Compliance of the bladder neck supporting structures: Importance of activity pattern of levator ani muscle and content of elastic fibers of endopelvic fascia

Barbič, Matija; Kralj, Božo; Cör, Andrej

doi:10.1002/nau.10116

Cited by 55 publications

(54 citation statements)

References 37 publications

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“…Although changes in static architectural parameters (eg, position of the bladder base) can contribute some elements of the story, this analysis does not take into account the timing of a contraction, or its influence on other structures (eg, tension in the endopelvic fascia). As alteration in the neuromuscular control of the pelvic floor muscles and abdominal muscles have been reported in individuals with dysfunctions such as stress UI, 5 limb-loading activities, as well as to speculate on resting activity of the pelvic floor muscles and the ability of the endopelvic fascia to transmit tension. 94 Although this reasoning appears to have clinical utility, it is speculative and requires further investigation.…”

Section: Qualitative Evaluation T He Use Of Ultrasound Imagingmentioning

confidence: 97%

Rehabilitative Ultrasound Imaging of Pelvic Floor Muscle Function

Whittaker¹,

Thompson²,

Teyhen³

et al. 2007

J Orthop Sports Phys Ther

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found that 78% of women with LBP report concurrent UI. As such, there is a need for physical therapists to have access to tools that accurately evaluate the various aspects of pelvic floor muscle function (elevating and occlusion functions, as well as neuromuscular control, strength, and endurance) both in laboratory and clinical environments.Ultrasound imaging is a potential tool that has been used to evaluate the morphology 7,52 and certain components of the function 24,27,67,81,82,86 of these muscles. Specifically, ultrasound imaging has been shown to be more specific than intravaginal palpation for measurement of the lifting action of the pelvic floor muscles on the bladder neck 31 and base, 20,31 and it provides information about the supporting function of the pelvic floor muscles during various maneuvers. 20,57,85 As the use of rehabilitative ultrasound imaging for assessment of pelvic floor muscles function is a relatively new procedure, the goal of this commentary i t is well accepted that the pelvic floor muscles, specifically the levator ani, provide an important contribution to the continence mechanism.17 is to provide an understanding of current applications, the available quantitative and qualitative information, the associated limitations, and to show how rehabilitative ultrasound imaging can be incorporated as a form of biofeedback during rehabilitation. Furthermore, as the compilation and comparison of data depends on consistency of measurement techniques, this commentary highlights considerations for measurement accuracy and interpretation and provides generic guidelines for future investigation based upon international consensus. 80QuantitatiVe eVaLuation u ltrasound imaging has been used to measure the morphology 7,52 of the pelvic floor muscles. It has also been used to measure the impact of pelvic floor muscle contraction or increase in intra-abdominal pressure (straining, cough, sneeze, or leg-raising task) on the bladder from a variety of approaches (transperineal and transabdominal; Figure 1), planes (sagittal and transverse), and positions. 6,22,27,57,61,67,76,83,84,96 The transperineal approach (placement of the ultrasound transducer in a sagittal plane along the midline of the perineum) is considered advantageous to the transabdominal approach, as both the pubic symphysis and the proximal junction of the bladder neck and urethra are included within the field of view and can serve

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Section: Qualitative Evaluation T He Use Of Ultrasound Imagingmentioning

confidence: 97%

Rehabilitative Ultrasound Imaging of Pelvic Floor Muscle Function

Whittaker¹,

Thompson²,

Teyhen³

et al. 2007

J Orthop Sports Phys Ther

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“…If abdominal pressure increase as in cough, urethra is displaced in a dorsocaudal line and the anterior edge of urethra move longer interval than posterior edge of urethra, so SUI would be occur (15). To prevent the movement of urethra and support urethra against increased abdominal pressure, polyprolen mesh is placed in the obturator foramen in TOT procedure with a route of the trocar that avoid potential complications as bladder, bowel and vessels injuries (16).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery

