Stress Urinary Incontinence: Relative Importance of Urethral Support and Urethral Closure Pressure

DeLancey, John O.L.; Trowbridge, Elisa R.; Miller, Janis M.; Morgan, Daniel M.; Guire, Kenneth E.; Fenner, Dee E.; Weadock, William J.; Ashton‐Miller, James A.

doi:10.1016/j.juro.2008.01.098

Cited by 222 publications

(245 citation statements)

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“…These increases in sphincter size appear to be clinically relevant; thickness and cross-sectional area both increased by ∼20 %, which is well above the estimated mean percent error of 12-15 %. Further, when improvements in continence are considered along with morphological changes, these results suggest that the training effect produced appears to be sufficient to overcome deficiencies in urethral pressure in women with SUI found by DeLancey's group [5,6].…”

Section: Discussionmentioning

confidence: 77%

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

et al. 2014

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Section: Discussionmentioning

confidence: 77%

“…Interest grew when DeLancey et al reported that decreased urethral closure pressure is the factor most strongly associated with SUI [5,6]. This is supported by both morphological and electromyographic (EMG) evidence.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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“…According to DeLancey and Asthon-Miller, damage of pelvic floor muscle and endopelvic fascia, the supportive layer under urethra, is related with delayed closure of urethral lumen (13,14). 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).…”

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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“…1 This was a casecontrol study involving 103 women with SUI and 108 asymptomatic controls matched for age, race, parity and hysterectomy. The key variables analyzed were maximum urethral closure pressure (MUCP), urethral and pelvic organ support, levator ani muscle function, and intravesical pressure.…”

Section: Rose Studymentioning

confidence: 99%

What causes stress incontinence: Fallacies, fascias and facts

DeLancey

2012

CUAJ

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The traditional view of the pathophysiology of stress urinary incontinence (SUI) was that a loss of urethral support was the primary abnormality present. Recent research has challenged this hypothesis, demonstrating that impaired urethral function plays the key causative role. Improving our understanding of the underlying pathologic mechanisms is important to identifying the cause of treatment failures and for developing novel therapies to treat SUI. O ver the last century, several hypotheses have been proposed to explain the pathophysiology of stress urinary incontinence (SUI). These theories have largely been based on uncontrolled clinical observations or comparing women with stress incontinence to women undergoing urodynamics that did not have stress incontinence (i.e., urge incontinence), focusing on loss of urethral support and an open vesical neck as the primary causative abnormalities. This traditional view of SUI causation has, however, been challenged by recent research investigating the potential role of urethral function in SUI using asymptomatic volunteers for comparison. ROSE studyThe Research On Stress incontinence Etiology (ROSE) study compared measurements of urethral support and function in women with primary SUI to asymptomatic volunteers. 1 This was a casecontrol study involving 103 women with SUI and 108 asymptomatic controls matched for age, race, parity and hysterectomy. The key variables analyzed were maximum urethral closure pressure (MUCP), urethral and pelvic organ support, levator ani muscle function, and intravesical pressure.The study showed that the mean MUCP was 42% lower among women with primary SUI (40.8 cm H 2 O vs. 70.2 cm H 2 O; Fig. 1). MUCP was found to be, by far, the strongest predictor of SUI; the effect size (1.47) was substantially higher than that of any other single predictor. In fact, after adjusting for body mass index (BMI), MUCP alone correctly classified 50% of cases. No measure of urethral support had an effect size greater than 0.6. Ultrasound investigationThe investigators of the ROSE study were surprised by their findings that MUCP was the most powerful predictor, with an effect size so much greater than any of the urethral mobility variables assessed in the study. To alleviate concerns that they had not included the correct urethral mobility parameter in their assessments, they subsequently performed a secondary analysis of ultrasound videos of the ROSE subjects' urethral mobility during coughing. 2 This was carried out by a panel of international experts who were asked to identify which patterns they felt were most likely to be associated with stress incontinence.The investigators were surprised to discover that none of the experts were able to consistently discern which women were stress incontinent and which were continent based on review of the ultrasounds alone. Indeed, the mean accuracy of these evaluators was 57.4% (i.e., only 7% better than the success rate one would expect by random chance). This finding further supports the concept that ure...

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Stress Urinary Incontinence: Relative Importance of Urethral Support and Urethral Closure Pressure

Abstract: The finding that maximal urethral closure pressure and not urethral support is the factor most strongly associated with stress incontinence implies that improving urethral function may have therapeutic promise.

Cited by 222 publications

References 20 publications

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

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

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

What causes stress incontinence: Fallacies, fascias and facts

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