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Kjeldsen AC, Taastrøm KA, Gommesen D, Hjorth S, Axelsen S, Nohr EA. Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow-up study. BJOG 2024. [PMID: 38800995 DOI: 10.1111/1471-0528.17862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/08/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To investigate how reproductive history was associated with urinary incontinence in midlife. DESIGN A follow-up study. SETTING Denmark. POPULATION A total of 39 977 mothers who participated in the Maternal Follow up (2013-2014) in the Danish National Birth Cohort. National registries provided their reproductive history. METHODS How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression. MAIN OUTCOME MEASURES Self-reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence. RESULTS At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10-1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35-0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86-0.98). Compared with no tear/first-degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86-0.97) whereas third/fourth-degree tears were associated with more (OR 1.14, 95% CI 1.04-1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence. CONCLUSIONS Vaginal birth was associated with a higher risk of long-term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.
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Affiliation(s)
- Anne Cathrine Kjeldsen
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Katja Albert Taastrøm
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte Gommesen
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Sarah Hjorth
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Susanne Axelsen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen Aagaard Nohr
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Impact of Urinary Incontinence on Postpartum Sexual Function. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:753-762. [PMID: 36288114 DOI: 10.1097/spv.0000000000001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the incidence of urinary incontinence (UI) and its impact on sexual function among women within 3 years of delivery. METHODS This was a cross-sectional study of 531 participants who gave birth by any method in the past 3 years. Participants were administered the Edinburgh Depression Screening Questionnaire, Generalized Anxiety Disorder-7 questionnaire, the Overactive Bladder Symptom Score questionnaire, Incontinence Impact Questionnaire, Sexual Function Questionnaire's Medical Impact Scale, and Decreased Sexual Desire Screener. The primary outcome of interest was the report of any sexual dysfunction and urinary symptoms. RESULTS There were 531 total participants of 600 who completed the survey in its entirety. The mean age of the cohort was 29.6 ± 7.1 years, the majority were non-Hispanic White (76.6%). It was found that 55% of the women (n = 292) reported postpartum UI (73% [n = 213] stress incontinence, 26.7% [n = 78] urgency incontinence, and 0.003% [n = 1] mixed incontinence). Sexual dysfunction was more likely to be reported in participants with UI compared with those without UI (34.2% vs 17.8%, P < 0.001). Urinary incontinence was found to be associated with any form of sexual dysfunction after adjustment for confounders (adjusted odds ratio [aOR], 1.63; 95% confidence interval [CI], 1.07-2.14). Additional variables that were correlated with sexual dysfunction were perceived difficulty healing after any delivery injury (aOR, 4.79; 95% CI, 1.11-20.72), current breastfeeding (aOR, 3.29; 95% CI, 1.26-8.59), and an increasing Generalized Anxiety Disorder-7 score (aOR, 1.10 per 1-point increase; 95% CI, 1.05-1.15). CONCLUSION Urinary incontinence is independently associated with sexual dysfunction and should be systematically evaluated during postpartum care.
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3
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Rahman MN, Wilopo SA, Emilia O. The Efficacy of Divabirth Vaginal Dilator to Prevent Pelvic Floor Trauma During Labor: A Protocol Study. Int J Surg Protoc 2022; 26:88-93. [DOI: 10.29337/ijsp.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/14/2022] [Indexed: 11/06/2022] Open
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Habes D, Kestranek J, Stranik J, Kacerovsky M, Spacek J. Is there an association between pelvic organ prolapse and oxidative stress? A systematic review. PLoS One 2022; 17:e0271467. [PMID: 35925910 PMCID: PMC9352098 DOI: 10.1371/journal.pone.0271467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and hypothesis The pathophysiology of pelvic organ prolapse (POP) has not been fully elucidated, although accumulating evidence suggests that oxidative stress is involved. The present systematic review comprehensively discusses this topic. Methods The PubMed/Medline, Scopus, and Web of Science databases were searched for relevant studies published up to May 2021. This systematic review was registered in the PROSPERO database (registration number CRD42021242240). Two independent researchers screened and selected articles that fulfilled predefined inclusion criteria, performed a quality assessment, and extracted the relevant data. Of 901 original articles retrieved, 8 fulfilled the selection criteria and were included in the review. Results Elevated levels of markers of oxidative stress, such as advanced glycation end products, hydroxynonenal and hydroxydeoxyguanosine, were found in various parts of the pelvic floor of patients with POP. Accordingly, the levels of glutathione peroxidase and superoxide dismutase, known as major antioxidant enzymes, were reduced, compared to those in healthy controls. Levels of two other markers (mitofusin 2 and nuclear factor erythroid derived 2) also support hypotheses suggesting the involvement of oxidative stress in POP. Conclusions In the literature available, an association between oxidative stress and pelvic organ prolapse was confirmed.
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Affiliation(s)
- Dominik Habes
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
- * E-mail:
| | - Jan Kestranek
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jaroslav Stranik
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
- Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jiri Spacek
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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Christopher SM, Cook CE, Snodgrass SJ. What are the biopsychosocial risk factors associated with pain in postpartum runners? Development of a clinical decision tool. PLoS One 2021; 16:e0255383. [PMID: 34383792 PMCID: PMC8360599 DOI: 10.1371/journal.pone.0255383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/14/2021] [Indexed: 01/29/2023] Open
Abstract
Background In 2019, a majority of runners participating in running events were female and 49% were of childbearing age. Studies have reported that women are initiating or returning to running after childbirth with up to 35% reporting pain. There are no studies exploring running-related pain or risk factors for this pain after childbirth in runners. Postpartum runners have a variety of biomechanical, musculoskeletal, and physiologic impairments from which to recover from when returning to high impact sports like running, which could influence initiating or returning to running. Therefore, the purpose of this study was to identify risk factors associated with running-related pain in postpartum runners with and without pain. This study also aimed to understand the compounding effects of multiple associative risk factors by developing a clinical decision tool to identify postpartum runners at higher risk for pain. Methods Postpartum runners with at least one child ≤36 months who ran once a week and postpartum runners unable to run because of pain, but identified as runners, were surveyed. Running variables (mileage, time to first postpartum run), postpartum variables (delivery type, breastfeeding, incontinence, sleep, fatigue, depression), and demographic information were collected. Risk factors for running-related pain were analyzed in bivariate regression models. Variables meeting criteria (P<0.15) were entered into a multivariate logistic regression model to create a clinical decision tool. The tool identified compounding factors that increased the probability of having running-related pain after childbirth. Results Analyses included 538 postpartum runners; 176 (32.7%) reporting running-related pain. Eleven variables were included in the multivariate model with six retained in the clinical decision tool: runner type-novice (OR 3.51; 95% CI 1.65, 7.48), postpartum accumulated fatigue score of >19 (OR 2.48; 95% CI 1.44, 4.28), previous running injury (OR 1.95; 95% CI 1.31, 2.91), vaginal delivery (OR 1.63; 95% CI 1.06, 2.50), incontinence (OR 1.95; 95% CI 1.31, 2.84) and <6.8 hours of sleep on average per night (OR 1.89; 95% CI 1.28, 2.78). Having ≥ 4 risk factors increased the probability of having running-related pain to 61.2%. Conclusion The results of this study provide a deeper understanding of the risk factors for running-related pain in postpartum runners. With this information, clinicians can monitor and educate postpartum runners initiating or returning to running. Education could include details of risk factors, combinations of factors for pain and strategies to mitigate risks. Coaches can adapt running workload accounting for fatigue and sleep fluctuations to optimize recovery and performance. Future longitudinal studies that follow asymptomatic postpartum women returning to running after childbirth over time should be performed to validate these findings.
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Affiliation(s)
- Shefali Mathur Christopher
- Department of Physical Therapy Education, Elon University, Elon, NC, United States of America
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
- * E-mail:
| | - Chad E. Cook
- Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University School of Medicine, Durham, NC, United States of America
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
- Duke Department of Population Health Sciences, Durham, NC, United States of America
| | - Suzanne J. Snodgrass
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
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White WD, Avery M, Jonely H, Mansfield JT, Sayal PK, Desai MJ. The interdisciplinary management of coccydynia: A narrative review. PM R 2021; 14:1143-1154. [PMID: 34333873 DOI: 10.1002/pmrj.12683] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/05/2021] [Accepted: 07/27/2021] [Indexed: 11/07/2022]
Abstract
Pain that develops in the coccyx or surrounding tissues is known as coccydynia, which occurs as a result of many etiologies both traumatic and nontraumatic. Although coccydynia most commonly affects middle-aged women, it may be found in both sexes and in all age groups. The aim of this article is to provide an overview of the presentation, diagnostic imaging, and pathophysiology of coccydynia, and to comprehensively review the current treatment options. A review of publications from 1990 to 2020 using search words related to the treatment of coccydynia in PubMed and Google Scholar was completed. Level II evidence was found supporting stretching, manipulation, and extracorporeal shock wave therapy. There are no data from high-quality studies to support injection-based therapy including corticosteroids, prolotherapy, nerve blocks, and radiofrequency ablation, although there are small retrospective and prospective observational studies suggesting benefit. Level III evidence was found supporting coccygectomy for chronic/refractory coccydynia. There are no data from randomized controlled trials to support the use of neuromodulation (sacral burst and dorsal root ganglion stimulation), although there are case reports suggesting benefit. High-level, comparative studies are lacking to guide the treatment of coccydynia and should be a focus for future research studies.
