Stress Urinary Incontinence Group Research Articles

Deep Learning–Assisted Two-Dimensional Transperineal Ultrasound for Analyzing Bladder Neck Motion in Women With Stress Urinary Incontinence

BACKGROUNDNo universally recognized transperineal ultrasound parameters are available for evaluating stress urinary incontinence. The information captured by commonly used perineal ultrasound parameters is limited and insufficient for a comprehensive assessment of stress urinary incontinence. Although bladder neck motion plays a major role in stress urinary incontinence, objective and visual methods to evaluate its impact on stress urinary incontinence remain lacking. OBJECTIVETo use a deep learning–based system to evaluate bladder neck motion using two-dimensional transperineal ultrasound videos, exploring motion parameters for diagnosing and evaluating stress urinary incontinence. We hypothesized that bladder neck motion parameters are associated with stress urinary incontinence and are useful for stress urinary incontinence diagnosis and evaluation. STUDY DESIGNThis retrospective study including 217 women involved the following parameters: maximum and average speeds of bladder neck descent, β angle, urethral rotation angle, and duration of the Valsalva maneuver. The fitted curves were derived to visualize bladder neck motion trajectories. Comparative analyses were conducted to assess these parameters between stress urinary incontinence and control groups. Logistic regression and receiver operating characteristic curve analyses were employed to evaluate the diagnostic performance of each motion parameter and their combinations for stress urinary incontinence. RESULTSOverall, 173 women were enrolled in this study (82, stress urinary incontinence group; 91, control group). No significant differences were observed in the maximum and average speeds of bladder neck descent and in the speed variance of bladder neck descent. The maximum and average speed of the β and urethral rotation angles were faster in the stress urinary incontinence group than in the control group (151.2 vs 109.0 mm/s, P=0.001; 6.0 vs 3.1 mm/s, P <0.001; 105.5 vs 69.6 mm/s, P <0.001; 10.1 vs 7.9 mm/s, P=0.011, respectively). The speed variance of the β and urethral rotation angles were higher in the stress urinary incontinence group (844.8 vs 336.4, P <0.001; 347.6 vs 131.1, P <0.001, respectively). The combination of the average speed of the β angle, maximum speed of the urethral rotation angle, and duration of the Valsalva maneuver demonstrated a strong diagnostic performance (area under the curve, 0.87). When 0.481*β anglea + 0.013*URAm + 0.483*Dval = 7.405, the diagnostic sensitivity was 70% and specificity was 92%, highlighting the significant role of bladder neck motion in stress urinary incontinence, particularly changes in the speed of the β and urethral rotation angles. CONCLUSIONSA system utilizing deep learning can describe the motion of the bladder neck in women with stress urinary incontinence during the Valsalva maneuver, making it possible to visualize and quantify bladder neck motion on transperineal ultrasound. The speeds of the β and urethral rotation angles and duration of the Valsalva maneuver were relatively reliable diagnostic parameters.

Can Primigravid Stress Urinary Incontinence be Predicted by Translabial Urethral Motion Profile Ultrasonography?

Aims: To determine SUI prevalence and its association with urethral and bladder neck mobility among late third-trimester primigravid women. Introduction: Stress urinary incontinence (SUI) is a relatively common urogynecological disorder in pregnant women that significantly disrupts their quality of life. Although its prevalence is increasing along with gestational age, there have been reports of underreporting due to various reasons. Therefore, a diagnostic modality is needed to determine the presence of SUI in such a population. Methods: A total of 209 late third-trimester primigravid women included in the study between November 2016 and July 2019 were examined by translabial ultrasound. Bladder neck descent (BND), retrovesical angle (RVA), urethral rotation (RoU) and funneling were observed in each patient. SUI was diagnosed using a cough stress test and Questionnaire for Urinary Incontinence Diagnosis (QUID). Thirty-five subjects from each group were randomly selected for further analysis. Results: Among 209 late third-trimester primigravid women, SUI was observed in 57 patients (prevalence 27.3%). The RVA and funneling of the SUI group were significantly higher than the control group (P &lt; 0.05). The BND and RoU were similar between groups. Identified risk factors of SUI were body mass index &gt;23 kg/m2 and the presence of funneling in the translabial ultrasound. Conclusions: The prevalence of SUI among late third-trimester primigravid was 27.3%. Positive funneling and higher BMI were shown to be the independent risk factors for SUI.

