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You C, Zhao Y, Zhang C, Chen M, Shen W. Pelvic floor parameters predict postpartum stress urinary incontinence: a prospective MRI study. Insights Imaging 2023; 14:160. [PMID: 37755551 PMCID: PMC10533763 DOI: 10.1186/s13244-023-01488-5] [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: 02/13/2023] [Accepted: 07/22/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE To investigate the pelvic floor changes in primiparas with postpartum stress urinary incontinence (SUI) after vaginal delivery using pelvic floor MRI. MATERIALS AND METHODS Fifty-two women were enrolled in the primiparous stress urinary incontinent (PSUI) group and 51 in the primiparous continent (PC) group. Thirty nulliparas were also recruited as the nulliparous control (NC) group. Levator ani muscle (LAM) injury, levator hiatus area (LHA), H-line, M-line, the distance from the bladder neck and cervix to the pubococcygeal line (B-PCL and U-PCL), levator plate angle, the anterior angle of the urethra, bladder neck descent, retrovesicourethral angle, functional urethral length, and a bladder neck funnel were evaluated on MRI images. Univariate and multivariate logistic regression analyses were used to explore anatomical predictors for SUI. RESULTS The primiparas in the PSUI group showed more obvious LAM injuries than in the PC groups (p = 0.001). LAM function assessment: the PSUI group had larger LHA and shorter B-PCL and U-PCL than the other groups during straining. Assessment of urethral mobility and function: the PSUI group had larger anterior angle of the urethra, bladder neck descent, retrovesicourethral angle, and shorter functional urethral length than the other two groups (all p < 0.05). Up to 88.5% of primiparas in the PSUI group showed bladder funnel (p < 0.001). The logistic regression analysis showed that retrovesicourethral angle, functional urethral length, and the presence of bladder funnel were significantly associated with postpartum SUI (p < 0.05). CONCLUSIONS Increased retrovesicourethral angle, shortened functional urethral length, and the presence of bladder funnel may be anatomical predictors for SUI in the early postpartum period. Urethral sphincter dysfunction plays an essential role in developing postpartum SUI. CRITICAL RELEVANCE STATEMENT This study used several measurements to reflect the anatomical structure and functional changes of the pelvic floor to identify the best anatomical predictors associated with postpartum stress urinary incontinence (SUI), aiming to provide new insights into treatment strategies for postpartum SUI. KEY POINTS • Increased retrovesicourethral angle, shortened functional urethral length, and the presence of bladder funnel are more commonly seen in primiparas with SUI. • The combination of retrovesicourethral angle, functional urethral length, and bladder funnel had the highest diagnostic performance in predicting postpartum SUI (AUC=0.947). • Urethral sphincter dysfunction may be the main pathophysiological foundation in SUI development.
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Affiliation(s)
- Cong You
- The First Central Clinical School, Tianjin Medical University, Nankai District, Tianjin, China
| | - Yujiao Zhao
- The First Central Clinical School, Tianjin Medical University, Nankai District, Tianjin, China
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Cheng Zhang
- The First Central Clinical School, Tianjin Medical University, Nankai District, Tianjin, China
| | - Mengyao Chen
- The First Central Clinical School, Tianjin Medical University, Nankai District, Tianjin, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No.24 Fukang Road, Nankai District, Tianjin, 300192, China.
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Establishment and validation of a risk prediction model for postpartum stress urinary incontinence based on pelvic floor ultrasound and clinical data. Int Urogynecol J 2022; 33:3491-3497. [PMID: 36278986 PMCID: PMC9666322 DOI: 10.1007/s00192-022-05395-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study aimed to establish a risk prediction model for postpartum stress urinary incontinence (SUI) based on pelvic floor ultrasound measurement data and certain clinical data. METHODS Singleton pregnant women aged ≥ 18 years who underwent delivery were selected. All participants were followed up to determine the symptoms of SUI, and pregnancy-related data were collected at the time of registration. Pelvic floor ultrasound was performed at 6-12 weeks postpartum to obtain ultrasonic measurement data. Logistic regression analysis was used to select predictors and establish a nomogram to predict the risk of postpartum SUI. Area under the ROC curve (AUC) values and calibration curves were used for discrimination and calibration, respectively. Finally, external verification of the model was carried out. RESULTS A total of 255 participants were included in the analysis, comprising 105 in the postpartum SUI group and 150 in the non-SUI group. Logistic regression analysis identified age, parity, vaginal delivery, bladder neck descent (BND), and angle of internal urethral orifice funnel as risk factors for postpartum SUI (all P < 0.05). CONCLUSIONS We constructed a prediction model for postpartum SUI based on pelvic floor ultrasound measurement data and certain clinical data. In clinical practice, this convenient and reliable tool can provide a basis for formulation of treatment strategies for patients with postpartum SUI.
