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Mahmoudnejad N, Abrishami A, Sharifiaghdas F, Guitynavard F, Zadmehr A, Ansari R, Borumandnia N. Correlation between trans-perineal ultra-sonography, urodynamic study and physical examination findings in female patients with stress urinary incontinence: Single center experience. Urologia 2023:3915603231153708. [PMID: 36756857 DOI: 10.1177/03915603231153708] [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: 02/10/2023]
Abstract
BACKGROUND To evaluate the efficacy of Trans-perineal ultrasonography (TPUS) in assessment of stress urinary incontinence (SUI) and its correlation with urodynamic study (UDS) and physical examination in women with SUI. METHODS The study enrolled a total of 91 females including 66 women with SUI and 25 women with no history of urinary incontinence as control group. The α and β angles (anterior urethral and posterior urethro-vesical angle respectively) were recorded both at rest and at straining, using TPUS. The differences between these angles at rest and during the straining were considered as the rotational angles (Rα and Rβ). Urethral length and caliber, bladder neck funneling, and pubo-urethral distance were measured as well. RESULTS The mean (SD) α angle at rest of the SUI group was 49.0 (±14.3)°, which was higher than the same parameter in the control group: 47.6 (±9.7)°. Similarly, the α angle at straining was significantly higher in the SUI group versus the control group, 61.0 (±15.4)° versus 55.8 (±15.8)°. The mean (SD) β angle in the SUI group at rest was 124.6 (±28.5)°, which was significantly higher than that of the control group at 114.0 (±22.5)°. The mean (SD) β angle at straining was also higher in the SUI group versus the control group: 151.8 (±90.6) versus 136.0 (±27)°. Moreover, higher Rα and Rβ angels were documented in the SUI group. CONCLUSION Our data suggest that TPUS can be considered as a non-invasive, easily conducted, and accurate modality in early diagnosis of female SUI. It may reduce the need for performing relatively invasive UDS. However, the role of TPUS in assessment of SUI severity remains to be studied probably with a larger sample size.
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Affiliation(s)
- Nastaran Mahmoudnejad
- Labbafinegad Center of Excellence in Urology, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences School of Medicine, Tehran, Iran
| | - Alireza Abrishami
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences School of Medicine, Tehran, Iran
| | - Farzaneh Sharifiaghdas
- Labbafinegad Center of Excellence in Urology, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences School of Medicine, Tehran, Iran
| | - Fateme Guitynavard
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Zadmehr
- Labbafinegad Center of Excellence in Urology, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences School of Medicine, Tehran, Iran
| | - Roya Ansari
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences School of Medicine, Tehran, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Beheshti university of Medical Sciences, Tehran, Iran
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The Clinical Effects of Pixel CO 2 Laser on Bladder Neck and Stress Urinary Incontinence. J Clin Med 2022; 11:jcm11174971. [PMID: 36078900 PMCID: PMC9457154 DOI: 10.3390/jcm11174971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Our study aims to assess Pixel CO2 laser efficacy for female stress urinary incontinence (SUI). Methods: In the study, 25 women with SUI were included and scheduled for vaginal Pixel CO2 Laser (FemiLift™, Alma Lasers, Israel) treatment. All subjects had a baseline and 6-month post-treatment assessment that included three-dimensional perineal ultrasound and validated questionnaires. Results: Data showed that monthly three-session vaginal Pixel CO2 Laser treatment significantly improved SUI symptoms, as evidenced by validated questionnaires, including UDI-6, IIQ-7, ICIQ, and vaginal laxity questionnaire (p < 0.05). The Pixel CO2 Laser efficacy in vaginal treatment was 20/25 (80%), and the perineal sonography showed that laser treatment significantly decreased bladder neck mobility and middle urethral area (during resting and straining). Permanent adverse events were not found. Conclusions: The results of our study suggested that for the treatment of mild to moderate SUI symptoms, Pixel CO2 Laser is effective and safe; however, more studies and a longer follow-up should be conducted to confirm its efficacy and durability.
