SUMMARY OBJECTIVE: The objective of this study was to evaluate the effects of home-based pelvic floor muscle training in women with urinary incontinence, addressing the difficulties arising from social isolation due to the coronavirus disease 2019 pandemic by utilizing a specialized mobile app. METHODS: This randomized, single-group clinical trial aimed to assess the efficacy of pelvic floor muscle training guided by a mobile app (Diario Saúde) in women with stress urinary incontinence. Participants were instructed via telephone to engage in pelvic floor muscle training exercises twice a day for 30 days. Pre- and post-treatment, participants completed validated questionnaires regarding urinary symptoms and quality of life through telephone interviews. Additionally, treatment adherence was evaluated. RESULTS: A total of 156 women were enrolled in the study, with a mean age of 49.3±14.2 years. Significant improvements in urinary incontinence symptoms and quality of life were observed following pelvic floor muscle training guided by the mobile app (p<0.001). Notably, 74.3% of the participants reported performing the exercises with appropriate frequency. Of the participants, 62% reported either complete or substantial improvement in urinary symptoms post-treatment. CONCLUSION: This study revealed notable enhancements in stress urinary incontinence, urinary storage, and overall quality of life subsequent to pelvic floor muscle training guided by a mobile app, particularly during the coronavirus disease 2019 pandemic. The mobile app demonstrated robust acceptance and adherence among women experiencing urinary incontinence. OBJECTIVE homebased home based 201 METHODS randomized singlegroup single group Diario Saúde 3 days Pre posttreatment, posttreatment post treatment, post-treatment interviews Additionally evaluated RESULTS 15 493142 49 14 2 49.3±14. years p<0.001. p0001 p p<0.001 . 0 001 (p<0.001) Notably 743 74 74.3 frequency 62 posttreatment. treatment. CONCLUSION storage 20 1 49314 4 49.3±14 p000 p<0.00 00 (p<0.001 7 74. 6 4931 49.3±1 p00 p<0.0 (p<0.00 493 49.3± p0 p<0. (p<0.0 49.3 p<0 (p<0. 49. p< (p<0 (p< (p

Abstract Objective This study aimed to translate and validate the Estro-Androgenic-Symptom Questionnaire in Women (EASQ-W) into Brazilian Portuguese language, as we hypothesized that this tool would be consistent for addressing the specific context of hormonal symptoms in menopause. Methods In a cross-sectional study, a total of 119 women with Genitourinary Syndrome of Menopause (GSM) and 119 climacteric women without GSM were included. The EASQ-W was translated, and its psychometric properties were rigorously examined. Participants completed questionnaires covering sociodemographic details, the EASQ-W, and the Menopause Rating Scale (MRS). A subgroup of 173 women was re-invited after 4 weeks for test-retest analysis of the EASQ-W. Additionally, the responsiveness of the questionnaire was evaluated in 30 women who underwent oral hormonal treatment. Results The internal consistency of the EASQ-W was found to be satisfactory in both GSM and control groups (Cronbach’s alpha ≥ 0.70). Notably, a floor effect was observed in both groups; however, a ceiling effect was only evident in the sexual domain of the GSM group. Construct validity was established by comparing the EASQ-W with the MRS, yielding statistically significant correlations (0.33831-0.64580, p < 0.001). The test-retest reliability over a 4-week period was demonstrated to be satisfactory in both the GSM and control groups (ICC 0.787-0.977). Furthermore, the EASQ-W exhibited appropriate responsiveness to oral hormonal treatment (p < 0.001). Conclusion This study successfully translated and validated the Estro-Androgenic-Symptom Questionnaire in Women (EASQ-W) into Brazilian Portuguese, with satisfactory internal consistency, test-retest reliability, and construct validity. EstroAndrogenicSymptom Estro Androgenic Symptom EASQW EASQ W (EASQ-W language menopause crosssectional cross sectional 11 (GSM included examined details EASQW, W, MRS. MRS . (MRS) 17 reinvited re invited testretest test retest EASQW. W. Additionally 3 Cronbachs Cronbach s 0.70. 070 0.70 0 70 0.70) Notably however group 0.338310.64580, 033831064580 0.33831 0.64580, 33831 64580 (0.33831-0.64580 0.001. 0001 0.001 001 0.001) 4week week ICC 0.7870.977. 07870977 0.787 0.977 787 977 0.787-0.977) Furthermore 1 (MRS 07 0.7 7 338310 0.338310.64580 03383106458 033831 0.3383 064580 0.64580 3383 6458 (0.33831-0.6458 000 0.00 00 7870 0.7870.977 0787097 0787 0.78 0977 0.97 78 97 0.787-0.977 0. 0.338310.6458 0338310645 03383 0.338 06458 0.6458 338 645 (0.33831-0.645 0.0 0.7870.97 078709 078 097 0.9 9 0.787-0.97 0.338310.645 033831064 0338 0.33 0645 0.645 33 64 (0.33831-0.64 0.7870.9 07870 09 0.787-0.9 0.338310.64 03383106 033 0.3 064 0.64 6 (0.33831-0.6 0.7870. 0.787-0. 0.338310.6 0338310 03 06 0.6 (0.33831-0. 0.7870 0.787-0 0.338310. (0.33831-0 0.787- 0.338310 (0.33831- (0.33831 (0.3383 (0.338 (0.33 (0.3 (0. (0 (

