Management Of Stress Urinary Incontinence With Surface Electromyography- Assisted Biofeedback In Women Of Reproductive Age

Background and Purpose: Although surgery has been widely accepted as the treatment of choice for stress urinary incontinence (SUI), there has recently been an increased interest in the conservative management of this condition. The aims of this study were to test the ability of a biofeedback-assisted pelvic-floor muscle exercise (PFME) program to affect symptoms of SUI in premenopausal women and to evaluate a training program that might lead to successful outcomes in a relatively limited number of sessions. Subjects: Twenty-six women with SUI were treated with PFME with surface electromyography (sEMG)-assisted biofeedback. All participants were of reproductive age and were treated individually for 12 sessions. Methods: Results were evaluated with a 7-day voiding diary, a 1-hour pad test, pelvic-floor muscle strength measurements, sEMG amplitudes, a leakage index, and a quality-of-life questionnaire. These variables were compared before and after the intervention. Results: The frequency of urine loss, the occurrence of nocturia, and the number of pads required decreased significantly after the intervention. Objective cure was found in 61.5% of women. There was a significant improvement in the quality of life, in pelvic-floor muscle strength, and in the sEMG amplitudes of all contractions throughout the intervention. Discussion and Conclusion: A relatively short-term intervention of PFME with sEMG-assisted biofeedback appeared to be helpful in relieving symptoms of SUI in premenopausal women and represents a reasonable conservative management option. © 2007 American Physical Therapy Association.872136142Hannestad, Y.S., Rortveit, G., Sandvik, H., Hunskaar, A., A community-based epidemiological survey of female urinary incontinence: The Norwegian EPINCONT study (2000) J Clin Epidemiol, 53, pp. 1150-1157Fultz, N.H., Burgio, K., Diokno, A., Burden of stress urinary incontinence for community-dwelling women (2003) Am J Obstet Gynecol, 189, pp. 1275-1282Burns, P.A., Pranikoff, K., Nochajski, T.H., A comparison of effectiveness of biofeedback and pelvic floor muscle exercise treatment of stress urinary incontinence in older community dwelling women (1993) J Gerontol Med Sci, 48, pp. 167-174Bo, K., Talseth, T., Holme, I., Single blind randomized controlled trial of pelvic floor exercise, electrical 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Six New Cases Confirm The Clinical Molecular Profile Of Complete Combined 17α-hydroxylase/ 17,20-lyase Deficiency In Brazil [seis Novos Casos Confirmam O Perfil Clínico Molecular De Deficiência Combinada De 17 Alfa-hidroxilase/17,20-liase No Brasil]

In 2004, Costa-Santos and cols. reported 24 patients from 19 Brazilian families with 17α-hydroxylase deficiency and showed that p.W406R and p.R362C corresponded to 50% and 32% of CYP17A1 mutant alleles, respectively. The present report describes clinical and molecular data of six patients from three inbred Brazilian families with 17α-hydroxlyse deficiency. All patients had hypogonadism, amenorrhea and hypertension at diagnosis. Two sisters were found to be 46,XY with both gonads palpable in the inguinal region. All patients presented hypergonadotrophic hypogonadism, with high levels of ACTH (> 104 ng/mL), suppressed plasmatic renin activity, low levels of potassium ( 4.4 ng/mL). Three of them, including two sisters, were homozygous for p.W406R mutation and the other three (two sisters and one cousin) were homozygous for p.R362C. The finding of p.W406R and p.R362C in the CYP17A1 gene here reported in additional families, confirms them as the most frequent mutations causing complete combined 17α-hydroxylase/17,20-lyase deficiency in Brazilian patients. © ABE&M todos os direitos reservados.548711716Auchus, R.J., The genetics, pathophysiology, and management of human deficiencies of P450c17 (2001) Endocrinol Metab Clin N Am, 30, pp. 101-119Yanase, T., Simpson, E.R., Waterman, M.R., 17-hydroxylase/17,20-lyase deficiency from clinical investigation to molecular definition (1991) Endocr Rev, 12, pp. 91-108Matteson, K.J., Picado-Leonard, J., Chung, B.C., Mohandas, T.K., Miller, W.L., Assignment