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Turkoglu A, Coskun ADE, Arinkan SA, Vural F. The role of transperineal ultrasound in the evaluation of stress urinary incontinence cases. Int Braz J Urol 2021; 48:70-77. [PMID: 34528775 PMCID: PMC8691236 DOI: 10.1590/s1677-5538.ibju.2020.1100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/21/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose: To evaluate the use of transperineal ultrasonography while diagnosing stress urinary incontinence (SUI) by comparing the urethral angle (α), posterior urethrovesical angle (β), and bladder neck descent (BND) during rest and Valsalva maneuver in continent women and women with SUI. Materials and methods: This prospective observational study was conducted with 50 women with SUI and 50 continent women. Transperineal ultrasonography was performed at rest and during Valsalva maneuver. Q-tip test was performed. Results: During the Valsalva maneuver, both α and β angles were significantly higher in women with SUI (p <0.001). The difference between Valsalva and rest measurements of α and β angles (R α, R β) were also significantly higher in women with SUI (p <0.001). The cut-off point determined for the R α in the diagnosis of stress incontinence was 16° (80% sensitivity, 98% specificity). A statistically significant strong correlation was found between Q-tip test angle and R α value (p=0.000; r=0.890). Q-tip VAS pain scores were significantly higher than ultrasonography VAS pain scores (p <0.001). In relation to the bladder neck descent comparison between the two groups showed that BND was significantly higher in SUI group (p <0.001). The cut-off point determined for BND in the diagnosis of SUI was >11mm (90% sensitivity, 98% specificity). Conclusion: Transperineal ultrasonography is a practical, reliable, non-invasive and comfortable method for evaluation of SUI. It has the advantage of dynamic evaluation during the Valsalva maneuver. Rotation angles and BND have high sensitivity and specificity for detection of SUI. The change in α angle with Valsalva (Rα) can be used as an alternative to Q-tip test.
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Affiliation(s)
- Alper Turkoglu
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turke
| | - Ayse Deniz Erturk Coskun
- Department of Obstetrics and Gynecology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Sevcan Arzu Arinkan
- Department of Obstetrics and Gynecology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fisun Vural
- Department of Obstetrics and Gynecology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Keshavarz E, Pouya EK, Rahimi M, Bozorgan TJ, Saleh M, Tourzani ZM, Kabir K, Bakhtiyari M. Prediction of Stress Urinary Incontinence Using the Retrovesical (β) Angle in Transperineal Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1485-1493. [PMID: 33035377 DOI: 10.1002/jum.15526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/08/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The accurate, rapid diagnosis of stress urinary incontinence (SUI) in women can profoundly improve their sexual and psychosocial life. In this study, the diagnostic power of SUI was assessed by transperineal ultrasound. METHODS In this hospital-based case-control study, married women who were referred to the gynecologic and ultrasound wards with negative urinalysis and culture results were enrolled by random sampling. Patients with positive cough signs based on the urodynamic testing data were considered cases, whereas control women showed no cough symptoms and were recruited from the same ward. RESULTS There was a significant difference (P < .001) in bladder neck descent (mean ± SD, 10.89 ± 5.51 versus 7.08 ± 2.60 mm, respectively; P = .0001) and the retrovesical (β) angle with the Valsalva maneuver (144.22° ± 19.63° versus 111.81° ± 24.47°; P < .001) between the case and control groups. Also, the β angle without the Valsalva maneuver was higher in the case group (112.35° ± 23.10°) than the control group (120.17° ± 25.16°; P = .001). There was no case of a urinary leak, urethral diverticulitis, a bladder stone or mass, and cystourethrocele in the patients of each group. The results of multivariate logistic regression with a backward method showed that bladder neck descent (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09-1.40), the β angles with and without the Valsalva maneuver (OR, 1.1; 95% CI, 1.06-1.13; and OR, 1.04; 95% CI, 1.01-1.06) were the predictors of SUI. A β angle higher than 127° with the Valsalva maneuver, with an area under the curve of 0.89 (95% CI, 0.75-0.96), could very well predict the SUI response. This finding shows that it can be very well used to distinguish between normal and non-normal responses, with 89% sensitivity and 79% specificity. CONCLUSIONS The β angle with the Valsalva maneuver could very well predict the SUI response.