Abstract Objectives To assess the status of the pelvic floor muscle (PFM) of premature ovarian insufficiency women (POI women) and the incidence of fecal incontinence (FI) and pelvic organ prolapse (POP). Methods A secondary analysis of a cross-sectional study with 150 women with POI was performed. Pelvic floor muscle assessment was performed with the PERFECT scale. The subscales POPDI-6 and CRADI-8 of the questionnaire Pelvic Floor Distress Inventory-20 (PFDI-20) were used for pelvic floor symptoms focused on FI and POP. Moreover, FI and POP were also assessed as dichotomous variables (yes/no). Results Women with FI and POP did not present differences in the PFM assessment across P (p = 0.61), E (p = 0.78), R (p = 0.22), and F (p = 0.79) variables when compared with women with POI; no differences were also seen between women with and without POP according the pelvic muscles: P (p = 0.91), E (p = 0.99), R (p = 0.62), and F (p = 0.10). Women with FI and POP presented higher scores in all PFDI-20 subscales and total score when compared with the control group (p < 0.05). Conclusions Pelvic floor muscle assessment within POI women with or without FI or POP did not differ. However, PF symptoms are more severe in the FI or POP groups. (PFM (FI . (POP) crosssectional cross sectional 15 scale POPDI6 POPDI 6 POPDI- CRADI8 CRADI 8 CRADI- Inventory20 Inventory 20 Inventory-2 PFDI20 PFDI (PFDI-20 Moreover yes/no. yesno yes/no yes (yes/no) p 0.61, 061 0.61 , 0 61 0.61) 0.78, 078 0.78 78 0.78) 0.22, 022 0.22 22 0.22) 0.79 079 79 muscles 0.91, 091 0.91 91 0.91) 0.99, 099 0.99 99 0.99) 0.62, 062 0.62 62 0.62) 0.10. 010 0.10 10 0.10) PFDI-2 0.05. 005 0.05 05 0.05) differ However groups (POP 1 Inventory2 2 Inventory- PFDI2 (PFDI-2 (yes/no 06 0.6 07 0.7 7 02 0.2 09 0.9 9 01 0.1 PFDI- 00 0.0 (PFDI- 0. (PFDI

RESUMO O objetivo desta revisão de literatura é trazer alguns resultados de gestação em mulheres transplantadas, propostas de avaliação pré-concepcional, pré-natal e do puerpério, incluindo a contracepção pós-parto e orientação terapêutica na concomitância da gestação e lactação. Com base nos resultados encontrados em pesquisa no PubMed sem limitação de data ou língua, discutimos a importância do planejamento reprodutivo para mulheres com transplante de órgãos sólidos e que deve ser feito desde antes da realização do transplante. Existem contraindicações formais de gestação, entretanto quando planejada, dentro de critérios clínicos, laboratoriais e uso de imunossupressão adequada e em seguimento de pré-natal especializado essa gestação é possível e com bons resultados perinatais. Salientamos também a importância do acompanhamento psicológico entre gestantes com transplantes de órgãos sólidos. transplantadas préconcepcional, préconcepcional pré concepcional, concepcional pré-concepcional prénatal natal puerpério pósparto pós parto lactação língua planejada clínicos perinatais