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Cao F, Zhang S, Huang J, Gan L, Zhuansun Q, Lin X. The effect of acupuncture on postpartum stress urinary incontinence: A protocol for systemic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29177. [PMID: 35866780 PMCID: PMC9302277 DOI: 10.1097/md.0000000000029177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Postpartum stress urinary incontinence (PSUI) is a widespread complaint in postpartum women, which significantly affects their quality of life. Acupuncture has been widely used as an alternative complementary therapy for the treatment of PSUI. This protocol is carried out to comprehensively explore the effectiveness and safety of acupuncture for treating PSUI. METHODS Randomized clinical trials related to acupuncture treatment of PSUI will be searched in Chinese and English literature databases: PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Database, and the Technology Periodical Database. Changes in pelvic floor muscle strength compared with baseline will be accepted as the primary outcomes, and secondary outcomes will be the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score, the urodynamic indexes, the incontinence quality of life questionnaire, and adverse effects of acupuncture. All publications will be screened and extracted by 2 reviewers independently. Quality of the eligible publications will be assessed according to the Cochrane Risk of Bias tool and statistical analyses will be conducted by using the Review Manager V.5.3. RESULTS This study will provide a high-quality comprehensive evaluation for the clinical efficacy and safety of acupuncture for PSUI. CONCLUSION This systematic review will provide comprehensive evidence of acupuncture treatment on specific outcomes for PSUI. ETHICS AND DISSEMINATION Because of the study will not collect personal information, ethical approval will not be required. The results will be published in a peer-reviewed journal. TRIAL REGISTRATION INPLASY 202220045.
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Affiliation(s)
- Fengye Cao
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Shanshan Zhang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Jingmei Huang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Lin Gan
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Qinshuai Zhuansun
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Xianming Lin
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
- *Correspondence: Xianming Lin, The Third Clinical Medical College of Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang District, Hangzhou, Zhejiang Province, China (e-mail: )
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Li M, Tian Q. Risk factors for postoperative pelvic floor dysfunction in patients with cervical cancer: evidences for management strategies. Transl Cancer Res 2022; 10:4338-4346. [PMID: 35116292 PMCID: PMC8798382 DOI: 10.21037/tcr-21-365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/20/2021] [Indexed: 12/22/2022]
Abstract
Background It’s necessary to evaluate the potential risk factors for postoperative pelvic floor dysfunction (PFD) in patients with cervical cancer, to provide insights into the treatment and nursing care of cervical cancer. Methods Our study was a case-control study design. Patients who underwent radical cervical cancer surgery in our hospital from January 2018 to January 2020 were included. We selected the patients with benign uterine lesions after hysterectomy at the same time as the control group. The patient characteristics of two groups were retrospectively compared and analyzed. Multiple logistic regression analyses were conducted to identify the potential risk factors. Results A total of 247 patients were included. The duration of surgery, estimated blood loss, duration of urinary catheter, and length of hospital stay in cervical cancer group were significantly more than that of control group (all P<0.05). The incidence of postoperative PFD was 63.93%. There were significant differences in the age, postoperative constipation, number of deliveries, duration of urinary catheter between PFD and no PFD patients (all P<0.05). Age ≥45y (OR 4.39, 1.05–9.83), duration of urinary catheter ≥7d (OR 4.31, 1.22–8.05), postoperative constipation (OR 3.17, 1.07–5.89) and number of deliveries ≥2 (OR 2.75, 1.22–5.43) were the risk factors for postoperative PFD in patients with cervical cancer. Conclusions Early measures targeted on those risk factors should be implemented for the prophylaxis of PFD.
