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
6 resultados
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- A randomized trial comparing vaginal laser therapy and pelvic floor physical therapy for treating women with stress urinary incontinence(2023) FONSECA, Lucilia C. da; GIARRETA, Fernanda Bacchi Ambrosano; PETERSON, Thais V.; LOCALI, Priscila Katsumi Matsuoka; BARACAT, Edmund C.; FERREIRA, Elizabeth A. Goncalves; HADDAD, Jorge MilhemIntroductionFemale stress urinary incontinence (SUI) is considered a major public health issue. Physical therapy is an important conservative treatment; however, it is primarily limited by poor long-term compliance. Furthermore, surgical treatment entails significant risks. Therefore, new treatment techniques must be identified. ObjectiveTo compare the use of laser therapy and pelvic floor (PF) physical therapy for treating postmenopausal women with SUI. MethodsThis pilot study enrolled 40 women with a clinical and urodynamic diagnosis of SUI who were randomized into two groups: those who received erbium-doped yttrium-aluminum-garnet (Er:YAG) laser therapy implemented over three sessions with a 1-month interval (n = 20) and those who received physical therapy with supervision twice a week for 3 months (n = 20). In total, 16 women completed the treatment in each group. The patients were assessed for PF function using the modified Oxford scale and for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System. The 1-h pad test and quality of life questionnaires, King's Health Questionnaire (KHQ), and Incontinence Quality of Life (IQOL) were also administered. Patients were re-evaluated at 1, 3, 6, and 12 months after treatment. ResultsThe mean patient age was 62.7 & PLUSMN; 9.1 and 57.9 & PLUSMN; 6.1 years, median Oxford score at baseline was 3 (2-4.5) and 4 (3-4), mean IQOL score was 79.8 & PLUSMN; 17 and 74.6 & PLUSMN; 18 for physical therapy group (PTG) and laser group (LG), respectively. For the amount of urine leak in the 1-h pad test evaluation, we found significance for the interaction of group and time points only for the Laser intragroup. The cure rate, that is, the rate of reaching an insignificant score in the pad test, at 6 and 12 months was 43.75% and 50% in PTG and 62.5% and 56.25% in the LG, respectively (p > 0.05). IQOL scores demonstrated considerable improvement in both groups (p > 0.05). Upon comparing the initial and follow-up results, the LG showed an improvement at all consultations, whereas the PTG showed improvements at 1, 3, and 6 months but not at 12 months after treatment. KHQ analysis revealed a considerable improvement in the quality of life (QOL) of patients over time, with no substantial difference between the groups. QOL comparison before and after treatment revealed that the vaginal LG improved more consistently in some domains. Only the PTG showed a significant increase in the mean Oxford score from pretreatment to 1 and 3 months after treatment (p < 0.001 and p = 0.002, respectively). However, no statistically significant difference was observed between the groups. ConclusionBoth treatments are safe and have a positive influence on the impact of UI on patients' QOL. The laser caused a greater reduction in the urinary loss, as measured using the weight of pad test, at 6-month and 12-month after treatment without difference with PTG at the end of the follow-up.
- Comparison between anterior and posterior vaginal approach in apical prolapse repair in relation to anatomical structures and points of fixation to the sacrospinous ligament in fresh postmenopausal female cadavers(2023) JUNQUEIRA, Silvia Cristiane Alvarinho; LOURENCO, Thais Regina de Mattos; SOARES JUNIOR, Jose Maria; FONSECA, Lucilia Carvalho da; BARACAT, Edmund Chada; HADDAD, Jorge MilhemIntroduction and hypothesis The high prevalence of pelvic organ prolapse (POP) in women requires attention and constant review of treatment options. Sacrospinous ligament fixation (SSLF) for apical prolapse has benefits, high efficacy, and low cost. Our objective is to compare anterior and posterior vaginal approach in SSLF in relation to anatomical structures and to correlate them with body mass index (BMI). Methods Sacrospinous ligament fixation was performed in fresh female cadavers via anterior and posterior vaginal approaches, using the CAPIO (R) SLIM device (Boston Scientific, Natick, MA, USA). The distances from the point of fixation to the pudendal artery, pudendal nerve, and inferior gluteal artery were measured. Results We evaluated 11 cadavers with a mean age of 70.1 +/- 9.9 years and mean BMI 22.4 +/- 4.6 kg/m(2). The mean distance from the posterior SSLF to the ischial spine, pudendal artery, pudendal nerve, and inferior gluteal artery were 21.18 +/- 2.22 mm, 17.9 +/- 7.3 mm, 19.2 +/- 6.8 mm, and 18.9 +/- 6.9 mm respectively. The same measurements relative to the anterior SSLF were 19.7 +/- 2.7 mm, 18.6 +/- 6.7 mm, 19.2 +/- 6.9 mm, and 18.3 +/- 6.7 mm. Statistical analysis showed no difference between the distances in the two approaches. The distances from the fixation point to the pudendal artery and nerve were directly proportional to the BMI. Conclusions There was no difference in the measurements obtained in the anterior and posterior vaginal approaches. A direct correlation between BMI and the distances to the pudendal artery and pudendal nerve was found.
conferenceObject Pelvic floor structures fiber direction after vaginal birth as seen on ultrasound: feasibility study(2023) PIPITONE, F.; MASTELING, M.; CHEN, L.; HADDAD, J. Milhem; DELANCEY, J. O.- AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery(2022) LATTHE, Pallavi; MARQUINI, Gisele Vissoci; ACHTARI, Chahin; HADDAD, Jorge; JANKOWSKI, Christopher J.; HEISLER, Christine A.; REAGAN, Krista; HICKMAN, Lisa C.; PANZA, JosephIntroduction and hypothesis Enhanced recovery after surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing urogynecological surgery. Methods A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and review articles was conducted via PubMed and other databases for ERAS and urogynecological surgery. ERAS protocol components were established, and then quality of the evidence was both graded and used to form consensus recommendations for each topic. These recommendations were developed and endorsed by the writing group, which is comprised of the American Urogynecologic Society and the International Urogynecological Association members. Results All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. The components of ERAS with a high level of evidence to support their use include fasting for 6 h and taking clear fluids up to 2 h preoperatively, euvolemia, normothermia, surgical site preparation, antibiotic and antithrombotic prophylaxis, strong antiemetics and dexamethasone to reduce postoperative nausea and vomiting, multimodal analgesia and restrictive use of opiates, use of chewing gum to reduce ileus, removal of catheter as soon as feasible after surgery and avoiding systematic use of drains/vaginal packs. Conclusions The evidence base and recommendations for a urogynecology-relevant ERAS perioperative care pathway are presented in this consensus review. There are several elements of ERAS with strong evidence of benefit in urogynecological surgery.
conferenceObject Appearance of the Normal and Abnormal Perineal Membrane On MRI(2022) PIPITONE, F.; CHEN, L.; SWENSON, C.; HADDAD, Milhem J.; DELANCEY, J.- AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery(2023) LATTHE, Pallavi; MARQUINI, Gisele Vissoci; ACHTARI, Chahin; HADDAD, Jorge; PANZA, Joseph; JANKOWSKI, Christopher. J.; HEISLER, Christine. A.; REAGAN, Krista; HICKMAN, Lisa. C.