ABSTRACT The objective of this literature review is to provide some pregnancy results in transplanted women, proposals for preconception, prenatal and postpartum evaluation, including postpartum contraception, and therapeutic guidance during pregnancy and lactation. Based on the results found in research on PubMed without date or language limitations, we discuss the importance of reproductive planning for women with solid organ transplants and what should be done before the transplant. There are formal contraindications to pregnancy; however, when planned, within clinical and laboratory criteria, and with adequate immunosuppression and specialized prenatal care, pregnancy is possible with good perinatal results. We also highlight the importance of psychological support among pregnant women with solid organ transplants. preconception evaluation contraception lactation limitations transplant however planned criteria care

RESUMO O aumento na sobrevida após o transplante e o crescimento da população feminina receptora de órgãos destacam a importância de considerar cuidadosamente a saúde reprodutiva e ginecológica dessas mulheres. Uma das principais preocupações é o risco aumentado de câncer após o transplante, atribuído em parte ao uso de terapia imunossupressora. Cânceres ginecológicos com alta associação com infecções virais, como câncer de colo uterino, devem receber cuidados e rastreios específicos, em especial entre mulheres mais jovens. Além disto, o caráter imunoprevinível do câncer de colo uterino torna a vacinação mandatória antes da realização do transplante. O câncer de mama, outro câncer ginecológico de especial interesse por sua alta prevalência, deve ser rastreado na população transplantada, seguindo as diretrizes da população geral. A fertilidade e o planejamento familiar também são considerações importantes, pois a maioria das mulheres apresenta o retorno da ovulação e da menstruação após o transplante. Estratégias de contracepção, como métodos de longa ação reversíveis, são recomendadas devido à sua eficácia e baixa taxa de falhas. O uso de contraceptivos hormonais e imunossupressores também devem ser avaliados, enfatizando a necessidade de observar cuidadosamente as possíveis interações medicamentosas. A abordagem integrada à saúde ginecológica das mulheres após um transplante de órgão sólido possibilita melhores resultados, tanto para a saúde do enxerto quanto para a saúde ginecológica daquela mulher, revertendo em melhores desfechos para a paciente. O acompanhamento e a vigilância cuidadosa, a prevenção do câncer e a gestão eficaz da fertilidade e contracepção são cruciais para garantir sua qualidade de vida e bem-estar. imunossupressora virais específicos jovens disto mama prevalência transplantada geral importantes reversíveis falhas avaliados medicamentosas resultados mulher paciente cuidadosa bemestar. bemestar bem estar. estar bem-estar

ABSTRACT The increase in survival after transplantation and the growth of the female organ recipient population underscore the importance of carefully considering the reproductive and gynecological health of these women. One of the main concerns is the increased risk of cancer after transplantation, partly attributed to the use of immunosuppressive therapy. Gynecological cancers with a high association with viral infections, such as cervical cancer, should receive specific care and screening, especially among younger women. Additionally, the preventable nature of cervical cancer makes vaccination mandatory before undergoing transplantation. Breast cancer, another gynecological cancer of special interest due to its high prevalence, should be screened in the transplant population following guidelines for the general population. Fertility and family planning are also important considerations, as most women experience the return of ovulation and menstruation after transplantation. Contraception strategies, such as reversible long-acting methods, are recommended due to their effectiveness and low failure rate. The use of hormonal contraceptives and immunosuppressants should also be evaluated, emphasizing the need to carefully monitor potential drug interactions. An integrated approach to the gynecological health of women after solid organ transplantation enables better outcomes for both graft health and the gynecological health of the woman, resulting in improved outcomes for the patient. Ongoing follow-up, careful surveillance, cancer prevention, and effective management of fertility and contraception are crucial to ensure their quality of life and well-being. therapy infections screening Additionally prevalence considerations strategies longacting long acting methods rate evaluated interactions woman patient followup, followup follow up, up follow-up surveillance prevention wellbeing. wellbeing well being. being well-being

