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Pająk PM, Wlaźlak E, Surkont G, Kalinka J. An assessment of the relationship between urethral hypermobility as measured by ultrasound and the symptoms of stress urinary incontinence in primiparous women 9-18 months postpartum. J Ultrason 2024; 24:20240010. [PMID: 38496788 PMCID: PMC10940277 DOI: 10.15557/jou.2024.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 02/29/2024] [Accepted: 07/25/2023] [Indexed: 03/19/2024] Open
Abstract
Aim The aim of the study was to estimate the relationship between bladder neck hypermobility as assessed by ultrasound and the occurrence of stress urinary incontinence as measured with the UDI-6 questionnaire in primiparous women 9-18 months postpartum. Materials and methods The study included 100 women 9-18 months after their first delivery, 19% of whom (study group) presented with urethral hypermobility. Ultrasound was used to determine the position and mobility of the bladder neck in order to assess the urethral hypermobility. A vector of ≥15 mm was defined as urethral hypermobility. Symptoms of stress urinary incontinence were assessed using question 3 of the UDI-6 questionnaire, in which the presence of symptoms was defined as a response rated from 1 to 4. Results We demonstrated a statistically significant relationship between urethral hypermobility and the symptoms of stress urinary incontinence with a statistical significance level of p <0.002. Conclusions Stress urinary incontinence is a common disorder in women, the pathophysiology of which is not fully understood. It has adverse effects on the quality of life, perception of one's own body and sexual function. Impairment of urethral fixation may play an important role in the pathophysiology of this common form of urinary incontinence. The study showed that urethral hypermobility, as assessed by ultrasound, contributes to stress urinary incontinence, as measured with the UDI-6 score. Although stress urinary incontinence is a multifactorial disorder influenced by anatomical changes and congenital anatomical features, it is easily diagnosed. Suburethral slings are an effective surgical technique; however, the incidence of postoperative voiding dysfunction or recurrent stress urinary incontinence is 10-20%. Therefore, an assessment of anatomical changes in stress urinary incontinence may help individualize the surgical strategy.
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Affiliation(s)
- Paulina Maria Pająk
- Department of Perinatology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
| | - Edyta Wlaźlak
- Department of Operative Gynecology and Gynecologic Oncology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Surkont
- Department of Operative Gynecology and Gynecologic Oncology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
| | - Jarosław Kalinka
- Department of Perinatology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
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Zhao B, Wen L, Liu D, Huang S. Visualized Urethral Mobility Profile During Urine Leakage in Supine and Standing Positions. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e158-e163. [PMID: 35168283 DOI: 10.1055/a-1700-2862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe the urethral course and position during urine leakage based on the visualized urethral mobility profile (UMP) and to explore the differences between supine and standing positions. METHOD This was a prospective study of 100 women with SUI and 100 control women who underwent a cough stress test (CST) with transperineal ultrasound (TPUS) in supine and standing positions. In the mid-sagittal plane, the UMP software automatically placed six equidistant points from the bladder neck (point 1) to the external urethral meatus (point 6). It determined the x and y coordinates of the points relative to the symphysis pubis. The distance between the points and symphysis pubis (dist. 1 to 6) was calculated using the formula SQRT (x2 + y2). The visualized UMP was created by reproducing the six points on a bitmap. RESULTS Valid UMP data of 78 control women and 90 women with SUI were analyzed. In the two positions, distances 1 to 6 were significantly greater in the SUI group than the continent group (all p < 0.05). During Valsalva, the distance between the mid-urethra (dist. 3 and 4) and the symphysis was significantly increased (all p < 0.001) in the SUI group. The visualized UMP showed a similar upper-urethral course in the two groups. The gap between the mid-urethra (points 3 and 4) and symphysis was wider in the SUI group. CONCLUSION The visualized UMP in supine and standing positions showed no difference in the bladder neck and upper urethral stability between incontinent and continent women, but mid-urethral stability was weaker in SUI.
