The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

Effect of lattice CO2 laser combined with Kegel exercise mild moderate stress urinary incontinence and postpartum depression anxiety

BACKGROUND

Postpartum stress urinary incontinence (SUI) symptoms affect a patient's daily activities and quality of life and increase the negative emotions that they experience. At present, there is no research on the effect of fractional CO2 laser treatment combined with Kegel exercise on postpartum SUI and postpartum depression and anxiety.

AIM

To investigate the effect of lattice CO2 laser treatment combined with Kegel exercise on mild to moderate postpartum SUI and its influence on postpartum depression and anxiety.

METHODS

Using a retrospective study, data from 82 cases of mild to moderate postpartum SUI in Huzhou Maternal & Child Health Care Hospital from January to April 2024 were retrospectively collected. The cases were divided into groups according to the different treatment methods, namely Group S (41 cases, only receiving lattice CO2 laser treatment) and Group L (41 cases, receiving lattice CO2 laser combined with Kegel exercise treatment). The baseline data of the two groups were compared. In addition, we analyzed and compared the scores of the international commission on urinary incontinence questionnaire short form (ICI-Q-SF), incontinence quality of life questionnaire (I-QOL), Edinburgh postnatal depression scale (EPDS), and postpartum specific anxiety scale (PSAS) before treatment, at the end of treatment, and 3 months after the end of treatment between the two groups. Furthermore, the clinical efficacy and adverse reactions of the two groups were analyzed and compared at the end of treatment and 3 months after the end of treatment.

RESULTS

There was no significant difference in the baseline data and the ICI-Q-SF, I-QOL, EPDS, and PSAS scores between the two groups before treatment. However, at the end of treatment, the ICI-Q-SF, I-QOL, EPDS, and PSAS scores between Groups L and S were significantly different. The overall effective rate of treatment in Group L was significantly higher than that in Group S. During the 3-month follow-up after treatment, it was found that the ICI-Q-SF, EPDS, and PSAS scores of Group L were still lower than those of Group S. In comparison, the I-QOL score and total effective rate of treatment were still higher in Group L than those in Group S, and this difference was significant. There was no significant difference in the adverse reactions between Group L and Group S.

CONCLUSION

The combination of dot lattice CO2 laser and Kegel exercise has a significant therapeutic effect on mild to moderate postpartum SUI. It can prolong the duration of therapeutic effects, improve a patient's quality of life, and alleviate postpartum depression and anxiety.

Long-Term Subjective Efficacy of Female Stress Urinary Incontinence with Tension-Free Vaginal Tape-Obturator Technique

INTRODUCTION AND HYPOTHESIS

The objective was to evaluate the long-term subjective efficacy of the tension-free vaginal tape-obturator (TVT-O) technique in the treatment of female stress urinary incontinence (SUI).

METHODS

A retrospective analysis was performed on 84 patients who underwent TVT-O surgery for SUI in a tertiary center between January 2007 and December 2013. All patients filled in the Urinary Incontinence Quality of Life Questionnaire (I-QOL), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12). Subjective efficacy, including surgical efficacy, clinical severity of SUI, improvement in quality of life (QoL), and sexual activity with regard to TVT-O were compared before and after surgery (≥ 10 years).

RESULTS

The average postoperative follow-up time was 12.6 ± 1.9 years, range, 10-16 years. The overall subjective effectiveness of the surgery was 94.0% (79 out of 84). The subjective clinical severity significantly improved more than 10 years after surgery compared with the preoperative value (p = 0.000). The median I-QOL score was 88.1 (84.1-92.0) preoperatively and 98.3 (94.3-99.7) postoperatively, and the long-term QoL of postoperative patients was significantly improved (p < 0.05). The median ICIQ-SF score was 10.5 (8-15) preoperatively, and 3 (0-5) postoperatively, and the ICIQ-SF score before and after surgery showed significant improvement in urinary incontinence symptoms (p < 0.05). No difference was observed in the PISQ-12 scores before and after surgery in the sexually active population.

