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Abe-Takahashi Y, Kitta T, Ouchi M, Chiba H, Higuchi M, Togo M, Kusakabe N, Kakizaki H, Shinohara N. Morphological examination of pelvic floor muscles in a rat model of vaginal delivery. BMC Pregnancy Childbirth 2024; 24:95. [PMID: 38297206 PMCID: PMC10832168 DOI: 10.1186/s12884-024-06278-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE This study investigated morphological changes in the composition of the pelvic floor muscles, degree of atrophy, and urethral function in a rat of simulated birth trauma induced by vaginal distension (VD) model. METHODS Female Sprague-Dawley rats were classified into four groups: a sham group, and 1, 2, and 4 weeks post-VD (1 W, 2 W, and 4 W, respectively) groups. We measured the amplitude of urethral response to electrical stimulation (A-URE) to evaluate urethral function. After measuring the muscle wet weight of the pubococcygeus (Pcm) and iliococcygeus (Icm) muscles, histochemical staining was used to classify muscle fibers into Types I, IIa, and IIb, and the occupancy and cross-sectional area of each muscle fiber were determined. RESULTS There were 24 Sprague-Dawley rats used. A-URE was significantly lower in the 1 W group versus the other groups. Muscle wet weight was significantly lower in the VD groups versus the sham group for Pcm. The cross-sectional area of Type I Pcm and Icm was significantly lower in the VD groups versus the sham group. Type I muscle fiber composition in Pcm was significantly lower in the VD groups versus the sham groupand lowest in the 2 W group. Type I muscle fiber composition in Icm was significantly lower in the 2 and 4 W groups versus the sham group. CONCLUSION Muscle atrophy and changes in muscle composition in the pelvic floor muscles were observed even after improvements in urethral function. These results may provide insight into the pathogenesis of stress urinary incontinence after VD.
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Affiliation(s)
- Yui Abe-Takahashi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Japan
| | - Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan.
| | - Mifuka Ouchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Chiba
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Madoka Higuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mio Togo
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naohisa Kusakabe
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Katz CMS, Barbosa CP. Effects of hypopressive exercises on pelvic floor and abdominal muscles in adult women: A systematic review of randomized clinical trials. J Bodyw Mov Ther 2024; 37:38-45. [PMID: 38432833 DOI: 10.1016/j.jbmt.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Hypopressive exercises (HE) are postural and breathing exercises that activate deep muscles in the abdomen and pelvic floor. Despite this, there is still no consensus in the literature on its real effectiveness. The objective was to analyze the effects of HE on the abdominal and pelvic floor muscles in women with or without dysfunctions in these regions. METHODS This is a systematic review of randomized clinical trials found in the PEDro, PubMed, Cochrane, LILACS, and Embase databases. We include studies that evaluate the effects of HE (with or without other techniques) on the pelvic floor and abdominal region for 8 weeks or more, in women over 18 years old, with or without dysfunction in these regions, with the presence of a control group (active or passive). RESULTS HE were effective in improving strength, tone, and reducing symptoms of pelvic floor dysfunctions, in magnitude less than (in two studies) or equal (in one study) to the pelvic floor muscle training (PFMT). When HE were performed with PFMT in the same group, no additional benefits were found. Only one study evaluated abdominal muscles activation, where HE were effective in improving postural control and activation of the transversus abdominis muscle. CONCLUSIONS The HE presented positive results to the evaluated parameters. However, the information is still preliminary and scarce. There are methodological divergences regarding the execution, follow-up and standardization of the method, which could affect the results. According to the existing information, HE cannot yet be reliably indicated for the treatment of the pelvic floor, despite pointing out relevant results in some studies. More randomized clinical trials and long-term studies are needed to analyze the effects of HE not only for pelvic floor, but also for other regions, such as abdominal muscles and related dysfunctions.
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Oliveira MCE, Bezerra LO, Melo Ângelo PH, de Oliveira MC, Silva-Filho E, Ribeiro TS, Pegado R, Micussi MTABC. Game therapy a new approach to treat women facing mixed urinary incontinence: A study protocol. Neurourol Urodyn 2020; 39:1592-1600. [PMID: 32243660 DOI: 10.1002/nau.24350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/22/2020] [Indexed: 12/20/2022]
Abstract
AIMS To describe a pelvic floor muscle training (PFMT) isolated and associated with game therapy (PFMT + GT) for women facing mixed urinary incontinence (MUI) during climacteric period. METHODS To standardize a randomized controlled clinical trial intervention, a protocol was created, in an attempt to decrease women's symptomatology generated by MUI, through pelvic floor and abdomino-loin-pelvic muscles strength, and endurance. This study protocol will be composed of 32 volunteers, divided into two groups of 16. They will perform PFMT isolated or PFMT + GT, twice a week during 8 weeks. Interventions will last 40 minutes and will be divided into warming (5 minutes), training (30 minutes), and 5 minutes will be composed of resting time between exercises (1 minute each). Isolated PFMT sessions will be performed through four modalities of exercises: diaphragmatic, bridge, abdominal (plank), and pelvic mobility. PFMT + GT training will be carried out by using Wii Fit Plus games, such as Lotus Focus, Penguin Slide, Basic Step, and Hula Hoop from Wii equipment. Assessments will occur before, after, and 1 month after interventions. Vaginal manometry, 1-hour Pad Test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Intervention (PGI) will be used to evaluate the sample. CONCLUSIONS It is expected greater increase on pelvic floor muscle (PFM) strength, endurance, vaginal pressure for PFMT + GG. Moreover, it is supposed that PFMT + GT volunteers present better treatment adherence due to games motivational inclusion.
