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Wang QH, Liu LH, Ying H, Chen MX, Zhou CJ, Li H. Clinically significant changes in anal sphincter hiatal area in patients with gestational diabetes mellitus and pelvic organ prolapse. World J Diabetes 2024; 15:1726-1733. [PMID: 39192856 PMCID: PMC11346099 DOI: 10.4239/wjd.v15.i8.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/07/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The prevalence of pelvic organ prolapse (POP) increases with age and parity. Specifically, the prevalence of POP among women aged 20 to 39 is 9.7%, while it rises to 49% among women over 80 years old. Additionally, as the number of deliveries increases, the prevalence of POP also rises accordingly, with a rate of 12.8% for women with one delivery history, 18.7% for those with two deliveries, and 24.6% for women with three or more deliveries. It causes immense suffering for pregnant women. AIM To evaluate the relationship between the levator ani muscle's hiatus (LH) area and POP in patients with gestational diabetes mellitus (GDM) using perineal ultra-sound. METHODS The study cohort comprised 104 patients aged 29.8 ± 3.7 years who sought medical care at our institution between January 2021 and June 2023. All were singleton pregnancies consisting of 75 primiparas and 29 multiparas, with an average parity of 1.7 ± 0.5. According to the POP diagnostic criteria, the 104 subjects were divided into two groups with 52 members each: POP group (patients with GDM combined with POP) and non-POP group (patients with GDM without POP). Perineal ultrasound was used to measure differences in the anteroposterior diameter, transverse diameter, and LH area. Receiver operating characteristic curves were drawn to determine the optimal cutoff values for the LH anteroposterior diameter, transverse diameter, and area for diagnosing POP. RESULTS Statistically significant increase in the LH area, anteroposterior diameter, and lateral diameter were observed in the POP group compared with the non-POP group (P < 0.05). Both groups exhibited markedly elevated incidence rates of macrosomia and stress urinary incontinence. For the POP group, the area under the curve (AUC) for the LH area was 0.906 with a 95% confidence interval (CI): 0.824-0.988. The optimal cutoff was 13.54cm², demonstrating a sensitivity of 83.2% and a specificity of 64.4%. The AUC for the anteroposterior diameter reached 0.836 with a 95%CI: 0.729-0.943. The optimal cutoff was 5.53 cm with a sensitivity of 64.2% and a specificity of 73.4%. For the lateral diameter, its AUC was 0.568 with a 95%CI: 0.407-0.729. The optimal cutoff was 4.67 cm, displaying a sensitivity of 65.9% and a specificity of 69.3%. Logistic regression analysis unveiled that age, body weight, number of childbirths, total number of pregnancies, and gestational weight gain constituted the independent risk factors for the cooccurrence of GDM and POP. CONCLUSION Three-dimensional perineal ultrasonography of LH size and shape changes can effectively diagnose POP. Age, weight, number of births, number of pregnancies, and weight gain during pregnancy are independent risk factors affecting the cooccurrence of GDM and POP. GDM can increase the LH area in patients, and an enlarged LH leads to an increased incidence of POP.
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Affiliation(s)
- Qing-Hong Wang
- Department of Sonography, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
| | - Li-Hua Liu
- Department of Sonography, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
| | - Hua Ying
- Department of Sonography, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
| | - Ming-Xu Chen
- Department of Sonography, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
| | - Chang-Jiang Zhou
- Department of Sonography, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
| | - Hui Li
- Department of Obstetrics and Gynecology, People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, Shandong Province, China
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Zhao H, Shen L, Liu Y. Curvilinear relationship was found between visceral adiposity index and stress urinary incontinence among US adult women: A cross-sectional study. Neurourol Urodyn 2024. [PMID: 39086153 DOI: 10.1002/nau.25564] [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: 04/17/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024]
Abstract
AIMS The purpose of this study was to find out the relation between visceral adipose index (VAI) levels and stress urinary incontinence (SUI) in adult women. METHODS From the National Health and Nutrition Examination Survey (NHANES) 2007-2020, females aged 20 or above were identified for this study. Visceral adiposity was determined using the VAI score, and the assessment of urinary incontinence was carried out through a correlation questionnaire. Logistic regression models and restricted cubic spline (RCS) regression were employed to analyze the relationship between VAI levels and SUI. RESULTS Among the 6522 participants, 2672 (41.0%) were reported SUI. Multivariate logistic regression revealed significantly higher odds of SUI with increasing VAI levels (Q4 vs. Q1), adjusted odds ratio (aOR) = 1.53 (CI: 1.29-1.81, p < 0.001). RCS regression indicated a curvilinear relationship between VAI and SUI (p = 0.003). In threshold analysis, aOR for developing SUI was 1.18 (CI: 1.11-1.26, p < 0.001) for participants with VAI < 4.73, suggesting an 18% increased risk of SUI with each unit increase in VAI. No association between VAI and SUI was observed when VAI was ≥4.73. CONCLUSIONS Our study has revealed a significant curvilinear relationship between VAI and SUI within a large and representative sample of women. Future research is necessary to evaluate the relationship between the two and explicate the underlying mechanisms of this relationship.
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Affiliation(s)
- Haibo Zhao
- Department of Obstetrics and Gynaecology, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Liping Shen
- Department of Obstetrics and Gynaecology, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Yu Liu
- Department of Obstetrics and Gynaecology, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
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Bhandari Randhawa S, Rizkallah A, Nelson DB, Duryea EL, Spong CY, Pruszynski JE, Rahn DD. Factors Associated With Persistent Bothersome Urinary Symptoms and Leakage After Pregnancy. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00219. [PMID: 38710008 DOI: 10.1097/spv.0000000000001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
IMPORTANCE Urinary incontinence is a common postpartum morbidity that negatively affects quality of life. OBJECTIVE This study aimed to identify factors associated with persistent (ie, 12 months postpartum) bothersome urinary symptoms, including stress urinary incontinence (SUI) and urgency urinary incontinence (UUI), and explore their association with mental health in medically underserved communities. STUDY DESIGN This was a cross-sectional analysis of a prospective study of individuals enrolled into "extending Maternal Care After Pregnancy," a program providing 12 months of postpartum care to individuals with health disparities. Patients were screened at 12 months for urinary dysfunction, anxiety, and depression using the Urinary Distress Index-6, Generalized Anxiety Disorder-7, and Edinburgh Postnatal Depression Scale, respectively. Bivariate and multivariable logistic regression analyses were performed for at-least-somewhat-bothersome SUI versus no-SUI, UUI versus no-UUI, and for bothersome versus asymptomatic urinary symptoms, using demographic and peripartum and postpartum variables as associated factors. RESULTS Four hundred nineteen patients provided data at median 12 months postpartum. Patients were 77% Hispanic White and 22% non-Hispanic Black. After multivariable analysis, SUI (n = 136, 32.5%) was significantly associated with increasing body mass index at the time of delivery and greater depression screening scores. Fetal birthweight, mode of delivery, degree of laceration, and breastfeeding status were not associated. Urgency urinary incontinence (n = 69, 16.5%) was significantly associated with increasing parity and higher anxiety screening scores. Similarly, participants with urinary symptom bother had significantly greater parity and higher anxiety screening scores. CONCLUSIONS At 12 months postpartum, bothersome urinary symptoms and incontinence were quite common. Since these are treatable, postpartum screening for urinary complaints-and associated anxiety and depression-is essential, as is assisting patients in achieving a healthy weight.
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Affiliation(s)
- Sonia Bhandari Randhawa
- From the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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Koenig JB, Burnett LA. Understanding the Role of Obesity and Metabolism in Pelvic Floor Disorders. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:389-393. [PMID: 38564623 DOI: 10.1097/spv.0000000000001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Jenny B Koenig
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences
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Vahiddastjerdi M, Vaghar ME, Astahi MR. Evaluation of the effect of biofeedback in women with urinary and fecal incontinence referring to the hospitals of Islamic Azad university of medical sciences, Tehran branch, Iran (2021). J Family Med Prim Care 2024; 13:492-497. [PMID: 38605806 PMCID: PMC11006072 DOI: 10.4103/jfmpc.jfmpc_877_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/18/2023] [Accepted: 08/01/2023] [Indexed: 04/13/2024] Open
Abstract
Background and Purpose Urinary incontinence (URIN) and fecal incontinence (FEIN) are common in women, which affect various aspects of their daily life and general health. Therefore, the main purpose of this study was to evaluate the effect of biofeedback (BFB) in women with urinary and FEIN referring to the hospitals of Islamic Azad University of Medical Sciences, Tehran branch, Iran (2021). Materials and Methods This research was a cohort study that was conducted on 100 women with urinary and FEIN who were referred to selected hospitals of the Islamic Azad University of Medical Sciences, Tehran branch. In this study, before and after BFB, the amount of urinary and FEIN in patients was measured and finally compared by SPSS-ver. 16 software. Results The results of this study showed that the frequency of patients with URIN and FEIN was equal to 66 (66%) and 34 (66%) patients, respectively. After treatment with BFB, 39 (59.1%) patients with URIN and 39 (59.1%) patients with FEIN had symptom improvement. The mean body mass index and the number of pregnancies in patients who improved urinary and FEIN symptoms after BFB were significantly lower than in patients who did not improve symptoms. Conclusion Based on the findings of the present study, it can be concluded that effective and significant factors on the improvement of urinary and FEIN symptoms after BFB include fiber consumption, the presence of underlying diseases such as diabetes, blood pressure, type of delivery, history of depression, history of anorectal surgery, and vaginal delivery was difficult. In addition, based on the findings of the study, it can be said that BFB has an acceptable effect in improving the symptoms of urinary and FEIN in women, although additional studies are needed to confirm the results.
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Affiliation(s)
- Mehdi Vahiddastjerdi
- Department of Neurology, Faculty of Medicine, Tehran Medical Sciences Islamic, Azad University, Tehran, Iran
| | | | - Mohammad Rasool Astahi
- Medical Student, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Costa SMB, Hallur RLS, Reyes DRA, Floriano JF, de Barros Leite Carvalhaes MA, de Carvalho Nunes HR, Sobrevia L, Valero P, Barbosa AMP, Rudge MCV. Role of dietary food intake patterns, anthropometric measures, and multiple biochemical markers in the development of pregnancy-specific urinary incontinence in gestational diabetes mellitus. Nutrition 2024; 117:112228. [PMID: 37948994 DOI: 10.1016/j.nut.2023.112228] [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: 05/29/2023] [Revised: 09/04/2023] [Accepted: 09/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The aim of this study was to assess maternal dietary food intake patterns, anthropometric measures, and multiple biochemical markers in women with gestational diabetes mellitus and pregnancy-specific urinary incontinence and to explore whether antedating gestational diabetes mellitus environment affects the pregnancy-specific urinary incontinence development in a cohort of pregnant women with gestational diabetes mellitus and pregnancy-specific urinary incontinence. METHODS Maternal dietary information and anthropometric measurements were collected. At 24 wk of gestation, with a fasting venipuncture sample, current blood samples for biochemical markers of hormones, vitamins, and minerals were analyzed. The groups were compared in terms of numerical variables using analysis of variance for independent samples followed by multiple comparisons. RESULTS Of the 900 pregnant women with complete data, pregnant women in the gestational diabetes mellitus pregnancy-specific urinary incontinence group had higher body mass index during pregnancy, arm circumference, and triceps skinfold than the non-gestational diabetes mellitus continent and non-gestational diabetes mellitus pregnancy-specific urinary incontinence groups, characterizing an obesogenic maternal environment. Regarding dietary food intake, significant increases in aromatic amino acids, branched-chain amino acids, dietary fiber, magnesium, zinc, and water were observed in pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus continent group. Serum vitamin C was reduced in the gestational diabetes mellitus pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus pregnancy-specific urinary incontinence group. CONCLUSIONS This study emphasizes the necessity for a comprehensive strategy for gestational diabetes mellitus women with pregnancy-specific urinary incontinence in terms of deviation in maternal adaptation trending toward obesity and maternal micronutrients deficiencies.
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Affiliation(s)
- Sarah Maria Barneze Costa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | - Raghavendra Lakshmana Shetty Hallur
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil; College of Biosciences and Technology, Pravara Institute of Medical Sciences (DU), Loni-413736, Rahata Taluka, Ahmednagar District, Maharashtra State, India
| | - David Rafael Abreu Reyes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | - Juliana Ferreira Floriano
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | | | | | - Luis Sobrevia
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil; Cellular and Molecular Physiology Laboratory, Division of Obstetrics and Gynecology, Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Institute for Obesity Research, School of Medicine and Health Sciences, Monterrey Institute of Technology and Higher Education, Monterrey, Mexico
| | - Paola Valero
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil; Faculty of Health Sciences, Universidad de Talca, Talca, Chile
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil; Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University, Marília, Brazil
| | - Marilza Cunha Vieira Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil.