CONCLUSIONS

The TVT-O technique still has good subjective efficacy in SUI more than 10 years after surgery and significantly improves the QoL of patients.

A new approach to treatment of stress urinary incontinence using non-ablative transurethral laser

Stress urinary incontinence (SUI) is a prominent incontinence caused by increased abdominal pressure. Sling treatments are surgical procedures used to treat SUI by inserting an artificial mesh into the urethra. However, after the sling treatments, patients can be at risk of chronic pain and infection in the urological system. The current research aims to develop new non-ablative transurethral laser treatment for SUI as a minimally invasive and non-implantable procedure. Six females porcine were randomly divided into three groups: Control, day 0 and day 28 after laser treatment. The urethra was dilated using a balloon-assisted diffusing applicator and irradiated with a 980-nm laser light at 20 W for 15 s. To compare the efficacy of the treatment, urethral tissues were harvested on days 0 and 28 for histological evaluation. 28 days after the laser treatment, the urethra thickness was 46% greater than the control group, indicating an increase in collagen deposition in the urethra. The transurethral laser treatment groups exhibited significantly higher levels of collagen reconstruction-related proteins (VEGF and collagen type 3), compared to the control group, without causing thermal damage to the urethral mucosa. The current findings demonstrated the feasibility of the non-ablative transurethral laser treatment for SUI without thermal damage to the urethral mucosa. Further investigations will be pursued to validate functional and molecular changes of the laser-treated urethra in a disease-induced animal model in order to warrant the efficacy and safety of the transurethral laser treatment for clinical translations.

Prevalence and risk factors of stress urinary incontinence in a 2023 Japanese community health survey - differences between males and females

Objectives

The aim of the present epidemiological study was to evaluate the sex-related prevalence of stress urinary incontinence (SUI) and the associated factors using data from the 2023 Japan Community Health Survey.

Methods

We investigated 3097 males and 3056 females aged 20-99 years. All participants answered web-based questionnaires on their health status and lower urinary tract symptoms. Data on the frequency of SUI, comorbidities and health-related behaviour were extracted. The Cochran-Armitage trend test was used to evaluate the trend between the prevalence of SUI and age. Multivariate analysis was performed using logistic regression analysis to identify factors associated with SUI.

Results

SUI was consistently observed in about 10% of individuals in their 20s and 30s, including in males. There were no age-related differences in the prevalence of SUI in males (P = 0.55). In females, the prevalence of SUI statistically significantly increased with age (P < 0.0001). The frequency of SUI was, however, low in both sexes. Drinking habits (OR, 1.43; 95% CI, 1.10-1.87) and frequent spicy food intake (OR, 1.55; 95% CI, 1.19-2.01) were associated with SUI only in males. Age (OR, 1.36; 95% CI, 1.13-1.62), BMI (OR, 1.87; 95% CI, 1.50-2.32) and history of vaginal delivery (OR, 2.15; 95% CI, 1.77-2.63) were only associated with SUI in females.

Conclusions

Although the frequency of SUI was low in both sexes, the correlation between the prevalence of SUI and age was different between both sexes. Female SUI might involve weakness of the pelvic floor muscle, while male SUI might be affected by health-related behaviours.

Bladder neck position differences on CT in patients with incidental asymptomatic urinary bladder gas: A comparative retrospective study

OBJECTIVE

To investigate the potential link between differences in bladder neck position and the occurrence of incidental asymptomatic urinary bladder gas on computed tomography (CT) scans in female patients.

METHODS

CT scans reports from January 2012 to December 2023 were analyzed in this retrospective study to identify adults presenting with bladder gas. Exclusion was based on factors such as prior urological procedures, urinary tract infections (UTIs), and other potential contributors to bladder gas. The distance between the bladder neck and the pubococcygeal line (B-PCL) was measured to assess bladder neck position. Patients without bladder gas, matched by age and sex, were selected as the control group. The B-PCL distances between the study and control groups were compared, and the reliability of the measurements was assessed through inter- and intra-reader agreement analysis.