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Affiliation(s)
- William D White
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar National Rehabilitation Hospital, Physical Medicine & Rehabilitation, Washington, District of Columbia, USA.,International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Melinda Avery
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Holly Jonely
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA.,The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - John T Mansfield
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar National Rehabilitation Hospital, Physical Medicine & Rehabilitation, Washington, District of Columbia, USA.,International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Puneet K Sayal
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA.,The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Salman L, Shmueli A, Aharony S, Pardo A, Chen R, Wiznitzer A, Gabbay-Benziv R. Postpartum voiding dysfunction following vaginal versus caesarean delivery. J OBSTET GYNAECOL 2021; 42:256-260. [PMID: 34027805 DOI: 10.1080/01443615.2021.1907553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this prospective study, we evaluated postpartum voiding dysfunction stratified by mode of delivery - vaginal delivery versus elective caesarean delivery (CD). We recruited nulliparous women carrying singleton gestation at term admitted to delivery room or elective CD. Pre-labour voiding function was assessed by recording the post-voiding residual volume (PVRV) using a bladder scan. PVRV evaluation was repeated at least 12 hours following delivery and before discharge. PVRVs were considered abnormal if ≥150 mL. PVRVs were compared between vaginal and CD. Overall, 54 women were included. Of them, 34 (63%) delivered vaginally and 20 (37%) had an elective CD. Postpartum mean PVRVs were significantly higher compared to pre-labour PVRVs (215 vs. 133 mL, p<.001). Abnormal postpartum PVRV was significantly higher in vaginal delivery compared to CD (73.5% vs. 45%, p<.05). In conclusion, delivery adversely affects voiding function. Vaginal delivery is associated with more severe voiding dysfunction compared to elective CD.Impact StatementWhat is already known on this subject? Delivery is associated with voiding dysfunction. While most studies on postpartum voiding dysfunction were related to vaginal delivery, little is known on the effect of mode of delivery (vaginal versus caesarean delivery (CD)) on voiding dysfunction.What the results of this study add? In this study, we found that postpartum post-voiding residual volume is significantly higher than the pre-labour PVRV in women delivered vaginally. In addition, postpartum PVRV was significantly higher in women delivered vaginally compared to elective CD.What the implications are of these findings for clinical practice and/or further research? This study implicates that women with vaginal delivery are more prone to voiding dysfunction compared to elective CD. However, larger observational studies are warranted to confirm these results and evaluate whether this difference still exists beyond the post-partum period.
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Affiliation(s)
- Lina Salman
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shmueli
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Aharony
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Urology Service, Rabin Medical Center, Petah Tikva, Israel
| | - Anat Pardo
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rony Chen
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Gabbay-Benziv
- Hillel Yaffe Medical Center, Hadera, Israel.,The Rappaport Faculty of Medicine, Technion, Haifa, Israel
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8
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Vesentini G, Barbosa AMP, Floriano JF, Felisbino SL, Costa SMB, Piculo F, Marini G, Nunes SK, Reyes DRA, Marcondes JPC, Hallur RLS, Rozza AL, Magalhães CG, Costa R, Abbade JF, Corrente JE, Calderon IMP, Matheus SMM, Rudge MVC. Deleterious effects of gestational diabetes mellitus on the characteristics of the rectus abdominis muscle associated with pregnancy-specific urinary incontinence. Diabetes Res Clin Pract 2020; 166:108315. [PMID: 32679058 DOI: 10.1016/j.diabres.2020.108315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/05/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
AIMS To evaluate the effects of gestational diabetes mellitus (GDM) on the structural characteristics of the rectus abdominis muscle (RAM) and its indirect effects on pregnancy-specific urinary incontinence (PSUI). METHODS A total of 92 pregnant women were divided into four groups, according to their clinical conditions: non-GDM continent, non-GDM associated PSUI, GDM continent and GDM associated PSUI. The muscle morphometry (histochemistry and immunohistochemistry) for the fiber types and collagen fiber distribution, the ultrastructural analysis (transmission electron microscopy), the protein expression of fiber types and calcium signaling (Western blotting), and the content of types I and III collagen fiber (ELISA) in RAM collected at delivery were assessed. RESULTS The GDM groups presented a significantly increased number of slow fibers and slow-twitch oxidative fiber expression; decreased fiber area, number of fast fibers, and area of collagen; an increase in central nuclei; ultrastructural alterations with focal lesion areas such as myeloid structures, sarcomere disorganization, and mitochondrial alteration. The PSUI groups presented a considerable decrease in types I and III collagen contents and the localization of collagen fiber. CONCLUSIONS Our data reveal that GDM causes morphological, biochemical and physiological changes in the RAM, and this might predispose women to PSUI.
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Affiliation(s)
- Giovana Vesentini
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Angélica M P Barbosa
- São Paulo State University (UNESP), School of Philosophy and Sciences, Department of Physical Therapy and Occupational Therapy, Marilia, São Paulo State, Brazil
| | - Juliana F Floriano
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Sérgio L Felisbino
- São Paulo State University (UNESP), Institute of Biosciences, Department of Morphology, Botucatu, São Paulo State, Brazil
| | - Sarah M B Costa
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Fernanda Piculo
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Gabriela Marini
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil; Universidade Sagrado Coração, Department of Health Sciences, Bauru, São Paulo, Brazil
| | - Sthefanie K Nunes
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - David R A Reyes
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - João P C Marcondes
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Raghavendra L S Hallur
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Ariane L Rozza
- São Paulo State University (UNESP), Institute of Biosciences, Department of Morphology, Botucatu, São Paulo State, Brazil
| | - Cláudia G Magalhães
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Roberto Costa
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Joelcio F Abbade
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - José E Corrente
- São Paulo State University (UNESP), Institute of Biosciences, Biostatistics Department, Botucatu, São Paulo, Brazil
| | - Iracema M P Calderon
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil
| | - Selma M M Matheus
- São Paulo State University (UNESP), Institute of Biosciences, Department of Anatomy, Botucatu, São Paulo State, Brazil
| | - Marilza V C Rudge
- Perinatal Diabetes Research Center, University Hospital, Botucatu Medical School, Univ Estadual Paulista_UNESP, São Paulo State, Brazil; São Paulo State University (UNESP), Botucatu Medical School, Department of Gynecology and Obstetrics, Botucatu, Sao Paulo, Brazil.
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Sadeghi Z, Kenyon JD, Richardson B, Khalifa AO, Cartwright M, Conroy B, Caplan A, Cameron MJ, Hijaz A. Transcriptomic Analysis of Human Mesenchymal Stem Cell Therapy in Incontinent Rat Injured Urethra. Tissue Eng Part A 2020; 26:792-810. [PMID: 32614683 DOI: 10.1089/ten.tea.2020.0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Periurethral human mesenchymal stem cell (hMSC) injections are associated with functional improvement in animal models of postpartum stress urinary incontinence (SUI). However, limited data exist on the role of hMSCs in modulating gene expression in tissue repair after urethral injury. To this end, we quantified temporal gene expression modulation in hMSCs, and in injured rat urethral tissue, using RNA-seq in an animal model of SUI, over a 3-day period following urethral injury, and local hMSC injection. We injected PKH fluorescent-labeled hMSC into the periurethral space of rats following a 4 h vaginal distention (VD) (three rats per time point). Control rats underwent VD injury only, and all animals were euthanized at 12, 24, 36, 72 h postinjury. Rat urethral and vaginal tissues were frozen and sectioned. Fluorescent labeled hMSCs were distinguished from adjacent, unlabeled rat urethral tissue. RNA was prepared from hMSCs and urethral tissue obtained by laser dissection of frozen tissue sections and sequenced on an Illumina HiSeq 2500. Differentially expressed genes (DEGs) over 72 h were evaluated using a two-group t-test (p < 0.05). Our transcriptional analyses identified candidate genes involved in tissue injury that were broadly sorted by injury and exposure to hMSC throughout the first 72 h of acute phase of injury. DEGs in treated urethra, compared with untreated urethra, were functionally associated with tissue repair, angiogenesis, neurogenesis, and oxidative stress suppression. DEGs included a variety of cytokines, extracellular matrix stabilization and regeneration genes, cytokine signaling modification, cell cycle regulation, muscle differentiation, and stabilization. Moreover, our results revealed DEG changes in hMSCs (PKH-labeled) harvested from injured urethra. The expressions are related to DNA damage repair, transcription activation, stem cell regulation, cell survival, apoptosis, self-renewal, cell proliferation, migration, and injury response. Impact statement Stress urinary incontinence (SUI) affects nearly half of women over 40, resulting in reduced quality of life and increased health care cost. Development of SUI is multifactorial and strongly associated with vaginal delivery. While stem cell therapy in animal models of SUI and limited preliminary clinical trials demonstrate functional improvement of SUI, the role of stem cell therapy in modulating tissue repair is unclear impeding advanced clinical trials. Our work provides a new understanding of the transcriptional mechanisms with which human mesenchymal stem cells improve acute injury repair thus guiding the development of cell-based therapies for women with nonacute established SUI.
