Midurethral support is also necessary for reflex closure of the urethra

Vries, Allert M. de; Venema, Pieter L.; Heesakkers, John

doi:10.1002/nau.23807

Cited by 17 publications

(9 citation statements)

References 31 publications

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“…Ensuring the proper functional urethral length is the key factor in female continence. The thickest part of the urethral sphincter in the whole of the urethra is the middle part, which is the part mainly controlling urinary continence [ 37 , 38 , 39 ]. Tension-free middle urethral suspension for the treatment of SUI aims to ensure the effective functional length of the middle of the urethra when abdominal pressure increases and effectively improve the patient’s urinary continence function [ 38 ].…”

Section: Anatomical Factors Of the Urethra Itselfmentioning

confidence: 99%

“…The thickest part of the urethral sphincter in the whole of the urethra is the middle part, which is the part mainly controlling urinary continence [ 37 , 38 , 39 ]. Tension-free middle urethral suspension for the treatment of SUI aims to ensure the effective functional length of the middle of the urethra when abdominal pressure increases and effectively improve the patient’s urinary continence function [ 38 ]. Pelsang et al [ 40 ] showed that when the abdominal pressure of SUI patients increased, the bladder neck and the proximal urethra moved downward, forming a funnel shape and leading the relative length of the functional urethra to become shorter, thus causing urethral resistance, and the hydrostatic pressure of the urethra decreased, which can easily contribute to the occurrence of urinary incontinence.…”

Section: Anatomical Factors Of the Urethra Itselfmentioning

confidence: 99%

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The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

et al. 2022

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Stress urinary incontinence is a common disease in middle-aged and elderly women, which seriously affects the physical and mental health of the patients. For this reason, researchers have carried out a large number of studies on stress urinary incontinence. At present, it is believed that the pathogenesis of the disease is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomy, including the anatomical factors of the urethra itself, the anatomical factors around the urethra and the anatomical factors of the pelvic nerve. The combined actions of a variety of factors lead to the occurrence of stress urinary incontinence. This review aims to summarize the anatomical pathogenesis of stress urinary incontinence from the above three perspectives.

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Section: Anatomical Factors Of the Urethra Itselfmentioning

confidence: 99%

Section: Anatomical Factors Of the Urethra Itselfmentioning

confidence: 99%

The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

et al. 2022

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“…Urethral bulk injection therapy is an alternative noninvasive, ambulatory treatment that involves injecting a bulk material transurethral or periurethral, with or without urethroscopic view, in the mucosa of the urethra between the mid‐urethra and bladder neck. The injected material gives resistance to the urine flow and thereby aims to prevent leakage of urine, although it is hypothesized that mid‐urethral support is needed for the closure mechanism of the urethra as well 5 . To date, randomized controlled trials comparing bulk injection therapy with other surgical options show significant lower objective cure rates regarding urethral bulk injection therapy 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Patients' satisfaction and safety of bulk injection therapy Urolastic for treatment of stress urinary incontinence: A cross‐sectional study

Casteleijn

Kowalik

Berends

et al. 2020

Neurourology and Urodynamics

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Aims Primary outcome was to evaluate patients' satisfaction after being treated with bulk injection therapy polydimethylsiloxane Urolastic (PDMS‐U) for stress urinary incontinence (SUI). Secondary outcomes were: subjective cure, objective cure, severity of SUI symptoms, complications, reintervention rate, and disease‐specific quality of life. Furthermore, to determine if outcomes worsened during time‐after‐treatment (time‐frames: 0‐12, 13‐24, and ≥25 months). Methods In a cross‐sectional design, patients treated with PDMS‐U were recruited for hospital revisit. The primary outcome, patients' satisfaction, was assessed by the surgical satisfaction questionnaire. Subjective cure, objective cure, and severity of symptoms were assessed by the patients global impression of improvement, standardized cough stress test, and Sandvik severity scale, respectively. Medical charts and face‐to‐face interviews were used to determine complications and reinterventions. Results About 110 patients participated, 87 revisited the hospital. Median follow‐up was 25 months (interquartile range: 14;35 months). Patients' satisfaction rate was 51%. Subjective and objective cure were respectively 46% and 47%. Most prevalent complications were: urinary retention (22%), pain (15%), and dyspareunia (15%). Exposure and erosion occurred in 7% and 5%, respectively. Reintervention rate of reinjection and excision of bulk material was 6% and 18.0%, respectively. Objective cure significantly worsened during time‐after‐treatment (P = < .05). Conclusions About half of the patients being treated with PDMS‐U were satisfied and subjectively cured 2 years after treatment, although the majority still experienced symptoms of SUI. Most complications were mild and transient, however, in 18% excision of bulk material was indicated for severe or persistent complications such as pain, exposure, or erosion.

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“…Mid-urethral support is important for reflex closure of the urethra. 4 Another factor may therefore be (mid-)urethral support bulk provides, reducing hypermobility of the urethra often seen in women with SUI and improving sphincter function.…”

Section: Introductionmentioning

confidence: 99%

Imaging findings of vinyl dimethyl polydimethylsiloxane used as a paraurethral injectable for female stress urinary incontinence

Vries

Casteleijn

Roovers

et al. 2021

Therapeutic Advances in Urology

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Objectives: Vinyl dimethyl polydimethylsiloxane (VDPDMS) is a urethral bulking agent used for female stress urinary incontinence (SUI), that is clearly visible on computed tomography (CT). Clinical effects are promising, but it remains difficult to identify factors predicting clinical success. Clinical outcome might depend on the shape and position of the implants after injection. Objective of this study is to analyze the appearance and position of bulk material on CT scans and to see whether it is delivered the intended circumferential and mid-urethral position. Methods: A single-center retrospective study was performed in 20 women, treated with VDPDMS for SUI. A senior radiologist analyzed all CTs, using an assessment scheme. This scheme describes whether the bulk is scattered, mid-urethral, and/or circumferentially distributed. The imaging findings were subsequently correlated to the patient global impression of improvement (PGI-I) and the percentage of subjective improvement experienced 6 weeks post-operatively. Results: The patient’s mean age was 61 years, and they underwent median 2.0 previous surgical treatments for SUI. Three patients reported no improvement, 9 patients had 20–90% improvement and 8 reported >90% improvement of their SUI. In 17/74 (24%) positions, the implant was scattered rather than spherical. In 9/20 (45%), the implants were not located in the intended mid-urethral position. In 8/20 patients (40%), the material was distributed circumferentially. Conclusion: This is the first study describing the position and shape of VDPDMS in patients after treatment. The appearance and position of the implants appears to be variable, but optimal positioning or shape seems to be no absolute requisite for success.

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Midurethral support is also necessary for reflex closure of the urethra

Abstract: Continence is a result of passive as well as active urethral closure mechanisms. The most important factor in female continence seems to be the proper functioning of an active reflex urethral closing mechanism.

Cited by 17 publications

References 31 publications

The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

Patients' satisfaction and safety of bulk injection therapy Urolastic for treatment of stress urinary incontinence: A cross‐sectional study

Imaging findings of vinyl dimethyl polydimethylsiloxane used as a paraurethral injectable for female stress urinary incontinence

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