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Affiliation(s)
- Meng Li
- Department of Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Qing Tian
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China.,Department of Operation, West China Second University Hospital, Sichuan University, Chengdu, China
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Gao J, Liu X, Zuo Y, Li X. Risk factors of postpartum stress urinary incontinence in primiparas: What should we care. Medicine (Baltimore) 2021; 100:e25796. [PMID: 34011042 PMCID: PMC8137028 DOI: 10.1097/md.0000000000025796] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/14/2021] [Indexed: 01/05/2023] Open
Abstract
Stress urinary incontinence (SUI) is a common clinical postpartum complication. It is necessary to explore the risk factors of postpartum SUI in primiparas to provide evidence support for preventing and reducing the occurrence of SUI.Primiparas who were delivered in our hospital from March 2019 to October 2020 were identified, the personal information and related treatment details of SUI and no-SUI primiparas were collected and analyzed. Logistic regression analyses were conducted to identify the risk factors of postpartum SUI in primiparas.A total of 612 primiparas were included, the incidence of SUI in primiparas was 32.03%. There were significant differences in the body mass index (BMI) before pregnancy, diabetes, abortion, delivery method, newborn's weight, epidural anesthesia, and duration of second stage of labor (all P < .05) between SUI and no-SUI group, and there were no significant differences in the age, BMI at admission, hypertension and hyperlipidemia SUI and no-SUI group (all P > .05). Logistic regression analyses indicated that BMI before pregnancy ≥24 kg/m2 (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.042-4.394), diabetes (OR: 2.250, 95% CI: 1.891-3.544), abortion history (OR: 3.909, 95% CI: 1.187-5.739), vaginal delivery (OR: 2.262, 95% CI: 1.042-4.011), newborn's weight ≥3 kg (OR: 1.613, 95% CI: 1.095-2.316), epidural anesthesia (OR: 2.015, 95% CI: 1.226-3.372), and duration of second stage of labor ≥90 minutes (OR: 1.726, 95% CI: 1.084-2.147) were the risk factors of postpartum SUI in primiparas (all P < .05).The clinical incidence of SUI in primiparas is relatively high. In clinical practice, medical staff should conduct individualized early screening for those risk factors, and take prevention measures to reduce the occurrence of SUI.
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Zhong R, Zeng L, Wang X, Wang Y. A retrospective study of risk factors for stress urinary incontinence 1 year after delivery in multiparous women. Int Urogynecol J 2021; 33:2275-2281. [PMID: 33944979 DOI: 10.1007/s00192-021-04802-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/12/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is a common postpartum disorder. In this study, we aim to identify the risk factors for SUI in multiparous women 1 year after delivery. METHODS A retrospective cohort study was conducted in multiparous women who gave birth from January 2016 to March 2018 in Peking University Third Hospital. We interviewed all of the participants with the help of The International Consultation on Incontinence questionnaire short form (ICI-Q-SF) 1 year after delivery by telephone to identify symptoms of SUI. Univariate and multivariate analyses were applied to assess the potential risk factors of SUI. A decision tree was used to assess the prevalence of SUI in the different subgroups. RESULTS A total of 172 multiparous women were recruited. The prevalence of SUI was 30.2% (52/172) 1 year after delivery. In univariate analysis, maternal age ≥ 35 years, SUI after the first delivery, GDM and birth exclusively by vaginal delivery increased the risk for SUI 1 year after delivery. Multivariate analysis indicated that SUI after the first delivery (OR: 3.937, 95% CI: 1.764-8.787), gestational diabetes mellitus (GDM) (OR: 3.754, 95% CI: 1.599-8.810) and age ≥ 35 years (OR: 2.964, 95% CI: 1.208-7.274) were independent risk factors for SUI 1 year after delivery. A decision tree showed that participants who had SUI after the first delivery and patients with GDM were more likely to have SUI than patients without GDM (73.3% vs. 50%). CONCLUSIONS For multiparous women, SUI after the first delivery, GDM and age ≥ 35 years increase the risk of SUI 1 year after delivery.