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Affiliation(s)
- Zhina Sadeghi
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, USA
| | - Jonathan D Kenyon
- Biology Department, Skeletal Research Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Brian Richardson
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ahmad O Khalifa
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, USA.,Menoufia University Faculty of Medicine, Urology, Shebin El-Kom, Egypt
| | - Michael Cartwright
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Britt Conroy
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, USA
| | - Arnold Caplan
- Biology Department, Skeletal Research Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mark J Cameron
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adonis Hijaz
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, USA
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10
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Cardaillac C, Delga B, Thubert T, Labat JJ, Levesque A, Winer N, Riant T, Ploteau S. Description and classification of postpartum chronic pain: A multicentric prospective study. J Gynecol Obstet Hum Reprod 2020; 49:101769. [PMID: 32461069 DOI: 10.1016/j.jogoh.2020.101769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION To classify persistent perineal and pelvic postpartum pain using the classification usually employed in chronic pelvic pain. MATERIAL AND METHOD Prospective observational study including all women who have consulted an algologist or gynecologist at one of the six French centers for a chronic pain (superior or equal to 3 months) spontaneous linked by the mother with her childbirth were included. During semi-directed interviews, a questionnaire regarding sociodemographic factors and detailed questions about pain were collected. Then, pelvic and perineal pain were classified into 7 pain syndromes: pelvic sensitization (Convergences PP criteria), complex regional pain syndrome (Budapest criteria), pudendal or cluneal neuralgia (Nantes criteria), neuroma, thoraco-lumbar junction syndrome, myofascial pain (muscle trigger zone), fibromyalgia (American College of Rheumatology criteria). The principal objective of this study is to assess the prevalence of each painful disorder. The secondary aims were the description of socio-demographic factors and clinical characteristics of this population, identify the related symptoms and the impact on daily function associated with the chronic pelvic or perineal postpartum pain. RESULTS 40 women with chronic pelvic or perineal pain spontaneously linked with childbirth were included. 78 % experienced pain for more than 12 months. A large majority had a vaginal birth (95 %) with perineal suture (90 %) and severe acute pain within the first week postpartum (62 %). Postpartum pain impacted participant's sexual activity (80 %), micturition (28 %) and defecation (38 %). In the sample, 17 cases of neuroma, 6 patients with pudendal or cluneal neuralgia, 13 patients with pelvic sensitization and 2 cases of fibromyalgia were identified. Complex regional pain syndrome was diagnosed in 8 patients, and myofascial pain in 11 women, and only 1 patient had thoraco-lumbar junction syndrome. Neuropathic pain was found in 31 participants (77.5 %) according to DN4 criteria. DISCUSSION The classification scheme proposed in this study may be a very useful tool to investigate postpartum pelvic and perineal pain and to propose a treatment.
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Affiliation(s)
- Claire Cardaillac
- Department of Gynecology-Obstetrics and Reproductive Medecine, 38 Boulevard Jean Monnet, 44000, Nantes, France; Pelvic Pain Center, Nantes, France
| | - Bérénice Delga
- Department of Gynecology-Obstetrics and Reproductive Medecine, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | - Thibault Thubert
- Department of Gynecology-Obstetrics and Reproductive Medecine, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | | | | | - Norbert Winer
- Department of Gynecology-Obstetrics and Reproductive Medecine, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | - Thibault Riant
- Pelvic Pain Center, Nantes, France; Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine De Sienne, Nantes, France
| | - Stéphane Ploteau
- Department of Gynecology-Obstetrics and Reproductive Medecine, 38 Boulevard Jean Monnet, 44000, Nantes, France; Pelvic Pain Center, Nantes, France.
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Schwarzman P, Paz Levy D, Walfisch A, Sergienko R, Bernstein EH, Sheiner E. Pelvic floor disorders following different delivery modes-a population-based cohort analysis. Int Urogynecol J 2019; 31:505-511. [PMID: 31813040 DOI: 10.1007/s00192-019-04151-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Identifying protective factors against pelvic floor disorders (PFDs) is important. We investigated whether cesarean delivery (CD) at the indication of abnormal second stage of labor (ASSL) has the same protective effect against future PFDs. METHODS This population-based cohort study included deliveries occurring from 1991-2017 in a tertiary medical center. Women were grouped by their delivery mode: patients with vaginal deliveries (VD) only; those with CD only, excluding second-stage indications; and those with CD due to ASSL. The outcome measure, PFDs and related repair diagnoses, included any recorded hospitalization involving a pre-defined set of ICD-9 codes. A Kaplan-Meier survival curve compared cumulative PFD morbidity in the different groups, and a Cox proportional hazards model controlled for confounders. RESULTS A total of 106,003 patients met the inclusion criteria; 86.7% (n = 91,856) experienced VD only, 11.7% (n = 12,359) underwent CD only and 1.7% (n = 1788) had at least one CD due to ASSL. PFD-related hospitalization incidence was 0.7% (n = 719) for the entire cohort. While a significantly higher PFD-related hospitalization rate was recorded in the VD group (0.7%) compared with the ASSL CD group (0.3%) and the non-ASSL CD group (0.5%, p < 0.001), after controlling for potential confounders, an independent and protective association was noted between CD and later PFDs only in parturients who did not experience ASSL (aHR 0.679, 95% CI 0.51-0.90, p = 0.006). CONCLUSIONS CDs may be protective against later PFD development only if performed prior to the second stage of labor.
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Affiliation(s)
- Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhak Rager Boulevard, 84105, Be'er Sheva, Israel.
- , Be'er Sheva, Israel.
| | - Dorit Paz Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhak Rager Boulevard, 84105, Be'er Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Mount Scopus Medical Center, Jerusalem, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eli H Bernstein
- The Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhak Rager Boulevard, 84105, Be'er Sheva, Israel
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12
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Montaguti E, Cariello L, Dodaro MG, Rizzo N, Pilu G, Youssef A. The role of a new three‐dimensional ultrasound technique in the diagnosis of levator ani muscle avulsion. Neurourol Urodyn 2019; 39:455-463. [DOI: 10.1002/nau.24236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 11/09/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Elisa Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital University of Bologna Bologna Italy
| | - Luisa Cariello
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital University of Bologna Bologna Italy
| | - Maria Gaia Dodaro
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital University of Bologna Bologna Italy
| | - Nicola Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital University of Bologna Bologna Italy
| | - Gianluigi Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital University of Bologna Bologna Italy
| | - Aly Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital University of Bologna Bologna Italy
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13
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Maßlo K, Möllers M, de Murcia KO, Klockenbusch W, Schmitz R. New Method for Assessment of Levator Avulsion Injury: A Comparative Elastography Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1301-1307. [PMID: 30208248 DOI: 10.1002/jum.14810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim of this study was to introduce elastography as a new method for sonographic assessment of postpartum pelvic floor trauma. METHODS We examined 86 postpartum primiparous women, of whom 43 had undergone primary caesarean section (group_CS) and 43 vaginal delivery (group_VD). In a puborectal-symphysis plane, B-mode and elastographic ultrasonography were used to evaluate pelvic floor trauma. The strain value of left and right puborectal muscle was assessed close to the symphysis (Trauma_Elastography). The strain ratio maximum of this measurement was stored (Trauma_Index). RESULTS The elastographic evaluation revealed more trauma-suspicious lesions than the B-mode investigation (60.5% versus 39.5%; P < .001). The median Trauma_Index was higher in group_VD compared to group_CS (1.63 versus 1.18; P < .001). CONCLUSION Sonographic elastography assessment in a new examination plane shows postpartum trauma of the pelvic floor in women after vaginal delivery. This new method may help to identify women with a higher risk of postpartum pelvic floor disorders.
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Affiliation(s)
- Katharina Maßlo
- Department of Obstetrics and Gynaecology, Asklepios Klinik Altona, Hamburg, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | | | - Walter Klockenbusch
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
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de Tayrac R, Schantz C. [Childbirth pelvic floor trauma: Anatomy, physiology, pathophysiology and special situations - CNGOF perineal prevention and protection in obstetrics guidelines]. ACTA ACUST UNITED AC 2018; 46:900-912. [PMID: 30396762 DOI: 10.1016/j.gofs.2018.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether pelvic size and shape, spinal curvature, perineal body length and genital hiatus size are associated with the incidence of childbirth pelvic floor trauma. Special situations, such as obesity, ethnicity and hyperlaxity, will also be studied. METHODS A bibliographic research using Pubmed and Cochrane Library databases was conducted until May 2018. Publications in English and French were selected by initial reading of the abstracts. Randomized trials, meta-analyzes, case-control studies and large cohorts were studied in a privileged way. RESULTS A pubic arch angle<90° (measured clinically) does not appear to increase the risk of OASIS (Level 3), but appears to be a risk factor for postnatal anal incontinence at short-term, but not at long-term (Level 3). Measurement of pelvic dimensions and the subpubic angle is not recommended to predict OASIS or to choose the mode of delivery for the purpose of protecting the perineum (GradeC). Prenatal measurement of both perineal body (Level 3) and genital hiatus (Level 2) does not predict the incidence of 2nd or 3rd degree OASIS. Therefore, the routine prenatal measurement of the length of the perineal body or the genital hiatus is not recommended for any objective related to perineal protection (Grade C). Levator avulsion, resulting in a widening of the genital hiatus, is potentially a source of long-term pelvic floor dysfunction. Biomechanical models suggest that performing a mediolateral episiotomy and applying the fingers to the posterior perineum at the time of expulsive phase may reduce pelvic floor trauma. Obese women have a longer perineal body (Level 3), and obesity does not seem to increase the risk of OASIS (Level 2). There is no difference between Asian and non-Asian women perineal body (Level 3). No studies have validated that the liberal practice of episiotomy in Asian women reduced the risk of OASIS. It is therefore not recommended to practice an episiotomy for simple ethnic reasons in Asian women (GradeC). Compared to white women, black women do not appear to have an increased risk of OASIS and even appear to have a decreased risk of perineal tears of all stages (Level 2). Ligament hyperlaxity seems to be associated with an increased risk of OASIS (Level 2). CONCLUSIONS Prenatal assessment of pelvis bone, spine curvature, perineal body and genital hiatus do not allow to predict the incidence of childbirth pelvic floor trauma. Obesity and ethnicity are not risk factors for OASIS.