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Affiliation(s)
- Elham Keshavarz
- Clinical Research Development Center, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ensi Khalili Pouya
- Department of Radiology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rahimi
- Department of Radiology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tayebeh Jahed Bozorgan
- Department of Obstetrics and Gynecology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Saleh
- Department of Obstetrics and Gynecology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Kourosh Kabir
- Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahmood Bakhtiyari
- Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran
- Noncommunicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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5
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Moosavi SY, Samad-Soltani T, Hajebrahimi S, Sadeghi-Ghyassi F, Pashazadeh F, Abolhasanpour N. Determining the risk factors and characteristics of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery: A systematic review. Turk J Urol 2020; 46:427-435. [PMID: 32976089 DOI: 10.5152/tud.2020.20291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Stress urinary incontinence (SUI) is a common problem in women that affects their quality of life. According to the current evidence, 15%-50% of severe pelvic organ prolapse (POP) surgeries lead to de novo urinary incontinence (UI). This study aimed at determining the risk factors and characteristics of de novo SUI after POP surgeries in a systematic review. MATERIAL AND METHODS We conducted a systematic search of articles in English related to the risk of UI after POP surgery published until December 2019 in the selected bibliographic databases, including PubMed, EMBASE, Scopus, Cochrane Library, and ProQuest. RESULTS The initial search resulted in 2,363 studies, and after reviewing the titles and abstracts, 146 studies were identified. Moreover, 2 independent reviewers, using the Joanna Briggs Institute checklists, evaluated the risk of biases in the selected studies. Finally, 40 studies met the inclusion criteria. The most important predictors of UI after POP surgery were positive pessary testing, age >50 years, and maximum urethral closure pressure (MUCP) <60 cmH2O. CONCLUSION Positive pessary testing, older age, and low MUCP were the most important risk factors for de novo incontinence after POP surgeries.
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Affiliation(s)
- Seyyde Yalda Moosavi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taha Samad-Soltani
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.,Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Sadeghi-Ghyassi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Abolhasanpour
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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Farshbaf-Khalili A, Alizadeh M, Hajebrahimi S, Ostadrahimi A, Malakouti J, Salehi-Pourmehr H. Pre-natal and post-natal anxiety in relation to pre-pregnancy obesity: A cohort study on Iranian pregnant women. CASPIAN JOURNAL OF INTERNAL MEDICINE 2020; 11:250-258. [PMID: 32874431 PMCID: PMC7442456 DOI: 10.22088/cjim.11.3.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: To determine the association between pre-conception obesity and screening results of pre-natal and post-natal anxiety in women that referred to the health centers of Tabriz, Iran. Methods: 62 obese (class 2-3) and 245 normal-weight women were enrolled in the first trimester of pregnancy through the cohort study and followed-up 1 year after childbirth from December 2012 to January 2016. The Beck anxiety inventory scale (BAI-II) was completed in five time points: the first, second, third trimester of pregnancy, 6–8 weeks and 12 months after childbirth. Chi-square, Fisher’s exact tests, Independent t-test, Mann-Whitney, and multivariate logistic regression adjusted for confounders were used for data analysis. Statistically significant was considered as p<0.05. Results: The rate of moderate to severe anxiety in 1st, 2nd, 3rd trimesters of gestation, 6–8 weeks and 12 months after birth was 8.6%, 10%, 12.6%, 7.8%, 6.5% in normal weight women versus 18%, 17.9%, 19.2%, 12.5%, 19.4% in obese class II women, respectively. The odds of anxiety in the first trimester of pregnancy for class 2–3 obesity was 2.72-fold greater than normal weight group [adjusted odds ratio (aOR) 2.72, 95% confidence interval (CI) 1.14–6.47; p=0.023]. This odd was 3.30- fold (aOR 3.30, 95%CI 1.13-9.60; p=0.045) for 1 year after birth. Conclusion: Obesity remained associated with positive screening for anxiety in the first trimester of pregnancy and one year after birth. Obese women more likely require special medical care during their pregnancy due to its impacts on mood.
