Quantitative Sonographic Differences in Mid-Urethra between Postmenopausal Women with and without Stress Urinary Incontinence

Olgan, Şafak; Mantar, Ozge Piri; Okyay, Recep Emre; Gülekli, Bülent

doi:10.1159/000445748

Cited by 3 publications

(2 citation statements)

References 24 publications

(29 reference statements)

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“…muscle, surrounds the middle third of the urethra. [3][4][5][6][7] As part of the continence mechanism, it contracts the urethra to prevent the accidental flow of urine. Damage to the rhabdosphincter through childbirth or atrophy from aging may lead to SUI.…”

Section: Urogynecology Special Issue Submission Nmentioning

confidence: 99%

“…Stress urinary incontinence occurs in part because of a weakened or atrophic urethral sphincter and negatively affects the social, psychological, and sexual domains of a woman's life. The urethral rhabdosphincter, made of skeletal muscle, surrounds the middle third of the urethra 3–7 . As part of the continence mechanism, it contracts the urethra to prevent the accidental flow of urine.…”

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confidence: 99%

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Web-Based Yoga-Pilates: A Prospective Cohort Study

Cramer¹,

Holland²,

Boniface³

et al. 2023

UROGC

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ImportanceThere are limited data to determine the change in severity, efficacy, and mechanism of action of yoga-Pilates in the treatment of stress urinary incontinence (SUI).ObjectivesThe primary objective was to evaluate the effect of an 8-week web-based home yoga-Pilates exercise program on SUI severity and to evaluate the potential mechanism of action through ultrasound examination of the urethral rhabdosphincter cross-sectional area.Study DesignThis was a prospective cohort study of women with SUI. Participants underwent visits pre- and post-intervention, completed quality of life/severity surveys, and underwent pelvic examination and 3-dimensional transperineal ultrasonography to determine the urethral cross-sectional area. Pre- and post-intervention 24-hour voiding diaries were also collected. The intervention was an 8-week online yoga-Pilates video that tracked and prompted participation.ResultsSixty women completed the study; they were predominantly premenopausal (67%) and vaginally parous (65%) and had done yoga (76%) and/or Pilates (44%). Seventy-three percent performed the exercises ≥3 times per week. For the primary outcome, the International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form score improved from 9.5 (95% confidence interval [CI], 8.7–10.4) to 7.1 (95% CI, 6.3–7.9) (P < 0.001). The median (interquartile range) number of incontinence episodes per 24 hours decreased from 1 (1–3) to 1 (0–1) (P < 0.001). The Brink pelvic floor strength score improved from 7.1 (95% CI, 6.6–7.7) to 7.7 (95% CI, 7.2–8.2) (P = 0.01). Eighty-three percent reported that they were “better” on Patient Global impression of Improvement. There were no significant changes in urethral measurements.ConclusionsAlthough it did not meet the minimal clinically important difference, this 8-week web-based yoga-Pilates exercise program improved SUI symptoms and decreased the number of incontinence episodes in women with SUI.

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Section: Urogynecology Special Issue Submission Nmentioning

confidence: 99%

mentioning

confidence: 99%

Web-Based Yoga-Pilates: A Prospective Cohort Study

Cramer¹,

Holland²,

Boniface³

et al. 2023

UROGC

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The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

et al. 2021

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Introduction and hypothesis To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. Methods For the data sources, a structured search of the peer-reviewed literature (English language; 1960–April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses. Results Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI. Conclusion The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.

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Changes in Morphology of the Urethral Rhabdosphincter Postpartum

Cramer

Boniface

Holland

et al. 2021

Female Pelvic Med Reconstr Surg

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Objective The aim of the study was to determine the effect of pregnancy on urethral rhabdosphincter cross-sectional area (CSA) and any association of CSA to urinary symptoms. Methods Nulliparous women planning pregnancy (N = 135) underwent standardized evaluations (symptom and quality of life [QOL] questionnaires, magnetic resonance imaging, ultrasonography, and neurophysiologic testing) between January 2008 and December 2013 (V1). The participants who became pregnant and gave birth underwent the same evaluations at 6 weeks (V2) and 6 months postpartum (V3). Participants who had magnetic resonance imaging data from both V1 and V3 were selected. We measured urethral rhabdosphincter CSA from high-resolution axial MRIs in a masked fashion. The mean CSA for each participant was calculated. The change from V1 to V3 was assessed. Results Sixty-eight women were evaluated. There was a significant decrease of 0.05 cm2 (interquartile range, −0.03 to 0.16 cm2; P = 0.002) in the median sphincter CSA between V1 and V3. There was a significant increase in the median Urinary Distress Inventory (UDI) subscore of the Pelvic Floor Distress Inventory (PFDI) from V1 to V3 (median increase of 0 [IQR, 0 to 8.3]; P = 0.033), but this was not significantly correlated with the change in the urethral CSA (Spearman correlation, 0.199; P = 0.107). Increasing fetal weight was correlated with a decrease in CSA postpartum after vaginal birth (Spearman correlation, −0.340; P = 0.017). Conclusions There is a decrease in urethral rhabdosphincter CSA with worsening Urinary Distress Inventory scores from prepregnancy to postpartum, but these two do not correlate in this cohort with low symptom levels. Among women who give birth vaginally, decrease in rhabdosphincter CSA is correlated with increasing fetal weight, perhaps with ramifications to be seen later in life.

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Quantitative Sonographic Differences in Mid-Urethra between Postmenopausal Women with and without Stress Urinary Incontinence

Cited by 3 publications

References 24 publications

Web-Based Yoga-Pilates: A Prospective Cohort Study

Web-Based Yoga-Pilates: A Prospective Cohort Study

The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

Changes in Morphology of the Urethral Rhabdosphincter Postpartum

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