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Affiliation(s)
- R de Tayrac
- Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Debré, 30900 Nîmes, France.
| | - C Schantz
- Commission Scientifique du Collège National des Sages-Femmes (CNSF), Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, 75006, Paris, France
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15
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Predictive role of measurement of pelvic floor muscle thickness with static MRI in stress and mixed urinary incontinence. Int Urogynecol J 2018; 30:271-277. [DOI: 10.1007/s00192-018-3663-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 01/04/2018] [Indexed: 10/16/2022]
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16
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Catanzarite T, Bremner S, Barlow CL, Bou-Malham L, O'Connor S, Alperin M. Pelvic muscles' mechanical response to strains in the absence and presence of pregnancy-induced adaptations in a rat model. Am J Obstet Gynecol 2018; 218:512.e1-512.e9. [PMID: 29432755 DOI: 10.1016/j.ajog.2018.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/09/2018] [Accepted: 02/05/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Maternal birth trauma to the pelvic floor muscles is thought to be consequent to mechanical demands placed on these muscles during fetal delivery that exceed muscle physiological limits. The above is consistent with studies of striated limb muscles that identify hyperelongation of sarcomeres, the functional muscle units, as the primary cause of mechanical muscle injury and resultant muscle dysfunction. However, pelvic floor muscles' mechanical response to strains have not been examined at a tissue level. Furthermore, we have previously demonstrated that during pregnancy, rat pelvic floor muscles acquire structural and functional adaptations in preparation for delivery, which likely protect against mechanical muscle injury by attenuating the strain effect. OBJECTIVE We sought to determine the mechanical impact of parturition-related strains on pelvic floor muscles' microstructure, and test the hypothesis that pregnancy-induced adaptations modulate muscle response to strains associated with vaginal delivery. STUDY DESIGN Three-month-old Sprague-Dawley late-pregnant (N = 20) and nonpregnant (N = 22) rats underwent vaginal distention, replicating fetal crowning, with variable distention volumes. Age-matched uninjured pregnant and nonpregnant rats served as respective controls. After sacrifice, pelvic floor muscles, which include coccygeus, iliocaudalis, and pubocaudalis, were fixed in situ and harvested for fiber and sarcomere length measurements. To ascertain the extent of physiological strains during spontaneous vaginal delivery, analogous measurements were obtained in intrapartum rats (N = 4) sacrificed during fetal delivery. Data were compared with repeated measures and 2-way analysis of variance, followed by pairwise comparisons, with significance set at P < .05. RESULTS Gross anatomic changes were observed in the pelvic floor muscles following vaginal distention, particularly in the entheseal region of pubocaudalis, which appeared translucent. The above appearance resulted from dramatic stretch of the myofibers, as indicated by significantly longer fiber length compared to controls. Stretch ratios, calculated as fiber length after vaginal distention divided by baseline fiber length, increased gradually with increasing distention volume. Paralleling these macroscopic changes, vaginal distention resulted in acute and progressive increase in sarcomere length with rising distention volume. The magnitude of strain effect varied by muscle, with the greatest sarcomere elongation observed in coccygeus, followed by pubocaudalis, and a smaller increase in iliocaudalis, observed only at higher distention volumes. The average fetal rat volume approximated 3 mL. Pelvic floor muscle sarcomere lengths in pregnant animals undergoing vaginal distention with 3 mL were similar to intrapartum sarcomere lengths in all muscles (P > .4), supporting the validity of our experimental approach. Vaginal distention resulted in dramatically longer sarcomere lengths in nonpregnant compared to pregnant animals, especially in coccygeus and pubocaudalis (P < .0001), indicating significant attenuation of sarcomere elongation in the presence of pregnancy-induced adaptations in pelvic floor muscles. CONCLUSION Delivery-related strains lead to acute sarcomere elongation, a well-established cause of mechanical injury in skeletal muscles. Sarcomere hyperelongation resultant from mechanical strains is attenuated by pregnancy-induced adaptations acquired by the pelvic floor muscles prior to parturition.
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Affiliation(s)
- Tatiana Catanzarite
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of California-San Diego, San Diego, CA; Department of Reproductive Medicine, University of California-San Diego, San Diego, CA
| | - Shannon Bremner
- Department of Orthopedic Surgery, University of California-San Diego, San Diego, CA
| | - Caitlin L Barlow
- Department of Reproductive Medicine, University of California-San Diego, San Diego, CA
| | - Laura Bou-Malham
- Department of Reproductive Medicine, University of California-San Diego, San Diego, CA
| | - Shawn O'Connor
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA
| | - Marianna Alperin
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of California-San Diego, San Diego, CA; Department of Reproductive Medicine, University of California-San Diego, San Diego, CA.
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de Araujo CC, Coelho SA, Stahlschmidt P, Juliato CRT. Does vaginal delivery cause more damage to the pelvic floor than cesarean section as determined by 3D ultrasound evaluation? A systematic review. Int Urogynecol J 2018; 29:639-645. [PMID: 29564512 DOI: 10.1007/s00192-018-3609-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/16/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pregnancy and delivery are well-established risk factors for pelvic floor dysfunction (PFD), but the physiopathology, such as the delivery route, is not well understood. This study evaluated the impact of delivery route on the pelvic floor muscles via 3D ultrasound. METHODS This review is registered in the PROSPERO database. The criteria for inclusion were prospective studies with 3D translabial ultrasound assessment in primigravida women during pregnancy and postpartum published in English, Spanish or Portuguese between 1980 and 2016. We excluded studies that did not include the topic of urogenital hiatus measurement and literature reviews. The MeSH terms were obstetric delivery, postpartum period, labor, parturition, three-dimensional images, ultrasonography, pelvic floor, and pelvic floor disorders. RESULTS The search retrieved 155 articles. After analysis, 6 articles were included. Four studies showed that vaginal delivery (VD) was associated with a larger hiatal area. One study associated the hiatal area with levator ani muscle (LAM) defects in VD. Four articles evaluated the bladder neck, 3 of which showed a significant increase in bladder neck mobility associated with VD and 1 showed decreased bladder neck elevation, not associated with the delivery mode; the first 3 articles all evaluated LAM injuries and showed an association between VD and LAM injury. Women who underwent VD presented defects of the puborectalis muscle. CONCLUSIONS Vaginal delivery was associated with a higher number of LAM injuries, puborectalis defects, increased bladder neck mobility, and enlargement of the hiatal area.
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Affiliation(s)
- Camila Carvalho de Araujo
- School of Medicine, University of Campinas (UNICAMP), R. Euclides de Moraes Rosa, 180. Jardim Itália. Itapetininga, Campinas, SP, 18.201-760, Brazil.
| | - Suelene A Coelho
- School of Medicine, University of Campinas (UNICAMP), R. Euclides de Moraes Rosa, 180. Jardim Itália. Itapetininga, Campinas, SP, 18.201-760, Brazil
| | - Paulo Stahlschmidt
- School of Medicine, University of Campinas (UNICAMP), R. Euclides de Moraes Rosa, 180. Jardim Itália. Itapetininga, Campinas, SP, 18.201-760, Brazil
| | - Cassia R T Juliato
- School of Medicine, University of Campinas (UNICAMP), R. Euclides de Moraes Rosa, 180. Jardim Itália. Itapetininga, Campinas, SP, 18.201-760, Brazil
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18
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Callewaert G, Da Cunha MMCM, Sindhwani N, Sampaolesi M, Albersen M, Deprest J. Cell-based secondary prevention of childbirth-induced pelvic floor trauma. Nat Rev Urol 2017; 14:373-385. [PMID: 28374792 DOI: 10.1038/nrurol.2017.42] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
With advancing population age, pelvic-floor dysfunction (PFD) will affect an increasing number of women. Many of these women wish to maintain active lifestyles, indicating an urgent need for effective strategies to treat or, preferably, prevent the occurrence of PFD. Childbirth and pregnancy have both long been recognized as crucial contributing factors in the pathophysiology of PFD. Vaginal delivery of a child is a serious traumatic event, causing anatomical and functional changes in the pelvic floor. Similar changes to those experienced during childbirth can be found in symptomatic women, often many years after delivery. Thus, women with such PFD symptoms might have incompletely recovered from the trauma caused by vaginal delivery. This hypothesis creates the possibility that preventive measures can be initiated around the time of delivery. Secondary prevention has been shown to be beneficial in patients with many other chronic conditions. The current general consensus is that clinicians should aim to minimize the extent of damage during delivery, and aim to optimize healing processes after delivery, therefore preventing later dysfunction. A substantial amount of research investigating the potential of stem-cell injections as a therapeutic strategy for achieving this purpose is currently ongoing. Data from small animal models have demonstrated positive effects of mesenchymal stem-cell injections on the healing process following simulated vaginal birth injury.