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Affiliation(s)
- Azizeh Farshbaf-Khalili
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences Tabriz, IR Iran
| | | | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Urology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Jamileh Malakouti
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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7
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Salehi-Pourmehr H, Hajebrahimi S, Rahbarghazi R, Pashazadeh F, Mahmoudi J, Maasoumi N, Sadigh-Eteghad S. Stem Cell Therapy for Neurogenic Bladder Dysfunction in Rodent Models: A Systematic Review. Int Neurourol J 2020; 24:241-257. [PMID: 33017895 PMCID: PMC7538284 DOI: 10.5213/inj.2040058.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/23/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Neurogenic bladder dysfunction (NGB) has an impact on the quality of life, which made it an important research subject in preclinical studies. The present review investigates the effect of stem cell (SC) therapy on bladder functional recovery after the onset of spinal cord injury (SCI), multiple sclerosis (MS), Parkinson disease (PD), and stroke in rodent models. METHODS All experiments evaluated the regenerative potential of SC on the management of NGB in rodent models up to June 2019, were included. From 1,189 relevant publications, 20 studies met our inclusion criteria of which 15 were conducted on SCI, 2 on PD, 2 on stroke, and 1 on MS in the rodent models. We conducted a meta-analysis on SCI experiments and for other neurological diseases, detailed urodynamic findings were reported. RESULTS The common SC sources used for therapeutical purposes were neural progenitor cells, bone marrow mesenchymal SCs, human amniotic fluid SCs, and human umbilical cord blood SCs. There was a significant improvement of micturition pressure in both contusion and transaction SCI models 4 and 8 weeks post-SC transplantation. Residual urine volume, micturition volume, and bladder capacity were improved 28 days after SC transplantation only in the transaction model of SCI. Nonvoiding contraction recovered only in 56 days post-cell transplantation in the contusion model. CONCLUSION Partial bladder recovery has been evident after SC therapy in SCI models. Due to limitations in the number of studies in other neurological diseases, additional studies are necessary to confirm the detailed mechanism for bladder recovery.
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Affiliation(s)
- Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
- Urology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Rahbarghazi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Mahmoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Narjes Maasoumi
- University Hospital Southampton, Southampton, United Kingdom
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- East-Azerbaijan Comprehensive Stroke Program, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Persian Medicine, Faculty of Persian Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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8
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Mostafaei H, Sadeghi‐Bazargani H, Hajebrahimi S, Salehi‐Pourmehr H, Ghojazadeh M, Onur R, Al Mousa RT, Oelke M. Prevalence of female urinary incontinence in the developing world: A systematic review and meta‐analysis—A Report from the Developing World Committee of the International Continence Society and Iranian Research Center for Evidence Based Medicine. Neurourol Urodyn 2020; 39:1063-1086. [DOI: 10.1002/nau.24342] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Hadi Mostafaei
- Research Center for Evidence Based MedicineFaculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
- Iranian Evidence Based Medicine (EBM) CentreJoanna Briggs Institute Affiliated Group Tabriz Iran
- Department of UrologyMedical University of Vienna Vienna Austria
| | - Homayoun Sadeghi‐Bazargani
- Research Center for Evidence Based MedicineFaculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
- Iranian Evidence Based Medicine (EBM) CentreJoanna Briggs Institute Affiliated Group Tabriz Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based MedicineFaculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
- Iranian Evidence Based Medicine (EBM) CentreJoanna Briggs Institute Affiliated Group Tabriz Iran
- Department of UrologyImam Reza Teaching Hospital, Tabriz University of Medical Sciences Tabriz Iran
- ICS Developing World Committee Bristol UK
| | - Hanieh Salehi‐Pourmehr
- Research Center for Evidence Based MedicineFaculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
- Iranian Evidence Based Medicine (EBM) CentreJoanna Briggs Institute Affiliated Group Tabriz Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence Based MedicineFaculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
- Iranian Evidence Based Medicine (EBM) CentreJoanna Briggs Institute Affiliated Group Tabriz Iran
