1
|
Shi L, Zhao Y, Li W, Chen L, Shen W, Zhai L. Evaluation of pelvic structural abnormalities in primiparous women with stress urinary incontinence. Int Urogynecol J 2024; 35:369-380. [PMID: 37966496 DOI: 10.1007/s00192-023-05675-2] [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: 07/11/2023] [Accepted: 10/08/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the morphological characteristics of pelvic floor structure specific to de novo stress urinary incontinence (SUI) in primiparous women using three-dimensional (3D) reconstruction fusion technology based on static MRI combined with dynamic MRI. METHODS Eighty-one primiparous women after the first vaginal delivery were studied, 40 with SUI and 41 without SUI. 3D reconstruction models based on static MRI were used to describe the anatomical abnormalities of pelvic floor tissues. Dynamic MRI was used to describe segmental activities of the urethra and vagina. The relationship between the morphometry and postpartum SUI was evaluated by logistic regression analysis and receiver operator characteristic curve. RESULTS The differences in the distance from the bladder neck to the pubic symphysis (BSD), the angle between the posterior wall of the urethra and the anterior wall of the vagina, the width of the distal region of the vagina, urethral length, urethral compression muscle volume (CUV), and pubovisceral muscle volume, puborectal muscle volume, were measured, and except for the extremity of the anterior urethral wall, the total displacements (TDs) of the other sites between the two groups were statistically significant (p < 0.05). Logistic regression analysis showed that the BSD decreased, the CUV decreased, the TDs of the first site and the eighth site increment correlated significantly with postpartum SUI occurrence (p < 0.05). CONCLUSIONS 3D reconstruction fusion technology provides an important support for a precise assessment of the pelvic floor dysfunction. The BSD, CUV, and iliococcygeus muscle volume have certain values in predicting de novo SUI after first vaginal birth.
Collapse
Affiliation(s)
- Li Shi
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Yujiao Zhao
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Fukang Road No. 24, Nankai District, Tianjin, 300192, China
| | - Weijun Li
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Lihua Chen
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Fukang Road No. 24, Nankai District, Tianjin, 300192, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Fukang Road No. 24, Nankai District, Tianjin, 300192, China.
| | - Lidong Zhai
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China.
| |
Collapse
|
2
|
Ongenda ION, Mengistu Z, Tincello D, Williams C, Pitchforth E. Opinion: pelvic floor disorders: learning from chronicity & chronic care models. Front Glob Womens Health 2023; 4:1006693. [PMID: 37404229 PMCID: PMC10315837 DOI: 10.3389/fgwh.2023.1006693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Affiliation(s)
- Inès Osenge-Nyoyi Ongenda
- Primary Care Research Group, Department of Health and Community Sciences and Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Zelalem Mengistu
- Obstetrics and Gynecology Department, University of Gondar, Gondar, Ethiopia
| | - Douglas Tincello
- Women's and Children's CBU, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Christopher Williams
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Emma Pitchforth
- Primary Care Research Group, Department of Health and Community Sciences and Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| |
Collapse
|
3
|
Tian D, Gao Z, Zhou H, Lin H, Wang X, Li L, Yang X, Wen Y, Zhang Q, Shen J. A Comparative Study on the Clinical Efficacy of Simple Transobturator Midurethal Sling and Posterior Pelvic Floor Reconstruction. Medicina (B Aires) 2023; 59:medicina59010155. [PMID: 36676779 PMCID: PMC9862824 DOI: 10.3390/medicina59010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Background and Objectives: The purpose of this study was to compare the complications, success rate and satisfaction of pelvic floor reconstruction after transobturator midurethral sling (TOT) and TOT combined with pelvic floor reconstruction in the treatment of female stress urinary incontinence. To explore the pathogenesis of stress urinary incontinence after pelvic floor stress injury and improve the surgical treatment strategy. Materials and Methods: From 15 August 2018 to 24 February 2022, patients diagnosed with stress urinary incontinence (SUI) and secondary prolapse of the anterior pelvis were selected to receive surgically. Participants were followed up and evaluated at 2 months, 6 months and 1 year after treatment. According to the patient's chief complaint, the patient can urinate automatically without incontinence. The number of urinary incontinence and urine leakage was significantly reduced compared with those before operation. Urinary incontinence symptoms did not improve or worsen as ineffective, observing the efficacy and complications. Results: We included 191 patients in the TOT group and 151 patients in the pelvic floor reconstruction group after TOT was combined. The operation time and hospital stay in the TOT group were short, but the TOT group needed a second operation to treat recurrent SUI. Perioperative complications were mostly dysuria, and the incidence of postoperative complications in the group of TOT combined with pelvic floor reconstruction was low. The complete success rate and effective rate of pelvic floor reconstruction after TOT in the merger group were significantly higher than those in the TOT group, and the patient satisfaction and complete success rate were also higher. Conclusions: TOT combined with posterior pelvic floor reconstruction has a definite short-term effect on patients with SUI and anterior pelvic secondary prolapse. The operation design should pay attention to the support of the posterior wall of the perineum to the bladder neck and the middle and proximal end of the urethra.