MR defecography in assessing stress urinary incontinence with or without symptomatic pelvic organ prolapse.

Utilize magnetic resonance defecography (MRD) to analyze the primary pelvic floor dysfunctions in patients with stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP), and in SUI patients with asymptomatic POP. We performed MRD in both SUI and POP subjects. As a primary analysis, the functional MR parameters were compared between the isolated POP and POP combined SUI groups. As a secondary analysis, the functional MR data were compared between the POP combined SUI and the SUI with asymptomatic POP (isolated SUI) groups. MRD noted the main characteristics of SUI combined moderate or severe POP, including the shorter closed urethra length (1.87cm vs. 2.50cm, p < 0.001), more prevalent urethral hypermobility (112.31° vs. 85.67°, p = 0.003), bladder neck funneling (48.28% vs. 20.51%, p = 0.020), lower position of vesicourethral junction (2.11cm vs. 1.67cm, p = 0.030), and more severe prolapse of the posterior bladder wall (6.26cm vs. 4.35cm, p = 0.008). The isolated SUI patients showed the shortest length of the closed urethra (1.56cm vs. 1.87cm, p = 0.029), a larger vesicourethral angle (153.80° vs. 107.58°, p < 0.001), the more positive bladder funneling (84.85% vs. 48.28%, p = 0.002) and a special urethral opening sign (45.45% vs. 3.45%, p < 0.001). Patients with SUI accompanying POP primarily exhibit excessive urethral mobility and a shortened urethral closure. SUI patients with asymptomatic POP mainly show dysfunction of the urethra and bladder neck, characterized by the opening of the urethra and bladder neck and a shortened urethral closure.

Long-term efficacy and safety of a bioresorbable polycaprolactone-based injectable in female stress incontinence

A fully bioresorbable polycaprolactone (PCL)-based bulking agent was evaluated for safety and efficacy in female patients with mild to moderate stress urinary incontinence (SUI) who attempted and failed prior pelvic floor muscle training. A total of 44 adult female subjects with mild or moderate SUI (median age 60 and 57, respectively) were treated by transurethral sub-mucosal injection. Safety was evaluated at 6-, 12-, and 24-month follow-up visits. Efficacy was assessed at the same intervals with the Stamey grading system (SGS). SGS improvement was shown in both the mild and moderate SUI groups. At 24 months, most participants were continent: 78.1% in the mild SUI group and 66.7% in the moderate SUI group. All participants in the moderate SUI group showed an improvement in the SGS grade, and most participants were continent. The study shows that the PCL-based bioresorbable bulking agent treatment seems to be a safe and effective treatment option for women with mild to moderate SUI who attempted and failed prior pelvic floor exercises.

Effect of stress urinary incontinence on vaginal microbial communities

BackgroundPostpartum women often experience stress urinary incontinence (SUI) and vaginal microbial dysbiosis, which seriously affect women’s physical and mental health. Understanding the relationship between SUI and vaginal microbiota composition may help to prevent vaginal diseases, but research on the potential association between these conditions is limited.ResultsThis study employed 16S rRNA gene sequencing to explore the association between SUI and vaginal dysbiosis. In terms of the vaginal microbiota, both species richness and evenness were significantly higher in the SUI group. Additionally, the results of NMDS and species composition indicated that there were differences in the composition of the vaginal microbiota between the two groups. Specifically, compared to postpartum women without SUI (Non-SUI), the relative abundance of bacteria associated with bacterial dysbiosis, such as Streptococcus, Prevotella, Dialister, and Veillonella, showed an increase, while the relative abundance of Lactobacillus decreased in SUI patients. Furthermore, the vaginal microbial co-occurrence network of SUI patients displayed higher connectivity, complexity, and clustering.ConclusionThe study highlights the role of Lactobacillus in maintaining vaginal microbial homeostasis. It found a correlation between SUI and vaginal microbiota, indicating an increased risk of vaginal dysbiosis. The findings could enhance our understanding of the relationship between SUI and vaginal dysbiosis in postpartum women, providing valuable insights for preventing bacterial vaginal diseases and improving women’s health.

