Pelvic floor muscle behavior during Valsalva leak point pressure measurement in males and females affected by stress urinary incontinence

Experimental characterization and constitutive modeling of the biomechanical behavior of male human urethral tissues validated by histological observations

This work aims at observing the mechanical behavior of the membranous and spongy portions of urethrae sampled on male cadavers in compliance with French regulations on postmortem testing, in accordance with the Scientific Council of body donation center of Grenoble. In this perspective, a thermostatic water tank was designed to conduct ex vivo planar tension tests in a physiological environment, i.e., in a saline solution at a temperature of [Formula: see text] [Formula: see text]. In order to observe the anisotropy of the tissues, the samples were tested in two directions. Tests consisting of a series of load-unload cycles of increasing amplitudes were performed to highlight their viscous behavior. The results were then discussed according to the microstructure of tissue, which was investigated using different staining methods and histological analysis. The observed behaviors were then fitted using an anisotropic hyperelastic or a visco-hyperelastic matrix-fiber model.

Pelvic Organ Prolapse Repair with and without Concomitant Burch Colposuspension in Incontinent Women: A Randomised Controlled Trial with at Least 5-Year Followup

The aim of this study was to reevaluate and update the followup of a previously published randomized controlled trial (RCT) on the impact of Burch Colposuspension (BC), as an anti-incontinence procedure, in patients with UI and POP, who underwent POP repair. Forty-seven women were randomly assigned to abdominal POP repair and concomitant BC (24 patients; group A) or POP repair alone without any anti-incontinence procedure (23 patients; group B). Median followup was 82 months (range 60-107); from over 47 patients, 30 reached 6-year followup. Two patients were lost at followup. In group A, 2 patients showed a stage I rectocele. In group B, 2 patients had a stage I rectocele and 1 a stage II rectocele. In group A, 13/23 (56.5%) were still incontinent after surgery compared with 9/22 patients (40.9%) in group B (P = 0.298). No significant changes were observed between the first and the current followup. The update of long-term followup confirmed that BC did not improve outcome significantly in incontinent women when they undergo POP repair.

Variation of the anal resting pressure induced by postexpiratory apnea effort in patients with constipation

CONTEXT

Intestinal constipation--a common symptom among the general population--is more frequent in women. It may be secondary to an improper diet or organic or functional disturbances, such as dyskinesia of the pelvic floor. This is basically characterized by the absence of relaxation or paradoxical contraction of the pelvic floor and anal sphincter during evacuation.

OBJECTIVE

To analyze, by manometric data, the anal pressure variation at rest, during evacuation effort by using the Valsalva maneuver and forced post-expiratory apnea in subjects with secondary constipation.

METHODS

Twenty-one patients (19 females--90.4%) with a mean age of 47.5 years old (23-72) were studied. The diagnosis was performed using anorectal manometry, with a catheter containing eight channels disposed at the axial axis, measuring the proximal (1) and distal (2) portions of the anal orifice. The elevation of the pressure values in relation to the resting with the evacuation effort was present in all patients. The Agachan score was used for clinical evaluation of constipation. The variables studied were: mean anal pressure of the anal orifice for 20 seconds at rest, the effort of evacuation using Valsalva maneuver and the effort of evacuation during apnea after forced expiration, as well as the area under the curve of the manometric tracing at moments Valsalva and apnea.

RESULTS

The analysis of the mean values of the anal pressure variation at rest evidenced difference between proximal and distal channels (P = 0.007), independent of the moment and tendency to differ during moments Valsalva and apnea (P = 0.06). The mean of values of the area under the manometric tracing curve showed differences between moments Valsalva and apnea (P = 0.0008), either at the proximal portion or at the distal portion of the anal orifice.

CONCLUSION

The effort of evacuation associated with postexpiratory apnea, when compared with the effort associated with the Valsalva maneuver, provides lower elevation of anal pressure at rest by the parameter area under the curve.

Patients of surgical educational course may have a poorer outcome for pelvic organ prolapse repair and higher complication rate: a case-control study in urogynecology

INTRODUCTION AND HYPOTHESIS

To investigate the outcome of the surgical educational course setting in patients undergoing urinary incontinence (UI)/pelvic organ prolapse (POP) repair.

