Pathophysiology Of Stress Urinary Incontinence Research Articles

STRESS URINARY INCONTINENCE: A TEN YEARS SYSTEMATIC REVIEW

Introduction: Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) affect a substantial percentage of women, significantly impacting their quality of life. This review explores the prevalence, definitions, and pathophysiology of SUI, POP, and associated urinary incontinence, emphasizing the need for medical attention and offering insights into current treatment trends over the past 5 years. Methods: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research. Result: Our search produced 21 results. After looking at the titles and summaries, we found 9 papers that fit our criteria. At first, we excluded several articles because they were written in review style. But after reading the full papers carefully, we included five papers in our final analysis. These papers included a retrospective observational study, prospective study, and randomized control trial. Conclusion: In this decade-long systematic review on stress urinary incontinence (SUI), notable findings include a 2.2 prevalence of SUI operations post-hysterectomy, persistent links between vaginal hysterectomy (VH) and SUI operations, and significant associations with preceding pelvic organ prolapse (POP), vaginal deliveries, laparoscopic hysterectomy (LH), and urinary incontinence (UI) visits. Combining pelvic floor muscle (PFM) strengthening with hip synergic muscle exercises improves daily urine loss frequency, while modifiable risk factors such as achieving an ideal body weight and preventing traumatic vaginal delivery are identified for SUI prevention. Cost analysis indicates that savings from avoiding unnecessary surgical treatments through urodynamic investigations (UDIs) in uncomplicated patients cover associated expenses, emphasizing the need to consider potential legal actions in a comprehensive cost assessment of negative externalities

Possibilities of elastography in the diagnosis of stress urinary incontinence in women

BACKGROUND:Stress urinary incontinence in women is a widespread disease. It can occur in women of reproductive age, while progressing and disrupting the quality of life. Ultrasound elastography allows for evaluating the stiffness of the urethral supporting structures and can help in studying the pathophysiology of stress urinary incontinence and in diagnosing its mild forms for timely initiation of therapy and preventing the development of severe forms of the disease.
 AIM:The aim of this study was to improve the diagnosis of mild stress urinary incontinence in women using ultrasound compression elastography of the ureterovesical junction.
 MATERIALS AND METHODS:We examined 25 women with mild stress urinary incontinence (main group) and 15 patients without urinary incontinence (control group) of reproductive and perimenopausal age. The diagnosis of stress urinary incontinence was confirmed during a comprehensive urodynamic study. To assess the urethral mobility and determine the stiffness of the supporting structures, a 2D ultrasound examination was performed with compression elastography of the ureterovesical junction using Voluson E6 and E10 ultrasound systems equipped with a transvaginal probe (GE Healthcare, USA). Four areas of interest in the paraurethral region of the proximal and middle urethra were examined. The obtained elastograms were used to evaluate the color characteristics and strain ratio of the areas of interest in three dimensions, the average values being calculated.
 RESULTS:The strain ratios in all studied areas of the paraurethral region had no significant relationship with age and were lower in patients with stress urinary incontinence compared to control values (p 0.01). Urethral hypermobility (mobility: mean urethral α angle rotation of 40 degrees) was identified in 84% of women with stress urinary incontinence. According to the results of correlation analysis, the strain ratios in the three areas of interest had a significant negative relationship with changes in the urethral α angle rotation. The ROC analysis showed that the stiffness values of the paraurethral region of the proximal posterior wall of the urethra are the most significant parameters for the diagnosis of stress urinary incontinence. The threshold value of the strain ratio for diagnosing stress urinary incontinence was determined to be less than or equal to 0.85 (sensitivity 96.0%; specificity 86.7%;p 0.001).
 CONCLUSIONS:Ultrasound compression elastography of the ureterovesical junction is a new non-invasive technique that can improve the accuracy of diagnosing stress urinary incontinence in women. It is advisable to use the technique in women with mild stress urinary incontinence who are planned for conservative treatment to confirm the diagnosis and monitor therapy.