Persistent and De Novo Stress Urinary Incontinence After Minimally Invasive Sacrocolpopexy.

Data on stress urinary incontinence (SUI) after minimally invasive sacrocolpopexy (SCP) with or without midurethral sling placement are limited. The aim of the study was to determine the incidence of SUI after minimally invasive sacrocolpopexy. This was a secondary analysis of 2 randomized clinical trials of participants undergoing SCP. Participants completed symptom assessment and urodynamic testing. Participants underwent SCP with or without midurethral sling placement. Preoperatively, participants were defined as having symptomatic SUI, occult SUI, or no SUI. Participants completed the Pelvic Floor Distress Inventory-20 at 6 and 12 months postoperatively and were categorized as having persistent SUI in the setting of symptomatic or occult SUI or de novo SUI. Eighty-one participants were included. Sixty-one participants met inclusion criteria for the persistent SUI analysis: 42 participants with symptomatic SUI and 19 participants with occult SUI. There were 20 participants in the de novo SUI group. The overall incidence of persistent SUI was 26.2% (95% confidence interval [CI], 15.8%-39.1%) with 33.3% (95% CI, 19.6%-49.6%) of symptomatic and 10.5% (95% CI, 1.5%-33.1%) of occult participants. Bothersome symptoms were defined as "moderately" or "quite a bit" bothered postoperatively. Of participants with symptomatic SUI, 14.3% participants were bothered and no participants underwent retreatment. No patient with occult SUI was bothered; however, 1 patient underwent retreatment. The incidence of de novo SUI was 45% (95% CI, 23.1%-68.5%). No patient in the de novo SUI group was bothered or underwent SUI treatment. Approximately 1 in 4 participants reported persistent SUI. Almost 50% reported de novo SUI. However, few participants were bothered or underwent treatment.

Unilateral levator avulsion increases the risk of de novo stress urinary incontinence after cystocele repair.

Patients without concurrent baseline stress urinary incontinence (SUI) can develop de novo SUI after transvaginal mesh surgery (TVM) for cystocele repair. Surgeons should be aware of de novo SUI risk factors after TVM. A total of 1124 women who were underwent TVM surgeries were recruited and assessed for eligibility from January 1, 2012 to April 30, 2021. All data related to patients and surgeries was collected, which included general conditions, clinical examination, surgery records, and follow-up results. Patients were divided into three groups according to follow-up results and data were compared with each group. The relative risk (RR) of de novo SUI with levator avulsion was also calculated. Three hundred thirty-six patients were included in this study. They were divided into no complication group (n = 249), de novo SUI group (n = 68), and other complications group (n = 19). It seemed elder or obese women had a higher risk of de novo SUI after TVM (p < 0.05). In de novo SUI group, incidence of levator avulsion before surgery were higher than the other two groups (p = 0.001). TVM can significantly change a prolapse to point Aa and Ba on POP-Q quantification system (p < 0.05). RR ratios of de novo SUI with unilateral avulsion group is 2.60 (95% confidence interval [CI] 1.39-4.87), and 2.58 (95%CI 0.82-8.15) for bilateral group. Unilateral levator avulsion, instead of bilateral levator avulsion, is a risk factor of de novo SUI after cystocele repair surgery.

Lateral abdominal muscle thickness and contractile function in women with and without stress urinary incontinence.