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Affiliation(s)
- Baihua Zhao
- Ultrasound diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
| | - Lieming Wen
- Ultrasound diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
| | - Dan Liu
- Ultrasound diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
| | - Shanya Huang
- Ultrasound diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
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Arian A, Ghanbari Z, Rasoulighasemlouei S, Yazdi SNM, Arab-Ahmadi M. Association between 2D trans-perineal ultrasound and physical examination in evaluation of ani function. J Ultrasound 2023; 26:423-428. [PMID: 36781614 PMCID: PMC10247925 DOI: 10.1007/s40477-023-00776-6] [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: 11/23/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE To compare the correlation between 2D transperineal ultrasonography and physical examination (intravaginal palpation) for assessing pelvic floor and levator ani function. METHODS Due to symptoms of pelvic floor disorder, 40 women between the ages of 29 and 75 were enrolled in this study as candidates for urodynamic and structural evaluation of the pelvic floor. A pelvic floor gynaecologist and radiologist assessed the levator ani function via physical examination (graded based on the Oxford Grading System) and transperineal 2D ultrasound, respectively. RESULTS The ultrasound parameters for calculating the Levator Ani Index (LAI) demonstrate a difference between the anteroposterior dimension of the levator hiatus (r = 0.691, p < 0.001) and the cranial shift of muscle (r = 0.499, p < 0.001) at rest and during a squeezing manoeuvre in the mid-sagittal plane. Reduced anteroposterior diameter of the hiatus and increased cranial shift were associated with a higher Oxford Physical Examination Score (OPES). The association between LAI and OPES was independent of baseline variables such as age, BMI, number of births, and the presence of incontinence symptoms. CONCLUSION Measures such as the LAI can be used to quantify the function of the levator ani muscle, which may be useful for evaluating the efficacy of pelvic floor physiotherapy and exercise.
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Affiliation(s)
- Arvin Arian
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zinat Ghanbari
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedehsahel Rasoulighasemlouei
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyedeh Nooshin Miratashi Yazdi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Arab-Ahmadi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Dong B, Shi Y, Chen Y, Liu M, Lu X, Liu Y. Perineal ultrasound to assess the urethral spatial movement in stress urinary incontinence in women. BMC Urol 2023; 23:44. [PMID: 36973802 PMCID: PMC10041725 DOI: 10.1186/s12894-023-01220-x] [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: 03/30/2022] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Perineal ultrasound as a non-invasive method for the diagnosis of female stress urinary incontinence has attracted more and more attention. However, the criteria for stress urinary incontinence in women using perineal ultrasound have not been fully established. Our study aimed to evaluate characteristics of the urethral spatial movement with perineal ultrasonography. METHODS A total of 136 female patients with stress urinary incontinence and 44 controls were enrolled. Stress urinary incontinence was diagnosed using the International Consultation on Incontinence Questionnaire Short Form, medical history and physical examination, and severity was assessed using a 1 h pad test. We described the mobility of four equidistant points (A-D) located along the urethra length. The retrovesical and urethral rotation angles were measured using perineal ultrasonography at rest and during the maximal Valsalva maneuver. RESULTS Patients with stress urinary incontinence showed a more significant vertical movement at Points A, B and C than controls. The mean variations in the retrovesical angle were significantly larger in patients with stress urinary incontinence at rest and during the Valsalva maneuver than in controls (21.0 ± 16.5° vs. 14.7 ± 20.1°, respectively). The cut-off value for the retrovesical angle variation was 10.7° with 72% sensitivity and 54% specificity. There was a receiver-operating characteristic curve area of 0.73 and 0.72 for Points A and B, respectively. A cut-off of 10.8 mm, and 9.4 mm provided 71% sensitivity and 68% specificity and 67% sensitivity and 75% specificity, respectively. CONCLUSIONS The spatial movement of the bladder neck and proximal urethra, and variations in the retrovesical angle may be correlated with clinical symptoms and facilitate to the assessment of SUI.
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Affiliation(s)
- Binbin Dong
- Department of Urology, The Sixth Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
- Department of Urology, Yancheng Third People's Hospital, Yancheng, Jiangsu Province, China
| | - Yingqiu Shi
- Department of Urology, The Sixth Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
- Department of Urology, Yancheng Third People's Hospital, Yancheng, Jiangsu Province, China
| | - Yin Chen
- Department of Urology, The Sixth Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
- Department of Urology, Yancheng Third People's Hospital, Yancheng, Jiangsu Province, China
| | - Ming Liu
- Department of Urology, The Sixth Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
- Department of Urology, Yancheng Third People's Hospital, Yancheng, Jiangsu Province, China
| | - Xiaoming Lu
- Department of Urology, The Sixth Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China.
- Department of Urology, Yancheng Third People's Hospital, Yancheng, Jiangsu Province, China.
| | - Yadong Liu
- Department of Urology, The Sixth Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China.
