Is there a correlation among simulated operations, urodynamics (VLPP) and urethral mobility?

Orientador: Paulo César Rodrigues PalmaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: O diagnóstico de incontinência urinária de esforço (IUE) é baseado na história e no exame físico associados, se necessário, a exames complementares, especialmente o estudo urodinâmico. Com o surgimento da Teoria Integral, criou-se uma nova maneira de avaliar essas pacientes através das operações simuladas, que consistem em manobras realizadas durante o exame físico (teste da tosse) para identificar os defeitos dos elementos de suporte uretral na incontinência. Objetivos: (1) Estabelecer correlação entre as operações simuladas e o Valsalva leak point pressure (estudo urodinâmico); (2) Correlacionar as manobras das operações simuladas com o resultado do teste do cotonete; (3) Correlacionar a intensidade da incontinência com as operações simuladas por meio do teste do absorvente. Materiais e Métodos: As operações simuladas compõem-se de quatro manobras realizadas durante o teste da tosse, com o auxílio de uma pinça atraumática, observando se a perda urinária cessa durante a manobra: manobra 1: aplicação de uma pinça unilateralmente na inserção do ligamento pubouretral; manobra 2: plicatura suburetral; manobra 3: suporte suburetral sem tensão; manobra 4: suporte suburetral com tensão. Foram avaliadas 82 mulheres com incontinência urinária de esforço. Todas foram submetidas ao exame urodinâmico, teste do cotonete e teste do absorvente. 50 pacientes foram avaliadas com as manobras 1 e 2 e todas as 82 mulheres foram submetidas às manobras 3 e 4 das operações simuladas. O teste do cotonete avaliou a mobilidade uretral. O teste do absorvente de uma hora mensurou a intensidade da perda urinária. Resultados: Quando as manobras 1, 2 e 3 foram realizadas, a maioria das pacientes parou de perder urina. Houve associação estatisticamente significativa entre o Valsalva leak point pressure e a cessação de perda urinária com as manobras 1, 2 e 3 (p = 0,008, OR 0.965; p = 0,0140, OR 0.953; p = 0,0002, OR 0.949, respectivamente às manobras 1, 2 e 3, com IC 95%). As pacientes que ficaram secas durante as manobras apresentavam valores maiores de pressão de perda quando comparadas ao grupo que permaneceu incontinente. Durante a manobra 4 nenhuma paciente perdeu urina. O teste do cotonete apresentou significância estatística com as manobras 2, 3 e 4. O teste do absorvente não apresentou correlação com as operações simuladas. Conclusão: As operações simuladas demonstram uma boa correlação com o Valsalva leak point pressure e o teste do cotonete. O teste do absorvente não mostrou associação com as operações simuladas. Por serem acuradas, recomenda-se sua utilização na prática clínicaAbstract: Introduction: The diagnosis of stress urinary incontinence is based on history and physical examination and, if necessary, could be associated with additional tests especially the urodynamic. The Integral Theory, developed a new way to evaluate patients with stress urinary incontinence, known as simulated operations. These techniques are maneuvers performed during the stress test (cough), to identify the defects of the urethral support elements that cause incontinence. Objectives: (1) To establish a correlation between simulated operations with the Valsalva leak point pressure (urodynamics); (2) To correlated the simulated operations with the result of the Q-tip test; (3) To correlate intensity of symptoms with simulated operations through the pad test. Material and Methods: From May 2012 to February 2015 were evaluated 82 women with stress urinary incontinence. All patients underwent simulated operations that consisted of four maneuvers during the cough test observing if there is urinary leakage during the maneuvers. For the maneuver 1, the atraumatic clamp was applied unilaterally at the pubourethral ligament insertion on the inferior border of the pubis (simulating the plication of the pubourethral ligament). In the maneuver 2, a clamp was used to plicate the vaginal on the level of the midurethra (simula the plication of the urethropelvic ligament). In the maneuver 3 the index finger is placed the index finger is placed in the suburethral region without tension. The maneuver 4 is the same maneuver 3 with tension. The Q-tip test has been used to evaluation of urethral mobility and the one-hour pad test to measure the severity of urinary leakage. The simulated operations were compared with the values of Valsalva leak point pressure, Q-tip test and pad test. Results: When performing the maneuvers 1, 2 and 3, most patients did not have urinary leakage. There was a significant association between Valsalva leak point pressure and the cessation of stress urinary incontinence with the maneuvers 1, 2 e 3 (p = 0.008, OR 0.965; p = 0.0140, OR 0.953; p = 0.0002, OR 0.949, respectivamente às manobras 1, 2 e 3, com IC 95%). During the maneuver 4, no patient presented had leak urine. The Q-tip test was statistically significant with maneuvers 2, 3 and 4. The pad test don't showed statistical correlation with the simulated operations. Conclusion: The simulated operations demonstrated correlation with Valsalva leak point pressure and urethral mobility. The pad test don't showed statistical correlation with the simulated operations. For having good accuracy, it is recommended their use in clinical practiceMestradoFisiopatologia CirúrgicaMestra em Ciência

Leiomioma uretral durante a gravidez: relato de caso Urethral leiomyoma during pregnancy: a case report

<abstract language="eng">The authors report a case of urethral leiomyoma diagnosed during pregnancy, which was conservatively treated up to the 38th week, when the pregnancy was interrupted. Thirty days after delivery, exeresis of the lesion was performed from the upper border of the urethral meatus and sutured with interrupted delayed-absorbable suture. The patient evolved favorably and presented no lesion recurrence during three months of follow up

[urethral Leiomyoma During Pregnancy: A Case Report].

The authors report a case of urethral leiomyoma diagnosed during pregnancy, which was conservatively treated up to the 38th week, when the pregnancy was interrupted. Thirty days after delivery, exeresis of the lesion was performed from the upper border of the urethral meatus and sutured with interrupted delayed-absorbable suture. The patient evolved favorably and presented no lesion recurrence during three months of follow up.39560-

Urethral leiomyoma during pregnancy: a case report

The authors report a case of urethral leiomyoma diagnosed during pregnancy, which was conservatively treated up to the 38th week, when the pregnancy was interrupted. Thirty days after delivery, exeresis of the lesion was performed from the upper border of the urethral meatus and sutured with interrupted delayed-absorbable suture. The patient evolved favorably and presented no lesion recurrence during three months of follow up.56056