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Tai H, Kalayeh K, Ashton-Miller JA, DeLancey JO, Brian Fowlkes J. Urethral tissue characterization using multiparametric ultrasound imaging. ULTRASONICS 2024; 145:107481. [PMID: 39348748 DOI: 10.1016/j.ultras.2024.107481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/30/2024] [Accepted: 09/25/2024] [Indexed: 10/02/2024]
Abstract
A decrease in urethral closure pressure is one of the primary causes of stress urinary incontinence in women. Atrophy of the urethral muscles is a primary factor in the 15 % age-related decline in urethral closure pressure per decade. Incontinence not only affects the well-being of women but is also a leading cause of nursing home admission. The objective of this research was to develop a noninvasive test to assess urethral tissue microenvironmental changes using multiparametric ultrasound (mpUS) imaging technique. Transperineal B-scan ultrasound (US) data were captured using clinical scanners equipped with curvilinear or linear transducers. Imaging was performed on volunteers from our institution medical center (n = 15, 22 to 76 y.o.) during Valsalva maneuvers. After expert delineation of the region of interest in each frame, the central axis of the urethra was automatically defined to determine the angle between the urethra and the US beam for further analysis. By integrating angle-dependent backscatter with radiomic texture feature analysis, a mpUS technique was developed to identify biomarkers that reflect subtle microstructural changes expected within the urethral tissue. The process was repeated when the urethra and US beam were at a fixed angle. Texture selection was conducted for both angle-dependent and angle-independent results to remove redundancies. Ultimately, a distinct biomarker was derived using a random forest regression model to compute the urethra score based on features selected from both processes. Angle-dependent backscatter analysis shows that the calculated slope of US mean image intensity decreased by 0.89 (±0.31) % annually, consistent with the expected atrophic disorganization of urethral tissue structure and the associated reduction in urethral closure pressure with age. Additionally, textural analysis performed at a specific angle (i.e., 40 degrees) revealed changes in gray level nonuniformity, skewness, and correlation by 0.08 (±0.04) %, -2.16 (±1.14) %, and -0.32 (±0.35) % per year, respectively. The urethra score was ultimately determined by combining data selected from both angle-dependent and angle-independent analysis strategies using a random forest regression model with age, yielding an R2 value of 0.96 and a p-value less than 0.001. The proposed mpUS tissue characterization technique not only holds promise for guiding future urethral tissue characterization studies without the need for tissue biopsies or invasive functional testing but also aims to minimize observer-induced variability. By leveraging mpUS imaging strategies that account for angle dependence, it provides more accurate assessments. Notably, the urethra score, calculated from US images that reflect tissue microstructural changes, serves as a potential biomarker providing clinicians with deeper insight into urethral tissue function and may aid in diagnosing and managing related conditions while helping to determine the causes of incontinence.
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Affiliation(s)
- Haowei Tai
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Kourosh Kalayeh
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - John O DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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Walgren LA, Wade C, Dessaulles M, Martin Ginis K, Locke J. A review of the role for pelvic floor physiotherapy in postmenopausal women with urinary incontinence. Post Reprod Health 2024:20533691241272830. [PMID: 39129175 DOI: 10.1177/20533691241272830] [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: 08/13/2024]
Abstract
Urinary incontinence is a prevalent condition affecting women. Pelvic floor physiotherapy is a specialized field of physiotherapy dedicated to assessing and treating pelvic floor muscles. This therapy has demonstrated benefits in addressing stress urinary incontinence in premenopausal women, with numerous studies supporting its efficacy in this population. However, pelvic floor physiotherapy in the treatment of postmenopausal women is less well-established, and furthermore, the types of urinary incontinence in postmenopausal women are much broader. We provide a comprehensive review of recent literature investigating the effectiveness of pelvic floor physiotherapy therapy for various conditions in postmenopausal women, including urinary incontinence, urgency urinary incontinence, pelvic organ prolapse, genitourinary syndrome of menopause, sexual dysfunction, and urinary incontinence in the context of obesity, frailty, mobility, and dementia. After evaluating the current literature, it is evident that there is insufficient data to definitively endorse or dismiss the utilization of Pelvic floor physiotherapy for treating urinary incontinence in postmenopausal women. Nevertheless, considering the low associated risks of pelvic floor physiotherapy, we advocate for the initiation of comprehensive, large-scale randomized studies aimed at evaluating its effectiveness in addressing urinary incontinence in postmenopausal women with special attention to vulnerable subgroups, including individuals who are obese, frail or experiencing cognitive impairment.
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Affiliation(s)
- Lauren A Walgren
- Department of Medicine, University of British Columbia Southern Medical Program, Kelowna, BC, Canada
- Division of Urology, Kelowna General Hospital, Kelowna, BC, Canada
| | | | | | | | - Jennifer Locke
- Department of Medicine, University of British Columbia Southern Medical Program, Kelowna, BC, Canada
- Division of Urology, Kelowna General Hospital, Kelowna, BC, Canada
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Afyouni AS, Wu YX, Balis UGJ, DeLancey J, Sadeghi Z. An Overview of the Effect of Aging on the Female Urethra. Urol Clin North Am 2024; 51:239-251. [PMID: 38609196 DOI: 10.1016/j.ucl.2024.02.001] [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] [Indexed: 04/14/2024]
Abstract
Urethral function declines by roughly 15% per decade and profoundly contributes to the pathogenesis of urinary incontinence. Individuals with poor urethral function are more likely to fail surgical management for stress incontinence that focus on improving urethral support. The reduced number of intramuscular nerves and the morphologic changes in muscle and connective tissue collectively impact urethral function as women age. Imaging technologies like MRI and ultrasound have advanced our understanding of these changes. However, substantial knowledge gaps remain. Addressing these gaps can be crucial for developing better prevention and treatment strategies, ultimately enhancing the quality of life for aging women.
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Affiliation(s)
- Andrew S Afyouni
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Yi Xi Wu
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Ulysses G J Balis
- Division of Pathology Informatics, Department of Pathology, University of Michigan Medical School, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA
| | - John DeLancey
- Department of Obstetrics and Gynecology, University of Michigan Medical School, L4208 UH South, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Zhina Sadeghi
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA.
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Ilunga-Mbaya E, Mukwege D, De Tayrac R, Mbunga B, Maroyi R, Ntakwinja M, Sengeyi MAD. Exploring risk factors of pelvic organ prolapse at eastern of Democratic Republic of Congo: a case-control study. BMC Womens Health 2024; 24:199. [PMID: 38532409 DOI: 10.1186/s12905-024-03010-5] [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: 09/03/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Pelvic organ prolapse is a common debilitating condition worldwide. Despite surgical treatment, its recurrence can reach up to 30%. It has multiple risk factors, some of which are particular for a low-resource settings. The identification these factors would help to devise risk models allowing the development of prevention policies. The objective of this study was to explore risk factors for pelvic organ prolapse in a population in eastern Democratic Republic of Congo (DRC). METHODS This was an unmatched case-control study conducted between January 2021 and January 2022. The sample size was estimated to be a total of 434 women (217 with prolapse as cases and 217 without prolapse as controls). Data comparisons were made using the Chi-Square and Student T tests. Binary and multivariate logistic regressions were used to determine associated factors. A p < 0.05 was considered significant. RESULTS Variables identified as definitive predictors of pelvic organ prolapse included low BMI (aOR 2.991; CI 1.419-6.307; p = 0.004), home birth (aOR 6.102; CI 3.526-10.561; p < 0.001), family history of POP (aOR 2.085; CI 1.107-3.924; p = 0.023), history of birth without an episiotomy (aOR 3.504; CI 2.031-6.048; p = 0), height ≤ 150 cm (aOR 5.328; CI 2.942-9.648; p < 0.001) and history of giving birth to a macrosomic baby (aOR 1.929; IC 1.121-3.321; p = 0.018). CONCLUSIONS This study identified that Body Mass Index and birth-related factors are definitive predictors of pelvic organ prolapse in a low-resource setting. These factors are potentially modifiable and should be targeted in any future pelvic organ prolapse prevention policy. Additionally, there seems to be a genetic predisposition for prolapse, which warrants further assessment in specifically designed large scale studies.
