Fórum Público para a Promoção do

Tratamento da Incontinência Urinária

04 de Novembro de 2015

Incontinência Urinária na América Latina

Valter Yasushi HonjiProf. Assistentes da Disciplina Urologia da Faculdade de Medicina de

Sorocaba do Centro de Ciências Médicas e da Saúde da Pontifícia Universidade Católica de São Paulo

América Latina

• Região do continente americano que engloba os países onde são faladas, primordialmente, línguas românicas (derivadas do latim) — espanhol, português e francês.

• Área de cerca de 21 069 501 km2 ;

• População de 569 milhões de pessoas, em 2008.

Índice de Desenvolvimento Humano

medida comparativa usada para classificar os países ( ìndice de educação, longevidade e renda per capita)

• Desenvolvidos: desenvolvimento humano muito alto.

• Em desenvolvimento: desenvolvimento humano médio e alto.

• Subdesenvolvidos: desenvolvimento humano baixo.

Concluindo• Região heterogênea, com povos culturalmente distintos e de índices de

desenvolvimento extremamente variáveis

• Impacto direto acesso ao tratamento médico e na disponibilidade de informações epidemiológicas

Dados disponíveis• Pubmed

• Lilacs

• Scielo

Overactive bladder: prevalence and implications in Brazil.Teloken C, Caraver F, Weber FA, Teloken PE, Moraes JF, Sogari PR, Graziottin TM. Eur Urol. 2006 Jun;49(6):1087-92. Epub 2006 Feb 9.

OBJECTIVES: To assess overactive bladder (OAB) prevalence, associated factors and implications in a young population.

METHODS: An independent population-based study was carried out. A self-applicative questionnaire covering urinary

symptoms, coping strategies, quality of life and treatment seeking behavior was developed.

RESULTS: A total of 848 subjects between 15 and 55 years completed the questionnaire. The overall prevalence of OAB

was 18.9%. Women were significantly more affected than men (p = 0.001). All age groups were equally affected (p = 0.152). Subjects with OAB reported significant impairment on household chores (p = 0.009), physical activities (p = 0.016), sleep (p < 0.001), work (p < 0.001), social life (p < 0.001) and sexual life (p < 0.001). In addition, OAB individuals present higher prevalence of depression (p = 0.036), anxiety (p < 0.001), shame (p < 0.001) and tiredness (p < 0.001) OAB was independently associated to sexual life impairment (OR = 3.36, 95% CI=1.20-9.39). Only 27.5% of OAB subjects sought for medical counseling.

CONCLUSIONS: OAB is a highly prevalent condition, even in such a young population. It affects both genders, yet it is more frequently observed in women. OAB is an important health condition, with serious impact on quality of life and sexual function. A large percentual of individuals remain unrecognized, under treated and consequently suffer for long periods of time

Association between urinary incontinence in elderly patients and caregiver burden in the city of Sao Paulo/Brazil: Health, Wellbeing, and Ageing Study.

Tamanini JT1, Santos JL, Lebrão ML, Duarte YA, Laurenti R. Neurourol Urodyn. 2011 Sep;30(7):1281-5. doi: 10.1002/nau.21040. Epub 2011 May 10.

Some elderly patients with incontinence require the care of third parties, known as caregivers. Such care can occur on a daily basis leaving little opportunity for the caregiver to take care of himself/herself. The aims are to assess the association between urinary incontinence in elderly patients and caregiver burden and identify independent factors for caregiver's burden in the city of Sao Paulo, Brazil.METHODS: The Pan-American Health Organization and World Health Organization coordinated a multicenter study named Health, Wellbeing and Aging (SABE Study) in elderly people living in seven countries of Latin America and the Caribbean. In Brazil, the study population carried out in São Paulo in the year 2000 and reassessed in 2006 (COHORT A). Urinary incontinence was assessed by ICIQ-SF and caregiver burden by means of Zarit Burden Scale.RESULTS: A total of 327 patients with caregivers were included in the study. The general prevalence of urinary incontinence was 25.8%, higher among the women. There was a significant positive association between caregiver burden and incontinent patients, demonstrating that urinary incontinence in elderly patients produced greater caregiver burden. In the present study, the variables with significant correlations were assessed using the multivariate logistic regression model. Category 2 of the ICIQ-SF (incontinent patients) increased the chances of caregiver burden 1.96-fold in comparison to Category 1 (continent patients). Likewise, the category of impaired cognition increased the chances of caregiver burden 2.34-fold.CONCLUSIONS: Urinary incontinence and cognitive impairment in elderly patients were associated to an increase in caregiver burden.

Analysis of the prevalence of and factors associated with urinary incontinence among elderly people in the Municipality of São Paulo, Brazil: SABE Study (Health, Wellbeing and Aging).

Tamanini JT, Lebrão ML, Duarte YA, Santos JL, Laurenti R. Cad Saude Publica. 2009 Aug;25(8):1756-62.

AbstractTo investigate the prevalence of urinary incontinence among elderly people living in São Paulo, Brazil and their associated risk factors. The Pan-American Health Organization and World Health Organization coordinated a multicenter study named Health, Wellbeing and Aging (SABE Study) in elderly people (over 60 years old) living in seven countries in Latin America and the Caribbean. In Brazil, the study was carried out in São Paulo in the year 2000. The total Brazilian sample included 2,143 people. The prevalence of self reported urinary incontinence was 11.8% among men and 26.2% for women. It was verified that among those reporting urinary incontinence, 37% also reported stroke and 34% depression. It was found that the greater the dependence that the elderly people presented, the greater the prevalence of urinary incontinence. The associated factors found were depression (odds ratio = 2.49), female (2.42), advanced age (2.35), important functional limitation (2.01). Urinary incontinence is a highly prevalent symptom among the elderly population of the municipality of São Paulo, especially among women. The adoption of preventive measures can reduce the negative effects of urinary incontinence.

• Frente à falta informação técnica disponível:

• AVALIEMOS A NOSSA REALIDADE

Salários na América Latina•Salários Mínimos (em Dólares / mês)

• Brasil: 223,00 (R$788,00)• Argentina: 561,00• Bolívia: 116,00• Colômbia: 357,00• Chile: 452,00• Cuba: 40,00• Equador: 233,00• Paraguai: 414,00• Peru: 362,00• Uruguai: 400,00• Venezuela: 96,00

•SALÁRIO MÉDIO NO BRASIL: R$ 1.116,84

Custos de medicações no Brasil

• Retemic UD10 mg: 78,06 (10,7 % SM)

• Vesicare (solifenacina) 5 mg: 132,96 ( 18,3% SM)

10 mg: 162,67

• Enablex (darifenacina) 7.5 mg: 161.88 (22 % SM)

15 mg: 180.68

Sondas uretrais: 150 unidades / mês = 125,00 (17% SM)

Xilocaina gel 2 %: 26,19 (3,6% SM)

40 % renda mensal!!

cirurgia

Devices

Conclusões• Grande deficiência de dados para análise, levando à dificuldade de definir

política de saúde adequada, voltada para o problema;

• Condição que afeta grande número de pessoas, de todas as idades e de ambos os sexos ( poucos procuram ou tem acesso aos tratamentos);

• Impacto direto na qualidade de vida, auto imagem, trabalho, vida sexual, levando á depressão, vergonha, timidez.

• Custos elevados dos tratamentos

• Impacto dos mesmos sobre a renda familiar

Site: www.incontinenciaurinariabcs.orgEmail: associacaobrasileira.bcstuart.com