Does estrogen deprivation affect pelvic floor muscle contractility?

A comprehensive review of conservative therapies for female stress urinary incontinence: Advancements, efficacy, and future directions

Pelvic floor dysfunction poses a significant challenge to women worldwide. Female urinary incontinence is one of the most prevalent types of pelvic floor dysfunctions, affecting at least 50% of females, particularly those who are pregnant or menopausal. Among the various urinary incontinence subtypes, stress urinary incontinence takes the lead, characterized by involuntary urine leakage during activities that increase intra-abdominal pressure, such as sneezing, coughing, laughing, or exercising. This comprehensive review explores the latest advancements and critical insights into conservative treatments for stress urinary incontinence. Stress urinary incontinence symptoms result in profound physical and psychological consequences for individuals and impose a substantial medical and economic burden on society; however, only 5%-10% seek professional help. This narrative review meticulously examines a spectrum of interventions, ranging from lifestyle modifications to emerging modalities, such as laser treatment and electroacupuncture.

Comparative study of two different rat models of stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

The purpose of this study was to compare the success rate and urodynamic characteristics of the rat model of stress Urinary incontinence established by ovariectomy at different times after vaginal dilation.

METHODS

Eighty female rats were randomly divided into three groups: the control group (n = 20), model group A (n = 30), i.e., the animals received colpectasis and bilateral oophorectomy within 1 day; model group B (n = 30), i.e., the animals received bilateral oophorectomy 1 week after colpectasis. The sneeze test and urodynamics were tested.

RESULTS

There was no significant difference between the model group A and the model group B (p > 0.05) in the sneeze test. The leak point pressure (LPP) of model groups A and B was lower than that of the control group (p < 0.05). The LPP value of model group A was lower than that of model group B (p < 0.05). There was no significant difference in maximum bladder capacity (MBC) between model group A and the control group (p > 0.05); the MBC value of model group B was lower than that of the control group and model group A (p < 0.05).

CONCLUSIONS

Models of stress urinary incontinence in rats can be successfully established by both modeling methods. In terms of LPP, model groups A and B had lower values than the control group, and model group A had lower values than model group B. In terms of MBC, there was no difference between model group A and the control group, and model group B had lower values than the control group and model group A.

Three-dimensional ultrasound evaluation of the pelvic floor in postmenopausal women using hormone therapy

OBJECTIVE

To evaluate the three-dimensional (3D) ultrasound characteristics of the pelvic floor muscles (PFM) in two groups of postmenopausal women: users and nonusers of menopausal hormone therapy (MHT).

STUDY DESIGN

Observational, cross-sectional cohort study.

MAIN OUTCOME MEASURES

In this study 226 sexually active heterosexual women, aged 45-60 years with amenorrhea >12 months and without clinical pelvic floor disorders or urinary incontinence were included. Women using MHT ≥ 6 months were classified as systemic users. PFM strength was assessed by digital vaginal palpation and scored on the Modified Oxford Scale. Biometry of the PFM was performed by 3D transperineal ultrasound for evaluation of total urogenital hiatus area, transverse and anteroposterior diameters, and levator ani muscle thickness.

RESULTS

The participants were divided into users (n = 78) and nonusers (n = 148) of MHT. There were no differences in clinical or anthropometric parameters between groups. The mean age was 55 years and the time since menopause was six years in both groups. The mean duration of MHT use was 43.4 ± 33.3 months. Users of MHT had greater levator ani muscle thickness (p = 0.001) and higher PFM strength (p = 0.029) than nonusers. Risk analysis adjusted for age, time since menopause, BMI, parity, and type of delivery showed an association of MHT use with greater levator ani muscle thickness (OR = 2.69; 95% CI 1.42-5.11, p = 0.029), and higher PFM strength (OR = 1.78; 95% CI1.01-3.29, p = 0.046). There was a weak positive correlation between levator ani muscle thickness and duration of MHT use (r = 0.25, p = 0.0002) and PFM strength (r = 0.12, p = 0.043).

CONCLUSIONS

Postmenopausal women using MHT had a greater levator ani muscle thickness associated with higher PFM strength than nonusers.

Urethral sphincter volume and urodynamic diagnosis

AIM

To compare urethral sphincter measurements in women with different urodynamic diagnoses using three-dimensional transperineal ultrasound (TPU).

METHODS

Women with lower urinary tract dysfunction having urodynamic studies (UDS) were prospectively recruited to this study. A detailed history and vaginal examination were conducted. Saline cystometry was performed and the women were divided into groups according to their urodynamic diagnosis, which were nondiagnostic urodynamics (NUDS), pure detrusor overactivity (PureDO), pure urodynamic stress incontinence (PureUSI) and mixed urinary incontinence (MUDS). Three-dimensional TPU was performed to measure total urethral sphincter volume, striated sphincter volume, core volume, sphincter length and maximum cross-sectional area. The ultrasound measurements were compared with the diagnostic urodynamics.

RESULTS

One hundred fifty women were included in the study. There were 37, 53, 22 and 38 women in the groups of NUDS, PureDO, PureUSI and MUDS respectively. The average striated sphincter volumes in these groups were 1.84 ml, 2.24 ml, 1.32 ml and 1.98 ml respectively. There was no difference in average age, body mass index or presence of prolapse in these groups. All measurements were larger in the PureDO and smaller in the PureUSI group compared with the NUDS group. The measurements in the MUDS group were larger than in the NUDS group and smaller than in the PureDO group but this difference was not statistically significant.

CONCLUSION

The urethral sphincter of women with PureDO is larger than in women with PureUSI. The value in women with MUDS was between the two. The size of the urethral sphincter appears to be related to the pathophysiology.