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Kasper-Jędrzejewska M, Starzec-Proserpio M, Paprocka-Borowicz M, Kawka S, Halski T, Ptaszkowski K. The effects of one-time soft tissue therapy on pelvic floor muscle electromyographic signals in women with urinary incontinence: A randomized intervention trial. Neurourol Urodyn 2024; 43:320-328. [PMID: 38078660 DOI: 10.1002/nau.25354] [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: 05/17/2023] [Revised: 09/22/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024]
Abstract
AIMS To investigate the effects of one-time soft tissue therapy (STT) on pelvic floor muscle (PFM) electromyographic signals in women with stress and/or mixed urinary incontinence. METHODS An intervention study conducted with 63 women with stress and/or mixed urinary incontinence. Participants were randomly assigned to either the one-time STT group (experimental group) or the control group. The same teaching model for voluntary contraction and relaxation of the PFM was used for all participants. Electromyographic signals from the PFM during functional tasks were the primary clinical outcome measures at baseline and immediately after the intervention. Electromyographic signals were analyzed using root mean square amplitude. RESULTS There was no significant difference between groups in electromyographic PFM signals in prebaseline rest (mean difference: -0.146 [95% confidence interval (CI): -0.44 to 0.148; p = 0.470]), phasic contractions (mean difference: 0.807 [95% CI: 0.123-1.491; p = 0.459]), tonic contractions (mean difference: 1.06 [95% CI: 0.255-1.865; p = 0.302]), endurance contractions (mean difference: 0.896 [95% CI: 0.057-1.735; p = 0.352]) and postbaseline rest (mean difference: -0.123 [95% CI: -0.406 to 0.16; p = 0.591]) immediately after the one-time STT intervention. CONCLUSION A one-time STT intervention does not appear to effectively alter electromyographic signal of the PFM in women with urinary incontinence. Due to the limitations of the study, further research is needed to confirm these results.
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Affiliation(s)
| | | | | | - Szymon Kawka
- Euro-Med Sp. Zoo, Physiotherapist, Tychy, Poland
| | - Tomasz Halski
- Department of Physiotherapy, Faculty of Medical Science, Jan Grodek State University in Sanok, Sanok, Poland
| | - Kuba Ptaszkowski
- Division of Rehabilitation in the Movement Disorders, Wroclaw Medical University, Wroclaw, Poland
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Bérubé MÈ, McLean L. The acute effects of running on pelvic floor morphology and function in runners with and without running-induced stress urinary incontinence. Int Urogynecol J 2024; 35:127-138. [PMID: 37991566 PMCID: PMC10811036 DOI: 10.1007/s00192-023-05674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/28/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to examine the impact of a single running session on pelvic floor morphology and function in female runners, and to compare those with and without running-induced stress urinary incontinence (RI-SUI). METHODS This cross-sectional, observational study involved two groups: female runners who regularly experienced RI-SUI (n = 19) and runners who did not (n = 20). Pelvic floor muscle (PFM) properties were assessed using intravaginal dynamometry during maximal voluntary contractions (MVC) and during passive tissue elongation. The morphology of the pelvic floor was assessed at rest, during MVC and during maximal Valsalva maneuver (MVM) using 2D and 3D transperineal ultrasound imaging before and after a running protocol. Mixed-effects ANOVA models were used to compare all outcomes between groups and within-groups, including the interaction between group and time. Effect sizes were calculated. RESULTS No changes in PFM function assessed using intravaginal dynamometry were observed in either group after the run. Significant and large within-group differences were observed on ultrasound imaging. Specifically, the area and antero-posterior diameter of the levator hiatus were larger after the run, the bladder neck height was lower after the run, and the levator plate length was longer after the run (p ≤ 0.05). At the peak MVM and MVC, the bladder neck height was lower after the run than before the run (p ≤ 0.05). No between-group differences were observed for any outcomes. CONCLUSIONS Running appears to cause transient strain of the passive tissues of the female pelvic floor in runners both with and without RI-SUI, whereas no concurrent changes are observed in PFM contractile function.
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Affiliation(s)
- Marie-Ève Bérubé
- School of Rehabilitation Sciences, University of Ottawa, 200 Lees Avenue E260C, Ottawa, ON, K1N 6N5, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, 200 Lees Avenue E260C, Ottawa, ON, K1N 6N5, Canada.