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Affiliation(s)
- Eloge Ilunga-Mbaya
- Faculty of Medicine, Department of Gynecology and Obstetrics, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Denis Mukwege
- Department of Gynecology and Obstetrics, Université Evangélique en Afrique, Panzi Hospital, Bukavu, Democratic Republic of Congo
| | - Renaud De Tayrac
- Department of Obstetrics and Gynecology, University of Montpellier, Nîmes University Hospital, Montpellier, France
| | - Branly Mbunga
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, Kinshasa, Democratic Republic of Congo
| | - Raha Maroyi
- Department of Gynecology and Obstetrics, Université Evangélique en Afrique, Panzi Hospital, Bukavu, Democratic Republic of Congo
| | - Mukanire Ntakwinja
- Department of Gynecology and Obstetrics, Université Evangélique en Afrique, Panzi Hospital, Bukavu, Democratic Republic of Congo
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DeLancey JOL, Masteling M, Pipitone F, LaCross J, Mastrovito S, Ashton-Miller JA. Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it? Am J Obstet Gynecol 2024; 230:279-294.e2. [PMID: 38168908 PMCID: PMC11177602 DOI: 10.1016/j.ajog.2023.11.1253] [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: 09/15/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
Pelvic floor disorders after childbirth have distressing lifelong consequences for women, requiring more than 300,000 women to have surgery annually. This represents approximately 10% of the 3 million women who give birth vaginally each year. Vaginal birth is the largest modifiable risk factor for prolapse, the pelvic floor disorder most strongly associated with birth, and is an important contributor to stress incontinence. These disorders require 10 times as many operations as anal sphincter injuries. Imaging shows that injuries of the levator ani muscle, perineal body, and membrane occur in up to 19% of primiparous women. During birth, the levator muscle and birth canal tissues must stretch to more than 3 times their original length; it is this overstretching that is responsible for the muscle tear visible on imaging rather than compression or neuropathy. The injury is present in 55% of women with prolapse later in life, with an odds ratio of 7.3, compared with women with normal support. In addition, levator damage can affect other aspects of hiatal closure, such as the perineal body and membrane. These injuries are associated with an enlarged urogenital hiatus, now known as antedate prolapse, and with prolapse surgery failure. Risk factors for levator injury are multifactorial and include forceps delivery, occiput posterior birth, older maternal age, long second stage of labor, and birthweight of >4000 g. Delivery with a vacuum device is associated with reduced levator damage. Other steps that might logically reduce injuries include manual rotation from occiput posterior to occiput anterior, slow gradual delivery, perineal massage or compresses, and early induction of labor, but these require study to document protection. In addition, teaching women to avoid pushing against a contracted levator muscle would likely decrease injury risk by decreasing tension on the vulnerable muscle origin. Providing care for women who have experienced difficult deliveries can be enhanced with early recognition, physical therapy, and attention to recovery. It is only right that women be made aware of these risks during pregnancy. Educating women on the long-term pelvic floor sequelae of childbirth should be performed antenatally so that they can be empowered to make informed decisions about management decisions during labor.
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Affiliation(s)
- John O L DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - Mariana Masteling
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI
| | - Fernanda Pipitone
- Faculty of Medicine, Hospital das Clinicas of the University of São Paulo, São Paulo, Brazil
| | - Jennifer LaCross
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Sara Mastrovito
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
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van Geelen H, Sand PK. The female urethra: urethral function throughout a woman's lifetime. Int Urogynecol J 2023; 34:1175-1186. [PMID: 36757487 DOI: 10.1007/s00192-023-05469-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/01/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this narrative review is to describe changes in urethral function that occur during a woman's lifetime. Evaluation of urethral function includes measurements of urethral closure pressure, at rest and during stress, leak point pressure, and the detailed study of anatomical and histological changes of the urethral sphincteric mechanism. METHODS A literature search in MEDLINE, PubMed, and relevant journals from 1960 until 2020 was performed for articles dealing with urethral function and the impact of aging, pregnancy, and childbirth, female hormones, and menopausal transition on the urethral sphincteric mechanism. Longitudinal and cross-sectional epidemiological surveys, studies on histological changes in urethral anatomy during aging, and urodynamic data obtained at different points in a woman's lifetime, during pregnancy, after childbirth, as well as the effects of female hormones on urethral sphincter function are reviewed. Relevant studies presenting objective data are analyzed and briefly summarized. RESULTS AND CONCLUSIONS The findings lead one to conclude that a constitutional or genetic predisposition, aging, and senescence are the most prominent etiological factors in the development of urinary incontinence and other pelvic floor disorders. Vaginal childbirth dilates and may damage the compressed pelvic supportive tissues and is invariably associated with a decline in urethral sphincter function. Pregnancy, hormonal alterations, menopausal transition, weight gain, and obesity are at best of secondary influence on the pathology of lower urinary tract dysfunction. The decline of circulating estrogens during menopausal transition may play a role in the transition of fibroblasts to cellular senescence.
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Tatschl JM, Schwerdtfeger AR. Squeeze the beat: Enhancing cardiac vagal activity during resonance breathing via coherent pelvic floor recruitment. Psychophysiology 2022; 59:e14129. [PMID: 35722933 PMCID: PMC9786605 DOI: 10.1111/psyp.14129] [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: 01/14/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 12/30/2022]
Abstract
Resonance breathing (RB) has been shown to benefit health and performance within clinical and non-clinical populations. This is attributed to its baroreflex stimulating effect and the concomitant increase in cardiac vagal activity (CVA). Hence, developing methods that strengthen the CVA boosting effect of RB could improve its clinical effectiveness. Therefore, we assessed whether supplementing RB with coherent pelvic floor activation (PRB), which has been shown to entrain the baroreflex, yields stronger CVA than standard RB. N = 32 participants performed 5-min of RB and PRB, which requires to recruit the pelvic floor during the complete inspiratory phase and release it at the initiation of the expiration. CVA was indexed via heart rate variability using RMSSD and LF-HRV. PRB induced significantly larger RMSSD (d = 1.04) and LF-HRV (d = 0.75, ps < .001) as compared to RB. Results indicate that PRB induced an additional boost in CVA relative to RB in healthy individuals. However, subsequent studies are warranted to evaluate whether these first findings can be replicated in individuals with compromised health, including a more comprehensive psychophysiological assessment to potentially elucidate the origin of the observed effects. Importantly, longitudinal studies need to address whether PRB translates to better treatment outcomes.
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Pipitone F, Sadeghi Z, DeLancey JO. Urethral function and failure: A review of current knowledge of urethral closure mechanisms, how they vary, and how they are affected by life events. Neurourol Urodyn 2021; 40:1869-1879. [PMID: 34488242 PMCID: PMC8556259 DOI: 10.1002/nau.24760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/15/2021] [Accepted: 07/18/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION A critical appraisal of the literature regarding female urethral function and dysfunction is needed in light of recent evidence showing the urethra's role in causing stress and urge urinary incontinence. METHODS An evidence assessment was conducted using selected articles from the literature that contained mechanistic data on factors affecting urethral function and failure. RESULTS Maximal urethral closure pressure (MUCP) is 40% lower in stress urinary incontinence (SUI) than normal controls. Evidence from five women shows relatively equal contributions to MUCP from striated/smooth muscle, vascular-plexus, connective tissue. MUCP varies twofold in individuals of similar age and declines 15% per decade even in nulliparous women. Age explains 57% of the variance in MUCP. This parallels with striated/smooth muscle loss and reduced nerve density. Factors influencing pressure variation minute-to-minute and decade-to-decade are poorly understood. Connective tissue changes have not been investigated. MUCP in de novo SUI persisting 9-months postpartum is 25% less than in age and parity-matched controls. Longitudinal studies do not show significant changes in urethral function after vaginal birth suggesting that changes in urethral support from birth may unmask pre-existing sphincter weakness and precipitate SUI. Mechanisms of interaction between support injury, pre-existing urethral weakness, and neuropathy are unclear. CONCLUSION Urethral failure is the predominant cause of SUI and a contributing factor for UUI; potentially explaining why mixed symptoms predominate in epidemiological studies. Age-related striated muscle loss and differences between women of similar age are prominent features of poor urethral closure. Yet, connective tissue changes, vasculature function, and complex interactions among factors are poorly understood.
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Affiliation(s)
- Fernanda Pipitone
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
- Hospital das Clínicas da FMUSP, University of São Paulo, São Paulo, Brazil
| | - Zhina Sadeghi
- Division of Neurourology and Pelvic Reconstructive Surgery, Department of Urology University of Michigan, Ann Arbor, MI
| | - John O.L. DeLancey
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI, USA
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Parker-Autry C, Kuchel GA. Urinary Incontinence in Older Women: A Syndrome-Based Approach to Addressing Late Life Heterogeneity. Obstet Gynecol Clin North Am 2021; 48:665-675. [PMID: 34416944 DOI: 10.1016/j.ogc.2021.05.017] [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: 11/28/2022]
Abstract
Urinary incontinence is a prevalent pelvic floor disorder among women of all ages. However, in many older women, especially those who have multiple chronic conditions it may be a geriatric syndrome because of its shared characteristics of physical function impairments, cognitive decline, and mobility disability. The geriatric incontinence syndrome may represent a poorly characterized phenotype of UI among older women which in many ways reflects unhealthy aging. In this article, we explore the evidence behind these concepts together with potentiel impact on the diagnosis and management of UI in this group.
