The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

A New Automated Ultrasound Quantification of Urethral Mobility for Stress Urinary Incontinence: A Feasibility Study

OBJECTIVES

Stress urinary incontinence (SUI) is a prevalent condition that can significantly affect quality of life. Urethral mobility is an important factor in SUI and transperineal ultrasound (TPUS) imaging can provide clear visualization of this movement; however, its quantification has been limited. An automated system to track and quantify urethral movement could provide richer information and reduce inter-observer effects on measurements.

METHODS

As proof-of-concept for technique development, we used TPUS cine loops obtained on commercial scanners (GE Healthcare and Philips Healthcare) from consented research volunteers. We developed the tracking software based on fundamental concepts from computer vision, specifically corner detection and optical flow-based tracking algorithms. In doing so we account for inadvertent probe movements by using the symphysis pubis as a reference coordinate system.

RESULTS

The system successfully tracks the motion of the urethra during Valsalva maneuvers. It accurately captures and quantifies complex movements, including directional shifts, rotations, displacement vectors of different structures, and the trajectory of motion. These measurements are corrected for any probe movement. We demonstrated the system's efficiency and reliability in near real-time analysis across various ultrasound platforms and video formats. The intraclass correlation coefficients exceeded 0.89 and 0.5 for intra- and inter-rater reliability, respectively.

CONCLUSIONS

By providing detailed, objective measurements of urogenital movement, this approach has potential to advance the understanding, diagnosis and treatment of SUI, which in turn, can help tailor more effective treatment strategies. This methodology paper confirms the feasibility of automated quantification of urethral mobility.

Upright Open MRI (MRO) Evaluation of the Anatomic Effects of Yoga Postures on the Bladder Neck and Urethra

Background/Objectives: Upright open magnetic resonance imaging allows the impact of posture and gravity to be evaluated. Randomized controlled trials of yoga for treating urinary incontinence (UI) in women show significant clinical benefit, yet the anatomic impact of this therapy on the lower urinary tract remains unelucidated. This study tested the hypothesis that open MRI scans can be obtained with sufficient detail to visualize the bladder neck and urethra. Methods: We scanned a volunteer subject using a 0.5 Tesla MRO Open Evo scanner to obtain axial and sagittal T2-weighted pelvic scans during poses used in yoga therapy. To obtain images with the necessary detail, we employed variations in sequencing during scanning of each individual pose. The changes observed in the bladder neck and urethral outline in each pose were then compared to baseline supine images. Results: Images with sufficient anatomic detail were obtained in each of the four poses studied. These scans identified that the urethral outline changes anatomically based on the posture adopted and is dynamic with regional alternations evident in caliber during specific yoga poses. Conclusions: Open MRI can identify anatomical changes involving the bladder neck and urethra that occur during yoga poses used in the treatment of UI in women; these likely relate to effects of posture and gravity. Open MRI offers a way to elucidate the anatomic effects that specific yoga poses generate and to identify those with the potential to be most beneficial clinically to women as a form of therapy.

Magnetoactive elastomer-based dynamic urethral support device for stress urinary incontinence

Stress urinary incontinence (SUI) is the involuntary leakage of urine in response to increased intra-abdominal pressure during episodes of exertion. A common treatment method for SUI is sling implantation underneath the urethra to provide support. Most current sling procedures, however, cannot adjust urethral tension postoperatively. To address this limitation, we designed a soft magnetoactive elastomer (MAE) device capable of changing shape in response to moderate magnetic fields. To ensure shape change after fibrotic scar tissue encapsulation, MAE devices were embedded in agar gels with different stiffnesses, and their shape change was studied in response to up to 200 mT magnetic fields. A simple in vitro model of the lower urinary tract was designed to study device performance. Flow time was measured as a function of pressure in the simulated bladder as the model system leaked before and after activating sling with a hand-held magnet. MAE devices embedded in agar gel (100 kPa) in hammock-like configuration achieved 4.7% ± 1.1% change in height. Devices with silica-coated magnetic particles showed minimal loss in mass after two weeks in accelerated oxidative (2.36% ± 1.55%) and hydrolytic (0.58% ± 0.25%) conditions. Placing a sling under the model urethra provided urethral support; thus, increasing its resistance to flow. Normalized flow time significantly reduced from 1.56 ± 0.18 to 1.11 ± 0.16 when magnetic field was applied, indicating urethral support modulation at 60 cm-H2O. This dynamic sling, powered externally with physiologically safe magnetic fields, allowed for urethral support modulation in a model of the lower urinary tract. STATEMENT OF SIGNIFICANCE: Stress urinary incontinence (SUI) affects up to half the adult women during their lifetime, and slings are commonly used to treat severe cases. While sling implantation is minimally invasive and offers moderate to high cure rates, long-term sling complications, such as urine retention, remain a significant concern. Available adjustable SUI devices often require invasive surgeries, implantable electronics, and multiple mechanical components, increasing the overall invasiveness. Here, we report a proof of concept for using shape-morphing biomaterials to fabricate a dynamic device that can provide continence support and be triggered to change shape, enabling complete voiding. Such a dynamic device may prevent many complications associated with traditional slings and improve quality of life for women suffering from severe SUI.

The impact of pelvic floor contraction on urethral mobility and urogenital hiatus size in pelvic floor ultrasound

Aim

The aim of the study was to assess the effect of pelvic floor contraction on urethral mobility and the size of the urogenital hiatus, as well as to compare two ultrasonographic approaches for the assessment of urethral mobility: transperineal with a transabdominal probe and transvestibular with a transvaginal transducer.

Materials and methods

Modified Oxford Scale (MOS) was used for clinical evaluation of muscle contraction. The parameters obtained in both ultrasound approaches were assessed for all six Oxford grades. The values of ΔH, ΔD and vector, measured at rest and on pelvic floor muscle contraction, were used to evaluate urethral mobility parameters in both ultrasound methods. Patients with a history of urogynecological surgery, pelvic radiotherapy, significant pelvic prolapse (grade 2 or grater in at least one compartment), as well as those with unilateral or bilateral complete avulsion of the puborectalis muscle were excluded.

Results

A total of 272 women were included in the analysis. A statistically significant correlation was found between the contraction force and urethral mobility parameters ΔH and vector-positive and ΔD-negative, obtained in both ultrasound approaches. However, no correlation was demonstrated between the contraction force and changes in the analyzed hiatal parameters. The Bland-Altman analysis showed a high agreement of both measurement methods.

Conclusions

The force of pelvic floor muscle contraction, as measured with the Oxford Scale, correlated with urethral mobility in both ultrasound examinations. Assessment of urethral mobility using the three assessed parameters (ΔH, ΔD, vector) allows for the most comprehensive analysis. Only minor differences were found in the analyzed urethral mobility parameters between both ultrasonographic approaches. The impact of pelvic floor muscle contraction on the size of the urogenital hiatus was not confirmed.

Deep learning-assisted two-dimensional transperineal ultrasound for analyzing bladder neck motion in women with stress urinary incontinence

BACKGROUND

No universally recognized transperineal ultrasound parameters are available for evaluating stress urinary incontinence. The information captured by commonly used perineal ultrasound parameters is limited and insufficient for a comprehensive assessment of stress urinary incontinence. Although bladder neck motion plays a major role in stress urinary incontinence, objective and visual methods to evaluate its impact on stress urinary incontinence remain lacking.

OBJECTIVE

To use a deep learning-based system to evaluate bladder neck motion using 2-dimensional transperineal ultrasound videos, exploring motion parameters for diagnosing and evaluating stress urinary incontinence. We hypothesized that bladder neck motion parameters are associated with stress urinary incontinence and are useful for stress urinary incontinence diagnosis and evaluation.

STUDY DESIGN

This retrospective study including 217 women involved the following parameters: maximum and average speeds of bladder neck descent, β angle, urethral rotation angle, and duration of the Valsalva maneuver. The fitted curves were derived to visualize bladder neck motion trajectories. Comparative analyses were conducted to assess these parameters between stress urinary incontinence and control groups. Logistic regression and receiver operating characteristic curve analyses were employed to evaluate the diagnostic performance of each motion parameter and their combinations for stress urinary incontinence.

RESULTS

Overall, 173 women were enrolled in this study (82, stress urinary incontinence group; 91, control group). No significant differences were observed in the maximum and average speeds of bladder neck descent and in the speed variance of bladder neck descent. The maximum and average speed of the β and urethral rotation angles were faster in the stress urinary incontinence group than in the control group (151.2 vs 109.0 mm/s, P=.001; 6.0 vs 3.1 mm/s, P<.001; 105.5 vs 69.6 mm/s, P<.001; 10.1 vs 7.9 mm/s, P=.011, respectively). The speed variance of the β and urethral rotation angles were higher in the stress urinary incontinence group (844.8 vs 336.4, P<.001; 347.6 vs 131.1, P<.001, respectively). The combination of the average speed of the β angle, maximum speed of the urethral rotation angle, and duration of the Valsalva maneuver demonstrated a strong diagnostic performance (area under the curve, 0.87). When 0.481∗β anglea+0.013∗URAm+0.483∗Dval=7.405, the diagnostic sensitivity was 70% and specificity was 92%, highlighting the significant role of bladder neck motion in stress urinary incontinence, particularly changes in the speed of the β and urethral rotation angles.

CONCLUSIONS

A system utilizing deep learning can describe the motion of the bladder neck in women with stress urinary incontinence during the Valsalva maneuver, making it possible to visualize and quantify bladder neck motion on transperineal ultrasound. The speeds of the β and urethral rotation angles and duration of the Valsalva maneuver were relatively reliable diagnostic parameters.