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Wang X, Wang H, Xu P, Mao M, Feng S. Epidemiological trends and risk factors related to lower urinary tract symptoms around childbirth: a one-year prospective study. BMC Public Health 2023; 23:2134. [PMID: 37907879 PMCID: PMC10617094 DOI: 10.1186/s12889-023-17065-w] [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: 03/10/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) are prevalent and distressing concerns for women worldwide. The prevalence of LUTS reaches the first peak during pregnancy and postnatal period. However, less attention has been paid to LUTS around childbirth and little progress has been made in the prevention of LUTS. Understanding the epidemiological characteristics of LUTS around childbirth would inform decision making for health care providers and perinatal women in the prevention of LUTS. The study aims to investigate the epidemiological trends and associated risk factors related to LUTS around childbirth. METHODS Pregnant women were consecutively enrolled during pregnancy in the obstetrical wards of a tertiary hospital and followed up at 6-8 weeks and one year postpartum through a prospective design. Urinary incontinence was assessed with the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form. Other symptoms were measured with questions based on definitions of the International Incontinence Society. Multiple logistic regression was used to examine the risk factors for LUTS including urinary incontinence, increased daytime frequency, nocturia and urgency. The report followed the STROBE statement. RESULTS A total of 1243 pregnant women participated in this study. The prevalence of at least one type of storage symptoms was 94%, 55% and 35% in late pregnancy, at 6-8 weeks and one year postpartum, respectively. The prevalence of urinary incontinence remained at 21% within one year postpartum. The majority of the participants suffered from mild to moderate urinary incontinence. Age, job, BMI before pregnancy, gestational diabetes mellitus, urinary tract infection history, previous history of LUTS, age at first birth and birth mode were predictors of LUTS one year postpartum. CONCLUSION LUTS were highly prevalent during pregnancy and postnatal period. The prevalence of urinary incontinence was more stable than that of other LUTS within one year postpartum. Women aged more than 35 years, engaging in manual work, with gestational diabetes mellitus, with a history of urinary tract infection and LUTS, with advanced age at first birth and vaginal delivery were more likely to suffer from LUTS postpartum. The findings provided a novel and deep insight into the epidemiological trends and related risk factors of LUTS around childbirth.
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Affiliation(s)
- Xiaojuan Wang
- School of Medicine, Zhejiang University, No.866 Yu Hang Tang Road, Hangzhou, Zhejiang Province, 310058, China
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Hongyan Wang
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Ping Xu
- School of Medicine, Zhejiang University, No.866 Yu Hang Tang Road, Hangzhou, Zhejiang Province, 310058, China
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Minna Mao
- School of Medicine, Zhejiang University, No.866 Yu Hang Tang Road, Hangzhou, Zhejiang Province, 310058, China
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Suwen Feng
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China.
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Vesentini G, Piculo F, Marini G, Barbosa AMP, Corrente JE, Rudge MVC. Impact of Obesity and Hyperglycemia on Pregnancy-specific Urinary Incontinence. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:303-311. [PMID: 37494572 PMCID: PMC10411106 DOI: 10.1055/s-0043-1770087] [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: 09/15/2022] [Accepted: 04/17/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE The lack of data on the impact of hyperglycemia and obesity on the prevalence of pregnancy-specific urinary incontinence (PSUI) led us to conduct a cross-sectional study on the prevalence and characteristics of PSUI using validated questionnaires and clinical data. METHODS This cross-sectional study included 539 women with a gestational age of 34 weeks who visited a tertiary university hospital between 2015 and 2018. The main outcome measures were the prevalence of PSUI, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Incontinence Severity Index (ISI) questionnaires. The women were classified into four groups: normoglycemic lean, normoglycemic obese, hyperglycemic lean, and hyperglycemic obese. The differences between groups were tested using descriptive statistics. Associations were estimated using logistic regression analysis and presented as unadjusted and adjusted odds ratios. RESULTS Prevalence rates of PSUI were no different between groups. However, significant difference in hyperglycemic groups worse scores for severe and very severe PSUI. When adjusted data for confound factors was compared with normoglycemic lean group, the hyperglycemic obese group had significantly higher odds for severe and very severe forms of UI using ICIQ-SF (aOR 3.157; 95% CI 1.308 to 7.263) and ISI (aOR 20.324; 95% CI 2.265 to 182.329) questionnaires and highest perceived impact of PSUI (aOR 4.449; 95% CI 1.591 to 12.442). CONCLUSION Our data indicate that obesity and hyperglycemia during pregnancy significantly increase the odds of severe forms and perceived impact of PSUI. Therefore, further effective preventive and curative treatments are greatly needed.
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Affiliation(s)
- Giovana Vesentini
- Perinatal Diabetes Research Center, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Fernanda Piculo
- Perinatal Diabetes Research Center, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Gabriela Marini
- Perinatal Diabetes Research Center, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, SP, Brazil
- Department of Health Sciences, Universidade Sagrado Coração, Bauru, São Paulo, Brazil
| | | | - José Eduardo Corrente
- Perinatal Diabetes Research Center, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, SP, Brazil
- Department of Biostatistics, Bioscience Institute, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Marilza Vieira Cunha Rudge
- Perinatal Diabetes Research Center, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Gari AM, Alamer EHA, Almalayo RO, Alshaddadi WA, Alamri SA, Aloufi RS, Baradwan S. Prevalence of Stress Urinary Incontinence and Risk Factors among Saudi Females. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050940. [PMID: 37241172 DOI: 10.3390/medicina59050940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/16/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Stress urinary incontinence (SUI) is involuntary urine leakage upon effort or physical exertion, sneezing, or coughing, and it is the most prevalent type of urinary incontinence (UI) in women. We aimed to estimate the prevalence of SUI and its risk factors among Saudi females. Materials and Methods: A descriptive cross-sectional study was conducted in the Kingdom of Saudi Arabia between March 2022 and July 2022, with a total of 842 respondents. We included Saudi females over the age of 20 years. Data were collected through an online questionnaire distributed to the target group and analyzed using SPSS software. Results: The prevalence of SUI was found to be 3.3% among Saudi women. Moreover, only 41.8% of the participants had at least one pregnancy; the majority had five or more pregnancies (29%). According to our findings, the majority of the participants diagnosed with SUI had the following risk factors: increased age, widowhood, a family history of SUI, and a history of pregnancy. The results revealed that the odds of SUI increased among Saudi females with a family history of SUI by 19.68-fold compared with those who had no family history of SUI, and this was statistically significant (p < 0.001). Conclusion: The prevalence of SUI among Saudi females was found to be relatively low. The above-listed associated factors should be considered in future research and interventions.
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Affiliation(s)
- Abdulrahim M Gari
- Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah 11211, Saudi Arabia
| | | | - Rania O Almalayo
- College of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Wafa A Alshaddadi
- College of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Sadin A Alamri
- College of Medicine, University of Jeddah, Jeddah 21959, Saudi Arabia
| | - Razan S Aloufi
- College of Medicine, AlRayan Colleges, Al-Madinah 42541, Saudi Arabia
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah 11211, Saudi Arabia
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Xu P, Jin Y, Guo P, Xu X, Wang X, Zhang W, Mao M, Feng S. Barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence: a qualitative analysis using the theoretical domains framework. BMC Pregnancy Childbirth 2023; 23:300. [PMID: 37118702 PMCID: PMC10148524 DOI: 10.1186/s12884-023-05633-2] [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: 11/14/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Stress urinary incontinence during pregnancy is closely related to the occurrence of postpartum and long-term urinary incontinence. Early pelvic floor management is of great significance in promoting the recovery of pelvic floor tissues in pregnant women. However, effective management of urinary incontinence is far from achievable owing to the low adherence of pregnant women in partaking in pelvic floor rehabilitation. As a comprehensive framework for behavioural theory, the Theoretical Domain Framework allows for comprehensive identification of behavioural determinants. Using Theoretical Domain Framework, this study aimed to identify barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence. METHODS A descriptive, qualitative design was used in this study. Face-to-face semi-structured interviews were conducted with pregnant women with stress urinary incontinence based on the Theoretical Domain Framework. The data were analysed using a combination of inductive and deductive methods. RESULTS Twenty pregnant women with stress urinary incontinence were interviewed. Seven themes were summarised and used to explain the pelvic floor rehabilitation behaviours of pregnant women with stress urinary incontinence. The seven themes were (1) individual knowledge and experience of pelvic floor management, (2) judgments about expected outcomes, (3) interactions of interpersonal situations, (4) environment, resources, and decision-making processes, (5) personal goal-setting and efforts towards behaviour change, (6) emotional influences on decision-making, and (7) personal characteristics. Besides the "Optimism" domain, 13 of the 14 Theoretical Domains Framework domains were found to influence pregnant patients' pelvic floor rehabilitation behaviours after deductive mapping of themes to the Theoretical Domains Framework. In addition, the inductive analysis generated a theme of personal characteristics that did not map to any of the Theoretical Domains Framework domains. CONCLUSIONS The pelvic floor rehabilitation behaviours of pregnant women with stress urinary incontinence are complex and are affected by many factors. The findings confirm the need for multiple interventions to support pelvic floor management in pregnant women with stress urinary incontinence, focusing on enhancing knowledge and skills in pelvic floor care and using appropriate behaviour change techniques (such as prompts) to provide a supportive environment.
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Affiliation(s)
- Ping Xu
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Ying Jin
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Pingping Guo
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Xuefen Xu
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Xiaojuan Wang
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Wei Zhang
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Minna Mao
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Suwen Feng
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China.
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Wang X, Sun Z, Xu T, Fan G. Efficacy of supervised pelvic floor muscle training with a home-based biofeedback device for urinary incontinence in postpartum women: protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e069874. [PMID: 37185188 PMCID: PMC10151990 DOI: 10.1136/bmjopen-2022-069874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Supervised pelvic floor muscle training (PFMT) of at least 3 months duration has been strongly recommended as a first-line treatment for women with stress urinary incontinence (SUI) or SUI-predominant mixed urinary incontinence (MUI), including elderly and postnatal women. However, for the treatment of SUI and MUI in postpartum women, it is currently uncertain whether supervised PFMT combined with a biofeedback device is superior to PFMT alone. Despite some supportive results, more reliable evidence is lacking. METHODS AND ANALYSIS The study is designed as a multicentre assessor-blinded parallel-group randomised controlled trial comparing the efficacy of PFMT with a home-based pressure-mediated biofeedback device (intervention group) and that of at-home PFMT alone (control group) for women with new-onset SUI or SUI-predominant MUI after delivery. Five hundred eligible women from the obstetric outpatient clinics of five tertiary hospitals will be randomly allocated (1:1) and evaluated with repeated questionnaires, physical examinations and pelvic floor assessments at baseline (pretest), 3 months, 6 months and 12 months (postintervention) during the study period. Both groups will be instructed to follow the same training protocol under 3-month supervision after randomisation. The use of a biofeedback device with a self-assessment function will be added to the PFMT regime for patients in the intervention group. The primary outcome is the self-reported severity of urinary incontinence assessed through the short form of the International Consultation on Incontinence Questionnaire-Urinary Incontinence. Secondary outcomes include pelvic muscle support and strength, symptoms of pelvic organ prolapse, quality of life, sexual function, self-efficacy and adherence. ETHICS AND DISSEMINATION Ethical approval has been received from the Peking Union Medical College Hospital ethics committee (JS-3192D). All results from the study will be submitted to international journals and international conferences. TRIAL REGISTRATION NUMBER NCT05115864.
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Affiliation(s)
- Xiuqi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Zhijing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Guorong Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
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Reis BM, Corrêa MDS, Hirakawa HS, Sato TDO, Driusso P. Association between pelvic floor muscle function and stress urinary incontinence in the third gestational trimester: A cross-sectional observational study. Physiother Theory Pract 2023; 39:582-589. [PMID: 34965836 DOI: 10.1080/09593985.2021.2021573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Investigate the association between pelvic floor muscle function and stress urinary incontinence (SUI) in women in the third trimester of pregnancy. METHODS Cross-sectional observational study. Urinary symptoms were collected through a questionnaire. The physical examination of the pelvic floor muscle was performed by vaginal palpation and manometry. Multivariate logistic regression analyses were performed to investigate the factors associated with SUI. RESULTS Analysis of the data collected from nulliparous and multiparous women identified an association between decreased pelvic floor muscle function (i.e. Power, Repetition, and Maximal Voluntary Contraction (MVC)) and the presence of SUI. There were also associations noted between power and SUI [AOR (95% CI) = 1.41 (1.01-1.97)], repetition and SUI [AOR (95% CI) = 1.31 (1.06-1.63)], and MVC and SUI [AOR (95% CI) = 1.02 (1.00-1.03)]. In the analysis of nulliparous women, there was also an association between low resting vaginal pressure (manometry) and SUI [AOR (95% CI) = 1.03 (1.01-1.06)]. CONCLUSIONS Low pelvic floor muscle strength, low MVC, and decreased ability to repeat sustained pelvic floor muscle contractions were associated with SUI in the third gestational trimester. In nulliparous women, there was an association between low resting vaginal pressure and SUI; however, none these associations were identified in multiparous women.