Şimşek

Kireççi

Bayar

et al. 2017

Arch Ital Urol Androl

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This study has been presented in EAU 2015 Meeting in Madrid.Purpose: Currently, it is unclear how the mesh tension should be adjusted on the transobturator tape surgery (TOT) for improving continence. The aim of this study was to evaluate the effects of per-operative cough stress test on TOT. Materials and methods: Between March 2007 and December 2011, 206 women with SUI were enrolled in this study. Patients were randomly categorized to treatment with TOT (96) or TOT with cough stress test (110). The IIQ-7 and the UDI-6 were used to identify satisfaction level. At the end of 1st year, two groups were compared patient characteristics, operation time, duration of hospital stay, cure and complication rates. Results: The cure rate was 84.37% 81/96) versus 83.63% (92/110) in TOT and TOT with cough test groups, respectively. Postoperatively ten patient (10/110, 9.09%) suffered voiding difficulties (> 250 ml residual urine) in TOT with cough stress test group. Five patients were discharged with transurethral catheter, whereas, in traditional TOT group, two patients (2/96, 2.1%) had transient postoperative voiding difficulty and two patients were treated with repeated catheterization for 1 week (p < 0.05). Postoperative groin pain was present in 7/96 (8%) versus 24/110 (22%) in TOT and TOT with cough test groups, respectively (p < 0.05). TOT with cough stress test group had an higher rate of complications like, retention of urine, necessitating to cut the tape, mesh erosion and pain in groin or leg. No patient had resistant voiding difficulty or prolonged urinary retention (> 1 week) in traditional TOT group. Conclusions: We believe that per-operative cough stress test leads to overtreatment of stress urinary incontinence when the complication rates were considered. KEY WORDS: Cough stress test; Transobturator tape; Stress urinary incontinence (SUI). time and hospitalisation time, TOT has a high success rate up to 90% with lower complication rate (6-7). Although TOT is a safe and favorable for surgery for SUI, success of procedure is related with age, body mass index (BMI), diabetes mellitus, intrinsic sphincter deficiency and concomitant prolapsus surgery (8-9). Also urodynamic parameters including Q max , maximum urethral closure pressure and Valsalva leak point pressure have effects on operation success (10). Additionally, achieve adequate mesh tension is the one of most important point to prevent urinary incontinence. For assessment of the mesh tension, cough stress test (CST) is used intreoperatively while TOT procedure (11). As less tension is associated with leaving the patient incontinent, more tension may cause voiding disorders (12). In this study, we evaluated affect of CST on TOT procedure success rate and patients quality of life with using the Incontinence Impact Questionnaire and Urinary Distress Inventory Questionnaire. Also we assessed the effect of the adjustment of mesh tension with using CST on postoperative voiding disorders.

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“…Może być przydatna na przykład, gdy uzyska się właściwą normalizację maksymalnej siły mięśniowej [49]. Ponadto EMG może być interesująca w aspekcie oceny aktywacji mięśni dna miednicy lub koaktywacji wraz z mięśniami otaczającymi [44,[50][51][52], a także w ocenie strefy odnerwienia [53,54].…”

Section: Elektromiografiaunclassified

“…W ostatnich 20 latach wynaleziono kilka wersji dynamometrów mięśni dna miednicy [51,[56][57][58][59][60][61]. Różnią się one rozmiarami, kształtem, siłą działającego wektora (siła przednio-tylna, boczno-boczna, wielokierunkowa) lub innymi technicznymi szczegółami.…”

Section: Dynamometriaunclassified

Evaluation of pelvic floor muscle anatomy and function in women: modern techniques