Correlation analysis of selected anatomical and functional parameters of the urethra, assessed through ultrasound and urodynamic examinations

Aim

This study aimed to examine the correlations between specific urethral function parameters observed in urodynamic testing and selected urethral characteristics evaluated by pelvic floor ultrasonography. Additionally, the presence of urethral funneling during straining was evaluated in female patients referred for surgical treatment of stress urinary incontinence.

Material and methods

A retrospective study was conducted on 192 female patients referred for surgical treatment of stress urinary incontinence with the use of retropubic tension-free vaginal tape. Maximum urethral closure pressure and functional urethral length were evaluated urodynamically during resting profilometry. Ultrasound measurements, along with the assessment of funneling, were performed as part of the pelvic floor examination, following the technique described by Kociszewski. Patients with clinically significant pelvic organ prolapse, a history of anterior compartment surgery, prior radiotherapy, or symptoms of overactive bladder were excluded from the analysis.

Results

The values obtained from urodynamic and ultrasound examinations were evaluated statistically. No correlation was identified between the analyzed urodynamic and ultrasound parameters. Long urethral funneling was confirmed in all patients with stress urinary incontinence assessed as eligible for the placement of tension-free vaginal tape.

Conclusions

The results indicate that urodynamic and ultrasound examinations assess distinct aspects of urethral anatomy and function, and therefore their findings cannot be used interchangeably. Long urethral funneling assessed during pelvic floor ultrasonography was noted in all patients with clinically and urodynamically confirmed stress urinary incontinence.

Electromyographic parameters for treatment of pelvic floor disorders in pregnant and postpartum women: A review protocol

Electromyography is a widely used instrument in clinical practice to evaluate and treat pelvic floor disorders in pregnant and postpartum women. The objective of this study is to analyze the scientific evidence on the electromyography parameters used for treatment of pelvic floor disorders in pregnant women in any gestational week and postpartum women up to 12 months after delivery. A systematic review of randomized controlled experimental studies (clinical trials) and quasi-experimental studies in English, Portuguese or Spanish, which used electromyography as an intervention for treatment of pelvic floor disorders in pregnant or postpartum women up to 12 months after delivery will be performed in online databases (Scopus, Medline, Pedro, Scielo and Pubmed),. Risk of bias assessment will be performed using Cochrane group tools. The Rob 2.0 tool will be used for experimental studies and the Robins-I tool for non-experimental studies. The protocol was registered in PROSPERO (no.433510). The quality of the evidence will be analyzed using the GRADE System Methodological Guide and the systematic review structure will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Quality of life following transobturator sling surgery for female stress urinary incontinence

OBJECTIVE

This descriptive study examines quality of life in women undergoing placement of a midurethral sling for stress urinary incontinence.

MATERIALS AND METHODS

This was a retrospective cohort study based on data from 51 women consecutively undergoing this procedure at a tertiary hospital in the years 2014 and 2015. The main outcome variable was quality of life assessed through the Sandvick severity test and International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF) at the time points baseline or presurgery, and 6 months and 5 years postsurgery. Factors associated with treatment failure were determined through binary logistic regression.

RESULTS

At 5-year follow up we obtained an absolute reduction of 8.78 points (95% CI 6.43-11.14; p < 0.001) in the ICIQ-IU-SF questionnaire and 4.54 (95% CI 3.25-5.83; p < 0.001) in the Sandvick severity test score, compared to baseline, in the 35 patients that completed follow-up. Out of the 51 patients that were followed, the rate of success in incontinence correction was 86.3% (44/50) with a failure rate of 12% (6/50). Multiparity and previous gynaecological surgery were identified as predisposing factors for treatment failure. Obesity was associated with a worse treatment outcome.

CONCLUSION

Sling treatment for incontinence was successful in 86.3% (44/50) of participants and remained effective 5 years after surgery in terms of quality of life.

Heterogeneity in extracellular matrix and immune microenvironment of anterior vaginal wall revealed by single-cell sequencing in women with stress urinary incontinence

Stress urinary incontinence (SUI), characterized by involuntary urine leakage during increased abdominal pressure, remains poorly understood regarding its pathophysiology and treatment. In this study, we utilized single-cell sequencing to analyze the transcriptomic profiles of different cell types in anterior vaginal wall of SUI patients, aiming to explore the heterogeneity of the extracellular matrix (ECM) and immune microenvironment in SUI pathogenesis. Our results identified eleven cell types, including connective tissue cells, immune cells, and glial cells. Specifically, fibroblasts, smooth muscle cells, epithelial cells and T cells displayed transcriptional characteristics highly relevant to SUI pathogenesis. We observed that most cell types participate in ECM metabolism and immune-inflammatory responses, indicating a synergistic role of multiple vaginal cell types in SUI. Furthermore, altered intercellular communication, particularly between fibroblasts and T cells, was noted in SUI. This study provides novel single-cell insights into SUI and identifies potential biomarkers and therapeutic targets for future research.

Prevalence of stress urinary incontinence symptoms and their impact on the quality of life of Palestinian women: the first large cross-sectional study among the general population

BACKGROUND

Little studies were conducted to assess the prevalence of stress urinary incontinence among Palestinian women. This study was conducted to determine the prevalence of stress urinary incontinence symptoms, their impact on the quality of life, and the risk factors that were associated with stress incontinence symptoms among Palestinian women.

METHODS

This study was conducted in a cross-sectional design from 2023 to 2024. The data were collected through an interviewer-administered questionnaire. The questionnaire collected the demographic and health characteristics of the women. Additionally, the questionnaire also contained the PRAFAB questionnaire (PRAFAB-Q). Moreover, the questionnaire included the Assessment of Quality of Life (AQoL)-8D scale.

RESULTS

Data were collected from 386 Palestinian women (response rate = 85.8%). The mean age of women in this study was 37.1 ± 14.7 years. In this study, 104 (26.9%) reported stress urinary incontinence symptoms. Of the women, 102 (26.4%) reported urinary leakage during coughing, 100 (25.9%) reported urinary leakage during sneezing, and 94 (24.4%) reported urinary leakage during laughing. The women who had a family history of stress incontinence were 2.5-fold (95% CI: 1.2-5.2) more likely to have stress incontinence symptoms compared to the women who did not have a family history of stress incontinence. Similarly, the women who were overweight/obese were 2.0-fold (95% CI: 1.1-3.7) more likely to have stress incontinence symptoms compared to the women who were underweight or had a normal weight. PRAFAB-Q scores were predicted by place of residence, family history of stress incontinence, and being recruited from a hospital.

CONCLUSION

The study reported a high prevalence of stress urinary incontinence and identified the risk factors that were associated with stress incontinence symptoms among Palestinian women. The findings showed that the intensity of stress urinary incontinence symptoms was associated with deteriorated quality of life of the affected women. These findings could be used by urologists, gynecologists, obstetricians, and other healthcare providers caring for women to design ways to reduce the burden of stress urinary incontinence among Palestinian women and improve their quality of life.

Comparison of the effects of pelvic floor muscle training and modified pilates exercises in elderly women with stress urinary incontinence: A randomized clinical trial

OBJECTIVE

The aim of this study was to compare the effects of pelvic floor muscle training (PFMT) and modified pilates exercises (MPE) in elderly women with stress urinary incontinence (SUI).

STUDY DESIGN

Both randomized groups [Group 1: PFMT (n = 17), Group 2: MPE (n = 17)] performed their exercises twice a week for 12 weeks. Incontinence Severity Index (ISI), Urogenital Distress Inventory-Short Form (UDI-6) and Incontinence Impact Questionnaire-Short Form (IIQ-7) were used to assess SUI frequency and level of exposure from symptoms, electromyography (EMG) device was used to assess PFM activation response and a stabilizer was used to assess transversus abdominis (TrA) muscle strength. The assessments were performed at baseline and at week 12.

RESULTS

While in-group assessment there were statistically significant differences in ISI, UDI-6, IIQ-7 in both groups at week 12 (p < 0.05); in the assessment between groups, there were statistically significant difference for EMG-work avarage (U = 60.00, P = 0.02), EMG-work peak (U = 62,50, P = 0.03) and EMG-rest peak (U = 61,50, P = 0.03) in favor of Group 1 and TrA muscle strength (U = 61.00, P = 0.02) in favor of Group 2 from baseline to week 12 (p < 0.05).

CONCLUSION

In summary, MPE can be considered alternative and safe exercise in clinic for elderly women with SUI who do not want to receive PFMT for various reasons.

Cellular regenerative therapy in stress urinary incontinence: new frontiers?-a narrative review

Background and Objective

Even if treatment with stem cells has been shown to be safe and effective in many patients with stress urinary incontinence (SUI), there is still room for improvement using other regenerative medicine alternatives. Since the beneficial effects of stem cells are probably mediated by secretion of factors rather than by the cells themselves there is a good rationale for further exploring the therapeutic effects of the secretome and/or its components. However, homing factors such as stromal derived growth factor 1 (SDF-1; CXCL12), stimulation of stem cell growth and stem cell mobilization in vivo using low intensity shock wave therapy (Li-ESWT) or regenerative electrical stimulation (RES), are also promising approaches.

Methods

A literature search was performed based on PubMed, Scopus and Google Scholar. The search criteria included original basic science articles, systematic reviews and randomized control trials. All studies were published between 2000 and 2023. Selected, peer-reviewed studies were further analyzed to identify those of relevance. Keywords searched included: "female stress incontinence", "homing factors", "CXCL12", "secretome", "low intensity shockwave therapy" and "regenerative electrical stimulation". The peer-reviewed publications on the key word subjects that contained a novel addition to the existing body of literature were included.

Key Content and Findings

There is evidence from studies on non-human primates (NHPs) with experimental urinary sphincter injury that CXCL12 can restore sphincter structure and function. Studies with homing factors in human patients with SUI are still to be performed. A large number of clinical studies on the use of secretome or secretome products from mesenchymal stem cells (MSCs) on indications other than human SUI are already available. However, controlled clinical trials on patients with SUI, have to the best of our knowledge, not yet been performed. Also, RES has not been studied in patients with SUI. In contrast, there is clinical evidence that Li-ESWT may improve female SUI.