RESULTS

Out of 1322 initial patients, 66 satisfied the inclusion criteria, with a median age of 70.9 years (IQR: 64.3-78.0) and a female majority (93.9 %). Among female patients, the median B-PCL distance was significantly shorter in the study group (5.3 mm) compared to controls (9.3 mm) (p = 0.002), suggesting a correlation between bladder neck position and bladder gas. Reliability measures indicated strong agreement among assessments (ICC > 0.95).

CONCLUSION

Preliminary findings suggest a correlation between lower bladder neck position and the presence of bladder gas on CT scans.

CRITICAL RELEVANCE

This study sheds light on a possible association between bladder neck position and incidental bladder gas on CT scans, which may inform future diagnostic and clinical considerations.

KEY POINTS

Study examines bladder gas's incidental detection and bladder neck position via CT. Among females, shorter bladder neck to pubococcygeal line distance correlates with bladder gas. Identifying this link may suggest that a low bladder position could facilitate the presence of bladder gas.

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

BACKGROUND

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSIONS

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

Clinical efficacy of tension-free vaginal tape-ischiopubic ramus versus transobturator tension-free vaginal tape in the management of female stress urinary incontinence

BACKGROUND

Stress urinary incontinence (SUI), a prevalent condition among middle-aged and elderly women in China, is characterized by the involuntary leakage of urine during instances of increased abdominal pressure [1]. Although SUI is not life-threatening, it substantially impacts patients' physical and psychological well-being, impairs their social interactions, and diminishes their overall quality of life.

OBJECTIVE

The aim of this study was to evaluate and compare the clinical efficacy of tension-free vaginal tape-ischiopubic ramus (TVT-IR) and transobturator tension-free vaginal tape (TVT-O) in the treatment of female stress urinary incontinence (SUI).

METHODS

A retrospective analysis of clinical data from 83 female SUI patients was conducted, dividing them into a TVT-IR group (n= 41) and a TVT-O group (n= 42) based on the surgical procedures employed. Perioperative indices, surgical efficacy, complications, symptom improvement pre- and post-operation (3 months), urodynamic measurements, and indices related to pelvic floor function and quality of life were compared between the two groups.

RESULTS

The TVT-IR group had significantly shorter operative time than the TVT-O group (P< 0.05). Three months after surgery, both groups had significantly lower frequency of incontinence, incontinence score, and number of nocturnal urination, significantly higher Pdet, ALPP, Qmax, and MUCP, significantly higher class I and class II fiber muscle strength and muscle potential, and significantly higher I-QOL scores (P< 0.05). The aforementioned indicators were superior in the TVT-IR group compared to the TVT-O group three months after surgery (P< 0.05).

CONCLUSION

Both TVT-IR and TVT-O are effective in treating SUI, with comparable complication rates.

A clinical trial on pelvic floor sensory testing in women with and without stress urinary incontinence

OBJECTIVES

Pelvic floor sensory training is commonly used in clinical practice for the treatment of stress urinary incontinence (SUI); however, there is a lack of comparative studies evaluating pelvic floor sensation between women with SUI and healthy controls. Additionally, normative data for two-point discrimination thresholds in the female pelvic floor region remain scarce. This study aims to compare the results of 4 sensory tests in the pelvic floor region between women with mild SUI and healthy women, in order to provide reference values for two-point discrimination thresholds in this area.

METHODS

From April 1 to October 30, 2023, 108 healthy women [(32.5±3.6) years] and 90 women with mild SUI [(32.9±3.3) years] were recruited from the Third Xiangya Hospital, Central South University. Participants underwent 4 sensory tests in the pelvic floor region: Two-dot discrimination, weight perception, shape recognition, and 9-grid localization. The results were compared between the 2 groups.

RESULTS

Compared with healthy women, those with mild SUI had lower sensitivity and higher thresholds in 2-dot discrimination tests in the pelvic floor region (all P<0.001). No significant differences were found between groups in weight perception, shape recognition, or grid localization tests (P>0.05).

