Postpartum stress urinary incontinence (PSUI) commonly impairs quality of life in postpartum women. Pelvic floor muscle training (PFMT), as a primary foundational treatment, faces challenges such as inadequate adherence and significant individual differences in efficacy. Electrical stimulation (ES) and magnetic stimulation (MS), as passive pelvic floor rehabilitation techniques, are often used in conjunction with PFMT in clinical settings. However, there is a lack of systematic retrospective cohort study evidence comparing the efficacy, safety, and adherence of these three methods. Compare the effects of the three intervention strategies: PFMT, PFMT combined with ES, and PFMT combined with MS, on the recovery of pelvic floor function and the improvement of clinical symptoms in patients with PSUI. This retrospective study enrolled patients with PSUI who received systematic treatment at our hospital's plastic surgery department between June 2020 and June 2025. Patients were divided based on their treatment regimens: PF (receiving PFMT guidance), ES (receiving PFMT combined with outpatient ES therapy), and MS (receiving PFMT combined with outpatient MS therapy). A total of 102 patients (n = 34) were ultimately included. All patients received a 12-week course of systematic rehabilitation treatment. Primary indicators were objective measures: the amount of urine leakage during a 1-hour pad test, pelvic floor muscle strength (modified Oxford grading), and urodynamic parameters (maximum urethral closure pressure [MUCP], abdominal pressure leak point pressure [LPP]). Secondary indicators included the overall clinical response rate, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores, Incontinence Quality of Life Questionnaire (I-QOL) scores, and the incidence of adverse events. Baseline characteristics were balanced among the three groups (P > 0.05). After 12 weeks of treatment, the urine leakage volume in all three groups decreased compared to the baseline (P < 0.001). Specifically, the urine leakage volume after MS and ES treatments was lower than after PF treatment (P < 0.01). In terms of pelvic floor muscle strength, both MS and ES treatments resulted in higher Oxford grades compared to PF (P < 0.001). Regarding urodynamic parameters, both MS and ES treatments showed higher MUCP and LPP values than PF (P < 0.001) with MS higher than ES (P < 0.05). In terms of clinical overall effectiveness, PF had a rate of 73.5% (25/34), ES had a rate of 91.2% (31/34), and MS had a rate of 94.1% (32/34). Both ES and MS had higher rates compared to PF (P < 0.05). Both MS and ES showed lower ICIQ-SF scores (P < 0.01) and higher I-QOL scores (P < 0.001) than PF. Moreover, MS had higher I-QOL scores than ES (P = 0.008). In this non-randomized study, PFMT combined with ES or MS was associated with greater improvements than PFMT alone, and MS showed more favorable urodynamic and quality-of-life changes. Causal superiority cannot be determined.

BackgroundIn order to improve the diagnostic accuracy of anatomical/intrinsic sphincter deficiency (ISD) in female patients with stress urinary incontinence (SUI) and to provide a reference for surgical approaches, we developed a nomogram model based on urodynamic parameters.MethodsClinical data from 1150 women with complicated SUI treated at the Department of Urology, Third Xiangya Hospital, Central South University (01/01/2017–10/30/2023) were retrospectively analyzed. Patients were randomly divided into a training cohort (805 cases, 70%) and a validation cohort (345 cases, 30%). ISD was diagnosed by maximum urethral closure pressure (MUCP <30 cmH2O) or Valsalva leak point pressure (VLPP ≤60 cmH2O). Independent predictors of ISD were identified in the training cohort using binary logistic regression to construct the nomogram, validated using the validation cohort.ResultsMultivariate analysis identified abdominal pressure to urinate, IBPM, voiding time, urethral closure pressure, MUCP, and VLPP as independent predictors of ISD. The nomogram demonstrated good discrimination: training cohort AUC = 0.8308 (95% CI: 0.8022–0.8604); validation cohort AUC = 0.8408 (95% CI: 0.7964–0.8844). Decision curve analysis (DCA) indicated significant clinical benefit for both cohorts.ConclusionThis urodynamic parameter-based nomogram (incorporating abdominal pressure to urinate, IBPM, voiding time, urethral closure pressure, MUCP, and VLPP) provides higher diagnostic accuracy for identifying anatomical/structural differences (ISD) in women with complicated SUI compared to traditional criteria (MUCP <30 cmH2O or VLPP ≤60 cmH2O), providing important references for the selection of surgical approaches.

