O desempenho da escala de Oxford e do biofeedback manométrico perineal na avaliação da incontinência urinária de esforço em mulheres no período do climatério

Abstract

Aims: To verify the efficiency of two methods for perineal muscle strength assessment - vaginal digital palpation using the modified Oxford scale and manometric perineal biofeedback - in the diagnosis of stress urinary incontinence in climacteric women. Methods: The study population consisted of women aged 35 to 65 years (in the climacteric) enrolled at Family Health Strategy units in two southern Brazilian towns (Ijuí and Catuípe). The following inclusion criteria were used for sample selection: functional assessment of the urinary tract (history and physical examination) and continent women or women with stress urinary incontinence. The evaluation of pelvic floor functionality was performed by digitally palpating the vaginal and perineal muscles and measuring perineal pressure using manometric perineal biofeedback. The data were analyzed using IBM SPSS 18.0. The association between the degree of muscle strength and continence status was analyzed using the chi-square test. The perineal pressure mean values, based on the degree of muscle strength, were calculated by the Mann-Whitney test for independent samples. A p value ≤0.05 was considered statistically significant. Results: The study included 50 women - 28 (56%) with urinary continence and 22 (44%) with stress urinary incontinence. No statistically significant association was observed between the degree of muscle strength and urinary continence status (p=0.96). No statistically significant difference was found in the comparison of the perineal pressure mean values of continent and incontinent women. A positive predictive value of 93% was obtained with manometric perineal biofeedback, but its accuracy was as low as 46% whereas that of the modified Oxford scale was 54%. Conclusions: Neither of the methods used to assess the functionality of the pelvic floor muscles - Oxford scale and manometric perineal biofeedback - when used separately, were conclusive regarding the diagnosis of stress urinary incontinence in climacteric women.