Prevalência dos sintomas urinários e efeitos da eletroestimulação superficial parassacral em comparação à eletroestimulação superficial no nervo tibial posterior nos sintomas urinários de mulheres com doenças desmielinizantes: um estudo de viabilidade

Abstract

Considering the need to investigate the prevalence and associated factors of the urinary symptoms of individuals with demyelinating diseases residing in Ceará, in addition to investigate feasible and effective therapeutic strategies in this population, this doctoral thesis was divided in two studies. The first study consists of a cross-sectional study which aim was to investigate the prevalence of urinary symptoms and to describe associated factors in women with demyelinating diseases. The second study consisted of a feasibility study of a randomized controlled trial on the effects of the therapeutic strategies electrostimulation parassacral and electrostimulation of the posterior tibial nerve in women with demyelinating diseases residing in Ceará. For the prevalence study, women with demyelinating disease were questioned about the presence of urinary symptoms, following the International Continence Society. Spearman's correlation and chi-square coefficients were calculated to assess the associations between the presence of urinary symptoms and clinical-demographic variables. Logistic regression was used to identify the multivariate predictors of urinary symptoms. 133 women were included in the first study. Of these, 83 (62.4%) had at least one symptom. Urinary incontinence (74%) was the most prevalent symptom. Age, type of demyelinating disease, time of diagnosis, body mass index, weakness, sphincteric disorder and walking disorder were significantly correlated with urinary symptoms (r = 0.35, 0.164, 0.164, 0.171, 3.95, 20.57 and 10,19, respectively; p <0.07). Only sphincter dysfunction (OR 11.4, 95% CI 2.5-52.2, p = 0.002) and walking disorder (OR 3.7, 95% CI 1.1-12.4, p = 0.035) were maintained in the model. Together, they explained 69% of the variation in the questionnaire scores on the presence of urinary symptoms. For the feasibility study, a randomized controlled Phase I trial was implemented with 16 women with urinary symptoms. The women were randomly assigned to receive Parassacral Electrostimulation (experimental group) or Electrostimulation of the Posterior Tibial Nerve (control group) once a week for 30 minutes, during approximately 3 months, resulting in 12 sessions. The number of women screened, eligible and recruited was recorded. Presence in the sessions of electrostimulation and adherence to treatment and measurement protocols were recorded. Of the 133 women with demyelinating diseases screened, eighty-three (62%) were eligible and twenty (15%) agreed to initiate treatment. However, only 16 (12%) presented for the first intervention session. The presence rate was 88% and adherence rates to the protocols of measurement and treatment were 100%. No adverse effects of the intervention were reported. In conclusion, the prevalence of urinary tract symptoms was 62%. Urge incontinence was the most prevalent symptom. The main contributors to the symptoms were sphincter dysfunction and gait disturbance. Considering the feasibility study, it was concluded that recruitment, presence and adherence rates were adequate. These results demonstrated that the therapeutic strategies of parassacral electrostimulation and electrostimulation of the posterior tibial nerve are feasible and well tolerated by women with demyelinating diseases, suggesting the need for a randomized controlled Phase II trial.