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Affiliation(s)
- Candace Parker-Autry
- Department of Urology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27103, USA.
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA
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Brito LGO, Pereira GMV, Moalli P, Shynlova O, Manonai J, Weintraub AY, Deprest J, Bortolini MAT. Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis. Int Urogynecol J 2021; 33:15-29. [PMID: 34351465 DOI: 10.1007/s00192-021-04953-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/25/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Age is named as a risk factor for pelvic organ prolapse (POP), despite not being the primary outcome for many observational studies. Postmenopausal status is another associated factor but has many confounders. We aimed to systematically review the role of age and/or postmenopausal status in POP development. METHODS Systematic review addressing age and hormones, more specifically by postmenopausal status, from inception to March 2020 in four databases (PubMed, Embase, WOS, Cochrane Library). Quality of evidence was classified by the ROBINS-I classification for non-randomized studies. Experimental studies, animal studies, studies linking age with recurrent POP and case series were excluded. Effect estimates were collected from adjusted odds ratio plus 95% confidence intervals. Significance level was 5%. A discussion exploring mechanistic factors was also included. RESULTS Nineteen studies (11 cross sectional, 6 cohort and 2 case control) were included for quantitative analysis. Only two studies presented a low overall risk of bias for age; most of the domains were of moderate risk. Every additional year was responsible for a 10% increase in the risk to develop POP (OR = 1.102 [1.021-1.190]; i2 = 80%, random analysis, p = 0.012). This trend was confirmed when age was dichotomized into a cutoff of 35 (p = 0.035) and 50 (p < 0.001) years. Although an increase in the risk for POP was noted in postmenopausal women, this did not reach statistical significance (OR = 2.080 [0.927-4.668], i2 = 0%, p = 0.076). CONCLUSION Age is a risk factor for POP; postmenopausal status was not statistically associated with POP, prompting the need for further studies addressing this factor.
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Affiliation(s)
- Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101 - Cidade Universitária, Campinas, 13148-254, Brazil.
| | - Glaucia Miranda Varella Pereira
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101 - Cidade Universitária, Campinas, 13148-254, Brazil
| | - Pamela Moalli
- Division of Urogynecology & Pelvic Reconstructive Surgery, UPMC Magee-Womens Hospital, Pittsburgh, VA, USA
| | - Oksana Shynlova
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Jittima Manonai
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Bem-Gurion University of the Negev, Beer Sheva, Israel
| | - Jan Deprest
- Academic Department of Development and Regeneration, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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On Structure-Function Relationships in the Female Human Urethra: A Finite Element Model Approach. Ann Biomed Eng 2021; 49:1848-1860. [PMID: 33782810 DOI: 10.1007/s10439-021-02765-4] [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: 11/20/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
Remarkably little is known about urethral striated and smooth muscle and vascular plexus contributions to maintaining continence or initiating micturition. We therefore developed a 3-D, multiphysics, finite element model, based on sequential MR images from a 23-year-old nulliparous heathy woman, to examine the effect of contracting one or more individual muscle layers on the urethral closure pressure (UCP). The lofted urethra turned out to be both curved and asymmetric. The model results led us to reject the current hypothesis that the striated and smooth muscles contribute equally to UCP. While a simulated contraction of the outer (circular) striated muscle increased closure pressure, a similar contraction of the large inner longitudinal smooth muscle both reduced closure pressure and shortened urethral length, suggesting a role in initiating micturition. When age-related atrophy of the posterior striated muscle was simulated, a reduced and asymmetric UCP distribution developed in the transverse plane. Lastly, a simple 2D axisymmetric model of the vascular plexus and lumen suggests arteriovenous pressure plays and important role in helping to maintain luminal closure in the proximal urethra and thereby functional urethral length. More work is needed to examine interindividual differences and validate such models in vivo.
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12
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Ostrzenski A. Anatomy of the bulbus vestibuli: A cadaveric study. Ann Anat 2020; 233:151588. [PMID: 32889108 DOI: 10.1016/j.aanat.2020.151588] [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: 05/01/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To describe the BV anatomy in detail, to compare previous BV descriptions and illustrations to the current study's findings and photograms, to show the BV topographic relation of the BV to the urethral meatus, to document the BV anatomy using photograms. METHODS Ten fresh human female adult cadavers were used. Stratum-by-stratum anatomical dissections in sagittal, transverse, and coronal planes were performed. The BV was dissected-off from the original location of the posterior-distal vaginal wall and the anterior anal wall. RESULTS The BV was located within the posterior-distal vagina and composed of two vertical legs, which fused to one another. The inferior pars intermedia fused both descending legs to the anterior-proximal perineal urethral wall, and BV embraced the anterior-proximal urethra. The superior pars intermedia connects the BV to the posterior-distal clitoral body. The BV legs traversed parallel to and aside from the vaginal introitus and the lateral urethra and not crossing the anterior-distal urethra. The tile-end was a tapered end which terminates in the vicinity of Bartholin glands. Laterally, the BV legs outspread to the medial labia minora and attach to the ischiopubic ramus. The anatomical site-specific defect (s) occurs within the BV. CONCLUSIONS The present study resolves the BV anatomical controversy and shows that the BV runs parallel to and aside from the anterior-distal urethra and the BV. The site-specific defect(s) can occur within the BV. This study provides important information for anatomy educators and surgeons.
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Affiliation(s)
- Adam Ostrzenski
- Institute of Gynecology, Inc., 7001 Central Ave, St. Petersburg, FL 33710, USA.
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13
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Saltiel F, Miranda-Gazzola APG, Vitória RO, Sampaio RF, Figueiredo EM. Linking Pelvic Floor Muscle Function Terminology to the International Classification of Functioning, Disability and Health. Phys Ther 2020; 100:1659-1680. [PMID: 32201881 DOI: 10.1093/ptj/pzaa044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 02/11/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE A previous systematic review on pelvic floor muscle function (PFMF) identified a miscellaneity of terms. The lack of consensual terminology might have come from the complexity of neuromusculoskeletal function itself. This study sought to link the previously identified PFMF terms to the International Classification of Functioning, Disability and Health (ICF) terminology. METHODS In this secondary analysis study, 10 linkage rules were applied to link 196 previously identified PFMF terms to the ICF. Two researchers performed the linking process independently. Disagreements were solved by open dialogue with a third researcher. Percentage agreement was computed for main outcome. RESULTS A total of 184 (93.9%) PFMF terms were subsumed into the following 6 ICF terms: tone, involuntary movement reaction, control, coordination, strength, and endurance. The most frequently investigated PFMF was strength (25.5%), followed by involuntary movement reaction (22.9%), endurance (17.2%), control (14.1%), coordination (9.9%), and tone (4.2%). Only 6.2% PFMF could not be linked to ICF terminology. A wide variation of instruments/methods was used to measure PFMF. Vaginal palpation was the only method employed to measure all 6 PFMF. Percentage agreement between raters was 100%. CONCLUSIONS Linking PFMF terminology to the ICF was feasible and valid. It allowed the identification of the most investigated PFMF and their measuring methods. ICF terminology to describe PFMF should be used since it may improve communication, data gathering, and the advance in scientific knowledge. IMPACT Standardized terminology anchored in a theoretical framework is crucial to data gathering, communication, and dissemination of evidence-based practice. PFMF terminology based on ICF can be used to improve data pooling and communication.
