Predictors Of Stress Urinary Incontinence Research Articles

Prediction of Stress Urinary Incontinence Using the Retrovesical (β) Angle in Transperineal Ultrasound.

The accurate, rapid diagnosis of stress urinary incontinence (SUI) in women can profoundly improve their sexual and psychosocial life. In this study, the diagnostic power of SUI was assessed by transperineal ultrasound. In this hospital-based case-control study, married women who were referred to the gynecologic and ultrasound wards with negative urinalysis and culture results were enrolled by random sampling. Patients with positive cough signs based on the urodynamic testing data were considered cases, whereas control women showed no cough symptoms and were recruited from the same ward. There was a significant difference (P < .001) in bladder neck descent (mean ± SD, 10.89 ± 5.51 versus 7.08 ± 2.60 mm, respectively; P = .0001) and the retrovesical (β) angle with the Valsalva maneuver (144.22° ± 19.63° versus 111.81° ± 24.47°; P < .001) between the case and control groups. Also, the β angle without the Valsalva maneuver was higher in the case group (112.35° ± 23.10°) than the control group (120.17° ± 25.16°; P = .001). There was no case of a urinary leak, urethral diverticulitis, a bladder stone or mass, and cystourethrocele in the patients of each group. The results of multivariate logistic regression with a backward method showed that bladder neck descent (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09-1.40), the β angles with and without the Valsalva maneuver (OR, 1.1; 95% CI, 1.06-1.13; and OR, 1.04; 95% CI, 1.01-1.06) were the predictors of SUI. A β angle higher than 127° with the Valsalva maneuver, with an area under the curve of 0.89 (95% CI, 0.75-0.96), could very well predict the SUI response. This finding shows that it can be very well used to distinguish between normal and non-normal responses, with 89% sensitivity and 79% specificity. The β angle with the Valsalva maneuver could very well predict the SUI response.

Stress Urinary Incontinence post-Holmium Laser Enucleation of the Prostate: a Single-Surgeon Experience.

ABSTRACTPurpose To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP).Materials and Methods We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI.Results 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, 44 men (70.9%) with incontinence were catheter dependent preoperatively. Mean prostatic volume was 148.7mL in tSUI patients, 111.6mL in long-term SUI, and 87.9mL in others (p <0.0001). On univariate analysis, laser energy used (p <0.0001), laser “on” time (p=0.0204), resected prostate weight (p <0.0001), overall International Prostate Symptom Score (IPSS) (p=0.0005), and IPSS QOL (p=0.02) were associated with SUI. On multivariate analysis, resected prostate weight was predictive of any SUI and tSUI, with no risk factors identified for long-term SUI.Conclusion Post-HoLEP SUI occurs in ~10% of patients, with 1.5% continuing beyond six months. Most patients with tSUI recover within the first six weeks. Prostate size >100g and catheter dependency are associated with increased risk tSUI. Larger prostate volume is an independent predictor of any SUI, and tSUI.

MP05-03 USEFULNESS OF VESICAL NECK MOVEMENT MEASUREMENT BY CINEMRI IN PREDICTING STRESS URINARY INCONTINENCE AFTER PELVIC ORGAN PROLAPSE REPAIR SURGERY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (MP05)1 Apr 2020MP05-03 USEFULNESS OF VESICAL NECK MOVEMENT MEASUREMENT BY CINEMRI IN PREDICTING STRESS URINARY INCONTINENCE AFTER PELVIC ORGAN PROLAPSE REPAIR SURGERY Masao Kataoka*, Hitomi Imai, Yuki Yoshida, Toru Meguro, Ruriko Honda, Kanako Matsuoka, Seiji Hoshi, Junya Hata, Yuichi Sato, Hidenori Akaihata, Souichiro Ogawa, Nobuhiro Haga, and Yoshiyuki Kojima Masao Kataoka*Masao Kataoka* More articles by this author , Hitomi ImaiHitomi Imai More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Toru MeguroToru Meguro More articles by this author , Ruriko HondaRuriko Honda More articles by this author , Kanako MatsuokaKanako Matsuoka More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Junya HataJunya Hata More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Souichiro OgawaSouichiro Ogawa More articles by this author , Nobuhiro HagaNobuhiro Haga More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000819.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been reported that urinary symptoms, especially stress urinary incontinence may worsen after pelvic organ prolapse repair surgery. In this study, we try to evaluate the possibility that the parameters obtained by cine MRI could be a predictor of stress urinary incontinence after POP repair. METHODS: 116 patients who underwent POP repair with a diagnosis of pelvic organ prolapse were included in the analysis. All patients were performed reinforcement of the anterior vaginal wall using a mesh. In patients with uterine prolapse and large rectocele, mesh was also placed on the posterior vaginal wall. In all cases, cine MRI was performed before surgery. Urethral length, urethral mobility (UM), vesical neck movement (VNM) were evaluated, and correlation analysis with postoperative urinary symptoms were performed. RESULTS: Among 90 preoperative SUI negative cases, postoperative SUI was observed in 38 cases (42%).Among the preoperative SUI negative cases, the VNM of the group with postoperative SUI and the group without postoperative SUI were 10.9 ± 6.7 mm and 4.4 ± 3.7 mm, respectively, with a significant difference (p <0.01). There was a correlation between preoperative VNM and de novo SUI (r: 0.51, 95% CI: 0.28-0.68, p <0.01, ROC curve: AUC 0.78, cut off value 6.5 mm). On the other hand, among 26 preoperative SUI positive cases, SUI was persisted in 6 cases (23%). Among them, there was a significant difference in VNM of 14.0 ± 7.1mm and 5.3 ± 3.9mm in the postoperative SUI persisted group and postoperative SUI disappearance group (p <0.01). Correlation was observed between preoperative VNM and postoperative SUI (r: 0.51, 95% CI: 0.28-0.68, p <0.01, ROC curve: AUC 0.70, cut off value 7.6 mm). CONCLUSIONS: VNM evaluation by cine MRI was considered to be a useful tool with excellent objectivity that can predict SUI after POP repair without depending on the operator's skill like Barrier test. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e41-e42 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masao Kataoka* More articles by this author Hitomi Imai More articles by this author Yuki Yoshida More articles by this author Toru Meguro More articles by this author Ruriko Honda More articles by this author Kanako Matsuoka More articles by this author Seiji Hoshi More articles by this author Junya Hata More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Souichiro Ogawa More articles by this author Nobuhiro Haga More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