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Affiliation(s)
- Bianca Manzan Reis
- Physical Therapy Post-Graduate Program, Federal University of São Carlos (Ufscar), Monjolinho, Brazil
| | - Mikaela Da Silva Corrêa
- Physical Therapy Post-Graduate Program, Federal University of São Carlos (Ufscar), Monjolinho, Brazil
| | | | - Tatiana de Oliveira Sato
- Physical Therapy Post-Graduate Program, Federal University of São Carlos (Ufscar), Monjolinho, Brazil
| | - Patricia Driusso
- Physical Therapy Post-Graduate Program, Federal University of São Carlos (Ufscar), Monjolinho, Brazil
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Rashidi F, Mirghafourvand M. Pelvic floor disorder and relevant factors in Iranian women of reproductive age: a cross-sectional study. BMC Womens Health 2023; 23:71. [PMID: 36797735 PMCID: PMC9933298 DOI: 10.1186/s12905-023-02226-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND With high severity and prevalence, pelvic floor disorder is a health issue that women face worldwide. Different demographic-obstetric factors are involved in the emergence of this dysfunction that can have many adverse effects on a woman's quality of life. Hence, this study aimed to determine the prevalence of pelvic floor disorder and its related socio-demographic and obstetric factors among Iranian women of reproductive age. METHODS The statistical population of this cross-sectional study included 400 woman of reproductive age (15-49 years) covered by the health centers of Tabriz, Iran in 2022. The cluster sampling method was employed to select the participants. The data collection tools were a socio-demographic and obstetric characteristics questionnaire and the PDFI-20 (Pelvic Floor Distress Inventory-20). The chi-squared test was conducted to determine the association between socio-demographic and obstetric characteristics and prevalence of pelvic floor disorder in a bivariate analysis, whereas the multivariate logistic regression test was used in a multivariate analysis. RESULTS The general prevalence of pelvic floor disorder was 76%. The prevalence rates of pelvic organ prolapse distress 6 (POPDI-6), colorectal-anal distress 8 (CRAD-8), and urinary distress (UDI-6) were 54.3%, 61.8%, and 49.3%, respectively. The results of the multivariate logistic regression test indicated that constipation (odds ratio = 5.62; 95% CI 1.97 to 16.03; P = 0.001) increased the risk of pelvic floor disorder. CONCLUSIONS According to the findings, the prevalence of pelvic floor disorder is high among Iranian women of reproductive age. This condition is correlated with constipation. Therefore, screening is recommended through valid tools in addition to offering preventive measures such as preventing and curing constipation to reduce the risk of pelvic floor disorder.
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Affiliation(s)
- Fatemeh Rashidi
- grid.412888.f0000 0001 2174 8913Students’ Research Committee, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- grid.412888.f0000 0001 2174 8913Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati Street, P.O. Box: 51745-347, Tabriz, 513897977 Iran
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Wang XX, Zhang L, Lu Y. Advances in the molecular pathogenesis and cell therapy of stress urinary incontinence. Front Cell Dev Biol 2023; 11:1090386. [PMID: 36846586 PMCID: PMC9944745 DOI: 10.3389/fcell.2023.1090386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Stress urinary incontinence (SUI) is very common in women. It affects patients' mental and physical health, and imposed huge socioeconomic pressure. The therapeutic effect of conservative treatment is limited, and depends heavily on patient persistence and compliance. Surgical treatment often brings procedure-related adverse complications and higher costs for patients. Therefore, it is necessary to better understand the potential molecular mechanisms underlying stress urinary incontinence and develop new treatment methods. Although some progress has been made in the basic research in recent years, the specific molecular pathogenic mechanisms of SUI are still unclear. Here, we reviewed the published studies on the molecular mechanisms associated with nerves, urethral muscles, periurethral connective tissue and hormones in the pathogenesis of SUI. In addition, we provide an update on the recent progresses in research on the use of cell therapy for treating SUI, including research on stem cells therapy, exosome differentiation and gene regulation.
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Affiliation(s)
- Xiao-xiao Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Lei Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Aydogmus S, Aydogmus H, Gul S, Kahraman GN, Yilmaz A. Is vitamin D replacement effective in the treatment of postpartum urinary incontinence? Int Urogynecol J 2023; 34:1103-1108. [PMID: 36645442 DOI: 10.1007/s00192-022-05446-5] [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: 11/12/2022] [Accepted: 12/15/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The main objective of this study was to compare the effectiveness of pelvic floor muscle training, and vitamin D replacement in the treatment of urinary incontinence in the postpartum period of pregnant women with vitamin D deficiency. METHODS The study was planned as an ancillary study of a study on the determination of the relationship between vitamin D deficiency and urinary incontinence in third-trimester pregnant women. Total 61 women who defined urinary incontinence at postpartum 8th week were included in the study. The participants were divided into two groups: the vitamin D replacement group and the pelvic floor muscle training (PFMT) group. Participants in both groups received appropriate treatment for 12 weeks. İnitial evaluations of which Pelvic Organ Prolapse-Quantification stage, International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) query, and pelvic floor muscle strength were repeated after 12 weeks of treatment for each patient. RESULTS In the vitamin D replacement group, there was a significant increase in Oxford scores measured after treatment compared with pre-treatment and a significant decrease in ICIQ-FLUTS scores. In the comparison of the groups, it was determined that the changes in the Oxford and ICIQ-FLUTS scores of the vitamin D group after treatment were significantly higher than those of the PFMT group. In this pilot study, it was determined that the effectiveness of vitamin D replacement in the treatment of pelvic floor dysfunction in pregnant women with hypovitaminosis D was significantly higher than PFMT. CONCLUSION Vitamin D replacement may be useful in the treatment of urinary incontinence in pregnant women with hypovitaminosis D.
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Affiliation(s)
- Serpil Aydogmus
- İzmir Atatürk Research and Training Hospital, Department of Gynecology and Obstetrics, İzmir, Turkey. .,School of Medicine, Department of Gynecology and Obstetrics, İzmir Katip Çelebi University, İzmir, Turkey.
| | - Huseyin Aydogmus
- İzmir Atatürk Research and Training Hospital, Department of Gynecology and Obstetrics, İzmir, Turkey
| | - Sezer Gul
- İzmir Atatürk Research and Training Hospital, Department of Gynecology and Obstetrics, İzmir, Turkey.,Hınıs Şehit Yavuz Yürekseven State Hospital, Department of Gynecology and Obstetrics, Erzurum, Turkey
| | - Gizem Naz Kahraman
- İzmir Atatürk Research and Training Hospital, Department of Gynecology and Obstetrics, İzmir, Turkey
| | - Alpay Yilmaz
- İzmir Atatürk Research and Training Hospital, Department of Gynecology and Obstetrics, İzmir, Turkey
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Zeng JC, Yang YY, Shen Y. Analysis of the status quo of pelvic floor muscle and the effect of pelvic floor muscle training in second pregnant women. Medicine (Baltimore) 2022; 101:e31370. [PMID: 36397372 PMCID: PMC9666209 DOI: 10.1097/md.0000000000031370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aims to investigate the current situation of pelvic floor muscle (PFM) in the second trimester postpartum 42 days by detecting the electrophysiological indexes of PFM on pelvic floor rehabilitation after 2 months. METHODS In total, 198 cases of second child puerpera were selected, who were delivered in our hospital between June 1, 2020, and December 10, 2020, and underwent outpatient reexamination 42 days after delivery. RESULTS Except for the rest post-baseline stage values, the pelvic floor surface electromyography evaluation values significantly differed from each other at the considered time points in group A, P < .05; on day 72 in group B, no obvious improvement in the evaluation values was observed as than those on day 42 (P > .05) except for the endurance contractions stage values. However, on day 102, all values were markedly different at each considered time point (P < .05). On day 102 postpartum, the evaluation values of group A in the rest pre-baseline stage, the time before and after peak of phasic (flick) contractions stage, and the endurance contractions stage were significantly improved to those in group B with all P < .05. On day 42 after parturition, each index of the tonic contractions stage was higher after spontaneous labor than that after cesarean; the differences were all significant, P < .05, but on day 102 postpartum, all of the values exhibited no difference between the 2 modes. In only the phasic (flick) contractions stage at 42th, were the values of younger mothers obviously higher, P = .025; the other stage values for different ages of women during different time periods were not statistically significant, P > .05. CONCLUSIONS In the short term, the effect of biofeedback plus electrical stimulation on the PFM function in second pregnant women was better than that of the Kegel exercise, but with time, there was no significant difference between the 2 training methods on the recovery of the PFM.
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Affiliation(s)
- Jun Chao Zeng
- Health Management Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Ying Yang
- Obstetrics and Gynecology Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Shen
- Health Management Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Clinical Outcomes of Mid-Urethral Sling (MUS) Procedures for the Treatment of Female Urinary Incontinence: A Multicenter Study. J Clin Med 2022; 11:jcm11226656. [PMID: 36431133 PMCID: PMC9695694 DOI: 10.3390/jcm11226656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: Stress urinary incontinence (SUI) has a significant impact on the quality of life of many women. Due to embarrassment, most women do not seek medical attention for this condition. The treatment of this problem includes preventive therapies, and in the more advanced stage of urinary incontinence, surgery is a solution. Despite doubts regarding the implantation of urological tapes, the use of tension-free minimally invasive methods constitutes the “gold standard” in the treatment of stress urinary incontinence in women. Objective: The purpose of this article was to evaluate the efficacy and safety of ultralight, polypropylene urogynecological tape (Dallop® NM ULTRALIGHT, Tricomed S.A., Poland) in the surgical treatment of female stress urinary incontinence and mixed urinary incontinence. Methods: This is a multicenter, retrospective cohort study. The included women were adults with stress urinary incontinence (Grade 2 with a positive cough test or Grade 3) or had mixed urinary incontinence and who had undergone “retropubic” or “transobturator” surgery and completed a postoperative follow-up. Results: The study included 68 women from three hospitals. All women completed <6-month and >6-month follow-ups. The median age was 55 (range 36−80). The average value of BMI in the “retropubic” group was 28.6 ± 5.58, and in the “transobturator” group, it was 26.1 ± 4.60. Sixty-three percent (63%, n = 43) of patients were operated on using the “transobturator” method, while thirty-seven percent (37%, n = 25) were operated on using the “retropubic” method. Both the “retropubic” and “transobturator” groups had comparable results in the treatment of SUI. The study showed efficiencies of 84% for the “transobturator” method and 80% for the “retropubic” method. In the “retropubic” group, intraoperative complications were reported in three patients (7%), in comparison to none in the “transobturator” group. There were no tape-related adverse events or infections reported in any case. Conclusions: The presented research confirms the safety and efficacy of retropubic and transobturator tape methods in both short- and long-term follow-up—the success rate was over 80%. In addition to the surgical method used, the experience of the surgeons also has an impact on the final outcome of the surgery. The conducted multi-center study offers the opportunity to eliminate the influence of the human factor on the effectiveness of the procedure.
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Prudencio CB, Nunes SK, Pinheiro FA, Sartorão Filho CI, Nava GTDA, Salomoni SE, Pedroni CR, Rudge MVC, Barbosa AMP. Gestational diabetes is associated with alteration on pelvic floor muscle activation pattern during pregnancy and postpartum: Prospective cohort using electromyography assessment. Front Endocrinol (Lausanne) 2022; 13:958909. [PMID: 36277705 PMCID: PMC9582526 DOI: 10.3389/fendo.2022.958909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objective Gestational diabetes mellitus (GDM) is a comorbidity which may cause acute and lifelong disorders to mother and child. Alterations in muscular and connective tissues have been associated with GDM in translation studies, characterizing gestational diabetic myopathy. Pregnancy-specific urinary incontinence and sexual disabilities, disorders that depend on the pelvic floor muscle (PFM) integrity, are also associated with GDM both during and after pregnancy. The aim was to compare PFM activation patterns between GDM and non-GDM women from 24-30 gestational weeks to 18-24 months postpartum during a standard clinical test during gestation and postpartum. Methods We conducted a prospective three-time-point cohort study from gestation (24-30 weeks-T1, and 36-38 weeks-T2) to 18-24 months postpartum (T3). PFM electromyography was recorded in primigravida or primiparous women with one previous elective c-section with or without the diagnosis of GDM according to the American Diabetes Association criteria. A careful explanation of the muscle anatomy and functionality of the PFM was given to participants before EMG assessment. The outcome measures were PFM activation patterns assessed during pregnancy and postpartum, comparing intra and between groups. PFM activation patterns were assessed by normalized electromyography signal at rest and during 1-second (sec) phasic, 10-sec hold, and 60-sec sustained contractions. Results Demographic and obstetric data showed homogeneity between groups. The GDM group achieved peak PFM EMG amplitudes similarly to the non-GDM group, but they took longer to return to baseline levels during the ~1-sec contraction (flicks). During 10-sec hold contractions, the GDM group sustained lower levels of PFM activation than the non-GDM group at both 36-38 weeks of gestation and 18-24 months postpartum when compared to the non-GDM group. Conclusion The results suggest that GDM impaired PFM control mainly on 1-sec flicks and 10-sec hold contraction, which appears to develop during late pregnancy and extends long-term postpartum. This motor behavior may play a role on pelvic floor dysfunctions.