Better Sense of Force Accuracy in Women with Stress Urinary Incontinence Compared with Women Without Stress Urinary Incontinence: A Surprising Result in a Case-Control Study

Background: It has been demonstrated that pelvic floor muscles (PFMs) are involved in the pathophysiology of stress urinary incontinence (SUI). Sense of force, an aspect of proprioception, has never been evaluated in PFMs. Objectives: This study aimed to assess the proprioception of PFMs by evaluating the accuracy of force sense in adult women with SUI compared to those with continence. A further aim was to study the accuracy of force sense between various lengths and tensions of PFMs. Methods: Twenty-three women with SUI and 18 women without it were recruited in six trials with four different test conditions: 5 mm/40% (speculum opening/maximum voluntary contraction (MVC) percentage to produce), 5 mm/70%, 10 mm/40%, and 10 mm/70%. All participants were asked to reproduce the target force based on their own perceptions. The dynamometer was used to evaluate the sense of force. Results: The accuracy of force sense differed between women with SUI and those without it. In all test conditions, women with SUI had higher force reproduction accuracy. The highest amount of error was recorded at 10 mm and 40% MVC for either group. Conclusions: Women with SUI were more accurate in reproducing the target force than those with continence. Higher force sense accuracy may result from more attention to the pelvic floor area and a lack of automaticity of movements in women with SUI. Therefore, developing therapeutic management focusing on restoring automaticity seems advisable.

Comparison of efficacy of extracorporeal magnetic innervation and Kegel exercises for stress urinary incontinence in adult women: study protocol for a randomized controlled trial.

Stress urinary incontinence (SUI) is defined as a complaint of inadvertent loss of urine occurring as a result of an increase in intraabdominal pressure. Strong evidence supports the use of pelvic floor muscle training (PFMT) as the first-line conservative treatment for SUI. Extracorporeal magnetic stimulation (EMS) is a non-invasive, effective, acceptable, and safe therapeutic modality for SUI. Although PFMT and EMS share most of their influences on the pathophysiology of SUI, it is unclear whether one of these routinely used treatment modalities is superior to another in terms of improvement of clinical outcomes or cost-effectiveness. To the best of our knowledge, no randomized controlled trials have so far directly compared PFMT with EMS. Our aim here is to describe a protocol for such a study.This will be a parallel-group, single-blind, randomised controlled trial compliant with the SPIRIT, CONSORT, and TIDieR reporting guidelines. Participants will be women aged 18 to 65 years who have previously given at least one vaginal delivery (at least 12 months before joining the study) who present with symptoms of SUI lasting at least 6 months yet have not previously received treatment for it. In the first study arm, patients will receive an eight-week, high-intensity, home-based Kegel exercises regimen. In the second study arm, the treatment scheme will consist of 2 sessions of EMS per week for a total of eight weeks. The primary outcome will be effectiveness of treatment as measured by the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form overall score, eight weeks, three months, and six months after commencement of treatment.

Development of an MS Workflow Based on Combining Database Search Engines for Accurate Protein Identification and Its Validation to Identify the Serum Proteomic Profile in Female Stress Urinary Incontinence

A critical stage of shotgun proteomics is database search, a process which attempts to match the experimental spectra to the theoretical one. Given the considerable time and effort spent in analysis, it is self-evident for a researcher to aspire for rigorous computational analysis and a more confident and accurate peptide/protein identification. Mass spectrometry (MS) has been applied across several clinical disciplines. The pathophysiology of Stress Urinary Incontinence (SUI), caused by a damaged pelvic floor, has become a boundless disease altering the quality of life worldwide. Although some studies pointed markers that can be bioindicators for SUI, these findings raise the issue of sensitivity and specificity. Therefore, it is critical to have a sensitive and specific analytical approach to identify markers that have been associated with protective and deleterious associations in disease. Here, we describe our designed and developed workflow for protein identification from tandem mass spectrometry that uses multiple search engines. We apply our workflow to an existing study addressing the pathophysiology of SUI. We demonstrate how using the combined approach together with high-performance computing techniques can surmount the challenges of complex analyses and extended computing time. We also compare the relative performance of each combination. Our results suggest that a combination of MS-GF+ and COMET represents the best sensitivity-specificity trade-off, outperforming all other tested combinations. The approach was also sensitive and accurately identified a set of protein that was shown to be markers for categories of diseases associated with the pathophysiology of SUI. This workflow was developed to encourage proteomic researchers to adopt MS-based techniques for accurate analysis and to promote MS as a routine tool to the clinical cohorts.

