JORGE MILHEM HADDAD
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject A review of mobile voiding diary apps: Content and functionality features(2018) VACCARI, N.; SILVEIRA, L.; HADDAD, J.; BARACAT, E.; BERTOLINI, M. A.; FERREIRA, E.- Pelvic floor muscle function and quality of life in postmenopausal women with and without pelvic floor dysfunction(2018) FROTA, Isabella Parente Ribeiro; ROCHA, Adriana Bombonato Oliveira; VASCONCELOS NETO, Jose Ananias; VASCONCELOS, Camila Teixeira Moreira; MAGALHAES, Thais Fontes De; KARBAGE, Sara Arcanjo Lino; AUGUSTO, Kathiane Lustosa; NASCIMENTO, Simony Lira Do; HADDAD, Jorge Millem; BEZERRA, Leonardo Robson Pinheiro SobreiraIntroductionThis study aims to compare pelvic floor muscle (PFM) function in postmenopausal women with and without pelvic floor dysfunction (PFD) and the relation between PFM function and quality of life. Material and methodsA case-control study with 216 postmenopausal women with (n=126) and without (n=90) PFD. PFM function was assessed by digital vaginal palpation using the PERFECT scale. Specific quality of life was evaluated using the King's Health Questionnaire for women with urinary incontinence and the Prolapse Quality-of-Life Questionnaire for women with pelvic organ prolapse. We analyzed women with PFD into two categories: Oxford's grade 2 or 3 using a chi-squared test. ResultsOut of 126 womem with PFD 44 (34.9%) presented stress urinary incontinence, 21 (16.6%) had pelvic organ prolapse and 61 (48.4%) had urinary incontinence + pelvic organ prolapse. Strength had a median value 2 (0-5) in all women studied and most of them had insufficient strength, reduced endurance and repetition without statistical difference between groups. Incontinent women with strength 2 had worse perception of general health domain of King's Health Questionnaire (p=0.007). No association was found between PFM function and Prolapse Quality-of-Life Questionnaire. ConclusionsPFM function assessed by bidigital palpation in postmenopausal women was not sufficiently sensitive to differentiate between women with vs. women without PFM dysfunction and was not related with specific quality of life in women with urinary incontinence and pelvic organ prolapse, respectively. These data should be used to reinforce the widespread recommendation that PFM training is essencial in PFD treatment.
conferenceObject Transcutaneous tibial nerve electrical stimulation combined with transvaginal electrical stimulation in the treatment of overactive bladder syndrome: a blind randomized clinical trial(2018) GIARRETA, F.; HADDAD, J.; FUSCO, H.; BARACAT, E.; CASAROTTO, R.; FERREIRA, E.- Surgical Treatment for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis(2018) OLIVEIRA, Leticia Maria de; DIAS, Marcia Maria; MARTINS, Sergio Brasileiro; HADDAD, Jorge Milhem; GIRAO, Manoel Joao Batista Castello; CASTRO, Rodrigo de AquinoObjective To compare surgical treatments for stress urinary incontinence in terms of efficiency and complications. Data Sources We searched the MEDLINE and COCHRANE databases using the terms stress urinary incontinence , surgical treatment for stress urinary incontinence and sling . Selection of Studies Forty-eight studies were selected, which amounted to a total of 6,881 patients with scores equal to or higher than 3 in the Jadad scale. Data Collection Each study was read by one of the authors, added to a standardized table and checked by a second author. We extracted data on intervention details, follow-up time, the results of treatment and adverse events. Data Synthesis Comparing retropubic versus transobturator slings, the former was superior for both objective (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.05-1.54) and subjective (OR, 1.23; 95% CI, 1.02-1.48) cures. Between minislings versus other slings, there was a difference favoring other slings for subjective cure (OR, 0.58; 95% CI, 0.39-0.86). Between pubovaginal sling versus Burch surgery, there was a difference for both objective (OR, 2.04; 95% CI, 1.50-2.77) and subjective (OR, 1.64; 95% CI, 1.10-2.44) cures, favoring pubovaginal sling. There was no difference in the groups: midurethral slings versus Burch, pubovaginal sling versus midurethral slings, transobturator slings, minislings versus other slings (objective cure). Retropubic and pubovaginal slings are more retentionist. Retropubic slings have more bladder perforation, and transobturator slings, more leg and groin pain, neurological lesion and vaginal perforation. Conclusion Pubovaginal slings are superior to Burch colposuspension surgery but exhibit more retention. Retropubic slings are superior to transobturator slings, with more adverse events. Other slings are superior to minislings in the subjective aspect. There was no difference in the comparisons between midurethral slings versus Burch colposuspension surgery, pubovaginal versus midurethral slings, and inside-out versus outside-in transobturator slings.