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Affiliation(s)
| | - Livia Oliveira Bezerra
- Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Maiara Costa de Oliveira
- Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Edson Silva-Filho
- Graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Tatiana Souza Ribeiro
- Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Deng K, Balog BM, Lin DL, Hanzlicek B, Song QX, Zhu H, Damaser MS. Daily bilateral pudendal nerve electrical stimulation improves recovery from stress urinary incontinence. Interface Focus 2019; 9:20190020. [PMID: 31263536 DOI: 10.1098/rsfs.2019.0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2019] [Indexed: 01/04/2023] Open
Abstract
Stress urinary incontinence (SUI) in women is strongly associated with childbirth which injures the pudendal nerve (PN) and the external urethral sphincter (EUS) during delivery. Electrical stimulation (ES) can increase brain-derived neurotrophic factor (BDNF) expression in injured neurons, activate Schwann cells and promote neuroregeneration after nerve injury. The aim of this study was to determine if more frequent ES would increase recovery from SUI in a rat model. Forty female Sprague-Dawley rats underwent either sham injury or pudendal nerve crush (PNC) and vaginal distention (VD) to establish SUI. Immediately after injury, electrodes were implanted at the pudendal nerve bilaterally. Each injured animal underwent sham ES, twice per week ES (2/week), or daily ES of 1 h duration for two weeks. Urethral and nerve function were assessed with leak point pressure (LPP), EUS electromyography and pudendal nerve sensory branch potential (PNSBP) recordings two weeks after injury. LPP was significantly increased after daily ES compared to 2/week ES. EUS neuromuscular junction innervation was decreased after injury with sham ES, but improved after 2/week or daily ES. This study demonstrates that daily bilateral ES to the pudendal nerve can accelerate recovery from SUI. Daily ES improved urethral function more than 2/week ES.
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Affiliation(s)
- Kangli Deng
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Urology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, People's Republic of China.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
| | - Brian M Balog
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA.,Department of Biology, University of Akron, Akron, OH, USA
| | - Dan Li Lin
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
| | - Brett Hanzlicek
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
| | - Qi-Xiang Song
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA.,Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Hui Zhu
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave. Q100, Cleveland, OH 44195, USA
| | - Margot S Damaser
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA.,Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave. Q100, Cleveland, OH 44195, USA
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Zhang L, Luo X. Clinical Significance of Neuropeptide Y Expression in Pelvic Tissue in Patients with Pelvic Floor Dysfunction. Open Life Sci 2019; 14:126-132. [PMID: 33817144 PMCID: PMC7874799 DOI: 10.1515/biol-2019-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To investigate the neuropeptide Y (NPY) expression in the tissue of pelvic floor ligament and anterior vaginal wall in female patients with pelvic organ prolapse (POP) and stress urinary incontinence (SUI). METHOD Seventeen patients with POP, 6 with SUI, 13 with POP and SUI (POP&SUI), and 10 controls were included in this study from First Affiliated Hospital of JiNan University. Immunohistochemical assay was used to examine NPY expression in the tissue of round ligament, cardinal ligament of uterus, uterosacral ligament, and anterior vaginal wall. NPY expression were compared between POP, SUI, POP&SUI and controls. RESULTS NPY was positive expressed in the round ligament, cardinal ligament of uterus, uterosacral ligament, and anterior vaginal subepithelial connective tissue. Compared with the control group, NPY expression in the round, cardinal, and uterosacral ligaments in patients with POP&SUI group was decreased with significant statistical difference (p<0.05). NPY expression in anterior vaginal wall was significantly decreased in POP, SUI, and POP&SUI groups compared to normal group (p<0.05). Compared to POP group, NPY expression in SUI and POP&SUI groups were significantly decreased (p<0.05), however the difference was not statistical different between SUI and POP&SUI groups (p>0.05). In POP and POP&SUI groups, the NPY expression in the cardinal ligament of uterus, uterosacral ligament, and anterior vaginal wall were negatively correlated with age (p<0.05), however, was not correlated with number of pregnancy, number of delivery, and BMI (p>0.05). CONCLUSIONS NPY expression was reduced in the round ligament, cardinal ligament of uterus, Uterosacral ligament, and vaginal anterior wall of the patients with POP and SUI. The decreased NPY expression may play an important role in the development of pelvic floordysfunction.
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Affiliation(s)
- Limin Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Fujian Medical University, Fuzhou350005 PRChina
| | - Xin Luo
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Jinan510632 PRChina
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Lo TS, Shailaja N, Chua S, Tseng LH, Kao CC, Wu MP. Evaluation of Clinical Outcome and Risk Factors for Failure of Single-incision Midurethral Short Tape Procedure (Solyx Tape) for Stress Urinary Incontinence. J Minim Invasive Gynecol 2018; 26:688-694. [PMID: 30040998 DOI: 10.1016/j.jmig.2018.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/14/2018] [Accepted: 07/17/2018] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To evaluate the clinical outcome and identify risk factors for failure of the Solyx (Boston Scientific Corporation, Marlborough, MA) single-incision sling (SIS) in the treatment of urodynamic stress incontinence (USI). DESIGN A retrospective observational study (Canadian Task Force classification II-2). SETTING A tertiary referral center. PATIENTS Patients diagnosed with USI without needing concurrent procedures that underwent continence surgery using the Solyx SIS from February 2015 to May 2017. INTERVENTIONS Anti-incontinence surgery. MEASUREMENTS AND MAIN RESULTS The primary outcome of this study was the rate of objective cure defined as the absence of demonstrable leakage of urine on the cough stress test and a 1-hour pad test weight of less than 2g. The secondary outcome was the rate of subjective cure defined as a negative response to Urinary Distress Inventory question 3 (no leakage on coughing, sneezing, or laughing) and the identification of the different risk factors of cure failure. A total of 113 patients were evaluated in the study. Postoperative USI and the 1-hour pad test significantly improved from 24.2 ± 26.9 gm (range, 19.1-29.3) to 2.5 ± 8.7 gm (range, 0.9-4.2); p <0.001 through 1 year. Data analysis showed an objective cure rate of 90% (102/113) and a subjective cure rate of 86% (97/113). USI recurred in 11 patients with no repeat surgery done becausesymptoms were tolerable to the patients. No patient had bladder outlet obstruction. Peak flow rates 23.7 ± 9.1 ml/s (20.0-27.4) and residual urine volume 38.5 ± 25.8 ml (29.8-47.2) were within normal limits with no significant changes. Previous anti-incontinent surgery, previous prolapsed surgery, intrinsic sphincter deficiency, maximum urethral closure pressure <40cm H2O, and neurogenic disease were significant risk factors for sling failure. Subjective assessment on the quality of life significantly improved (p <0.001). CONCLUSION The Solyx SIS is an effective and safe treatment option for women with USI, showing high objective and subjective cure rates with a low incidence of complications 1 year after treatment. The identified independent risk factors forfailure are related to poor urethral function and previous pelvic reconstructive surgery.