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Affiliation(s)
- Ruoxin Zhong
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China.,National Center for Healthcare Quality Management in Obstetrics, Beijing, 100191, China.,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Lin Zeng
- Center for Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China
| | - Xiaoye Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China. .,National Center for Healthcare Quality Management in Obstetrics, Beijing, 100191, China. .,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
| | - Yan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China. .,National Center for Healthcare Quality Management in Obstetrics, Beijing, 100191, China. .,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
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Barca JA, Bravo C, Pintado-Recarte MP, Asúnsolo Á, Cueto-Hernández I, Ruiz-Labarta J, Buján J, Ortega MA, De León-Luis JA. Pelvic Floor Morbidity Following Vaginal Delivery versus Cesarean Delivery: Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10081652. [PMID: 33924472 PMCID: PMC8070303 DOI: 10.3390/jcm10081652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022] Open
Abstract
Objective: To compare pelvic floor disorders between vaginal delivery (VD) and cesarean delivery (CD). Methods: For this study, a PUBMED database search was used, utilizing a combination of relevant medical subjects’ headings (MeSH) terms, with the following keywords: “Pelvic floor disorders” or “Pelvic floor morbidity” and “Delivery”. Search limits were articles in English or Spanish, about women, published from December 2009 to December 2019. The STATA 16 package was used for meta-analysis and data heterogeneity assessment. Results: Thirteen studies meeting eligibility criteria were identified comprising 1,597,303 participants. Abstract: Pelvic floor morbidity prevalence was Urinary Incontinence (UI) 27.9% (5411 patients in 7 studies with reported cases), Pelvic Organ Prolapse (POP) 14.2% (6019 patients in 8 studies with reported cases), and Anal Incontinence (AI) 0.4% (1,589,740 patients in 5 studies with reported cases). Our meta-analyses revealed significantly higher rates of all three morbidities and overall morbidity in the VD versus CD group: UI OR = 2.17, 95% CI 1.64–2.87, p for heterogeneity ≤ 0.0001, I2 = 84%; POP OR = 3.28, 95% CI 1.91–5.63, p for heterogenicity ≤ 0.043, I2 = 63%; AI OR = 1.53, 95% CI 1.32–1.77; p for heterogeneity ≤ 0.291, I2 = 20%; and overall morbidity (OR = 2.17, 95% CI 1.64–2.87; p for heterogeneity ≤ 0.0001, I2 = 84%). Conclusion: Vaginal delivery is directly related to the appearance of pelvic floor disorders, mainly UI, POP, and AI. The risk of POP should be taken into higher consideration after vaginal delivery and postpartum follow-up should be performed, to identify and/or treat it at the earliest stages.
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Affiliation(s)
- Juan A. Barca
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.A.B.); (C.B.); (M.P.P.-R.); (I.C.-H.); (J.R.-L.); (J.A.D.L.-L.)
| | - Coral Bravo
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.A.B.); (C.B.); (M.P.P.-R.); (I.C.-H.); (J.R.-L.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Maria P. Pintado-Recarte
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.A.B.); (C.B.); (M.P.P.-R.); (I.C.-H.); (J.R.-L.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Ángel Asúnsolo
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain;
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
- Department of Epidemiology & Biostatistics, Graduate School of Public Health and Health Policy, University of New York, New York, NY 10027, USA
| | - Ignacio Cueto-Hernández
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.A.B.); (C.B.); (M.P.P.-R.); (I.C.-H.); (J.R.-L.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Javier Ruiz-Labarta
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.A.B.); (C.B.); (M.P.P.-R.); (I.C.-H.); (J.R.-L.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
| | - Julia Buján
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
| | - Miguel A. Ortega
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
- Correspondence: ; Tel.: +34-91-885-45-40; Fax: +34-91-885-48-85
| | - Juan A. De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (J.A.B.); (C.B.); (M.P.P.-R.); (I.C.-H.); (J.R.-L.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
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Witkoś J, Hartman-Petrycka M. Do future healthcare professionals have adequate knowledge about risk factors for stress urinary incontinence in women? BMC Womens Health 2020; 20:254. [PMID: 33198742 PMCID: PMC7670780 DOI: 10.1186/s12905-020-01124-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stress urinary incontinence worsens living conditions as far as the occupational, social, mental, physical and sexual aspects of a woman's life. Despite its real impact on the everyday lives of millions of women around the world, this problem is still disregarded and treated only as a discomfort associated with personal hygiene. Could this be due to negligence on the part of medical personnel in this matter and perhaps this lack of knowledge and proper information intended for women with stress urinary incontinence? Implementing educational activities to increase knowledge about urinary incontinence will translate into better educated women and earlier implementation of urinary incontinence treatment in the future. To properly educate women at risk of urinary incontinence, one needs to be familiar with the condition, in particular the risk factors for its development. The purpose of the study was to evaluate the degree of knowledge of students graduating from medical faculties have regarding risk factors for stress urinary incontinence in women and assess where the students' knowledge of this problem came from. METHODS The research involved 1581 final year students of medical faculties: nursing and midwifery (258), medicine (432), physiotherapy (402) and other medical (489). The author's survey was used for the research. The chi2 test was used for analysis. RESULTS Students in faculties of nursing and midwifery, general medicine, physiotherapy, and other medical faculties could correctly list stress urinary incontinence risk factors in 88.8%, 81.7%, 74.4% and 51.9% of their answers respectively (p < 0.01). The most frequently mentioned source of knowledge about stress urinary incontinence was higher level education in 82.6%, 89.8%, 90.0% and 34.4% of the respective groups' replies (p < 0.001). CONCLUSIONS Nursing and midwifery students had the greatest theoretical knowledge of stress urinary incontinence, and lesser knowledge was found among general medicine students, while physiotherapy students and students of other medical faculties had the least theoretical knowledge about risk factors for urinary incontinence. It is advisable that more emphasis be placed on educating students about stress urinary incontinence due to their insufficient knowledge, in particular for future doctors and physiotherapists who will have direct contact with patients.