- Department of Urology, Yancheng Third People's Hospital, Yancheng, Jiangsu Province, China.
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Assessment of the Elastographic and Electromyographic of Pelvic Floor Muscles in Postmenopausal Women with Stress Urinary Incontinence Symptoms. Diagnostics (Basel) 2021; 11:diagnostics11112051. [PMID: 34829398 PMCID: PMC8618737 DOI: 10.3390/diagnostics11112051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background. Shear wave elastography is an effective method for studying the condition of various musculoskeletal soft tissues. The primary aim of this study was the objective elastographic and electromyographic assessment of the pelvic floor during the rest and contraction of the pelvic floor muscles (PFM) in postmenopausal women. Methods. This was a prospective observational study that was carried out at the University Hospital in Wroclaw, Poland, between January 2017 and December 2019. Patients. The target group of the study included postmenopausal women with stress urinary incontinence. The primary outcomes were the features of the elastographic assessment of the pelvic floor during rest and contraction of the PFM obtained using shear wave elastography. Results. Based on the inclusion and exclusion criteria for the study, 14 patients took part in the measurements. There was a significant difference between the elastographic assessment of the pelvic floor during rest and contraction of the PFM at all locations in front of the urethra. No statistically significant correlation was found between the results of elastography and the bioelectrical activity of PFM. Conclusion. The elasticity of the periurethral structures is higher during active pelvic floor muscle contraction than at rest, it seems that shear wave elastography is an effective test that objectively assesses the strength of PFM contraction.
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Huang Y, Chen Z, Shen B, Shao Y, Gao J, Zhou Y, Margit F, Wei Z, Ding L. Management and Follow-Up Practices of Women With Recurrent Stress Urinary Incontinence Following Transobturator Mid-urethral Synthetic Sling Procedure: A 6-Year Retrospective Monocentric University-Based Study. Front Surg 2021; 8:710594. [PMID: 34540886 PMCID: PMC8448289 DOI: 10.3389/fsurg.2021.710594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the efficacy of management and follow-up practices in repeat retropubic mid-urethral synthetic sling (MUS) procedure after transobturator tape/tension-free vaginal tape-obturator (TOT/TVT-O) failure, and to clarify the possible etiology of recurrent stress urinary incontinence. Methods: The charts of all women patients who underwent tension-free vaginal tape (TVT) slings after previous failed transobturator MUS procedures between February 2012 and November 2018 at a single center were reviewed retrospectively. The transperineal ultrasound was performed to assess the pre-operative or post-operative urethral mobility and location of the slings. Furthermore, some essential evaluations were also made, mainly including medical history, physical examination, 1 h pad test, and urodynamic study. Finally, primary outcomes were evaluated according to the above items at 3, 6, and 12 months after the second operation, respectively. Results: Thirty-five patients were included in the primary transobturator MUS sling procedure. At the 6 months follow-up, 32 (91.42%) patients were socially continent and negative in 1 h pad test. The transperineal ultrasound measurement results revealed that the bladder neck descent (BND) values were significantly decreased after the repeat sling operation, and better urinary continence function was observed according to the post-operative urodynamic study. Multifactorial etiologies resulted in recurrent stress urinary incontinence (SUI), including poor surgical technique, inadequate sling tension when treating ISD, and inappropriate sling position. Then the detail of the surgical procedure varied with the results of pre-operative evaluations, affecting the validity of the second sling. Conclusion: Recurrent SUI has resulted from multi factors, pre-operative urodynamic study and transperineal ultrasound might be valuable tools to guide repeat sling operation and predict post-operative outcomes. A repeat TVT procedure may be regarded as a remedial measure for a failed transobturator MUS operation.