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Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China (Drs. Lo and Kao); Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China (Drs. Lo, Tseng, and Kao); Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China (Drs. Lo, Tseng, and Kao).
| | - Nagashu Shailaja
- Department of Obstetrics and Gynaecology, Peoples Education Society Medical College and Research Centre, Kuppam, Andhra Pradesh, India (Dr. Shailaja)
| | - Sandy Chua
- Department of Obstetrics and Gynecology, Cebu Velez General Hospital, Cebu City, Philippines (Dr. Chua)
| | - Ling-Hong Tseng
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China (Drs. Lo, Tseng, and Kao); Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China (Drs. Lo, Tseng, and Kao)
| | - Chuan-Chi Kao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China (Drs. Lo and Kao); Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China (Drs. Lo, Tseng, and Kao); Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China (Drs. Lo, Tseng, and Kao)
| | - Ming-Ping Wu
- Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan, Republic of China (Dr. Wu); Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan, Republic of China (Dr. Wu)
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López-García K, Mariscal-Tovar S, Serrano-Meneses MA, Castelán F, Martínez-Gómez M, Jiménez-Estrada I. Fiber type composition of pubococcygeus and bulbospongiosus striated muscles is modified by multiparity in the rabbit. Neurourol Urodyn 2016; 36:1456-1463. [DOI: 10.1002/nau.23143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/02/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Kenia López-García
- Departamento Fisiología, Biofísica y Neurociencias; Centro de Investigación y Estudios Avanzados Instituto Politécnico Nacional; México Mexico
- Departamento de Biología Celular y Fisiología, Unidad Periférica Tlaxcala, Instituto de Investigaciones Biomédicas; Universidad Nacional Autónoma de México; Tlaxcala Mexico
| | - Silvia Mariscal-Tovar
- Departamento Fisiología, Biofísica y Neurociencias; Centro de Investigación y Estudios Avanzados Instituto Politécnico Nacional; México Mexico
| | | | - Francisco Castelán
- Departamento de Biología Celular y Fisiología, Unidad Periférica Tlaxcala, Instituto de Investigaciones Biomédicas; Universidad Nacional Autónoma de México; Tlaxcala Mexico
- Centro Tlaxcala de Biología de la Conducta; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
| | - Margarita Martínez-Gómez
- Departamento de Biología Celular y Fisiología, Unidad Periférica Tlaxcala, Instituto de Investigaciones Biomédicas; Universidad Nacional Autónoma de México; Tlaxcala Mexico
- Centro Tlaxcala de Biología de la Conducta; Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
| | - Ismael Jiménez-Estrada
- Departamento Fisiología, Biofísica y Neurociencias; Centro de Investigación y Estudios Avanzados Instituto Politécnico Nacional; México Mexico
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Kim T, Sridharan I, Ma Y, Zhu B, Chi N, Kobak W, Rotmensch J, Schieber JD, Wang R. Identifying distinct nanoscopic features of native collagen fibrils towards early diagnosis of pelvic organ prolapse. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2015; 12:667-675. [PMID: 26656625 DOI: 10.1016/j.nano.2015.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/20/2015] [Accepted: 11/09/2015] [Indexed: 01/02/2023]
Abstract
UNLABELLED Pelvic organ prolapse (POP) is characterized by weakening of the connective tissues and loss of support for the pelvic organs. Collagen is the predominant, load-bearing protein within pelvic floor connective tissues. In this study, we examined the nanoscopic structures and biomechanics of native collagen fibrils in surgical, vaginal wall connective tissues from healthy women and POP patients. Compared to controls, collagen fibrils in POP samples were bulkier, more uneven in width and stiffer with aberrant D-period. Additionally, the ratio of collagen I (COLI) and collagen III (COLIII) is doubled in POP with a concomitant reduction of the amount of total collagen. Thus, POP is characterized by abnormal biochemical composition and biophysical characteristics of collagen fibrils that form a loose and fragile fiber network accountable for the weak load-bearing capability. The study identifies nanoscale alterations in collagen as diagnostic markers that could enable pre-symptomatic or early diagnosis of POP. FROM THE CLINICAL EDITOR Pelvic organ prolapse (POP) occurs due to abnormalities of the supporting connective tissues. The underlying alterations of collagen fibers in the connective tissues have not been studied extensively. In this article, the authors showed that collagen fibrils in POP patients were much different from normal controls. The findings may provide a framework for the diagnosis of other connective diseases.