A timeline of female stress urinary incontinence: how technology defined theory and advanced treatment.

Prevailing theories and treatments of female stress urinary incontinence are built on 120 years of evolution in understanding the structure and function of the female bladder neck and urethra and of considering why treatments failed. In our management of patients, it is important to understand and appreciate how our management of female stress urinary incontinence has evolved and which treatments have prevailed as we advance our knowledge for future treatments. The purpose of this review is to describe how advances in technology impacted and shaped prevailing theories or understanding of the pathophysiology of stress urinary incontinence and influences our treatment approach. An extensive literature search was performed from 1900 to present identifying articles that discussed technological advancements in female urology, theories of female stress incontinence, and treatments. The literature from the 20th century to the present shows a nonlinear evolution of the pathophysiological mechanism of stress urinary incontinence (SUI) from a notion of SUI and secondary to a simple anatomic finding to consideration of the effects of neurophysiologic pathways on SUI. Slings, however, have been a staple in the management of SUI. The pubovaginal sling (PVS) is a procedure that, with minor modifications (graft size, suture preference) has withstood the test of time and maintained its place in the armamentarium of SUI treatment for 100 years. It is therefore imperative that we continue to educate our residents and fellows on the surgical techniques and indications for use of the PVS.

Surgical Treatment of Female Stress Urinary Incontinence: Midurethral Slings

Stress urinary incontinence (SUI) is the loss of urine caused by increased physical activity such as coughing or exercise. In this review, the anatomy and pathophysiology of SUI are discussed, particularly the presence of a hypermobile urethra. This specific anatomic finding allows the midurethral sling to be a viable surgical option. The evolution and different types of midurethral slings, including retropubic, transobturator, and single-incision slings, are described. We then discuss outcomes of the different types of slings in patients with SUI and special populations, including elderly and obese patients. Finally, we review the complications associated with midurethral slings. This review contains 7 figures, 3 tables, and 110 references. Keywords: complications, elderly, incontinence, intrinsic sphincter deficiency, meshexposure, midurethral sling, mixed incontinence, outcomes, retropubic sling, single-incision sling, stress urinary incontinence, transobturator sling

Pelvic floor muscle activity during impact loads in continent and incontinent women: A systematic review

Introduction: Investigating electromyographic activity of female pelvic floor muscle (PFM) during impact loads helps to clarify the pathophysiology of stress urinary incontinence (SUI).

Serum proteomic pattern in female stress urinary incontinence.

The pathophysiology of Stress Urinary Incontinence (SUI) is poorly understood. The aim of this study was to identify the serum proteomic profile in patients with SUI and to replicate findings from a preceding study in which a significant difference in the urinary proteome was identified. Serum samples were collected from 38patients (19 SUI; 19 matched, continent controls). Sample preparation included serum albumin depletion, in-solution enzymatic digestion of proteins applying a combination of Gluc-C and trypsin and peptide separation using nano High Performance Liquid Chromatography. Label-free quantitation of peptides and proteins was performed after triplicate measurements using quadrupole time-of-flight mass spectrometry. Peptide identification was achieved by searching the Human SwissProt Database using Mascot and X!Tandem. Main outcome measure was the relative abundance of each detected protein in serum. Of 7012 identified proteins, 33 proteins were induced (detected in SUI, not in controls) and five proteins were depleted (detected in controls, not in SUI). All depleted proteins play a role in immune/DNA damage response. Induced proteins are involved in inflammatory response, response to cellular stress, coagulation and cytoskeleton stability/ motility. Plasma serine protease inhibitor (SERPINA5) was found induced and previously also showed a higher abundance in urine samples of SUI patients. Data are available via ProteomeXchange with identifier PXD008553.