Conclusions

Treatment with homing factors, MSC secretome/secretome components, Li-ESWT and RES are promising frontiers in the treatment of human SUI caused by sphincter damage.

Single Incision Sling Surgery for Female Stress Urinary Incontinence: A Retrospective Cohort Single-Institution Study

Background: Stress urinary incontinence (SUI) affects around 35% of adult women and has a significant impact on quality of life. A single incision sling (SIS), such as Altis®, was introduced to improve original slings and avoid complications. The present study aimed to evaluate the SIS Altis® subjective and objective cure rates of women with SUI, mixed urinary incontinence (MUI), recurrent SUI, and SUI with concomitant prolapse and report its complications from one single medical center. Methodology: A retrospective cohort, unsponsored study was conducted at the Jordan University Hospital. All women patients were treated with the SIS Altis® procedure, and prolapse procedures were also completed as necessary. The chi square analysis for the cure rates was conducted between the subgroups. Results: From June 2016 to June 2019, 111 women patients with a mean age of 48.0 ± 11.3 years underwent a SIS Altis® procedure. The overall outcome resulted in 81% and 85% of patients being subjectively and objectively cured. The subjectively cured MUI patients were significantly fewer than SUI patients (70% versus 86%, p < 0.05), and patients with recurrent SUI had significantly lower rates (56% for subjective and objective cure rates; p < 0.01 and 0.001). Of the 44 patients who underwent SIS Altis® and concomitant vaginal repair surgery, no significant differences in subjective and objective cure rates were observed. Only 2.7% of women had mild pain, 2.7% had vaginal tape erosion, and 9% had to be re-operated on. Conclusions: The Altis® procedure is effective in women who suffer from SUI for a 19-month follow-up period. However, recurrent SUI patients had lower subjective and objective cure rates than primary SUI patients. Further research is needed with a larger sample size in a prospective study design to determine the effectiveness of single SIS in patients with recurrent SUI.

Management of Stress Urinary Incontinence by Obstetricians and Gynecologists in Jordan: A Nationwide Survey Study

BACKGROUND

Stress urinary incontinence (SUI) is a common condition that can significantly impact a patient's quality of life. Although multiple diagnostic and treatment options exist, significant variability in SUI management exists between countries. Since women's SUI prevalence in Jordan is high, and Jordan is a lower-middle-income country, this study aimed to investigate how obstetricians and gynecologists (OBGYNs) across Jordan manage and treat women with SUI.

METHOD

A Google Forms survey was prepared and sent out to Jordanian OBGYNs via WhatsApp. The results were collected and arranged in Microsoft Excel and then transferred to SPSS for statistical analysis.

RESULTS

Out of the 804 Jordanian registered OBGYNs, 497 could be reached, 240 conduct gynecological surgeries, and 94 completed the survey, providing a response rate of 39.2%. Most of the respondents were females between 41 and 55 years old. More than 70% of the OBGYNs worked in the private sector, and 88.3% operated in the capital of Jordan. Most of the respondents favored lifestyle and behavior therapy (43.6%) or pelvic floor physiotherapy (40.4%) as the first-line management for SUI. The transobturator mid-urethral sling (MUS) was the most common initial surgical treatment option. The physicians preferred two-staged procedures for the repair of pelvic organ prolapse alongside concomitant SUI. In the case of recurrent SUI following surgery, 77% of the respondents chose to refer to a urologist or urogynecologist.

CONCLUSIONS

The Jordanian OBGYNs preferred using lifestyle/behavioral therapy and pelvic floor muscle physiotherapy as the first-line treatment to manage SUI. Secondly, the MUS would be the most frequently preferred surgical choice. To effectively manage SUI, adequate training in urogynecology and referral resources are essential in lower-middle-income countries.

Associations between running mechanics, functional lower extremity strength, and stress urinary incontinence in parous female runners

Background

Women with stress urinary incontinence (SUI) may have altered running mechanics and reduced hip muscle strength compared to women without SUI. Little research has examined running metrics and functional lower extremity strength of parous runners.

Objective

To determine if stress urinary incontinence (SUI) severity correlates with running metrics and lower extremity muscle strength among parous women.

Study Design

Cross-sectional observational study of 22 parous participants (mean age 39.8 years, with a mean of 3.4 pregnancies and 8.1 years interval since last delivery).

Methods

Participants completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI), Urinary Distress Inventory (UDI) 6, Colorectal-Anal Distress (CRAD) Inventory 8, and Pelvic Organ Prolapse Distress Inventory (POPDI) 6, Questionnaire for Urinary Incontinence Diagnosis (QUID), and provided demographic, relevant running, and obstetric/gynecologic history information. After a brief warm-up, participants completed 30-second single leg sit to stand tests bilaterally and a standardized 10-minute treadmill run with pod cadence assessment. Pearson-product moment correlation coefficients were calculated (alpha = 0.05).

Results

Prolonged ground contact times were associated with higher ICIQ-UI SF (r = 0.523, p = 0.015), POPDI-6 (r = 0.694, p < 0.001), and UDI-6 scores (r = 0.577, p = 0.006), while lower cadences were associated with higher POPDI-6 (r = -0.550, p = 0.010) and UDI-6 scores (r = -0.444, p=0.044).

Conclusion

Parous female runners with more severe SUI and prolapse symptoms demonstrate altered running mechanics characterized by prolonged ground contact times and slower cadences.

The effect of electroacupuncture applied to women with stress urinary incontinence on urinary incontinence severity and symptoms: Systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Stress Urinary Incontinence is a condition that impairs the quality of life in women and randomized controlled trials of electroacupuncture for stress urinary incontinence have been conducted.

OBJECTIVE

The aim of this systematic review and meta-analysis was to examine the effect of electroacupuncture on the severity and symptoms of urinary incontinence in women with stress urinary incontinence.

METHODS

Literature searches were conducted in PubMed, CINAHL, Scopus and Science Citation Index until November 2023. This study was based on the recommendations of the Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4). The methodological quality of the studies was assessed using the RoB-2 tool.

RESULTS

The analysis included 888 women with stress urinary incontinence and three studies. In women with stress urinary incontinence, electroacupuncture intervention improved urinary incontinence severity and quality of life (MD: -2.37, 95% CI: -3.29 to 1.45, Z = 5.07, p < 0.001), urinary leakage (SMD: -0.79, 95% CI: -1.02 to -0.55, Z = 6.60, p = 0.001) and incontinence episode frequency (SMD: -2.24, 95% CI: -4.17 to -0.32, Z = 2.29, p < 0.02).

CONCLUSION

In women with stress urinary incontinence, electroacupuncture intervention decreased the severity of urinary incontinence and improved the quality of life. Symptoms related to urinary incontinence were found to decrease urinary leakage and incontinence episode frequency. The studies included in the analysis were determined to be low-risk studies in quality assessment.

Effects of vaccination against COVID-19 on overactive bladder symptoms on young population

Introduction

The vaccines developed against COVID-19 have different modes of action, with a primary focus on the spike protein of the virus. Adverse effects following vaccination have been reported, including local and systemic symptoms. Understanding the potential side effects on the urinary tract after vaccination is of importance. Actively investigating and comprehending the potential impact on the urinary tract, we can enhance public health strategies and pave the way for safer and more effective vaccination programs.

Methodology

The study was based on an online survey that included the Spanish Version of the Overactive Bladder Symptom Score (OABSS-S); 2,362 men and women replied to the survey. After the application of the exclusion criteria, 1,563 participants were insured. In the context of COVID-19, individuals were questioned regarding several key factors related to their vaccination status and medical history. These factors included the number of vaccine doses received, the specific type of vaccine administered, whether they had previously contracted COVID-19, and the frequency of prior infections, if applicable.

Results

A total of 1,563 (74.7% women and 27.3% men) subjects between the ages of 18 and 45 completed the survey and were included in the final analyses. The most frequently administered vaccine type was Pfizer-BioNTech (42.2%), and most subjects received three doses. The proportion of females who received the AstraZeneca vaccine and do not require to urinate during the night is significantly higher compared to males (59.1% vs. 33.3%; p<0.05). The proportion of individuals who urinate five or more times during the night is higher in those who have received a single vaccine dose than in those who have received three doses (2.2% vs. 0.1%; p<0.05).

Conclusion

COVID-19 vaccination has been found to impact the lower urinary tract (LUT) and overactive bladder (OAB). Initially, LUT symptoms worsened, and OABSS-S scores increased after the first vaccine dose in individuals under 45 years old. However, symptoms improved after receiving the third and fourth doses. Gender differences were observed in the vaccination effects. Men vaccinated with AstraZeneca reported a higher number of nighttime voids, while women vaccinated with Moderna reported more daytime voids.

Association of plasma high-density lipoprotein cholesterol level with risk of stress urinary incontinence in women: a retrospective study

BACKGROUND

Studies have found that high density lipoprotein cholesterol (HDL-C) levels are linked to a variety of diseases. However, evidence for the relationship between stress urinary incontinence (SUI) and HDL-C remain limited.

METHODS

590 eligible women were enrolled. Basic characteristic, gynecological examinations and blood sampling were collected. The examination of the possible link between HDL-C and SUI was done using univariate and multivariate logistic regression. Feature importance ranking and Receiver operating characteristic (ROC) curves were performed to further evaluate the association between HDL-C and SUI in women.