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Affiliation(s)
- Taeyoung Kim
- Department of Chemistry, Illinois Institute of Technology, Chicago, IL, USA
| | | | - Yin Ma
- Department of Chemistry, Illinois Institute of Technology, Chicago, IL, USA
| | - Bofan Zhu
- Department of Chemistry, Illinois Institute of Technology, Chicago, IL, USA
| | - Naiwei Chi
- Department of Chemistry, Illinois Institute of Technology, Chicago, IL, USA
| | - William Kobak
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jacob Rotmensch
- Department of Obstetrics and Gynecology, Rush University Medical School, Chicago, IL, USA
| | - Jay D Schieber
- Center for Molecular Study of Condensed Soft Matter, Illinois Institute of Technology, Chicago, IL, USA
| | - Rong Wang
- Department of Chemistry, Illinois Institute of Technology, Chicago, IL, USA.
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Fiber type characterization of striated muscles related to micturition in female rabbits. Acta Histochem 2014; 116:481-6. [PMID: 24231156 DOI: 10.1016/j.acthis.2013.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/06/2013] [Accepted: 10/07/2013] [Indexed: 12/11/2022]
Abstract
Pelvic and perineal striated muscles are relevant for reproduction and micturition in female mammals. Damage to these muscles is associated with pelvic organ prolapse and stress urinary incontinence. The fiber type composition of skeletal muscle influences the susceptibility for damage and/or regeneration. The aim of the present study was to determine the fiber type composition of a perineal muscle, the bulbospongiosus, and a pelvic muscle, the pubococcygeus. Both muscles were harvested from adult female rabbits (8-10 months old). NADH-TR (nicotinamide adenine dinucleotide tetrazolium reductase) histochemistry was undertaken to identify oxidative and glycolytic muscle fibers. Alkaline (pH 9.4) ATP-ase (actomyosin adenosine triphosphatase) histochemistry was used to classify type I, type IIb or type IIa/IId muscle fibers. Results showed that the content of glycolytic fibers in the bulbospongiosus muscle was higher than that of oxidative fibers. Meanwhile, the opposite was true for the pubococcygeus. In the bulbospongiosus muscle, the content of type IIb muscle fibers was higher than that of type I, but was similar to that of type IIa/IId. In contrast, the content of each fiber type was similar in the pubococcygeus muscle. The relative proportion of fibers in bulbospongiosus and pubococcygeus muscles is consistent with their function during voiding and storage phases of micturition.
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Abstract
BACKGROUND For a long time pelvic floor muscle training (PFMT) has been the most common form of conservative (non-surgical) treatment for stress urinary incontinence (SUI). Weighted vaginal cones can be used to help women to train their pelvic floor muscles. Cones are inserted into the vagina and the pelvic floor is contracted to prevent them from slipping out. OBJECTIVES The objective of this review is to determine the effectiveness of vaginal cones in the management of female urinary stress incontinence (SUI).We wished to test the following comparisons in the management of stress incontinence: 1. vaginal cones versus no treatment; 2. vaginal cones versus other conservative therapies, such as PFMT and electrostimulation; 3. combining vaginal cones and another conservative therapy versus another conservative therapy alone or cones alone; 4. vaginal cones versus non-conservative methods, for example surgery or injectables.Secondary issues which were considered included whether:1. it takes less time to teach women to use cones than it does to teach the pelvic floor exercise; 2. self-taught use is effective;3. the change in weight of the heaviest cone that can be retained is related to the level of improvement;4. subgroups of women for whom cone use may be particularly effective can be identified. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Trials Register (searched 19 September 2012), MEDLINE (January 1966 to March 2013), EMBASE (January 1988 to March 2013) and reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing weighted vaginal cones with alternative treatments or no treatment. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed studies for inclusion and trial quality. Data were extracted by one reviewer and cross-checked by the other. Study authors were contacted for extra information. MAIN RESULTS We included 23 trials involving 1806 women, of whom 717 received cones. All of the trials were small, and in many the quality was hard to judge. Outcome measures differed between trials, making the results difficult to combine. Some trials reported high drop-out rates with both cone and comparison treatments. Seven trials were published only as abstracts.Cones were better than no active treatment (rate ratio (RR) for failure to cure incontinence 0.84, 95% confidence interval (CI) 0.76 to 0.94). There was little evidence of difference for a subjective cure between cones and PFMT (RR 1.01, 95% CI 0.91 to 1.13), or between cones and electrostimulation (RR 1.26, 95% CI 0.85 to 1.87), but the confidence intervals were wide. There was not enough evidence to show that cones plus PFMT was different to either cones alone or PFMT alone. Only seven trials used a quality of life measures and no study looked at economic outcomes.Seven of the trials recruited women with symptoms of incontinence, while the others required women with urodynamic stress incontinence, apart from one where the inclusion criteria were uncertain. AUTHORS' CONCLUSIONS This review provides some evidence that weighted vaginal cones are better than no active treatment in women with SUI and may be of similar effectiveness to PFMT and electrostimulation. This conclusion must remain tentative until larger, high-quality trials, that use comparable and relevant outcomes, are completed. Cones could be offered as one treatment option, if women find them acceptable.
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Affiliation(s)
- G Peter Herbison
- Department of Preventive&SocialMedicine,Dunedin School ofMedicine, University ofOtago,Dunedin, New
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Bodhare TN, Valsangkar S, Bele SD. An epidemiological study of urinary incontinence and its impact on quality of life among women aged 35 years and above in a rural area. Indian J Urol 2011; 26:353-8. [PMID: 21116353 PMCID: PMC2978433 DOI: 10.4103/0970-1591.70566] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There have been few community-based epidemiological studies on urinary incontinence (UI) evaluating the risk factors and impact on quality of life (QOL) in India. OBJECTIVES This study was designed (1) to estimate age-specific prevalence and risk factors of UI among women aged 35 years and above in a rural area and (2) to analyze the impact of UI on the QOL of incontinent women. DESIGN AND SETTING A cross-sectional descriptive study was conducted. MATERIALS AND METHODS A semi-structured questionnaire assessing socio-demographic factors, severity and type of incontinence, and obstetrical and other risk factors along with impact on QOL was administered in two clusters (villages) in Karimnagar district through multistage cluster sampling. RESULTS In a sample of 552 women, 53 (10%) reported episodes of UI. The prevalence of UI showed significant association with increasing age (P < 0.01). Fifty-seven percent of the women had symptoms of stress incontinence, 23% of urge, and 20% mixed symptoms. Obstetrical factors associated with UI included high parity (P < 0.003), young age at first childbirth (P < 0.01), forceps delivery (P < 0.001), and prolonged labor (P < 0.001). Chronic constipation, chronic cough, and history of urinary tract infection were predictors of UI in regression analysis (Nagelkerke R (2)= 0.7). Women with stress incontinence had the severest perceived impact on QOL on a five-point scale questionnaire, mean 24.87 (95% CI 21.26-28.47). CONCLUSION One in 10 women reported episodes of UI with impaired QOL. The outcome is predicted both by obstetric and other risk factors.
