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Mülkoğlu C, Ersever EM, Çakıt BD. Evaluation of incontinence and lymphedema in gynecological cancer patients along with their impact on the quality of life. Support Care Cancer 2023; 31:437. [PMID: 37395832 DOI: 10.1007/s00520-023-07896-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE The aim of this study is to evaluate the patients who developed both urinary incontinence and lymphedema in gynecological cancer survivors and to investigate the impact of these conditions on the quality of life among these patients. METHODS Our study included 56 patients who have lymphedema and urinary incontinence which started within first 2 years after surgery for gynecological cancer. We evaluated the presence of urinary incontinence by Overactive Bladder Assessment Tool (OABT) and Urogenital Distress Inventory (UDI). Incontinence Impact Questionnaire (IIQ-7) was used to assess the quality of life. RESULTS OABT and UDI scores were found to be statistically significantly increased in patients with grade 3 lymphedema (respectively p: 0.006, p: 0.008). A statistically significant difference was found between lymphedema grade 1-2-3 patients in terms of IIQ-7 (p:0.002). The difference was statistically significant between the grade 1-3 (p:0.001) and grade 2-3 (p:0.013) groups. We did not find any correlation between age, type of cancer, radiotherapy, and urinary incontinence. There was a statistically significant positive correlation between BMI and OABT, UDI scores (respectively, r = 0.43, p = 0.001; r = 0.38, p = 0.003). CONCLUSION It was concluded that there was a relationship between urinary incontinence and grade 3 lymphedema in gynecological cancer survivors. Grade 3 lymphedema increases urinary incontinence and worsens daily living functions in these patients.
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Affiliation(s)
- Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Emine Merve Ersever
- Department of Physical Therapy, Ankara Training and Research Hospital, Ankara, Turkey
| | - Burcu Duyur Çakıt
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
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Kim JH, Ko IK, Jeon MJ, Kim I, Vanschaayk MM, Atala A, Yoo JJ. Pelvic floor muscle function recovery using biofabricated tissue constructs with neuromuscular junctions. Acta Biomater 2021; 121:237-249. [PMID: 33321220 DOI: 10.1016/j.actbio.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023]
Abstract
Damages in pelvic floor muscles often cause dysfunction of the entire pelvic urogenital system, which is clinically challenging. A bioengineered skeletal muscle construct that mimics structural and functional characteristics of native skeletal muscle could provide a therapeutic option to restore normal muscle function. However, most of the current bioengineered muscle constructs are unable to provide timely innervation necessary for successful grafting and functional recovery. We previously have demonstrated that post-synaptic acetylcholine receptors (AChR) clusters can be pre-formed on cultured skeletal muscle myofibers with agrin treatment and suggested that implantation of AChR clusters containing myofibers could accelerate innervation and recovery of muscle function. In this study, we develop a 3-dimensional (3D) bioprinted human skeletal muscle construct, consisting of multi-layers bundles with aligned and AChR clusters pre-formed human myofibers, and investigate the effect of pre-formed AChR clusters in bioprinted skeletal muscle constructs and innervation efficiency in vivo. Agrin treatment successfully pre-formed functional AChR clusters on the bioprinted muscle constructs in vitro that increased neuromuscular junction (NMJ) formation in vivo in a transposed nerve implantation model in rats. In a rat model of pelvic floor muscle injury, implantation of skeletal muscle constructs containing the pre-formed AChR clusters resulted in functional muscle reconstruction with accelerated construct innervation. This approach may provide a therapeutic solution to the many challenges associated with pelvic floor reconstruction resulting from the lack of suitable bioengineered tissue for efficient innervation and muscle function restoration.