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Affiliation(s)
- Yi Huang
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China.,Department of Urology, Jiangnan University Affiliated Hospital, Wuxi, China
| | - Zhengsen Chen
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Baixin Shen
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Yunpeng Shao
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Jie Gao
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Yiduo Zhou
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Fisch Margit
- Department of Urology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Zhongqing Wei
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Liucheng Ding
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
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Turkoglu A, Coskun ADE, Arinkan SA, Vural F. The role of transperineal ultrasound in the evaluation of stress urinary incontinence cases. Int Braz J Urol 2021; 48:70-77. [PMID: 34528775 PMCID: PMC8691236 DOI: 10.1590/s1677-5538.ibju.2020.1100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/21/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose: To evaluate the use of transperineal ultrasonography while diagnosing stress urinary incontinence (SUI) by comparing the urethral angle (α), posterior urethrovesical angle (β), and bladder neck descent (BND) during rest and Valsalva maneuver in continent women and women with SUI. Materials and methods: This prospective observational study was conducted with 50 women with SUI and 50 continent women. Transperineal ultrasonography was performed at rest and during Valsalva maneuver. Q-tip test was performed. Results: During the Valsalva maneuver, both α and β angles were significantly higher in women with SUI (p <0.001). The difference between Valsalva and rest measurements of α and β angles (R α, R β) were also significantly higher in women with SUI (p <0.001). The cut-off point determined for the R α in the diagnosis of stress incontinence was 16° (80% sensitivity, 98% specificity). A statistically significant strong correlation was found between Q-tip test angle and R α value (p=0.000; r=0.890). Q-tip VAS pain scores were significantly higher than ultrasonography VAS pain scores (p <0.001). In relation to the bladder neck descent comparison between the two groups showed that BND was significantly higher in SUI group (p <0.001). The cut-off point determined for BND in the diagnosis of SUI was >11mm (90% sensitivity, 98% specificity). Conclusion: Transperineal ultrasonography is a practical, reliable, non-invasive and comfortable method for evaluation of SUI. It has the advantage of dynamic evaluation during the Valsalva maneuver. Rotation angles and BND have high sensitivity and specificity for detection of SUI. The change in α angle with Valsalva (Rα) can be used as an alternative to Q-tip test.
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Affiliation(s)
- Alper Turkoglu
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turke
| | - Ayse Deniz Erturk Coskun
- Department of Obstetrics and Gynecology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Sevcan Arzu Arinkan
- Department of Obstetrics and Gynecology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fisun Vural
- Department of Obstetrics and Gynecology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Rodrigues MP, Paiva LL, Mallmann S, Bessel T, Ramos JGL. Can the inability to contract the pelvic floor muscles influence the severity of urinary incontinence symptoms in females? Int Urogynecol J 2021; 33:1193-1197. [PMID: 34170343 DOI: 10.1007/s00192-021-04880-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to analyze if the inability to perform a maximal voluntary contraction (MVC) of the pelvic floor muscles (PFMs) in a first assessment can influence the severity of urinary incontinence symptoms in women. METHODS A cross-sectional study was carried out using the medical records of women with UI who were referred for pelvic floor physiotherapy after undergoing a gynecological evaluation between May 2013 and December 2019. Records included data referring to age, body mass index (BMI), obstetric history, Modified Oxford Scale (MOS), and the final score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) from a baseline assessment. Data were divided into women who were unable and those who were able to voluntarily perform an MVC of the PFMs. Statistical analysis was conducted using SPSS version 21. RESULTS A total of 498 medical records were analyzed and 36.3% of those women were not able to perform a PFM MVC after verbal command and digital stimulus. Homogeneity was observed among groups and no significant difference was found regarding the severity of UI symptoms when the groups were compared. CONCLUSIONS No association was found between the inability to contract the PFMs and the severity of UI symptoms. Other studies should be developed to better understand why some women are incapable of performing a voluntary PFM contraction. Also, it would be relevant to compare women with PFM dysfunction who are not able to contract the PFMs with healthy women with the same PFM condition to analyze whether this muscle condition could be related to dysfunctions such as UI or pelvic organ prolapse.
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Affiliation(s)
- Marina Petter Rodrigues
- Graduate Program in Health Sciences: Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.
