Continent women have better urethral neuromuscular function than those with stress incontinence

Kenton, Kimberly; Brubaker, Linda

doi:10.1007/s00192-011-1447-7

Cited by 17 publications

(18 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More detailed histological descriptions are needed that include different types of collagen, decorin, biglycan, aggrecan, and other possible constituents that may form this particular enthesis . Investigation of the nerve supply to this region might also be worthwhile, since pudendal nerve damage has been noted in women with pelvic floor dysfunction . Finally, a traction force was applied to the top of the perineal body of a cadaveric hemipelvis in an attempt to show deformed pattern of the levator ani by increased intra‐abdominal pressure.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of the pubovisceral muscle origin: Macroscopic and microscopic findings within the injury zone

Kim

Betschart

Ramanah

et al. 2014

Neurourol. Urodynam.

View full text Add to dashboard Cite

Aims The levator ani muscle (LA) injury associated with vaginal birth occurs in a characteristic site of injury on the inner surface of the pubic bone to the pubovisceral portion of the levator ani muscle's origin. This study investigated the gross and microscopic anatomy of the pubic origin of the LA in this region. Methods Pubic origin of the levator ani muscle was examined in situ then harvested from nine female cadavers (35 - 98 years). A combination of targeted feature sampling and sequential sampling was used where each specimen was cut sequentially in approximately 5 mm thick slices apart in the area of known LA injury. Histological sections were stained with Masson's trichrome. Results The pubovisceral origin is transparent and thin as it attaches tangentially to the pubic periosteum, with its morphology changing from medial to lateral regions. Medially, fibers of the thick muscle belly coalesce towards multiple narrow points of bony attachment for individual fascicles. In the central portion there is an aponeurosis and the distance between muscle and periosteum is wider (~ 3 mm) than in the medial region. Laterally, the LA fibers attach to the levator arch where the transition from pubovisceral muscle to the iliococcygeal muscle occurs. Conclusions The morphology of the levator ani origin varies from the medial to lateral margin. The medial origin is a rather direct attachment of the muscle, while lateral origin is made through the levator arch.

show abstract

Section: Discussionmentioning

confidence: 99%

Anatomy of the pubovisceral muscle origin: Macroscopic and microscopic findings within the injury zone

Kim

Betschart

Ramanah

et al. 2014

Neurourol. Urodynam.

View full text Add to dashboard Cite

show abstract

“…In imaging studies, the striated urethral sphincter has been found to be smaller in women with SUI compared to continent controls [7,8]. In EMG studies, the striated urethral sphincters of women with SUI demonstrated smaller EMG amplitudes and shorter motor-unit-potential durations with more phases than do continent controls [9,10], indicating primarily myogenic changes.…”

Section: Introductionmentioning

confidence: 95%

Changes in urethral sphincter size following rehabilitation in older women with stress urinary incontinence

et al. 2014

View full text Add to dashboard Cite

show abstract

“…These studies have shown that there is a neurogenic basis for stress incontinence [1] and uterovaginal prolapse [2] caused by vaginal delivery as well as other associated factors of weakness of the pelvic floor muscles and connective tissue. A study by Kenton et al [3] again confirms the value of neurological investigations in the study of pelvic floor disorders. Using concentric needle electromyography, they showed that women with stress incontinence had poorer urethral innervation than continent controls.…”

mentioning

confidence: 76%

Neurophysiology in urogynaecology

Dwyer

2011

Int Urogynecol J

View full text Add to dashboard Cite

In this issue of the International Urogynecology Journal, there is a focus on neurophysiology in urogynaecology. Neurophysiological studies have provided considerable advances in our understanding of the pathophysiology of pelvic floor disorders including urinary incontinence and pelvic organ prolapse. These studies have shown that there is a neurogenic basis for stress incontinence [1] and uterovaginal prolapse [2] caused by vaginal delivery as well as other associated factors of weakness of the pelvic floor muscles and connective tissue. A study by Kenton et al. [3] again confirms the value of neurological investigations in the study of pelvic floor disorders. Using concentric needle electromyography, they showed that women with stress incontinence had poorer urethral innervation than continent controls. They also found that there were significant neuropathic changes with ageing which is consistent with lower urethral pressures and decreasing numbers and diameter of striated muscles fibres of the urethral sphincter and pubococcygeus muscle with increasing age.Although neurophysiological investigations have contributed to our understanding of causation of urinary incontinence and prolapse, they have not to date been shown to have a significant role in the routine investigation and management of female urinary incontinence or uterovaginal prolapse. With this in mind, we have asked David Vodušek to provide an overview of the role of neurophysiological investigations in urogynaecology today. In his review [4], he discusses what neurophysiological tests tell us about nerves and muscles and what neurological investigations we should perform and when.Chronic pelvic pain in women is a common and difficult problem affecting one in five women, with most not having a clearly defined cause [5]. Many women date their pain back to gynaecological surgery, so not surprisingly, this is also an area of high medical litigation and anxiety to pelvic surgeons. The study of Possover et al. [6] in this issue reports on 95 consecutive women with pelvic pain and/or bladder or bowel dysfunction following pelvic prolapse surgery. These women underwent laparoscopic exploration and neurolysis for what the authors considered to be iatrogenic pelvic nerve injury. The authors' conclusions are that prolapse surgery is a common cause of nerve injury and pelvic pain, which is frequently underdiagnosed but can be successfully treated surgically.Many women with chronic pelvic pain often present having already been told that their pain is caused by surgical nerve injury or entrapment. This explanation is very attractive to women with chronic pain as it gives them a clear understandable cause for their pain and hope that it can be successfully treated by surgical exploration; but how true is this? The causes, diagnosis and management of pudendal neuralgia have recently been reviewed by Stav et al. [7] including the role of neurophysiological studies and nerve decompression surgery. Neurophysiological tests were considered to have a low diagnost...

show abstract

Continent women have better urethral neuromuscular function than those with stress incontinence

Cited by 17 publications

References 28 publications

Anatomy of the pubovisceral muscle origin: Macroscopic and microscopic findings within the injury zone

Anatomy of the pubovisceral muscle origin: Macroscopic and microscopic findings within the injury zone

Changes in urethral sphincter size following rehabilitation in older women with stress urinary incontinence

Neurophysiology in urogynaecology

Contact Info

Product

Resources

About