Minimally Invasive Single-Incision Sling Surgery for Stress Urinary Incontinence: Age-Related Outcomes and Predictors of Failure.

Integrated traditional Chinese medicine (TCM) and Western medicine for perimenopausal urinary incontinence combines the holistic regulatory concepts of TCM with the targeted therapeutic approaches of Western medicine, aiming to synergistically improve patients'incontinence symptoms and overall quality of life. Whilst effective, conventional Western therapies, such as pharmacotherapy and pelvic floor muscle training, can be limited by side effects (e.g., dry mouth from anticholinergics) and suboptimal long-term compliance. Conversely, the advantages of TCM interventions, including acupuncture and herbal formulations, have often been constrained by a reliance on subjective symptom scores, lacking robust objective metrics in efficacy evaluation. Quantitative urodynamic parameters, such as maximum cystometric capacity, detrusor pressure at end filling, abdominal leak point pressure and maximum urethral closure pressure, provide a critical and objective toolset for quantifying lower urinary tract function and therapeutic outcomes. In recent years, alongside the broadened clinical adoption of urodynamic studies, research has increasingly focused on evaluating the specific effects of combined therapies (e.g., acupuncture or herbal medicine integrated with pelvic floor rehabilitation or pharmacotherapy) on these objective parameters. This article reviews the clinical research progress in evaluating integrated TCM and Western medicine treatment for perimenopausal urinary incontinence, using urinary function parameters as the core assessment tool. Key findings, mechanistic insights and prevalent methodological limitations within the existing literature are synthesised. The review aims to provide a scientific reference to inform clinical decision-making and future research directions in treatment strategy selection for this prevalent condition.

BackgroundEctopic ureters (EU) are the main cause of urinary incontinence in juvenile dogs with a continence rate ranging from 22 to 72% reported after surgical correction. The objective of this retrospective preliminary study was to evaluate the usefulness of pre- and postoperative urethral pressure profiles (UPP) in predicting long-term continence in dogs with EU.ResultsUPP were performed in 16 female dogs prior to surgical correction of EU, as well as postoperatively, between 2012 and 2022. Urodynamic parameters included maximal urethral pressure (MUP), maximal urethral closure pressure (MUCP), anatomical profile length (APL), functional profile length (FPL) and integrated pressure (IP). A continence score (CS), defined as 1 = incontinent, 2 = continent with sporadic episodes of incontinence, 3 = continent, was given at the time of pre- and postoperative UPP. Neoureterostomy with dissection of the intramural portion (23 EU) or neoureterocystostomy (3 extramural EU) were performed. Seven dogs were neutered before or during surgical correction. Median preoperative CS was 1 (min 1, max 2). All dogs were continent with a CS of 3 in the immediate postoperative period. Long-term median follow-up time was 24 [8.5–42] months. Recurrence of incontinence occurred in 9 dogs (56.3%). Median time duration without recurrence was 5 months. In the 16 dogs, postoperative FPL values (median 70.5 [56-82.5] mm) were significantly increased compared to preoperative values (median 56.5 [41-72.3] mm) (P = 0.034). In the group of 7 dogs without recurrence of incontinence, IP increased significantly from a preoperative median value of 102 [19–171] cm.cmH2O to a postoperative median value of 132 [67–225] cm.cmH2O (P = 0.016). In dogs without recurrence, ranges of variation between pre- and postoperative MUP and IP values, as well as postoperative MUCP values (median 47.3 [24.5–52] cmH2O, P = 0.026) were significantly higher (P = 0.017 and P = 0.039 respectively). Recurrence hazard of incontinence was neither significantly associated with age, breed, preoperative urodynamic measurements, CS, neutering, or the type of EU.ConclusionsIn our population, preoperative UPP could not be considered as a diagnostic procedure predictive for incontinence recurrence after surgical correction of EU. Our urodynamic findings support potential improvement in urethral tone in female dogs without recurrence of incontinence.