RESULTS

A significant association was found between HDL-C and SUI in women, revealing higher HDL-C levels were related to a lower risk of SUI (OR 0.238; 95%CI: 0.091-0.623; P < 0.01) after adjustment for potential key confounders. The AUC for the SUI predicted by the combined HDL-C was 0.845 (95%CI: 0.798-0.891, P < 0.001). The feature importance ranking revealed that vaginal delivery, HDL-C were the top two important factors.

CONCLUSIONS

HDL-C levels were correlated with the development of SUI. In addition to physical and surgical treatments, HDL-C may offer the possibility of potential targeted treatment and prevention of SUI afterwards.

Neuromodulation Improves Stress Urinary Incontinence-Like Deficits in Female Rabbits

Objective: Stress urinary incontinence (SUI) affects a third of the female population and is characterized by involuntary urine leakage during abdominal efforts such as sneezing, laughing, or coughing. Acute neuromodulation of the bulbospongiosus nerve (BsN) was shown to increase bladder efficiency in aged and multiparous rabbits. This study investigates the efficacy of sub-chronic BsN neuromodulation in alleviating SUI-like deficits in mature multiparous rabbits, characterized by increased urine leakage and reduced leak point pressure. Results: Using the voiding spot assay, we observed a 40% reduction in urine leakage events after 30 days of BsN stimulation, which correlated with a 60% increase in daily micturition volume, a 10-fold increase in voided volume, and improvements in voiding efficiency and leak point pressure compared to negative control animals. Conclusion: In multiparous rabbits, BsN neuromodulation improves important SUI-like metrics including bladder capacity and urethral closure, supporting the use of this bioelectronic modality as treatment for SUI.

An estimation of the biomechanical properties of the continent and incontinent woman bladder via inverse finite element analysis

Stress urinary incontinence often results from pelvic support structures' weakening or damage. This dysfunction is related to direct injury of the pelvic organ's muscular, ligamentous or connective tissue structures due to aging, vaginal delivery or increase of the intra-abdominal pressure, for example, defecation or due to obesity. Mechanical changes alter the soft tissues' microstructural composition and therefore may affect their biomechanical properties. This study focuses on adapting an inverse finite element analysis to estimate the in vivo bladder's biomechanical properties of two groups of women (continent group (G1) and incontinent group (G2)). These properties were estimated based on MRI, by comparing measurement of the bladder neck's displacements during dynamic MRI acquired in Valsalva maneuver with the results from inverse analysis. For G2, the intra-abdominal pressure was adjusted after applying a 95% impairment to the supporting structures. The material parameters were estimated for the two groups using the Ogden hyperelastic constitutive model. Finite element analysis results showed that the bladder tissue of women with stress urinary incontinence have the highest stiffness (α1 = 0.202 MPa and µ1 = 7.720 MPa) approximately 47% higher when compared to continent women. According to the bladder neck's supero-inferior displacement measured in the MRI, the intra-abdominal pressure values were adjusted for the G2, presenting a difference of 20% (4.0 kPa for G1 and 5.0 kPa for G2). The knowledge of the pelvic structures' biomechanical properties, through this non-invasive methodology, can be crucial in the choice of the synthetic mesh to treat dysfunction when considering personalized options.

Biomechanical Integrity Score of the Female Pelvic Floor for Stress Urinary Incontinence

INTRODUCTION AND HYPOTHESIS

This study is aimed at developing and validating a new integral parameter, the Biomechanical Integrity score (BI-score) of the female pelvic floor for stress urinary incontinence conditions.

METHODS

A total of 130 subjects were included in the observational cohort study; 70 subjects had normal pelvic floor conditions, and 60 subjects had stress urinary incontinence (SUI). A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t test, correlation) to identify the VTI parameters sensitive to the pelvic SUI conditions.

RESULTS

Twenty-seven parameters were identified as statistically sensitive to SUI development. They were subdivided into five groups to characterize tissue elasticity (group 1), pelvic support (group 2), pelvic muscle contraction (group 3), involuntary muscle relaxation (group 4), and pelvic muscle mobility (group 5). Every parameter was transformed to its standard deviation units using the dataset for normal pelvic conditions, similar to the T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups 1-5 and to the BI-score in standard deviation units. The p value for the BI-score has p = 4.0 × 10-28 for SUI versus normal conditions.

CONCLUSIONS

Quantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the SUI BI-score in future research and clinical applications.

An Overview of the Effect of Aging on the Female Urethra

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.

Influence of vaginal birth on lumbopelvic muscle mechanical properties on urinary incontinence

OBJECTIVE

To identify differences in the muscle mechanical properties of the pelvic floor (PF) and lumbar paravertebral (LP) muscles between young nulliparous and uni/multiparous women. Secondarily, specific behaviors, depending on the presence or absence or urinary incontinence (UI), were also researched.

DESIGN

Case-control study.

SETTING

Higher education institution.

PARTICIPANTS

One hundred young women participated, divided into two groups depending on whether they had vaginal birth (nulliparous or uni/multiparous). Each group included women with and without UI.

MAIN MEASURES

A muscle mechanical properties (tone, stiffness, decrement-inverse of elasticity-, and viscoelastic properties: relaxation and creep) assessment of the PF and LP muscles were performed with a hand-held tonometer.

RESULTS

Tone and stiffness of both sides of the PF presented group by UI interaction (p < 0.05), with uni/multiparous women with UI showing higher tone and stiffness compared to multiparous women without UI. In LP muscles, uni/multiparous women showed greater tone and stiffness on the right and left sides [-2.57 Hz (95% confidence interval -4.42,-0.72) and -79.74 N/m (-143.52,-15.97); -2.20 Hz (-3.82,-0.58) and -81.30 N/m (-140.66-,21.95), respectively], as well as a decrease in viscoelastic properties compared to nulliparous women [relaxation: 2.88 ms (0.31,5.44); creep: 0.15 (0.01,0.30); relaxation: 2.69 ms (0.13,5.25); creep: 0.14 (0,0.28), respectively].

CONCLUSIONS

Vaginal birth and UI have a differential influence on the muscle mechanical properties of the PF and LP muscles. The determination of muscle mechanical properties by externally applied hand-held tonometry improves the knowledge of the lumbopelvic status, with applicability in clinical and research fields.

Autologous platelet rich plasma (A-PRP) combined with pelvic floor muscle training for the treatment of female stress urinary incontinence (SUI): A randomized control clinical trial

IMPORTANCE

Autologous platelet-rich plasma (A-PRP) injection is a novel intervention for stress urinary incontinence (SUI) in women. However, no Phase II clinical trial has compared the outcomes of A-PRP injection combined with pelvic floor muscle training (PFMT) with those of PFMT alone in these women.

OBJECTIVE

The primary aim was to compare the efficacy of A-PRP + PFMT versus PFMT alone in women with SUI. The secondary aim was to determine any adverse effects of A-PRP injection.

DESIGN

Randomized clinical trial, single-blind assessment.

SETTING

Urogynecology clinic at a tertiary medical center.

PARTICIPANTS

Women with previously untreated SUI. Women in whom there was any suspicion of urgency, those with an Overactive Bladder Symptoms Score of ≥1, and those with obesity, pelvic organ prolapse, thrombocytopenia, or coagulopathy were excluded.

INTERVENTIONS

Two injections of A-PRP were administered with a 1-month interval between injections in the A-PRP injection + PFMT group. Both groups received PFMT.

MAIN OUTCOMES AND MEASURES

The primary outcome was determined using the 1-h pad weight test (PWT). Secondary outcomes were measured using the Incontinence Quality of Life Questionnaire, item 11 on the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms questionnaire, Patient Global Impression of Improvement, and the percentage subjective improvement score.

RESULTS

Data for 60 study participants were available for analysis (A-PRP + PFMT group, n = 31; PFMT group, n = 29). The 1-h PWT decreased significantly in the A-PRP + PFMT group but only slightly in the PFMT group at the 5-month follow-up. There was a statistically significant between-group difference in the 1-h pad weight of about 8 g in favor of the A-PRP + PFMT group. A statistically significant difference in symptoms of SUI measured by the questionnaires was found between the A-PRP + PFMT group and the PFMT group at the 2- and 5-month follow-up assessments. There were no reports of adverse events following injection of A-PRP.

CONCLUSIONS AND RELEVANCE

A-PRP + PFMT could be a treatment option for women with SUI. Large Phase III randomized controlled trials are required to confirm our findings.

The acute effects of running on pelvic floor morphology and function in runners with and without running-induced stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

The aim of this study was to examine the impact of a single running session on pelvic floor morphology and function in female runners, and to compare those with and without running-induced stress urinary incontinence (RI-SUI).

METHODS

This cross-sectional, observational study involved two groups: female runners who regularly experienced RI-SUI (n = 19) and runners who did not (n = 20). Pelvic floor muscle (PFM) properties were assessed using intravaginal dynamometry during maximal voluntary contractions (MVC) and during passive tissue elongation. The morphology of the pelvic floor was assessed at rest, during MVC and during maximal Valsalva maneuver (MVM) using 2D and 3D transperineal ultrasound imaging before and after a running protocol. Mixed-effects ANOVA models were used to compare all outcomes between groups and within-groups, including the interaction between group and time. Effect sizes were calculated.

RESULTS

No changes in PFM function assessed using intravaginal dynamometry were observed in either group after the run. Significant and large within-group differences were observed on ultrasound imaging. Specifically, the area and antero-posterior diameter of the levator hiatus were larger after the run, the bladder neck height was lower after the run, and the levator plate length was longer after the run (p ≤ 0.05). At the peak MVM and MVC, the bladder neck height was lower after the run than before the run (p ≤ 0.05). No between-group differences were observed for any outcomes.

CONCLUSIONS

Running appears to cause transient strain of the passive tissues of the female pelvic floor in runners both with and without RI-SUI, whereas no concurrent changes are observed in PFM contractile function.