Resumo Objetivo Avaliar a taxa de aceitação do dispositivo intrauterino pós-placentário (DIUPP); os motivos de recusa e propor medidas que aumentem sua aceitação. Métodos Estudo de corte transversal realizado no Hospital daMulher da Universidade Estadual de Campinas, Campinas, SP, Brasil. O DIUPP foi oferecido amulheres admitidas em trabalho de parto que não apresentavam: infecções,malformação uterina, gravidez gemelar, parto prematuro e com idade mínima de 18 anos. Em caso de recusa, perguntou-se o motivo, e as respostas foram agrupadas em informações equivocadas sobre contracepção ou outros motivos. Considerou-se informação equivocada: medo de dor, sangramentos, falha da contracepção e prejuízo da fertilidade. Análises bivariadas foram realizadas. Resultados Entre 241 mulheres, a taxa de recusa foi de 41,9%. A desinformação correspondeu a 50,5% de todos osmotivos de recusa, que foram:medo da dor (39,9%); medo da falha da contracepção (4,9%); medo de sangramento (3,9%), medo de o dispositivo intrauterino (DIU) prejudicar a fertilidade (1,9%). Outros motivos de recusa atingem 49,5%. Parturientes com idade entre 18 e 27 anos recusaram o PPIUD com mais frequência devido a desinformação (67,4%), e as mais velhas (com idade entre 28 e 43 anos) recusaram com frequência devido a outros motivos (63,6%) (p=0,002). Houve diferença entre a idade média de quem recusou o PPIUD por desinformação (27,3 ± 6,4 anos) em comparação com outras razões (29,9 ± 5,9 anos), (p=0,017). Além disso, ambos os grupos apresentaram altas taxas de recusa por desinformação, de 67,4 e 36,4%, respectivamente. Conclusão A recusa do DIUPP foi alta, principalmente entre as mulheres jovens e por desinformação. Diante disso, é necessário o desenvolvimento de medidas educativas durante o pré-natal e aconselhar as mulheres sobre contracepção, saúde reprodutiva e gravidez indesejada.

Abstract Objective To evaluate the acceptability of postplacental placement of intrauterine devices (PPIUD), reasons for refusal and suggested policies to increase its use. Methods Cross-sectional study conducted at the Women Hospital of the Universidade de Campinas, Campinas, SP, Brazil. Postplacental placement of intrauterine devices was offered to women admitted in labor who did not present infections, uterinemalformation, twin pregnancy, preterm birth, and were at least 18 years old. In case of refusal, the parturient was asked to give their reasons and the answers were classified as misinformation about contraception or other reasons. The following were considered misinformation: fear of pain, bleeding, contraception failure and future infertility. Bivariate analysis was performed. Results Amongst 241 invited women, the refusal rate was of 41.9%. Misinformation corresponded to 50.5% of all refusals, and the reasons were: fear of pain (39.9%); fear of contraception failure (4.9%); fear of bleeding (3.9%); fear of future infertility (1.9%); other reasons for refusal were 49.5%. Parturients aged between 18 and 27 years old refused the PPIUD more frequently due to misinformation (67.4%), and older parturients (between 28 and 43 years old) refused frequently due to other reasons (63.6%) (p=0.002). Themean age of those who declined the PPIUD due to misinformation was 27.3 ± 6.4 years old, while those who declined for other reasons had a mean age of 29.9 ± 5.9 years old (p=0.017). Conclusion The refusal of the PPIUD was high, especially amongst young women and due to misinformation. It is necessary to develop educative measures during antenatal care to counsel women about contraception, reproductive health and consequences of unintended pregnancy.