The evaluation of surgical outcomes for mid-urethral sling (MUS) procedures in treating stress urinary incontinence (SUI) is critical for optimizing patient care. This study is aimed at evaluating the association between empty cough stress test (CST) results and surgical outcomes in MUS procedures, and its role in detecting intrinsic sphincter deficiency (ISD). This was a retrospective cohort study of women who underwent MUS procedures at a single academic center between 2017 and 2023.Patient information including demographics, perioperative factors, urodynamic parameters, and postoperative outcomes were extracted from electronic medical records. A total of 1215 women underwent MUS procedures, with 347 (28.6%) testing positive on the empty CST. The median follow-up period was 12months (range 8 to 16). Empty CST-positive women were younger (median age 53 vs 57years, p < 0.001) and more likely premenopausal. No significant differences were observed between the groups in SUI recurrence after MUS procedures (3.2% vs 4.8%, p = 0.477) or in reoperation rates for persistent SUI. The empty CST showed high specificity for leak point pressure ≤ 60cm H20 (86.5%) and low maximum urethral closure pressure ≤ 20cm H20 (85.3%), but limited sensitivity (17.7% and 3.7% respectively). CST positivity was initially associated with lower point Aa values (55.3% vs 74.0%, p < 0.001), but this lost significance after adjustment for confounders. Empty CST is not predictive of MUS success outcomes and shows high specificity with low sensitivity for detecting ISD, making it a useful yet limited diagnostic tool.

The primary aim was to evaluate the impact of body mass index (BMI) category on objective and subjective cure following single incision sling (SIS) surgery for stress urinary incontinence (SUI). The secondary aim was to compare outcomes among different SIS types within and across BMI categories. This retrospective study included 636 women (mean age 57.4 ± 10.4years) with urodynamic SUI who underwent SIS using the Ophira, Solyx, or I-stop mini between 2015 and 2023. Patients were stratified into BMI categories: normal (< 25kg/m2), overweight (25-29.9kg/m2), and obese (≥ 30kg/m2). Objective cure was defined as no leak on urodynamic testing and the 1-h pad test < 2g, while subjective cure was based on patient-reported outcomes using the UDI-6. Objective and subjective cure rates differed across BMI categories, with the highest rates observed in patients with normal BMI (93.1% and 90.5%) and the lowest in obese patients (77.8% and 75%). Within each BMI category, cure rates did not differ significantly by sling type. However, when outcomes were examined across BMI categories for individual sling types, fixed-length SIS (Ophira and Solyx) showed a significant decline in cure rates with increasing BMI, whereas the adjustable length I-stop mini maintained more consistent outcomes. Independent risk factors for failure included age ≥ 66, menopause, intrinsic sphincter deficiency (ISD), and maximal urethral closure pressure (MUCP) < 40cm H2O. BMI category is associated with SIS outcomes, with obese patients demonstrating lower cure rates compared with normal BMI patients. While sling type does not influence outcomes within BMI groups, preoperative counseling is essential for high-risk patients.

Stress urinary incontinence (SUI) is the predominant form of urinary incontinence in women. While not life-threatening, this condition significantly affects quality of life through social embarrassment, withdrawal, and anxiety. Magnetic stimulation, a non-invasive and convenient intervention, has gained considerable attention. However, its efficacy in SUI is still controversial. Hence, its clinical value needs to be further explored through systematic reviews and meta-analyses. To clarify the efficacy of magnetic stimulation therapy for SUI in women. Chinese and English studies were searched in PubMed, EMbase, Cochrane Library, Web of Science, CNKI, and Wanfang Databases up to August 2024. Randomized controlled trials of female SUI were included, focusing on urinary incontinence status, quality of life, urine pad test, urodynamics, pelvic floor muscle strength, and poor pelvic floor electromyographic signal. Information, such as author, study period, study type, age, intervention measures, intervention time, intervention frequency, and outcome indicators was extracted. Review Manager 5.4 and StataSE15.0 were adopted for data analyses. Sensitivity analyses and subgroup analyses were also implemented. In total, 17 studies with 1389 patients were included. The results demonstrated that magnetic stimulation-centered treatment significantly improved urinary incontinence, quality of life, 1-hour pad test results, maximum urethral closure pressure, and fast-twitch contraction potential difference of the pelvic floor muscles. However, the therapy did not show a statistical difference in the 24-hour pad test and pelvic floor muscle strength compared with the control measure. Magnetic stimulation-based therapeutic strategy can be used to improve SUI in women. However, it could not significantly improve pelvic floor muscle strength. In addition, the limited number and high heterogeneity of some research indicators may undermine the accuracy of the results. Therefore, caution is needed when translating the conclusions into clinical practice. These findings can be further corroborated through large-scale, high-quality multicenter randomized controlled trials.