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Affiliation(s)
- Joanna Witkoś
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, ul. G. Herlinga -Grudzińskiego 1, 30-705, Kraków, Poland.
| | - Magdalena Hartman-Petrycka
- Department of Basic Biomedical Science, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, The Medical University of Silesia, Katowice, Poland
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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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Wang K, Xu X, Jia G, Jiang H. Risk Factors for Postpartum Stress Urinary Incontinence: a Systematic Review and Meta-analysis. Reprod Sci 2020; 27:2129-2145. [PMID: 32638282 DOI: 10.1007/s43032-020-00254-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/05/2020] [Accepted: 06/30/2020] [Indexed: 12/20/2022]
Abstract
Stress urinary incontinence (SUI) is a distressing symptom affecting females globally and is one of the most common complications of delivery. The etiology of female SUI is multifactorial, and the trauma caused by delivery is one of the most important risk factors for SUI. We performed a meta-analysis to determine the relationship between these various factors and postpartum SUI. We searched PubMed, Embase, Web of Science, and the Cochrane Library until January 2019 using appropriate keywords and extracted 46 eligible studies that included 73,010 participants. The study protocol was registered with PROSPERO (No. CRD42020150094). The pooled results indicated that 12 risk factors, including vaginal delivery (OR 2.08, 95% CI 1.72-2.52), advanced age at gestation (OR 1.06, 95% CI 1.04-1.08), advanced maternal BMI (OR 1.04, 95% CI 1.03-1.06), excess weight gain during pregnancy (OR 1.13, 95% CI 1.00-1.26), advanced current BMI (OR 1.32, 95% CI 1.02-1.70), diabetes (OR 1.91, 95% CI 1.53-2.38), episiotomy (OR 1.76, 95% CI 1.06-2.94), forceps delivery (OR 2.69, 95% CI 1.25-5.76), gestational UI (OR 5.04, 95% CI 2.07-12.28), gestational SUI (OR 4.28, 95% CI 2.61-7.01), prenatal UI (OR 8.54, 95% CI 3.52-20.70), and early postpartum UI (OR 3.52, 95% CI 1.61-7.69), were associated with postpartum SUI. The findings of this analysis could serve to generate risk prediction models and provide a basis for developing treatment strategies for patients with postpartum SUI.
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Affiliation(s)
- Kai Wang
- Department of Urology, Sir Run Run Hospital Nanjing Medical University, Nanjing, 211100, Jiangsu Province, China
| | - Xianlin Xu
- Department of Urology, Sir Run Run Hospital Nanjing Medical University, Nanjing, 211100, Jiangsu Province, China
| | - Genmei Jia
- Department of Gynecology and Obstetrics, Women's Hospital of Nanjing Medical University Nanjing Maternity and Child Health Care Hospital Tianfei Alley, Mochou Road, Nanjing, 210004, Jiangsu Province, China
| | - Hua Jiang
- Department of Gynecology and Obstetrics, Women's Hospital of Nanjing Medical University Nanjing Maternity and Child Health Care Hospital Tianfei Alley, Mochou Road, Nanjing, 210004, Jiangsu Province, China.