RESUMO OBJETIVO: O pessário é uma opção para o tratamento conservador do prolapso genital. MÉTODOS: Um estudo prospectivo e observacional foi realizado com 19 mulheres com prolapso genital avançado. A avaliação da qualidade de vida e dos sintomas vaginais foi mensurada pelos questionários SF-36 e ICIQ-VS antes e seis meses depois da colocação do pessário. Uma pergunta simples sobre satisfação do uso do dispositivo foi também feita (impressão subjetiva). RESULTADOS: A idade média das mulheres foi de 76 anos. A maioria era parda/negra (52,6%), sem cirurgias pélvicas (57,5%), com sintomas urinários (78,9%). Um terço das pacientes relatou atividade sexual. Depois do tratamento, 22,2% apresentaram infecção vaginal e 27,7% fluxo vaginal aumentado. Não houve alteração da prevalência dos sintomas urinários. As mulheres relataram 100% de satisfação (77,7% melhora parcial e 22,3% melhora completa) depois do uso do pessário. Houve melhora em três domínios do SF-36: saúde em geral (p=0,090), vitalidade (p=0,0497) e aspectos sociais (p=0,007). O ICIQ-VS apresentou redução nos sintomas vaginais (p<0,0001) e melhora da qualidade de vida (p<0,0001). CONCLUSÕES: O uso do pessário por seis meses em mulheres com prolapso genital melhorou a qualidade de vida e reduziu os sintomas vaginais.

SUMMARY OBJECTIVE: The use of pessary is an option for the conservative treatment of pelvic organ prolapse (POP). However, here are few studies assess the quality of life (QoL) after inserting the pessary for POP. We have hypothesized that the use of pessary would modify QoL in women with POP. METHODS: A prospective, observational study was performed that included 19 women with advanced POP. Pessary was introduced, and the SF-36 (general quality of life) and ICIQ-VS (vaginal symptoms and quality of life subdomain) questionnaires were applied before the introduction and after six months. A single question about the satisfaction regarding the use of the device was presented (subjective impression). RESULTS: The mean age of the women included was 76 years. Most of them were non-caucasian (52.6%), with no prior pelvic surgery (57.5%), with urinary symptoms (78.9%). A third of the patients reported sexual activity. After treatment, 22.2% of them presented vaginal infection, and 27.7% increased vaginal discharge. Urinary symptoms remained unaltered. Women reported 100% satisfaction after using the pessary (77.7% partial improvement; 22.3% total improvement). SF-36 had significant improvement in three specific domains: general state of health (p=0.090), vitality (p=0.0497) and social aspects (p=0.007). ICIQ-VS presented a reduction in the vaginal symptoms (p < 0.0001) and an improvement in QoL (P < 0.0001). CONCLUSION: The use of pessary for six months improved the QoL and reduced vaginal symptoms for women with advanced POP.

Resumo Introdução O pessário vaginal é utilizado como tratamento conservador para o prolapso de órgãos pélvicos (POP). Alguns estudos demonstraram que as queixas mais comuns do seu uso são o desconforto vaginal e um aumento do fluxo vaginal. As informações são escassas a respeito do que ocorre com a microflora vaginal após o uso do pessário. Objetivo Determinar se o uso do pessário pode interferir com o ambiente vaginal. Métodos Um estudo transversal realizado de março de 2014 a julho de 2015 com 90 mulheres com POP; metade delas usaram pessário e a outra metade permaneceu como grupo controle. Todas preencheram um questionário e realizaram exame ginecológico para coleta de amostras vaginais para análise microbiológica. Dados clínicos e microbiológicos foram comparados entre os grupos de estudo e de controle. Resultados O fluxo vaginal foi confirmado em 84% das mulheres do grupo de estudo versus 62,2% do grupo de controle (p< 0,01); prurido foi encontrado em 20 e 2,2%, respectivamente (p< 0,05). As úlceras genitais foram somente encontradas no grupo pessário (20%). Não houve diferenças com relação ao tipo de flora vaginal. A vaginose bacteriana fora encontrada em 31,1% das mulheres do grupo de estudo versus 22,2% do grupo de controle (p= 0,34). Conclusão Mulheres usando pessários vaginais para tratamento do POP apresentaram maior fluxo vaginal, prurido e úlcera genital do que as não usuárias do dispositivo.