Stress urinary incontinence (SUI) primarily results from the weakness of pelvic floor muscles, working synergistically with the abdominal muscles. The current study aimed to compare thickness and contractile function of lateral abdominal muscles in women with and without SUI. Thirty-nine women with SUI (SUI group; age: 38.87±8.96 years, body mass index (BMI): 24.03 (5.94) kg/m2) and 42 healthy women (control group; age: 36.21±11.46 years, BMI: 23.90 (5.85) kg/m2) were included. Transverse abdominis (TrA) and internal oblique (IO) muscle thickness at rest and during abdominal drawing-in maneuver (ADIM) were measured with ultrasound imaging in B-mode using a Logiq S7/Expert device and a 9-11 MHz linear transducer. Percentage change in thickness and contractile function of these muscles were also calculated. No significant differences in the thickness of TrA and IO muscles at rest and during ADIM between the groups were found (p>0.05). The percent change in thickness and contractile function of both right and left side TrA muscles and the right side IO muscle were lower in SUI group than control group (p<0.05). The percentage change in thickness and the contractile function of the left side IO muscle did not change (p>0.05). Women with SUI had a smaller percentage change in thickness and contractile function of TrA and IO muscle than women without SUI. However, there was no difference in the morphological features of these muscles between the groups. Considering the lateral abdominal muscle, training may be important for management of SUI.

Small Extracellular Vesicles Secreted by Peri-urethral Tissues Regulate Fibroblast Function and Contribute to the Pathogenesis of Female Stress Urinary Incontinence.

This study aimed to explore the existence of small extracellular vesicles (sEVs) in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence (SUI). sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy (TEM). The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis (NTA) and bicinchoninic acid (BCA) protein assay. Fibroblasts were cultured separately with SUI (SsEVs group) and normal tissue sEVs (NsEVs group). Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays, respectively. Expression levels of collagen I and III were compared among blank control (BC), NsEVs, and SsEVs groups using real-time PCR. Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups. sEVs were extracted and found under the electron microscope. There were significantly more sEVs extracted from the SUI group compared to the normal group. Fibroblasts showed increased proliferative and decreased migratory abilities, and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups. Protein spectrum analysis demonstrated several differentially expressed targets, including components of microfibrils, elastin polymer, and anti-inflammatory factors. sEVs were detected in the peri-urethral tissues. SUI tissues expressed more sEVs than control. The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.

Postpartum stress urinary incontinence: a clinical study of 6,302 cases in Jiangsu Province.

To investigate the prevalence and influencing factors of stress urinary incontinence (SUI) within 6-8 weeks postpartum in Jiangsu Province. We designed a multi-center cross-sectional study involving seven hospitals in Jiangsu province, and enrolled women who underwent postpartum examination at 6-8 weeks in these hospitals between July 2019 and June 2021. According to the presence or absence of SUI, the enrolled patients were divided into two groups: the SUI group and the non-SUI group, respectively. We assessed the general health status, noted the details of delivery, and checked the pelvic floor electromyographic parameters of the postpartum women in both groups. Among 6,302 cases of postpartum women in Jiangsu province, there were 1,579 cases of SUI, with a prevalence of 25.06%. The prevalence of SUI increased significantly with age, BMI, increasing parity, coexisting constipation, organ prolapse, and diastasis recti abdominis. Compared to the non-SUI group, the SUI group had a lower mean value of the pre-baseline rest phase, shorter rise and fall times of fast muscle contractions, and a lower mean value of the endurance contraction phase. Multiple regression analysis revealed associations with weight (especially overweight and obesity), coexisting organ prolapse, constipation, parity, gestational week of delivery, mode of delivery, and mean value of endurance contraction phase. The prevalence of postpartum stress urinary incontinence in Jiangsu Province was 25.06%, and was linked to being overweight, parity > 2, coexisting organ prolapse, constipation, and a decrease in the mean value of the endurance contraction phase of the electromyograph. In this report, we offer a theoretical basis for the effective prevention of postpartum SUI clinically.