Pelvic floor muscle activity during impact activities in continent and incontinent women: a systematic review.

Investigating the activity of the pelvic floor muscles (PFMs) in women during impact activities such as jumping, running or coughing may elucidate different aspects of PFM activation and therefore clarify the pathophysiology of stress urinary incontinence (SUI). A systematic review (PROSPERO 2016:CRD42016035624) was conducted to summarize current evidence on PFM activity during impact activities in both continent and incontinent women. PubMed, EMBASE, Cochrane, and SPORTDiscus databases were systematically searched for studies published up to December 2016. The PICO approach (patient, intervention, comparison, outcome) was used to construct the search queries. Original studies were included that investigated PFM activity during impact activities if they included terms related to muscle activity and measurement methods, test positions, activities performed and continence status. Two reviewers screened titles and abstracts independently to ascertain if the included studies fulfilled the inclusion criteria, and extracted data on outcome parameters. The search revealed 28 studies that fulfilled the inclusion criteria, of which 26 were cross-sectional studies. They used different electromyography measurement methods, test activities, test positions, and comparisons with other structures. Ten studies compared continent and incontinent women. The timing of PFM activity in relation to the activity of other trunk muscles seems to be a crucial factor in maintaining continence. Women with SUI have delayed PFM activity. The findings of this systematic review suggest that impact activities causing involuntary and reflex PFM activity should be the subject of further study. This may help guide clinical studies to improve our understanding of how the PFMs react during impact activities and to determine best practices that can be included in rehabilitation programmes.

Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review.

Investigations of the dynamic function of female pelvic floor muscles (PFM) help us to understand the pathophysiology of stress urinary incontinence (SUI). Displacement measurements of PFM give insight into muscle activation and thus help to improve rehabilitation strategies. This systematic review (PROSPERO 2013: CRD42013006409) was performed to summarise the current evidence for PFM displacement during voluntary and involuntary activation in continent and incontinent women. MEDLINE, EMBASE, Cochrane and SPORTDiscus databases were searched using selected terminology reflecting the PICO approach. Screening of Google Scholar and congress abstracts added to further information. Original articles investigating PFM displacement were included if they reported on at least one of the aims of the review, e.g., method, test position, test activity, direction and quantification of displacement, as well as the comparison between continent and incontinent women. Titles and abstracts were screened by two reviewers. The papers included were reviewed by two individuals to ascertain whether they fulfilled the inclusion criteria and data were extracted on outcome parameters. Forty-two predominantly observational studies fulfilled the inclusion criteria. A variety of measurement methods and calculations of displacement was presented. The sample was heterogeneous concerning age, parity and continence status. Test positions and test activities varied among the studies. The findings summarise the present knowledge of PFM displacement, but still lack deeper comprehension of the SUI pathomechanism of involuntary, reflexive activation during functional activities. We therefore propose that future investigations focus on PFM dynamics during fast and stressful impact tasks.

Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review

Investigations of the dynamic function of female pelvic floor muscles (PFM) help us to understand the pathophysiology of stress urinary incontinence (SUI). Displacement measurements of PFM give insight into muscle activation and thus help to improve rehabilitation strategies. This systematic review (PROSPERO 2013: CRD42013006409) was performed to summarise the current evidence for PFM displacement during voluntary and involuntary activation in continent and incontinent women. MEDLINE, EMBASE, Cochrane and SPORTDiscus databases were searched using selected terminology reflecting the PICO approach. Screening of Google Scholar and congress abstracts added to further information. Original articles investigating PFM displacement were included if they reported on at least one of the aims of the review, e.g., method, test position, test activity, direction and quantification of displacement, as well as the comparison between continent and incontinent women. Titles and abstracts were screened by two reviewers. The papers included were reviewed by two individuals to ascertain whether they fulfilled the inclusion criteria and data were extracted on outcome parameters. Forty-two predominantly observational studies fulfilled the inclusion criteria. A variety of measurement methods and calculations of displacement was presented. The sample was heterogeneous concerning age, parity and continence status. Test positions and test activities varied among the studies. The findings summarise the present knowledge of PFM displacement, but still lack deeper comprehension of the SUI pathomechanism of involuntary, reflexive activation during functional activities. We therefore propose that future investigations focus on PFM dynamics during fast and stressful impact tasks.

