Efectividad de los tratamientos no farmacológicos para el manejo de los síntomas urinarios del tracto bajo en pacientes con esclerosis múltiple: revisión sistemática de la literatura

dc.contributor.advisorDonoso Donoso, Wilfredospa
dc.contributor.advisorCastañeda Millan, David Andresspa
dc.contributor.authorRivera Villamil, Jorge Enriquespa
dc.contributor.orcidRivera Villamil, Jorge Enrique [0000000172711838]spa
dc.contributor.researchgroupGrupo de Investigación e Innovación en Urología Universidad Nacional de Colombiaspa
dc.date.accessioned2024-02-01T18:27:07Z
dc.date.available2024-02-01T18:27:07Z
dc.date.issued2023-12
dc.description.abstractLa prevalencia de síntomas urinarios del tracto bajo en pacientes con esclerosis múltiple varía en la literatura entre 32-96%. Se ha mostrado un efecto negativo sobre la calidad de vida, además de su asociación a complicaciones como la enfermedad renal crónica, las infecciones urinarias a repetición y la enfermedad litiásica. En la actualidad hay pocas opciones terapéuticas farmacológicas como los anticolinérgicos, los beta-3 agonistas y terapias intravesicales como la inyección de toxina botulínica intravesical. Sin embargo, estas terapias no son inocuas y pueden estar asociadas a efectos adversos, baja efectividad o disminución de su efectividad con el tiempo. Es por esto que es importante evaluar la efectividad de terapias no farmacológicas disponibles con el fin de mejorar la calidad de vida de estos pacientes y encontrar alternativas o adyuvantes a la terapia farmacológica. Nuestro objetivo fue determinar cuál es la efectividad de las terapias no farmacológicas para el manejo de los síntomas urinarios del tracto bajo en pacientes con esclerosis múltiple, con base a una revisión sistemática de la literatura Se realizo una revisión sistemática de la literatura de acuerdo con las guías PRISMA para la publicación de metaanálisis y revisiones sistemáticas, previo registro del protocolo en la base de datos PROSPERO. Se usaron las bases de datos de MEDLINE, EMBASE, biblioteca Cochrane y Clinicaltrial.gov con términos asociados a esclerosis múltiple y terapias no farmacológicas como terapia de piso pélvico, neuromodulación sacra, neuromodulación tibial, y estimulación magnética transcraneal. De los 2490 estudios encontrados en la búsqueda se seleccionaron 18 estudios para revisión completa, 11 de ellos ensayos clínicos aleatorizados y 7 ensayos clínicos controlados no aleatorizados. A pesar de la heterogeneidad de los estudios, la neuroestimulacion tibial posterior y la terapia de piso pélvico, especialmente con electroestimulación, mejoraron los síntomas de hiperactividad vesical, la incontinencia de urgencia, la fuerza del piso pélvico y se vieron traducidos en mejor calidad de vida En conclusión, las terapias no farmacológicas emergentes como la terapia de piso pélvico y la neuroestimualcion tibial posterior son alternativas efectivas para el manejo de los síntomas urinarios del tracto bajo en pacientes con EM. (Texto tomado de la fuente)spa
dc.description.abstractLower urinary tract symptoms in patients with multiple sclerosis have a prevalence reported in literature between 32-96%. Their negative impact on quality of life and its association with various complications such as renal kidney disease, urinary tract infections and stone disease have been documented. Nowadays, there is a few pharmacological therapies such as anticholinergics, betta-3 receptor agonists and intravesical injection of botulinum toxin. However, these therapies are not free of adverse effects, low or diminished effectiveness with repeat usage. Therefore, it is important to evaluate the effectiveness of non-pharmacological therapies available to improve quality of life in these patients and be able to offer alternatives or adjuncts to pharmacological therapies. The objective of our study was to determine the effectiveness of non-pharmacological therapies for the treatment of lower urinary tract symptoms in patients with multiple sclerosis, based on a systematic review of literature. We performed a review of the literature based on the PRISMA guidelines for the publication of systemic reviews and metanalyses after publishing of the protocol on the PROSPERO data base. The data bases consulted were MEDLINE, EMBASE, Cochrane library and Clinicaltrial.gov, using terms related to multiple sclerosis and non-pharmacological therapies such as: pelvic floor muscle training, sacral neuromodulation, tibial nerve neuromodulation and transcranial magnetic stimulation. From the 2490 studies retrieved, 18 were selected for complete review; 11 of these were randomized controlled trials and 7 were non-randomized controlled trials. Despite heterogeneity of the studies, posterior nerve neurostimulation and pelvic floor training with electrical stimulation improve bladder hyperactivity, urge urinary incontinence, pelvic floor strength and quality of life. In conclusion, emerging non-pharmacological therapies such as pelvic floor training and posterior nerve neurostimulation are effective alternatives for treatment of urinary tract synptoms in patients with multiples sclerosis.eng
dc.description.degreelevelEspecialidades Médicasspa
dc.description.degreenameEspecialista en Urologíaspa