Abstract Introduction Vaginal pessary is used as a conservative treatment for pelvic organ prolapse (POP). Some studies have shown that common complaints of its use may include vaginal discomfort and increased vaginal discharge. Scant information is available about the microflora status after using this device. Objective To determine if the usage of vaginal pessary can interfere with the vaginal environment. Methods A cross-sectional study was performed from March of 2014 to July of 2015 including 90 women with POP. The study group was composed of 45 women users of vaginal pessary and 45 nom-users. All enrolled women answered a standardized questionnaire and were subjected to a gynecological exam to collect vaginal samples for microbiological evaluation under optic microscopy. Clinical and microbiological data were compared between study and control groups. Results Vaginal discharge was confirmed in 84% of the study group versus 62.2% in the control group (p< 0.01); itching was reported in 20 and 2.2%, respectively (p< .05); genital ulcers were only found in the pessary group (20%). There was no difference with regard to the type of vaginal flora. Bacterial vaginosis was prevalent in the study group (31.1% study group versus 22.2% control group), (p=.34). Conclusion Women using vaginal pessaries for POP treatment presented more vaginal discharge, itching and genital ulcers than non-users.

Resumo Introdução Prolapso de órgãos pélvicos é problema de saúde públicas, sendo o mais comumo anterior. Para tratamento são utilizadas cirurgias, comou semtelas. O uso de telas é para diminuir recidivas, mas não h á consenso. Métodos Foi realizada revisão da literatura e metanálise, sobre uso de telas na correção do prolapso anterior. Base de dados foi PUBMED , com termos (MESH): "Anterior Pelvic Organ OR Cystocele AND Surgery AND (Mesh or Colporrhaphy)". Critérios de exclusão foram: seguimento menor que 1 ano, telas biológicas ou absorvíveis. Resultados: foram avaliados 115 artigos. Após revisão dos títulos, 70 estudos foram descartados e 18 após leitura de resumos. Após critérios de Jadad (>2), 12 estudos foram incluídos. Análise estatística foi razão de risco ou diferença entre médias dos grupos, e as análises com grande heterogeneidade foram avaliadas através de análise de efeito aleatório. Resultados Cura objetiva foi superior no grupo com tela - OR 1,28 (1,07-1,53, p 1 0,00001), maior perda sanguínea - diferença média (MD) 45,98 (9,72-82,25, p = 0,01), tempo cirúrgico mais longo - MD 15,08 (0,48-29,67, p = 0,04), porém menor recorrência - OR 0,22 (0,13-0,38, p = 0,00001), não apresentando maior resolução dos sintomas - OR 1,93 (0,83-4,51, p = 0,15). Dispareunia e taxa de reoperação também não foram diferentes entre grupos. Qualidade de vida não apresentou diferença. Conclusões Cirurgia com tela para prolapso vaginal anterior apresenta melhor taxa de cura anatômica e menor recorrência, sem diferenças cura subjetiva, reoperação e qualidade de vida. Há maior tempo cirúrgico e perda sanguínea. Uso de telas deve ser individualizado.

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 vaginalmeshes, 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.

Objetivo Avaliar os resultados da cirurgia de colpofixação sacroespinal associada a colporrafia anterior, para o tratamento de mulheres com prolapso de cúpula vaginal pós-histerectomia. Métodos Estudo prospectivo que incluiu 20 mulheres com prolapso de cúpula em estágio≥2 de acordo com o Sistema de Quantificação do Prolapso Genital (POP-Q) tratadas no período de janeiro de 2003 a fevereiro de 2006 e avaliadas emrevisão tardia (maior que um ano). O prolapso genital foi avaliado qualitativamente em estágios e, quantitativamente, emcentímetros. Como critério de cura, consideramos prolapso em estágio < 2. Para análise estatística, foi utilizado teste de Wilcoxon (amostras pareadas) para comparar os pontos e estágios dos prolapsos antes e depois da cirurgia. Resultados Na cúpula vaginal a avaliação após um ano mostrou 95% em estágio zero e 5% em estágio 1. Cistocele: 50% em estágio 1, 10% em estágio zero (curadas) e 40% emestágio 2. Retocele: trêsmulheres apresentavamestágio 1 (15%), uma emestágio 2 (5%) e dezesseis não apresentavam prolapso posterior. As complicações mais frequentes foramdor no glúteo direito com remissão do sintoma emtodos os três casos após três meses da cirurgia. Conclusões Neste estudo retrospectivo, a cirurgia de correção do prolapso de cúpula pela técnica de fixação no ligamento sacroespinal, associada à colporrafia anterior, se mostrou efetiva na resolução do prolapso genital com baixa taxa de complicações; porém com alta taxa de cistocele - o que pode ter sido decorrente do desvio vaginal posterior pela técnica, ou ainda uma supervalorização pelo sistema POP-Q.