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Artymuk NV, Khapacheva SY. Device-assisted pelvic floor muscle postpartum exercise programme for the management of pelvic floor dysfunction after delivery. J Matern Fetal Neonatal Med 2020; 35:481-485. [PMID: 32019378 DOI: 10.1080/14767058.2020.1723541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Pelvic floor dysfunction (PFD) is a multifactorial condition that clinically manifests as the pelvic prolapse, urinary and/or rectal incontinence, and sexual dysfunction.Aim: We aimed to evaluate the efficacy of two pelvic floor trainers for the prevention of PFD in women during the postpartum period.Materials and methods: This was a prospective, randomized, open-label study in 70 women in the postpartum period. Participants were randomized to complete a daily, 20-min set of pelvic floor muscle exercises using the EmbaGYN (UK; Group 1, n = 40) or the Magic Kegel Master device (China; Group 2, n = 40) for 4 weeks. All participants anonymously completed the PFDI-20 questionnaire and FSFI form at baseline and last visit. Pelvic floor muscle strength was measured using the XFT-0010 device.Results: After the completion of the 4-week pelvic floor muscle exercise program, there was a significant decrease in the rates of all PFD symptoms including pelvic organ prolapse and urinary and/or fecal incontinence in both groups. The rates of sexual dysfunction after the exercise program decreased significantly only in Group II (69.4 versus 25.0%; р =.001). After the program, Group I showed a significant reduction in the number of women with symptoms of urgent urinary incontinence versus baseline (35.3 versus 8.8% p = .009). Similarly, the rates of urine loss associated with coughing, sneezing or laughing in Group I decreased from 41.2% at baseline to 11.8% after the program (р =.006) and the rates of urine leakage independent of physical activity from 23.5 to 5.9% (p = .040), respectively.Conclusion: The 4-week postpartum pelvic floor muscle exercise program utilizing the EmbaGYN or Magic Kegel Master device has significantly increased the pelvic floor muscle strength and decreased the symptoms of pelvic organ prolapse, urinary and fecal incontinence. The use of the Magic Kegel Master device significantly reduced the symptoms of sexual dysfunction. The use of the EmbaGYN device was effective in addressing the individual symptoms of urinary incontinence.
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Qi X, Shan J, Peng L, Zhang C, Xu F. The effect of a comprehensive care and rehabilitation program on enhancing pelvic floor muscle functions and preventing postpartum stress urinary incontinence. Medicine (Baltimore) 2019; 98:e16907. [PMID: 31464923 PMCID: PMC6736454 DOI: 10.1097/md.0000000000016907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This study was to investigate the incidence and the risk factors of postpartum stress urinary incontinence (SUI), and the effect of comprehensive care and rehabilitation program (CCRP) on preventing postpartum SUI.In stage I, 479 puerperae were recruited within 1 week postpartum, then the postpartum SUI incidence at 8th week and its risk factors were investigated. In stage II, 240 vaginal delivery puerperae were enrolled within 1 week postpartum and randomly assigned to CCRP group or control group as 1:1 ratio. The postpartum SUI incidence and pelvic floor muscle function indexes were evaluated at 8th week.In stage I, the postpartum SUI incidence was 25.7%, and SUI puerperae presented with higher body mass index (BMI), vaginal delivery rate, newborn weight, and larger newborn head diameter compared with non-SUI puerperae. Besides, the vaginal delivery, the elevated age and BMI were independent risk factors for postpartum SUI. In stage II, the postpartum SUI incidence in CCRP group was decreased compared with control group, and the vaginal resting pressure, vaginal squeezing pressure, and vaginal contraction duration were increased in CCRP group compared to control group at 8th week postpartum.The incidence of postpartum SUI is 25.7%, and the vaginal delivery, increased age, and BMI are independent risk factors for postpartum SUI. More importantly, CCRP strengthens pelvic floor muscle functions and decreases postpartum SUI incidence in puerperae.
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Affiliation(s)
| | | | - Lei Peng
- Department of Emergency, Tongji Hospital, Tongji University School of Medicine
| | - Cuihong Zhang
- Department of Nursing, The Eighth people's Hospital of Shanghai
| | - Fanglei Xu
- Department of Nursing, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
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