of the gene for adrenal P450c17 (steroid 17 alphahydroxylase/17,20-lyase) to human chromosome (1986) J Clin Endocrinol Metab, 63, pp. 789-791Fan, Y.S., Sasi, R., Lee, C., Winter, J.S., Waterman, M.R., Lin, C.C., Localization of the human CYP17A1 gene (cytochrome P450 (17alpha)) to 10q24.3 by fluorescence in situ hybridization and simultaneous chromosome banding (1992) Genomics, 14, pp. 1110-1111Picado-Leonard, J., Miller, W.L., Cloning and sequence of the human 17 gene for P450c17 (steroid 17 alpha-hydroxylase/17,20 lyase): Similarity with the gene for P450c21 (1987) DNA, 6, pp. 439-448Miura, K., Yasuda, K., Yanase, T., Yamakita, N., Sasano, H., Nawata, H., Mutation of cytochrome P-45017 alpha gene (CYP17A1) in a Japanese patient previously reported as having glucocorticoid responsive hyperaldosteronesteronism: With a review of Japanese patients with mutations of CYP17A1 (1996) J Clin Endocrinol Metab, 81, pp. 3797-3801Hahm, J.R., Kim, D.R., Jeong, D.K., Chung, J.H., Lee, M.S., Min, Y.K., A novel compound heterozygous mutation in the CYP17A1 (P450 17alpha-hydroxylase) gene leading to 17alpha-hydroxylase/17,20--lyase deficiency (2003) Metabolism, 52, pp. 488-492Martin, R.M., Lin, C.J., Costa, E.M., de Oliveira, M.L., Carrilho, A., Villar, H., P450c17 deficiency in Brazilian patients: Biochemical diagnosis through progesterone levels confirmed by CYP17 genotyping (2003) J Clin Endocrinol Metab, 88, pp. 5739-5746Costa-Santos, M., Katar, C.E., Auchus, R.J., Two prevalent CYP17 mutations and genotype-phenotype correlations in 24 Brazilian patients with 17-hydroxylase deficiency (2004) J Clin Endocrinol Metab, 89, pp. 49-60. , and Brazilian Congenital Adrenal Hyperplasia Multicenter Study GroupPatocs, A., Liko, I., Varga, I., Gergics, P., Boros, A., Futo, L., Novel mutation of the CYP17A1 gene in two unrelated patients with combined 17alphahydroxylase/17,20-lyase deficiency: Demonstration of absent enzyme activity by expressing the mutant CYP17A1 gene and by three-dimensional modeling (2005) J Steroid Biochem Mol Biol, 97, pp. 257-265Yang, J., Cui, B., Sun, S., Shi, T., Zheng, S., Bi, Y., Phenotype-genotype correlation in eight Chinese 17αhydroxylase/17,20-lyase deficiency patients with five novel mutations of CYP17A1 gene (2006) J Clin Endocrinol Metab, 91, pp. 3619-3625Rosa, S., Duff, C., Meyer, M., Lang-Muritano, M., Balercia, G., Boscaro, M., P450c17 deficiency: Clinical and molecular characterization of six patients (2007) J Clin Endocrinol Metab, 92, pp. 1000-1007Martin, R.M., Oliveira, P.S.L., Costa, E.M.F., Arnhold, I.J.P., Mendonça, B.B., Combined 17 alpha-hydroxylase/17,20-lyase deficiency due to a homozygous 25 BP duplication (NT 4157-4181) at exon 5 in CYP17 resulting in a premature stop codon predicated by molecular modeling (2008) Arq Bras Endocriol Metab, 52, pp. 1317-1320Qiao, J., Chent, X., Zuo, C.-L., Gu, Y.-Y., Liu, B.-L., Liang, J., Identification of steroid biosynthetic defects in genotype-proven heterozygous individuals for 17α-hydroxylase/17-20-lyase deficiency (2010) Clin Endocrinol, 72, pp. 312-319Nuzzo, V., Tauchmanova, L., Brunetti-Pierri, R., Zuccoli, A., Lupoli, G., Colao, A., A novel mutation in the N-terminal region of the CYP17A1 gene in a patient with 17 alpha-hydroxylase/17,20-lyase deficiency (2009) J Endocrinol Invest, 32, pp. 322-324Rosa, S., Steigert, M., Lang-Muritano, M., L'allemand, D., Schoenle, E.J., Biason-Lauber, A., Clinical, genetic and functional characteristics of three novel CYP17A1 mutations causing combined 17alpha-hydroxylase/17,20-lyase deficiency (2010) Horm Res Paediatr, 73, pp. 198-204Katsumata, N., Ogawa, E., Fujiwara, I., Fujikura, K., Novel CYP17A1 mutation in a Japanese patient with combined 17alpha--hydroxylase/17,20-lyase deficiency (2010) Metabolism, 59, pp. 275-278Kater, C.E., Biglieri, E.G., Disorders of steroid 17α-hydroxylase deficiency (1994) Endocrinol Metab Clin North Am, 23, pp. 341-357Geller, D.H., Auchus, R.J., Mendonça, B.B., Miller, W.L., The genetic and functional basis of isolated 17,20 lyase deficiency (1997) Nat Genet, 17, pp. 201-205(2010) Instituto Brasileiro De Geografia E Estatística 2000 Brasil: 500 Anos De Povoamento, , http://www.ibge.gov.br/brasil500, IBGE, Available at, Accessed on: 17 Ju