Adamiak‐Godlewska¹,

Rechberger²

2012

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Ultrasonografia "real-time" w ocenie funkcjonowania dna miednicy Prawidłowy skurcz mięśni dna miednicy został zdefiniowany jako uniesienie i zaciśnięcie mięśni wokół pochwy wraz ze wzrostem ciśnienia wewnątrzcewkowego bez wykonywania znaczącego manewru Valsalvy oraz wysiłku związanego z napięciem [1]. Dno miednicy nie jest organem odizolowanym -kurcząc się, koaktywuje mięśnie brzucha i przeponę, aby wygenerować i utrzymać ciśnienie wewnątrzbrzuszne [2][3][4]. Dlatego w jakiejkolwiek ocenie prawidłowego uniesienia mięśni dna miednicy podczas skurczu należy brać pod uwagę aktywność innych mięśni w obrębie jamy brzusznej czy miednicy. Właściwa diagnoza dysfunkcji mięśni dna miednicy jest kluczowa do wdrożenia terapii celowanej. Ocena funkcji mięśni dna miednicy jest konieczna, aby nauczyć pacjentkę ćwiczyć oraz żeby ocenić efektywność programów treningowych. Ocena powinna zawierać zarówno aktywację świadomą mięśni dna miednicy (pelvic floor muscles -PFM), jak i odruchową, gdyż świadomy skurcz PFM nie zawsze dobrze odzwierciedla ich automatyczną aktywację w odpowiedzi na zmiany ciśnienia śródbrzusznego [5,6].Badanie ultrasonograficzne (USG) może przynieść korzyść fizjoterapeutom, ponieważ pozwala na dynamiczną ocenę w czasie rzeczywistym świadomej, jak również odruchowej aktywacji PFM w sytuacjach bardzo zbliżonych do życia codziennego. Nie jest to badanie inwazyjne [USG przezbrzuszne (transabdominal -TA)] lub jest minimalnie inwazyjne [USG przezkroczowe (transperineal -TP)], a generowane obrazy pozwalają na silny biofeedback zarówno dla terapeuty, jak i pacjentki. Ultrasonografię można wykonywać u mężczyzn, kobiet i dzieci, a droga przezbrzuszna jest szczególnie przydatna do uzyskania bezpośredniej obiektywnej oceny funkcji PFM w populacjach, w których badania dopochwowego lub badania przezodbytniczego należałoby unikać, np. u dzieci i osób, które były wykorzystywane seksualnie [7].Ultrasonografia przewyższa wszystkie inne kliniczne metody oceny PFM, gdyż pozwala obiektywnie zmierzyć uniesienie PFM podczas skurczu i jest bardziej dokładna niż ocena palpacyjna [1]. Jest także przydatna Streszczenie W pracy dokonano przeglądu prac opisujących nowoczesne techniki oceniające anatomię i funkcję mięśni dna miednicy. Pokazano wiarygodność i przydatność różnych metod ultrasonografii, perineometrii, elektromiografii oraz nadzieje związane z dynamometrią. Jak wykazuje medycyna oparta na faktach (evidence-based medicine -EBM), ultrasonografia to najbardziej dostępna i najlepsza obecnie metoda umożliwiająca postawienie właściwej diagnozy i wdrożenie celowanej terapii dna miednicy u kobiet.Słowa kluczowe: mięśnie dna miednicy, anatomia, funkcja, metody diagnostyczne. SummaryThis is a review of studies on modern techniques used to assess the anatomy and function of women's pelvic floor muscles. The usefulness of different methods of ultrasound examination is explained. The validity and reliability of perineometry, electromyography and hopes connected with dynamometry were also analyzed. According to evidence-based medicine, curr...

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Compliance of the bladder neck supporting structures: Importance of activity pattern of levator ani muscle and content of elastic fibers of endopelvic fascia

Abstract: Firm bladder neck support enables effective pressure transmission. Timely activation of the levator ani seems to be an important feature.

Cited by 55 publications

References 37 publications

Rehabilitative Ultrasound Imaging of Pelvic Floor Muscle Function

Rehabilitative Ultrasound Imaging of Pelvic Floor Muscle Function

Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery

Evaluation of pelvic floor muscle anatomy and function in women: modern techniques

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