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Affiliation(s)
- Trupti N Bodhare
- Department of Community Medicine, Prathima Institute of Medical Sciences, Karimnagar, AP, India
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Phull HS, Pan HQ, Butler RS, Hansel DE, Damaser MS. Vulnerability of continence structures to injury by simulated childbirth. Am J Physiol Renal Physiol 2011; 301:F641-9. [PMID: 21613415 DOI: 10.1152/ajprenal.00120.2011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The goal of this study was to examine acute morphological changes, edema, muscle damage, inflammation, and hypoxia in urethral and vaginal tissues with increasing duration of vaginal distension (VD) in a rat model. Twenty-nine virgin Sprague-Dawley rats underwent VD under anesthesia with the use of a modified Foley catheter inserted into the vagina and filled with saline for 0, 1, 4, or 6 h. Control animals were anesthetized for 4 h without catheter placement. Urogenital organs were harvested after intracardiac perfusion of fixative. Tissues were embedded, sectioned, and stained with Masson's trichrome or hematoxylin and eosin stains. Regions of hypoxia were measured by hypoxyprobe-1 immunohistochemistry. Within 1 h of VD, the urethra became vertically elongated and displaced anteriorly. Edema was most prominent in the external urethral sphincter (EUS) and urethral/vaginal septum within 4 h of VD, while muscle disruption and fragmentation of the EUS occurred after 6 h. Inflammatory damage was characterized by the presence of polymorphonuclear leukocytes in vessels and tissues after 4 h of VD, with the greatest degree of infiltration occurring in the EUS. Hypoxia localized mostly to the vaginal lamina propria, urethral smooth muscle, and EUS within 4 h of VD. Increasing duration of VD caused progressively greater tissue edema, muscle damage, and morphological changes in the urethra and vagina. The EUS underwent the greatest insult, demonstrating its vulnerability to childbirth injury.
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Affiliation(s)
- Hardeep S Phull
- Dept. of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic, OH 44195, USA
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13
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Abstract
PURPOSE OF REVIEW There is strong epidemiological evidence linking vaginal childbirth and the development of postpartum incontinence and prolapse. This article examines possible mechanisms of pelvic floor damage related to delivery and their possible consequences. RECENT FINDINGS Histology, imaging and physiology studies have revealed that vaginal delivery results in direct pelvic muscle trauma, disruption of fascial supports and pudendal nerve injury. SUMMARY Epidemiology studies implicate parity and childbirth in the development of incontinence and prolapse; however, despite imaging and functional studies revealing damage to the pelvic floor muscles, nerves and fascial supports, it is unclear what the clinical significance of these findings is. In addition, the effect of mode of delivery is uncertain, and although cesarean section reduces the risk of pelvic floor trauma, it is not entirely protective. Further research is required into the effect of pregnancy on pelvic floor dysfunction and the effect of mode of delivery.
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Castro RA, Arruda RM, Zanetti MRD, Santos PD, Sartori MGF, Girão MJBC. Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence. Clinics (Sao Paulo) 2008; 63:465-72. [PMID: 18719756 PMCID: PMC2664121 DOI: 10.1590/s1807-59322008000400009] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 05/05/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS One hundred eighteen subjects were randomly selected to receive pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment. CONCLUSION Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.
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Affiliation(s)
- Rodrigo A Castro
- Urogynecology and Vaginal Surgery Section, Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Tunn R, Goldammer K, Neymeyer J, Gauruder-Burmester A, Hamm B, Beyersdorff D. MRI morphology of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2005; 126:239-45. [PMID: 16298035 DOI: 10.1016/j.ejogrb.2005.10.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Revised: 10/06/2005] [Accepted: 10/17/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate pathomorphologic changes of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence (SUI) by MRI. STUDY DESIGN Fifty-four women with SUI were examined by MRI (1.5T): body phased-array coil, axial and coronal proton-density-weighted sequences. RESULTS The urethral sphincter muscle showed a reduced thickness of its posterior portion (37%), an omega shape (13%) or higher signal intensity (50%); its abnormal configuration was associated with an increased signal intensity in 70% (p=0.001). The levator ani muscle comprised an unilateral loss of substance in 30%, a higher signal intensity in 28%, and altered origin in 19%. Central defects of the endopelvic fascia were present in 39% (n=21), lateral defects in 46%. There was a significant association between loss of the symphyseal concavity of the anterior vaginal wall and lateral fascial defects (p=0.001) and levator ani changes (p=0.016). CONCLUSION MRI yields findings supporting current theories on the pathogenesis of SUI.
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Affiliation(s)
- Ralf Tunn
- Department of Gynecology and Obstetrics, Charité Medical School, Humboldt-Universität zu Berlin, Germany.