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Gödl-Purrer B. Der Beckenboden im Alter. MANUELLE MEDIZIN 2020. [DOI: 10.1007/s00337-020-00702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Association of pubovisceral muscle tear with functional capacity of urethral closure: evaluating maternal recovery from labor and delivery. Am J Obstet Gynecol 2020; 222:598.e1-598.e7. [PMID: 31765643 DOI: 10.1016/j.ajog.2019.11.1257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/04/2019] [Accepted: 11/17/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vaginal birth is a risk factor for pubovisceral muscle tear, decreased urethral closure pressure, and urinary incontinence. The relationship between these 3 factors is complicated. Urinary continence relies on maintaining urethral closure pressure, particularly when low urethral closure pressure can usefully be augmented by a volitional pelvic muscle (Kegel) contraction just before and during stress events like a cough. However, it is unknown whether a torn pubovisceral muscle decreases the ability to increase urethral closure during an attempted pelvic muscle contraction. OBJECTIVE We tested the null hypothesis that a pubovisceral muscle tear does not affect the ability to increase urethral closure pressure during a volitional pelvic muscle contraction in the Evaluating Maternal Recovery from Labor and Delivery (EMRLD) study. STUDY DESIGN We studied 56 women 8 months after their first vaginal birth. All had at least 1 risk factor for pubovisceral muscle tear (eg, forceps and long second stage). A tear was assessed bilaterally by magnetic resonance imaging. Urethral closure pressure was measured both at rest and during an attempted volitional pelvic muscle contraction. A Student t test was used to compare urethral closure pressures. Multiple linear regression was used to estimate the effect of a magnetic resonance imaging-confirmed pubovisceral muscle tear on volitionally contracted urethral closure pressure after adjusting for resting urethral closure pressure. RESULTS The mean age was just a little more than 30 years, with the majority being white. By magnetic resonance imaging measure, unadjusted for other factors, the 21 women with tear had significantly lower urethral closure pressure during an attempted contraction compared with the 35 women without tear (65.9 vs 86.8 cm H2O, respectively, P = .004), leading us to reject the null hypothesis. No significant group difference was found in resting urethral closure pressure. After adjusting for resting urethral closure pressure, pubovisceral muscle tear was associated with lower urethral closure pressure (beta = -21.1, P = .001). CONCLUSION In the first postpartum year, the presence of a pubovisceral muscle tear did not influence resting urethral closure. However, women with a pubovisceral muscle tear achieved a 25% lower urethral closure pressure during an attempted pelvic muscle contraction than those without a pubovisceral muscle tear. These women with pubovisceral muscle tear may not respond to classic behavioral interventions, such as squeeze when you sneeze or strengthen through repetitive pelvic muscle exercises. When a rapid rise to maximum urethral pressure is used as a conscious volitional maneuver, it appears to be reliant on the ability to recruit the intact pubovisceral muscle to simultaneously contract the urethral striated muscle.
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Pelvic Floor Muscle Training for Older Women with Urinary Incontinence. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00316-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Corona-Quintanilla DL, López-Juárez R, Pacheco P, Romero-Ortega MI, Castelán F, Martínez-Gómez M. Bladder and urethral dysfunction in multiparous and mature rabbits correlates with abnormal activity of pubococcygeus and bulbospongiosus muscles. Neurourol Urodyn 2020; 39:116-124. [PMID: 31578766 PMCID: PMC9271261 DOI: 10.1002/nau.24176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/16/2019] [Indexed: 11/11/2023]
Abstract
AIMS To evaluate the combined effect of age and multiparity on the micturition reflex, including pelvic floor muscle activation. METHODS Young and mature nulliparous rabbits were compared to young and mature multiparas (n = 6 per group). Cystometrograms and urethral pressure (UP) were performed while simultaneously recording the electromyogram (EMG) activity of the pubococcygeus and bulbospongiosus muscles to establish their functional correlation to urological function. RESULTS Multiparity and age significantly influence the bladder and UP affecting the voiding efficiency and intercontraction interval. Such interaction also reduced the UP threshold, timing, and duration. Other bladder and urethral variables were predominantly affected only by age. Urodynamic alterations correlated with abnormal patterns or absent EMG activity of the pubococcygeus and bulbospongiosus muscles. CONCLUSIONS The present findings strongly suggest that multiparity and age affects specific pelvic floor muscle reflex activation during micturition, and may contribute to alterations in bladder and urethral function. This data broadens our understanding of the critical role of the appropriate activity of the individual pelvic floor muscles in micturition.
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Affiliation(s)
| | - Rhode López-Juárez
- Doctorado en Ciencias Biológicas, Universidad Autónoma de Tlaxcala, Tlaxcala, México
| | - Pablo Pacheco
- Instituto de Investigaciones Biomédicas, Departamento de Biología Celular y Fisiología, Universidad Nacional Autónoma de México, Ciudad de México, México
- Instituto de Neuroetología, Universidad Veracruzana, Xalapa, Veracruz, México
| | | | - Francisco Castelán
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, México
- Instituto de Investigaciones Biomédicas, Departamento de Biología Celular y Fisiología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Margarita Martínez-Gómez
- Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala, México
- Instituto de Investigaciones Biomédicas, Departamento de Biología Celular y Fisiología, Universidad Nacional Autónoma de México, Ciudad de México, México
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Swenson CW, Masteling M, DeLancey JO, Nandikanti L, Schmidt P, Chen L. Aging effects on pelvic floor support: a pilot study comparing young versus older nulliparous women. Int Urogynecol J 2019; 31:535-543. [PMID: 31388719 DOI: 10.1007/s00192-019-04063-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/16/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We sought to determine age-related changes to the pelvic floor in the absence of childbirth effects. METHODS A case-control study was conducted from June 2017 to August 2018 comparing two groups of nulliparous women: <40 years old and ≥ 70 years old. Clinical evaluation included POP-Q, instrumented speculum testing, and handgrip strength. Dynamic 3D-stress MRI was performed on all women to obtain genital and levator hiatus (LH) lengths, LH area, and levator bowl volume. LH shape was quantified using a novel measure called the "V-U index." Pubovisceral muscle (PVM) cross-sectional area (CSA) was also measured. Bivariate comparisons between the two groups were made for all variables. Effect sizes were calculated for MRI measurements. RESULTS Twelve young and 9 older nulliparous women were included. Levator bowl volume at rest was 83% larger in older women (108.0 ± 34.5 cm3 vs 59.2 ± 19.3 cm3, p = 0.001, d = 1.82). MRI genital hiatus at rest was larger among the older group (2.7 ± 0.6 cm vs 3.5 ± 0.6 cm, p = 0.007, d = 1.34). V-U index, a measure of LH shape where 0 = "V" and 1 = "U," differed between groups indicating a more "U"-like shape among older women (0.71 ± 0.23 vs 0.35 ± 0.18, p = 0.001, d = 1.72). Handgrip strength was lower in the older vs young group (23.2 ± 5.2 N vs 33.4 ± 5.2 N, p < 0.0001); however, the Kegel augmentation force and PVM CSA were similar (3.2 ± 1.1 N vs 3.3 ± 2.2 N, p = 0.89, and 0.8 ± 0.3 cm2 vs 0.7 ± 0.2 cm2, p = 0.23 respectively). CONCLUSIONS Levator bowl volume at rest was over 80% larger among older women, reflecting a generalized posterior distension with age.
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Affiliation(s)
- Carolyn W Swenson
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Mariana Masteling
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - John O DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | | | - Payton Schmidt
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Luyun Chen
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Kriete AS, Prudnikova K, Marcolongo MS. Modulating physical properties of porcine urethra with injection of novel biomimetic proteoglycans ex vivo. Interface Focus 2019; 9:20190013. [PMID: 31263533 DOI: 10.1098/rsfs.2019.0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 12/18/2022] Open
Abstract
Urinary incontinence is a significant challenge for women who are affected by it. We propose augmenting the tissue structure to restore normal biomechanics by molecularly engineering the tissue using a novel family of biomimetic proteoglycans (BPGs). This work examines the ability of BPGs to modulate the mechanical and physical properties of porcine urethras ex vivo to determine the feasibility of BPGs to be implemented as molecular treatment for stress urinary incontinence (SUI). We investigated compliance by performing a unique radial expansion testing method using urethras from six- to nine-month-old pigs. The urethras were injected with 0.5 ml BPG solution at three sites every approximately 120° (conc.: 25 mg ml-1, 50 mg ml-1 and 75 mg ml-1 in 1× phosphate-buffered saline (PBS); n = 4 per group) and compared them with PBS-injected controls. Young's modulus was calculated by treating the urethra as a thin-walled pressure vessel. A water uptake study was performed by soaking 10 mm urethra biopsy samples that were injected with 0.1 ml BPG solution (conc.: 50 mg ml-1, 100 mg ml-1 and 200 mg ml-1 in 1× PBS; n = 6 per group) in 5 ml PBS for 24 h. Although there was no significant difference in Young's modulus data, there were differences between groups as can be seen in the raw radial expansion testing data. Results showed that BPGs have the potential to increase hydration in samples, and that there was a significant difference in water uptake between BPG-injected samples and the controls (100 mg ml-1 samples versus PBS samples, p < 0.05). This work shows that BPGs have the potential to be implemented as a molecular treatment for SUI, by restoring the diminished proteoglycan content and subsequently increasing hydration and improving the compliance of urethral tissue.