IntroductionWomen with spina bifida often experience neurological impairments leading to pelvic organ dysfunction, including difficulties with bladder and bowel emptying that necessitate frequent Valsalva manoeuvres. These factors, combined with pelvic floor weakness, may increase the risk of pelvic organ prolapse (POP). This study aimed to assess the prevalence of POP in women with spina bifida, identify associated risk factors and evaluate outcomes of surgical management.MethodsWe retrospectively analysed a prospectively maintained database of women with spina bifida seen at a French referral centre from 2007 to 2024. Age under 18 and congenital perineal abnormality were exclusion criteria. The primary outcome was the presence of POP grade 2 or higher (Baden‐Walker classification). Secondary outcomes included symptomatic POP requiring surgery, recurrence after surgery, use of vaginal pessaries and related symptoms.ResultsPOP grade ≥2 was present in 14.8% of patients. Women with POP were older (median 44 vs. 31 years; p < 0.0001) and more frequently parous (58.5% vs. 18.3%; p < 0.0001), although 41.5% of POP cases occurred in nulliparous women. Apical prolapse was predominant (64.3%). Among 11 patients who underwent POP surgery, 54.5% experienced recurrence. Multivariate analysis identified parity (OR 5.33; p = 0.005) and lower maximum urethral closure pressure (OR 0.97; p = 0.02) as independent risk factors.ConclusionsPOP is highly prevalent in young adult women with spina bifida, including many nulliparous patients. The parity status and a low maximum urethral closure pressure could be associated with an increased risk of POP in this population. High recurrence after surgery highlights the need for information, routine screening and tailored management in this population.

This study aimed to evaluate lower urinary tract dysfunction after radical hysterectomy using urodynamic studies and to identify urinary biomarkers for detrusor underactivity via proteomic analysis. This prospective single-center study included women who underwent nerve-sparing radical hysterectomy for cervical carcinoma. Preoperative and postoperative assessments (at 1 and 6 months) included the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, urethral pressure profiling, and pressure flow studies. Detrusor contractility was assessed using the projected isovolumetric pressure (PIP1). Proteomic analysis was performed to identify urinary biomarkers associated with postoperative detrusor underactivity. Twenty-five patients were included. The total IPSS increased significantly at 1 and 6 months postoperatively. The maximum urethral closure pressure decreased significantly at 1 month and stabilized thereafter. PIP1 and voiding efficiency decreased significantly at 1 month, but improved by 6 months. Proteomic analysis revealed significant correlations between the changes in urinary ezrin, moesin, transthyretin, and PIP1 levels. Receiver operating characteristic analysis identified the optimal cutoff values for these biomarkers in diagnosing detrusor underactivity (PIP1 < 30). It was concluded that nerve-sparing radical hysterectomy impairs detrusor contractility and urethral function. Additionally, urinary ezrin, moesin, and transthyretin levels may be valuable biomarkers for diagnosing detrusor underactivity.