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Affiliation(s)
- Geertje Callewaert
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | | | - Nikhil Sindhwani
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Maurilio Sampaolesi
- Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Maarten Albersen
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium.,Department of Urology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, University of Leuven, Herestraat 49, Leuven 3000, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
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Ferreira CWS, Atan IK, Martin A, Shek KL, Dietz HP. Pelvic organ support several years after a first birth. Int Urogynecol J 2017; 28:1499-1505. [DOI: 10.1007/s00192-017-3297-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/14/2017] [Indexed: 12/19/2022]
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Lo TS, Jaili S, Uy-Patrimonio MC, Karim NB, Ibrahim R. Transvaginal management of severe pelvic organ prolapse in nulliparous women. J Obstet Gynaecol Res 2017; 43:543-550. [PMID: 28160508 DOI: 10.1111/jog.13234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/15/2016] [Accepted: 10/07/2016] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to evaluate the management outcomes of advanced pelvic organ prolapse (POP) in nulliparous women. METHODS Eight nulliparous women diagnosed with POP ≥ stage 3 between January 2005 and August 2013, according to the Pelvic Organ Quantification System (POPQ), were reviewed. Seven were managed surgically and one was managed with pessary. Primary outcome was surgical objective cure (POP-Q ≤ 1) and subjective cure, defined as negative response to questions 2 and 3 on Pelvic Organ Prolapse Distress Inventory 6. Secondary outcomes were complications, symptoms' severity and quality of life according to validated questionnaires. RESULTS A total of 1275 prolapse patients with POP-Q ≥ stage 3 were managed surgically, among whom seven (0.55%) were nulliparous. Each woman had at least one risk factor associated with POP. Risk factors identified were history of pelvic trauma, obesity, menopause, chronic cough, hard physical labor and constipation. Five patients underwent surgical correction (vaginal hysterectomy with sacrospinous fixation) with mesh (Perigee, n = 3; Avaulta, n = 2). Two patients had uterine preservation without mesh (hysteropexy with sacrospinous ligament fixation). One patient preferred treatment with pessary. The total cure rate (objective and subjective cure rates) was 86% after surgical reconstructive surgery. CONCLUSION Management of nulliparous advanced POP poses significant challenges with regard to uterine preservation, future pregnancy and childbirth. Conservative management with pessary insertion should be offered followed by surgical correction. Reconstructive surgery with mesh may improve prolapse symptoms objectively and subjectively.
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Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, Keelung, Taiwan.,Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sukanda Jaili
- Fellow of Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Hospital Sultanah Nurzahirah, Kuala Terengganu, Malaysia
| | - Ma Clarissa Uy-Patrimonio
- Fellow of Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Dr Pablo O. Torre Memorial Hospital, Bacolod City, Philippines
| | - Nazura Bt Karim
- Fellow of Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Hospital Tuanku Jaafar, Seremban, Malaysia
| | - Rami Ibrahim
- Fellow of Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Al-Bashir Hospital, Amman, Jordan
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21
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Increasing Age Is a Risk Factor for Decreased Postpartum Pelvic Floor Strength. Female Pelvic Med Reconstr Surg 2017; 23:136-140. [PMID: 28067746 DOI: 10.1097/spv.0000000000000376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to determine factors associated with decreased pelvic floor strength (PFS) after the first vaginal delivery (VD) in a cohort of low-risk women. METHODS This is a secondary analysis of a prospective study examining the risk of pelvic floor injury in a cohort of primiparous women. All recruited participants underwent an examination, three-dimensional ultrasound and measurement of PFS in the third trimester and repeated at 4 weeks to 6 months postpartum using a perineometer. RESULTS There were 84 women recruited for the study, and 70 completed the postpartum assessment. Average age was 28.4 years (standard deviation, 4.8). There were 46 (66%) subjects with a VD and 24 (34%) with a cesarean delivery who labored. Decreased PFS was observed more frequently in the VD group compared with the cesarean delivery group (68% vs 42%, P = 0.03).In modified Poisson regression models controlling for mode of delivery and time of postpartum assessment, women who were aged 25 to 29 years (risk ratio = 2.80, 95% confidence interval, 1.03-7.57) and 30 years and older (risk ratio = 2.53, 95% confidence interval, 0.93-6.86) were over 2.5 times more likely to have decreased postpartum PFS compared with women younger than 25 years. CONCLUSIONS In this population, women aged 25 years and older were more than twice as likely to have a decrease in postpartum PFS.
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Hallock JL, Handa VL. The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update. Obstet Gynecol Clin North Am 2016; 43:1-13. [PMID: 26880504 DOI: 10.1016/j.ogc.2015.10.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Using a lifespan model, this article presents new scientific findings regarding risk factors for pelvic floor disorders (PFDs), focusing on the role of childbirth in the development of single or multiple coexisting PFDs. Phase I of the model includes predisposing factors, such as genetic predisposition and race. Phase II includes inciting factors, such as obstetric events. Prolapse, urinary incontinence (UI), and fecal incontinence (FI) are more common among vaginally parous women, although the impact of vaginal delivery on risk of FI is less dramatic than prolapse and UI. Phase III includes intervening factors, such as age and obesity.
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Affiliation(s)
- Jennifer L Hallock
- Female Pelvic Medicine & Reconstructive Surgery, Johns Hopkins School of Medicine, 4940 Eastern Avenue, 301 Building, Suite 3200, Baltimore, MD 21224, USA
| | - Victoria L Handa
- Gynecology & Obstetrics, Johns Hopkins School of Medicine, 4940 Eastern Avenue, 301 Building, Suite 3200, Baltimore, MD 21224, USA.
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Legendre G, Gonzalves A, Levaillant JM, Fernandez D, Fuchs F, Fernandez H. Impact of at-home self-rehabilitation of the perineum on pelvic floor function in patients with stress urinary incontinence: Results from a prospective study using three-dimensional ultrasound. ACTA ACUST UNITED AC 2016; 45:139-46. [DOI: 10.1016/j.jgyn.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
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Mehrvarz S, Towliat SM, Mohebbi HA, Heydari S, Farahani M, Rasouli HR. Obstructed Defecation Syndrome After Delivery Trauma. Trauma Mon 2015; 20:e25611. [PMID: 26839863 PMCID: PMC4727471 DOI: 10.5812/traumamon.25611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 06/06/2015] [Accepted: 07/07/2015] [Indexed: 12/13/2022] Open
Abstract
Background: Obstructed defecation syndrome (ODS) occurs in about 7% of adults; it seems that the etiology of pelvic floor disorders is multifactorial. Pregnancy and childbirth damage to the pelvic nerve and muscles are proposed causes for this condition. The precise role of vaginal delivery (VD) is not clearly defined, although in recent studies association of pelvic floor disorder with Operative vaginal delivery and episiotomy has been proposed. Objectives: In this prospective study, we assessed the outcome of stapled transanal rectal resection (STARR) in females with one of the two modes of delivery (VD or caesarean section (C/S). Patients and Methods: We used Longo’s ODS score for the assessment of the severity of pelvic floor malfunction. Stapled Trans Anal Rectal Resection (STARR) procedure was performed using two circular staplers. Follow-up was done 12 months after the discharge. To assess the role of episiotomy in patient with VD, we divided them into two subgroups; females who had VD with episiotomy (Vd + epi) and females who had VD alone. Data were analyzed using SPSS version 20 software. P values less than 0.05 were considered statistically significant. Results: In 30 consecutive females undergoing STARR for the treatment of ODS, who enrolled in this prospective study, 19 (63.3%) had Vaginal Delivery VD and 11 (36.7%) had Cesarean Section (C/S). The ODS score before the surgery was higher in females who had C/S, although there was no significant difference between VD and C/S groups in terms of the percentage of the ODS score improvement after the STARR surgery. Conclusions: Higher ODS score in females who had C/S showed that C/S could not protect the pelvic organ from pregnancy and delivery trauma. It seems that episiotomy has a protective effect during VD; it can reduce the severity of trauma in pelvic organs during childbearing.