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Affiliation(s)
- Alicia S Kriete
- Materials Science and Engineering, Drexel University, Philadelphia, PA, USA
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Dietz HP, Socha M, Atan IK, Subramaniam N. Does estrogen deprivation affect pelvic floor muscle contractility? Int Urogynecol J 2019; 31:191-196. [DOI: 10.1007/s00192-019-03909-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/11/2019] [Indexed: 01/04/2023]
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Kriete AS, Ginzburg N, Shah N, Huneke RB, Reimold E, Prudnikova K, Montgomery O, Hou JS, Phillips ER, Marcolongo MS. In vivo
molecular engineering of the urethra for treatment of stress incontinence using novel biomimetic proteoglycans. J Biomed Mater Res B Appl Biomater 2019; 107:2409-2418. [DOI: 10.1002/jbm.b.34334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/26/2018] [Accepted: 01/13/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Alicia S. Kriete
- Materials Science and EngineeringDrexel University Philadelphia Pennsylvania 19104
| | - Natasha Ginzburg
- College of MedicineDrexel University Philadelphia Pennsylvania 19129
| | - Nima Shah
- College of MedicineDrexel University Philadelphia Pennsylvania 19129
| | - Richard B. Huneke
- College of MedicineDrexel University Philadelphia Pennsylvania 19129
| | - Emily Reimold
- College of MedicineDrexel University Philadelphia Pennsylvania 19129
| | | | - Owen Montgomery
- College of MedicineDrexel University Philadelphia Pennsylvania 19129
| | - J. Steve Hou
- College of MedicineDrexel University Philadelphia Pennsylvania 19129
| | - Evan R. Phillips
- Materials Science and EngineeringDrexel University Philadelphia Pennsylvania 19104
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Abstract
Female pelvic floor muscles form a diaphragm that spans the entire pelvic cavity. They consist of the fibers of the coccygeus and the levator ani muscles, the latter of which is composed of five parts. Together with their fascia, the pelvic floor muscles provide support for the urethra, the vagina, and the rectum and constrict the urethral, vaginal, and anal orifices. Alterations in the composition of the pelvic floor muscles at menopause appear to affect their properties and, thereby, their ability to function adequately. This can lead to an increased prevalence in urinary incontinence and other lower urinary tract dysfunction, pelvic organ prolapse, and genitourinary syndrome of menopause. This article aims to define the pelvic floor muscles and functions and to summarize the direct and indirect changes to women's pelvic floor muscles during and after menopause and through aging. A particular focus is also given to the evidence-based literature on how to keep pelvic floor muscles healthy during menopause and in postmenopause using conservative management therapy.
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Affiliation(s)
- C Dumoulin
- a School of Rehabilitation, Faculty of Medicine , University of Montreal, Research Centre of the Institut Universitaire de Gériatrie de Montréal , Montreal , QC, Canada
| | - L Pazzoto Cacciari
- a School of Rehabilitation, Faculty of Medicine , University of Montreal, Research Centre of the Institut Universitaire de Gériatrie de Montréal , Montreal , QC, Canada
| | - J Mercier
- a School of Rehabilitation, Faculty of Medicine , University of Montreal, Research Centre of the Institut Universitaire de Gériatrie de Montréal , Montreal , QC, Canada
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Sergeant GP, Hollywood MA, Thornbury KD. Spontaneous Activity in Urethral Smooth Muscle. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1124:149-167. [DOI: 10.1007/978-981-13-5895-1_6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Myer EN, Roem JL, Lovejoy DA, Abernethy MG, Blomquist JL, Handa VL. Longitudinal changes in pelvic floor muscle strength among parous women. Am J Obstet Gynecol 2018; 219:482.e1-482.e7. [PMID: 29902445 DOI: 10.1016/j.ajog.2018.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND There is limited knowledge of the effects of time on change in pelvic floor muscle strength after childbirth. OBJECTIVE The objectives of this study were to estimate the change in pelvic floor muscle strength in parous women over time and to identify maternal and obstetric characteristics associated with the rate of change. STUDY DESIGN This is an institutional review board-approved prospective cohort study of parous women. Participants were recruited 5-10 years after first delivery and followed annually. Pelvic floor muscle strength (peak pressure with voluntary contraction) was measured at 2 annual visits approximately 4 years apart with the use of a perineometer. We calculated the change in peak pressures, which were standardized per 5-year interval. Linear regression was used to identify maternal and obstetric characteristics that are associated with the rate of change in peak pressure. The obstetric variable of greatest interest was delivery group. Participants were classified into 3 delivery groups (considering all deliveries for each multiparous woman). Delivery categories included cesarean only, at least 1 vaginal birth but no forceps-assisted deliveries, and at least 1 forceps-assisted vaginal birth. Statistical analysis was completed with statistical software. RESULTS Five hundred forty-three participants completed 2 perineometer measurements with a median 4 years between measures (interquartile range, 3.1-4.8). At initial measurement, women were, on average, 40 years old and 8 years from first delivery. Initial strength was higher in participants who delivered all their children by cesarean (38.5 cm H2O) as compared with women with any vaginal non-forceps delivery (26.0 cm H2O) or vaginal forceps delivery (13.5 cm H2O; P<.001). There was a strong correlation between the first and second perineometry measurement (r=0.84). Median change in pelvic floor muscle strength was small at 1.2 cm H2O per 5 years (interquartile range, -5.6, 9.9 cm H2O). In multivariable analysis, women who delivered by cesarean only demonstrated almost no change in strength over 5 years (0.2 increase cm H2O per 5 years); those who experienced at least 1 vaginal or vacuum delivery increased strength (4.8 cm H2O per 5 years) as did women with at least 1 forceps delivery (5.0 cm H2O per 5 years). Additionally, obese women had a significant reduction in strength (-3.1 cm H2O per 5 years) compared with normal weight participants (0.2 cm H2O per 5 years). CONCLUSION Among parous women, pelvic muscle strength increased minimally over time with an average change of 1.2 cm H2O per 5 years; change in strength was associated with mode of delivery and obesity.
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Saltiel F, Miranda-Gazzola APG, Vitória RO, Figueiredo EM. Terminology of Pelvic Floor Muscle Function in Women With and Without Urinary Incontinence: A Systematic Review. Phys Ther 2018; 98:876-890. [PMID: 30010919 DOI: 10.1093/ptj/pzy084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/08/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pelvic floor muscle function (PFMF) is a target of the physical therapist intervention for women with urinary incontinence (UI). However, possible variations in PFMF terminology might hamper communication among researchers and health care professionals in Women's Health. OBJECTIVE The objective of this study was to investigate the terminology of PFMF regarding clear terms, conceptual definitions, and operational definitions. DATA SOURCES Data sources include PUBMED, CINAHL, LILACS, and SCIELO. STUDY SELECTION Observational studies investigating any PFMF in women with or without UI, published in English, Spanish, or Portuguese from 2005 through 2017, were considered. DATA EXTRACTION The risk of bias was assessed by a questionnaire on the quality of observational studies. Data on terminology were extracted as terms, conceptual definitions, and operational definitions of PFMF and were synthesized according to key words, key ideas, and key operationalization, respectively. Consistencies and variations were identified for the most frequently investigated PFMF. DATA SYNTHESIS Sixty-four studies were included, and a low risk of bias was identified. All studies presented terms and operational definitions of PFMF, but only 29.7% presented conceptual definitions of those terms. One hundred ninety-six different terms referred to PFMF. According to similarities in terminology, 161 PFMF terms could be grouped under 26 terms; the other 35 were left ungrouped. Therefore, a total of 61 different PFMF terms were identified in the literature. LIMITATIONS A limitation in the study was that only observational studies were included. CONCLUSIONS A large variation in PFMF terminology was identified, precluding data gathering and meta-analysis. The lack of use of standardized terminology delays the progress of scientific knowledge and evidence-based practice dissemination. Efforts toward creating a collaborative, consensual terminology based on a sound framework are necessary.