To identify factors that can predict both test phase and midterm success of sacral neuromodulation (SNM) in refractory non-neurogenic overactive bladder syndrome (nnOAB) based on preoperative clinical and urodynamic data. We conducted a two-center retrospective study and included all individuals with nnOAB who underwent a test phase between 2005 and 2021, with or without subsequent implantation of an SNM device. Only those with preoperative urodynamic assessment data were included. SNM success was defined as 50% improvement in one of the bladder diary parameters, associated with 50% symptom improvement. Individuals underwent follow-up evaluation at 2 years. In total, 191 individuals were included (163 women), 69% of whom underwent SNM device implantation. At the preoperative urodynamic exam, 115 individuals had detrusor overactivity (DO). Test phase success was associated with younger age (p = 0.009). 24-month SNM success was associated with lower maximal detrusor pressure at DO (Pdet max DO) at baseline (p = 0.045). Other predictive factors for success at 2 years were female (p = 0.03), a history of stress incontinence surgery (p = 0.01), a low maximum urethral closure pressure (MUCP) (p = 0.04), a low volume at first DO (VFDO) (p = 0.03), and a high maximum cystometric capacity (MCC) (p = 0.03). We developed a tool to predict success at 2 years. The following threshold values were significantly associated with treatment success: MUCP < 58 cmH2O, VFDO < 170 mL, and MCC > 254 mL. Age predicted test phase success. Pdet max DO, gender, history of incontinence surgery, high MUCP, MCC, and VFDO predicted midterm success of SNM in people with nnOAB.

We aimed to assess the predictivity of preoperative urodynamics (UDS) on de novo stress urinary incontinence (SUI) in patients having advanced pelvic organ prolapse (POP). Between January 2016 and June 2019, 133 patients with symptomatic POP at stage 3 or higher were included in the study. The presence of postoperative SUI symptoms after a minimum of six months of followup was considered the primary outcome. The results of all patients' preoperative UDS were compared to their postoperative SUI symptoms. In addition, patients were divided into two groups based on whether SUI was detected during preoperative UDS testing (group 1) or not (group 2). Although preoperative measurements, such as bladder capacity and residual urine volume, were not different between groups, group 1 had lower maximal urethral closure pressures (p=0.001). Preoperative SUI symptoms had a sensitivity of 32.1% and a specificity of 91.4% for predicting de novo SUI. In patients with advanced POP, preoperative UDS had a sensitivity of 60.7% and a specificity of 87.6% for predicting de novo SUI. Urodynamic examination with a pessary can significantly predict the development of de novo SUI.

This study aimed to examine the correlations between specific urethral function parameters observed in urodynamic testing and selected urethral characteristics evaluated by pelvic floor ultrasonography. Additionally, the presence of urethral funneling during straining was evaluated in female patients referred for surgical treatment of stress urinary incontinence. A retrospective study was conducted on 192 female patients referred for surgical treatment of stress urinary incontinence with the use of retropubic tension-free vaginal tape. Maximum urethral closure pressure and functional urethral length were evaluated urodynamically during resting profilometry. Ultrasound measurements, along with the assessment of funneling, were performed as part of the pelvic floor examination, following the technique described by Kociszewski. Patients with clinically significant pelvic organ prolapse, a history of anterior compartment surgery, prior radiotherapy, or symptoms of overactive bladder were excluded from the analysis. The values obtained from urodynamic and ultrasound examinations were evaluated statistically. No correlation was identified between the analyzed urodynamic and ultrasound parameters. Long urethral funneling was confirmed in all patients with stress urinary incontinence assessed as eligible for the placement of tension-free vaginal tape. The results indicate that urodynamic and ultrasound examinations assess distinct aspects of urethral anatomy and function, and therefore their findings cannot be used interchangeably. Long urethral funneling assessed during pelvic floor ultrasonography was noted in all patients with clinically and urodynamically confirmed stress urinary incontinence.