MP52-07 MOLECULAR CHARACTERIZATION OF NEUROGENIC INTRINSIC SPHINCTER DEFICIENCY OF SPINA BIFIDA PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP52-07 MOLECULAR CHARACTERIZATION OF NEUROGENIC INTRINSIC SPHINCTER DEFICIENCY OF SPINA BIFIDA PATIENTS Benoit Peyronnet, Claire Richard, Claude Bendavid, Juliette Hascoet, Camille Haudebert, Caroline Voiry, Emmanuelle Samson, Jacques Kerdraon, Andrea Manunta, and Xavier Gamé Benoit PeyronnetBenoit Peyronnet More articles by this author , Claire RichardClaire Richard More articles by this author , Claude BendavidClaude Bendavid More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Camille HaudebertCamille Haudebert More articles by this author , Caroline VoiryCaroline Voiry More articles by this author , Emmanuelle SamsonEmmanuelle Samson More articles by this author , Jacques KerdraonJacques Kerdraon More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , and Xavier GaméXavier Gamé More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intrinsic sphincter deficiency is common in patients with spina bifida have a different pathophysiology and impact than in other neurogenic and non neurogenic populations. The objective of this study was to evaluate the association between five urinary biomarkers (NGF, BDNF, TIMP-2, TGF-B1 and PGE2) and intrinsic sphincter deficiency (ISD) in adults with spina bifida. METHODS: A single center prospective study was conducted between March 2015 and March 2017 including all consecutive adult spina bifida patients who were seen for urodynamic testing. Urinary tract imaging was also performed in all patients. At the end of the inclusion period, urines were defrosted and urinary NGF, BDNF, TIMP-2, TGF-B1 were assessed using validated ELISA kits. The urinary markers levels were adjusted on the urinary creatinine level. Urinary MMP-2 levels were assessed by zymography. Associations between urinary markers levels and clinical (stress urinary incontinence (SUI)) and/or urodynamic (lowered maximum urethral closure pressure (MUCP)) of intrinsic sphincter deficiency were sought. RESULTS: Forty patients were included. Of these, 17 had SUI (42.5%). The mean MUCP was 56.7 cm H2O. Urinary TIMP-2/Cr and urinary BDNF/Cr were the only two markers significantly associated with MUCP (r=-0.37; p=0.02 in both cases, Figure 1). TIMP-2/Cr was significantly higher in the SUI group (p=0.003), as was BDNF/Cr (p=0.02). Urinary NGF/Cr, TGF-B1/Cr and MMP2 did not differ significantly between SUI and non-SUI groups. CONCLUSIONS: Urinary TIMP-2 and BDNF may be associated with intrinsic sphincter deficiency in adults with spina bifida. These results suggest a possible pathophysiological role of extracellular matrix remodeling and both a fibrosis and a neurogenic component in the intrinsic sphincter deficiency of adults with spina bifida. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e705 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benoit Peyronnet More articles by this author Claire Richard More articles by this author Claude Bendavid More articles by this author Juliette Hascoet More articles by this author Camille Haudebert More articles by this author Caroline Voiry More articles by this author Emmanuelle Samson More articles by this author Jacques Kerdraon More articles by this author Andrea Manunta More articles by this author Xavier Gamé More articles by this author Expand All Advertisement PDF downloadLoading ...

Correlation between trans-perineal ultra-sonography, urodynamic study and physical examination findings in female patients with stress urinary incontinence: Single center experience.

To evaluate the efficacy of Trans-perineal ultrasonography (TPUS) in assessment of stress urinary incontinence (SUI) and its correlation with urodynamic study (UDS) and physical examination in women with SUI. The study enrolled a total of 91 females including 66 women with SUI and 25 women with no history of urinary incontinence as control group. The α and β angles (anterior urethral and posterior urethro-vesical angle respectively) were recorded both at rest and at straining, using TPUS. The differences between these angles at rest and during the straining were considered as the rotational angles (Rα and Rβ). Urethral length and caliber, bladder neck funneling, and pubo-urethral distance were measured as well. The mean (SD) α angle at rest of the SUI group was 49.0 (±14.3)°, which was higher than the same parameter in the control group: 47.6 (±9.7)°. Similarly, the α angle at straining was significantly higher in the SUI group versus the control group, 61.0 (±15.4)° versus 55.8 (±15.8)°. The mean (SD) β angle in the SUI group at rest was 124.6 (±28.5)°, which was significantly higher than that of the control group at 114.0 (±22.5)°. The mean (SD) β angle at straining was also higher in the SUI group versus the control group: 151.8 (±90.6) versus 136.0 (±27)°. Moreover, higher Rα and Rβ angels were documented in the SUI group. Our data suggest that TPUS can be considered as a non-invasive, easily conducted, and accurate modality in early diagnosis of female SUI. It may reduce the need for performing relatively invasive UDS. However, the role of TPUS in assessment of SUI severity remains to be studied probably with a larger sample size.