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Affiliation(s)
- Fernanda Saltiel
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Women's Health Specialist, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Elyonara M Figueiredo
- Physical Therapy Department, Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Av. Antonio Carolos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901 Brazil
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Sartori DVB, Gameiro MO, Kawano PR, Yamamoto HA, Guerra R, Domingues MAC, Leitão VASS, Amaro JL. Impact of vulvovaginal atrophy on pelvic floor muscle strength in healthy continent women. Int J Urol 2018; 26:57-61. [DOI: 10.1111/iju.13788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 07/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Dulcegleika VB Sartori
- Department of Urology; Medical School of Botucatu; Sao Paulo State University; Botucatu Sao Paulo Brazil
| | - Monica O Gameiro
- Department of Urology; Medical School of Botucatu; Sao Paulo State University; Botucatu Sao Paulo Brazil
| | - Paulo R Kawano
- Department of Urology; Medical School of Botucatu; Sao Paulo State University; Botucatu Sao Paulo Brazil
| | - Hamilto A Yamamoto
- Department of Urology; Medical School of Botucatu; Sao Paulo State University; Botucatu Sao Paulo Brazil
| | - Rodrigo Guerra
- Department of Urology; Medical School of Botucatu; Sao Paulo State University; Botucatu Sao Paulo Brazil
| | - Maria AC Domingues
- Department of Urology; Medical School of Botucatu; Sao Paulo State University; Botucatu Sao Paulo Brazil
| | - Victor ASS Leitão
- Department of Urology; Medical School of Botucatu; Sao Paulo State University; Botucatu Sao Paulo Brazil
| | - João L Amaro
- Department of Urology; Medical School of Botucatu; Sao Paulo State University; Botucatu Sao Paulo Brazil
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Robinson D, Thiagamoorthy G, Ford A, Araklitis G, Giarenis I, Cardozo L. Does assessing urethral function allow the selection of the optimal therapy for recurrent SUI? Report from the ICI-RS 2017. Neurourol Urodyn 2018; 37:S69-S74. [PMID: 30133793 DOI: 10.1002/nau.23588] [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] [Received: 12/14/2017] [Accepted: 03/21/2018] [Indexed: 12/28/2022]
Abstract
AIMS The management of recurrent stress urinary incontinence following failed previous continence surgery remains challenging. Whilst the role of urodynamic investigations has been questioned in the management of primary stress incontinence there is a widely held view that women with recurrent symptoms require further investigation although there is no agreement regarding which tests are required. We sought to understand what testing is recommended prior to managing this difficult cohort of patients. METHOD This research proposal was presented at the International Consultation on Incontinence Research Society (ICI-RS) in order to clarify our current knowledge regarding the assessment of urethral function and to set research priorities for the future. RESULTS Whilst the majority of clinicians would advocate urodynamic evaluation of women with recurrent stress incontinence following previous surgery there is no consensus of opinion as to which tests should be performed, on whom or where. The available evidence to date suggests that urethral function tests do have a role with regard to prognosis following surgery and also in planning the most appropriate surgical intervention. CONCLUSION The ICI-RS developed a list of research questions which may be able to assist in improving the investigation and management of women with recurrent SUI. Questions included whether patients felt the information gained via urethral function tests had an important role in their counseling regarding outcome of repeat SUI surgery.
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Affiliation(s)
- Dudley Robinson
- Consultant Urogynaecologist, Department of Urogynaecology,, Kings College Hospital, London, UK
| | | | - Abigail Ford
- Urogynaecology Research Fellow, St Mary's Hospital, Paddington, London, UK
| | - George Araklitis
- Urogynaecology Research Fellow, Kings College Hospital, London, UK
| | - Ilias Giarenis
- Consultant Urogynaecologist, Norfolk And Norwich Hospital, Norwich, UK
| | - Linda Cardozo
- Professor of Urogynaecology, Kings College Hospital, London, UK
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Masteling M, Ashton-Miller JA, DeLancey JOL. Technique development and measurement of cross-sectional area of the pubovisceral muscle on MRI scans of living women. Int Urogynecol J 2018; 30:1305-1312. [PMID: 29974138 DOI: 10.1007/s00192-018-3704-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/18/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Measurements of the anatomic cross-sectional area (CSA) of the pubovisceral muscle (PVM) in women are confounded by the difficulty of separating the muscle from the adjacent puborectal (PRM) and iliococcygeal (ICM) muscles when visualized in a plane orthogonal to the fiber direction. We tested the hypothesis that it might be possible to measure the PVM CSA within a defined region of interest based on magnetic resonance images (MRI). METHODS MRI scans of 11 women with unilateral PVM tears and seven primiparous women with intact muscles following elective C-section were used to identify the PVM injury zone defined by the mean location of its boundaries with the adjacent intact PRM and ICM from existing anatomic reference points using 3D Slicer and ImageJ software. Then, from the 15 or more 2-mm transverse slices available, the slice with the maximum anatomic CSA of the left and right PVM was found in 24 primiparous women with bilaterally intact muscles who had delivered via C-section. RESULTS Mean [± standard deviation (SD)] of the maximum left or right PVM cross-section areas for the 24 women, measured by two different raters, was 1.25 ± 0.29 cm2 (range 0.75-1.86). The 5th, 50th, and 95th percentile values were 0.77, 1.23, and 1.80 cm2, respectively. Inter- and intrarater measurement repeatability intraclass correlation coefficients exceeded 0.89 and 0.90, respectively. CONCLUSIONS It is possible to use MRI to identify the volume of interest with the maximum anatomic cross section of the PVM belly while minimizing the inadvertent inclusion of adjacent PRM or ICM in that measurement.
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Affiliation(s)
- Mariana Masteling
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St, Ann Arbor, MI, 48109, USA.
| | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St, Ann Arbor, MI, 48109, USA
| | - John O L DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48109, USA
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Bocardi DAS, Pereira-Baldon VS, Ferreira CHJ, Avila MA, Beleza ACS, Driusso P. Pelvic floor muscle function and EMG in nulliparous women of different ages: a cross-sectional study. Climacteric 2018; 21:462-466. [DOI: 10.1080/13697137.2018.1453493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- D. A. S. Bocardi
- Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - V. S. Pereira-Baldon
- Faculty of Physical Education and Physiotherapy, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - C. H. J. Ferreira
- Physical Therapy Department, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - M. A. Avila
- Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
- Post-Graduate Program on Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - A. C. S. Beleza
- Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - P. Driusso
- Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
- Post-Graduate Program on Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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Bernard S, Moffet H, Plante M, Ouellet MP, Leblond J, Dumoulin C. Pelvic-Floor Properties in Women Reporting Urinary Incontinence After Surgery and Radiotherapy for Endometrial Cancer. Phys Ther 2017; 97:438-448. [PMID: 28201796 DOI: 10.1093/ptj/pzx012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Endometrial cancer is the fourth most prevalent cancer in Canadian women. Radiotherapy (RT) is frequently recommended as an adjuvant treatment. There is a high prevalence (>80%) of urinary incontinence (UI) after RT. It is plausible that UI is associated, at least in part, with alterations of the pelvic-floor muscles (PFM). OBJECTIVE The aim of this exploratory study was to compare the PFM functional properties of women reporting UI after hysterectomy and RT for endometrial cancer with those of women with a history of hysterectomy but without UI. DESIGN A descriptive cross-sectional study was conducted. Eleven women were recruited for the affected group, and 18 were recruited for the comparison group. METHODS Urogenital and bowel functions were assessed using International Consultation on Incontinence Questionnaires, and PFM properties were evaluated using a Montreal dynamometer. Nonparametric tests were used for comparison of personal characteristics, functional status, and muscle properties. A correspondence analysis detailed the association between UI severity and PFM properties. RESULTS Maximal opening of dynamometer branches, maximal vaginal length, PFM maximum force and rate of force development in a strength test, and number of rapid contractions during a speed test were reduced in the affected group. No significant difference was found for the endurance test. The severity of UI was found to correspond to the rate of force development and the number of rapid contractions in a speed test, endurance, age, and vaginal length. LIMITATIONS The results are limited to the population studied. The small sample size limited the strength of the conclusions. CONCLUSIONS Some evidence of alterations in PFM properties were found in women with UI after hysterectomy and RT for endometrial cancer. These alterations appeared to be associated with UI, suggesting a possible role for rehabilitation.