Background: The aim of the study was to assess the effect of high-intensity focused electromagnetic (HIFEM) technology in the treatment of female stress urinary incontinence (SUI). Materials and Methods: 20 women with SUI were delivered a treatment course with HIFEM technology. Patients attended 6 therapies scheduled twice a week. Validated questionnaires were assessed, including the overactive bladder symptoms score (OABSS), urogenital distress inventory-6 (UDI-6), incontinence impact questionnaire-7 (IIQ-7), international consultation on incontinence questionnaire (ICIQ), and valued living questionnaire (VLQ). Some urodynamic parameters, such as maximum flow rate (Qmax), residual urine (RU), and bladder volume at first sensation to void (Vfst). Bladder neck mobility in ultrasound topography was also collected pre- and post-treatment at 1- and 6-month follow-up visits. Results: HIFEM treatment significantly improved SUI symptoms on pad tests from 4.2 ± 5.5 to 0.6 ± 1.3 and patients' self-assessment in the 6-month follow-up. Additionally, the data from urinary-related questionnaires, including OABSS (5.3 ± 3.9 to 3.9 ± 3.6), UDI-6 (35.7 ± 22.3 to 15.2 ± 10.6), IIQ-7 (33.1 ± 28.7 to 14.3 ± 17.2), and ICIQ (9.4 ± 5.0 to 5.4 ± 3.6), all showed a significant reduction. Then, the analysis of the urodynamic study revealed that only maximum urethral closure pressure (MUCP) (46.4 ± 25.2 to 58.1 ± 21.2) and urethral closure angle (UCA) (705.3 ± 302.3 to 990.0 ± 439.6) significantly increased after the six sessions of HIFEM treatment. The urethral and vaginal topography were performed and found that HIFEM mainly worked on pelvic floor muscles (PFM) and enhanced their function and integrity. Conclusions: The results suggest that HIFEM technology is an efficacious therapy for the treatment of SUI.

The urethral wall consists of layers of striated muscle, circular and longitudinal smooth muscles, collagen fibers, and a vascular plexus. However, the relative contributions of these components to urethral pressure in humans remain poorly understood. The circular and longitudinal smooth muscle components can develop a spontaneous contractile activity, generating a basal tone. They can further contract or relax in response to excitatory or inhibitory stimuli. Animal studies suggest that smooth muscle activity in the mid-urethra plays a crucial role in determining maximal urethral closing pressure. Notably, the highest sympathetic activity occurs in the middle segment of the female urethra during increasing smooth muscle tone. This finding is supported by human studies that did not detect any electromyographic activity from striated muscle in this region. This study was conducted to review the contributions of the primary structural components and control mechanisms of urethral. In females, the external urethral striated sphincter is located at the distal urethra, which is not the segment associated with the highest closing pressure. Rather, the sphincter has been shown to modulate urethral pressure during exercise and physical stress. Basic science research does not support the notion that mid-urethral pressure is caused by the external striated sphincter tone in females. Instead, findings suggest that, at rest and during bladder filling, maximal urethral pressure is primarily determined by the activity of the urethral smooth muscles.

Nonneurogenic chronic urinary retention is an uncommon problem in young female individuals, and a well characterised causes is Fowler syndrome (primary disorder of urethral sphincter relaxation). Intermittent catheterisation is often challenging, and gold standard treatment sacral neuromodulation is not widely available. Urethral sphincter botulinum toxin injection has been shown to be effective cross-sectionally, however little is known about long-term outcomes. Female individuals presenting with urinary retention due to Fowler syndrome were reviewed retrospectively from a single tertiary referral centre over an 11-year period (2010-2021). One hundred units of onabotulinum toxin A (BoTX-A) was injected into the striated urethral sphincter in a divided dose by the periurethral approach. Efficacy and side effects were assessed 4 weeks after injection. Thirty-three female individuals with a mean age of 40.1±14.1 years received 165 unique urethral sphincter BoTX-A injections over 11 years. Nineteen individuals (57.6%) presented in acute urinary retention, and 28 (84.8%) were reliant on catheterisation. Twenty-one individuals (64%) responded to BoTX-A injections and had a significantly raised baseline maximum urethral closure pressure (MUCP), compared to nonresponders (114.6 cm H2O, P=0.012). Side effects were reported following 19 injections (11.5%) however, were mild and transient. Fifteen individuals received more than 1 botulinum toxin injection (median, 3 injections), with a median interval of 112 days (interquartile range) and efficacy persisted following repeat injections and no safety concerns were seen. Sphincter botulinum toxin through the periurethral approach is safe and effective following repeat injections, and offers a low-cost, minimally invasive alternative to managing female chronic urinary retention due to Fowler syndrome, particularly when there was a high baseline MUCP.