The Role of Fascial Slings in the Treatment of Stress Urinary Incontinence in Women: A 2013 Update

During the last decade, a variety of commercial innovations in synthetic sling materials have emerged as a result of an evolution in the understanding of the pathophysiology of stress urinary incontinence (SUI), and a push to less invasive surgical approaches. The advent of midurethral slings (MUS), with their relative ease of placement, has modernized and become the most commonly used technique for treatment of SUI. Nevertheless, this innovative technology has been associated with complications not previously associated with anti-incontinence procedures. In this article, we review the current literature regarding the use, indications, and efficacy of pubovaginal fascial slings (PVS) in the era of expanding synthetic sling use.

What causes stress incontinence: Fallacies, fascias and facts

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.

What causes stress incontinence: Fallacies, fascias and facts.

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.

The many facets of stress urinary incontinence.

The 2nd Annual Canadian Urology Forum (2012) focused on decisions and controversies in the management of two distinct clinical entities: stress urinary incontinence (SUI) in women; and lower urinary tract symptoms (LUTS) in men. Both sessions involved a distinguished panel of Canadian and international experts and combined the best evidence-based medicine with the considerable clinical experience of the faculty. The overall learning objectives of this session were to: Describe the pathophysiology of SUI in female patients; Determine appropriate approaches to treatment-related complications or failure in female patients who are experiencing SUI; and Measure patient outcomes and define successful treatment of SUI. To that end, faculty members were asked to cover six individual topics in SUI. Dr. John DeLancey, Norman F. Miller Professor of Gynecology and Professor of Urology at the University of Michigan Medical School, discussed the causes of SUI. Dr. Philippe Zimmern, Professor of Urology at the University of Texas Southwestern Medical Center at Dallas, provided an overview of what constitutes an appropriate workup for a woman with SUI. Dr. J. Christian Winters, Professor of Urology and Gynecology at the Louisiana State University Health Sciences Centre, reviewed the relevant evidence in presenting a rational approach to selecting a surgical intervention for women with SUI. Dr. Victor Nitti, Professor of Urology and Obstetrics and Gynecology and the Vice Chairman of the Department of Urology at New York University (NYU) Langone Medical Center, was tasked with reviewing the potential complications of midurethral slings and presenting options for managing these complications. Dr. E. Ann Gormley, Professor of Surgery (Urology) and the Program Director of the Urology Residency at Dartmouth–Hitchcock Medical Center in Lebanon, New Hampshire, discussed the appropriate management of women with a failed midurethral synthetic sling. Finally, Dr. Zimmern led a thought-provoking discussion of what constitutes treatment success for patients with SUI. The following pages feature brief summaries of each of the above topics. At the conclusion of these presentations, the faculty and participants interacted to discuss a case study detailing the appropriate management of a woman with complicated SUI. The highlights of this discussion are also captured in the following pages. The presentations and discussions on SUI at the 2012 Canadian Urology Forum were highly informative and clinically valuable to those in attendance. We hope that by providing the following summaries in this supplement format, these sessions can also provide valuable information to other health-care professionals in Canada and around the world.