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Affiliation(s)
- Shaban Mehrvarz
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Seyed Mohsem Towliat
- Department of Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hassan Ali Mohebbi
- Department of Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Soleyman Heydari
- Department of Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Soleyman Heydari, Department of Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2181263550, Fax: +98-2188053766, E-mail:
| | - Mahdi Farahani
- Department of Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hamid Reza Rasouli
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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Yoshida M, Murayama R, Hotta K, Higuchi Y, Sanada H. Differences in motor learning of pelvic floor muscle contraction between women with and without stress urinary incontinence: Evaluation by transabdominal ultrasonography. Neurourol Urodyn 2015; 36:98-103. [DOI: 10.1002/nau.22867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 08/04/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Mikako Yoshida
- Department of Life Support Technology (Molten), Graduate School of Medicine; the University of Tokyo; Tokyo Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Division of Health Sciences and Nursing, Graduate School of Medicine; the University of Tokyo; Tokyo Japan
| | - Kumi Hotta
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine; University of Tokyo; Tokyo Japan
| | - Yoshihide Higuchi
- Department of Physical Therapy, Faculty of Health Care; Takasaki University of Health and Walfare; Takasaki Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; the University of Tokyo; Tokyo Japan
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Brown RA, Ellis CN. The role of synthetic and biologic materials in the treatment of pelvic organ prolapse. Clin Colon Rectal Surg 2014; 27:182-90. [PMID: 25435827 PMCID: PMC4226752 DOI: 10.1055/s-0034-1394157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pelvic organ prolapse is a significant medical problem that poses a diagnostic and management dilemma. These diseases cause serious morbidity in those affected and treatment is sought for relief of pelvic pain, rectal bleeding, chronic constipation, obstructed defecation, and fecal incontinence. Numerous procedures have been proposed to treat these conditions; however, the search continues as colorectal surgeons attempt to find the procedure that would optimally treat these conditions. The use of prosthetics in the repair of pelvic organ prolapse has become prevalent as the benefits of their use are realized. While advances in biologic mesh and new surgical techniques promise improved functional outcomes with decreased complication rates without de novo symptoms, the debate concerning the best prosthetic material, synthetic or biologic, remains controversial. Furthermore, laparoscopic ventral mesh rectopexy has emerged as a procedure that could potentially fill this role and is rapidly becoming the procedure of choice for the surgical treatment of pelvic organ prolapse.
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Affiliation(s)
- Ramon A Brown
- Keesler Medical Center, Keesler Air Force Base, Biloxi, Mississippi ; The views expressed in this article are those of the authors, and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the U.S. Government
| | - C Neal Ellis
- VA Gulf Coast Veterans Health Care System, Biloxi, Mississippi
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Dai M, Xu P, Hou M, Teng Y, Wu Q. In vivo imaging of adipose-derived mesenchymal stem cells in female nude mice after simulated childbirth injury. Exp Ther Med 2014; 9:372-376. [PMID: 25574200 PMCID: PMC4280933 DOI: 10.3892/etm.2014.2092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 10/27/2014] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to track in vivo the distribution and survival of adipose-derived mesenchymal stem cells (ASCs) transplanted into female BALB/c nude mice following simulated childbirth injury, using green fluorescent protein and luciferase dual labeling, bioluminescent imaging (BLI) and histological evaluation. The results demonstrated that the dually labeled ASCs could be detected for up to eight weeks in vivo. The number of implanted cells decreased during the first three weeks, and then stabilized until the end of the experiment. According to the linear regression plot, ~27,621 implanted cells survived until eight weeks after implantation. Transplanted ASCs predominantly existed at the inoculation site of the vagina, with little or no spread to other organs. Histological analysis confirmed the survival of the engrafted ASCs. The study provided basic evidence that BLI techniques can be used to monitor ASCs in vivo in real time and in the long term. Through local administration, ASCs could survive in the long term to facilitate repair following pelvic-floor injury.
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Affiliation(s)
- Miao Dai
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Peirong Xu
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Min Hou
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Yincheng Teng
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Qingkai Wu
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
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Marsoosi V, Jamal A, Eslamian L, Oveisi S, Abotorabi S. Prolonged second stage of labor and levator ani muscle injuries. Glob J Health Sci 2014; 7:267-73. [PMID: 25560352 PMCID: PMC4796514 DOI: 10.5539/gjhs.v7n1p267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/14/2014] [Accepted: 07/10/2014] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine the effect of pregnancy and vaginal delivery on the pelvic floor and levatorani morphology and function. Methods: Design. Cross-sectional study. Setting. Tertiary care teaching hospital. Population. 75 primigravid women were recruited for assessment at 6 weeks postpartum compared with 25 nulliparous women. Hiatal morphology and levator ani muscle avulsion were assessed by 4-dimensional translabial ultrasound examination. The volume achievement obtained by ultrasound was performed in supine position with empty bladder at rest, on maximum Valsalva maneuver, and on maximum pelvic floor muscle contraction. Main Outcome Measures. Hiatal diameter and area were measured at the plane of minimal hiatal dimension as defined in the midsagittal plane and Levator avulsion was assessed. Results: There were significant differences in hiatal area morphology at rest, on Valsalva maneuver and during contraction of muscles among the study groups, but there was no difference in pelvic diameter at rest, on Valsalva maneuver, and during contraction. There were 21 cases of puborectalis avulsion (42%) with no significant difference between non-progressive labor (8 cases) and Normal Vaginal Delivery (NVD) (13 cases) groups. Conclusions: The results of the present study showed that non-progressive labor is the main risk factor for pelvic muscle injuries, indicating the necessity of a better management and timely cesareans in women with prolonged second stage of labor.
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Affiliation(s)
| | | | | | | | - Shokohossadat Abotorabi
- Assistant Professor of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
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Aytan H, Ertunç D, Tok EC, Yaşa O, Nazik H. Prevalence of pelvic organ prolapse and related factors in a general female population. Turk J Obstet Gynecol 2014; 11:176-180. [PMID: 28913013 PMCID: PMC5558330 DOI: 10.4274/tjod.90582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/30/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the prevalence and the related factors of pelvic organ prolapse (POP) in a female population to whom health care services are offered. MATERIALS AND METHODS 1354 of the 3000 women admitted to the outpatient clinic between June 2008 and December 2008 were enrolled as they accepted to participate to the study. 34 of these patients with a history of previous hysterectomy and/or any kind of pelvic reconstructive surgery were excluded. Baseline characteristics, as well as medical and obstetric history of the patients were recorded. All women underwent vaginal examination to determine the degree of prolapse by pelvic organ prolapse quantification (POPQ) system. POP-Q stages ≥2 were defined as prolapse. Women with and without prolapse were compared. Regression analysis was used in order to determine the independent predictors. RESULTS Prolapse (stage ≥2) was detected in 358 patients (27.1%). Patients with prolapse were found to be significantly older and heavier. They had a higher waist to hip ratio and had a higher parity. Compared to women without prolapse, cesarean rate was significantly lower in women with prolapse (10.6% vs. 20.8%; p<0.001), and the mean birth weight of the babies of the women with prolapse was significantly higher (3584±574 vs. 3490±389 g, p=0.004). Prevalence of prolapse was found to be decreased as the level of education increased. Waist to hip ratio (OR:46.2, CI: 3.3-655, p=0.005), parity (OR:1.5, CI:1.3-1.7, p<0.001), vaginal delivery (OR:1.5, CI: 0.3-0.8, p=0.005), and menopausal status (OR:1.2, CI: 1.1-1.4, p=0.005) were found to be independent predictors of development of POP. CONCLUSION In the present study, POP was found to be associated with waist to hip ratio, parity, vaginal delivery, and menopausal status.
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Affiliation(s)
- Hakan Aytan
- Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - Devrim Ertunç
- Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - Ekrem C Tok
- Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - Osman Yaşa
- Mersin University Faculty of Medicine, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - Hakan Nazik
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
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Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature. Eur J Obstet Gynecol Reprod Biol 2014; 178:27-34. [DOI: 10.1016/j.ejogrb.2014.04.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 02/10/2014] [Accepted: 04/08/2014] [Indexed: 12/30/2022]
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Biomechanics of the rat vagina during pregnancy and postpartum: a 3-dimensional ultrasound approach. Int Urogynecol J 2014; 25:915-20. [DOI: 10.1007/s00192-013-2313-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/16/2013] [Indexed: 11/27/2022]
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Brandão S, Da Roza T, Parente M, Ramos I, Mascarenhas T, Natal Jorge RM. Magnetic resonance imaging of the pelvic floor: from clinical to biomechanical imaging. Proc Inst Mech Eng H 2013; 227:1324-32. [PMID: 24030164 DOI: 10.1177/0954411913502952] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reviews the current role of magnetic resonance imaging in the study of the pelvic floor anatomy and pelvic floor dysfunction. The application of static and dynamic magnetic resonance imaging in the clinical context and for biomechanical simulation modeling is assessed, and the main findings are summarized. Additionally, magnetic resonance-based diffusion tensor imaging is presented as a potential tool to evaluate muscle fiber morphology. In this article, focus is set on pelvic floor muscle damage related to urinary incontinence and pelvic organ prolapse, sometimes as a consequence of vaginal delivery. Modeling applications that evaluate anatomical and physiological properties of pelvic floor are presented to further illustrate their particular characteristics. Finally, finite element method is described as a method for modeling and analyzing pelvic floor structures' biomechanical performance, based on material and behavioral properties of the tissues, and considering pressure loads that mimic real-life conditions such as active contraction or Valsalva maneuver.