CONCLUSIONS

Women with mild stress urinary incontinence have impaired two-point discrimination ability in the pelvic floor region.

Efficacy of Electroacupuncture in the Treatment of Mild to Moderate Female Stress Urinary Incontinence: Protocol for a Systematic Review and Network Meta-Analysis

BACKGROUND

Stress urinary incontinence (SUI), the most common form of urinary incontinence, is a condition that affects many women. It is characterized by involuntary urine leakage during activities that increase abdominal pressure, such as sneezing, coughing, or physical exertion, according to the International Continence Society. SUI affects patients' quality of life and causes depression and emotional disorders, which negatively influences physical and mental health. The participants in the studies in this review comprised women with mild to moderate SUI, because there are more female patients than male patients, and most patients with severe SUI are treated surgically. Moreover, after retrieval, there were no systematic reviews or network meta-analyses (NMAs) of conservative treatments, such as electroacupuncture (EA), in women with mild to moderate SUI.

OBJECTIVE

This study aims to investigate the efficacy of electroacupuncture among women with mild to moderate SUI using an NMA.

METHODS

Randomized clinical trials related to conservative treatments for SUI will be searched in 5 English and 3 Chinese literature databases: EMBASE, PubMed, Cochrane, Web of Science, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), WanFang, and the Chinese BioMedical Literature Database. The search period for these 8 electronic databases will be from 2002 to 2022. The PROSPERO database and the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) database will also be searched. Two reviewers will independently complete the research selection. After screening the studies, 2 other researchers will extract the data, and the quality of the included studies will be evaluated according to the quality standards specified in the Cochrane Collaboration Tool (version 2). The primary outcomes will be the change in urine leakage determined by a 1-hour pad test and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores at baseline and at the conclusion of the follow-up. The secondary outcomes will be 72-hour incontinence episodes, residual bladder volume, effective rate, urodynamic indexes, and other reported measurements. Stata (version 14.0; StataCorp) and Review Manager (RevMan version 5.3; Cochrane) will be implemented for data synthesis and meta-analysis.

RESULTS

The results are not yet accessible because this is a protocol for a systematic review and meta-analysis. The protocol was registered on INPLASY on February 22, 2023. By April 6, 2023, we had completed the literature search of the 8 databases and completed the selection and data extraction of the articles.

CONCLUSIONS

The results of this systematic review will demonstrate the efficacy of EA among women with mild to moderate SUI. The results will provide evidence for clinicians and guideline makers to choose suitable treatments for SUI.

TRIAL REGISTRATION

International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) 202320098; https://inplasy.com/inplasy-2023-2-0098/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55870.

The SDF-1/CXCR4 axis is involved in adipose-derived stem cell migration

BACKGROUND

Intravenous injection of adipose-derived stem cells (ADSCs) can improve the urinary function of stress urinary incontinence (SUI) model rats and C-X-C chemokine receptor type 4 (CXCR4)-positive ADSCs are found in urethral tissues. The CXCR4 ligand stromal cell-derived factor-1 (SDF-1) is highly expressed in urinary incontinence model rats. In this study, we investigated the involvement of the SDF-1/CXCR4 axis in the homing of ADSCs.

METHODS

ADSCs were isolated from rats and purified. The levels of CXCR4 and CXCR7 were determined by western blot analysis and immunofluorescence assays following stimulation with SDF-1. Hypoxia conditioning was performed to treat the cells in vitro, following which the messenger RNA (mRNA) and protein level of SDF-1, CXCR4, and CXCR7 were estimated.