Most of the pelvic floor muscle functions in women differ in different body positions, yet others remain similar: systematic review with meta-analysis

Objectives

This systematic literature review and meta-analysis aimed to determine the effect of body position on the measurement of pelvic floor muscle (PFM) contractility and to analyze the influential factors.

Data sources

Five databases (PubMed, Web of Science, EMBASE, Cochrane Library and Scopus) were searched for relevant studies published up to 12nd October 2023.

Study selection or eligibility criteria

Included cross-sectional studies had to involve the assessment of pelvic floor muscle function in at least two positions.

Study appraisal and synthesis methods

We calculated standardized mean difference (SMD) with 95% confidence intervals (CI) to ascertain the potential effect of body position on outcomes.

Results

In total, we included 11 cross-sectional studies to ascertain the potential effect of body position on outcomes. There was no statistical difference in the results of maximum voluntary contraction (MVC) of the pelvic floor muscles when assessed in between supine and standing positions (SMD -0.22; 95% CI -0.72 to 0.28; p = 0.38). The results of the meta-analysis showed significantly larger values of resting voluntary contractions (RVC) measured in the standing position compared to the supine position (SMD -1.76; 95% CI -2.55 to -0.97; p < 0.001). Moreover, pelvic floor muscle movement during pelvic floor muscle contraction in the standing position was significantly better than that measured in the supine position (SMD -0.47; 95% CI -0.73 to 0.20; P < 0.001).

Conclusion

The results of this study showed that the RVC and PFM movement varied with the position of the assessment. In contrast, MVC values are independent of the assessment position and can be selected according to clinical needs.

Systematic review registration

PROSPERO, identifier CRD42022363734, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022363734.

Multiparity Reduces Urethral and Vaginal Pressures Following the Bulboglandularis Muscle Stimulation in Rabbits

Unlike male mammals showing a well-delimited external urethral sphincter, female mammals have urogenital sphincters shaped by muscles like the urethrovaginal sphincter. Childbirth-related injuries affect morphometry and function of urogenital sphincters in women, which frequently underlies pelvic floor disorders, including stress urinary incontinence and pelvic organ prolapse. The bulboglandularis muscle (Bgm) seems to shape a urogenital sphincter in rabbits. We determined herein the effect of multiparity on urethral and vaginal pressures generated by the Bgm stimulation in age-matched nulliparous and multiparous chinchilla-breed rabbits to stimulate the Bgm with trains of ascending frequencies (from 1 to 100 Hz; 4 s duration each). Subsequently, the Bgm was excised, measured in width, and weighed. Significant differences (P ≤ 0.05) were determined with Mann-Whitney U or Student t-tests or repeated measures two-way ANOVA followed by Tukey tests. Spearman's partial coefficients were calculated to investigate the correlation between the highest pressure (urethral or vaginal) and the Bgm width. Multiparity reduced the weight and the width in the Bgm origin and medial regions. Urethral and vaginal pressures increased in response to the electrical stimulation of Bgm with frequencies from 20 to 100 Hz. Multiparas showed significant reductions in both types of pressures. We detected a strong correlation (conditioned by multiparity) between the medial Bgm width and the highest vaginal pressure. Our present findings demonstrate that multiparity impairs the function of Bgm, resulting in diminished urethral and vaginal pressures. Furthermore, the significant narrowness of the Bgm was correlated with the vaginal pressure recorded.

Bladder neck incompetence could be an etiology of overactive bladder syndrome in women with stress urinary incontinence after anti-incontinence surgery: insights from transrectal sonography

PURPOSE

To investigate the prevalence of bladder neck incompetence (BNI) and the anatomic differences between different types of urinary incontinence (UI) and overactive bladder (OAB) by transrectal sonography, and to investigate these differences among those with stress UI (SUI) or mixed UI (MUI) who exhibited de novo or persistent OAB symptoms following anti-incontinence surgery.

METHODS

A retrospective analysis was conducted on a total of 184 patients with SUI, MUI, urge UI (UUI), or OAB dry who underwent transrectal ultrasound between 2017 and 2022. The presence of BNI and urethral incompetence assessed by transrectal ultrasound were recorded in all included patients, and recorded preoperatively and postoperatively among patients with SUI and MUI who underwent anti-incontinence surgery.

RESULTS

Among the patients, 91%, 84%, 76%, and 71% exhibited BNI in MUI, SUI, UUI, OAB dry group, respectively. Significantly higher rate of patients with BNI were found in MUI than in OAB dry group. Patients with OAB symptoms after anti-incontinence surgery exhibited significantly higher rates of BNI and urethral incompetence than those who did not have postoperative OAB symptoms. Among MUI patients with preoperative BNI, significantly lower rate of postoperative BNI and urethral incompetence was observed in individuals who had improved OAB symptoms after surgery, compared to those without improvement.

CONCLUSION

A higher BNI rate was observed in the MUI group. A significantly higher BNI rate was observed in women with OAB symptoms after anti-incontinence surgery. Patients with MUI had improved OAB symptoms if BNI was successfully corrected after anti-incontinence surgery.

Differences in pelvic floor muscle morphology and function between female runners with and without running-induced stress urinary incontinence

OBJECTIVE

To investigate the differences in pelvic floor muscle (PFM) morphology and function between female runners with and without running-induced stress urinary incontinence (RI-SUI).

DESIGN

This was a cross-sectional, observational study.

METHODS

Experienced female runners were recruited into two groups: runners who regularly experience RI-SUI (n = 19) and runners who do not (n = 20). Active and passive pelvic floor muscle (PFM) properties were assessed using intravaginal dynamometry during maximal voluntary contractions (MVC) and during passive tissue elongation. The morphology of the urethra and PFMs was assessed using 2D and 3D transperineal ultrasound imaging. Independent t tests or Mann-Whitney U were used as appropriate to test group differences on all study outcomes, and Cohen's d effect sizes were calculated.

RESULTS

The rate of force development during the MVC was significantly higher in participants reporting RI-SUI (p ≤ 0.05) and conversely, significantly lower during passive elongation of the PFMs (p ≤ 0.05) compared to runners with no history of leakage. Concurrently, the extent of bladder neck elevation between rest and maximum voluntary activation was significantly higher among those with RI-SUI compared to those without. Although not significant, small to moderate effect sizes were observed for other outcomes-active force outcomes measured during MVC tended to be higher in runners with RI-SUI, while passive force outcomes measured during passive tissue elongation tended to be lower. The cross-sectional area of the urethral wall and the area of the levator hiatus tended to be larger in runners with RI-SUI compared to those without.

CONCLUSION

Runners who experience RI-SUI demonstrate better PFM contractile function but lower passive support when compared to their continent counterparts.

Efficacy and safety of intraurethral Erbium:YAG laser treatment in women with stress urinary incontinence following failed intravaginal laser therapy: a retrospective study

Urinary incontinence (UI) is a prevalent condition affecting 25-45% of women and is linked to factors such as menopause, parity, high body mass index, and radical pelvic surgery. Among the three types of UI, stress incontinence (SUI) is the most common, accounting for almost 50% of cases, followed by urgency and overflow incontinence. UI has been found to be associated with reduced quality of life and mental stress. Non-invasive laser treatment is the safest and most effective option for managing SUI, with intraurethral Erbium SMOOTHTM laser treatment holding promise for patients experiencing SUI even after undergoing previous failed intravaginal Erbium:YAG laser treatment. The study recruited 93 female patients with mild to moderate SUI who had received two courses of intravaginal Erbium:YAG laser between January 2015 and June 2018. Of these, 22 patients (23%) who continued to experience SUI after a four-week interval for a second intravaginal Erbium:YAG laser were selected for intraurethral laser treatment in January 2019. The efficacy of the treatment was evaluated by comparing the pre- and post-treatment ICIQ-UI SF score. The urethral length was measured before the procedure. The main procedure involved delivering non-ablative laser energy using Erbium SMOOTHTM technology 2940 nm via a 4-mm cannula with personalized length and fluence was 1.5 J/cm. The 22 female patients with persistent SUI received intraurethral Erbium:YAG laser treatment. Their average age was 47.5 years, with an average of 2 parities and a mean body mass index of 20.97. All patients completed the ICIQ-SF questionnaire before and 3 months after the procedure. Of the patients, 77% reported improvement in symptoms, with 6 reporting strong improvement and 11 reporting improvement. The treatment was well-tolerated, with mild and transient adverse effects such as urinary infection in 1 patient (4.5%) and mild pain in 7 patients (31.8%). Intraurethral laser treatment may be helpful for Taiwanese women with persistent SUI after vaginal laser treatment. However, patients with prior pelvic surgery or pelvic organ prolapse history may limit the efficacy of intraurethral laser. Additional research is necessary to comprehensively investigate the advantages of intraurethral laser therapy. However, using intraurethral Erbium SMOOTHTM laser treatments to rejuvenate tissues and enhance structural support could be a promising avenue for managing stress urinary incontinence in Taiwanese women.

Characteristics Associated with Pelvic Floor Disorders among Female Canadian Armed Forces Members

OBJECTIVES

Urinary incontinence (UI) and pelvic organ prolapse (POP) are prevalent pelvic floor disorders (PFDs) among the female population. In the military environment, being a non-commissioned member (NCM), and physically demanding occupations are factors associated with higher PFD risk. This study seeks to characterize the profile of female Canadian Armed Forces (CAF) members reporting symptoms of UI and/or POP.

METHODS

Present CAF members (18-65 years) responded to an online survey. Only current members were included in the analysis. Symptoms of UI and POP were collected. Multivariate logistic regressions analyzed the relationships between PFD symptoms and associated characteristics.