Diagnostic value of transperineal ultrasound in patients with stress urinary incontinence (SUI): a systematic review and meta-analysis.

We aimed to analyze the diagnostic value of transperineal ultrasound in patients with stress urinary incontinence (SUI) using evidence-based methods. A comprehensive search of the studies on the diagnosis of SUI by transperineal ultrasound in PubMed, EMBASE, MEDLINE, Cochrane library, Medicine, Web of Science, and clinicaltrials.gov databases on August 1, 2022. Studies were included if they met the inclusion criteria and were evaluated by different quality evaluation methods according to study types. Various ultrasound parameters were collected and counted to analyze and judge the diagnostic value of transperineal ultrasound in SUI patients. A total of 13 studies with 1563 participants were finally included. The combined statistics showed no significant difference in age and parity among the included patients, and the BMI of the SUI group was slightly higher than that of the normal population (MD 1.20, 95%CI 0.68-1.72). The results indicated that compared with the normal population, the α angle (MD 15.56, 95%CI 9.93-21.90), β angle (at rest: MD 10.02mm, 95%CI 1.95-18.09; at Valsalva: MD 22.40mm, 95%CI 13.79-31.01), bladder neck descent (MD 6.82mm, 95%CI 4.49-9.14), area of hiatus (MD 2.83 cm2, 95%CI 0.71-4.94) and bladder neck funneling (RR 4.71, 95%CI 1.08-20.62) of SUI patients were significantly different, which illustrated the potential value of transperineal ultrasound in diagnosing SUI. Evidence-based medicine was applied to statistically analyze published articles on the diagnostic value of transperineal ultrasound in SUI. The results suggested that transperineal ultrasound had application value in the diagnosis of SUI and had the potential to become a routine examination method to assist clinical decision-making.

Association between urethral funneling in stress urinary incontinence and the biological properties of the urethral rhabdosphincter muscle based on shear wave elastography.

To apply shear wave elastography (SWE) combined with transperineal ultrasonography (TPUS) to study the association between urethral funneling in stress urinary incontinence (SUI) and the biological properties of the urethral rhabdosphincter muscle in women. This single-center retrospective study included 166 women with SUI (SUI group) and 185 women who underwent a routine physical examination (control group). The control group and SUI group were divided into nonfunneling and funneling groups according to the presence or absence of urethral funneling, respectively, and their ultrasound findings were compared to analyze the association between funneling and ultrasound measurements. The SUI group had a lower mean E than the control group (15.54 vs. 20.82 kPa, p < 0.001). The SUI-funneling group had a lower mean E than the SUI-nonfunneling group (15.50 vs. 17.21 kPa, p < 0.001). The area under the (AUC) receiver operating characteristic (ROC) curve of the mean E for predicting SUI was 0.864, with a cutoff value of 19.19 kPa. The AUC of the mean E for predicting urethral funneling was 0.832, with a cutoff value of 17.15 kPa. The stiffness of the urethral rhabdosphincter was an independent factor related to SUI and urethral funneling in SUI. SWE can be used to assess the biological properties of the urethral rhabdosphincter, and reduced stiffness of the rhabdosphincter was significantly correlated with SUI and funneling in SUI. Thus, women with urethral funneling in SUI may have a weak urethral rhabdosphincter.