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Affiliation(s)
- Caroline Baldini Prudencio
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Sthefanie Kenickel Nunes
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Fabiane Affonso Pinheiro
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Carlos Izaias Sartorão Filho
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | | | | | | | - Marilza Vieira Cunha Rudge
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
| | - Angélica Mércia Pascon Barbosa
- São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School, Botucatu, Brazil
- São Paulo State University (Unesp), School of Philosophy and Sciences, Marilia, Brazil
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Huang G, He Y, Hong L, Zhou M, Zuo X, Zhao Z. Restoration of NAD + homeostasis protects C2C12 myoblasts and mouse levator ani muscle from mechanical stress-induced damage. Anim Cells Syst (Seoul) 2022; 26:192-202. [PMID: 36046029 PMCID: PMC9423866 DOI: 10.1080/19768354.2022.2106303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Excessive mechanical traction damages the levator ani muscle (LAM), increasing the incidence of pelvic floor dysfunction (PFD). In this study, we explored the effects of oxidized nicotinamide adenine dinucleotide (NAD+) on the damage to both muscle cells and LAM tissue induced by mechanical stress (MS) at the cellular and animal levels. The cell damage model was established using a four-point bending system. The LAM damage model was established using vaginal distention and traction. Exogenous addition of PJ34, an inhibitor of poly (ADP-ribose) polymerase-1 (PARP-1), and the nicotinamide mononucleotide (NMN) precursor of NAD+ increased NAD+ levels. ATP content and mitochondrial membrane potential were measured to assess mitochondrial function. NAD+ levels, cell viability, and PARP-1 activity were detected using commercial kits. DNA damage in cells was detected with immunofluorescence staining, and LAM damage was detected with tissue TUNEL staining. PARP-1 activity and DNA damage of LAM were detected by immunohistochemistry. A small amount of DNA damage and PARP-1 activation did not affect NAD+ levels, while excessive DNA damage and PARP-1 activation led to an imbalance of NAD+ homeostasis. Furthermore, increasing NAD+ levels in vivo and in vitro could rescue mitochondrial dysfunction and damage to both muscle cells and LAM tissue induced by MS. In conclusion, MS can induce damage to both C2C12 cells and LAM tissue. Restoring NAD+ homeostasis can rescue this damage by improving mitochondrial function.
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Affiliation(s)
- Guotao Huang
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Yong He
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Li Hong
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Min Zhou
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Xiaohu Zuo
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Zhihan Zhao
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
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Kokanalı MK, Ersak B, Tugrul D, Elmas B, Doganay M, Caglar AT. The neglected secret: Association of abdominal striae with stress urinary incontinence in primigravid pregnant women. Eur J Obstet Gynecol Reprod Biol 2022; 275:37-40. [PMID: 35717746 DOI: 10.1016/j.ejogrb.2022.06.011] [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: 03/06/2022] [Revised: 04/26/2022] [Accepted: 06/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE(S) To compare the presence and severity of striae gravidarum in pregnant women with and without stress urinary incontinence and to evaluate whether there is a relationship between the severity of striae gravidarum and the severity of incontinence in pregnant women with stress urinary incontinence. STUDY DESIGN Healthy primigravid pregnant women with an uneventful singleton pregnancy at 36-37 weeks of gestation were included. All women were asked two questions to assess the presence of urinary incontinence. Women who answered 'yes' to the question 'Do you have any involuntary urinary leakage during coughing/laughing/sneezing/running/jumping?' and 'no' to the question 'Do you have any involuntary urinary leakage accompanied by a strong urge to void?' were classified as women with stress urinary incontinence, and women who answered 'no' to both questions were classified as women without stress urinary incontinence. The presence and severity of striae gravidarum of these two groups were evaluated with the Davey score, and the severity of incontinence of women with stress urinary incontinence was evaluated with the Incontinence severity index questionnaire. RESULTS The Davey score of pregnant women with stress urinary incontinence was significantly higher than the score of women without stress urinary incontinence and the presence of severe striae gravidarum was more common in women with stress urinary incontinence. There was a positive, significant correlation between Incontinence severity index and Davey scores in women with stress urinary incontinence, and this was the only independent correlation that was significant in linear regression analysis. CONCLUSION(S) Presence and severity of striae gravidarum is correlated with the presence and severity of stress urinary incontinence in primigravid pregnant women. Evaluation of striae gravidarum may be useful in predicting the development of stress urinary incontinence and taking necessary precautions against it. This issue should be evaluated with good quality studies.
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Affiliation(s)
| | - Burak Ersak
- University of Health Sciences, Ankara City Hospital, Turkey
| | - Duygu Tugrul
- University of Health Sciences, Ankara City Hospital, Turkey
| | - Burak Elmas
- University of Health Sciences, Ankara City Hospital, Turkey
| | - Melike Doganay
- University of Health Sciences, Ankara City Hospital, Turkey
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Prudencio CB, Nunes SK, Pinheiro FA, Filho CIS, Antônio FI, de Aquino Nava GT, Rudge MVC, Barbosa AMP. Relaxin-2 during pregnancy according to glycemia, continence status, and pelvic floor muscle function. Int Urogynecol J 2022; 33:3203-3211. [PMID: 35657397 DOI: 10.1007/s00192-022-05245-y] [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: 11/16/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To investigate relaxin-2 concentration comparing gestational diabetes mellitus (GDM) and non-GDM patients during pregnancy according to urinary incontinence (UI) and pelvic function status. METHODS This is a cross-sectional study evaluating 282 pregnant women from 24 weeks of gestation. The participants were divided into two groups, non-GDM and GDM, according to American Diabetes Association's diabetes mellitus gestational threshold. In addition, according to subanalysis, both groups were subdivided according to the presence of pregnancy-specific urinary incontinence: non-GDM continent, non-GDM incontinent, GDM continent, and GDM incontinent. All participants filled in questionnaires on clinical, obstetric, and urinary continence status (International Consultation on Incontinence Questionnaire-Short Form, ICIQ-SF, and Incontinence Severity Index, ISI), followed by pelvic floor muscle evaluation by the PERFECT scheme in which strength, endurance, and speed of contractions were evaluated. RESULTS Serum relaxin-2 concentrations were significantly lower in pregnant women with pregnancy-specific urinary incontinence in both non-GDM and GDM patients, but GDM showed the lowest concentration. In addition, the stratification of the groups according to pelvic floor muscle strength showed that pregnant patients with GDM and modified Oxford scale 0-2 had significantly lower levels than those who were non-GDM and GDM with Modified Oxford Scale 3-5. Relaxin-2 level was much lower in GDM incontinent pregnant women with MOS 0-2 compared to the other three groups. CONCLUSIONS Lower relaxin-2 concentration was associated with the presence of pregnancy-specific urinary incontinence, but the combination of GDM, pregnancy-specific urinary incontinence, and lower levels of pelvic floor strength led to lower levels of relaxin-2 compared to the other three groups.
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Affiliation(s)
| | - Sthefanie Kenickel Nunes
- Postgraduate Program on Tocogynecology, São Paulo State University (UNESP), São Paulo, Botucatu, Brazil
| | - Fabiane Affonso Pinheiro
- Postgraduate Program on Tocogynecology, São Paulo State University (UNESP), São Paulo, Botucatu, Brazil
| | | | - Flávia Ignácio Antônio
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Guilherme Thomaz de Aquino Nava
- Department of Physical Education, Institute of Biosciences of Rio Claro, São Paulo State University (UNESP), São Paulo, Rio Claro, Brazil
| | | | - Angélica Mércia Pascon Barbosa
- Postgraduate Program on Tocogynecology, São Paulo State University (UNESP), São Paulo, Botucatu, Brazil. .,School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
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22
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Ying Y, Xu L, Huang R, Chen T, Wang X, Li K, Tang L. Relationship Between Blood Glucose Level and Prevalence and Frequency of Stress Urinary Incontinence in Women. Female Pelvic Med Reconstr Surg 2022; 28:304-310. [PMID: 34593685 PMCID: PMC9071020 DOI: 10.1097/spv.0000000000001112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the relationship between blood glucose level and the prevalence and frequency of stress urinary incontinence (SUI) in women. METHODS We conducted a cross-sectional study of female participants in the National Health and Nutrition Examination Survey database between 2007 and 2016. Dose-response analysis curves and univariate and multivariate logistic regressions were used to determine the relationship between blood glucose level and the prevalence and frequency of SUI. RESULTS A total of 10,771 participants were included in this study, of which 6,466 (60.0%) reported no SUI, 4,305 (31.1%) reported monthly SUI, and 953 (8.8%) reported weekly SUI. We found that the blood glucose levels were higher in the weekly SUI group than in the monthly SUI and no SUI groups. Based on blood glucose levels, participants were divided into 3 groups: ≤86.0 mg/dL group, >86.0 to 98.0 mg/dL group, and >98.0 mg/dL group. Dose-response curves showed a nonlinear positive correlation between blood glucose levels and the prevalence and extent of SUI, and participants in the glucose >98.0 mg/dL group had a 15.2% higher risk (adjusted odds risk, 1.152; 95% confidence interval, 1.027-1.293; P = 0.016) of SUI prevalence and 12.5% higher risk (adjusted odds risk 1.125; 95% confidence interval, 1.009-1.255; P = 0.034) of SUI frequency than participants in the glucose ≤86.0 mg/dL group. CONCLUSIONS We found that the prevalence and frequency of SUI in women were positively correlated with blood glucose levels, and these findings warrant further study and application to clinical practice to control SUI in women.
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Affiliation(s)
| | | | | | | | - Xinghong Wang
- Department of Urology, The First People's Hospital of Yongkang, Jinhua City, Zhejiang Province, China
| | - Ke Li
- From the Department of Endocrine
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23
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Hormonal Influence in Stress Urinary Incontinence During Pregnancy and Postpartum. Reprod Sci 2022; 29:2190-2199. [PMID: 35471548 DOI: 10.1007/s43032-022-00946-7] [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: 10/26/2021] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
Hormonal changes have been proposed as an etiological factor of stress urinary incontinence (SUI) during pregnancy. Our main objective was to demonstrate the role of hormones in SUI development during pregnancy and postpartum. A prospective longitudinal study was designed. Primiparous women without previous urinary incontinence symptoms were included. Symptoms and Quality of Life (QoL) Questionnaires, physical examinations, and hormone concentration (progesterone, estradiol, and relaxin) were collected twice during pregnancy and three times during postpartum. Logistic regression models, with Wald's forward variable selection method, were used. Prevalence of SUI was 11% in the first trimester, 50% in the third trimester, and 16.4% at 6 months postpartum. The risk of developing SUI throughout pregnancy is higher in women with higher progesterone concentration in the first trimester (OR 1.38, 95% CI 1.06-1.81, p < 0.05) and it is lower in women with stronger pelvic floor muscles in the first trimester (OR 0.35, 95% CI 0.17-0.72, p < 0.05). When occurred during pregnancy, SUI has a 14-fold higher risk of persistence 6 months after birth. In addition, the severity of these symptoms is also an independent risk factor for SUI persistence at 6 months postpartum (OR 1.41, 95% CI 1.15-1.73, p < 0.05). Quality of Life was affected for pregnant women with SUI symptoms. SUI is a highly prevalent condition during pregnancy, affecting the QoL of women in many areas. Higher concentration of progesterone can play a role in SUI development during pregnancy. The presence and severity of SUI during pregnancy are risk factors for the persistence of symptoms 6 months postpartum. Sustaining an optimal pelvic floor muscle strength could prevent SUI during pregnancy.
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Jaffar A, Mohd-Sidik S, Foo CN, Admodisastro N, Abdul Salam SN, Ismail ND. Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study. JMIR Hum Factors 2022; 9:e30989. [PMID: 35113025 PMCID: PMC8855292 DOI: 10.2196/30989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/10/2021] [Accepted: 11/30/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but their effectiveness in pregnant women was limited. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. OBJECTIVE This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. METHODS We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. RESULTS A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design-11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. CONCLUSIONS The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study.