RESULTS

We found that CXCR4 and CXCR7 were expressed in ADSCs at passage zero (P0), P1, and P3, and the expression of both increased after SDF-1 stimulation. The level of expression of the mRNAs and proteins of SDF-1, CXCR4, and CXCR7 in ADSCs was higher after hypoxic conditioning. We then knocked down CXCR4 or CXCR7 using small interfering RNAs and found that the mRNA levels of CXCR4 and CXCR7 were considerably downregulated in the si-CXCR4/7-transfected cells. We also found that the SDF-1/CXCR4 axis was required for the migration of ADSCs. The phosphorylation levels of Janus kinase (JAK), protein kinase B (AKT), and extracellular regulated protein kinase significantly increased in SDF-1-stimulated ADSCs. However, the migration of ADSCs was suppressed when the corresponding specific inhibitors were used to block JAK and AKT signaling or silence CXCR4, whereas no significant change was observed in the migratory ability of ADSCs when the ERK pathway was blocked or CXCR7 was silenced.

CONCLUSIONS

The SDF-1/CXCR4 axis is involved in the migration of ADSCs and may play a role in the migrate of ADSCs in SUI.

Curvilinear relationship was found between visceral adiposity index and stress urinary incontinence among US adult women: A cross-sectional study

AIMS

The purpose of this study was to find out the relation between visceral adipose index (VAI) levels and stress urinary incontinence (SUI) in adult women.

METHODS

From the National Health and Nutrition Examination Survey (NHANES) 2007-2020, females aged 20 or above were identified for this study. Visceral adiposity was determined using the VAI score, and the assessment of urinary incontinence was carried out through a correlation questionnaire. Logistic regression models and restricted cubic spline (RCS) regression were employed to analyze the relationship between VAI levels and SUI.

RESULTS

Among the 6522 participants, 2672 (41.0%) were reported SUI. Multivariate logistic regression revealed significantly higher odds of SUI with increasing VAI levels (Q4 vs. Q1), adjusted odds ratio (aOR) = 1.53 (CI: 1.29-1.81, p < 0.001). RCS regression indicated a curvilinear relationship between VAI and SUI (p = 0.003). In threshold analysis, aOR for developing SUI was 1.18 (CI: 1.11-1.26, p < 0.001) for participants with VAI < 4.73, suggesting an 18% increased risk of SUI with each unit increase in VAI. No association between VAI and SUI was observed when VAI was ≥4.73.

CONCLUSIONS

Our study has revealed a significant curvilinear relationship between VAI and SUI within a large and representative sample of women. Future research is necessary to evaluate the relationship between the two and explicate the underlying mechanisms of this relationship.

Prevalence and Spatial Distribution Characteristics of Female Stress Urinary Incontinence in Mainland China

Background and objective

Stress urinary incontinence (SUI) in women is a common condition that affects middle-aged and elderly women. Currently, there are still many limitations in the epidemiological research on SUI. This study aims to address the gap in the prevalence of female SUI in mainland China and provide theoretical support for the prevention and treatment of SUI.

Methods

A comprehensive literature search was conducted on the prevalence of female SUI in mainland China, systematically searching Chinese and English databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Weipu Database as of April 1, 2024. Detailed criteria for screening and exclusion were established. The prevalence of SUI in the selected studies was synthesized using Stata MP (version 15) software, and a multisubgroup analysis, a sensitivity analysis, and publication bias detection of the prevalence of SUI were also performed using the software. Additionally, ArcGIS software (version 10.8) and Geoda software (version 1.2) were utilized to explore the geographical distribution characteristics of the prevalence of female SUI in mainland China.

Key findings and limitations

A total of 688 articles were screened, and finally 85 articles were included. The overall rate of female SUI in mainland China was 24.5% (95% confidence interval: 22.5-26.5%). The heterogeneity of the study is statistically significant (I2 = 99.0%, p < 0.001). Based on significant heterogeneity, a multisubgroup analysis was conducted. The results showed that the prevalence of SUI varies among different publication years, literature quality scores, investigators, study settings, sampling methods, provinces, regions, coastal or inland areas, and rural or urban areas. A spatial econometric analysis indicated that the incidence of SUI in the east-west distribution showed a downward trend, while in the north-south distribution, the incidence rate of SUI showed a trend of first increasing and then decreasing. Additionally, a spatial metrology analysis showed similar trends in the distribution of SUI incidence.