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Increasing Age Is a Risk Factor for Decreased Postpartum Pelvic Floor Strength. Female Pelvic Med Reconstr Surg 2017; 23:136-140. [PMID: 28067746 DOI: 10.1097/spv.0000000000000376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to determine factors associated with decreased pelvic floor strength (PFS) after the first vaginal delivery (VD) in a cohort of low-risk women. METHODS This is a secondary analysis of a prospective study examining the risk of pelvic floor injury in a cohort of primiparous women. All recruited participants underwent an examination, three-dimensional ultrasound and measurement of PFS in the third trimester and repeated at 4 weeks to 6 months postpartum using a perineometer. RESULTS There were 84 women recruited for the study, and 70 completed the postpartum assessment. Average age was 28.4 years (standard deviation, 4.8). There were 46 (66%) subjects with a VD and 24 (34%) with a cesarean delivery who labored. Decreased PFS was observed more frequently in the VD group compared with the cesarean delivery group (68% vs 42%, P = 0.03).In modified Poisson regression models controlling for mode of delivery and time of postpartum assessment, women who were aged 25 to 29 years (risk ratio = 2.80, 95% confidence interval, 1.03-7.57) and 30 years and older (risk ratio = 2.53, 95% confidence interval, 0.93-6.86) were over 2.5 times more likely to have decreased postpartum PFS compared with women younger than 25 years. CONCLUSIONS In this population, women aged 25 years and older were more than twice as likely to have a decrease in postpartum PFS.
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Wang Z, Wen Y, Li YH, Wei Y, Green M, Wani P, Zhang P, Pera RR, Chen B. Smooth Muscle Precursor Cells Derived from Human Pluripotent Stem Cells for Treatment of Stress Urinary Incontinence. Stem Cells Dev 2016; 25:453-61. [PMID: 26785911 DOI: 10.1089/scd.2015.0343] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is great interest in using stem cells (SC) to regenerate a deficient urethral sphincter in patients with urinary incontinence. The smooth muscle component of the sphincter is a significant contributor to sphincter function. However, current translational efforts for sphincter muscle restoration focus only on skeletal muscle regeneration because they rely on adult mesenchymal SC as cell source. These adult SC do not yield sufficient smooth muscle cells (SMCs) for transplantation. We may be able to overcome this limitation by using pluripotent stem cell (PSC) to derive SMCs. Hence, we sought to investigate whether smooth muscle precursor cells (pSMCs) derived from human PSCs can restore urethral function in an animal model generated by surgical urethrolysis and ovariectomy. Rats were divided into four groups: control (no intervention), sham saline (surgery + saline injection), bladder SMC (surgery + human bladder SMC injection), and treatment (surgery + pSMC injection, which includes human embryonic stem cell (hESC) H9-derived pSMC, episomal reprogrammed induced pluripotent stem cells (iPSCs)-derived pSMC, or viral reprogrammed iPSC-derived pSMC). pSMCs (2 × 10(6) cells/rat) were injected periurethrally 3 weeks postsurgery. Leak point pressure (LPP) and baseline external urethral sphincter electromyography were measured 5 weeks postinjection. Both iPSC-derived pSMC treatment groups showed significantly higher LPP compared to the sham saline group, consistent with restoration of urethral sphincter function. While the difference between the H9-derived pSMC treatment and sham saline group was not significant, it did show a trend toward restoration of the LPP to the level of intact controls. Our data indicate that pSMCs derived from human PSCs (hESC and iPSC) can restore sphincter function.
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Affiliation(s)
- Zhe Wang
- 1 Department of OB/GYN, Stanford University School of Medicine , Stanford, California.,2 The Center for Reproductive Medicine, OB/GYN, Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong, People's Republic of China
| | - Yan Wen
- 1 Department of OB/GYN, Stanford University School of Medicine , Stanford, California
| | - Yan Hui Li
- 1 Department of OB/GYN, Stanford University School of Medicine , Stanford, California.,3 The Department of OB/GYN, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, People's Republic of China
| | - Yi Wei
- 1 Department of OB/GYN, Stanford University School of Medicine , Stanford, California
| | - Morgaine Green
- 1 Department of OB/GYN, Stanford University School of Medicine , Stanford, California
| | - Prachi Wani
- 1 Department of OB/GYN, Stanford University School of Medicine , Stanford, California
| | - Pengbo Zhang
- 4 Department of Pathology, Stanford University School of Medicine , Stanford, California
| | - Renee Reijo Pera
- 5 Department of Cell Biology and Neurosciences and Department of Chemistry and Biochemistry, Montana State University , Bozeman, Montana
| | - Bertha Chen
- 1 Department of OB/GYN, Stanford University School of Medicine , Stanford, California
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La disfunción del tracto urinario inferior en el paciente mayor. Med Clin (Barc) 2016; 147:455-460. [DOI: 10.1016/j.medcli.2016.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 11/18/2022]
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Sacomori C, Porto IDP, Cardoso FL, Sperandio FF. Associação entre aptidão cardiorrespiratória percebida e função do assoalho pélvico em mulheres. REVISTA BRASILEIRA DE CIÊNCIAS DO ESPORTE 2016. [DOI: 10.1016/j.rbce.2015.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Can pelvic floor dysfunction after vaginal birth be prevented? Int Urogynecol J 2016; 27:1811-1815. [DOI: 10.1007/s00192-016-3117-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/31/2016] [Indexed: 02/08/2023]
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Takahashi S, Takei M, Nishizawa O, Yamaguchi O, Kato K, Gotoh M, Yoshimura Y, Takeyama M, Ozawa H, Shimada M, Yamanishi T, Yoshida M, Tomoe H, Yokoyama O, Koyama M. Clinical Guideline for Female Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2015; 8:5-29. [PMID: 26789539 DOI: 10.1111/luts.12111] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 06/28/2015] [Indexed: 12/16/2022]
Abstract
The "Japanese Clinical Guideline for Female Lower Urinary Tract Symptoms," published in Japan in November 2013, contains two algorithms (a primary and a specialized treatment algorithm) that are novel worldwide as they cover female lower urinary tract symptoms other than urinary incontinence. For primary treatment, necessary types of evaluation include querying the patient regarding symptoms and medical history, examining physical findings, and performing urinalysis. The types of evaluations that should be performed for select cases include evaluation with symptom/quality of life (QOL) questionnaires, urination records, residual urine measurement, urine cytology, urine culture, serum creatinine measurement, and ultrasonography. If the main symptoms are voiding/post-voiding, specialized treatment should be considered because multiple conditions may be involved. When storage difficulties are the main symptoms, the patient should be assessed using the primary algorithm. When conditions such as overactive bladder or stress incontinence are diagnosed and treatment is administered, but sufficient improvement is not achieved, the specialized algorithm should be considered. In case of specialized treatment, physiological re-evaluation, urinary tract/pelvic imaging evaluation, and urodynamic testing are conducted for conditions such as refractory overactive bladder and stress incontinence. There are two causes of voiding/post-voiding symptoms: lower urinary tract obstruction and detrusor underactivity. Lower urinary tract obstruction caused by pelvic organ prolapse may be improved by surgery.
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Affiliation(s)
- Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Osamu Nishizawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Yamaguchi
- Division of Bioengineering and LUTD Research, School of Engineering, Nihon University, Koriyama, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Hideo Ozawa
- Department of Urology, Kawasaki Hospital, Kawasaki Medical School, Kurashiki, Japan
| | - Makoto Shimada
- Department of Urology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masayasu Koyama
- Women's Lifecare Medicine, Department of Obstetrics & Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Jung HB, Kim HJ, Cho ST. A current perspective on geriatric lower urinary tract dysfunction. Korean J Urol 2015; 56:266-75. [PMID: 25874039 PMCID: PMC4392025 DOI: 10.4111/kju.2015.56.4.266] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/09/2015] [Indexed: 01/17/2023] Open
Abstract
Lower urinary tract dysfunction-such as urinary incontinence (UI), detrusor overactivity, and benign prostatic hyperplasia-is prevalent in elderly persons. These conditions can interfere with daily life and normal functioning and lead to negative effects on health-related quality of life. UI is one of the most common urologic conditions but is poorly understood elderly persons. The overall prevalence of UI increases with age in both men and women. Elderly persons often neglect UI or dismiss it as part of the normal aging process. However, UI can have significant negative effects on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. Although UI is more common in elderly than in younger persons, it should not be considered a normal part of aging. UI is abnormal at any age. The goal of this review is to provide an overview of the cause, classification, evaluation, and management of geriatric lower urinary tract dysfunction.
