Background Genitourinary syndrome of menopause (GSM) involves vaginal dryness (VD), pain during sexual activity (SAPain), vaginal itching (VI), burning, pain, and symptoms in the urinary organs. Non-ablative radiofrequency (RF) is a type of current with electromagnetic waves with a thermal effect that generates an acute inflammatory process with consequent neocolagenesis and neoelastogenesis. We aimed to describe the clinical response to VD, SAPain, vaginal laxity (VL), VI, burning sensation, pain in the vaginal opening, urinary incontinence, sexual dysfunction, cytological changes, and adverse effects of non-ablative RF in patients with GSM. Methods This single-arm pilot study included 11 women diagnosed with GSM with established menopause. Patients with hormone replacement initiation for six months, who used a pacemaker, or had metals in the pelvic region, were excluded. Subjective measures (numeric rating scale of symptoms, Vaginal Health Index-VHI) and objective measures (vaginal maturation index-VMI, vaginal pH, sexual function by the FSFI, and urinary function by the ICIQ-SF) were used. A Likert scale measures the degree of satisfaction with the treatment. Five sessions of monopolar non-ablative RF (41°C) were performed with an interval of one week between each application. The entire evaluation was performed before treatment (T0), one month (T1), and three months (T2) after treatment. Adverse effects were assessed during treatment and at T1 and T2. Results The symptoms and/or signs were reduced after treatment in most patients (T1/T2, respectively): VD 90.9%/81.8%, SAPain 83.3%/66.7, VL 100%/100%, VI 100%/100%, burning 75%/87.5%, pain 75%/75%, and VHI 90.9%/81.9%. Most patients did not show changes in VMI (54.5%) and pH (63.6%) at T1, but there was an improvement in VMI in most patients (54.5%) at T2. Nine patients were satisfied, and two were very satisfied at T1. The treatment was well tolerated, and no adverse effects were observed. There was an improvement in sexual function (72.7%) and urinary function (66.7% in T1 and 83.3% in T2). Conclusion Intravaginal RF reduced the clinical symptoms of GSM in most patients, especially during T1, and women reported satisfaction with treatment. The technique showed no adverse effects, and there were positive effects on sexual and urinary function. Trial registration This research was registered at clinicaltrial.gov (NCT03506594) and complete registration date was posted on April 24, 2018.
Background: Genitourinary Syndrome of Menopause (GSM) involves vaginal dryness, dyspareunia, itching, burning, pain, and also symptoms in urinary organs. Non-ablative radiofrequency (RF) is a type of current with electromagnetic waves with the thermal effect that generates an acute inflammatory process with consequent neocolagenesis and neoelastogenesis. We aimed to describe the clinical response, cytological changes, and adverse effects of applying nonablative RF in patients with GSM and to assess sexual and urinary function after treatment. Methods: This is a pilot study with 11 women diagnosed with GSM with established menopause. Patients with hormone replacement initiation less than six months, who used a pacemaker or had metals in the pelvic region, were excluded. Subjective measures (Visual Numerical Scale-VNS of symptoms, Vaginal Health Index-VHI) and objective measures (Vaginal Maturation Index-VMI and vaginal pH) were used. Sexual function was assessed by the FSFI, and the ICIQ-SF measured the impact on urinary function. A Likert scale measured the degree of satisfaction with the treatment. Five sessions of monopolar non-ablative RF (41 °C) were performed with an interval of one week between each application. The entire evaluation was performed before treatment (T0), one month (T1), and three months (T2) after treatment. Adverse effects were assessed weekly. Results: There was a reduction in symptoms after treatment in most patients (T1/T2, respectively): vaginal dryness 90.9%/81.8%, dyspareunia 83.3%/66.7, vaginal laxity 100%/100%, pruritus 100%/100%, burning 75%/87.5%, pain 75%/75%, and in VHI 90.9%/81.9%. Most patients did not show changes in VMI (54.5%) and pH (63.6%) at T1, but there was an improvement in VMI in most patients (54.5%) at T2. Nine patients were satisfied and two were very satisfied at T1. The treatment was well tolerated and no adverse effects were observed. There was an improvement in sexual function in 72.7% and in urinary function in 66.7% in T1 and 83.3% in T2. Conclusion: Intravaginal RF reduced the clinical signs and symptoms of GSM and women reported satisfaction with treatment. The technique showed no adverse effects and there were positive effects on sexual and urinary function. Trial registration: This research was registered at clinicaltrial.gov (NCT03506594) and complete registration date (first date posted) April 24, 2018.
Definitive RP following SOC systemic therapy is safe and appears to be largely feasible robotically. Post-RP urinary QOL was comparable to RP for localized disease (with extrapolated benefit of avoiding symptomatic local disease progression). 25% pT0 response was seen; gene expression profiles of these patients should be sought. Despite a small sample, our analysis lends insight and support to the feasibility of the SWOG 1802 RP arm.
Introdução: A Artrite Reumatóide (AR) é uma doença inflamatória crônica, de etiologia desconhecida, caracterizada por inflamação articular, dor e déficit funcional. Como implicações da doença, os indivíduos podem apresentar fadiga, diminuição da amplitude de movimento e dor. A dor parece ser o sintoma mais importante para a maioria dos pacientes, sendo considerado o principal objetivo da maior parte dos tratamentos reumatológicos. Objetivo: identificar na literatura os mecanismos da dor nociceptiva em indivíduos com Artrite Reumatóide. Métodos: Foram acessadas as bases de dados: Medline, Cochrane e SciELO no período de 10 a 30 de abril de 2011. De acordo com as palavras-chave encontradas nos títulos e resumos dos estudos, foram incluídos aqueles que fizeram referência às causas e mecanismos da dor nociceptiva na AR e estavam publicados no idioma português, inglês e espanhol. Foram excluídos os estudos que se referiram apenas ao tratamento da AR e os que não descreveram a metodologia e/ou não apresentaram a sessão de resultados e discussão. Resultados: Foram selecionados 32 artigos para a leitura na íntegra, sendo 22 excluídos pela metodologia ou conteúdo incompatível com o tema proposto. Foi evidenciado que fatores como TNF-α, quimiocinas, citocinas, prostanóides, COX-2, PKC, neutrófilos e canal TRPV1 são as principais substâncias relacionadas à manifestação clínica álgica nociceptiva da AR. Conclusão: Neste estudo pôde-se observar que diversas substâncias desempenham um papel relevante para a potencialização da dor nociceptiva na AR através de diferentes mecanismos. Dessa forma evidenciou-se a importância de um tratamento multidisciplinar, abordando os diversos aspectos da dor, minimizando ou retardando as amplificações da dor no SNC.
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