RESULTS

765 active members responded to female-specific questions. The prevalence of self-reported POP and UI symptoms were 14.5% and 57.0%, respectively, with 10.6% of respondents reporting both. Advanced age (adjusted odds ratio [aOR]: 1.062, CI 1.038-1.087), a body mass index (BMI) categorized as obese (aOR: 1.909, [1.183-3.081]), parity ≥1 (e.g., aOR for 1: 2.420, [1.352-4.334]) and NCMs (aOR: 1.662, [1.144-2.414]) were factors associated with urine leakage. Parity of ≥2 (aOR: 2.351, [1.370-4.037]) compared to nulliparous and having a perception of a physically demanding job (aOR: 1.933, [1.186-3.148]) were associated with experiencing POP symptoms. Parity of ≥2 increased the odds of reporting both PFD symptoms (aOR: 5.709, [2.650-12.297]).

CONCLUSION

Parity was associated with greater odds of experiencing symptoms of UI and POP. Higher age, higher BMI, and being an NCM were associated with more symptoms of UI, and the perception of having a physically demanding role increased the likelihood of reporting POP symptoms.

Impact of Defined Risk Factors on Degree of Urinary Stress Incontinence and Sling Outcome: A Retrospective Cohort Analysis

Urinary stress incontinence is a distressing condition that has a severe impact on quality of life for most affected women. The insertion of the suburethral tension-free vaginal tape (TVT) is regarded as the gold-standard surgical treatment option. It is unclear whether all women with severe SUI benefit equally from TVT. Thus, the aim of our study was to identify risk factors for severe SUI and determine whether successful the resolution of incontinence after a TVT procedure was different in women with a higher degree of SUI. In total, 168 women were included in this retrospective cohort study. Women with severe SUI showed a significantly lower maximum urethral closure pressure (MUCP) (median 53 cmH2O in moderate vs. 39 cmH2O in severe, p = 0.001) and higher BMI (median 26.1 kg/m2 in moderate vs. 28.5 kg/m2 in severe, p = 0.045). Sonographic bladder neck funneling was detected significantly more often in women with severe SUI (27% in moderate vs. 57% in severe, p = 0.004). Lower MUCP and higher BMI were identified as significant predictors of severe SUI (p < 0.032). There was no difference in parity, age, functional urethral length and negative urethral stress pressure. Overall postoperative continence after the insertion of TVT was 91.9%. We found no significant difference in postoperative continence between women with severe vs. moderate SUI, suggesting that in our cohort the success of TVT was not significantly affected by the severity of SUI. In our cohort, low MUCP and high BMI were shown to be significant predictors of SUI severity. Nevertheless, treatment success of SUI with TVT did not differ substantially in women with more severe SUI.

One in four women with stress urinary incontinence who are taught "the knack" maneuver adopt this motor pattern while coughing: A prospective interventional cohort study

QUESTIONS

Do women with stress urinary incontinence (SUI) who receive instruction to perform the knack maneuver as part of a 12-week pelvic floor muscle training (PFMT) program perform it during voluntary coughing without specific instruction to do so, and are subjective and objective outcomes better among those who do than among those who do not demonstrate the knack during voluntary coughing?

DESIGN

Secondary analysis of a prospective interventional cohort.

PARTICIPANTS

Women with SUI.

INTERVENTION

12-week PFMT intervention including instruction to perform the knack.

OUTCOME MEASURES

Performance of the knack before a voluntary cough as confirmed through ultrasound imaging. SUI severity determined subjectively (International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms [ICIQ-FLUTS] overall score, ICIQ-FLUTS UI subscale score, 3-day bladder diary) and objectively (30-min pad test).

RESULTS

Outcome data were available from 69 participants. At baseline, no participants performed the knack when asked to cough. At follow-up, more participants performed the knack during a voluntary cough [18/69 (26%), 95% confidence interval [CI] 15%-35%] than at baseline. The extent of improvement in SUI symptoms was not different between participants who did and did not demonstrate the knack during a voluntary cough [FLUTS-UI subscale score (d = 0.31, 95% CI -0.78 to 2.77, n = 69), FLUTS overall score (d = 0.26, 95% CI -1.52-4.23, n = 69), 30-min pad test (d = 0.03, 95% CI -9.35 to 10.32, n = 69), 3-day bladder diary (d = 0.03, 95% CI -4.07 to 3.60, n = 51)].

CONCLUSION

Approximately one in four women appear to adopt the knack as a motor response to a cough command, however, adopting the knack was not independently associated with greater improvements in SUI.

Magnetically controlled artificial urinary sphincter: An overview from existing devices to future developments

BACKGROUND

Urinary incontinence is a common clinical problem in the world today. Artificial urinary sphincter is a good treatment approach for severe urinary incontinence, which is designed to mimic the action of the human urinary sphincter and assist patients to regain urinary function.

METHODS

There are many control methods based on artificial urinary sphincter, such as hydraulic control, electromechanical control, magnetic control, and shape memory alloy control. In this paper, the literature was first searched and documented based on PRISMA search strategy for selected specific subject terms. Then, a comparison of artificial urethral sphincters based on different control methods was conducted, and the research progress of magnetically controlled artificial urethral sphincters was reviewed, and their advantages and disadvantages were summarized. Finally, the design factors for the clinical application of magnetically controlled artificial urinary sphincter are discussed.

RESULTS

As magnetic control allows for non-contact force transfer and does not generate heat, it is proposed that magnetic control may be one of the more promising control methods. The design of future magnetically controlled artificial urinary sphincters will need a variety of considerations, including the structural design of the device, manufacturing materials, manufacturing costs, and convenience. In addition, validation of the safety and effectiveness of the device and device management are equally important.

CONCLUSIONS

The design of an ideal magnetically controlled artificial urinary sphincter is of great importance to enhance patient treatment outcomes. However, there are still great challenges to be faced for the clinical application of such devices.

Effect of gestational weight gain on postpartum pelvic floor function in twin primiparas: a single-center retrospective study in China

BACKGROUND

The effect of gestational weight gain (GWG) as a controllable factor during pregnancy pelvic floor function has rarely been investigated, and studies on twin primiparas are even less frequent. The objective of the present study was to explore the effect of GWG on postpartum pelvic floor function in twin primiparas.

METHODS

We retrospectively analyzed the clinical data of 184 twin primiparas in the pelvic floor rehabilitation system of the First Affiliated Hospital of Chongqing Medical University from January 2020 to October 2021. Based on the GWG criteria recommended by the Institute of Medicine, the study subjects were classified into two groups: adequate GWG and excessive GWG. Univariate and multivariate logistic regression models were applied to explore the relationship between GWG and pelvic floor function.

RESULTS

Among the 184 twin primiparas, 20 (10.87%) had excessive GWG. The rates of abnormal vaginal dynamic pressure (95% vs. 74.39%), injured type I muscle fibers (80% vs. 45.73%), anterior vaginal wall prolapse (90% vs. 68.90%), and stress urinary incontinence (50% vs. 20.12%) of twin primiparas with excessive GWG were significantly higher than those with adequate GWG. There was no significant difference between the total score of the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) or the scores of the Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), the Colorectal-Anal Distress Inventory 8 (CRADI-8), and the Urinary Distress Inventory 6 (UDI-6) in the two groups (P > 0.05). After adjusting for potential confounding factors, the results showed that excessive GWG was positively associated with abnormal vaginal dynamic pressure (OR = 8.038, 95% CI: 1.001-64.514), injured type I muscle fibers (OR = 8.654, 95% CI: 2.462-30.416), anterior vaginal wall prolapse (OR = 4.705, 95% CI: 1.004-22.054), and stress urinary incontinence (OR = 4.424, 95% CI: 1.578-12.403).

CONCLUSION

Excessive GWG in twin primiparas was positively correlated with the prevalence of pelvic floor dysfunction but did not exacerbate pelvic floor symptoms in twin primiparas. Controlling GWG within a reasonable range is recommended for reducing the risk of PFDs in pregnant women with twins.

Acute Effect of a Half-Marathon over the Muscular Function and Electromyographic Activity of the Pelvic Floor in Female Runners with or without Urinary Incontinence: A Pilot Study

OBJECTIVE

to verify the acute effect of running a half marathon on pelvic floor muscle (PFM) function and electromyographic (EMG) activity in female runners with and without urinary incontinence.

METHODS

This is a cross-sectional pilot study. The sample was divided into two groups: runners with urinary incontinence (with UI) and runners without urinary incontinence (without UI). A semi-structured form and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) were used for data collection. The EMG and PFM function were evaluated using the PERFECT method before and immediately after running a half marathon.

RESULTS

A total of 14 runners were included (8 with UI; 6 without UI). Runners with and without UI did not show significant differences for EMG and PERFECT. The acute effects of the half marathon on runners without UI were reduced PFM function in terms of strength (p = 0.00), reduced endurance (p = 0.02), and reduced repetition (p = 0.03), and an increase in EMG measured by the median frequency (p = 0.02). Runners with UI showed reduced PFM function in terms of strength (p = 0.05) and repetition (p = 0.01).

CONCLUSION

there was no difference in the acute effects of the half marathon on PFM function and EMG in women with and without UI.