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Affiliation(s)
- Sofia Brandão
- Department of Radiology, Centro Hospitalar de São João-EPE, Porto, Portugal
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Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J 2013; 24:901-12. [PMID: 23436035 PMCID: PMC3671107 DOI: 10.1007/s00192-013-2061-7] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/26/2013] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is the most common type of urinary incontinence (UI) in pregnant women and is known to have detrimental effects on the quality of life in approximately 54.3 %. Pregnancy is the main risk factor for the development of SUI. This review provides details of the pathophysiology leading to SUI in pregnant women and SUI prevalence and treatment during pregnancy. METHODS We conducted a PubMed search for English-language and human-study articles registered from January 1990 to September 2012. This search was performed for articles dealing with prevalence and treatment of SUI during pregnancy. In the intervention studies, we included studies that used a randomized controlled trial (RCT) design or studies comparing a treatment intervention to no treatment. RESULTS A total of 534 articles were identified; 174 full-text articles were reviewed, and 28 of them met eligibility criteria and are reported on here. The mean prevalence of SUI during pregnancy was 41 % (18.6-60 %) and increased with gestational age. The increasing pressure of the growing uterus and fetal weight on pelvic-floor muscles (PFM) throughout pregnancy, together with pregnancy-related hormonal changes, may lead to reduced PFM strength as well as their supportive and sphincteric function. These cause mobility of the bladder neck and urethra, leading to urethral sphincter incompetence. Pelvic floor muscle exercise (PFME) is a safe and effective treatment for SUI during pregnancy, without significant adverse effects. CONCLUSIONS Understanding these issues can be useful for health-care professionals when informing and counseling pregnant women to help prevent SUI during pregnancy and the postpartum period.
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Quiroz LH, Shobeiri SA, White D, Wild RA. Does age affect visualization of the levator ani in nulliparous women? Int Urogynecol J 2013; 24:1507-13. [PMID: 23411510 DOI: 10.1007/s00192-013-2053-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our aim was to assess whether differences in the ages of nulliparous women affect: (1) interobserver reliability, and (2) visualization of the levator ani (LA) muscle subdivisions in nulliparous women using 3D endovaginal ultrasound (3D-EVUS). METHODS This was a cross-sectional study. Community-dwelling nulliparous women ages 21-70 years were recruited. Participants underwent a standard examination and a 3D-EVUS. LA subdivisions of interest included the puboperinealis, puboanalis, pubococcygeus, puborectalis, and ileococcygeus muscles. Each ultrasound (US) volume was scored using a validated scale and assessed by two observers. Defect severity was scored for each muscle from 0 (no defect) to 6 (complete muscle loss). A summed score of the two sides was grouped as normal (0), minor (1-3), or major (4-6). Bias was examined using Bland-Altman plots. Intraclass coefficients were calculated to report agreement of total scores. Spearman's rank correlation was used to evaluate the association between age and LA scores. RESULTS Eighty nulliparous women were evaluated. Exact agreement for bilateral scoring of each LA subdivision ranged from 82 % to 84 %. Bilateral scoring of the puboperinealis, puborectalis, and ileococcygeus showed moderate to substantial agreement. Bilateral scores of the puboperinealis demonstrated substantial agreement between observers, with an ICC of 0.8 and a mean difference of -0.2 using the Bland-Altman analysis. When women were analyzed by age decade, reader agreement was overall good to excellent. There was no significant correlation between increasing age and total LA muscle scores (r = 0.179, p = 0.113). CONCLUSIONS Interobserver reliability or visualization of the LA muscle in nulliparous women was not affected by a woman's age.
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Affiliation(s)
- Lieschen H Quiroz
- Division Female Pelvic Medicine and Reconstructive Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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Yoshida M, Murayama R, Nakata M, Haruna M, Matsuzaki M, Shiraishi M, Sanada H. Pelvic floor function and advanced maternal age at first vaginal delivery. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojog.2013.34a005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The impact of cesarean delivery on pelvic floor dysfunction in lysyl oxidase like-1 knockout mice. Female Pelvic Med Reconstr Surg 2012; 16:21-30. [PMID: 22453086 DOI: 10.1097/spv.0b013e3181d00035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : Lysyl oxidase like-1 (LOXL1) knockout mice have abnormal elastic fiber homeostasis and frequently develop pelvic floor dysfunction after pregnancy and delivery. The objective of this study was to test the hypothesis that tissue changes associated with vaginal delivery lead to pelvic floor dysfunction as a result of abnormal elastic fiber homeostasis. METHODS : Female LOXL1 knockout mice delivered either spontaneously or by cesarean delivery. Mice were assessed weekly for pelvic organ prolapse (POP). At 12 weeks postpartum, lower urinary tract function was assessed by cystometry and leak-point pressure testing. Urethrovaginal cross-sections were analyzed using a histologic grading scale to assess elastin fiber disorganization. RESULTS : A total of 39 mice delivered by spontaneous vaginal delivery and 36 by cesarean delivery. Twelve weeks after spontaneous vaginal delivery or cesarean delivery, 23 (59%) and 11 (31%) mice had developed POP, respectively. The mean time to develop POP was 7.2 weeks after spontaneous vaginal delivery and 10.5 weeks after cesarean delivery (log rank, P = 0.0008). The Cox proportional hazard ratio was 0.55 (95% confidence interval, 0.38-0.79). Mice with POP had increased frequency of bladder contractions not associated with voiding during cystometry (P = 0.02). POP, but not mode of delivery, was associated with increased elastic fiber disorganization. CONCLUSIONS : Cesarean delivery delays the development of POP in LOXL1 knockout mice. POP is associated with increased bladder contraction frequency and increased elastic fiber disorganization in the urethra and vagina. The mechanisms underlying these findings warrant further investigation.
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Huang J, Cheng M, Ding Y, Chen L, Hua K. Modified vaginal dilation rat model for postpartum stress urinary incontinence. J Obstet Gynaecol Res 2012; 39:256-63. [DOI: 10.1111/j.1447-0756.2012.01959.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Okonkwo NS, Ojengbede OA, Morhason-Bello IO, Adedokun BO. Maternal demand for cesarean section: perception and willingness to request by Nigerian antenatal clients. Int J Womens Health 2012; 4:141-8. [PMID: 22505833 PMCID: PMC3325008 DOI: 10.2147/ijwh.s10325] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Contrary to the widely reported aversion to cesarean section in the West African subregion, maternal demand for cesarean section (MDCS) seems to be on the increase, and there is little evidence to explain this trend. The purpose of this study was to determine the perception and attitudes of Nigerian antenatal clients towards MDCS, their willingness to request MDCS, and the relationship between willingness to request MDCS and sociodemographic characteristics. Methods A cross-sectional survey was undertaken among 843 antenatal clients at Agbongbon/Orayan primary health care centers (PHCs), Adeoyo Maternity Hospital (SHC), and UCH Ibadan (THC), representing the three different levels of health care in Nigeria, ie, primary, secondary, and tertiary. Results The proportion of women aware of MDCS was 39.6%. Predictors of awareness were education and type of health facility. Women from THC and those with tertiary education and above were more likely to be aware of MDCS than others (P = 0.001). Doctors were major sources of information on MDCS (30.8%) as well as friends (24.3%). Common reasons reported for MDCS were fear of labor pains (68.9%), and fear of poor labor outcome (60.1%), and fear of fecal (20.2%) and urinary incontinence (16.8%). More women from the THC than other facilities believed that requests for MDCS should be granted (P < 0.001). However, willingness to request MDCS was low (6.6%). More than 50% of those willing to request MDCS would likely be criticized, mainly by their husbands. On multiple logistic regression, respondents at the THC were significantly more likely than those at the SHC or the PHCs to request cesarean section and to favor a woman’s right of autonomy to choose her mode of delivery. Conclusion The decision for MDCS is a difficult one, because willingness is low and criticism by partners of those who choose MDCS is high. Provision of epidural anesthesia and improved safety of vaginal delivery is recommended. This may prevent Nigerian women from making a difficult choice for MDCS based on fear of pain and poor labor outcome. The role of the male partner should be taken into consideration in order to make sustainable policies or guidelines for MDCS in developing countries.
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Affiliation(s)
- Ngozi S Okonkwo
- Department of Obstetrics and Gynecology, University College Hospital, University of Ibadan, Ibadan
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Combined ischemic and neuropathic insult to the anal canal in an animal model of obstetric-related trauma. Dis Colon Rectum 2012; 55:32-41. [PMID: 22156865 DOI: 10.1097/dcr.0b013e318236dcab] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Childbirth, in particular, when it involves instrumental vaginal delivery, can result in direct trauma to the external anal sphincter muscle. In addition, a global injury to the pelvic floor, including neurovascular injury to the anal sphincter complex, may occur. OBJECTIVE The aims of this study were to determine whether sensory drive from the anal canal and oxygenation of the external anal sphincter were compromised during simulated labor in a validated animal model of obstetric trauma. DESIGN Fifteen female Wister rats were operated on. Group 1 (n = 5) underwent pelvic balloon compression for 1 hour to simulate increased pelvic pressure during childbirth. Somatosensory cortical potentials, evoked by electrically stimulating the anal canal, were tracked. In group 2 (sham), the balloons were not inflated. In group 3, tissue PO2 values of the external anal sphincter and femoral arterial blood flow were measured simultaneously during the period of balloon inflation. RESULTS The peak amplitude of cortical evoked potentials was reduced (from 11.8 ± 1.5 μV to 3.1 ± 1.1 μV) during pelvic compression (p = 0.002, ANOVA). During this period, arterial blood flow to the hindlimb and the external anal sphincter tissue PO2 decreased by 20% (p < 0.001) and 60% (p < 0.001). CONCLUSION Pelvic compression that mimics obstetric trauma is associated with diminished anocortical drive. This neural insult may be compounded by concomitant ischemia of the external anal sphincter.