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Damaser MS, Valentini FA, Clavica F, Giarenis I. Is the time right for a new initiative in mathematical modeling of the lower urinary tract? ICI-RS 2023. Neurourol Urodyn 2023. [PMID: 38149773 DOI: 10.1002/nau.25362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION A session at the 2023 International Consultation on Incontinence - Research Society (ICI-RS) held in Bristol, UK, focused on the question: Is the time right for a new initiative in mathematical modeling of the lower urinary tract (LUT)? The LUT is a complex system, comprising various synergetic components (i.e., bladder, urethra, neural control), each with its own dynamic functioning and high interindividual variability. This has led to a variety of different types of models for different purposes, each with advantages and disadvantages. METHODS When addressing the LUT, the modeling approach should be selected and sized according to the specific purpose, the targeted level of detail, and the available computational resources. Four areas were selected as examples to discuss: utility of nomograms in clinical use, value of fluid mechanical modeling, applications of models to simplify urodynamics, and utility of statistical models. RESULTS A brief literature review is provided along with discussion of the merits of different types of models for different applications. Remaining research questions are provided. CONCLUSIONS Inadequacies in current (outdated) models of the LUT as well as recent advances in computing power (e.g., quantum computing) and methods (e.g., artificial intelligence/machine learning), would dictate that the answer is an emphatic "Yes, the time is right for a new initiative in mathematical modeling of the LUT."
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Affiliation(s)
- Margot S Damaser
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Françoise A Valentini
- Physical Medicine and Rehabilitation Department, Rothschild Hospital, Sorbonne Université, Paris, France
| | - Francesco Clavica
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ilias Giarenis
- Department of UroGynaecology, Norfolk and Norwich University Hospital, Norwich, UK
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Antônio FI, Yamamoto G, Varette K, McLean L. One in four women with stress urinary incontinence who are taught "the knack" maneuver adopt this motor pattern while coughing: A prospective interventional cohort study. Neurourol Urodyn 2023. [PMID: 37130076 DOI: 10.1002/nau.25196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/20/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
QUESTIONS Do women with stress urinary incontinence (SUI) who receive instruction to perform the knack maneuver as part of a 12-week pelvic floor muscle training (PFMT) program perform it during voluntary coughing without specific instruction to do so, and are subjective and objective outcomes better among those who do than among those who do not demonstrate the knack during voluntary coughing? DESIGN Secondary analysis of a prospective interventional cohort. PARTICIPANTS Women with SUI. INTERVENTION 12-week PFMT intervention including instruction to perform the knack. OUTCOME MEASURES Performance of the knack before a voluntary cough as confirmed through ultrasound imaging. SUI severity determined subjectively (International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms [ICIQ-FLUTS] overall score, ICIQ-FLUTS UI subscale score, 3-day bladder diary) and objectively (30-min pad test). RESULTS Outcome data were available from 69 participants. At baseline, no participants performed the knack when asked to cough. At follow-up, more participants performed the knack during a voluntary cough [18/69 (26%), 95% confidence interval [CI] 15%-35%] than at baseline. The extent of improvement in SUI symptoms was not different between participants who did and did not demonstrate the knack during a voluntary cough [FLUTS-UI subscale score (d = 0.31, 95% CI -0.78 to 2.77, n = 69), FLUTS overall score (d = 0.26, 95% CI -1.52-4.23, n = 69), 30-min pad test (d = 0.03, 95% CI -9.35 to 10.32, n = 69), 3-day bladder diary (d = 0.03, 95% CI -4.07 to 3.60, n = 51)]. CONCLUSION Approximately one in four women appear to adopt the knack as a motor response to a cough command, however, adopting the knack was not independently associated with greater improvements in SUI.
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Affiliation(s)
- Flávia I Antônio
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Grace Yamamoto
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Kevin Varette
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Linda McLean
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Xia W, Ameri G, Fakim D, Akhuanzada H, Raza MZ, Shobeiri SA, McLean L, Chen ECS. Automatic Plane of Minimal Hiatal Dimensions Extraction From 3D Female Pelvic Floor Ultrasound. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:3873-3883. [PMID: 35984794 DOI: 10.1109/tmi.2022.3199968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There is an increasing interest in the applications of 3D ultrasound imaging of the pelvic floor to improve the diagnosis, treatment, and surgical planning of female pelvic floor dysfunction (PFD). Pelvic floor biometrics are obtained on an oblique image plane known as the plane of minimal hiatal dimensions (PMHD). Identifying this plane requires the detection of two anatomical landmarks, the pubic symphysis and anorectal angle. The manual detection of the anatomical landmarks and the PMHD in 3D pelvic ultrasound requires expert knowledge of the pelvic floor anatomy, and is challenging, time-consuming, and subject to human error. These challenges have hindered the adoption of such quantitative analysis in the clinic. This work presents an automatic approach to identify the anatomical landmarks and extract the PMHD from 3D pelvic ultrasound volumes. To demonstrate clinical utility and a complete automated clinical task, an automatic segmentation of the levator-ani muscle on the extracted PMHD images was also performed. Experiments using 73 test images of patients during a pelvic muscle resting state showed that this algorithm has the capability to accurately identify the PMHD with an average Dice of 0.89 and an average mean boundary distance of 2.25mm. Further evaluation of the PMHD detection algorithm using 35 images of patients performing pelvic muscle contraction resulted in an average Dice of 0.88 and an average mean boundary distance of 2.75mm. This work had the potential to pave the way towards the adoption of ultrasound in the clinic and development of personalized treatment for PFD.
