Hiperatividade do detrusor: comparação entre oxibutinina, eletroestimulação funcional do assoalho pélvico e exercícios perineais. Estudo randomizado

Abstract

Hiperatividade do detrusor: comparação entre oxibutinina, eletroestimulação funcional do assoalho pélvico e exercícios perineais. Estudo randomizado ResultadOs: na avaliação do diário miccional, houve diminuição da urge-incontinência e dos absorventes utilizados nos três grupos (p<0,05) e diminuição da freqüência miccional no Grupo Oxibutinina (p=0,014). Observou-se redução dos episódios de noctúria nos Grupos Oxibutinina (p=0,003) e Eletroestimulação (p=0,036). Na comparação entre as três técnicas, a análise desses dados foi semelhante (p>0,05). A urgência desapareceu em 63,6% das pacientes do Grupo Oxibutinina, em 52,4% das do Grupo Eletroestimulação e em 57,1% das pacientes do Grupo Exercícios Perineais, resultado semelhante entre os grupos (p=0,754). A avaliação subjetiva mostrou que 77,3, 52,4 e 76,2% estavam satisfeitas nos Grupos Oxibutinina, Eletroestimulação e Exercícios Perineais, respectivamente, após o tratamento, sem diferença entre os grupos (p=0,142). A cura urodinâmica foi observada em oito (36,4%) das pacientes do Grupo Oxibutinina, 12 (57,1%) do Grupo Eletroestimulação e em 11 (52,4%) das mulheres tratadas com exercícios perineais, o que foi semelhante quando se compararam os grupos entre si (p=0,358). A diminuição da perda urinária correlacionou-se com a satisfação das pacientes (p<0,05). COnClusÃO: os tratamentos foram igualmente eficazes; a diminuição da perda urinária influenciou a satisfação das pacientes. AbstractPuRPOse: to evaluate and to compare the effectiveness of oxybutynin, electrostimulation (ES) and pelvic floor training (PFT) in the management of women with detrusor overactivity. MethOds: a total of 64 women, 35 to 80 years old, were enrolled in this randomized prospective trial. Patients were randomized in three groups: Oxybutynin (n=22), ES (n=21) and PFT (n=21). There were no statistical differences between the three groups with regards to race (p=0.948), age (p=0.747), hormonal status (p=0.813), time of symptomatology (p=0.789), previous surgery for urinary incontinence (p=0.993), or body mass index (p=0.897). Patients were assessed before and after treatment by urodynamic test, a seven-day voiding diary, and subjective response. The duration of the treatment was twelve weeks. For statistical analyses, the Pearson χ 2 , analysis of variance (ANOVA) and the paired t-test were used. Results: there was a decrease in the urge-incontinence episodes and in the number of pads required in all groups (p<0.05). There was reduction in the frequency of micturition in the Oxybutynin Group (p=0.014). Oxybutynin and ES Groups had reduction in nocturia episodes (p=0.003 and p=0.036, respectively). There were no significant differences in improvement between the three groups (p>0.05). Urgency was resolved in 14 (63.6%), 11 (52.4%) and 12 (57.1%) patients of the Oxybutynin, ES and PFT Groups, respectively, without differences among the groups (p=0.754). Subjectively, 17 (77.3%), 11 (52.4%) and 16 (76.2%) women who trabalho realizado no setor de uroginecologia e Cirurgia vaginal da disciplina ...

The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence

“…In our study, we found that the success rate varied among the different types of UI, as has been described in previous studies 25,26 . Approximately 90% of the 30 patients with SUI reported being satisfied or continent.…”

“…Seven of the nine patients with UUI in the present study completed the study reaching continence, whereas another study on women with the same type of UI reported lower success rates, with a reduction of episodes of urinary urgency in 52.4% of patients who performed electrical stimulation and in 57.1% of patients who performed perineal exercises 26 .…”

Pelvic floor muscle training for overactive bladder symptoms – A prospective study

“…In the subjective evaluation, the percentage of women who were satisfied after treatment was 77%, 52% and 76%, respectively, in the oxybutynin, electrostimulation and perineal exercise groups, with no significant differences between them (p=0.142). 5 The benefits of short-and long-term physiotherapeutic treatment programs depend on patient adherence. 27 In our study, we observed an outpatient attendance of 75% and a mean in-home adherence during the 3 month treatment of 80%.…”

“…4 Enuresis, nocturia and urinary leakage due to stress incontinence are also reported. 5 The main therapeutic modalities are conservative therapies, such as pharmacological treatment and behavioral therapy. Behavioral therapy includes the association of various resources, such as: educational program; changes in lifestyle; bladder training and urge suppression strategies; pelvic floor muscle training (PFMT); electro-stimulation; and programmed urination.…”

Intervenção fisioterapêutica em mulheres com incontinência urinária associada ao prolapso de órgão pélvico

“…The parameters of the electric current varied according to the type of UI: for UUI, heterodyne frequency of 2 K/10 Hz; for SUI, Kots current of 2 K/50 Hz, sustaining time=6 s, resting time=2 x sustaining time and rise of 100 µs; and for MUI, alternating frequencies of 10 Hz and 50 Hz, e.g. 10 Hz one week and 50 Hz the following week 17,18 .…”