active phases in patients with stress urinary incontinence. Clinics (Sao Paulo) 2011; 66:785-91. [PMID: 21789381 PMCID: PMC3109376 DOI: 10.1590/s1807-59322011000500013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/03/2011] [Accepted: 01/11/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate vaginal cone therapy in two phases, passive and active, in women with stress urinary incontinence. METHODS A prospective study was conducted at the Department of Obstetrics and Gynecology, São Paulo University, Brazil. Twenty-four women with a clinical and urodynamic diagnosis of stress urinary incontinence were treated with vaginal cones in a passive phase (without voluntary contractions of the pelvic floor) and an active phase (with voluntary contractions), each of which lasted three months. Clinical complaints, a functional evaluation of the pelvic floor, a pad test, and bladder neck mobility were analyzed before and after each phase. RESULTS Twenty-one patients completed the treatment. The reduction in absolute risk with the pad test was 0.38 (p<0.034) at the end of the passive phase and 0.67 (p<0.0001) at the end of the active phase. The reduction in absolute risk with the pelvic floor evaluation was 0.62 (p<0.0001) at the end of the passive phase and 0.77 (p<0.0001) at the end of the active phase. The reduction in absolute risk of bladder neck mobility was 0.38 (p<0.0089) at the end of the passive phase and 0.52 (p<0.0005) at the end of the active phase. Complete reversal of symptomatology was observed in 12 (57.1%) patients, and satisfaction was expressed by 19 (90.4%). CONCLUSION Using vaginal cones in the passive phase, as other researchers did, was effective. Inclusion of the active phase led to additional improvement in all of the study parameters evaluated in women with stress urinary incontinence. Randomized studies are needed, however, to confirm these results.
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Affiliation(s)
- Jorge Milhem Haddad
- Divisão de Clínica Ginecológica, Ginecologia Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Abstract
Assessments of changes in gait stability due to aging and disease are predominantly based on lower extremity kinematic and kinetic data. These gait changes are also often based on comparisons at preferred speed only. The purpose of this experiment was to: (1) examine age-related changes in range of motion and coordination of segments of the upper body during locomotion; and (2) investigate the effects of a systematic walking velocity manipulation on rotational motion and coordination. Participants (n=30) walked on a motor driven treadmill at speeds ranging from 0.2 to 1.8m/s and were divided into three groups with mean ages of 23.3, 49.3 and 72.6 years, respectively. Seven high-speed infrared cameras were used to record three-dimensional kinematics of the pelvis, trunk and head. Dependent variables were amplitude of segmental and joint rotations, as well as relative phase to assess coordination between segments. Although no differences in stride parameters were found between the groups, age-related changes in movement amplitude in response to speed manipulations were observed for all segments and joints. Pelvic rotations in sagittal, frontal and transverse planes of motion were systematically reduced with age. Older individuals showed reduced trunk flexion-extension in the sagittal plane and increased trunk axial rotation in the transverse plane. Coordination analysis showed reduced compensatory movement between pelvis and trunk in older individuals. These findings support the importance of systematic manipulation of walking velocity and three-dimensional upper body kinematics in assessing age-related changes in locomotor stability and adaptability.
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Affiliation(s)
- R E A Van Emmerik
- Motor Control Laboratory, Department of Exercise Science, University of Massachusetts, 160 Totman Building, Amherst, MA 01003, USA.
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Abstract
Urinary tract infections are of great importance during pregnancy owing to undesirable complications such as fetal and maternal morbidity. This paper describes the functional alterations that occur in this condition and predispose to infection. Clinical presentation and subsidiary diagnosis are discussed, including asymptomatic bacteriuria, cystitis and pyelonephritis. In addition, the authors report drug options, and their safety and duration of treatment during pregnancy.
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Affiliation(s)
- J F M Santos
- Centro Mineiro de Uroginecologia, Minas Gerais, Brazil
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Abstract
This article deals with many options in utilizing drugs commonly used in the therapy of uncomplicated urinary tract infections (UTIs), their doses and recommended durations of treatment. In addition, it discusses general and specific accompanying measures related to the decrease in prevalence, relapses and recurrences of UTIs, including some of the factors involved in patient adherence or discontinuation of drug regimens.
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Affiliation(s)
- R M Ribeiro
- University of São Paulo, Rua Tabapuã 649-81, CEP 04533-012, São Paulo, SP, Brazil
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Abstract
The reactivity of 40 panic disorder patients on mental arithmetic, cold pressor, and 5% CO2 inhalation stressors was tested before and after 8 weeks of treatment with imipramine, alprazolam, or placebo. Mean levels of subjective and physiological stress measures were compared during a baseline before any stressors were given, and at anticipation, stressor, and recovery periods for each stressor. After treatment, imipramine patients differed from the other two treatment groups on the prestressor baseline in showing higher systolic blood pressure (mean difference about 10 mmHg), higher diastolic blood pressure (10 mm Hg), higher heart rate (15 bpm), less respiratory sinus arrhythmia, shorter pulse transit time, and lower T-wave amplitude. Respiratory measures, electrodermal measures, body movement, and self-reported anxiety and excitement did not distinguish the groups. Reactivity to the stress tests was unaffected by the medications, but tonic differences present in the baseline persisted.
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Affiliation(s)
- W T Roth
- Veterans Affairs Medical Center, Palo Alto, CA 94304
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