Collapse
Affiliation(s)
- Daoming Tian
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Zhenhua Gao
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming 650032, China
| | - Hang Zhou
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Han Lin
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Xingqi Wang
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Ling Li
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Xunguo Yang
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Yubin Wen
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Quan Zhang
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming 650032, China
| | - Jihong Shen
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
- Yunnan Province Clinical Research Center for Chronic Kidney Disease, Kunming 650032, China
- Correspondence: ; Tel.: +86-135-7700-9705
| |
Collapse
|
4
|
Post WM, Widomska J, Grens H, Coenen MJH, Martens FMJ, Janssen DAW, IntHout J, Poelmans G, Oosterwijk E, Kluivers KB. Molecular Processes in Stress Urinary Incontinence: A Systematic Review of Human and Animal Studies. Int J Mol Sci 2022; 23:ijms23063401. [PMID: 35328824 PMCID: PMC8949972 DOI: 10.3390/ijms23063401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
Stress urinary incontinence (SUI) is a common and burdensome condition. Because of the large knowledge gap around the molecular processes involved in its pathophysiology, the aim of this review was to provide a systematic overview of genetic variants, gene and protein expression changes related to SUI in human and animal studies. On 5 January 2021, a systematic search was performed in Pubmed, Embase, Web of Science, and the Cochrane library. The screening process and quality assessment were performed in duplicate, using predefined inclusion criteria and different quality assessment tools for human and animal studies respectively. The extracted data were grouped in themes per outcome measure, according to their functions in cellular processes, and synthesized in a narrative review. Finally, 107 studies were included, of which 35 used animal models (rats and mice). Resulting from the most examined processes, the evidence suggests that SUI is associated with altered extracellular matrix metabolism, estrogen receptors, oxidative stress, apoptosis, inflammation, neurodegenerative processes, and muscle cell differentiation and contractility. Due to heterogeneity in the studies (e.g., in examined tissues), the precise contribution of the associated genes and proteins in relation to SUI pathophysiology remained unclear. Future research should focus on possible contributors to these alterations.
Collapse
Affiliation(s)
- Wilke M. Post
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
| | - Joanna Widomska
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.W.); (G.P.)
| | - Hilde Grens
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
| | - Marieke J. H. Coenen
- Radboud Institute of Health Sciences, Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Frank M. J. Martens
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Dick A. W. Janssen
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Joanna IntHout
- Department of Health Evidence, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Geert Poelmans
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.W.); (G.P.)
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Kirsten B. Kluivers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
- Correspondence:
| |
Collapse
|
5
|
Mahfouz W, Moussa A, Elbadry M. Adjustment of tension applied in transobturator tapes in females with intrinsic sphincteric deficiency: Two centers' prospective, comparative, randomized surgical trial. Urol Ann 2021; 13:134-141. [PMID: 34194139 PMCID: PMC8210713 DOI: 10.4103/ua.ua_73_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives: Stress incontinence is the most common type of urinary incontinence in females. Recently, the gold standard treatment is mid-urethral tapes, however their efficacy is questioned in intrinsic sphincter deficiency (ISD). In our study, we try to adjust the tension applied during transobturator tapes (TOT) to evaluate its effectiveness in ISD, in order to prevent obstruction or failure and persistence of stress urinary incontinence. Materials and Methods: This study was prospectively conducted on eighty female patients having ISD, presenting at the Urology Departments in Alexandria and Minia University Hospitals. The patients were randomly assigned to two groups, with Group I including forty patients, who underwent TOT using tension-free technique, and Group II including forty patients using our new tension adjustment technique under saddle anesthesia. Patients filled the International Continence Questionnaire and Urinary Distress Inventory and did pressure flow study pre- and postoperatively. Postoperatively, the patients filled Patient Global Impression of Improvement and underwent translabial ultrasound (U/S) to estimate the distance between the tape and the urethra. Results: In Group I, 70% of the patients were cured with mean Valsalva leak point pressure (VLPP) of 51.43 ± 3.39 preoperatively, 20% were not improved, and 10% were improved with a mean VLPP of 44.5 ± 3.54 preoperatively, which increased to 86 ± 4.24 postoperatively. In Group II, 95% of the patients were cured with a mean VLPP of 50.74 cmH2O ± 6.56 preoperatively and 5% improved but not cured with a mean VLPP of 31 cmH2O preoperatively, which increased to 127 cmH2O at a bladder capacity of 400 ml. All patients in both groups underwent translabial U/S 6 months postoperatively. The distance between the mid-tape and the outer urethra measured by translabial US showed no significant difference between the two studied groups. Conclusion: Performing TOT using our tensioned proposed technique in ISD seems to be effective and with low morbidity. Intraoperative adjustment of tension using Valsalva maneuver under saddle anesthesia gives better outcomes than the conventional tension-free technique. The concept of tension-free vaginal tape should be challenged.
Collapse
Affiliation(s)
- Wally Mahfouz
- Department of Urology, Alexandria University, Alexandria, Egypt
| | - Ahmed Moussa
- Department of Urology, Alexandria University, Alexandria, Egypt
| | - Mohamed Elbadry
- Urology and Nephrology Center, Minia University, Minya, Egypt
| |
Collapse
|