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Affiliation(s)
- Aida Jaffar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.,Primary Care Unit, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, Wilayah Persekutuan, Malaysia
| | - Sherina Mohd-Sidik
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Chai Nien Foo
- Department of Population Medicine, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Novia Admodisastro
- Software Engineering & Information System Department, Faculty of Computer Science & Information Technology, Universiti Putra Malaysia, Selangor, Malaysia
| | - Sobihatun Nur Abdul Salam
- School of Multimedia Technology and Communication, College of Arts and Sciences, Universiti Utara Malaysia, Kedah, Malaysia
| | - Noor Diana Ismail
- Klinik Kesihatan Bt 9 Cheras, Ministry of Health, Selangor, Malaysia
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25
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Rett MT, Santana JM, Paplinskie SA, Salata MC, Lima ÉAND, Gallo RBS, Alves AT. Prevalence and impact of urinary symptoms on quality of life during the last month of pregnancy. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract Introduction Adaptations of the maternal organism can adversely affect the lower urinary tract, leading to urinary symptoms with impact in quality of life (QoL). Objective To determine the prevalence of urinary symptoms and the impact of urinary incontinence (UI) on QoL during the last month of pregnancy. Methods Retrospective cross-sectional study, envolving 96 women in the immediate postpartum period personally interviewed about urinary symptoms and QoL during their last four weeks of gestation. Women were divided into two groups according to the number of pregnancies: G1 = 1 pregnancy (n = 41) and G2 = ≥ 2 pregnancies (n = 55). Those who reported the presence of stress urinary incontinence (SUI) and/or urge incontinence (UUI) were also administered the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Results The most common symptoms were nocturia (90.6%), urgency (82.3%), urinary frequency (71.9%) feeling of incomplete emptying (62.5%) and SUI and/or UUI (53.1%) with no differences between groups. Only the complaint of SUI in cough was significantly higher in G2 (p = 0.04). There was no difference on QoL between groups based on ICIQ-SF scores among those with UI (53.1%), however G1 reported serious impact and G2 very serious impact. Conclusion Almost all women reported some type of urinary symptom and the most prevalent were nocturia, urgency, pollakiuria, feeling of incomplete emptying and SUI and/or UUI. SUI was more prevalent among women with two or more pregnancies and during cough were significantly higher. Regardless of the number of pregnancies, the presence any type of UI had a negative impact on QoL.
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Zhang H, Wang L, Xiang Y, Wang Y, Li H. Nampt promotes fibroblast extracellular matrix degradation in stress urinary incontinence by inhibiting autophagy. Bioengineered 2021; 13:481-495. [PMID: 34967693 PMCID: PMC8805819 DOI: 10.1080/21655979.2021.2009417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Stress urinary incontinence (SUI) is defined as involuntary urinary leakage happening in exertion. Nicotinamide phosphoribosyltransferase (Nampt) is seldom researched in the pathogenesis of SUI. Accordingly, the current study set out to elucidate the role of Nampt in SUI progression. Firstly, we determined Nampt expression patterns in SUI patients and rat models. In addition, fibroblasts were obtained from the anterior vaginal wall tissues of non-SUI patients and subjected to treatment with different concentrations of interleukin-1β (IL-1β), followed by quantification of Nampt expressions in fibroblasts. Subsequently, an appropriate concentration of IL-1β was selected to treat anterior vaginal wall fibroblasts. Nampt was further silenced in IL-1β-treated fibroblasts to assess the role of Nampt in autophagy and extracellular matrix (ECM) degradation. Lastly, functional rescue assays were carried out to inhibit autophagy and evaluate the role of autophagy in the mechanism of Nampt modulating IL-1β-treated fibroblast ECM degradation. It was found that Nampt was highly-expressed in SUI patients and rat models and IL-1β-treated fibroblasts. On the other hand, Nampt silencing was found to suppress ECM degradation and promote SUI fibroblast autophagy. Additionally, inhibition of autophagy attenuated the inhibitory effects of Nampt silencing on SUI fibroblast ECM degradation. Collectively, our findings revealed that Nampt was over-expressed in SUI, whereas Nampt silencing enhanced SUI fibroblast autophagy, and thereby inhibited ECM degradation.
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Affiliation(s)
- Hui Zhang
- Gynecology II Ward, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China
| | - Lu Wang
- Gynecology II Ward, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuancui Xiang
- Gynecology II Ward, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yali Wang
- Gynecology II Ward, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China
| | - Hongjuan Li
- Gynecology II Ward, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China
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Natural history of urinary incontinence from first childbirth to 30-months postpartum. Arch Gynecol Obstet 2021; 304:713-724. [PMID: 34175975 DOI: 10.1007/s00404-021-06134-3] [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: 03/08/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The objectives of this study were to determine the incidence of UI in a large cohort of primiparous women before and during pregnancy and over the course of 30-months postpartum, and to identify risk factors for UI during and after pregnancy. METHODS Nulliparous women aged 18-35 years with singleton pregnancies were interviewed in their third trimester and asked about urinary incontinence before and during pregnancy (n = 3001). After delivery these women were interviewed at 1, 6, 12, 18, 24 and 30-months postpartum and asked about urinary incontinence occurring in the month prior to each interview. Multivariable logistic regression models identified risk factors for UI during pregnancy and during the follow-up period. RESULTS Overall, 4% reported having urinary incontinence before pregnancy and 36.8% during pregnancy. The strongest predictor of urinary incontinence during pregnancy was urinary incontinence before pregnancy (adjusted OR 13.11, 95% CI 7.43-23.13). Among the women with no subsequent pregnancies, the rate of urinary incontinence increased from 12.5% at 6-months postpartum to 27.4% at 30-months postpartum, 52.1% reported UI at one or more postpartum data collection stages, and the strongest predictors of postpartum UI were UI before pregnancy (adjusted OR 3.95 (95% CI 1.60-9.75) and during pregnancy (adjusted OR 4.36, 95% CI 3.24-5.87). CONCLUSION Our findings suggest that primiparous women who report UI before and during pregnancy should be monitored for the continuation or worsening of UI over the course of the first 2-3 years postpartum, and treatment options discussed.
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28
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Li T, Chen X, Wang J, Chen L, Cai W. Mobile App-Based Intervention for Pregnant Women With Stress Urinary Incontinence: Protocol for a Hybrid Effectiveness-Implementation Trial. JMIR Res Protoc 2021; 10:e22771. [PMID: 33688842 PMCID: PMC7991980 DOI: 10.2196/22771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 01/23/2023] Open
Abstract
Background Stress urinary incontinence (SUI) is a common source of distress among women during and after pregnancy. It has a negative effect on quality of life but with poor care-seeking. Mobile health (mHealth) may be a promising solution with potential advantages. However, there is uncertainty whether a mobile app is effective for SUI symptom improvement during and after pregnancy. The implementation is also unclear. We developed an app named UIW (Urinary Incontinence for Women) aimed at improving perinatal incontinence. Objective The objective of this study is to evaluate the effectiveness of the UIW app-based intervention in improving SUI symptoms among pregnant women and explore the facilitators and barriers to using the UIW app to help refine and optimize the intervention. Methods This study is a hybrid effectiveness-implementation trial with a randomized controlled trial alongside a mixed-methods process evaluation according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Pregnant women with SUI (n=336) will be recruited from a university-affiliated hospital in China. They will be randomly allocated (1:1) to either the intervention group that receive usual care plus UIW app or control group that receive usual care alone. The intervention period will last 2 months. The 5 dimensions of the RE-AIM framework will be evaluated at recruitment (-T1), baseline (T0), immediately after intervention (T1), 42 days after delivery (T2), 3 months after delivery (T3), and 6 months after delivery (T4) through project documents, online questionnaires and a pelvic floor muscle training diary, surface electromyography, log data in the background management system, and qualitative interviews. Data analysis will follow the intention-to-treat principle. Descriptive statistics, t tests, chi-square tests, and a linear mixed model will be used to analyze the quantitative data. Deductive and inductive content analysis will be used to analyze the qualitative data. Results The effectiveness-implementation trial started in June 2020, trial recruitment was completed in October 2020, and the intervention will last for a 2-month period. Completion of the 6-month follow-up will be in July 2021, and we anticipate that the results of this study will be published in December 2021. Conclusions This study will evaluate both effectiveness and implementation of the UIW app-based intervention among pregnant women. The hybrid effectiveness-implementation trial design according to the RE-AIM framework with a mixed-methods approach will give valuable insights into the effects as well as facilitators and barriers to the implementation that will influence the effects of the UIW app-based intervention. Trial Registration Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID) PRR1-10.2196/22771
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Affiliation(s)
- Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaomin Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Jia Wang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,School of Nursing, Southern Medical University, Guangzhou, China
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Abstract
OBJECTIVE The aim of the study was to determine the effect of pregnancy on urethral rhabdosphincter cross-sectional area (CSA) and any association of CSA to urinary symptoms. METHODS Nulliparous women planning pregnancy (N = 135) underwent standardized evaluations (symptom and quality of life [QOL] questionnaires, magnetic resonance imaging, ultrasonography, and neurophysiologic testing) between January 2008 and December 2013 (V1). The participants who became pregnant and gave birth underwent the same evaluations at 6 weeks (V2) and 6 months postpartum (V3). Participants who had magnetic resonance imaging data from both V1 and V3 were selected. We measured urethral rhabdosphincter CSA from high-resolution axial MRIs in a masked fashion. The mean CSA for each participant was calculated. The change from V1 to V3 was assessed. RESULTS Sixty-eight women were evaluated. There was a significant decrease of 0.05 cm2 (interquartile range, -0.03 to 0.16 cm2; P = 0.002) in the median sphincter CSA between V1 and V3. There was a significant increase in the median Urinary Distress Inventory (UDI) subscore of the Pelvic Floor Distress Inventory (PFDI) from V1 to V3 (median increase of 0 [IQR, 0 to 8.3]; P = 0.033), but this was not significantly correlated with the change in the urethral CSA (Spearman correlation, 0.199; P = 0.107). Increasing fetal weight was correlated with a decrease in CSA postpartum after vaginal birth (Spearman correlation, -0.340; P = 0.017). CONCLUSIONS There is a decrease in urethral rhabdosphincter CSA with worsening Urinary Distress Inventory scores from prepregnancy to postpartum, but these two do not correlate in this cohort with low symptom levels. Among women who give birth vaginally, decrease in rhabdosphincter CSA is correlated with increasing fetal weight, perhaps with ramifications to be seen later in life.
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30
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Li T, Wang J, Chen X, Chen L, Cai W. Obstetric Nurses' Knowledge, Attitudes, and Professional Support Related to Actual Care Practices About Urinary Incontinence. Female Pelvic Med Reconstr Surg 2021; 27:e377-e384. [PMID: 32925423 DOI: 10.1097/spv.0000000000000941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate obstetric nurses' knowledge, attitudes, and practices (KAP) toward urinary incontinence (UI) during pregnancy and identify factors associated with their actual specific care practices for recommending pelvic floor muscle training (PFMT). METHODS A cross-sectional study was conducted among obstetric nurses attending an academic conference about perinatal care in China. Data were collected through a self-administered questionnaire, including demographic and professional information, professional supports included clinical protocol and learning experience, knowledge, attitudes, and practices of UI. RESULTS Four hundred and seven obstetric nurses completed the survey (89.8% response rate). The correct answer rates of the vast majority of knowledge items was more than 80%. The majority of participants strongly agreed that antenatal PFMT is effective in UI treatment and prevention (69.5% and 69.0% respectively). Although only less than 30% of participants always recommended PFMT to incontinent or continent pregnant women (29.5% and 25.3%, respectively), obstetric nurses with clinical protocol, learning experience, and positive attitudes were more likely to recommend PFMT for treating UI (odds ratio [OR], 2.165, P < 0.001; OR, 1.759; P = 0.014; OR, 2.326; P < 0.001, respectively). Obstetric nurses with clinical protocol and positive attitudes were more likely to recommend PFMT for preventing UI (OR, 2.252; P < 0.001; OR, 1.693; P = 0.005, respectively). CONCLUSIONS Most obstetric nurses have good knowledge and positive attitudes toward UI during pregnancy, but fail to deliver care for it. Clinical protocol, learning experience, and positive attitudes are facilitators of their actual specific care practices for recommending PFMT. This finding suggests the need for developing clinical protocols and education programs regarding UI during pregnancy.
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Affiliation(s)
- Tiantian Li
- From the Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, and School of Nursing, Southern Medical University, Guangzhou
| | - Jia Wang
- From the Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, and School of Nursing, Southern Medical University, Guangzhou
| | - Xiaomin Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Wenzhi Cai
- From the Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, and School of Nursing, Southern Medical University, Guangzhou
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Comparing Differences and Similarities Between Chinese and American Women's Experiences of Stress Urinary Incontinence and Health-Seeking Behaviors During Pregnancy. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-20-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDStress urinary incontinence (SUI) is a globally pervasive health condition that is often first experienced during pregnancy and may well continue beyond pregnancy. Yet, definitive numbers of prevalence are uncertain due to multiple factors including embarrassment. This study compares differences and similarities between Chinese and American women's experiences of SUI and health-seeking behaviors during pregnancy.METHODOLOGYThis study used a cross-sectional design to explore health-seeking behaviors of primigravida women within the first 5 days following birth in China (n = 178) and the United States of America (n = 178) who experienced SUI using the Impact of Incontinence Questionnaire short form (IIQ-SF).RESULTSWhile more Chinese women experienced SUI (p =.049), American women who experienced SUI experienced it earlier in their pregnancy (p = .003) and more frequently (p < .0001) than the Chinese women. Therefore, it can be assumed that although less American women experienced SUI, the impact was greater on their daily living activities. Irrespective of ethnicity, only 14% (n = 18) of women who described having SUI sought medical aid.CONCLUSIONThe disconnect between high incidence and low rates of seeking treatment needs future exploration to develop interventions tailored to educate women about SUI and its role during pregnancy.