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Affiliation(s)
- Ha Bum Jung
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyung Jee Kim
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Urodynamics in the Elderly. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-014-0115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Changes in urethral sphincter size following rehabilitation in older women with stress urinary incontinence. Int Urogynecol J 2014; 26:277-83. [DOI: 10.1007/s00192-014-2507-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
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Thubert T, Deffieux X, Jousse M, Guinet-Lacoste A, Ismael SS, Amarenco G. Influence of a distraction task on pelvic floor muscle contraction. Neurourol Urodyn 2014; 34:139-43. [PMID: 24519688 DOI: 10.1002/nau.22524] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/21/2013] [Indexed: 11/08/2022]
Abstract
AIMS Attention may play a key role in the contraction of pelvic floor muscles in stressful situations, meaning that mental distraction may be involved in urinary incontinence. METHODS Informed consent was obtained from 20 healthy volunteers. The electromyographic (EMG) activity of the external anal sphincter (EAS) was recorded during voluntary contraction elicited by local stimulation. The trials were carried out twice: combined (or not) with a mental distraction task (PASAT), Paced auditory serial additional test. Reaction time, latency between the stimulus and maximum EAS EMG activity, duration of the contraction, maximum EAS EMG activity, and the area under the EAS EMG activity curve were measured. RESULTS The mental distraction task led to a 3.98 times greater reaction time (RT), (P = 0.00001 Wilcoxon's test). The RT increased from 217 (IQR: 170-270) to 779 msec (IQR: 550-1,025, P < 0.0001) when the EAS contraction was combined with PASAT. However, the maximum EAS EMG activity was weaker during PASAT than in the absence of a mental distraction task: 0.0850 mv versus 0.0701 mv, that is, 1.21 times weaker (P = 0.00077, Wilcoxon's test). Finally, when the two conditions (respectively with and without the mental distraction task) were compared, no significant difference was found in the area under the EAS EMG activity curve (0.0157 mv sec vs. 0.0162 mv sec, ratio 1.01, P = 0.52). CONCLUSIONS The mental distraction task altered voluntary contraction of the pelvic floor muscles.
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Affiliation(s)
- Thibault Thubert
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France; GMC-UPMC 01, GREEN, Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie, Paris, France; Service de gynécologie obstétrique et biologie de la reproduction, APHP, Hopital Antoine Béclère, Clamart, France
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Abstract
PURPOSE The physiopathology of the voiding and urinary continence was one of the hot topic of research these last few years. Unfortunately, anyone have already found a unique cause which could explain urinary incontinence (urge or stress). The concept of cognitive function highlights new ways of research to show the fundamental role of the cortex and the sub-cortex in these diseases. METHODS A comprehensive literature review using Pubmed, Medline, Embase and Cochrane: "cognition, urinary tract, urinary continence, neuroimaging, IRMf, micturition, urge, brain factor and cognitive therapy". In all the articles, 72 really dealt with micturition and cognition. RESULTS New imaging techniques allowed to show the relationship between the different brain area involved in the bladder control such as the periaqueductal gray, the hypothalamus, the insula, the anterior cingulated cortex and the prefrontal cortex. These cortical area are equally involved in cognition. An alteration of urinary continence implies a modification of activation of these cortical areas. CONCLUSION A better knowledge of the cognitive side of micturition and urinary continence will allow to improve the treatment of their associated diseases.
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Yang JM, Yang SH, Huang WC, Tzeng CR. Factors affecting reflex pelvic floor muscle contraction patterns in women with pelvic floor disorders. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:224-229. [PMID: 23495218 DOI: 10.1002/uog.12457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 01/05/2013] [Accepted: 01/11/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To explore factors affecting the presence of two reflex pelvic floor muscle contraction (PFMC) patterns in women with pelvic floor disorders. METHODS This was a retrospective analysis of pelvic floor ultrasonography and urodynamic data for 667 consecutive symptomatic women with pelvic floor disorders. We identified on ultrasonography the presence or absence of two reflex PFMC patterns, anorectal lift (ARL) and inward clitoral motion (ICM), preceding or occurring during coughing, and evaluated their associations with possible factors affecting reflex PFMC reactivity, including patient demographics, pelvic organ prolapse stages, ultrasonography findings and urodynamic data. RESULTS Of the 667 women, 560 (84.0%) clearly demonstrated reflex ARL and 536 (80.4%) demonstrated ICM. There were significant differences in age (P < 0.001), parity (P = 0.033) and menopausal status (P = 0.005) between women with and those without reflex ICM before or during coughing. The multivariable logistic regression model showed that age was the only independent factor associated with presence of reflex ICM (odds ratio, 0.93 (95% CI, 0.88-0.99), P = 0.017). In contrast, no significant differences were noted between women with and without reflex ARL. CONCLUSIONS Increasing age is negatively associated with the presence of reflex ICM during coughing in symptomatic women with pelvic floor disorders.
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Affiliation(s)
- J-M Yang
- Department of Obstetrics and Gynecology, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan
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Saaby ML, Klarskov N, Lose G. Urethral pressure reflectometry during intra-abdominal pressure increase-an improved technique to characterize the urethral closure function in continent and stress urinary incontinent women. Neurourol Urodyn 2013; 32:1103-8. [DOI: 10.1002/nau.22368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/10/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Marie-Louise Saaby
- Department of Obstetrics and Gynecology, Herlev Hospital; University of Copenhagen; Copenhagen Denmark
| | - Niels Klarskov
- Department of Obstetrics and Gynecology, Herlev Hospital; University of Copenhagen; Copenhagen Denmark
| | - Gunnar Lose
- Department of Obstetrics and Gynecology, Herlev Hospital; University of Copenhagen; Copenhagen Denmark
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Smith TM, DeLancey JOL, Fenner DE. Post-reduction stress urinary incontinence rates in posterior versus anterior pelvic organ prolapse: a secondary analysis. Int Urogynecol J 2013; 24:1355-60. [PMID: 23306769 DOI: 10.1007/s00192-012-2019-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 12/01/2012] [Indexed: 12/25/2022]
Abstract
INTRODUCTION/HYPOTHESIS Stress incontinence with vaginal prolapse reduction is less common in women with posterior-predominant prolapse (rectocele) compared with those with anterior-predominant prolapse (cystocele). METHODS This was a secondary analysis of a cohort of prospectively enrolled women with symptomatic pelvic organ prolapse at or beyond the hymen and prolapse-reduced stress urinary incontinence (SUI) testing. Subjects were included if they had anterior- or posterior-predominant prolapse with at least a 1 cm difference in pelvic organ prolapse quantification (POP-Q) points Ba and Bp (N = 214). We evaluated the prevalence and risk factors of post-reduction SUI between the two groups. RESULTS Comparing posterior (n = 45) and anterior (n = 169) prolapse groups, we identified similar rates of post-reduction SUI (posterior: 6/45, 13.3 %; anterior:18/169, 10.7 %; p = 0.52) and SUI without reduction (posterior:4.4 %; anterior:11.2 %; p = 0.26). Maximum prolapse size was slightly larger in anterior than in posterior patients (+3.1 vs +2.0 cm beyond the hymen, p = 0.001), while a higher proportion of posterior subjects reported a prior hysterectomy (p = 0.04). Among posterior subjects, lower maximum urethral closure pressure values (MUCP; p = 0.02) were associated with post-reduction SUI. In contrast, among anterior-predominant prolapse, larger prolapse measured at POP-Q point Ba (p = 0.003) and maximum POP-Q measurement (p = 0.006) were each associated with higher rates of post-reduction SUI and were highly correlated with each other (R = 0.90). CONCLUSIONS We observed similar rates of post-reduction SUI in women with anterior- and posterior-predominant pelvic organ prolapse. Factors affecting the anterior and posterior prolapse groups differed, suggesting different mechanisms of continence protection. These findings suggest that reduction incontinence testing for operative planning would be as relevant to posterior-predominant prolapses as it is to anterior prolapse.
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Affiliation(s)
- Tovia M Smith
- Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, Ann Arbor, MI 48109, USA.
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DeLancey J. What causes stress incontinence: Fallacies, fascias and facts. Can Urol Assoc J 2012; 6:S114-S115. [PMID: 23092768 PMCID: PMC3481940 DOI: 10.5489/cuaj.12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The traditional view of the pathophysiology of stress urinary incontinence (SUI) was that a loss of urethral support was the primary abnormality present. Recent research has challenged this hypothesis, demonstrating that impaired urethral function plays the key causative role. Improving our understanding of the underlying pathologic mechanisms is important to identifying the cause of treatment failures and for developing novel therapies to treat SUI.
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Affiliation(s)
- John DeLancey
- Correspondence: Dr. John O. L. DeLancey, Department of Obstetrics and Gynecology, University of Michigan Medical Center, 1500 E. Medical Center Dr, L4000 WH, Box 0276, Ann Arbor, MI 48109-0276; fax: 734-647-9727;
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FRITEL XAVIER, RINGA VIRGINIE, QUIBOEUF EMELINE, FAUCONNIER ARNAUD. Female urinary incontinence, from pregnancy to menopause: a review of epidemiological and pathophysiological findings. Acta Obstet Gynecol Scand 2012; 91:901-10. [DOI: 10.1111/j.1600-0412.2012.01419.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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