Effects of Age and Multiple Vaginal Births on Lower Urinary Tract Structure and Function in Nonhuman Primates

Purpose: The relative roles of urinary sphincter damage, aging, and childbirth in stress urinary incontinence (SUI), have not been established. This study was performed to elucidate the roles of these factors.Methods: The study included: (1) 8 female cynomolgus monkeys (17–19 years of age and 7–8 vaginal births each); (2) six 5-yearold nulliparous monkeys with surgically created chronic urinary sphincter dysfunction; and (3) six 5-year-old, nulliparous, nosurgery controls. Sedated abdominal leak point pressure (ALPP) and maximum urethral sphincter pressures (MUP) were measured. Sphincters, bladders, and pelvic support muscles were quantified for collagen content. Additionally, bladders were analyzed for collagen fiber thickness, length, and angle using CT-FIRE analysis of Picrosirius red-stained tissues.Results: Resting MUP values were similar in the controls and older multiparous monkeys (P>0.05). However, aging and multiple births reduced pudendal nerve-stimulated increases in MUP (P<0.05 vs. controls). ALPP values were lower in the older multiparous versus younger groups of monkeys (P<0.05). Sphincter collagen content was greater, and muscle content less, in the injury model (P<0.05 vs. controls). However, these measures were not affected by age and childbirth (P>0.05 vs. young groups). Bladder collagen content was greater, and muscle content less, in the old multiparous monkeys (P<0.05 vs. younger groups). Additionally, collagen fibers were thicker and more angular in the bladders of the older multiparous monkeys than in the other nonhuman primate groups (P<0.05). Pelvic support muscles had higher collagen and lower muscle content in the older multiparous monkeys than in the younger groups of monkeys (P<0.05).Conclusions: SUI, associated with aging and multiple childbirths, appeared to be more strongly associated with bladder dysfunction, reduced pelvic muscle support, and the compensatory response to neural stimulation than with selective urinary sphincter dysfunction.

Perineal ultrasound to assess the urethral spatial movement in stress urinary incontinence in women

BACKGROUND

Perineal ultrasound as a non-invasive method for the diagnosis of female stress urinary incontinence has attracted more and more attention. However, the criteria for stress urinary incontinence in women using perineal ultrasound have not been fully established. Our study aimed to evaluate characteristics of the urethral spatial movement with perineal ultrasonography.

METHODS

A total of 136 female patients with stress urinary incontinence and 44 controls were enrolled. Stress urinary incontinence was diagnosed using the International Consultation on Incontinence Questionnaire Short Form, medical history and physical examination, and severity was assessed using a 1 h pad test. We described the mobility of four equidistant points (A-D) located along the urethra length. The retrovesical and urethral rotation angles were measured using perineal ultrasonography at rest and during the maximal Valsalva maneuver.

RESULTS

Patients with stress urinary incontinence showed a more significant vertical movement at Points A, B and C than controls. The mean variations in the retrovesical angle were significantly larger in patients with stress urinary incontinence at rest and during the Valsalva maneuver than in controls (21.0 ± 16.5° vs. 14.7 ± 20.1°, respectively). The cut-off value for the retrovesical angle variation was 10.7° with 72% sensitivity and 54% specificity. There was a receiver-operating characteristic curve area of 0.73 and 0.72 for Points A and B, respectively. A cut-off of 10.8 mm, and 9.4 mm provided 71% sensitivity and 68% specificity and 67% sensitivity and 75% specificity, respectively.

CONCLUSIONS

The spatial movement of the bladder neck and proximal urethra, and variations in the retrovesical angle may be correlated with clinical symptoms and facilitate to the assessment of SUI.

Multifunctional Evaluation Technology for Diagnosing Malfunctions of Regional Pelvic Floor Muscles Based on Stretchable Electrode Array Probe

The pelvic floor dysfunction (PFD) has become a serious public health problem. Accurate diagnosis of regional pelvic floor muscle (PFM) malfunctions is vitally important for the prevention and treatment of PFD. However, there is a lack of reliable diagnostic devices to evaluate and diagnose regional PFM abnormality. In this work, we developed a multifunctional evaluation technology (MET) based on a novel airbag-type stretchable electrode array probe (ASEA) for the diagnosis of malfunctions of regional PFM. The inflatable ASEA has specifically distributed 32 electrodes along the muscles, and is able to adapt to different human bodies for tight contact with the muscles. These allow synchronous collection of high-quality multi-channel surface electromyography (MC-sEMG) signals, and then are used to diagnose regional PFM malfunctions and evaluate inter-regional correlation. Clinical trial was conducted on 15 postpartum stress urinary incontinence (PSUI) patients and 15 matched asymptomatic women. Results showed that SUI patients responded slowly to the command and have symptoms of muscle strength degeneration. The results were consistent with the relevant clinical manifestations, and proved the reliability of MET for multifunctional PFM evaluation. Furthermore, the MET can diagnose malfunctions of regional PFM, which is inaccessible with existing technology. The results also showed that the dysfunction of PSUI patients is mainly located in iliococcygeus, pubococcygeus, and urethral sphincter regions, and there is a weak correlation between these specific regions and nearby regions. In conclusion, MET provides a point-of-care diagnostic method for abnormal function of regional PFM, which has a potential for the targeted point-to-point electrical stimulation treatment and PFD pathology research.

Prevalence of urinary incontinence in female CrossFit athletes: a systematic review with meta-analysis

INTRODUCTION AND HYPOTHESIS

Studies on the prevalence of urinary incontinence (UI) among CrossFit practitioners are on the rise. This systematic review with meta-analysis was aimed at determining the prevalence of UI among CrossFit practitioners.

METHODS

A systematic review of the literature was performed by searching MEDLINE/PubMed, Scopus, and SPORTDiscus through January 2021. The search strategy included the keywords CrossFit, urine incontinence, exercise, high impact and pelvic floor dysfunction. The inclusion criterion was any study with a sample of CrossFit practitioners and results separated from the other fitness modalities analysed. The subjects were women with no restriction of age, parity, experience or frequency of training. Quality assessment of the studies included was conducted using the Oxford Centre of Evidence-Based Medicine scale and the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies.

RESULTS

Thirteen studies (6 comparative and 7 non-comparative) were included for the systematic review, all using a cross-sectional design. The level of evidence was 4, with their quality ranging from poor (n = 10) to fair (n = 3). A total of 4,823 women aged 18 to 71 were included, 91.0% participated in CrossFit, and 1,637 presented UI, which indicates a prevalence of 44.5%. Also, 55.3% and 40.7% presented mild or moderate UI respectively. Stress UI was the most common type reported (81.2%).

CONCLUSIONS

The factors that increased the likelihood of UI were age, body mass index and parity. Exercises based on jumps were commonly associated with urine leakage. CrossFit practitioners presented higher UI than control groups.

CT Three-Dimensional Visualization Model in Diagnosis and Treatment of Stress Urinary Incontinence: A Retrospective Study

OBJECTIVE

To study the clinical effect of stress urinary incontinence sling surgery based on CT 3-dimensional visualization model, and to explore the value of three-dimensional visualization model in the diagnosis and treatment of stress urinary incontinence.

METHODS

Patients with stress urinary incontinence in our center from October 2020 to March 2022 were studied retrospectively. Among them, 16 cases received preoperative 3-dimensional visualization model construction, 18 cases did not use preoperative 3-dimensional model construction. The perioperative results, the postoperative results and the correlation between some related parameters of 3-dimensional visualization model and the severity of stress urinary incontinence were analyzed.

RESULTS

Compared with traditional surgery, the operation time of 3D group is significantly shorter (P < 0.05). There was no significant difference in intraoperative blood loss, perioperative fever, bleeding, micturition, pudendal or inguinal pain and postoperative symptom improvement. The posterior vesicourethral angle measured by 3-dimensional reconstruction model was correlated with ICI-Q-SF score.

CONCLUSIONS

The construction of three-dimensional visualization model of stress urinary incontinence can be used in clinic as a safe and effective new preoperative evaluation technique, and more potential applications can be further explored.

Urinary Incontinence in Elite Female Athletes

PURPOSE OF REVIEW

To summarize the current understanding on the epidemiology, pathophysiology, and management strategies of urinary incontinence (UI) in female athletes, highlighting findings specific to nulliparous elite athletes.

RECENT FINDINGS

UI occurs in about 20-50% of female athletes of all ages and parity status, around 40% for younger nulliparous athletes, and is more prevalent in high-impact sports. Possible contributing factors to UI in female elite athletes include pelvic floor laxity and bladder neck descent, pelvic floor muscle fatigue, low energy availability, and hypermobility syndrome. In female elite athletes, urinary symptoms negatively affect quality of life, although the effects of symptoms on exercise participation are not well understood. Current management strategies are primarily conservative and centered on behavioral modifications and pelvic floor muscle physiotherapy. UI in female elite athletes appears to be multifactorial. Clarifying how individual factors influence UI in this population will inform athlete counseling, prevention, and treatment strategies.

Pilates Method and/or Photobiomodulation Therapy Combined to Static Magnetic Field in Women with Stress Urinary Incontinence: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

This clinical trial aims to provide evidence about the effectiveness of the Pilates method on stress urinary incontinence (SUI), as well as to elucidate the effects of photobiomodulation therapy associated with static magnetic field (PBMT/sMF) alone or associated with the Pilates Method on Pelvic floor muscle (PFM) in women affected by SUI. For that, a three-arm, parallel randomized, double-blinded, placebo-controlled trial was conducted (NCT05096936). We recruited thirty-three women diagnosed with SUI, randomly allocated to three groups: placebo PBMT/sMF plus method Pilates, PBMT/sMF active plus method Pilates and only PBMT/sMF active. The evaluation consisted of anamnesis and physical examination, muscle strength, completion of the ICIQ-SF questionnaire, and urinary loss. The evaluation of muscle strength and filling the ICIQ-SF were performed on the first and last days, while the Pad test was applied in baseline, one month, two months, and three months of intervention. We observed an increase in strength (p < 0.01), tone (p < 0.01), and quality of life (p < 0.01), in addition to a decrease in urinary lost (p < 0.01) for all groups comparing the pre and post-intervention. The PBMT/sMF alone, the Pilates, and the combination of the two therapies proved to be effective in improving the signs and symptoms of women with SUI.

CO2 laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis

Background

Carbon dioxide (CO2) laser therapy is an emerging treatment for women with stress urinary incontinence (SUI).

Objectives

To examine the efficacy of CO2 laser therapy for management of SUI-related symptoms in women.