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Augsburger HR, Eggenberger M. Histochemical and stereological analysis of the levator ani (pubocaudal) muscle in nulliparous and multiparous beagles. Theriogenology 2005; 64:144-54. [PMID: 15935850 DOI: 10.1016/j.theriogenology.2004.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Accepted: 11/14/2004] [Indexed: 11/28/2022]
Abstract
Fiber-type composition and several stereological parameters of the levator ani (pubocaudal) muscle were evaluated in five nulliparous and five multiparous beagles using myosin ATPase-histochemistry and systematically selected muscle cross-sections. With respect to the narrow canine pelvic cavity, this study was also undertaken to determine whether vaginal birth of at least seven litters causes similar neuromuscular changes in the canine levator ani (pubocaudal) muscle analoguous to those seen in the pelvic floor muscles of women after vaginal delivery. The canine pubocaudal muscle is comprised of approximately equal amounts of slow twitch type I and fast twitch type II (IIA, IIS) fibers. The muscles of both the nulliparous and multiparous beagles did not display any signs indicative of denervation or myopathology. The multiparous dogs exhibited significantly increased mean absolute muscle (1720 mm(3)) and total fiber-type I volumes (850 mm(3)) as well as relevantly increased mean diameter of type I fibers (72.0 microm) when compared with the nulliparous group. The canine levator ani (pubocaudal) muscle is not pathologically affected by vaginal deliveries and seems to adapt to numerous successive pregnancies and births through fiber-type I hypertrophy.
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Affiliation(s)
- Heinz R Augsburger
- Institute of Veterinary Anatomy, Faculty of Veterinary Medicine, University of Zürich, Winterthurerstr 260, CH-8057 Zürich, Switzerland.
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Busacchi P, Perri T, Paradisi R, Oliverio C, Santini D, Guerrini S, Barbara G, Stanghellini V, Corinaldesi R, De Giorgio R. Abnormalities of somatic peptide-containing nerves supplying the pelvic floor of women with genitourinary prolapse and stress urinary incontinence. Urology 2004; 63:591-5. [PMID: 15028474 DOI: 10.1016/j.urology.2003.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2003] [Accepted: 09/03/2003] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To test the hypothesis that genital prolapse may be related to peripheral nerve abnormalities, we examined the changes occurring to peptide-containing nerve processes supplying the periurethral muscles in women with stress urinary incontinence associated with prolapse. METHODS Thirty patients with genital prolapse and 10 age-matched control subjects entered the study. All patients were evaluated by urodynamic investigations. Ten of 30 patients had pure stress urinary incontinence; none of the control subjects was incontinent. During surgery, four biopsy samples were obtained from each woman from the periurethral and perirectal muscles. The muscle sections were processed for immunohistochemistry using specific antibodies to glial (S-100 protein) and general neuronal markers (neuron-specific enolase) and neuropeptides, including neuropeptide Y, vasoactive intestinal polypeptide, and substance P. The evaluation of immunolabeled nerves was based on a semiquantitative analysis that allowed for a four-point ordinate scale score. RESULTS S-100 and neuron-specific enolase immunoreactive nerve fibers, running either singly or in small bundles, along with a dense network of neural processes containing neuropeptide Y, vasoactive intestinal polypeptide, and substance P, were found throughout the connective tissue and striated muscle of the control specimens. In contrast, in the muscle specimens from those with genitourinary prolapse, both the density and the intensity of neuropeptide Y, vasoactive intestinal polypeptide, and substance P immunoreactive nerves were markedly reduced compared with the control specimens. CONCLUSIONS The evidence of a reduced peptide-containing nerve supply to the perineal muscles provides a morphologic basis suggesting that neural abnormalities contribute to the pathogenesis of genital prolapse and urinary incontinence.
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Affiliation(s)
- P Busacchi
- Department of Obstetrics and Gynecology, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Kane DD, Kerns JM, Lin DL, Damaser MS. Early structural effects of oestrogen on pudendal nerve regeneration in the rat. BJU Int 2004; 93:870-8. [PMID: 15050008 DOI: 10.1111/j.1464-410x.2003.04792.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the early effects of oestrogen on the ultrastructure of the pudendal nerve and distal nerve fascicles near the external urethra sphincter (EUS) after a pudendal nerve crush injury. The pudendal nerve is one of the pelvic floor tissues injured during vaginal delivery, possibly contributing to the development of stress urinary incontinence (SUI) in women, the symptoms of which often do not appear until menopause, implicating hormonal factors. MATERIALS AND METHODS Twenty-seven virgin female Sprague-Dawley rats were anaesthetized and underwent ovariectomy. Three days later, they had one of four procedures: bilateral pudendal nerve crush plus implant of a subcutaneous oestrogen-containing capsule (NC+E); nerve crush plus implant of a sham saline-containing capsule (NC+S); no nerve crush with an oestrogen capsule; or no nerve crush with a sham capsule. After 2 weeks the pudendal nerves and urethral tissues were prepared for light and electron microscopy. The number of axons, myelin figures and endoneurial nuclei in the pudendal nerve segment distal to the lesion were counted. Nerve fascicles near the EUS were also counted and categorized as normal or showing signs of degeneration and/or regeneration. The location of each nerve fascicle was specified as either ventral or dorsal. RESULTS As there were no significant differences between the two control groups they were combined to form a single control group. In the distal pudendal nerve there were significantly fewer myelinated axons and large myelinated axons in the NC+E and NC+S groups than in the control group. There were three times as many large unmyelinated axons in the NC+E group than in either the NC+S or control groups (P < 0.05). There were only half as many nerve fascicles near the ventral side of the EUS in the NC+S group than in both the control and NC+E groups (P < 0.05). CONCLUSION Oestrogen appears to affect large unmyelinated axons in both the injured pudendal nerve and at the denervated EUS target. After pudendal nerve crush, nerve fascicles with evidence of degeneration or regeneration near the EUS appear to be spared with oestrogen treatment, particularly in the ventral region. These observations may reflect the early stages of a neuroregenerative effect of oestrogen. Additional studies are needed to confirm these results at later periods and with functional methods.