METHODS

A case-control study of patients who underwent surgery for UI and/or POP during educational post-graduate courses (group A) or during routine hospital work (control--group B). The primary outcome measures were changes in the incontinence rate, presence/absence of POP, and complications. For 2 x 2 tables, chi (2) test was used. Multivariate logistic regression models were developed.

RESULTS

One hundred eighty-six patients belonged to group A and 158 to group B; median follow-up was 46.7 months. Failure, complication, and re-operation rates for UI repair were not significantly different in the two groups: p = 0.162, p = 0.110, p = 0.188, respectively. The logistic regression analysis for POP repair showed that group A has higher risk for failure (OR = 2.71; 95% CI: 1.31-5.61) and higher complication rate (OR = 2.38; 95% CI: 1.31-4.32).

CONCLUSION

Patients who underwent surgery during educational course developed a poorer outcome after POP repair and higher complication rate.

Preoperative Valsalva leak point pressure may not predict outcome of mid-urethral slings. Analysis from a randomized controlled trial of retropubic versus transobturator mid-urethral slings

OBJECTIVE

To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI).

MATERIALS AND METHODS

One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables.

RESULTS

Mean follow-ups were 32 +/- 12 months (range 12-55) for TVT and 31 +/- 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5%) patients showed a VLPP > 60 cm H2O and 50 (34.5%) patients had a VLPP < or = 60 cm H2O. The overall objective cure rates were 75.8% for patients with VLPP > 60 cm H2O and 72% for those with VLPP < or = 60 cm H2O (p < 0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures: VLPP > 60 cm H2O (82% vs. 68.9% p < 0.172); VLPP < or = 60 cm H2O (68% vs. 76% p < 0.528).

CONCLUSIONS

When patients were stratified for preoperative VLPP (< or = or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.

Improvement of quality of life, anxiety and depression after surgery in patients with stress urinary incontinence: results of a longitudinal short-term follow-up

Objective

The objective of this study was to compare the effect of incontinence surgery and pelvic floor training on quality of life (QOL), anxiety and depression in patients with stress urinary incontinence (SUI).

Methods

In a prospective longitudinal study, females with proven SUI were asked to complete a set of standardized questionnaires (sociodemographic data sheet, FACT-G, I-QOL, HADS) before and eight weeks after treatment. The comparison groups consisted of a surgical treatment group and a conservative group that underwent supervised pelvic floor training for eight weeks.

Results

From the 67 female patients included in the study a number of 53 patients completed both assessment time points (mean age 57.4, mean years of SUI 7.6). The surgical treatment group consisted of 32 patients of which 21 patients received a modified Burch colposuspension and 11 patients a tension-free mid-urethral tape suspension. The 21 patients in the conservative group attended eight once-weekly supervised pelvic floor training sessions.

After treatment the surgical intervention group showed a significantly higher improvement of QOL (FACT-G and I-QOL) and anxiety (HADS) than the pelvic floor training group.

Conclusion

For female patients with SUI surgery yielded a better outcome than pelvic floor training with regard to quality of life and anxiety.

Displacement and recovery of the vesical neck position during pregnancy and after childbirth

AIMS

(i) To describe the displacement and recovery of the vesical neck position during pregnancy and after childbirth and (ii) to discriminate between compliance of the vesical neck supporting structures with and without pelvic floor contraction.

METHODS

We focussed on the biomechanical properties of the vesical neck supporting structures during pregnancy and after childbirth by calculating the compliance and the hysteresis as a result from of abdominal pressure measurements and simultaneous perineal ultrasound.

RESULTS

This study shows that compliance of the supporting structures remains relatively constant during pregnancy and returns to normal values 6 months after childbirth. Hysteresis, however, showed an increase after childbirth, persisting at least until 6 months post partum.

CONCLUSIONS

Vaginal delivery may stretch and or load beyond the physiological properties of the pelvic floor tissue and in this way may lead to irreversible changes in tissue properties which play an important role in the urethral support continence mechanism.