Objective To evaluate the results of sacrospinous colpopexy surgery associated with anterior colporrhaphy for the treatment of women with post-hysterectomy vaginal vault prolapse. Methods This prospective study included 20women with vault prolapse, PelvicOrgan Prolapse Quantification System (POP-Q) stage≥2, treated between January 2003 and February 2006, and evaluated in a follow-up review (more than one year later). Genital prolapse was evaluated qualitatively in stages and quantitatively in centimeters. Prolapse stage < 2 was considered to be the cure criterion. Statistical analysis was performed using the Wilcoxon test (paired samples) to compare the points and stages of prolapse before and after surgery. Results Evaluation of the vaginal vault after one year revealed that 95% of subjects were in stage zero and that 5% were in stage 1. For cystocele, 50% were in stage 1, 10% were in stage 0 (cured) and 40% were in stage 2. For rectocele, three women were in stage 1 (15%), one was in stage 2 (5%) and 16 had no further prolapse. The most frequent complication was pain in the right buttock, with remission of symptoms in all three cases three months after surgery. Conclusions In this retrospective study, the surgical correction of vault prolapse using a sacrospinous ligament fixation technique associatedwith anterior colporrhaphy proved effective in resolving genital prolapse. Despite the low complication rates, there was a high rate of cystocele, which may be caused by posterior vaginal shifting due to either the technique or an overvaluation by the POP-Q system.

Objetivos: avaliar a utilização da conização por cirurgia de alta freqüência por alça (CAF) na neoplasia intra-epitelial cervical (NIC), a importância do comprometimento das margens de ressecção e o seguimento das pacientes. Métodos: foram avaliadas 95 mulheres submetidas à CAF por NIC entre janeiro de 1996 e dezembro de 1997. Para análise estatística, utilizamos o coeficiente de concordância kappa e o teste de tendência de Cochran Armitage. Resultados: dos 63 casos submetidos à biópsia dirigida antes da conização, o cone por CAF apresentou lesões mais graves que a biópsia em 24 casos, sendo um caso microinvasor, e em 8 mulheres a biópsia eliminou a lesão. Entre as pacientes submetidas à conização com biópsia prévia compatível com cervicite ou NIC 1, 14/25 (56%) apresentavam NIC 2 ou 3. Das 32 mulheres que não tinham biópsia prévia, 15 apresentavam NIC 2 ou 3, e quatro, carcinoma microinvasor no cone. Em relação às margens do cone, 25 casos (26%) apresentaram margens endocervicais comprometidas e quanto maior o grau da lesão cervical maior a possibilidade de presença de lesão nas margens (p = 0,024). Dessas pacientes, 2 de 10 submetidas a novo procedimento apresentavam doença residual na peça cirúrgica. Entre as 70 pacientes com margens livres foram realizadas três conizações a frio e uma histerectomia e duas apresentavam doença residual na peça cirúrgica. Conclusões: a conização por CAF sem biópsia prévia depende da combinação entre o diagnóstico citológico e a experiência do colposcopista e, em princípio, deve ser reservada para os casos em que a colpocitologia e a colposcopia são concordantes e compatíveis com NIC 2 ou 3. Por outro lado, a ampliação cirúrgica pós-CAF no tratamento da NIC não é determinada exclusivamente pelo comprometimento das margens, mas sim pelo seguimento, excluindo-se os casos de microinvasão e lesões glandulares que se beneficiam com a avaliação histológica posterior.