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Evaluation of Awareness, Adherence, and Barriers of Pelvic Floor Muscle Training in Pregnant Women: A Cross-sectional Study. Female Pelvic Med Reconstr Surg 2021; 27:e122-e126. [PMID: 32604200 DOI: 10.1097/spv.0000000000000852] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Adherence to pelvic floor muscle training (PFMT) may be enhanced when the women become aware of its preventive/therapeutic role in pelvic floor disorders. OBJECTIVE This study is conducted to evaluate the PFMT awareness, adherence, and barriers in pregnant women. METHOD We studied the awareness, adherence, and barriers of PFMT in 200 pregnant women attended in prenatal care clinic in their third trimester of pregnancy using semistructured interviews with open and closed questions derived from recent literature review on PFMT. RESULT Fifty-four (27%) of studied women were familiar with PFMT, 175 (87.5%) of patients thought that the UI is normal during pregnancy, and 25 (32.05%) had experienced UI episodes and had consulted with their obstetrician. Twenty-one (10.5%) of patients did the PFMT exercises before their pregnancy, 14 (66.6%) of them continued their PFMT exercises during their pregnancy, and 7 (33.4%) stopped it. Concerns about miscarriage were the main reason of discontinuing the exercises during pregnancy. Routes of knowledge acquisition were the Internet in 24 cases (44.4%), health system in 13 cases (24.07%), family and friends in 11 cases (20.3%), and books/magazines in 6 cases (11.1%). Main means of mass communication (including TV, radio, and newspapers) had no role in knowledge distribution in this filed. CONCLUSIONS Pregnant women require more health education regarding PFMT. Health care professionals should be more involved in patient education process. Internet resources are used widely by women and need more academic/scientific supervision.
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Brooks KCL, Varette K, Harvey MA, Robert M, Brison RJ, Day A, Baker K, Della Zazzera V, Sauerbrei E, McLean L. A model identifying characteristics predictive of successful pelvic floor muscle training outcomes among women with stress urinary incontinence. Int Urogynecol J 2020; 32:719-728. [PMID: 33237355 PMCID: PMC7902568 DOI: 10.1007/s00192-020-04583-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/20/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to prospectively identify aspects of baseline demographic, clinical, and pelvic morphology of women with stress urinary incontinence (SUI) that are predictive of cure with physiotherapist-supervised pelvic floor muscle training (PFMT). METHODS Women ≥18 years old with SUI were recruited from urogynecology and pelvic health physiotherapy clinics. Participants completed a 3-day bladder diary, the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), a standardized pad test, manual assessment of pelvic floor muscle (PFM) strength and tone, and transperineal ultrasound (TPUS) assessment of their urogenital structures at rest while in a supine position and standing, and during contraction, straining, and coughing. Participants attended six physiotherapy sessions over 12 weeks and performed a home PFMT program. The assessment was repeated after the intervention; cure was defined as a dry (≤2 g) pad test. RESULTS Seventy-seven women aged 50 (±10) years completed the protocol; 38 (49%) were deemed cured. Based on univariate testing, four predictors were entered into a binary logistic regression model: ICIQ-UI-SF, PFM tone, bladder neck (BN) height in a quiet standing position, and BN height during a cough in a standing position. The model was significant (p < 0.001), accurately classifying outcome in 74% of participants. The model, validated through bootstrapping, performed moderately, with the area under the receiver operating characteristic curve = 0.80 (95% CI: 0.69-0.90; p = 0.00), and with 70% sensitivity and 75% specificity. CONCLUSIONS Women with better bladder support in a standing position and less severe symptoms were most likely to be cured with PFMT. CLINICAL TRIAL REGISTRATION #NCT01602107.
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Affiliation(s)
- Kaylee C L Brooks
- School of Rehabilitation Sciences, University of Ottawa, Rm E260C, Building E, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
| | - Kevin Varette
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Marie-Andrée Harvey
- Department of Obstetrics and Gynaecology, Kingston General Hospital, Kingston, Canada
| | - Magali Robert
- Department of Obstetrics and Gynaecology, Foothills General Hospital, Calgary, Canada
| | - Robert J Brison
- Department of Emergency Medicine, Kingston General Hospital, Kingston, Canada
| | - Andrew Day
- Department of Population Health Sciences, Queen's University, Kingston, Canada
| | - Kevin Baker
- Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa, Canada
| | | | - Eric Sauerbrei
- Department of Radiology, Kingston General Hospital, Kingston, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, Rm E260C, Building E, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada. .,School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
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Dewaele P, Deffieux X, Villot A, Amarenco G, Billecocq S, Thubert T. Pelvic floor muscle activation in stress urinary incontinent women: Impact of a distraction task. Neurourol Urodyn 2019; 38:950-957. [PMID: 30779380 DOI: 10.1002/nau.23936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/13/2018] [Accepted: 01/09/2019] [Indexed: 11/10/2022]
Abstract
AIMS Our purpose was to explore the involvement of cognition in voluntary and involuntary pelvic floor muscle (PFM) contraction in stress urinary incontinent women. METHODS PFM contraction monitored by surface electromyography (EMG) was measured without a mental distraction task (DT), and with a DT called "paced auditory serial additional test" (PASAT). Forty stress incontinent women performed voluntary contractions of the external anal sphincter (EAS), and reflex EAS contractions induced by means of coughing were studied using the external intercostal muscle (EIC) EMG pattern. RESULTS A DT altered PFM pre-activation when coughing: the reaction time between EIC muscle contraction and EAS contraction (called RT3) was respectively -54.94 ms (IQR -87.12; 3.12) without the PASAT and -3.99 ms (IQR: -47.92; 18.69) with a DT (P = 0.02, Wilcoxon's test). Concerning voluntary contraction, women activated their PFM sooner without than with a DT. CONCLUSION The PASAT altered voluntary and reflex contractions of the PFM in stress urinary incontinent women. Our study suggests that cognition plays a role in urinary pathophysiology. Future studies should investigate rehabilitation programs that consider the role of cognition in stress urinary incontinent women.