| | - Rahmi Onur
- Department of Urology, Faculty of MedicineMarmara University Istanbul Turkey
| | - Riyad T. Al Mousa
- Department of UrologyKing Fahd Specialist Hospital‐Dammam Dammam Saudi Arabia
| | - Matthias Oelke
- Department of Urology, Pediatric Urology and Urologic OncologySt. Antonius Hospital Gronau Germany
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9
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Transperineal Ultrasound Assessment of a Cystocele's Impact on the Bladder Neck Mobility in Women with Stress Urinary Incontinence. ACTA ACUST UNITED AC 2019; 55:medicina55090562. [PMID: 31484328 PMCID: PMC6780490 DOI: 10.3390/medicina55090562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/14/2019] [Accepted: 08/23/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: As pelvic floor disorders are often difficult to assess thoroughly based on clinical examination alone, the use of imaging as a complementary technique is helpful. This study’s aim was to investigate by transperineal ultrasound (US) if there was any significant difference in the mobility of the bladder neck in women with stress urinary incontinence (SUI) without a cystocele and in those with SUI and an associated cystocele. The study also investigated whether the number of vaginal births and/or the heaviest newborn’s birth weight was correlated with the bladder neck mobility. Materials and Methods: A total of 71 women suffering from SUI were included in the study and divided into two groups based on the presence of a cystocele. Their bladder neck mobility was evaluated by transperineal US, calculating the distance from the inferior margin of the symphysis pubis to the bladder neck (SPBN), and the dorsocaudal linear movement (DLM), term used to illustrate the displacement of the bladder neck by subtracting rest and Valsalva values. GraphPad Prism 8 was used for statistical analysis. Results: Within both study groups, the SPBN values were significantly higher and the DLM values were significantly lower at rest as compared to Valsalva maneuver (p < 0.05). No significant difference between the groups regarding SPBN and DLM values at rest, Valsalva, or subtraction was demonstrated. A significant positive correlation was found between the bladder neck mobility and the heaviest newborn’s birth weight, regardless of the presence of a cystocele (p = 0.042). Conclusions: The presence of a cystocele had no significant impact on the bladder neck mobility measurements in patients with SUI. The heaviest newborn’s birth weight positively correlated with bladder neck hypermobility, as quantified by SPBN.
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10
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Pontbriand-Drolet S, Tang A, Madill SJ, Tannenbaum C, Lemieux MC, Corcos J, Dumoulin C. Differences in pelvic floor morphology between continent, stress urinary incontinent, and mixed urinary incontinent elderly women: An MRI study. Neurourol Urodyn 2015; 35:515-21. [PMID: 25727524 DOI: 10.1002/nau.22743] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/12/2015] [Indexed: 12/24/2022]
Abstract
AIMS To compare magnetic resonance imaging (MRI) of the pelvic floor musculature (PFM), bladder neck and urethral sphincter morphology under three conditions (rest, PFM maximal voluntary contraction (MVC), and straining) in older women with symptoms of stress (SUI) or mixed urinary incontinence (MUI) or without incontinence. METHODS This 2008-2012 exploratory observational cohort study was conducted with community-dwelling women aged 60 and over. Sixty six women (22 per group), mean age of 67.7 ± 5.2 years, participated in the study. A 3 T MRI examination was conducted under three conditions: rest, PFM MVC, and straining. ANOVA or Kruskal-Wallis tests (data not normally distributed) were conducted, with Bonferroni correction, to compare anatomical measurements between groups. RESULTS Women with MUI symptoms had a lower PFM resting position (M-Line P = 0.010 and PC/H-line angle P = 0.026) and lower pelvic organ support (urethrovesical junction height P = 0.013) than both continent and SUI women. Women with SUI symptoms were more likely to exhibit bladder neck funneling and a larger posterior urethrovesical angle at rest than both continent and MUI women (P = 0.026 and P = 0.008, respectively). There were no significant differences between groups on PFM MVC or straining. CONCLUSIONS Women with SUI and MUI symptoms present different morphological defects at rest. These observations emphasize the need to tailor UI interventions to specific pelvic floor defects and UI type in older women. PATIENT SUMMARY Older women with UI demonstrate different problems with their pelvic organ support structures depending on the type of UI. These new findings should be taken into consideration for future research into developing new treatment strategies for UI in older women. Neurourol. Urodynam. 35:515-521, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Stéphanie Pontbriand-Drolet