Design

A systematic review and meta-analysis of randomized controlled trials and cohort studies.

Data sources and methods

Four databases were screened until January 2023. All efficacy continuous endpoints were assessed via subtraction of the posttreatment from pretreatment values. The data were summarized as mean difference (MD) with 95% confidence interval (CI) using the random-effects model.

Results

A total of 15 studies with 700 patients were analyzed. CO2 laser therapy significantly decreased the 1-h pad weights at 3 months [n = 5 studies, MD = -3.656 g, 95% CI (-5.198, -2.113), p < 0.001], 6 months [n = 6 studies, MD = -6.583 g, 95% CI (-11.158, -2.008), p = 0.005], and 12 months [n = 6 studies, MD = -3.726 g, 95% CI (-6.347, -1.106), p = 0.005]. Moreover, CO2 laser therapy significantly decreased the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form Scores at 3 months [n = 10 studies, MD = -4.805, 95% CI (-5.985, -3.626), p < 0.001] and 12-months [n = 6 studies, MD = -3.726, 95% CI (-6.347, -1.106), p = 0.005]. Additionally, CO2 laser therapy significantly decreased the Pelvic Floor Impact Questionnaire scores at 6 months [n = 2 studies, MD = -11.268, 95% CI (-18.671, -3.865), p = 0.002] and 12 months [n = 2 studies, MD = -10.624, 95% CI (-18.145, -3.103), p = 0.006]. Besides, CO2 laser therapy significantly decreased the Urogenital Distress Inventory-6 scores at 3 months [n = 2 studies, MD = -21.997, 95% CI (-32.294, -11.699), p < 0.001], but not at 6 months [n = 3 studies, MD = -3.034, 95% CI (-7.357, 1.259), p = 0.169]. Lastly, CO2 laser therapy significantly increased the Vaginal Health Index Score at 6 months [n = 2 studies, MD = 2.826, 95% CI (0.013, 5.638), p = 0.047] and 12 months [MD = 1.553, 95% CI (0.173, 2.934), p = 0.027].

Conclusion

CO2 laser therapy improved the SUI-related symptoms in women. To obtain solid conclusions, future studies should be well-designed with standardized settings, consistent therapeutic protocols, and long-term follow-up periods.

Secondary urethral sphincter function of the rabbit pelvic and perineal muscles

Perineal and pelvic floor muscles play an important role in continence by providing mechanical support to pelvic organs. It is also known that the pubococcygeus muscle (PcM) contracts in the storage phase and is inactive during voiding, while the bulbospongiosus muscle (BsM) is active during the voiding phase. Recent evidence suggested an additional role of these muscles in supporting urethral closure in rabbits. However, the individual role of perineal and pelvic muscles as urethral sphincters is not well-defined. Here we evaluated the individual, sequential and synergistic roles of the PcM and BsM in assisting urethral closure and defined the optimal electrical stimulation parameters that can effectively contract these muscles and increase the urethral pressure (P _ura ) in young nulliparous animals (n = 11). Unilateral stimulation of either the BsM or PcM at 40 Hz induced modest increases in average P _ura (0.23 ± 0.10 and 0.07 ± 0.04 mmHg, respectively). Investigation on the changes in P _ura evoked by stimulation frequencies between 5 and 60 Hz show that sequential contralateral PcM-BsM activation at 40 Hz induced a 2-fold average P _ura increase (0.23 ± 0.07 mmHg) compared to that evoked by PcM stimulation. Simultaneous activation of PcM and BsM at 40 Hz also showed an increased average P _ura (0.26 ± 0.04 mmHg), with a 2-fold increase in average P _ura observed during the unilateral sequential PcM-BsM stimulation at 40 Hz (0.69 ± 0.2 mmHg). Finally, stimulation at 40 Hz of the bulbospongiosus nerve (BsN) induced an approximate 4-fold increase in average P _ura (0.87 ± 0.44 mmHg; p < 0.04) compared to that elicited by BsM stimulation, confirming that direct nerve stimulation is more effective. Together, this study shows that in the female rabbit, both perineal and pelvic muscles support of the urethral function during continence, and that unilateral stimulation of the BsN at 40-60 Hz is sufficient to achieve maximal secondary sphincter activity. The results also support the potential clinical value of neuromodulation of pelvic and perineal nerves as bioelectronic therapy for stress urinary incontinence.

Evaluation of the efficacy and safety of single incision sling vs TVT-O in obese patients with stress urinary incontinence: Quality of life and sexual function analysis

OBJECTIVES

The aim of the study is to demonstrate the best stress urinary incontinence (SUI) surgical technique for women with a Body mass index higher than 30. The results of Transvaginal Tension Free Vaginal Tape-Obturator and Mini-sling surgery were analyzed and compared through both clinical examination and standardized questionnaires at 36 months of follow-up.

MATERIALS AND METHODS

This is a retrospective multicenter study over 159 women with SUI who underwent surgery. Seventy-eight women underwent TVT-O and 81 Mini-sling technique. Intra and post-operative complications were recorded. Patients were monitored for 36 months by analyzing symptoms, voiding diary, quality of life and sexual activity through standardized questionnaires.

RESULTS

Complications had a low incidence in both groups and inter-group differences were superimposable. Only groin pain was statistically higher after TVT-O than after Mini-sling (12.8% vs1.2%, p = 0.03). At 36 months of follow-up, a statistically significant decrease in Positive stress test (%) and Q-Tip test (grade) was observed in both groups with no differences between them (p = 0.54 and p = 0.32 respectively). The mean number of daily voids was higher after TVT-O (p = 0.04) than after Altis (p = 0.22) with a significant difference in favor of the Altis group (p = 0.03). After 36 months, there were no significant differences between groups in terms of quality of life and sexual activity. PGI-I did not show any difference between groups (p = 0.21).

CONCLUSION

TVT-O and Minisling had the same efficacy and results in the surgical treatment of SUI in obese women. Both techniques relieved their symptoms and improved their quality of life without any significant difference except for a lower incidence of post- Mini-sling complications.

The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

Stress urinary incontinence is a common disease in middle-aged and elderly women, which seriously affects the physical and mental health of the patients. For this reason, researchers have carried out a large number of studies on stress urinary incontinence. At present, it is believed that the pathogenesis of the disease is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomy, including the anatomical factors of the urethra itself, the anatomical factors around the urethra and the anatomical factors of the pelvic nerve. The combined actions of a variety of factors lead to the occurrence of stress urinary incontinence. This review aims to summarize the anatomical pathogenesis of stress urinary incontinence from the above three perspectives.

Effect of vitamin D supplementation on the severity of stress urinary incontinence in premenopausal women with vitamin D insufficiency: a randomized controlled clinical trial

Background

Urinary incontinence, especially stress urinary incontinence (SUI), is one of the problems experienced by premenopausal women. Given the role of vitamin D in enhancing muscle strength and function, this study explored the effect of vitamin D3 supplementation on SUI in premenopausal women.

Methods

A randomized controlled trial was performed with 60 premenopausal women referring to Kerman gynecological clinic in 2020 and 2021. Eligible women received a 5000-unit vitamin D supplement or placebo weekly for 3 months. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) was utilized to assess SUI severity before and after the intervention. The t-test, Chi-square test, and repeated measures ANOVA were carried out in SPSS software (version 22) to analyze the data. P-values smaller than 0.05 were considered significant.

Results

Before the intervention, there was no significant difference between the intervention and control groups in SUI severity (P = 0.652) and the impact of SUI severity on premenopausal women’s lives (P = 0.804). In contrast, after 8-12 weeks of vitamin D supplementation, these scores decreased significantly in the intervention group relative to the control group (P <  0.001). In addition, after vitamin D supplementation, the number of SUI and urinary leakage symptoms decreased in the intervention group (P <  0.001).

Conclusion

Vitamin D supplementation improves SUI in premenopausal women.

Trial registration

This trial was registered with the Iranian Registry of Clinical Trials; https://fa.irct.ir/trial/53474 (IRCT20190724044318N2) on 11/02/2021.

A nomogram model predicting the risk of postpartum stress urinary incontinence in primiparas: A multicenter study

Stress urinary incontinence (SUI) is a common gynecological urinary system disease, and globally, 200 million or more people suffer from it. However, the existing literature mostly focuses on postpartum urinary incontinence (UI) or UI in middle-aged and elderly people, with little focus on primiparas. To analyse urinary incontinence prevalence and its risk factors in primiparas and establish a nomogram prediction model, 360 parturients were recruited from three hospitals between April and September 2021. A homemade electronic questionnaire was used to investigate the general demographic and perinatal characteristics of primiparas. The SUI was diagnosed by the physicians. Logistic regression analysis of independent risk factors for SUI and a nomogram prediction model were established. Ninety people were diagnosed as SUI. The number of pregnancies (OR = 3.322, 95% CI = 1.473-7.492), residence (OR = 5.451, 95% CI = 2.725-10.903), occupation (OR = 3.393, 95% CI = 1.144-10.064), education level (OR = 3.551, 95% CI = 1.223-10.308), delivery method (OR = 10.270, 95% CI = 4.090-25.789), and oxytocin use (OR = 2.166, 95% CI = 1.142-4.109) were independent risk factors for SUI. The C-index of the nomogram prediction model was 0.798 (95% CI = 0.749-0.846). The POPDI score, CRADI score, UDI score, and PFDI scores of women with SUI were significantly higher than those of non-SUI women, while I-QOL scores were significantly lower than those of non-SUI women. In conclusion, the prevalence of SUI among primiparas in Fuyang, China, was 25.00%, which exhibited a large impact on the quality of life of puerperae. The present study successfully established an individualized nomogram prediction model of SUI for primiparas with good discrimination and diagnostic efficiency, which was helpful for the early clinical identification of high-risk primiparas with SUI.