Background: Stress urinary incontinence (SUI) is characterized by a quick, uncontrollable loss of urine as a consequence of a rise in intra-abdominal pressure that exceeds the maximum urethral closure pressure and a rise in intra-vesical pressure.Aim: To assess the diagnostic efficacy of MRI in women patients with stress incontinence and pelvic floor dysfunction.Patients and Methods: This retrospective, case-control study was performed on twenty-five female cases suffering from stress urinary incontinence that had been clinically diagnosed. Five normal females were included as control cases; they were not complaining of any urinary symptoms. MRI examinations were conducted at Sayed Galal Hospital from March 2023 to March 2024.Results: There was no statistically significant variance among the continent volunteers incontinent cases regarding body mass index (BMI). At the same time, there was a significant variance among patient and control groups regarding Urethral Length, Length of supra pubic urethra and Levator hiatus width. 44.4% of the studied cases had Urethral motility, and 55.6% had Intrinsic sphincter Defects. 38.88% had continence, and 61.11% had no continence, as regard to cystocele there were 38.88% had no cystocele, 33.33% had grade I, 16.66% had grade II while 11.11% had grade III.Conclusion: When combined with dynamic and static sequences, MRI can identify the entire pelvic floor, making it a dependable alternative for noninvasive pelvic evaluation.

Female voiding dysfunction with cystocele have been widely studied, but there are no data regarding women without cystoceles. The present study aimed to evaluate the prevalence of detrusor underactivity (DU) and bladder outlet obstruction (BOO) without cystoceles in a large sample size. This was a retrospective cohort study. Between April 1996 and September 2018, 602 neurologically intact women with voiding dysfunction without cystoceles were enrolled. Detrusor pressure (DU) at the maximum flow rate (PdetQmax) <20 cmH2O, maximum flow rate (Qmax) <15 mL/s, and a bladder voiding efficiency <90% and BOO (PdetQmax ≥40 cmH2O and Qmax <12 mL/s) were diagnosed by urodynamic study. Otherwise, a non-DU/BOO diagnosis was made. The prevalence of DU and BOO was the primary outcome. The secondary outcomes were the analyses of the differences between these three groups in objective UDS parameters and subjective questionnaires and bladder diary parameters. This study included 100 (17%) women with DU, 60 (10%) with BOO, and 442 (73%) with a non-DU/BOO diagnosis. DU increased with age, but BOO decreased as age increased. The women in the DU group were older, had higher parity and pad weights, and lower PdetQmax, maximum urethral closure pressure, and functional profile length than the BOO group. The urodynamic findings did not correlate well to subjective questionnaire parameters. None of the symptoms revealed a significant difference between the groups. The retrospective design was the limitation of the study. The prevalence of DU increased with age in women with voiding dysfunction without advanced cystoceles. Conversely, BOO decreased with age. Prevalence intersected in the fourth decade. Diagnosis requires urodynamic evaluation, as subjective symptoms are inconclusive.

ABSTRACT Background To compare the effectiveness and safety of laparoscopic colposuspension using sutures (LCS) versus mesh and staples (LCM) in the treatment of female stress urinary incontinence. Methods This randomized study was conducted over a total of 80 women with genuine stress urinary incontinence between January 2020 and April 2022. Women were randomly assigned to the LCS group (n = 40) or the LCM group (n = 40). They underwent objective evaluations, including a standardized stress test, a 24-hour pad test, and a frequency-volume chart. Subjective assessments were made using a quality-of-life questionnaire. Results The LCS group exhibited superior outcomes in PAD test improvement (from 147 [31–304] to 3 [0–300] at 1 year, p < 0.001), stress test scores (from 82 [11–153] to 1 [0–124] at 1 year, p < 0.001), and mean micturated volume (increase from 294 ± 65 to 321 ± 57 at 1 year, p = 0.037) compared to the LCM group. Urodynamic findings revealed a higher Maximum Urethral Closure Pressure in the LCS group (33.1 ± 6.9) versus the LCM group (28.3 ± 6.4, p = 0.002). Quality of life improvements were significantly better in the LCS group across various domains. However, the LCM group benefitted from shorter surgery duration, hospital stays, and bladder drainage duration. Conclusion LCS demonstrates significant advantages over LCM in treating female stress urinary incontinence, particularly in cure rates and quality of life improvements. Despite the operational benefits of LCM in terms of reduced surgery and recovery times, LCS offers superior therapeutic outcomes.