Establishment and validation of a risk prediction model for postpartum stress urinary incontinence based on pelvic floor ultrasound and clinical data

Introduction and hypothesisThis study aimed to establish a risk prediction model for postpartum stress urinary incontinence (SUI) based on pelvic floor ultrasound measurement data and certain clinical data.MethodsSingleton pregnant women aged ≥ 18 years who underwent delivery were selected. All participants were followed up to determine the symptoms of SUI, and pregnancy-related data were collected at the time of registration. Pelvic floor ultrasound was performed at 6–12 weeks postpartum to obtain ultrasonic measurement data. Logistic regression analysis was used to select predictors and establish a nomogram to predict the risk of postpartum SUI. Area under the ROC curve (AUC) values and calibration curves were used for discrimination and calibration, respectively. Finally, external verification of the model was carried out.ResultsA total of 255 participants were included in the analysis, comprising 105 in the postpartum SUI group and 150 in the non-SUI group. Logistic regression analysis identified age, parity, vaginal delivery, bladder neck descent (BND), and angle of internal urethral orifice funnel as risk factors for postpartum SUI (all P < 0.05).ConclusionsWe constructed a prediction model for postpartum SUI based on pelvic floor ultrasound measurement data and certain clinical data. In clinical practice, this convenient and reliable tool can provide a basis for formulation of treatment strategies for patients with postpartum SUI.

Ultrasound imaging of abdominal muscles activity among women with stress urinary incontinence: case-control study in Poland.

The aim of the present study is the assessment of thickness and percentage change in thickness of the musculus obliquus externus abdominis (OE), musculus obliquus internus abdominis (OI) and musculus transversus abdominis (TrA) among women suffering from stress urinary incontinence (SUI) in comparison with healthy controls. The thickness and its percentage changes of the OE, OI and TrA among women with and without SUI were assessed. We observed the reactions of the abdominal muscles among 84 women by means of ultrasound imaging. The thickness of the OE was significantly greater in the SUI group during rest and tension of the lower part of the abdomen. Significant changes were found in the OI for the controls during isometric tension of the abdominal muscles, tension of the lower part of the abdomen, and ASLR (active straight leg raise) test of right leg. The thickness changes in the TrA were significant for the controls during isometric tension of the abdominal muscles. Our results suggest interactions of the pelvic floor and the abdominal muscles during pelvic floor activity, differing in the women with SUI and controls.

Comparison of Postural Control of Females with and without Urinary Incontinence: A Case-Control Study.

Background: So far, there is much less information about the effects of urinary incontinence on postural control. Therefore the aim of this study is to investigate the differences in postural control using linear and non-linear analyses of the center of pressure (COP) time-series in anteroposterior (AP) and mediolateral (ML) directions between females with and without stress urinary incontinence (SUI). Methods: This case-control study included 22 continent females and 22 SUI females. In this study, static postural control during four different postural tasks was evaluated using a force plate. All participants performed separate 60-sec standing trials with eyes open in the empty bladder and full bladder conditions. Mean, range, velocity, area circle of COP displacements, and approximate entropy (ApEn) of COP time-series were calculated from the 60-sec standing trials for all participants. The independent sample t-test was also used to compare COP variables between the two groups and paired sample t-test was used to assess changes between the full bladder and empty bladder conditions within each group. The effect size of Cohen's d was used to assess the magnitude of the differences between the two groups. Results: The findings revealed a significant group × task interaction for the mean of ML displacement and ApEn of COP. SUI females showed more AP displacement range in the full bladder (pvalue= 0.020, effect size=0.74) and a higher velocity (empty bladder: p=0.040, effect size=0.63) (full bladder: p=0.020, effect size=0.75) than the continent group. Generally, the SUI females had lower ApEn than the continent females, although the differences were not significant. While the variables of COP were unaffected by bladder fullness in the continent group, the SUI group in full bladder condition experienced more AP range (p=0.030), and area circle (p=0.007) of COP sway in quiet standing. Conclusion: These results provide more support for the hypothesis that postural control can be impaired following SUI, although future investigations on this topic are recommended.