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Affiliation(s)
- D D Kane
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, USA
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Wai CY, Liehr P, Tibbals HF, Sager M, Schaffer JI, Word RA. Effect of periurethral denervation on function of the female urethra. Am J Obstet Gynecol 2003; 189:1637-45. [PMID: 14710091 DOI: 10.1016/s0002-9378(03)00901-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effect of periurethral denervation on contractile function of the female rat urethra. STUDY DESIGN Periurethral nerve transection or sham operation was performed in 16 young female rats. After 2 weeks, contractile function of the external urethra sphincter (EUS) and longitudinal smooth muscle was determined. Inhibitors of nitric oxide (NO) signaling were used to evaluate the role of nitric oxide in nerve-mediated relaxation. Statistical comparisons were conducted by Student t test. RESULTS Periurethral nerve transection resulted in gross evidence of urinary retention and bladder distention. In normal and sham-operated rats, nerve-mediated relaxation of urethral smooth muscle was inhibited by L-nitroarginine and oxadiazolo quinoxalin-1-one (ODQ), and this relaxation response was impaired significantly after periurethral nerve injury. Relaxation responses to the NO donor sodium nitroprusside remained intact. Contractile function of the EUS was not altered by periurethral nerve injury. CONCLUSION Neurons surrounding the urethra contain NO and innervate smooth muscle of the inner urethra. Periurethral denervation results in impaired urethral smooth muscle relaxation with no appreciable effect on contractility of the external striated sphincter.
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Affiliation(s)
- C Y Wai
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, G6.220, Dallas, TX 75390-9032, USA.
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Dmochowski RR, Avon M, Ross J, Cooper JM, Kaplan R, Love B, Kohli N, Albala D, Shingleton B. Transvaginal radio frequency treatment of the endopelvic fascia: a prospective evaluation for the treatment of genuine stress urinary incontinence. J Urol 2003; 169:1028-32. [PMID: 12576838 DOI: 10.1097/01.ju.0000048686.50716.ef] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We evaluate the safety and efficacy of a new treatment modality for genuine stress urinary incontinence which was a transvaginal radio frequency applicator to deliver radio frequency energy to the endopelvic fascia. The purported mechanism of effect for this therapy is shrinkage of the collagenated tissue which composes the endopelvic fascia that supports the bladder neck and proximal urethra, thus stabilizing the proximal urethra and bladder neck. In prior animal trials and early pilot studies this therapy was shown to cause a reproducible thermal effect manifested by fascial shrinkage. Preliminary human trials indicated a therapeutic benefit of this therapy for women with genuine stress urinary incontinence. MATERIALS AND METHODS To our knowledge this is the first multicenter study of a transvaginal approach for radio frequency of the endopelvic fascia for treatment of genuine stress incontinence. Between June 1999 and June 2000, 120 consecutive women (mean age 49.9 years) at 10 sites underwent transvaginal radio frequency treatment in a prospective trial to evaluate the overall efficacy and safety profile of this therapy. All patients had preoperative urethral hypermobility (average cotton swab change 38 degrees). Detrusor instability was excluded by cystometry. In all procedures precisely controlled radio frequency energy was applied to the endopelvic fascia to heat and shrink the tissue. The patients were evaluated postoperatively at 1 week and at 1, 3, 6 and 12 months using objective and subjective measures. Primary end points consisted of physician assessment of continence, patient reported pad use and the number of patient reported episodes. Safety was determined for acute (immediate postoperative) and chronic time frames. RESULTS Of the 120 patients 96 completed 1-year evaluation. Average operative time was less than 30 minutes, and all patients were treated as outpatients. Preoperatively 101 patients (84%) averaged 1 or more episodes of urinary incontinence per day. At 3, 6 and 12 months 57%, 66% and 59% of patients, respectively, averaged 1 or no daily episodes of urinary incontinence. At 12-month followup 79 of 109 patients (73%) reported being continent or improved. Preoperatively, 43% of patients reported using 1 or no pads daily. At 3, 6 and 12 months 69%, 70% and 72% of patients, respectively, required 1 or no pads daily. On urodynamic evaluation at 12-month followup 76.0% of the patients did not leak with a Valsalva maneuver. A total of 30 cases were classified as failures and 11 women were lost to followup. There were no intraoperative complications, 3 (4%) minor postoperative complications which resolved, and no device related complications. CONCLUSIONS The transvaginal radio frequency applicator demonstrated good efficacy and excellent safety at 1-year followup. Ongoing analysis of the data has indicated opportunities for improvement of this new surgical technique that could result in higher efficacy rates without compromising safety. Further long-term evaluation is being conducted to assess chronic durability of the procedure.
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Kershen RT, Appell RA. De novo urge syndrome and detrusor instability after anti-incontinence surgery: current concepts, evaluation, and treatment. Curr Urol Rep 2002; 3:345-53. [PMID: 12354341 DOI: 10.1007/s11934-002-0075-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The onset of de novo irritative voiding symptoms after anti-incontinence surgery for stress urinary incontinence is troubling to both patient and physician alike. At present, mechanisms responsible for the development of these symptoms are incompletely elucidated. Although bladder outlet obstruction may certainly be a cause, correct diagnosis and treatment of this condition in its more insidious manifestation may be difficult. In addition, alternative etiologic factors related to surgical technique during outlet enhancing surgery may play a role, prompting a rethinking of these procedures. In this discussion, we review changes in voiding physiology and mechanisms for voiding dysfunction after anti-incontinence surgery, emphasizing de novo urge syndrome and detrusor instability. In addition, we present our approach to the evaluation, diagnosis, and treatment of these challenging patients.