Purpose: to evaluate conization by the loop electrosurgical excision procedure (LEEP) for the diagnosis and treatment of cervical intraepithelial neoplasms (CIN), the importance of the margins and follow-up of these women. Methods: 95 women who underwent conization by LEEP for CIN and microinvasive carcinoma from January 1996 to December 1997 were evaluated. For statistical analysis, we used the kappa agreement coefficient and the tendency test of Cochran Armitage. Results: among 63 cases who underwent colposcopically directed biopsy before the conization, the cone presented the same grade of lesion in 20 and no residual disease in 8. The cone lesion presented a higher grade in 24 cases and one of them was a microinvasive carcinoma. Among the 25 women who underwent the cone biopsy with a previous biopsy suggestive of cervicitis or CIN 1, 56% had CIN 2 or 3 in the cone. Among the 32 women without previous biopsy, 15 had CIN 2 or 3, and four had microinvasive carcinoma in the cone. Regarding the margins of the cone, 25 cases presented some grade of CIN in the endocervical margins and 2/10 who underwent a second procedure presented residual disease on histological analysis. Among the 70 women with free cone margins, 2/4 who underwent a second procedure had residual disease on histological analysis. Conclusion: conization by LEEP without previous directed biopsy depends on the experience of the colposcopist. The second resection after LEEP for the diagnosis and treatment of CIN depends not only on the presence of disease in the cone margins but also on the follow-up. A second histological analysis is recommended in cases with microinvasive carcinoma and glandular lesion and affected margins.

Objetivo: investigar alguns aspectos epidemiológicos, clínicos e patológicos dos vários graus de neoplasia intra-epitelial vilvar (NIV) e sua relação com o papilomavírus humano (HPV). Métodos: foram analisados os prontuários de 46 mulheres atendidas no Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas de janeiro de 1986 a dezembro de 1997. Para análise estatística foram utilizados os testes do chi2, com correção de Yates quando necessário, e exato de Fisher. Em relação à gravidade da lesão vulvar, seis mulheres apresentavam NIV 1, seis NIV 2 e 34 NIV 3. Resultados: A idade, estado menstrual e idade da atividade sexual não estiveram relacionados com a gravidade da NIV, porém, as mulheres com mais de um parceiro sexual mostraram uma tendência maior a apresentar NIV 3 (p=0,090). O tabagismo esteve significativamente associado à gravidade da lesão vulvar (p= 0,031). O HPV foi mais freqüente nas mulheres com idade inferior a 35 anos (p=0,005) e naquelas com múltiplas lesões (p=0,089). Embora o número não tenha mostrado relação com a gravidade da NIV (p=0,703), lesões maiores que 2 cm estiveram significativamente associadas com NIV 3 (p=0,009). O tratamento mais utilizado para NIV 3 foi cirúrgico, com exérese ou vulvectomia simples. Entre as oito mulheres que apresentaram recidiva, apenas uma era portadora de NIV 2. Conclusões: Entre as mulheres com NIV, as fumantes e com mais de um parceiro sexual apresentaram lesões mais graves. A presença de HPV foi maior nas pacientes jovens com múltiplas lesões. Mulheres com NIV 3 apresentaram lesões maiores que 2 cm e uma alta taxa de recidiva, independentemente do tratamento utilizado.

The purpose of the present study was to evaluate some epidemiological, clinical and pathological characteristics of the different grades of vulvar intraepithelial neoplasia (VIN), and its relation with the presence of human papillomavirus (HPV). The charts of 46 women with VIN, examined from 1986 through 1997, were reviewed. For statistical analysis the chi² with yates correction when appropriate, and Fisher's exact tests were used. Regarding the grade of VIN, six women presented VIN 1, six others had VIN 2 and the remaining 34 presented VIN 3. All women presented similar characteristics such as age, menstrual status and age at first sexual intercourse. Women with more than one lifetime sexual partner had a tendency to show more VIN 3 (p = 0.090). Cigarette smoking was significantly associated with the severity of the vulvar lesion (p = 0.031). HPV was significantly more frequent in women younger than 35 years of age (p = 0.005) and in women with multiple lesions (p = 0.089). Although the number of lesions were not related to the severity of VIN (p = 0.703), lesions with extensions greater than 2 cm were significantly associated with VIN 3 (p = 0.009). The treatment of choice for VIN 3 was surgery, including local resection and simple vulvectomy. Eight women relapsed, and only one had VIN 2. We concluded that among women with VIN, cigarette smoking and more than one lifetime sexual partner were associated with high-grade lesions. HPV was more frequent among patients younger than 35 years of age presenting multiple lesions. Women with VIN 3 presented lesions bigger than 2 cm and a high relapse rate, despite the type of treatment applied.