Racial differences in female urethral morphology and levator hiatal dimensions: An ultrasound study

To compare the urethral sphincter morphology and levator hiatal dimensions between white and black premenopausal nulliparous asymptomatic women using 3D/4D translabial ultrasonography. Nulliparous black and white women were recruited in a tertiary gynecological center. All women were completely asymptomatic for pelvic floor dysfunction. Women were assessed with 3D/4D translabial ultrasound scan of the pelvic floor, at rest. Measurements of the total urethral sphincter volume (TSV), rhabdosphincter volume, (RSV) and levator hiatal dimensions (LH) were taken at rest, after voiding. Twenty-three white and 14 black women (37 in total) were investigated. Subjects did not differ by age or body mass index (BMI). Black women were found to have significantly larger rhabdosphincters (RS) than their white counterparts (8.88 cm(3) ± 1.65 vs. 5.97 cm(3) ± 1.82, respectively, P = 0.000). With respect to levator hiatal dimensions at rest, black women had a significantly wider transverse diameter (LHt) than white women (mean difference of LHt = 0.43 cm, 95% CI 0.08-0.78, P < 0.05). Asymptomatic black nulliparous women have significantly larger rhabdosphincters than their white counterparts. Racial differences in the female urethral morphology could provide an insight on the pathophysiology of stress urinary incontinence.

Advanced maternal age as a risk factor for stress urinary incontinence: a review of the literature

The pathophysiology of stress urinary incontinence (SUI) is multifactorial and evidence supports a critical role of pregnancy and vaginal delivery. This review dissects epidemiologic literature to determine the weight of evidence on the role of advanced maternal age (AMA) as a risk factor for the development of subsequent or persistent SUI. We conducted a Medline search using the keywords postpartum, SUI, maternal age, pregnancy, and incontinence. The published literature was critically analyzed. Evidence supports that childbirth trauma contributes to the development and severity of SUI. Yet, there is contradicting evidence as to whether AMA increases the risk. AMA clearly represents an independent risk factor for postpartum SUI. However, long-term studies did not confirm this observation. Whether this finding is suggestive of a true biologic signal that is lost with competing risk factors over time warrants further research.

Clinical and pathophysiological correlates of the symptom severity of stress urinary incontinence

The pathophysiology of stress urinary incontinence (SUI) is multifactorial. The aim of this study was to explore the factor determining the symptom severity of SUI. One hundred twenty-four women with SUI were retrospectively investigated. Clinical data for analyses included demographics, pelvic organ prolapse quantification, SUI severity using a 4-point Likert scale, ultrasound, 1-h pad tests, and urodynamic studies. Data were analyzed using the Spearman's rho test and Kruskal-Wallis test. The symptom severity was not correlated with risk factors of SUI or the morphologic manifestations representing urethral support defect, but was significantly correlated with urine loss on 1-h pad test, Valsalva leak point pressure (VLPP) grading, and maximum urethral closure pressure (MUCP). Women with higher SUI severity had greater urine loss on 1-h pad tests, worse VLPP grading, and lower MUCP. Urethral sphincter function appears to be an important determinant for the symptom severity of SUI.

Application of a new method in the study of pelvic floor muscle passive properties in continent women

The aim of this study was to present a new methodology for evaluating the pelvic floor muscle (PFM) passive properties. The properties were assessed in 13 continent women using an intra-vaginal dynamometric speculum and EMG (to ensure the subjects were relaxed) in four different conditions: (1) forces recorded at minimal aperture (initial passive resistance); (2) passive resistance at maximal aperture; (3) forces and passive elastic stiffness (PES) evaluated during five lengthening and shortening cycles; and (4) percentage loss of resistance after 1 min of sustained stretch. The PFMs and surrounding tissues were stretched, at constant speed, by increasing the vaginal antero-posterior diameter; different apertures were considered. Hysteresis was also calculated. The procedure was deemed acceptable by all participants. The median passive forces recorded ranged from 0.54 N (interquartile range 1.52) for minimal aperture to 8.45 N (interquartile range 7.10) for maximal aperture while the corresponding median PES values were 0.17 N/mm (interquartile range 0.28) and 0.67 N/mm (interquartile range 0.60). Median hysteresis was 17.24 N∗mm (interquartile range 35.60) and the median percentage of force losses was 11.17% (interquartile range 13.33). This original approach to evaluating the PFM passive properties is very promising for providing better insight into the patho-physiology of stress urinary incontinence and pinpointing conservative treatment mechanisms.