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Caruso FB, Schreiner L, Todescatto AD, Crivelatti I, Oliveira JMD. Risk Factors for Urinary Incontinence in Pregnancy: A Case Control Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:787-792. [PMID: 33348394 PMCID: PMC10309199 DOI: 10.1055/s-0040-1718951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Urinay incontinence (UI) is a major public health problem that can harm women in any period of life, including during the gestational period. Urinary incontinence during pregnancy has been studied because this condition can reduce the quality of life and interfere in several aspects of the maternal-fetal binomial. The aim of this study was to determine the prevalence of UI in nullipara pregnant women and to identify risk factors associated with UI in this population. METHODS This is a case-control study in which we invited nullipara women between 12 and 20 weeks of pregnancy to participate in the research. They were asked to answer a specific questionnaire, write a 3-day bladder diary, and undergo a urogynecological evaluation including pelvic organ prolapse quantification (POP-Q), empty stress supine test (ESST), and pelvic floor muscle assessment. RESULTS A total of 70 out of 73 patients accepted to participate in the study, and the prevalence of UI in this population was 18.3%. Tobacco use was identified as an independent risk factor for UI in pregnant women (odds ratio 8.0). All other factors analyzed were not significantly associated to UI in pregnancy. CONCLUSION Urinary incontinence can be a major problem in pregnancy. We identified the use of tobacco as a risk factor for developing UI in pregnancy, which provides an extra reason to encourage patients to quit smoking.
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Affiliation(s)
| | - Lucas Schreiner
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Isabel Crivelatti
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Harada BS, De Bortolli TT, Carnaz L, De Conti MHS, Hijaz A, Driusso P, Marini G. Diastasis recti abdominis and pelvic floor dysfunction in peri- and postmenopausal women: a cross-sectional study. Physiother Theory Pract 2020; 38:1538-1544. [PMID: 33283590 DOI: 10.1080/09593985.2020.1849476] [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] [Indexed: 12/24/2022]
Abstract
Introduction: Diastasis recti abdominis (DRA) and pelvic floor dysfunction (PFD) occurs commonly with aging; however, little is known about what leads to these changes.Objective: We aimed to investigate and compare the presence or absence of DRA and PFD in peri- and postmenopausal women.Methods: This cross-sectional study involved 150 participants who answered questions on their sociodemographic and clinical profiles related to urinary and fecal incontinence and pelvic organ prolapse. Diastasis recti abdominis was diagnosed with a digital caliper.Results: Supra-umbilical diastasis occurred in 37.3% of cases, and 78.6% of participants with DRA had PFD. No significant differences existed between participants with and without DRA in terms of background and clinical variables. However, participants with DRA were 2.6 times more likely to have PFD than participants without DRA. Furthermore, the presence of DRA was significantly shown to be a risk factor for PFD on binary logistic regression analyses (p = .01, OR = 3.2).Conclusions: This cross-sectional study suggests that DRA is a predictive factor of PFD in women aged over 50 years.
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Affiliation(s)
- Beatriz Souza Harada
- Pró Reitoria de Pós Graduação e Pesquisa (PRPGP), Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, São Paulo, Brazil
| | - Thainá Tolosa De Bortolli
- Pró Reitoria de Pós Graduação e Pesquisa (PRPGP), Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, São Paulo, Brazil
| | - Letícia Carnaz
- Pró Reitoria de Pós Graduação e Pesquisa (PRPGP), Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, São Paulo, Brazil
| | - Marta Helena Souza De Conti
- Pró Reitoria de Pós Graduação e Pesquisa (PRPGP), Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, São Paulo, Brazil
| | - Adoniz Hijaz
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, United States
| | - Patricia Driusso
- Department of Physical Therapy, Federal University of Sao Carlos, São Carlos, São Paulo State, Brazil
| | - Gabriela Marini
- Pró Reitoria de Pós Graduação e Pesquisa (PRPGP), Centro Universitário Sagrado Coração - UNISAGRADO, Bauru, São Paulo, Brazil
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Bertuit J, Barrau M, Huet S, Rejano-Campo M. Intérêt des applications mobiles et internet dans la prise en charge de l’incontinence urinaire d’effort chez la femme. Prog Urol 2020; 30:1022-1037. [DOI: 10.1016/j.purol.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/04/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
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Liang CC, Chao M, Chang SD, Chiu SYH. Impact of prepregnancy body mass index on pregnancy outcomes, incidence of urinary incontinence and quality of life during pregnancy - An observational cohort study. Biomed J 2020; 43:476-483. [PMID: 33246799 PMCID: PMC7804172 DOI: 10.1016/j.bj.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/17/2019] [Accepted: 11/07/2019] [Indexed: 01/01/2023] Open
Abstract
Background To evaluate the effects of prepregnancy body mass index (BMI) on pregnancy outcomes, prevalence of urinary incontinence, and quality of life. Methods The observational cohort included 2210 pregnant women who were divided into 4 groups according to their prepregnancy BMI: underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), and obese (≥30). Data were analyzed for pregnancy outcomes, prevalence of urinary incontinence during pregnancy, scores of the Short Form 12 health survey (SF-12) and changes in sexual function. Results Compared with normal weight, overweight and obesity were associated with advanced maternal age, low education level, multiparity, preterm delivery, cesarean section, gestational weight gain above the Institute of Medicine (IOM) guidelines, preeclampsia, gestational diabetes, macrosomia and large fetal head circumference. After adjusting for confounding factors, women with overweight and obesity were more likely to have adverse maternal outcomes (gestational weight gain above the IOM guidelines, preeclampsia and gestational diabetes) and fetal outcomes (large fetal head circumference and macrosomia) compared to normal weight women. Overweight and obese women (BMI ≥ 25) were more likely to have urinary incontinence than normal weight and underweight women. There were no significant differences in SF-12 scores among the 4 BMI groups, but more than 90% of pregnant women had reduced or no sexual activities regardless of BMI. Conclusions Maternal prepregnancy overweight and obesity are associated with greater risks of preeclampsia, gestational diabetes, macrosomia and urinary incontinence. Health care providers should inform women to start their pregnancy at a BMI in the normal weight category.
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Affiliation(s)
- Ching-Chung Liang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Health Care Management, Chang Gung University, Taoyuan, Taiwan
| | - Minston Chao
- Department of Health Care Management, Chang Gung University, Taoyuan, Taiwan
| | - Shuenn-Dhy Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management and Healthy Aging Research Center, College of Management, Chang Gung University, Taoyuan, Taiwan; Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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Babini D, Lemos A. Risk Factors for Urinary Incontinence in Primiparous Adolescents after Vaginal Delivery: A Cohort Study. J Pediatr Adolesc Gynecol 2020; 33:500-505. [PMID: 32593748 DOI: 10.1016/j.jpag.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/29/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To evaluate urinary incontinence (UI) risk factors in primiparous adolescents between 7 and 48 months after vaginal delivery. DESIGN Cohort study. SETTING Physical Therapy Laboratory on Women's Health and Pelvic Floor at the Federal University of Pernambuco. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES Cohort follow-up time was 7-48 months after delivery, guaranteeing that no participant presented with UI until 7 months after the infant's birth. Primiparous adolescents aged 10-19 years were included in the study, and those who had UI during pregnancy were excluded. Sample size was estimated at 140 volunteers, considering the calculation for logistic regression, with 20 observation units for each of the 7 variables proposed in the theoretical model developed for the study. The volunteers answered the evaluation form, providing information on the outcome of interest and possible risk factors. Univariate logistic regression analysis was performed. RESULTS The following risk factors for UI were identified in primiparous adolescents after vaginal delivery: episiotomy (Relative risk [RR]a, 2.75; 95% confidence interval [CI], 1.22-6.06), large newborn for gestational age (RRa, 4.58; 95% CI, 1.68-12.46) and less than six prenatal appointments (RRa, 2.51; 95% CI, 1.05-6.04). CONCLUSION Professionals working in maternal health care should pay special attention to primigravid mothers, guide prenatal appointments, avoid routine episiotomy, and use obstetric practices recommended by the World Health Organization.
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Affiliation(s)
- Dominique Babini
- Graduate Program in Child and Adolescent Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Physical Therapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Andrea Lemos
- Graduate Program in Child and Adolescent Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Physical Therapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
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The effect of parity on the function of pelvic floor musculature in the long term: cross-sectional study. Obstet Gynecol Sci 2020; 63:577-585. [PMID: 32933227 PMCID: PMC7494773 DOI: 10.5468/ogs.19236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/12/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Parity is associated with an increased risk of pelvic floor muscle dysfunction. The aim of this study was to evaluate the long-term effects of parity on this musculature. Methods This cross-sectional study was completed at the Department of Physical Therapy, Federal University of São Carlos, Brazil. In total, 143 women participated in the study and were classified into three groups according to parity: nulliparae, primiparae, and secundiparae women. All parous participants had last given birth between 1 and 6 years prior. Pelvic floor muscle function was assessed through unidigital vaginal palpation using the PERFECT scheme, with the contraction grade classified according to the Modified Oxford Scale and through manometry. Results There was no difference in scores on the Modified Oxford Scale (the means and standard deviations were 2.5±0.8 in nulliparae women, 2.3±0.9 in primiparae women, and 2.2±0.9 in secundiparae women; P=0.482) and manometry findings (the means and standard deviations were 42.3±22.7 in nulliparae women, 35.0±21.8 in primiparae women, and 33.2±20.0 in secundiparae women; P=0.144) among the assessed groups. Conclusion Parity had no effect, regardless of mode of birth, on the function of pelvic floor muscles and the presence of urinary symptoms, such as long-term urinary incontinence after birth.
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Maternal, obstetrical and neonatal risk factors' impact on female urinary incontinence: a systematic review. Int Urogynecol J 2020; 31:2205-2224. [PMID: 32712698 DOI: 10.1007/s00192-020-04442-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) is one of the most serious problems during pregnancy and after delivery. It can influence the quality of life and cause psychological problems that lead to depression and decreased self-esteem. We aimed to investigate the maternal, obstetrical and neonatal risk factors of urinary incontinence 3 to 12 months after childbirth. METHODS The Cochrane Library, Medline, Science Direct and Web of Science were searched for studies published from the inception of the databases up to December 2019, including any observational full-text papers. All data were analyzed using Review Manager 5.3. Of 338 articles reviewed, 20 studies were considered for meta-analysis. RESULTS The results of our study showed that vaginal delivery in contrast to cesarean section (OR = 3.74, 95% CI: [2.71, 5.15], P < 0.00001), UI in pregnancy (OR = 5.27, 95% CI: [3.40, 8.17], P < 0.00001), episiotomy (OR = 1.23, 95% CI: [1.05, 1.45], P < 0.01), perineal tear > grade 2, instrumental delivery in contrast to cesarean section, epidural or spinal anesthesia, maternal age, pre-pregnancy BMI and neonatal birthweight have a direct relationship with UI. CONCLUSIONS This study confirmed that urinary incontinence during pregnancy and vaginal births had the strongest relationship with postpartum urinary incontinence. Also, the maternal upright positions during labor did not reduce the likelihood of urinary incontinence. The awareness of this issue helps find effective strategies to reduce the likelihood of female urinary incontinence.
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Ting HY, Cesar JA. Urinary incontinence among pregnant women in Southern Brazil: A population-based cross-sectional survey. PLoS One 2020; 15:e0234338. [PMID: 32511254 PMCID: PMC7279605 DOI: 10.1371/journal.pone.0234338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 05/24/2020] [Indexed: 11/18/2022] Open
Abstract
Urinary incontinence (UI) is a common condition that causes significant harm to the well-being and quality of life of pregnant women. This cross-sectional population-based study aimed to estimate the prevalence and identify factors associated with the occurrence of UI during pregnancy in women living in the municipality of Rio Grande (RS), Southern Brazil, between January 1 and December 31 of 2016, and included all puerperae living in this municipality that had a child in one of the two local maternity hospitals. The previously trained interviewers used a single standardized questionnaire, within 48 hours after delivery to retrieve information on maternal demographic, behavioral and reproductive/obstetric history, as well as socioeconomic status of the household and care received during pregnancy and childbirth. The multivariate analysis followed a previously defined hierarchical model using Poisson regression with robust variance adjustment and prevalence ratio (PR) as a measure of effect. As a result, 2,716 puerperae were identified, of which 2,694 (99.2%) participated in this study. The prevalence of urinary incontinence in the gestational period was 14.7% (95%CI: 13.4%-16.1%). After adjusted analysis, the likelihood of UI occurring varied significantly as per women's characteristics. For example, the PR for the occurrence of UI among women over 30 years of age was 2.05 (95% CI: 1.39-3.01) compared to adolescents. In two other groups of women who had their first pregnancy before the age of 20 or after the age of 30, the PR for UI was 1.36 (95% CI: 1.04-1.76) and 1.59 (95% CI: 1.01-2.51), respectively, when compared to those who became pregnant for the first time between 20 and 29 years of age. Finally, in two other groups of women, namely, those who reached 90 kg and over at the end of pregnancy and those who performed regular physical exercise and reported frequent urinary urgency, the PR was 2.49 (95% CI: 1.74-3.57), and 2.90 (95% CI: 2.10-4.00) compared to those who did not exercise and did not report urinary urgency, respectively. The authors concluded that UI showed a high prevalence in the study population. The identified risk factors can be well administered at primary health care level. The recommendation of regular physical exercise in pregnancy must be reviewed and better investigated with more robust designs because of possible facilitators for the occurrence of UI in this period.