| | - Luciana Laureano Paiva
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Suzana Mallmann
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Thaise Bessel
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - José Geraldo Lopes Ramos
- Graduate Program in Health Sciences: Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
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Kilic D, Guler T, Baser E, Kabukcu C, Fenkci V, Sivaslioglu A. Does apical prolapse in addition to early stage anterior prolapse have any effect on lower urinary tract symptoms? J Gynecol Obstet Hum Reprod 2020; 50:101922. [PMID: 32977045 DOI: 10.1016/j.jogoh.2020.101922] [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: 06/25/2020] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate whether apical prolapse in addition to early-stage anterior prolapse has any effect on lower urinary tract symptoms (LUTS). METHODS Patients with early-stage pelvic organ prolapse (POP) were retrospectively analyzed at the urogynecology unit of a tertiary referral center. Cases with posterior POP were excluded, and the remaining women were distributed across four main groups: (1) no determinable anterior and/or apical POP (control); (2) isolated anterior POP; (3) anterior + apical POP; and (4) isolated apical POP. Each LUTS symptom in these groups was recorded. Women with isolated anterior POP and women with anterior + apical POP were then compared to define the additional effects of apical prolapse on LUTS. In order to asses; symptoms of urgency, urinary incontinence, stress urinary incontinence, frequency, abnormal emptying, hesitancy, interrupted stream, nocturia, post-micturition dribble, and dysuria were noted and Incontinence Impact Questionnaire (IIQ-7), and domains of Urinary Distress Inventory (UDI-6) were compared between the groups. RESULTS Of the 225 patients, 66 were excluded from the analysis due to accompanying posterior compartment defect. There was no statistically significant difference for age, systemic disease history, or smoking status between the groups (p > 0.05). However, history of traumatic vaginal delivery was significantly lower in the control group than in the other groups (p = 0.039). The prevalence of hesitancy and interrupted stream were found to be significantly higher in the anterior + apical POP group than in the isolated POP group (p<0.05). Obstructive subscale of the Urinary Distress Inventory was higher both in the isolated anterior POP and anterior + apical POP groups than the control group (p<0.05). CONCLUSION The current study demonstrates that even minimal loss of apical support accompanying anterior prolapse exacerbates LUTS.
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Affiliation(s)
- Derya Kilic
- Department of Obstetrics and Gynecology, Pamukkale University, Denizli, Turkey
| | - Tolga Guler
- Department of Obstetrics and Gynecology, Pamukkale University, Denizli, Turkey.
| | - Emre Baser
- Department of Obstetrics and Gynecology, Bozok University, Yozgat, Turkey
| | - Cihan Kabukcu
- Department of Obstetrics and Gynecology, Pamukkale University, Denizli, Turkey
| | - Veysel Fenkci
- Department of Obstetrics and Gynecology, Pamukkale University, Denizli, Turkey
| | - Akin Sivaslioglu
- Department of Obstetrics and Gynecology, Mugla Sitki Kocman University, Mugla, Turkey
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Dos Santos Sousa AJ, Padilha JF, da Silva JB, Hirakawa HS, Seidel EJ, Driusso P. Intra- and inter-rater reliability of urethral mobility measurement by ultrasound in women: a cross-section study. Int Urogynecol J 2020; 32:119-125. [PMID: 32572542 DOI: 10.1007/s00192-020-04381-7] [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: 04/03/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To verify the intra- and inter-rater reliability of urethral mobility measurement evaluated by ultrasound (US). METHODS This is a reliability study realized according to Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. Twenty-one nulliparous women (25.5 ± 3.3 SD years) were volunteers. Two examiners (E1 and E2) performed the measurement of urethral mobility at rest and Valsalva on the same day. Three measurements were recorded for each moment and the mean of them were used for analysis. To perform the analysis, bladder mobility was calculated using the following equation: [Formula: see text], where "x" is the vertical distance, "y" is the horizontal distance from the dorsocaudal margin of the pubic symphysis, "V" is the Valsalva maneuver, and "R" means rest. The intraclass correlation coefficient (ICC) was calculated considering: ICC ≥ 0.75, excellent; 0.40 ≤ ICC <0.75, satisfactory; ICC < 0.40, poor, with a significance level of 5% and 95% confidence interval. RESULTS The intra-rater reliabilities of E1 and E2 were considered excellent between the two evaluations, with ICC 0.98 (p < 0.0001) for the E1 and 0.84 (p < 0.0001) for E2. The inter-rater reliability was considered excellent (ICC = 0.83). CONCLUSIONS Both intra- and inter-rater reliabilities of urethral mobility measurement were considered to have excellent agreement.
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Affiliation(s)
- Ana Jessica Dos Santos Sousa
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil
| | - Juliana Falcão Padilha
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil
| | - Jordana Barbosa da Silva
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil
| | - Humberto Sadanobu Hirakawa
- Medicine Department, São Carlos, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil
| | - Enio Júnior Seidel
- Statistics Department, Federal University of Santa Maria (UFSM), Av Roraima 1000, Santa Maria, Rio Grande do Sul, CEP 97105-900, Brazil
| | - Patricia Driusso
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil.
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