Objective: To explore the application of modified urethral separation method in artificial urethral sphincter (AUS) implantation in patients with stress urinary incontinence (SUI), and its influence on the results of urethral pressure profilometry. Methods: A prospective collection of clinical data was conducted on 25 patients with stress urinary incontinence who underwent modified urethral separation method in AUS implantation and underwent urethral pressure profilometry in Beijing Hospital, Beijing Jishuitan Hospital Affiliated to Capital Medical University and the Second Hospital Affiliated to Tianjin Medical University from March 2019 to June 2023. The improved urethral separation method was to borrow part of the white membrane tissue of the cavernous body while freeing the dorsal side of the cavernous body of the urethra. The circumference of the urethra, sleeve size, and urethral pressure were recorded, the patient's autonomous urinary control before and after surgery and the changes of the international consultation on incontinence questionnaire-short form (ICI-Q-SF) score, incontinence quality of life questionnaire (I-QoL) score, urinary frequency score, nocturia score were compared. Follow-up was conducted in the clinic or by telephone at 1, 3, 6, and 12 months after activation of the device, and once a year thereafter. Local skin status and urine control were assessed, residual urine volume was measured by ultrasound and subjective score scale was completed. Results: All patients were male, aged 27-85 (65.8±15.7) years old. The circumference of the cuff used in this study was 4.0 cm in 4 patients (16.0%), 4.5 cm in 16 patients (64.0%), 5.0 cm in 4 patients (16.0%), and 5.5 cm in 1 patient (4.0%). Among them, the urethral circumference matched the cuff size in 14 cases (56.0%), the urethral circumference was smaller than the cuff size in 4 cases (16.0%), and the urethral circumference was larger than the cuff size in 7 cases (28.0%). Preoperative urodynamic examination showed that the maximum urethral pressure (MUP) was (78.0±25.9) cmH2O, (1 cmH2O=0.098 kPa) and the maximum urethral closure pressure (MUCP) was (53.4±26.6) cmH2O. The MUP of AUS device in the inactivated state was (88.0±26.5) cmH2O, which was not significantly higher than that before operation (P>0.05). The MUCP was (68.2±24.5) cmH2O, which was significantly higher than that before operation (P<0.05). The MUP and MUCP of the AUS device in the activated state were (146.6±25.2) cmH2O and (123.0±28.3) cmH2O, which were significantly higher than those before surgery and in the inactivated state (both P<0.001). All patients in the group reached the social urinary control standards at the first month of device activation. During a follow-up period of 2-50 months, 22 patients (88.0%) used the initial AUS device and all met social urinary control standards. The AUS device was replaced in 1 case. One patient died of cerebrovascular accident. One patient removed the device due to complications. The number of pads [M (Q1, Q3)] used in 25 patients before and after operation was 4.5 (3.0, 6.5) and 1 (0, 1) respectively, with statistically significant differences (P<0.001). ICI-Q-SF score, I-QoL score, urinary frequency score and nocturia score of 25 patients were significantly improved after surgery (all P<0.05). The incidence of postoperative complications was 20.0% (5/25), including 2 cases of painless hematuria, 1 case of infection, 1 case of urethral erosion, and 1 case of dysuria. Except for one patient who experienced urethral erosion and had his sleeve removed, the remaining four patients regained social urination control with active support treatment, and no symptoms recurred until the last follow-up. Conclusion: The modified urethral separation method has no significant effect on urethral pressure in patients with SUI, and can increase the volume of peri-urethral tissue in the cuff, thereby reducing the risk of intraoperative urethral injury and the incidence of postoperative urethral erosion.