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Affiliation(s)
- Hsu Yuan Ting
- Postgraduate Program in Health Sciences, Federal University of Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
- * E-mail:
| | - Juraci A. Cesar
- Postgraduate Program in Public Health, Postgraduate Program in Health Sciences, Federal University of Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
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Babini D, Lemos A. Predictive factors for time to cessation of urinary incontinence in primiparous adolescents after vaginal delivery. Int J Gynaecol Obstet 2020; 150:329-334. [PMID: 32320070 DOI: 10.1002/ijgo.13176] [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: 01/17/2020] [Revised: 03/22/2020] [Accepted: 04/17/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate predictive factors for the time to cessation of urinary incontinence (UI) and estimate the median time for its cessation in primiparous adolescents after vaginal delivery. METHODS A cohort study with 102 adolescents aged 10-19 years with UI after vaginal delivery was developed in the Physical Therapy Laboratory for Women's Health and Pelvic Floor at the Federal University of Pernambuco between June 2017 and December 2019. Participants responded to the assessment form, providing information on the outcome of interest and possible predictive factors. For statistical analysis, the Cox regression model and the Kaplan-Meier method were used. RESULTS Risk factors identified for the outcome of interest were: age 15-19 years (adjusted hazard ratio [HRa ] 1.37, 95% confidence interval [CI] 0.11-2.8); non-instrumental delivery (HRa 2.95. 95% CI 1.19-7.53); adoption of vertical position during the expulsion stage of delivery (HRa 2.19, 95% CI 1.28-3.84); and absence of episiotomy (HRa 2.01, 95% CI 1.2-3.44). The median time to cessation of UI was 16 months (10-29). CONCLUSION Health professionals should reflect on obstetric practices adopted during delivery in adolescents, especially among 10-14-year-olds, regarding the use of episiotomy, instrumental delivery, and parturient position during the expulsion stage of delivery.
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Affiliation(s)
- Dominique Babini
- Graduate Program in Child and Adolescent Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil.,Department of Physical Therapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Andrea Lemos
- Graduate Program in Child and Adolescent Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil.,Department of Physical Therapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Slavin V, Creedy DK, Gamble J. Benchmarking outcomes in maternity care: Peripartum incontinence - a framework for standardised reporting. Midwifery 2020; 83:102628. [DOI: 10.1016/j.midw.2020.102628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/13/2019] [Accepted: 01/12/2020] [Indexed: 01/17/2023]
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Rudge MVC, Souza FP, Abbade JF, Hallur RLS, Marcondes JPC, Piculo F, Marini G, Vesentini G, Thabane L, Witkin SS, Calderon IMP, Barbosa AMP, Rudge MV, Barbosa AMP, Calderon IMP, Souza FP, Abbade JF, Hallur LSR, Piculo F, Marini G, Vesentini G, Thabane L, Palma MS, Graeff CFO, Arni RK, Herculano RD, Salvadori DF, Mateus S, Dal Pai Silva M, Magalhães CG, Costa RA, Lima SAM, Felisbino SL, Barbosa W, Atallah A, Girão MJB, Di Bella Z, Uchoa SM, Payão S, Hijas A, Berghman B, De Bie R, Sobrevia L, Junginger B, Alves FCB, Rossignoli PS, Prudencio CB, Orlandi MIG, Gonçalves MI, Nunes SK, Catinelli BB, Quiroz S, Sarmento BV, Pinheiro FA, Sartorão CI, Lucas RR, Reyes DRA, Quiroz SBCV, Enriquez EMA, Oliveira RG, Floriano JF, Marcondes JPC, Barneze S, Dangió TD, Pascon T, Rossignoli P, Freitas JV, Takano L, Reis F, Caldeirão TD, Fernandes JN, Carr AM, Gaitero MVC, Corrente JE, Nunes HRC, Candido AF, Costa SMB, Dangió TD, Pascon T, Melo JVF, Takano L, Reis FVDS, Caldeirão TD, Carr AM, Garcia GA, Rabadan GB, Bassin HCM, Suyama KS, Damasceno LN, Takemoto MLS, Menezes MD, Bussaneli DG, Nogueira VKC, Lima PR, Lourenço IO, Marostica de Sá J, Megid RA, Caruso IP, Rasmussen LT, Prata GM, Piculo F, Vesentini G, Arantes MA, Ferraz GAR, Camargo LP, Kron MR, Corrente JE, Nunes HRC. Study protocol to investigate biomolecular muscle profile as predictors of long-term urinary incontinence in women with gestational diabetes mellitus. BMC Pregnancy Childbirth 2020; 20:117. [PMID: 32075598 PMCID: PMC7031907 DOI: 10.1186/s12884-020-2749-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12 months after the Cesarean (C) section in women with GDM. Specifically, differences in PFM/RAM hyperglycemic myopathy will be evaluated. METHODS The Diamater is an ongoing cohort study of four groups of 59 pregnant women each from the Perinatal Diabetes Research Centre (PDRC), Botucatu Medical School (FMB)-UNESP (São Paulo State University), Brazil. Diagnosis of GDM and PS-UI will be made at 24-26 weeks, with a follow-up at 34-38 weeks of gestation. Inclusion in the study will occur at the time of C-section, and patients will be followed at 24-48 h, 6 weeks and 6 and 12 months postpartum. Study groups will be classified as (1) GDM plus PS-UI; (2) GDM without PS-UI; (3) Non-GDM plus PS-UI; and (4) Non-GDM without PS-UI. We will analyze relationships between GDM, PS-UI and hyperglycemic myopathy at 12 months after C-section. The mediator variables to be evaluated include digital palpation, vaginal squeeze pressure, 3D pelvic floor ultrasound, and 3D RAM ultrasound. RAM samples obtained during C-section will be analyzed for ex-vivo contractility, morphological, molecular and OMICS profiles to further characterize the hyperglycemic myopathy. Additional variables to be evaluated include maternal age, socioeconomic status, educational level, ethnicity, body mass index, weight gain during pregnancy, quality of glycemic control and insulin therapy. DISCUSSION To our knowledge, this will be the first study to provide data on the prevalence of PS-UI and RAM and PFM physical and biomolecular muscle profiles after C-section in mothers with GDM. The longitudinal design allows for the assessment of cause-effect relationships between GDM, PS-UI, and PFMs and RAMs myopathy. The findings may reveal previously undetermined consequences of GDM.
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Affiliation(s)
- Marilza V C Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), CEP18618-687, Sao Paulo, Brazil.
| | - Fátima P Souza
- Physics Department, Institute of Biosciences, Letters and Exact Sciences, Multiuser Center for Biomolecular Innovation, UNESP-São Paulo State University, Sao Paulo, Brazil
| | - Joelcio F Abbade
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), CEP18618-687, Sao Paulo, Brazil
| | - Raghavendra L S Hallur
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), CEP18618-687, Sao Paulo, Brazil
| | - João Paulo C Marcondes
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), CEP18618-687, Sao Paulo, Brazil
| | - Fernanda Piculo
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), CEP18618-687, Sao Paulo, Brazil.,Physiotherapy Department, Faculdades Integradas de Bauru, FIB, Sao Paulo, Brazil
| | - Gabriela Marini
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), CEP18618-687, Sao Paulo, Brazil.,Universidade do Sagrado Coração (USC), Jardim Brasil, Bauru, Sao Paulo, Brazil
| | - Giovana Vesentini
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), CEP18618-687, Sao Paulo, Brazil
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
| | - Steven S Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.,Institute of Tropical Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Iracema M P Calderon
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), CEP18618-687, Sao Paulo, Brazil
| | - Angélica M P Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), CEP18618-687, Sao Paulo, Brazil.,School of Philosophy and Sciences, Department of Physiotherapy and Occupational Therapy, UNESP-São Paulo State University, Marília, Sao Paulo, Brazil
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Wei A, Wang R, Wei K, Dai C, Huang Y, Xu P, Xu J, Tang H, Zhang Y, Fan Y. LncRNA and mRNA Expression Profiling in the Periurethral Vaginal Wall Tissues of Postmenopausal Women with Stress Urinary Incontinence. Reprod Sci 2020; 27:1490-1501. [PMID: 32046467 DOI: 10.1007/s43032-020-00144-3] [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: 07/23/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
Stress urinary incontinence (SUI) is one of the major pelvic floor disorders affecting postmenopausal women. To investigate the lncRNA and mRNA expression profiling of SUI in postmenopausal women, we used a microarray analysis to examine the differentially expressed long noncoding RNAs (lncRNAs) and messenger RNAs (mRNAs) in the periurethral vaginal wall of postmenopausal women with SUI. A total of 8840 lncRNAs and 7102 mRNAs were dysregulated in the two groups (absolute fold change ≥ 2 and P < 0.05). The expression levels of five randomly selected lncRNAs and mRNAs were validated by quantitative real-time PCR. A functional analysis revealed that several lncRNAs are involved in the lysosome pathway associated with extracellular matrix (ECM) remodeling. In addition, we also found several mRNAs involved in fibroblast pseudopodia formation, fibroblast growth, and the regulation of smooth muscle cell differentiation in the urinary tract. Our study offers essential data regarding differentially expressed lncRNAs and mRNAs and may provide new potential candidates for the study of SUI.
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Affiliation(s)
- Aimin Wei
- Department of Gynecology and Obstetrics, The Affiliated Obstetrics and Gynecology Hospital, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Ruohan Wang
- The First Clinical Medical College, Nanjing Medical University, Nanjing, 211166, China
| | - Kai Wei
- Kangda College of Nanjing Medical University, Lianyungang, 222002, China
| | - Chencheng Dai
- Department of Gynecology and Obstetrics, The Affiliated Obstetrics and Gynecology Hospital, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Yue Huang
- Kangda College of Nanjing Medical University, Lianyungang, 222002, China
| | - Pengfei Xu
- Department of Gynecology and Obstetrics, The Affiliated Obstetrics and Gynecology Hospital, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Juan Xu
- Department of Gynecology and Obstetrics, The Affiliated Obstetrics and Gynecology Hospital, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Hui Tang
- Department of Gynecology and Obstetrics, The Affiliated Obstetrics and Gynecology Hospital, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Zhang
- Kangda College of Nanjing Medical University, Lianyungang, 222002, China.
| | - Yun Fan
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, Nanjing Medical University, Nanjing, 211166, China. .,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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Szumilewicz A, Kuchta A, Kranich M, Dornowski M, Jastrzębski Z. Prenatal high-low impact exercise program supported by pelvic floor muscle education and training decreases the life impact of postnatal urinary incontinence: A quasiexperimental trial. Medicine (Baltimore) 2020; 99:e18874. [PMID: 32028397 PMCID: PMC7015656 DOI: 10.1097/md.0000000000018874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Pregnancy and high impact exercise may cause postnatal urinary incontinence. We aimed to evaluate the life impact of postnatal urinary incontinence in women attending prenatal, high-low impact exercise program, supported by pelvic floor muscle education and training, in comparison to controls. METHODS It was a quasiexperimental trial among 260 postpartum Caucasian women (age 29 ± 4 years; mean ± standard deviation). The training group (n = 133) attended a high-low impact exercise and educational program from the 2nd trimester of pregnancy until birth, 3 times a week. We educated this group to contract and relax pelvic floor muscles with surface electromyography biofeedback and instructed how to exercise postpartum. Control women (n = 127) did not get any intervention. All women reported on the life impact of urinary incontinence 2 months and 1 year postpartum using the Incontinence Impact Questionnaire (IIQ). RESULTS Training group started regular pelvic floor muscle exercises substantially earlier postpartum than controls (P < .001). Significantly less training women reported the life impact of urinary incontinence both 2 months (P = .03) and 1 year postpartum (P = .005). Two months after birth, for the symptomatic women the IIQ scores were significantly lower in the training than in the control women (median [Me] = 9.4 vs Me = 18.9; P = .002). Between the 1st and 2nd assessments the number of women affected by incontinence symptoms decreased by 38% in the training group and by 20% in the controls. CONCLUSION High-low impact activities supported by pelvic floor muscle exercises and education should be promoted among pregnant, physically active women. Such activities may help women to continue high-intensity exercise with the simultaneous prevention of postnatal urinary incontinence.Thy study was registered at ISRCTN under the title "Pelvic floor muscle training with surface electromyography" (DOI 10.1186/ISRCTN92265528).