Conclusions and clinical implications

The high incidence rate of female SUI in mainland China and the regional differences observed indicate the need for further rigorous epidemiological investigation in the future.

Patient summary

Stress urinary incontinence (SUI) is common among middle-aged and elderly women. The high prevalence of SUI in mainland China and the differences across regions emphasize the need for conducting more robust epidemiological studies in the future.

Animal models, treatment options, and biomaterials for female stress urinary incontinence

In the quest to tackle stress urinary incontinence (SUI), the synthesis of cutting-edge biomaterials and regenerative materials has emerged as a promising frontier. Briefly, animal models like vaginal distension and bilateral ovariectomy serve as crucial platforms for unraveling the intricacies of SUI, facilitating the evaluation of innovative treatments. The spotlight, however, shines on the development and application of novel biomaterials-ranging from urethral bulking agents to nano-gel composites-which aim to bolster urethral support and foster tissue regeneration. Furthermore, the exploration of stem cell therapies, particularly those derived from adipose tissues and urine, heralds a new era of regenerative medicine, offering potential for significant improvements in urinary function. This review encapsulates the progress in biomaterials and regenerative strategies, highlighting their pivotal role in advancing the treatment of SUI, thereby opening new avenues for effective and minimally invasive solutions.

Ultrasonographic features of female urethral caruncle: a retrospective study of 20 patients

Female urethral caruncle is the most common urethral mass in postmenopausal women, yet there is a lack of studies on its imaging. The aim of this study was to provide a summary of the clinical and ultrasound features as well as the precise location of female urethral caruncle. This study reviewed the clinical and ultrasonographic records of 20 consecutive women with pathologically confirmed urethral caruncle. Data on patient demographics, symptoms, and transperineal and transrectal ultrasound imaging features, including location, shape, margin, size, blood flow, and inner echo of the caruncle, were extracted. Each patient presented with only one mass at the urethral meatus. Most caruncles were located on the posterior lip (75%) of the urethra, presenting as oval (80%), mixed-echoic (50%), or hypo-echoic (40%) nodules with abundant linear (40%) or dendritic (60%) blood flow. The average distance between the bladder neck and the cranial end of the masses was 28 mm. Hyper-echogenic spots, cystic echo areas, and macrocalcifications were detected in thirteen caruncles (70%). This study shows that transperineal combined with transrectal ultrasound can be used to assess female urethral caruncle, and its relative location to the urethra can be accurately described, which is helpful for surgeons making preoperative localization and conversations.

The association between weight-adjusted-waist index and stress urinary incontinence in female adults: a population-based study

INTRODUCTION

Obesity has a significant impact on female stress urinary incontinence. The weight-adjusted-waist index (WWI), a newly explored metric for measuring physical obesity and stress urine incontinence, has not been investigated.

METHODS

Cross-sectional data were obtained from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES) of participants with complete data for WWI and SUI. The independent connection between WWI and SUI was examined using weighted multivariable logistic regression analyses. Smoothed curve fitting was used to study their relationship. In addition, subgroup analyses were performed, and interaction tests were undertaken.

RESULTS

In 2,361 female participants over 20, WWI and SUI showed a positive association. Model 3 found that for each one-unit increase in WWI, SUI prevalence increased by 38% [1.38 (1.20, 1.59)]. The prevalence of SUI was 84% higher among participants in the highest quartile of WWI compared to those in the lowest quartile [1.84 (1.32, 2.57)]. Observed nonlinear positive correlation between WWI and SUI was revealed through smoothed curve fitting. In addition, we found that WWI was more strongly associated with SUI than traditional indicators of obesity, including BMI and weight.

CONCLUSIONS

Females with higher weight-adjusted waist index levels were more likely to develop stress urinary incontinence and have a stronger correlation than traditional indicators of obesity. According to our research, WWI may help detect women's stress urinary incontinence (SUI), and managing obesity through the WWI index may reduce SUI prevalence rates.