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Affiliation(s)
- Richard T Kershen
- Scott Department of Urology, Baylor College of Medicine, 6560 Fannin, Suite 2100, Houston, TX 77030, USA.
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ACUTE AND LONG-TERM OUTCOMES OF RADIO FREQUENCY BLADDER NECK SUSPENSION. J Urol 2002. [DOI: 10.1097/00005392-200201000-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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FULMER BRANTR, SAKAMOTO KYOKO, TURK THOMASM, GALEN DONALD, PRESTHUS JAMESB, ABBOTT KAREN, ROSS JIM, CHAU-SU-OU, ALBALA DAVIDM. ACUTE AND LONG-TERM OUTCOMES OF RADIO FREQUENCY BLADDER NECK SUSPENSION. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65400-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- BRANT R. FULMER
- From the Geisinger Medical Center, Danville, Pennsylvania, Loyola University Medical Center, Maywood, Illinois, San Ramon, San Mateo and Salinas, California, Wayzata, Minnesota, Seattle, Washington, and Durham, North Carolina
| | - KYOKO SAKAMOTO
- From the Geisinger Medical Center, Danville, Pennsylvania, Loyola University Medical Center, Maywood, Illinois, San Ramon, San Mateo and Salinas, California, Wayzata, Minnesota, Seattle, Washington, and Durham, North Carolina
| | - THOMAS M.T. TURK
- From the Geisinger Medical Center, Danville, Pennsylvania, Loyola University Medical Center, Maywood, Illinois, San Ramon, San Mateo and Salinas, California, Wayzata, Minnesota, Seattle, Washington, and Durham, North Carolina
| | - DONALD GALEN
- From the Geisinger Medical Center, Danville, Pennsylvania, Loyola University Medical Center, Maywood, Illinois, San Ramon, San Mateo and Salinas, California, Wayzata, Minnesota, Seattle, Washington, and Durham, North Carolina
| | - JAMES B. PRESTHUS
- From the Geisinger Medical Center, Danville, Pennsylvania, Loyola University Medical Center, Maywood, Illinois, San Ramon, San Mateo and Salinas, California, Wayzata, Minnesota, Seattle, Washington, and Durham, North Carolina
| | - KAREN ABBOTT
- From the Geisinger Medical Center, Danville, Pennsylvania, Loyola University Medical Center, Maywood, Illinois, San Ramon, San Mateo and Salinas, California, Wayzata, Minnesota, Seattle, Washington, and Durham, North Carolina
| | - JIM ROSS
- From the Geisinger Medical Center, Danville, Pennsylvania, Loyola University Medical Center, Maywood, Illinois, San Ramon, San Mateo and Salinas, California, Wayzata, Minnesota, Seattle, Washington, and Durham, North Carolina
| | - CHAU-SU-OU
- From the Geisinger Medical Center, Danville, Pennsylvania, Loyola University Medical Center, Maywood, Illinois, San Ramon, San Mateo and Salinas, California, Wayzata, Minnesota, Seattle, Washington, and Durham, North Carolina
| | - DAVID M. ALBALA
- From the Geisinger Medical Center, Danville, Pennsylvania, Loyola University Medical Center, Maywood, Illinois, San Ramon, San Mateo and Salinas, California, Wayzata, Minnesota, Seattle, Washington, and Durham, North Carolina
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Abstract
BACKGROUND Pelvic floor muscle training has long been the most common form of conservative treatment for stress urinary incontinence. Weighted vaginal cones can be used to help women to train their pelvic floor muscles. Cones are inserted into the vagina and the pelvic floor is contracted to prevent them slipping out. OBJECTIVES To evaluate the effects of weighted vaginal cones in the treatment of women with urinary incontinence. SEARCH STRATEGY We searched the Cochrane Incontinence Group specialised register (to February 2001), MEDLINE (January 1966 to August 2001), EMBASE (January 1988 to August 2001) and reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing weighted vaginal cones with alternative treatments or no treatment in women with urinary incontinence. DATA COLLECTION AND ANALYSIS Three reviewers independently assessed studies for inclusion and trial quality. Data was extracted by one reviewer and cross checked by the others. Study authors were contacted for extra information. MAIN RESULTS Fifteen studies, involving 1126 women of whom 466 received cones, were included. All of the trials were small and in many the quality was hard to judge. Outcome measures differed between studies, making the results difficult to combine. Some studies reported high drop out rates with both cone and comparison treatments. Four of the studies recruited women with symptoms of stress incontinence without urodynamic confirmation. Six trials were only published as abstracts. Cones were better than no active treatment (RR for failure to cure incontinence 0.74, 95% CI 0.59 to 0.93). There was little evidence of difference between cones and PFMT (RR 1.09, 95% CI 0.86 to 1.38) or electrostimulation (RR 1, 95% CI 0.89 to 1.13), but the confidence intervals were wide. There was not enough evidence to show that that cones plus PFMT was different to either cones alone or PFMT alone. Only two studies used a Quality of Life measure and no study looked at economic outcomes. REVIEWER'S CONCLUSIONS This review provides some evidence that weighted vaginal cones are better than no active treatment in women with stress urinary incontinence and may be of similar effectiveness to PFMT and electrostimulation. This conclusion must remain tentative until further larger high quality studies are carried out using comparable and relevant outcome measures. Some women treated with cones, pelvic floor muscle training or electrostimulation drop out of treatment early. Therefore, cones should be offered as one option so that if women find them unacceptable they know there are other treatments available.
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Affiliation(s)
- P Herbison
- Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand, 9001.
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25
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Jozwik M, Jozwik M. The physiological basis of pelvic floor exercises in the treatment of stress urinary incontinence. BJOG 1998. [DOI: 10.1111/j.1471-0528.1998.tb09934.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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