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Tubaro A, Koelbl H, Laterza R, Khullar V, de Nunzio C. Ultrasound imaging of the pelvic floor: where are we going? Neurourol Urodyn 2011; 30:729-34. [PMID: 21661021 DOI: 10.1002/nau.21136] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We produced a non systematic review of ultrasound imaging of the pelvic floor in women with urinary incontinence (UI) and/or pelvic organ prolapse (POP). We have searched the PubMed and Embase databases for the following PICO question: women; imaging; urinary incontinence, pelvic organ prolapse, pelvic floor, pelvic floor muscle, pelvic floor muscle training; physical examination, no imaging; diagnosis, prognosis, outcome. The production of a systematic review was deemed impossible based on the type and quality of the published evidence. Clinical research focused on the pathophysiology of the UI and POP looking relation between anatomic abnormalities, childbirth, the risk of UI or POP, the outcome of conservative treatment and reconstructive surgery. Published papers fall into the remits of diagnostic studies but often fail to comply with the recommendations of the STARD initiative. Most published evidence remains the product of a single institution effort and confirmatory studies are rarely found. Imaging studies in patients with UI did not provide evidence of any clinical benefit in the management of patients. In patients with POP, interesting correlations have been identified such as between childbirth, dimension of levator hiatus, avulsion of levator ani and risk of prolapse, but the non clinical benefit of pelvic floor imaging could still not be identified. Research on pelvic floor imaging requires a coordinated, international, multicentre effort to improve internal and external validity of imaging techniques, confirm observations published by single institutions and provide health technology assessment of imaging in the management of UI or POP patients.
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Affiliation(s)
- Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, 2nd School of Medicine, La Sapienza University of Rome, Italy.
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Levator avulsion using a tomographic ultrasound and magnetic resonance-based model. Am J Obstet Gynecol 2011; 205:232.e1-8. [PMID: 21620359 DOI: 10.1016/j.ajog.2011.03.052] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 02/14/2011] [Accepted: 03/29/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Delivery-related levator avulsion can cause pelvic floor dysfunction. We compared agreement between tomographic ultrasound and magnetic resonance-based models for the detection of levator defects. STUDY DESIGN Sixty-nine Chinese women with pelvic organ prolapse were assessed prospectively by 3-dimensional ultrasound scans and magnetic resonance imaging. Levator-urethra gap (LUG), levator-symphysis gap (LSG), and puborectalis attachment width were measured offline with state-of-the-art software. Interobserver variability and agreement between the 2 methods were determined. RESULTS Interobserver repeatability was moderate-to-excellent for all parameters that were measured with both methods and agreement between methods in diagnosing levator avulsion. LUG and LSG measurements were significantly higher in women with a levator avulsion. With a diagnosis of complete levator avulsion, receiver operating characteristics analysis suggested a cutoff of 23.65 mm for LUG and 28.7 mm for LSG. CONCLUSION Levator avulsion can be diagnosed reliably by tomographic ultrasound scanning and magnetic resonance imaging evaluation, and linear measures, such as LSG and LUG, can be proxy measurements for avulsion.
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Apte G, Nelson P, Brismée JM, Dedrick G, Justiz R, Sizer PS. Chronic Female Pelvic Pain-Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region. Pain Pract 2011; 12:88-110. [DOI: 10.1111/j.1533-2500.2011.00465.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pelvic floor muscle strength and body self-perception among Brazilian pregnant women. Physiotherapy 2010; 96:337-43. [DOI: 10.1016/j.physio.2010.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 02/08/2010] [Indexed: 11/15/2022]
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Jundt K, Scheer I, Schiessl B, Karl K, Friese K, Peschers UM. Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. Eur J Med Res 2010; 15:246-52. [PMID: 20696633 PMCID: PMC3351993 DOI: 10.1186/2047-783x-15-6-246] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective To compare the function of the pelvic floor in primiparae before and during pregnancy with the status post partum concerning symptoms of incontinence, sphincter ruptures, bladder-neck mobility and the influence of the different modes of deliveries. Methods Questionnaire evaluating symptoms of urinary and anal incontinence in nulliparous women before and after delivery and correlating these symptoms with functional changes of the pelvic floor based on a careful gynaecologic examination as well as perineal and endoanal ultrasound. Results 112 women were included in our study and came for the first visit, 99 women returned for follow-up 6 months after childbirth. Stress and flatus incontinence significantly increased from before pregnancy (3 and 12%) to after childbirth (21 and 28%) in women with spontaneous delivery or vacuum extraction. No new symptoms occurred after c-section. There was no significant difference between the bladder neck position before and after delivery. The mobility of the bladder neck was significantly higher after vaginal delivery using a vacuum extraction compared to spontaneous delivery or c-section. The bladder neck in women with post partum urinary stress incontinence was significantly more mobile than in continent controls. The endoanal ultrasound detected seven occult sphincter defects without any correlation to symptoms of anal incontinence. Conclusion Several statistically significant changes of the pelvic floor after delivery were demonstrated. Spontaneous vaginal delivery or vacuum extraction increases the risk for stress or anal incontinence, delivery with vacuum extraction leads to higher bladder neck mobility and stress incontinent women have more mobile bladder necks than continent women.
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Affiliation(s)
- K Jundt
- Department for Gynecology and Obstetrics, Ludwig-Maximilians-Universität, München, Germany.
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Thor KB, de Groat WC. Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles. Am J Physiol Regul Integr Comp Physiol 2010; 299:R416-38. [PMID: 20484700 PMCID: PMC2928615 DOI: 10.1152/ajpregu.00111.2010] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/11/2010] [Indexed: 01/20/2023]
Abstract
The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided.
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Affiliation(s)
- Karl B Thor
- Urogenix, Inc., Durham, North Carolina, USA.
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Childbirth method has an effect on non-fistulous urinary incontinence amongst sub-Saharan African women: fact or fallacy? Int Urogynecol J 2010; 21:1391-5. [PMID: 20559619 DOI: 10.1007/s00192-010-1193-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 05/25/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The association of mode of childbirth and non-fistulous urinary incontinence has been largely explored among Caucasians with little or no information from black female population living in developing countries. The aim of this study is to address this gap in knowledge. METHODS A Household Survey of Urinary Incontinence was conducted in 2009. Of the 5,001 eligible respondents, 4,944 had information on childbirth. The relationships between mode of delivery (vaginal, caesarean and assisted--forceps and vacuum) and UI was explored using bivariate and multivariable analysis at 95% confidence level. RESULTS Of significant factors on bivariate analysis, only mode of childbirth was significant on regression analysis. Women with history of assisted delivery were about 4.7 times more likely than those who delivered through other means and over seven times more likely than nulliparous women to report urine leakage. CONCLUSION The outcome shows a linkage of childbirth methods with non-fistulous UI in a black population.
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Hendriks EJM, Kessels AGH, de Vet HCW, Bernards ATM, de Bie RA. Prognostic indicators of poor short-term outcome of physiotherapy intervention in women with stress urinary incontinence. Neurourol Urodyn 2010; 29:336-43. [PMID: 19475574 DOI: 10.1002/nau.20752] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS To identify prognostic indicators independently associated with poor outcome of physiotherapy intervention in women with primary or recurrent stress urinary incontinence (stress UI). METHODS A prospective cohort study was performed in physiotherapy practices in primary care to identify prognostic indicators 12 weeks after initiation of physiotherapy intervention. Patients were referred by general practitioners or urogynecologists. Risk factors for stress UI were examined as potential prognostic indicators of poor outcome. The primary outcomes were defined as poor outcome on the binary Leakage Severity scale (LS scale) and the binary global perceived effectiveness (GPE) score. RESULTS Two hundred sixty-seven women, with a mean age of 47.7 (SD = 8.3), with stress UI for at least 6 months were included. At 12 weeks, 43% and 59% of the women were considered recovered on the binary LS scale and the binary GPE score, respectively. Prognostic indicators associated with poor outcome included 11 indicators based on the binary LS scale and 8 based on the binary GPE score. The prognostic indicators shared by both models show that poor recovery was associated with women with severe stress UI, POP-Q stage > II, poor outcome of physiotherapy intervention for a previous UI episode, prolonged second stage of labor, BMI > 30, high psychological distress, and poor physical health. CONCLUSIONS This study provides robust evidence of clinically meaningful prognostic indicators of poor short-term outcome. These findings need to be confirmed by replication studies.
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Affiliation(s)
- Erik J M Hendriks
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
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Bortolini MAT, Drutz HP, Lovatsis D, Alarab M. Vaginal delivery and pelvic floor dysfunction: current evidence and implications for future research. Int Urogynecol J 2010; 21:1025-30. [PMID: 20445961 DOI: 10.1007/s00192-010-1146-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 03/12/2010] [Indexed: 01/04/2023]
Abstract
Vaginal delivery is the major risk factor for the development of pelvic organ prolapse and urinary and fecal incontinence, resulting from damage to the pelvic floor muscles, nerves and connective tissue. This article reviews the perineal trauma mechanism during vaginal delivery and discusses implications of current and future research projects.
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Affiliation(s)
- M A T Bortolini
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada.
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Fritel X. Périnée et grossesse. ACTA ACUST UNITED AC 2010; 38:332-46. [DOI: 10.1016/j.gyobfe.2010.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 03/16/2010] [Indexed: 01/26/2023]
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