Should sacrouterine plication be added to lateral suspension surgery? A prospective study

AIM

Laparoscopic lateral suspension is a novel approach for repairing anterior and apical pelvic organ prolapse (POP). According to integral theory, urinary symptoms and pelvic pain are believed to originate from suspensory ligaments. We aimed to investigate the objective and subjective outcomes of adding sacroterine plication to apical prolapse surgery.

METHODS

Sixty patients with Grade 2 or higher symptomatic apical POP were included in the study. The study sample was categorized into two groups: Group 1 underwent lateral suspension and Group 2 underwent lateral suspension and sacroterine plication. Anatomical cure was defined separately for the apical and anterior compartments as POP-Q scores for sites C and Ba of less than -1 cm for each compartment. A subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia, and constipation were assessed.

RESULTS

In Group 1, anatomical cure rates for apical and anterior prolapse were 100% and 70%, respectively (p <0.001). In Group 2, these rates were 100% for apical prolapse and 73.3% for anterior prolapse (p <0.001). The subjective cure was 96.6% in both groups. Furthermore, improvement in sexual and urinary symptoms was more significant in the group that underwent sacroterine plication (p <0.001).

CONCLUSIONS

The additional sacroterine plication (shortening) procedure with lateral suspension proved to be an effective and successful surgical approach for apical prolapse. Its routine addition to existing lateral suspension surgery can contribute significantly to the improvement of urinary and prolapse symptoms.

Age-Related Changes in Urethral Structure and Responds to Injury: Single-Cell Atlas of a Rat Model of Vaginal Birth Injury induced Stress Urinary Incontinence

Stress urinary incontinence (SUI) greatly affects the daily life of numerous women and is closely related to a history of vaginal delivery and aging. We used vaginal balloon dilation to simulate vaginal birth injury in young and middle-aged rats to produce a SUI animal model, and found that young rats restored urethral structure and function well, but not the middle-aged rats. To identify the characteristics of cellular and molecular changes in the urethral microenvironment during the repair process of SUI. We profiled 51,690 individual female rat urethra cells from 24 and 48 weeks old, with or without simulated vaginal birth injury. Cell interaction analysis showed that signal networks during repair process changed from resting to active, and aging altered the distribution but not the overall level of cell interaction in the repair process. Similarity analysis showed that muscle, fibroblasts, and immune cells underwent large transcriptional changes during aging and repair. In middle-aged rats, cell senescence occurs mainly in the superficial and middle urothelium due to cellular death and shedding, and the basal urothelium expressed many Senescence-Associated Secretory Phenotype (SASP) genes. In conclusion, we established the aging and vaginal balloon dilation (VBD) model of female urethral cell anatomy and the signal network landscape, which provides an insight into the normal or disordered urethra repair process and the scientific basis for developing novel SUI therapies.

Surgical Treatments for Women with Stress Urinary Incontinence: A Systematic Review

Stress urinary incontinence affects a large proportion of women in their lifetime. The objective of this review was to describe and compare the latest surgical trends in urinary incontinence and focus on the literature advantages, disadvantages, complications and efficacy of surgical procedures regarding this pathology. Using network meta-analysis, we have identified the most frequently used procedures (Burch surgery, midurethral sling and pubovaginal sling), and we have described and characterized them in terms of effectiveness and safety. Midurethral procedures remain the gold standard for surgical treatment of stress urinary incontinence, although the potential of serious complications following this procedure should be taken into consideration always. There is a clear need for a much more unified evaluation of possible complications and postoperative evolution. This process will help practitioners to adapt and individualize their strategy for each patient.

New Advances in Female Pelvic Floor Dysfunction Management

Pelvic floor dysfunctions (PFDs), which include various disorders such as urinary and anal incontinence, pelvic organ prolapse, and sexual disorders, are widespread amongst females, so much so that they affect one fifth of adult women [...].