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Hwang JC, Sun FJ, Su TH, Lau HH. Efficacy of Biofeedback and Electrostimulation-Assisted Pelvic Floor Muscle Training between Women with Mild and Moderate to Severe Stress Urinary Incontinence. J Clin Med 2022; 11:6424. [PMID: 36362651 PMCID: PMC9655096 DOI: 10.3390/jcm11216424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND To evaluate the efficacy of biofeedback and electrical stimulation-assisted pelvic floor muscle training (PFMT) between women with mild and moderate to severe stress urinary incontinence (SUI). METHODS This retrospective cohort study was conducted at a single center from 2014 to 2021. We included 57 patients with urodynamically proven SUI who underwent a biofeedback and electrical stimulation-assisted PFMT. They were categorized into mild and moderate to severe SUI. One-hour pad test from 2 to 10 g was defined as mild SUI, and ≥11 g was defined as moderate to severe SUI. RESULTS Fifty-seven patients were reviewed during the study period. Incontinence-related symptoms of distress, including the UDI-6, ISI, and VAS, all significantly improved in the mild SUI group (p = 0.001, p = 0.001 and p = 0.010, respectively), while only UDI-6 and VAS statistically improved in the moderate to severe SUI group (p = 0.027 and p = 0.010, respectively). There was significant improvement in IIQ-7 in the mild SUI group during serial treatments, but only in Session 6 in the moderate to severe SUI group. After 18 sessions of treatment, the UDI-6, ISI, and IIQ-7 scores showed significantly greater improvements in the mild SUI group compared to the moderate to severe SUI group (p = 0.003, p = 0.025, and p = 0.002, respectively). CONCLUSIONS Although biofeedback and electrical stimulation-assisted PFMT is an effective treatment option for SUI, it is more beneficial for patients with mild SUI and a 1-h pad weight ≤ 10 g urine leak.
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Affiliation(s)
- Jiun-Chyi Hwang
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
- Devision of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei 251, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei 251, Taiwan
| | - Tsung-Hsien Su
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
- Devision of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei 251, Taiwan
| | - Hui-Hsuan Lau
- Department of Medicine, Mackay Medical College, New Taipei 252, Taiwan
- Devision of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104, Taiwan
- Mackay Medicine, Nursing and Management College, Taipei 251, Taiwan
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What improvements in levator ani motor function lead to improvement in stress urinary incontinence signs and symptoms in females? Int Urogynecol J 2021; 33:2735-2747. [PMID: 34477898 DOI: 10.1007/s00192-021-04931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objectives were to determine whether levator ani muscle (LAM) motor function is associated with female stress urinary incontinence (SUI) severity, and whether changes in LAM motor function induced through pelvic floor muscle training (PFMT) are associated with improvements in SUI signs and symptoms. METHODS Pelvic morphology and LAM function were evaluated using ultrasound imaging and manual palpation using the elements of the PERFECT Scheme (Power, Endurance, Repetitions, Fast contractions, Elevation, Co-contraction and Timing) before and after women with SUI underwent a 12-week PFMT intervention. SUI severity was determined subjectively (ICIQ-FLUTS-UI) and objectively (30-min pad test [30MPT]). RESULTS At baseline (n = 97), less leakage on the 30MPT was weakly associated with higher bladder neck position (ρs = -0.209,p = 0.044), yet with lower LAM function based on the PERFECT Scheme (overall score: ρs = 0.206, p = 0.043; repeated maximum voluntary contractions (MVCs): ρs = 0.203, p = 0.046; power/motor control: ρs = 0.214, p = 0.035). Lower symptom severity (ICIQ-FLUTS-UI) was associated with observed perineal lift during coughing (U = 34.000; p = 0.042). All measures of SUI severity and LAM function were significantly improved after PFMT intervention. Greater improvements in bladder neck elevation during MVC (ρs = -0.261, p = 0.027) and greater reductions in levator plate length during MVC (ρs = 0.292, p = 0.016) were weakly associated with greater reductions in leakage (30MPT), the latter also being associated with more improvement symptoms (ICIQ-FLUTS-UI; ρs = 0.238, p = 0.041). Greater improvement in the ability to repeat MVCs (ρs = 0.303, p = 0.009) was weakly associated with smaller improvements in symptoms (ICIQ-FLUTS-UI). CONCLUSION Improvements in bladder neck support and elevation show weak associations with improvement in SUI signs and symptoms. LAM function as measured by the PERFECT Scheme is not associated with SUI severity in women, and improvements in LAM function when measured by the PERFECT Scheme are not associated with improvements in SUI signs and symptoms.
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