dc.description.methodsSe realizó una revisión sistemática de la literatura de acuerdo con las guías PRISMA para la publicación de metaanálisis y revisiones sistemáticas, previo registro del protocolo en la base de datos PROSPERO. La búsqueda de la literatura se hizo a través de las bases de datos de MEDLINE, EMBASE, biblioteca Cochrane y Clinicaltrial.gov usando los términos asociados a EM y terapias no farmacológicas como TPP, NMS, EENTP, y EMTC. Se incluyeron ensayos clínicos (aleatorizados o no aleatorizados) publicados hasta febrero de 2023 que evaluaron la efectividad de terapias no farmacológicas en pacientes con EM. Se incluyeron estudios que evaluaron la efectividad de las terapias, tanto subjetivamente a través de cuestionarios validados, como objetivamente a través de parámetros urodinámicos y ecográficos. Se incluyeron estudios que compararon la efectividad de las terapias no farmacológicas entre ellas, con placebo o con terapias farmacológicas usadas en la actualidad (anticolinérgicos, la inyección de toxina botulínica y los beta-3 agonistas). La revisión de la literatura, la selección de artículos, la evaluación de la calidad de los estudios y la extracción de los datos se realizó independientemente por dos autores. Un autor se encargó de hacer la selección primaria de los artículos incluidos y estos fueron revisados en conjunto con el segundo autor. 2.1 Criterios de inclusión Se incluyeron ensayos clínicos, tanto aleatorizados como no aleatorizados en cualquier idioma, de pacientes con diagnóstico de esclerosis múltiple de acuerdo con los criterios de McDonald considerando síntomas clínicos, características neurológicas y criterios imagenológicos; se incluyeron todas las variantes fenotípicas de la enfermedad, pacientes de ambos sexos, mayores de 18 años, sin límite de edad. 2.2 Criterios de exclusión Se excluyeron cartas al editor, estudios de casos y controles, reportes de caso o de corte transversal. También se excluyeron estudios de los cuales no se pudo obtener el texto completo. 2.3 Extracción de la información De los estudios seleccionados se extrajeron varios datos: el número de participantes, el número de participantes femeninos o masculinos, los datos del primer autor, el año y lugar de publicación, sus criterios de inclusión y exclusión. De la información relacionada con los síntomas urinarios, se evaluó la frecuencia urinaria, urgencia, nocturia, numero de episodios de incontinencia, cuestionarios de síntomas, escalas calidad de vida y parámetros de fuerza del piso pélvico. Así mismo, se extrajo información de parámetros urodinámicos como el RPM, la capacidad cistométrica máxima, presión máxima del detrusor, compliance vesical, siempre que fueran reportados. 2.4 Evaluación del riesgo de sesgos Una vez extraídos los datos de los estudios seleccionados y revisados por los 2 investigadores principales, la herramienta para evaluación critica de estudios de JBI actualizada en 2023 y disponible en jbi.global se usó para evaluar la calidad de los estudios, de acuerdo con el tipo de estudio.spa
dc.description.researchareaNeurourologíaspa
dc.format.extent51 páginasspa
dc.format.mimetypeapplication/pdfspa
dc.identifier.instnameUniversidad Nacional de Colombiaspa
dc.identifier.reponameRepositorio Institucional Universidad Nacional de Colombiaspa
dc.identifier.repourlhttps://repositorio.unal.edu.co/spa
dc.identifier.urihttps://repositorio.unal.edu.co/handle/unal/85594
dc.language.isospaspa
dc.publisherUniversidad Nacional de Colombiaspa
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotáspa
dc.publisher.facultyFacultad de Medicinaspa
dc.publisher.placeBogotá, Colombiaspa
dc.publisher.programBogotá - Medicina - Especialidad en Urologíaspa
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dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.licenseAtribución-NoComercial-SinDerivadas 4.0 Internacionalspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/spa
dc.subject.ddc610 - Medicina y salud::616 - Enfermedadesspa
dc.subject.ddc610 - Medicina y salud::615 - Farmacología y terapéuticaspa
dc.subject.decsEsclerosis múltiplespa
dc.subject.decsMultiple sclerosiseng
dc.subject.decsIncontinencia urinariaspa
dc.subject.decsUrinary incontinenceeng
dc.subject.proposalSíntomas urinariosspa
dc.subject.proposalEsclerosis múltiplespa
dc.subject.proposalUrgencia urinariaspa
dc.subject.proposalTenesmo urinariospa
dc.subject.proposalIncontinencia urinariaspa
dc.subject.proposalEjercicio de piso pélvicospa
dc.subject.proposalNeuromodulacion sacraspa
dc.subject.proposalEstimulación magnética transcranealspa
dc.subject.proposalNeuroestimulacion tibialspa
dc.subject.proposalLower urinary tract symptomseng
dc.subject.proposalMultiple sclerosiseng
dc.subject.proposalUrinary urgencyeng
dc.subject.proposalUrinary tenesmuseng
dc.subject.proposalUrinary incontinenceeng
dc.subject.proposalPelvic floor exerciseseng
dc.subject.proposalSacral neuromodulationeng
dc.subject.proposalTranscranial magnetic stimulationeng
dc.subject.proposalTibial neuromodulationeng
dc.subject.umlsEjercicios para el piso pélvicospa
dc.subject.umlsPelvic floor exerciseseng
dc.subject.umlsNeurostimulation procedureeng
dc.subject.umlsProcedimiento de neuroestimulaciónspa
dc.subject.umlsMúsculo detrusor de la vejigaspa
dc.subject.umlsBladder detrusor muscleeng
dc.titleEfectividad de los tratamientos no farmacológicos para el manejo de los síntomas urinarios del tracto bajo en pacientes con esclerosis múltiple: revisión sistemática de la literaturaspa
dc.title.translatedEffectiveness of non-phramacological therapies for treatment of lower urinary tract symptoms in patients with multiple sclerosis: systemic review of the literatureeng
dc.typeTrabajo de grado - Especialidad Médicaspa
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Efectividad de los tratamientos no farmacologicos para el manejo de los sintomas urinarios del tracto bajo en pacientes con esclerosis multiples - revision sistematica de la literatura.pdf
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Tesis de Especialidad en Urología

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