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - An Tang
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Stephanie J Madill
- School of Physical Therapy, University of Saskatchewan, Saskatchewan, Canada
| | - Cara Tannenbaum
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - Marie-Claude Lemieux
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Department of Obstetrics & Gynecology, Maisonneuve Rosemont Hospital, Montreal, Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Chantale Dumoulin
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
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11
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Antovska VS. Ultrasound Characteristics of Patients with Urinary Stress Incontinence with or without Genital Prolapse. Korean J Urol 2012; 53:691-8. [PMID: 23136629 PMCID: PMC3490089 DOI: 10.4111/kju.2012.53.10.691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/12/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose The study purpose was to evaluate the clinical and ultrasound characteristics of women with urinary stress incontinence (USI) with or without genital prolapse (GP). Materials and Methods A total of 268 patients who underwent ultrasound perineal evaluation were divided into two groups: isolated USI (n=132) and USIGP (n=136) with USI/GP stage I/II. The latter group was additionally divided into two subgroups: USIGP(A) (n=78) with USI/GP stage I and USIGP(B) (n=58) with USI/GP stage II. Results Point Aa (pelvic organ prolapse quantification system), which is the projection of the bladder neck (BN) on the anterior vaginal wall, was situated higher in the rest position (RP) but moved lower during a Valsalva maneuver (VM) in the USI group than in the USIGP group (p<0.05). The ultrasound parameters α-angle and the distance Sy-BN (symphisis-bladder neck) decreased, whereas distance H increased, in the USIGP group during VM. The ultrasound parameters that gave the best insight into the range of BN movements were as follows: distance R→V and angle of rotation (ρ), which were significantly higher in the USI group than in the USIGP group during VM. Conclusions According to the clinical and ultrasound findings, we can conclude that the BN is situated higher during the RP but moved lower during a VM in patients with isolated USI compared with those with concomitant USI/GP, which could be explained by the cystocele-immobilizing effect on the BN during the VM in the latter group but also by the deteriorated pubo-urethral ligaments in the former group.
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Affiliation(s)
- Vesna S Antovska
- Department for Urogynaecology and Pelvic Floor Disorders, University Clinic for Gynaecology and Obstetrics, Medical Faculty, University "Saint Cyril and Methodius", Skopje, Republic of Macedonia, Europe
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Smith PP, van Leijsen SA, Heesakkers JP, Abrams P, Smith AR. Can we, and do we need to, define bladder neck hypermobility and intrinsic sphincteric deficiency?: ICI-RS 2011. Neurourol Urodyn 2012; 31:309-12. [DOI: 10.1002/nau.22220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 01/12/2012] [Indexed: 11/06/2022]
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Hajebrahimi S, Asrbadr YA, Azaripour A, Sadeghi-Bazargani H. Effect of tamsulosin versus prazosin on clinical and urodynamic parameters in women with voiding difficulty: a randomized clinical trial. Int J Gen Med 2011; 4:35-9. [PMID: 21403790 PMCID: PMC3056329 DOI: 10.2147/ijgm.s16063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the effects of tamsulosin and prazosin on clinical and urodynamic parameters in women with voiding dysfunction. Methods Forty women aged 20–65 years with a clinical diagnosis of voiding dysfunction were blindly randomized to two equal groups for treatment with tamsulosin 0.4 mg or 1–2 mg of prazosin daily. Symptom assessment with the American Urological Association Symptom Score (AUASS) and urodynamic evaluation was performed initially and after three months of treatment. Patient satisfaction was evaluated and severe adverse drug effects recorded. Statistical analysis was carried out using the Student’s t-test and Mann–Whitney U test. Results Although AUASS improved in both groups, the rate of improvement was larger in the tamsulosin group. Urodynamic parameters improved but did not normalize in both groups. Adverse side effects from medication in the prazosin group were more common than in the tamsulosin group. Most of the patients in the tamsulosin group (80%) were satisfied with their treatment compared with those in the prazosin group (45%). Conclusion Tamsulosin and prazosin are both effective in palliating symptoms of women with voiding dysfunction and improving their urodynamic parameters. Tamsulosin may be the preferred drug to prescribe because of its more amenable side effect profile and greater patient satisfaction.
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