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Affiliation(s)
- Anna Szumilewicz
- Department of Fitness, Gdansk University of Physical Education and Sport
| | | | - Monika Kranich
- Department of Fitness, Gdansk University of Physical Education and Sport
| | | | - Zbigniew Jastrzębski
- Department of Physiology, Gdansk University of Physical Education and Sport, Gdansk, Poland
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Prevalence and associated risk factors of urinary incontinence and dyspareunia during pregnancy and after delivery. Eur J Obstet Gynecol Reprod Biol 2019; 245:45-50. [PMID: 31851895 DOI: 10.1016/j.ejogrb.2019.10.020] [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] [Received: 12/06/2018] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study is to estimate the prevalence of dyspareunia and stress urinary incontinence (SUI) during pregnancy and after delivery, in addition to evaluating possible associated risk factors. STUDY DESIGN A cross-sectional study was conducted in 2016 with the target population being women who had given birth within the previous 12 months (n = 6436) in Galicia (Spain). Information was collected regarding the mother's status 6 months before pregnancy, during pregnancy, at the time of delivery, and at the time of the survey. The prevalence of SUI and dyspareunia were estimated and regression models were performed to identify variables associated with both pathologies. RESULTS The prevalence of SUI and dyspareunia after delivery were 20.4 % (CI95 %: 19.2-22.0) and 23.4 % (22.3-24.8), respectively. The presence of dyspareunia during pregnancy (adjusted prevalence ratio PR 2.1), breastfeeding (PR 1.2), and having a history of episiotomy (PR 1.3) were all variables associated with the presence of dyspareunia after delivery. SUI after delivery was related to the mother's history of SUI before pregnancy (PR 2.4) and during pregnancy (PR 2.0), as well as having undergone vaginal delivery (PR 2.0). CONCLUSION Knowing which factors are associated with the manifestation of SUI and dyspareunia in women after delivery is useful for identifying susceptible or "at risk" patients. These variables should be included in the clinical history of every pregnant woman.
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Santini ACM, Santos ES, Vianna LS, Bernardes JM, Dias A. Prevalence and factors associated with the occurrence of urinary incontinence during pregnancy. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2019. [DOI: 10.1590/1806-93042019000400013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to determine the prevalence of urinary incontinence (UI) during pregnancy, to identify and quantify the factors associated with gestational UI. Methods: a cross-sectional study carried out with women admitted for deliveries in all maternity wards in the city of Botucatu (São Paulo). Data were collected through a structured questionnaire, based on the literature, containing questions about the occurrence of UI, its types, risk factors and moments when urinary losses occurred. Associations between UI and the predictive variables were analyzed with logistic regression models. Results: 950 women were interviewed, out of which 472 complained of urinary losses during pregnancy, resulting in a prevalence of 49.68% (CI95%= 46.51 - 52.86). The majority (61.8%) were classified as mixed UI. Among the covariates investigated, smoking (OR= 4.56), illicit drugs use (OR= 25.14), stimulant foods (OR= 1.84), constipation (OR=1.99), hypertensive disorders during gestation (OR= 3.23), gestational diabetes mellitus (OR= 2.89), parity (OR= 1.52) and previous caesarean sections (OR= 2.56) increased the chance of urinary losses during pregnancy. Conclusions: there was a high prevalence of UI during pregnancy. This condition was strongly associated with lifestyle habits and gestational morbidities. Finally, it is worth high-lighting the fact that delivery via caesarean section increased the chance of UI in subsequent pregnancies.
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Affiliation(s)
| | | | | | | | - Adriano Dias
- Universidade Estadual Paulista Julio de Mesquita Filho, Brasil
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Pelvic floor muscles after birth: Do unstable shoes have an effect on pelvic floor activity and can this be measured reliably? – A feasibility study / Der Beckenboden nach der Geburt: Verändern instabile Schuhe die Aktivität und kann diese reliabel gemessen werden? – Eine Machbarkeitsstudie. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2019. [DOI: 10.2478/ijhp-2019-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
Women often suffer from urinary incontinence after childbirth. Pelvic floor muscle training is an evidenced-based intervention to prevent urinary incontinence and improve its symptoms
Aim
The primary purpose of this study was to determine if there is a change in the activation of the pelvic floor muscles with different extrinsic parameters (barefoot versus unstable shoe). Second, we wanted to define variables that can be measured reliably and correlated with pelvic floor activity.
Methods
Data of 15 women who were 8 weeks to 6 months postpartum were analyzed. Two conditions (“barefoot” and “kyBoot”) were tested, with each participant performing three different tasks: walking, standing with an active pelvic floor, and standing with a passive pelvic floor. Three-dimensional kinematics of the body were recorded. Activity of the abdominal, back, and gluteal muscles was measured using surface electromyography (EMG). The activity of the pelvic floor was recorded using a vaginal electrode. Maximum pelvic floor activity was compared for each condition, and correlations among pelvic floor activity, kinematic variables, and skeletal muscle activity were determined.
Results
The maximum activity of the pelvic floor while walking was significantly higher when participants were barefoot than when they were wearing kyBoot shoes. For the standing trials, no significant differences between the conditions were detected. No surrogate marker was found to measure the pelvic floor activity.
Conclusion
With regard to the pelvic floor musculature, no recommendation is possible in favor of or against wearing unstable shoes. Technical developments are necessary to provide solutions to reliably measure the pelvic floor activity.
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Wang Q, Yu X, Chen G, Sun X, Wang J. Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study. Int Urogynecol J 2019; 31:277-283. [PMID: 31197430 DOI: 10.1007/s00192-019-04005-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to compare pelvic floor muscle strength (PFMS) and the prevalence of urinary incontinence (UI) and pelvic organ prolapse(POP) in women with and without diastasis recti abdominis (DRA) at 6-8 weeks postpartum. METHODS Three hundred and ten women underwent routine examinations, including POP quantification (POP-Q), PFMS measurement, DRA evaluation, and UI determination. Chi-squared tests and independent sample t test were used to compare the differences between women with DRA and without DRA. RESULTS Women with DRA presented significantly lower prepregnancy body mass index (BMI), predelivery BMI, and postpartum BMI; greater gestational age; and higher birth weights than women without DRA(p < 0.05). Moreover, DRA incidence was significantly higher in those who underwent cesarean section (CS) than in those who underwent vaginal delivery (VD)(p = 0.045). Although the PFMS of the DRA group was weaker and the prevalence of UI and POP was slightly higher than those of the no DRA group, the results were not statistically significant. The PFMS of the CS group was stronger than that of the VD group. Urinary incontinence and prolapse incidence were higher in the VD group than in the CS group. Women who underwent CS had a shorter genital hiatus (Gh) and smaller Ba and Bp values than those in the VD group. Women without DRA had an increased chance of Bp ≥ -2 and Gh ≥ 3(p < 0.05). CONCLUSIONS Women with DRA were not more likely to have weakened PFMS and increased UI or POP at 6-8 weeks postpartum.
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Affiliation(s)
- Qing Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China
| | - Xiaojie Yu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China
| | - Gengmin Chen
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China.
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China.
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China.
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing, 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
- Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China
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Jean-Michel M, Kroes J, Marroquin GA, Chau EMS, Salafia CM, Mikhail M. Urinary Incontinence in Pregnant Young Women and Adolescents: An Unrecognized At-Risk Group. Female Pelvic Med Reconstr Surg 2019; 24:232-236. [PMID: 28657990 PMCID: PMC5943077 DOI: 10.1097/spv.0000000000000445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aims of this study were to determine the prevalence of urinary incontinence (UI) in pregnant young women and adolescents, characterize UI subtype, and identify characteristics associated with UI. METHODS This was a cross-sectional study of pregnant females aged 25 years or below, presenting for routine obstetrical care at a New York City community hospital. Subjects were stratified into 2 groups: adolescents (age, ≤19 years) and young adults (age, >19 years). Demographic and obstetric data were collected. The 3 Incontinence Questions questionnaire was used to screen and evaluate UI symptoms. RESULTS A total of 98 young females with a mean age of 20.3 ± 2.6 years were enrolled. Most participants were nulliparous (64%). Of parous women, route of previous obstetric delivery was primarily vaginal (83%). Mean gestational age at recruitment was 34.5 ± 7.5 weeks. The prevalence of UI was 52%. Urinary incontinence was associated with the following conditions: strenuous activity, 73%; urinary urgency, 67%; and absence of either, 20%. However, the most predominant UI subtype was with strenuous activity (63%). There was no statistical difference detected in demographic characteristics (such as age, parity, mode of delivery, race, education, and trimester of pregnancy) between continent and incontinent pregnant females (P > 0.18). No differences were appreciated between pregnant adolescents and young adult females with UI (P > 0.18). CONCLUSIONS Urinary incontinence was present in 52% of pregnant females aged 25 years or below. By age group, approximately 50% of both adolescents and young adults reported UI during pregnancy. Continent and incontinent patients did not seem to differ demographically. Our study highlights the extent of UI in this segment of the population. This data may support the need for services targeting UI prevention and early intervention in this newly identified at-risk group.
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Affiliation(s)
- Marjorie Jean-Michel
- From the *Division of Female Pelvic Medicine & Reconstructive Surgery, †Department of Obstetrics & Gynecology, Bronx-Lebanon Hospital Center, Bronx, NY; ‡Department of Obstetrics & Gynecology, Essentia Health-St Mary's Hospital, Detroit Lakes, MN; and §Department of Family Medicine, Summa Health Systems/Barberton Campus, Barberton, OH
| | - Jessica Kroes
- From the *Division of Female Pelvic Medicine & Reconstructive Surgery, †Department of Obstetrics & Gynecology, Bronx-Lebanon Hospital Center, Bronx, NY; ‡Department of Obstetrics & Gynecology, Essentia Health-St Mary's Hospital, Detroit Lakes, MN; and §Department of Family Medicine, Summa Health Systems/Barberton Campus, Barberton, OH
| | - Guillermo A. Marroquin
- From the *Division of Female Pelvic Medicine & Reconstructive Surgery, †Department of Obstetrics & Gynecology, Bronx-Lebanon Hospital Center, Bronx, NY; ‡Department of Obstetrics & Gynecology, Essentia Health-St Mary's Hospital, Detroit Lakes, MN; and §Department of Family Medicine, Summa Health Systems/Barberton Campus, Barberton, OH
| | - Emily Man-Shan Chau
- From the *Division of Female Pelvic Medicine & Reconstructive Surgery, †Department of Obstetrics & Gynecology, Bronx-Lebanon Hospital Center, Bronx, NY; ‡Department of Obstetrics & Gynecology, Essentia Health-St Mary's Hospital, Detroit Lakes, MN; and §Department of Family Medicine, Summa Health Systems/Barberton Campus, Barberton, OH
| | - Carolyn M. Salafia
- From the *Division of Female Pelvic Medicine & Reconstructive Surgery, †Department of Obstetrics & Gynecology, Bronx-Lebanon Hospital Center, Bronx, NY; ‡Department of Obstetrics & Gynecology, Essentia Health-St Mary's Hospital, Detroit Lakes, MN; and §Department of Family Medicine, Summa Health Systems/Barberton Campus, Barberton, OH
| | - Magdy Mikhail
- From the *Division of Female Pelvic Medicine & Reconstructive Surgery, †Department of Obstetrics & Gynecology, Bronx-Lebanon Hospital Center, Bronx, NY; ‡Department of Obstetrics & Gynecology, Essentia Health-St Mary's Hospital, Detroit Lakes, MN; and §Department of Family Medicine, Summa Health Systems/Barberton Campus, Barberton, OH
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Tan R, Pu D, Cao J, Ge H, Chang X, Ye G, Wu J. Prevalence of Stress Urinary Incontinence in Women with Premature Ovarian Insufficiency. J Womens Health (Larchmt) 2018; 27:1508-1512. [PMID: 30484729 DOI: 10.1089/jwh.2018.6935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To determine the prevalence of stress urinary incontinence (SUI) and associated factors in women with premature ovarian insufficiency (POI). Materials and Methods: The study included 149 patients with POI and 303 control women without POI. Age, body mass index (BMI), gestational history, time since onset of POI, and status of hormone therapy (HT) for POI were recorded. Results: There was no statistical difference in the mean age, BMI, and parity between the two groups. The prevalence of SUI in the POI group tended to be higher than that in the control group (20.9%, 30/149 vs. 16.2%, 49/303), although not significantly (p = 0.297). About 41.6% (62/149) of patients with POI received HT. Patients with POI and SUI were older (p = 0.018) and had higher BMI (p = 0.007) than women with POI without SUI (p = 0.007). Compared to nulliparas, primiparas were more likely to have SUI (p = 0.046). However, SUI developed irrespective of time since onset of oligomenorrhea/amenorrhea or HT use. Furthermore, regression analysis showed that the prevalence of SUI was higher in women 30-39 years of age (odds ratio [OR] = 3.27, p = 0.002) and older than 40 years (OR = 7.78, p = 0.001). Primiparas (OR = 2.89, p = 0.001) and vaginal delivery (OR = 2.58, p = 0.023) were associated with SUI. Conclusions: The prevalence of SUI was fairly high among patients with POI, and age, parity, and vaginal delivery were the main risk factors. However, duration of POI and HT use had no effect on SUI. Increasing awareness of the importance of urinary system health in this population will improve the quality of life for these women.
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Affiliation(s)
- Rongrong Tan
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Danhua Pu
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Jinxiang Cao
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Huan Ge
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoxia Chang
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Guihua Ye
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Wu
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
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