Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

No abstract

An intravaginal device to prevent urinary incontinence was devised based on the notions of the 'viscoelasticity of the anterior vaginal' wall. As the anterior vaginal wall can be divided into segments with differing viscoelastic properties, this device is comprised of two parts: a rigid component to treat the urethral side, and a flexible ring-shaped component to exploit thee lastic properties of the anterior vaginal wall in its horizontal portion under the bladder. The resulting device has the potential to address each stage of bladder function in women: straining, bladder filling, and micturition. These specifications ensure that the device is effective and well tolerated by patients. This is hence a new therapeutic approach for the managementof female urinary incontinence. The high efficiency of the device is a validation of the physiological notion of differential viscoelastic properties of the pelvis (and the anterior vaginal wall) on either side of the vaginal cap.

No abstract

An analysis of the literature has allowed for a redefinition of the anatomy of the ilio-coccygeus muscle (ICM) its insertions and its trajectory, the direction of its fibers and its relation to the base of the bladder. Static MRI studies have revealed its V-shaped appearance, while dynamic MRI has been used to visualize its concave contraction into a dome-shape that provides support to the levator plate, raising the base of the bladder. Histological studies have shown that the percentage of type I muscle fibers is 66% to 69%, which is comparable to the type I fiber content of the pubovisceral muscle (PVM), thus reflecting both its postural role as well as functions based on frequent voluntary contractions. Together, these data suggest an active role for the ICM which, upon urination, allows for voluntary hardening of the levator plate. The abdominal pressure from bearing down hence enables urinary draining by compressing the bladder on a hard surface. The physiological function of the ICM is therefore not only postural, but also to enable urination. From a therapeutic perspective, a multicentric study has shown that, by reinforcing the action of the ICM, use of a Diveen intrauterine device improved dysuria.