Diastasis recti abdominis after childbirth: Is it a predictor of stress urinary incontinence?

IntroductionPregnancy and childbirth are considered risk factors for the development of diastasis recti abdominis (DRA). This anatomical change could be on the basis of stress urinary incontinence (SUI). Aim of this study was to assess the relationship between the value of DRA and SUI, in order to understand, if a specific abdominal rehabilitation might be indicated. MethodsAll women with clinically and urodynamically proven SUI (group 1) 6 months after first childbirth, have been enrolled and compared with women without any symptoms of SUI (group 2). Exclusion criteria were age > 45 years, pelvic organ prolapse > II stage, previous abdominal surgery including cesarean section, BMI (Body Mass Index) > 30, previous weight loss > 10 kg, presence of abdominal hernia, and pathological connective tissue laxity. Physical examination and ultrasound measurement of DRA were performed. DRA in women with SUI were compared with DRA in continent women. ResultsDuring the study period, 35 (48 %) incontinent women were included in group 1 and 38 (52 %) continent women were included in group 2. The two groups did not differ in any characteristics. No statistically significant differences in the mean value of DRA, 1.76 cm (±0.81 DS) in group 1 versus 1.69 (±0.79 DS) in group 2 (p value = 0.91), were found. ConclusionsDRA is not a risk factor for SUI. Therefore, an intervention on the abdominal muscles during pelvic floor rehabilitation for SUI does not seem to be justified.

Stress urinary incontinence in relation to pelvic floor muscle strength and associated factors in the third trimester of pregnancy: A cross-sectional study

Background: Many predictors of stress urinary incontinence (SUI) during pregnancy have been investigated. However, no studies have specifically identified a cutoff for pelvic floor muscle (PFM) strength and associated factors that could predict SUI during pregnancy. The aim of this study was to identify the cutoff between PFM strength and SUI, late in the third trimester of pregnancy and associated factors in Indonesian women. Methods: A cross-sectional study was conducted involving 142 women with a pregnancy of 36–40 weeks of gestational age at the Obstetrics and Gynecology clinic of Tebet Subdistrict Hospital, Jakarta, Indonesia. The data were collected through a medical interview, Questionnaire for Urinary Incontinence Diagnosis, physical examination, perineometer, and cough test. Results: SUI was identified in 54.2% of the 142 women. PFM strength 25.5 cmH2O and estimated fetal weight (EFW) ³3,100 g were the factors with the greatest influence on SUI (odds ratio (OR) = 2.52, p = 0.021, and OR = 3.34, p = 0.001, respectively). For women with PFM strength £25.5 cmH2O and EFW ³3,100 g, the prediction for SUI was ~75.39%. Conclusion: Weakening of the PFMs and EFW influence SUI. The cutoff values identified for both variables may be helpful for predicting SUI late in pregnancy.