Periurethral and Intravenous Injections of Adipose-Derived Stem Cells to Promote Local Tissue Recovery in a Rat Model of Stress Urinary Incontinence

ObjectiveTo compare the effects of periurethral and intravenous injection of adipose-derived stem cells (ADSCs) on voiding function and tissue recovery in a stress urinary incontinence (SUI) rat model. MethodsSixty-four postpartum rats were randomly allocated to a normal group and the SUI model was established in 48 rats by vagina balloon dilation and bilateral ovariectomy. The SUI rats were randomized into 3 groups and received urethral injection of PBS (SUI group), periurethral injection of ADSCs (PU group), and intravenous injection of ADSCs (IV group) in 10 days after the ovariectomy. After 1, 7, and 14 days, ADSCs were tracked in urethra specimen. The urinary function of the remaining rats was analyzed at day 28, and urethral tissues were harvested for Western blotting and histochemical analyses. ResultsAlpha smooth muscle actin, myosin heavy chain, vascular endothelial growth factor, and neurofilament protein expression was increased in the IV and PU groups. Voiding function was also improved, with no significant differences between the IV and PU groups. The cell retention rate in rat urethral tissues was higher in the PU group than that in the IV group. Compared with the IV group, myosin heavy chain, vascular endothelial growth factor, neurofilament and transforming growth factor-β1 (TGF-β1)/Smad pathway protein expression levels were significantly higher in the PU group, while alpha smooth muscle actin expression was significantly lower (P < .05). ConclusionPeriurethral and intravenous injection of ADSCs induces different degrees of recovery of the urethral sphincter, cytokine secretion levels and cell retention rates in the urethral tissues in SUI rats, however, there was no significant difference in 2 methods.

Usefulness of transperineal shear wave elastography of levator ani muscle in women with stress urinary incontinence.

This study aimed to quantitatively assess the quality of levator ani muscle (LAM) using shear wave elastography (SWE) and to evaluate the association between the elasticity of LAM and stress urinary incontinence (SUI). The study population included 32 women with SUI and 34 women with normal pelvic support. The thickness of LAM, bladder neck descent (BND), and urethral funneling (UF) were assessed by transperineal ultrasound. LAM elasticity was measured by SWE at rest and during the maximal Valsalva maneuver. Age, menopause, BND, and UF showed a positive correlation with SUI. There was no significant between-group difference in the elastic modulus values of LAM at rest. The thickness of LAM in women with SUI was greater than that in control group at rest and during the maximal Valsalva maneuver (P < 0.001). The elastic modulus values of Emax and Emean were significantly increased from rest to the maximal Valsalva maneuver in all participants (56.24 vs 82.43kPa and 47.92 vs 72.37kPa, P < 0.001). The change of these variables from rest to the maximal Valsalva maneuver in the control group was more obvious than that in the SUI group (34.09 vs 17.87kPa and 31.55 vs 16.82kPa, P < 0.05). The elasticity of LAM, as quantified by SWE, may potentially be used as an index for predicting SUI.

Relationship between low back pain and stress urinary incontinence at 3 months postpartum.

Previous studies have proposed that pelvic misalignment may be associated with stress urinary incontinence through a decrease in the contractile function of the pelvic floor muscles; however, this relationship remains unclear. This study aimed to clarify the relationship between low back pain, an indication of pelvic misalignment, and stress urinary incontinence at 3 months postpartum. We conducted a cross-sectional study of women who gave birth to full-term babies between July 2008 and July 2009. Stress urinary incontinence was defined as urinary leakage when coughing, sneezing, or exercising. Low back pain was defined as pain between the ribs and gluteal sulcus in the preceding 2 months. Of the 228 subjects included in the study, the prevalence of stress urinary incontinence was 22.8% (n = 52). The prevalence of low back pain in the stress urinary incontinence group was significantly higher than that in the non-stress urinary incontinence group (78.8% [n = 41] vs. 57.4% [n = 101]; p = 0.005). Stress urinary incontinence was associated with older age, primiparity, vaginal delivery, and low back pain at 3 months. In conclusion, low back pain was associated with stress urinary incontinence after adjusting for pregnancy and delivery factors, suggesting pelvic misalignment contributes to the development of stress urinary incontinence. We propose that including care for pelvic misalignment in pelvic floor muscle training, the treatment of choice for stress urinary incontinence, could be beneficial.