- Urinary incontinence in female athletes: a systematic review(2018) LOURENCO, Thais Regina de Mattos; MATSUOKA, Priscila Katsumi; BARACAT, Edmund Chada; HADDAD, Jorge MilhemPeople are increasingly aware of healthy lifestyles. Extenuating practice can injure the pelvic floor. Urinary incontinence (UI) is a prevalent condition in women whether they exercise professionally or not. The most common symptom is stress UI. It is reported in a large variety of sports and may interfere with everyday life or training, leading athletes to change or compromise their performance or risk compromising it. We aimed to assess the prevalence of UI in female athletes and to determine whether the type of sport might also influence UI. A systematic review of the literature was performed by searching PubMed, the Cochrane Library, and LILACS up to 23 January 2017. The search strategy included the keywords pelvic floor disorders, urinary incontinence, athletes, and sports. The inclusion criterion was studies of women who performed any kind of sport with a prevalence of UI. The subjects were female, with no restriction for age, sport modality, or frequency of training. The outcome was prevalence of UI. The search identified 385 studies, 22 of which met the methodologic criteria for complete analysis. In this review, 7507 women aged 12 to 69 years were included. Only five studies compared physically active women to controls. Every study included high or moderate impact activities involving jumping, fast running, and rotational movements. In total, 17 sport modalities were analyzed. The prevalence of UI varied from 5.56% in low-impact activity to 80% in trampolining. In athletes, the prevalence of incontinence ranged from 10.88% to 80%, showing that the amount of training influences UI symptoms. High-impact activities showed a 1.9-fold prevalence over medium-impact activities and 4,59-fold prevalence over impact activities. Factors such as hormone use, smoking, or menopausal status could not be assessed since they were not detailed in most of the studies. These data suggest that sports practice increases the prevalence of UI and that the type of activity performed by women also has a bearing on the disorder.
- Systematic Review of Oral Therapy for the Treatment of Symptoms of Bladder Pain Syndrome: The Brazilian Guidelines(2018) SANTOS, Thais Guimaraes dos; MIRANDA, Isabela Albuquerque Severo de; NYGAARD, Christiana Campani; SCHREINER, Lucas; CASTRO, Rodrigo de Aquino; HADDAD, Jorge MilhenInterstitial cystitis (IC), including bladder pain syndrome (BPS), is a chronic and debilitating disease that mainly affects women. It is characterized by pelvic pain associated with urinary urgency, frequency, nocturia and negative urine culture, with normal cytology. In 2009, the Society for Urodynamics and Female Urology (SUFU) defined the term IC/BPS as an unpleasant sensation (pain, pressure, and discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than 6 weeks duration, in the absence of infection or other identifiable causes. This is the definition used by the American Urological Association (AUA) in the most recent guidelines on IC/BPS. Interstitial cystitis may be sufficiently severe to have a devastating effect on the quality of life, but it may also be associated with moderate symptoms whose effects are less debilitating. Although there are several clinical trials to assess oral and intravesical therapies, the treatment for IC remains far from ideal. This systematic assessment evaluates published randomized clinical trials on oral medications used to treat symptoms of BPS. This study was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. Two independent reviewers screened the studies to determine their inclusion or exclusion and to perform the methodological analysis. The inclusion criteria included randomized studies published between April of 1988 and April of 2016 that used oral medications to treat symptoms of BPS or IC. According to the systematic review performed, we should consider pentosan polysulfate as one of the best options of oral drugs for the treatment of BPS symptoms. However, this drug is not an available option in Brazil. Orally administered amitriptyline is an efficacious medical treatment for BPS, and it should be the first treatment offered.
conferenceObject Multicenter, randomized trial comparing native vaginal tissue repair and synthetic mesh repair for genital prolapse treatment: 5 years follow-up(2018) SILVEIRA, S. dos Reis Brandao da; AUGE, A. Pedro; BELLA, Z. Ilona Katalin de Jarmy-Di; NASTRI, F.; MARGARIDO, P. Francisco Ramos; CARRAMAO, S. Silva; RODRIGUES, C. Alves; BARACAT, E. Chada; HADDAD, J. Milhem