The Association of Serum Testosterone Levels and Urinary Incontinence in Women

Pelvic floor integrity is an important predictor of stress urinary incontinence. Androgen receptors have been found in the pelvic floor musculature and fascia, and testosterone administration has been shown to increase levator ani hypertrophy and improve stress incontinence in a rodent model. We examined the relationship between serum total testosterone levels and self-reported urinary incontinence in women. We included women older than 20 years in the 2012 NHANES (National Health and Nutrition Examination Survey) cycle who underwent serum total testosterone measurement and answered self-reported urinary incontinence questions. A weighted, multivariate logistic regression model was used to determine the association between incontinence and serum testosterone levels after adjusting for age, body mass index, diabetes, race, parity, menopause and time of venipuncture. A total of 2,321 women were included in analysis, of whom 37.5% had stress incontinence, 29.8% had urge incontinence and 16.4% had mixed incontinence. Women in the lowest quartile of serum testosterone were more likely to complain of stress and mixed incontinence (OR 1.45, 95% CI 1.03-2.12 and OR 1.68, 95% CI 1.23-2.22, respectively). No association was noted between serum testosterone levels and urge incontinence. Low serum testosterone is associated with an increased likelihood of stress and mixed incontinence in women. Given the role of pelvic musculature in maintaining urethral support and the anabolic effect of androgens on skeletal muscle, a physiological mechanism for this relationship can be proposed and further evaluated in prospective and translational studies.

Comparison of low urinary tract symptoms during pregnancy between primiparous and multiparous women.

Background and Purpose. Low urinary tract symptoms (LUTS) are a common problem during pregnancy. This study aimed to compare changes in the prevalence of LUTS during pregnancy between primiparous and multiparous women. Methods. A chart review of consecutive pregnant women who attended our antenatal clinic from March 2002 to January 2006 was performed. All of the women were asked to respond to a LUTS questionnaire in either of the three trimesters. Results. Of the 270 women included, 164 were nullipara and 106 were multipara. The most common LUTS during pregnancy were frequency (77%), followed by nocturia (75.6%), stress urinary incontinence (SUI) (51.1%), incomplete emptying (43.7%), dysuria (17.8%), and urgency incontinence (10.4%). There was a significantly higher prevalence of SUI (P < 0.001) and urgency incontinence (P = 0.005) in the multiparous compared to the nulliparous women. Increasing prevalence rates of frequency, nocturia, SUI, and incomplete emptying were reported with gestational age in both the nulliparous and multiparous women. Conclusions. Frequency and nocturia were the two most common LUTS during pregnancy. The prevalence rates of all LUTS increased with increasing gestational age except for frequency in the nulliparous women during the second trimester. In addition, multipara was a predictor of SUI during pregnancy.

Pelvic floor muscle strength predicts stress urinary incontinence in primiparous women after vaginal delivery

This study aimed to investigate obstetrical, neonatal, and clinical predictors of stress urinary incontinence (SUI) focusing on pelvic floor muscle (PFM) strength after vaginal delivery. A cross-sectional study was used, and potential predictors of SUI were collected 5-7 months postpartum on 192 primiparous women. Predictors that reached significance in the bivariate analysis were entered into the Classification and Regression Tree that identified interactions among them and cutoff points to orient clinical practice. PFM strength was the strongest predictor of SUI. A combination of PFM strength ≤ 35.5 cmH(2)O, prior SUI, newborn weight > 2.988 g, and new onset of SUI in pregnancy predicted SUI. The model's accuracy was high (84%; p = 0.00). From the four predictors identified, three are modifiable by physical therapy. This could be offered to women targeting at PFM strength >35.5 cmH(2)O at the postpartum as well as at the prevention of SUI before and during pregnancy.

Vaginal childbirth and bladder neck mobility.

Hypermobility of the bladder base is a predictor of stress urinary incontinence (SUI) in the female and at least partly due to pregnancy and vaginal childbirth. The purpose of this study was to quantify the effect of vaginal parity and birthweight on anterior compartment relaxation. Retrospective observational study. Outpatient uroynaecological clinics. Five hundred and seventy three women seen for primary urogynaecological assessment. Files of patients seen by the first author for assessment and translabial ultrasound imaging at urogynaecological units in Brisbane and Sydney, Australia, were reviewed for routinely-collected obstetric data and imaging results. Ultrasound parameters of anterior vaginal wall descent such as urethral rotation on Valsalva manoeuvre, bladder neck position on Valsalva, bladder neck descent and maximal descent of a cystocele on Valsalva. ANOVA analysis demonstrated a highly significant relationship between vaginal childbirth and bladder neck position on Valsalva (p < 0.001), bladder neck descent (p = 0.002) and maximal descent of a cystocele (p = 0.001). A large part of this effect was seen after one vaginal delivery. There was a trend towards increased bladder neck mobility (p = 0.065) with vaginal operative deliveries. Maximal recorded birthweight did not correlate with parameters of hypermobility. Vaginal childbirth is strongly associated with increased anterior vaginal wall descent, with most of this effect being due to the first vaginal delivery.