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Affiliation(s)
- Pauline Dewaele
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,APHP, Hopital Antoine Béclère, Service de gynécologie obstétrique et biologie de la reproduction, Clamart, France
| | - Xavier Deffieux
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,APHP, Hopital Antoine Béclère, Service de gynécologie obstétrique et biologie de la reproduction, Clamart, France
| | - Anne Villot
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France
| | - Gérard Amarenco
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Sylvie Billecocq
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,Cabinet de rééducation périnéale, Paris, France
| | - Thibault Thubert
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,Centre Hospitalier Universitaire de Nantes, Hôtel Dieu, Service de Gynécologie Obstétrique Nantes, Nantes, France
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Gavira Pavón A, Walker Chao C, Rodríguez Rodríguez N, Gavira Iglesias FJ. [Prevalence and risk factors of urinary incontinence in women who visit the doctor with low back pain: multicentre study]. Aten Primaria 2013; 46:100-8. [PMID: 24129279 PMCID: PMC6983577 DOI: 10.1016/j.aprim.2013.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 11/19/2022] Open
Abstract
Objetivos Estimar la prevalencia y los factores de riesgo de incontinencia urinaria (IU) en mujeres con dolor lumbopélvico (DLP) y describir sus características sociodemográficas y clínicas. Diseño Estudio observacional transversal. Emplazamiento Dos centros de Atención Primaria del Sur de Córdoba y un centro privado en Madrid. Participantes Trescientas sesenta y cuatro mujeres de 20-65 años (de 466 contactadas, 33 fueron excluidas y 69 rechazaron participar) que consultaron por dolor de espalda localizado entre la doceava costilla y el pliegue glúteo. Intervenciones Entrevista mediante cuestionario. Mediciones principales Cuestionarios (Índice de discapacidad de Oswestry y cuestionarios de IU [International Consultation on Incontinence Questionnaire SF e Cuestionario de Impacto de la Incontinencia-7]), prueba funcional (test ASLR) y comorbilidad de interés para la IU. Análisis estadístico descriptivo y multivariante. Resultados Se encontró IU en 155 mujeres (43%; IC del 95%, 37%-48%), en su mayoría de esfuerzo (83%) y mínimo impacto (60%). Frente a las continentes, las mujeres incontinentes presentaron diferencias significativas en la edad, el índice de masa corporal (IMC), el estado civil, el nivel de instrucción y la convivencia, el consumo de fármacos/día, el número de partos vaginales y totales, las intervenciones quirúrgicas abdominopélvicas, el asma, el estreñimiento, la hipertensión, la diabetes, el porcentaje de incapacidad y el test funcional ASLR. En el análisis multivariante, las variables que más influyen en la probabilidad de ser incontinente fueron el asma, la hipertensión, el estreñimiento, el número de partos totales, el IMC y el porcentaje de incapacidad. Conclusiones La prevalencia de IU en mujeres con DLP es mayor que la encontrada en mujeres de similar edad sin DLP. El asma, el estreñimiento y la paridad son los factores más influyentes en la aparición de IU.
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Affiliation(s)
| | - Carolina Walker Chao
- Facultad de Ciencias de la Salud, Fundación Universitaria del Bages, Universidad Autónoma de Barcelona, Manresa, Barcelona, España
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